Virus immunity may disappear within months: study – CTV News

When coronavirus first hit in March, the freelance production manager paid about $30 for a three-month premium subscription on the dating app Hinge -- and he figured he'd just keep swiping until that ended.

Like many, the 29-year-old used dating apps like Hinge as a way to connect with others, especially since making in-person connections had become nearly impossible with Covid-19 shutdowns. He went on one Facetime date -- the girl, he said, seemed like she was "just going through her matches ... like on a spreadsheet."

But on May 29, he had plans to meet up with a different match -- this time in person. A 28-year-old nurse named Brooke, with whom he would hike Runyon Canyon -- Los Angeles' picturesque, influencer-ridden trail.

It was in the middle of their approximately three-mile hike, when the two decided they felt comfortable enough to remove their face masks, that he knew this was different. Their guards were down, or as he described it, "all caution (regarding coronavirus) was thrown to the wind."

Now, less than one month and many dates later, they split most of their time between his West Hollywood apartment and hers in Long Beach. He's done what many initially considered impossible with social distancing guidelines and stay-at-home orders:

He found love during a global pandemic.

"This is truly two people finding their soulmate during the most unlikely of times," he told CNN in a phone interview. "We're thinking about eloping to Vegas if the chapels open."

While this may sound extreme, many formerly single people -- and dating experts -- say the pandemic has actually helped people find their matches more easily.

"Because we have this dedicated time to find love, there are no distractions -- you're not a bar looking at people around you or looking at your drink. Everyone's more present and they are more conscious about the way they are showing up to these virtual or real-life dates."

Xu and podcast co-host Julie Krafchick, who are based in San Francisco, said they've noticed an overall change for the better in terms of the dating landscape over the past few months.

"Consider this a reset," Xu said. "Even though we're losing magic of that first date -- the first kiss, first touch -- we're forced to think about how we can reinvent dating."

The 'fail fast mentality'

Dating has never been -- and never will be -- perfect. Before the pandemic, Xu and Krafchick answered questions on their podcast such as "Do Millennials even want to find love?" and "Is monogamy dead?"

"We can't have amnesia that dating wasn't perfect before," Krafchick said. "Part of the reason we created the podcast in the first place was to answer the question, 'What the f**k is wrong with modern dating?'"

The biggest challenge for the singles out there before the pandemic, Krafchick said, was that many spent a lot of time in relationship limbo.

"No one wanted to say they were excited about someone," she said. "No one wanted to define the relationship."

Now, however, the pandemic has led to what Krafchick described as the "fail fast mentality."

"People are starting to feel it's better to fail fast than be in this constant state of equilibrium," she said. "Like, let's either get it off the ground or end it."

The podcast hosts have heard countless stories during these past few months of people who have successfully found love, and people who have felt more encouraged by their dating experiences even if their quarantine relationships didn't work out.

"Coming out of quarantine, everyone has a really strong feeling of a yes or no," Xu said.

Many have also taken this time in quarantine to self reflect, which has helped pave the way to finding healthier relationships.

"I think this time has given people a lot of clarity into what they want in life," Krafchick said. "It's shown life is short and at the end of the day, relationships are what matters most. A lot of people have used this time to do self work, especially in the dark middle period of quarantine, where it didn't feel like there was any way to meet someone."

Virtual dates have also made people throw their old notions of dating out of the window, as they are forced to get creative. For example, "there are 'Zootie' calls now," Xu explained. "Zoom booty calls."

'A whole other dimension of consent'

With this uncharted era of dating also comes new conversations around consent: Do you feel safe meeting in person during a pandemic? Do you agree to wearing masks on the first date? Do you feel comfortable being less than 6 feet apart?

Jessica Gerhardt, a Santa Monica, California, native, and her new partner -- they have not labeled the relationship yet -- waited three months before they decided to meet in person for the first time last week.

The two, who had mutual friends in the music scene, began talking after he "slid into her DMs" on Instagram. Before they met up, he researched and looked into data about social distancing, Gerhardt said.

"We both consented to hug when we first met," the 30-year-old told CNN. "There's a whole other dimension of consent during this pandemic. Under normal circumstances, of course I'd want to hug -- but it was helpful to have that conversation before and nice to know if we don't do something it's not necessarily a sign of 'Oh, I'm not attracted or interested, but I'm trying to be considerate of your safety and vice versa.'"

The lack of touching before meeting, Gerhardt said, made her feel like the two were cultivating "deeper intimacy" as they got to know each other.

They ended up going on a social distance walk in her neighborhood while both wore face masks. At the end of their walking date, he asked whether he could use her bathroom before he drove home.

"He came inside, and we both took off our masks after I asked, 'Do you feel comfortable being maskless?' and he said, 'I feel comfortable.' It was a nice surprise," she said. "We ended up feeling comfortable enough to also hold hands and cuddle. It was really sweet."

While they do not have plans to move in together any time soon, Gerhardt said he has now joined her quarantine pod, which includes her roommate and her roommate's boyfriend.

Learning each other's values early on

How people have acted during this time has helped provide a window into their beliefs, which for some singles has helped narrow down their pool of potential matches.

For example, on dating apps, many have said they have encountered photos of people holding "Black Lives Matter" signs at protests on their profiles. Others said they've seen people sporting face masks in their pictures, to highlight the fact that they are following social distancing guidelines recommended by the Centers for Disease Control and Prevention in order to curb the spread of the virus.

"With the Black Lives Matter movement, Covid, and everything else that's been going on, it's been causing people to have way deeper conversations," Krafchick said. "You can really quickly realize who has same values as you and who would be a better long-term partner. (Talking about) those things can really help you understand someone a lot better on a deeper level and get you past those basic dating questions."

Liz Dwyer, who lives in LA, fell for a guy named Demis Courquet-Lesaulnier, who she has been messaging on Instagram since before the pandemic. He lives in Paris, and they had plans -- pre-coronavirus -- to meet abroad. Now, that plan has been put on hold.

But that hasn't slowed their relationship down at all. In fact, it's sped things up. Dwyer said she's gotten closer to her now-boyfriend these past few months virtually, thanks to many of the current events they discuss.

"We have completely different cultural backgrounds," the writer and editor told CNN. "I'm American, he's French. I'm Black, he's White. We had to get to know each other -- not just on the 'I think you're good looking' and 'you're cute too' conversation."

"He was open to understanding what was happening in terms of racism," she said.

Without the pandemic, she doesn't know what their relationship would look like today.

"I don't know what the future holds," she added, "but no matter what, the experience has changed me for the better."

Finding your 'apocalypse partner'

Ronni Morgan, 32, and her partner Adriane (AJ) Johnson, 41, met on the HER app -- a dating app for queer people -- on March 23.

They started by texting, having FaceTime dates and watching Netflix together virtually, with Morgan in Fort Wayne, Indiana, and Johnson in Grand Rapids, Michigan.

When they finally reached a point where they felt safe enough to start planning an in-person meeting, they found an AirBnB in between their two locations that they considered secluded and off-the-beaten path.

From the beginning, Morgan said, the two were "on the same page about how to handle the pandemic."

"We have both taken it very seriously," Morgan told CNN. "I don't think we would've made it this far otherwise."

When they finally did meet, on June 26, Morgan said their weekend together "legitimately was like a lesbian romance novel, complete with a fireplace, velvety red blanket and epic thunderstorm."

"When we did finally get to meet in person, we were already so deeply connected there was no question of what the chemistry would be like," she told CNN.

Their relationship is still a long-distance one -- but Morgan said there's no doubt in her mind that she's found her "apocalypse partner," aka the person to ride out the pandemic with.

"There's this meme that talks about how dating in 2020 is about choosing your apocalypse partner wisely and honestly I couldn't agree more," Morgan said. "I can say, without a shadow of a doubt, there's no one I'd rather be braving the new world with than AJ."

"I never imagined I'd meet the love of my life during a global pandemic but here we are," Morgan wrote in a post sharing their story on Facebook.

"Anything is possible."

Meeting at the virtual bar

Back in March, Krafchick and Xu decided to bring their community of listeners together in a Facebook group they called "Love in the Time of Corona by the Dateable Podcast." They said they felt it was important for people to feel less alone as quarantine began.

So far, the group has amassed more than 500 members -- who all actively utilize the group to share their experiences with dating in comments, over virtual happy hours, and, sometimes even with the two hosts as guests on their show.

Thursday afternoon, a "Dateable"-hosted virtual happy hour was in full swing, with about 20 people from across the United States -- some returning faces, others new to the hangout -- hopping on a video chat on Facebook.

Group members could check out different Facebook rooms, including: "The Bar," where Krafchick and Xu kicked off the afternoon with intros. Then, some stayed behind to play a game of "Would You Rather?" with dating-themed questions.

"Would you rather date someone who is in a lot of debt but donates to charity on a regular basis," Xu asked the group, "or someone who has no debt, but doesn't donate to charities?"

Others joined the "Playtime" room, where they participated in dating-themed trivia. And some joined a new "room" called the "Dance Floor," where one member taught a dance class.

COVID-19 isnt going away anytime soon in Washington, King Countys top public health official said Friday so we need to learn to make protecting each others health part of our daily lives, he added. The county saw an average of 118 new cases per day during the week ending July 9, according to the countys COVID-19 dashboard.

Meanwhile, Washingtons colleges and universities are pushing back on a new federal directive that would require international students to return to their home countries if the schools have to go to all-online classes this fall. On Thursday, President Donald Trump in another push to get schools and colleges to reopen this fall threatened schools tax-exempt status.

Throughout Saturday, 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 Friday can be foundhere, and all our coronavirus coverage can be foundhere.

When her father died of COVID-19 last month, Kristin Urquiza minced no words assigning blame.

Mark Urquiza, 65, should still be alive, his daughter wrote in a scathing obituary, published Wednesday in the Arizona Republic.

His death is due to the carelessness of the politicians who continue to jeopardize the health of brown bodies through a clear lack of leadership, refusal to acknowledge the severity of this crisis, and inability and unwillingness to give clear and decisive direction on how to minimize risk, she wrote.

The searing tribute encapsulates the fury of critics who say governments at multiple levels are failing at their most basic duty: keeping citizens safe. The obituary also nods at the outbreaks disproportionate impact on Black and Hispanic communities, who have been devastated by higher rates of coronavirus-related hospitalization and death.

Among the leaders whom Kristin Urquiza feels disregarded her father, a Mexican American resident of Phoenix who worked in manufacturing, are Arizona Gov. Doug Ducey, a Republican, and the Trump administration. Ducey, she said, has blood on his hands for beginning to reopen the state in early May, roughly three weeks before new infections started to rise quickly.

Patrick Ptak, a spokesperson for Ducey, said in a statement: Our hearts go out to the family and loved ones of Mark Anthony Urquiza. We know nothing can fully alleviate the pain associated with his loss, and every loss from this virus is tragic.

The full story here.

The Washington Post

The governor of Japans Okinawa island demanded a top U.S. military commander take tougher prevention measures and provide more transparency hours after officials were told that more than 60 Marines at two bases have been infected over the past few days.

Okinawan officials on Sunday reported a total of 61 cases 38 of them at Marine Corps Air Station Futenma, which is at the center of a relocation dispute, and another 23 at Camp Hansen since July 7. They said that U.S. military officials told them the two bases have since been put in lockdown.

The disclosure of the exact figures came only after Okinawas repeated requests to the U.S. military. Gov. Denny Tamaki, in telephone talks late Saturday with Lt. Gen. H. Stacy Clardy, commander of III Marine Expeditionary Force, demanded the U.S military increase disease prevention measures to maximum levels, stop sending personnel from the mainland U.S. to Okinawa and seal the bases, as well as provide more transparency.

Okinawans are shocked by what we were told [by the U.S. military], Tamaki told a news conference Saturday. It is extremely regrettable that the infections are rapidly spreading among U.S. personnel when we Okinawans are doing our utmost to contain the infections. We now have strong doubts that the U.S. military has taken adequate disease prevention measures."

Read the full story.

The Associated Press

Taiwan wrapped up an annual film festival with an awards ceremony Saturday night as it holds more public events after keeping its coronavirus outbreak to a few hundred cases.

Actors and others lined up for photo shoots with no social distancing, and participants didnt wear masks in historic Zhongshan Hall in Taipei. Taiwan, with a population of about 23 million people, has had 451 confirmed cases and seven deaths.

A baseball game in the city of Taichung on Saturday drew more than 10,000 fans for the first time this season, the official Central News Agency said. Health authorities said last week that fans would be allowed to sit in alternate seats and no longer would have to wear masks, except when leaving their seats.

The horror film Detention, set during martial law in Taiwan in the 1960s, was the biggest winner at the Taipei Film Festival, taking six awards including the Grand Prize and Best Actress for 22-year-old Gingle Wang.

Chang Jung-chi, the Best Director winner for We Are Champions, said the virus outbreak had forced him to slow down his work. This comes to me like a friend patting my shoulder and saying, Hang in there, he said.

The Associated Press

"Hot or not, mask or not, we're just happy to be here," said an emotional guest as Walt Disney Worlds Magic Kingdom and Animal Kingdom reopened Saturday with new rules in place to help prevent the spread of COVID-19.

The reopening comes even as a huge surge of Floridians have tested positive for the new coronavirus in recent weeks. On Saturday, there were about 10,000 new cases reported, according to state statistics. Many cities and counties around the state have recently reinstated restrictions that had been lifted in May, when cases seemed to drop.

All of Disneys Orlando parks closed in mid-March in an effort to stop the viruss spread. Universal Orlando and SeaWorld Orlando closed around the same time but reopened several weeks ago. Epcot and Disneys Hollywood Studios are expected to open next week.

Full story here.

The Associated Press

There will be no daily update on coronavirus cases Saturday from the Washington state Department of Health.

The DOH announced that its data system would be down for maintenance on Saturday, and that new figures will be available in the late afternoon on Sunday.

Here's where to find the state's COVID-19 Data Dashboard.

Scott Hanson

Amitabh Bachchan has tested positive for the coronavirus and is hospitalized in Mumbai, Indias financial and entertainment capital, the Bollywood superstar announced Saturday.

Bachchan, 77, said in a tweet on Saturday that his family and staff have also undergone tests and are awaiting results. He appealed to those who were in close proximity to him in the past 10 days to get themselves tested.

The elder Bachchan has acted in more than 200 Indian films over the past five decades. He is also a former politician and a television host.

The Bachchans are often called Bollywoods first family. His wife, Jaya, is also an actress and a one-time member of Parliament. Their son, Abhishek, and daughter-in-law, Aishwarya Rai Bachchan, are Bollywood superstars as well. Abhishek Bachchan, who is 44, tweeted Saturday night that he also has tested positive for COVID-19 and is hospitalized.

Both of us having mild symptoms have been admitted to the hospital, he wrote. I request all to stay calm and not panic.

The full story here.

The Associated Press

New York Yankees closer Aroldis Chapman became the latest high-profile player to test positive for the coronavirus, his diagnosis announced Saturday hours after the Houston Astros canceled another practice due to virus concerns.

In New York, manager Aaron Boone said Chapman wouldnt be here for the foreseeable future. Boone said the left-handed reliever overall was doing well despite experiencing mild symptoms.

The Yankees are scheduled to start the virus-delayed season July 23 at the World Series champion Washington Nationals. The AL champ Yankees already were missing star infielder DJ LeMahieu and right-hander Luis Cessa, who both tested positive last week and are still isolating at home.

Boone wouldnt say whether Chapman had been at Yankee Stadium since throwing a bullpen session Tuesday.

In Houston, the Astros canceled their workout after learning that a staff member could have been exposed to a person outside the organization with the coronavirus. Its the second time this week the Astros have wiped out a practice session because of concerns about the pandemic. Houston also scrapped its Monday workout because of delays with testing results due to the holiday weekend.

The Associated Press

The Church of Jesus Christ of Latter-day Saints has asked all its members in Utah to wear face coverings when in public, a request that comes as confirmed infections in the state increase.

The Deseret News reports that the Utah Area Presidency sent out the request in an email on Friday evening. The area presidency operates under the authority of the Quorum of the Twelve Apostles.

Now we ask all Latter-day Saints in the Utah Area to be good citizens by wearing face coverings when in public, the email said. Doing so will help promote the health and general welfare of all.

About 62% of Utahs 3.1 million residents are members of the church.

Nearly 900 new cases were reported in the state on Friday, according to a tally by Johns Hopkins University. Overall, Utah had 28,223 confirmed cases and 207 deaths due to the virus as of Saturday. The number of infections is thought to be far higher because many people have not been tested, and studies suggest people can be infected with the virus without feeling sick.

The Associated Press

President Donald Trump wore a mask during a visit to a military hospital Saturday, the first time the president has been seen in public with the type of facial covering recommended by health officials as a precaution against spreading or becoming infected by the novel coronavirus.

Trump flew by helicopter to Walter Reed National Military Medical Center in suburban Washington, D.C., to meet wounded service members and health care providers caring for COVID-19 patients. As he left the White House, he told reporters: When youre in a hospital, especially I think its expected to wear a mask.

Trump was wearing a mask in Walter Reeds hallway as he began his visit. He was not wearing one when he stepped off the helicopter at the facility.

The president was a latecomer to wearing a mask during the pandemic, which has raged across the U.S. since March and infected more than 3.2 million and killed at least 134,000. Most prominent Republicans, including Vice President Mike Pence, endorsed wearing masks as the coronavirus gained ground this summer.

Trump, however, has declined to wear a mask at news conferences, coronavirus task force updates, rallies and other public events. People close to him have told The Associated Press the president feared a mask would make him look weak and was concerned that it shifted focus to the public health crisis rather than the economic recovery.

Read the full story here.

The Associated Press

Oregon officials Saturday reported 409 new coronavirus cases.

The Oregon Health Authority said the high number is partially due to a new reporting system that prevented processing some positive cases Thursday.

The state is reporting 11,851 total cases with 232 deaths.

Read the full story here.

The Associated Press

DALLAS The coronavirus pandemic has taken away another summertime tradition in the U.S.: There will be no free Slurpees at 7-Elevens on Saturday July 11 to hail a date that doubles as an abbreviation of the convenience store chain's name.

7-Eleven has been giving away its slushy beverage to all customers for nearly 20 years on July 11, but it scrapped the promotion this summer to reduce the risk of people flocking to its stores and risking contracting the coronavirus.

Gathering nine million of our closest friends in stores on one day just didnt feel right," said Marissa Jarratt, 7-Eleven's chief marketing officer.

The Dallas-based chain instead decided to donate 1 million meals to Feeding America, a hunger relief group.

Read the full story here.

The Associated Press

As Montana warily reopened last month to pandemic-weary tourists, an isolated community held firm with closures and stay-at-home orders. Few outsiders would have paid much attention but for one detail: The Blackfeet Nation borders Glacier National Park, and its decision blocked access to much of the vast wilderness there.

The result this month has meant throngs of visitors crowding into a tiny corner of Glacier a crown jewel of the park system with long lines of cars at what is now the only entry point.

And the bottleneck wont disappear anytime soon. Tribal leaders recently announced they would keep the eastern entrances and roads to Glacier, which lie on reservation land, closed at least through August.

Our number one objective is to keep people alive, said Robert DesRosier, who leads the tribes COVID-19 incident response team. We dont want one person to die. Our elders are the keepers of the culture, and we cant afford to lose them.

The Blackfeets fears are well-founded. COVID-19, the disease caused by the novel coronavirus, has ravaged some Native American communities. In Montana, state data show that more than a third of the people to have died so far identified as Native American, though natives make up less than 7% of the population. In the Southwest, the Navajo Nation has been one of the countrys worst hot spots.

The National Park Service and local tourist companies are backing the Blackfeet. Boat and bus operators are shut down for the summer, as are hotels and restaurants on Glaciers east side, and Park Service officials are weighing Glaciers first-ever ticketing and reservation plan to deal with the crush of traffic.

The park, which extends north to Canada, encompasses a million acres of glacially carved peaks, turquoise-colored lakes, trails and wild country. Until a controversial land agreement in 1895, all of it was Blackfeet country.

Read the full story here.

NEW YORK A long-expected upturn in U.S. coronavirus deaths has begun, driven by fatalities in states in the South and West, according to data on the pandemic, according to The Associated Press.

The number of deaths per day from the virus had been falling for months, and even remained down as states like Florida and Texas saw explosions in cases and hospitalizations and reported daily U.S. infections broke records almost daily.

Scientists warned it wouldnt last. A coronavirus death, when it occurs, typically comes several weeks after a person is first infected. And experts predicted states that saw increases in cases and hospitalizations would, at some point, see deaths rise too.

Now thats happening.

Its consistently picking up. And its picking up at the time youd expect it to, said William Hanage, a Harvard University infectious diseases researcher.

According to an Associated Press analysis of data from Johns Hopkins University, the seven-day rolling average for daily reported deaths in the U.S. has increased from 578 two weeks ago to 664 on July 10 still well below the heights hit in April.

Daily reported deaths increased in 27 states over that time period, but the majority of those states are averaging under 15 new deaths per day. A smaller group of states has been driving the nationwide increase in deaths.

Read a detailed story here.

Angel Pacheco tested positive for coronavirus last week. Before he was released from the Yakima County Jail on bail Wednesday, he said he spent a week in an isolation cell with no hot water.

Despite his continuous vomiting and diarrhea, he said corrections officers denied him a shower and change of clothes for three or four days, saying he could expose other inmates in the showers.

They allowed me to sit in my own, you know, filth, Pacheco, hoarse from coughing, said over the phone about an hour and a half after his release. When I was hospitalized, I was in really bad shape. I would consider myself on the verge of dying.

Pacheco is one of 83 inmates out of about 400 inmates who had tested positive for the coronavirus at the jail as of Tuesday, and he described conditions in the jail as gross and unhuman with mold growing in the showers its appalling.

But jail administrators deny the claims of Pacheco and other inmates. They say officers are not denying sick men showers and that the jail is following Centers for Disease Control and Prevention standards, though they acknowledge the facility has been affected by the pandemic like other institutions.

Jeremy Welch, chief of the security operations division of Yakima County Department of Corrections, said Yakima County has reduced the jails inmate population to 40% capacity through work with local courts, law enforcement and contract jurisdictions, Welch said.

But Pacheco, who suffers from underlying heart problems including hypertension, said his treatment was inhumane.

Read the full story here.

Seattle Times staff & news services

Airborne transmission is the most likely explanation for several clusters of infection, including a choir in Washington State and a restaurant in China, according to some scientists.

But W.H.O. staff members have yet to accept the importance of these case studies and instead have dreamed up an alternative story in which an infected person spat on his hands, wiped it on something and magically infected numerous other people, Dr. Greenhalgh said.

[Like the Science Times page on Facebook. | Sign up for the Science Times newsletter.]

The agencys staff and nearly 30 volunteer experts have spent weeks reviewing evidence on the possible modes of transmission: by exhalation of large and small droplets, for example, by contact with a contaminated surface, or from a mother to her baby.

The W.H.O. easily accepts that droplet and fomite transmission occur, but seems to want more definitive proof of spread by aerosols, some experts said. The agency has noted that the virus has not been cultured from air samples, for example, but the same was true of influenza for many years until two groups of scientists figured out how to do it, noted Don Milton, an aerosol expert at the University of Maryland.

W.H.O. staff members are reluctant to make statements when they do not have irrefutable proof of certain phenomena, and are slow to update their hypotheses, scientists have charged. They are still challenged by the absence of evidence, and the difficulty of proving a negative, Dr. Hanage said.

The W.H.O. is being overly cautious and shortsighted unnecessarily, Dr. Julian W. Tang, honorary professor of respiratory sciences at the University of Leicester in the United Kingdom, said in an email.

By recognizing aerosol transmission of SARS-CoV-2 and recommending improved ventilation facilities to be upgraded or installed, you can improve the health of people by eliminating a variety of hazards, including indoor pollutants and allergens, he added.

Isnt that what the W.H.O. stands for the improvement of human health from all angles?

One evening last week, after making one of his most consequential decisions yet in Texas response to the coronavirus, Gov. Greg Abbott settled in for his pandemic routine: a rapid-fire round of local TV interviews from his campaigns satellite studio in Austin.

In the hours since hed issued a statewide mask mandate, Abbott had taken a familiar shellacking from both sides of the aisle: the Democrats who had wanted the mask requirement weeks earlier, and some Republicans who had not wanted it at all.

An anchor with KIII in Corpus Christi offered a measure of sympathy.

Governor, I must tell you I wouldnt trade jobs with you for anything, he said, drawing chuckles from Abbott.

You articulate it well, Abbott later said. I get it from both sides.

Four months of unprecedented emergency have forced the cautious, measured governor into a leadership test like no other. While he has steered the state through major crises before Hurricane Harvey, multiple mass shootings no other has required the sustained, high-stakes decision-making that this one has, leaving Abbott with countless, constant choices that have immediate impact on millions of Texans. Abbott is leaning hard on his executive power and a small circle of advisers as the biennial Legislature remains on the sidelines.

If the virus has presented a leadership test, Abbotts metrics are getting worse. COVID-19 has already killed at least 3,013 Texans and is spreading rapidly, infecting new people and filling hospitals with the sick. Hospitals are beginning to get overwhelmed. Despite an early reopening, the states economy continues to struggle, with an unemployment rate in double digits and budgets facing major shortfalls. Even by the metrics Abbott has said he is focused on the percentage of COVID-19 patients who require hospitalization, and the share of tests coming back positive Texas is headed in an alarming direction. While Texas at first fared better than many other states, it is now a national hotspot.

For most of the pandemic, Abbott has been met with persistent criticism from Democrats and a small but vocal faction of his GOP, but lately his Republican skeptics have begun to grow in number.

Critics point to ever-changing, sometimes serially confusing top-down guidance. Facing down a public health emergency, the governor has more than once reversed himself, making virus mitigation decisions that some say came too late and others say should not have been made at all.

Abbotts defenders praise him for remaining characteristically calm during a dark hour for the state. Democrats plead with him to act on the advice of public health experts, many of whom urge further shutdown of the economy, and to allow local leaders to issue stricter guidelines than the statewide regulations. A growing group in his own party questions both his choices and his authority to make them.

Politically, Abbott who does not face re-election until 2022 has little to fear on his own. But he sits atop a Texas GOP that has plenty to worry about in November, with polls showing Joe Biden in striking distance of President Donald Trump and Democrats making a massive push farther down the ballot.

Abbott entered the pandemic with plenty of political capital as the states most popular Republican leader. While Abbott maintained a generally high approval rating during the first few months of the pandemic, his rating fell seven percentage points from April to June in University of Texas polling.

The second-term governor, who often seems reluctant to take political risks, is forging his legacy through a crisis that he is singularly positioned to address. With the Legislature out of session, and after he limited the power of the states mayors and county judges, Abbott has almost complete authority to make critical decisions about the states response. That means he owns the decisions that lead to lost jobs and lost lives.

The summer will prove a critical chapter: Can he change the states course, or will it careen further toward disaster?

Theres so much at stake here weve got to get it right. We dont have a whole lot of time, said state Rep. Donna Howard, D-Austin, a nurse and leader in the states minority party. And I dont believe the governor has shown the leadership we need. I realize its a tough job, but the buck stops with him. The Legislature is not in session. Hes the one thats running the ship.

In a public health crisis, government at all levels has a role to play: federal health agencies issuing guidance; states wrangling data; mayors and city councils communicating with their constituencies.

But Abbott came to the public health crisis with an already-tense relationship with local leaders. The GOP-dominated state government he heads clashes routinely with Democratic leaders in the states biggest cities and counties, over issues ranging from property taxes to paid sick leave requirements. As the coronavirus began to spread in China and then to Europe, the governor was bickering with Austins leaders about people experiencing homelessness.

Still, in March, as cases of the new coronavirus began to pop up in Texas cities, Abbott was uncharacteristically deferential to local officials.

Amid calls for a statewide stay-at-home order, a spokesman for the governor said in mid-March that cities and counties have done a very good job of doing what is right for their municipalities.Abbott ordered the states bars and restaurants to close, but resisted calls for a more comprehensive directive that Texans stay at home, insisting local officials have the authority to implement more strict standards. I would applaud them for doing so.

By the end of the month, though, with case counts surpassing 3,000 and states across the country battering down, Abbott finally took statewide action: He ordered Texans to remain in place except for essential activities like grocery shopping.

Was this the stay-at-home order Democrats and health experts had been agitating for? He didnt call it that.

Asked to clarify, the governor dithered, using language that experts said confused the public and undermined the seriousness of the situation.

Well candidly, when people talk in terms of shelter in place, what shelter in place really means as a term of art, would mean that wherever you may be at a particular time, you need to take shelter immediately right there. Whether you are at your home or some other location or in a roadside ditch, wherever you may be, youre supposed to take shelter because of something like a tornado would be coming. ... This is not a stay-at-home strategy. A stay-at-home strategy would mean that you have to stay at home, you cannot leave home under any circumstances, he told reporters.

Whatever it was called, experts agree it helped deter the spread of the virus. During the month of April, cases were on a steady but manageable rise, with Texas typically adding fewer than 1,000 new cases each day. Other mitigation measures, like barring elective medical procedures, kept hospitals freed up for a crush of patients that didn't materialize at the time. Abbott mostly steered clear of the culture wars that emerged, leaving Texas Attorney General Ken Paxton to defend a ban on nearly all abortions.

But many in Abbotts own party were growing restless. Texas Lt. Gov. Dan Patrick was making national headlines for telling Fox News there are more important things than living. The president had said he wanted the economy opened up and raring to go by Easter.

No sooner had Abbott shut the state down than he began to talk about reopening. He named a strike force of business leaders to advise him on his reopening plan, along with a group of medical advisers including Dr. John Zerwas, the executive vice chancellor for health affairs at the University of Texas System, state health Commissioner John Hellerstedt and Mark McClellan, a former commissioner of the U.S. Food and Drug Administration.

Abbott announced businesses would reopen in phases starting May 1, with the second phase coming as early as May 18 if all went well.

We need to see two weeks of data to confirm no flare-up of COVID-19, he said.

He also laid out tough enforcement measures fines of up to $1,000, jail sentences of up to 180 days.

Experts praised Abbotts plan for its promise to open businesses slowly, in measured phases. But they noted that unlike in some states, there were few specific health metrics that controlled further reopenings. Experts warned that the pandemic could spiral out of control.

Just hours after he had promised a measured approach, the governor hinted to a Houston TV station that he might allow more businesses to reopen even before the May 18 date some experts had cautioned was too early.

On the evening of April 30, with restaurants and malls set to reopen the next day, Texas reported its highest death toll yet: 50 people. But Abbott remained cautiously optimistic, pointing to two key metrics hospitalization rate, the share of COVID-19 patients who required hospital care; and positivity rate, the percentage of coronavirus tests that showed presence of the virus which remained in a manageable range. The governor had made clear from the start that cases would rise when the state reopened; his goal was not to prevent all spread, but to open slowly enough that hospitals could care for all the people who fell ill.

As Democrats and public health experts warned he was moving too fast, many in Abbotts own party urged him to move yet more quickly. Restaurants were open in limited capacity, but not bars or hair salons. What was the difference, critics demanded, between a waiter serving a meal and a bartender pouring a cocktail? Two hardline conservative lawmakers got haircuts at an illegally open salon in Houston, daring the governor to insist on the penalties hed warned about. In Dallas, a salon owner named Shelley Luther earned praise from Fox News, hundreds of thousands in donations from like-minded shutdown skeptics and a weeklong jail term after she repeatedly defied court orders to close her business until state law permitted her to open.

The governor backpedaled rapidly. He revised his coronavirus executive orders so that violators could not be forced to serve jail time. His team contacted Luther not to order her to close, but to seek her advice on how salons could open safely and soon. Abbott said salons could reopen May 8, more than a week before his target date for phase two. The slow reopening he promised had begun to speed up already and the penalties that were supposed to ensure compliance were beginning to disappear.

Heeding Luthers example, and watching their own bottom lines plummet amid the shutdown, bar owners started to wonder about their own strategy.

This one lady did it, and she got a lot of attention and now all the salons are open, bar owner Emil Bragdon told the Tribune in May. Is that something we have to do? Because if we have to do that, we'll do it.

The economic advisors on Abbotts strike force began to press for bars to open, too. After a substantial amount of conversation with medical advisors, Abbotts team agreed that the bars could open so long as they followed social distancing protocols, Zerwas recalled.

It would prove to be a major misstep one Abbott said he regrets.

Young people crowded into bars, and the Texas Alcoholic Beverage Commission was slow to enforce regulations or yank licenses. Cases began to rise among young people. Weeks later, with cases surging, Abbott shut the bars back down.

Clearly what happened is the bars, when they opened, did not comply. In hindsight, it wouldve been quite a challenge for them to comply, Zerwas said. We took a leap of faith on that.

Meanwhile, Abbotts tentative truce with local leaders was eroding, and the usual antagonism reemerged.

As Texas remains a hotspot for the virus, local leaders are pleading with him to either order more shutdowns or allow them to do it for their own communities.

Even some fellow Republicans, like Lubbock Mayor Dan Pope, have criticized Abbott for tying their hands with his statewide order. In an interview, Pope acknowledged it has been a little tough to keep up with the states evolving rules. But, Pope said, "we're in unprecedented times."

"I know how difficult COVID-19 has been locally and I can only imagine how difficult it is at the state level," Pope said, describing his citys relationship with the state as very strong at this point.

Clay Jenkins, the Democratic county judge in Dallas, said when he was navigating fears of an Ebola outbreak in 2014, he was in touch with former Gov. Rick Perry cellphone to cellphone at least once every day. This emergency has been different from any other hes weathered, Jenkins said, because the virus became politicized.

In this public health emergency, local officials have been left to guess at Abbotts intentions. Jenkins said he hasnt spoken to Abbott in more than a month.

Nowhere has the friction between state and local leaders been more visible than on the issue of masks.

After the Centers for Disease Control and Prevention began recommending masks in April, Abbott encouraged Texans to wear masks, but often appeared in public without wearing one himself. And when Abbott allowed businesses to reopen May 1, he stripped local leaders like mayors and county judges of the ability to mandate stronger restrictions, including the wearing of masks. His statewide standards were not a floor but a ceiling.

Local leaders in big cities like Houston and Dallas began to chafe under the states firm hand, agitating to impose the mask requirements that public health experts call essential. Abbott made it clear mask mandates would not be acceptable and the Texas attorney general threatened lawsuits against cities and counties that passed them.

We strongly recommend that everyone wear a mask, Abbott said in May. However, its not a mandate. And well make clear that no jurisdiction can impose any type of penalty or fine for anyone not wearing a mask.

That push and pull continued for weeks as case counts began to surge following the Memorial Day Weekend. The virus began to spread more rapidly in Texas than ever before, a trend Abbott attributed in part to young people gathering at the bars he had opened. For weeks, the governor remained optimistic, pointing to hospitals abundant capacity to serve the sick even as their ranks began to grow exponentially.

In June, with the virus rocketing through San Antonio, Bexar County Judge Nelson Wolff tried a workaround: Instead of ordering residents to wear masks, he required businesses to require them.

To the surprise of local officials, Abbott praised Wolff. He finally figured that out, Abbott said.

The riddle of the mask mandate earned Abbott immediate criticism: Either the governor had been intentionally misleading or confusing to the point of negligence, allowing local leaders to stumble in the dark for weeks.

I thought, my God, its not a scavenger hunt, Vivian Ho, a health economist at Rice University and Baylor College of Medicine, said of the mask order. Have you listened to the physicians who said that masks help? If you did, then you wouldve announced this yourself much earlier. You dont hide important facts about protecting peoples health.

That same week, Abbott acknowledged that the virus was spreading at an unacceptable rate. Days later he paused the states reopening process, closed bars again, and told Texans theres never a reason for you to have to leave your home.

Still, he left open the restaurants many Texans were leaving their homes for. And that weekend he appeared before a gathering of hundreds at a Dallas church. Another featured guest: Mike Pence, the vice president.

The next week, Abbott reversed himself again: Under mounting political pressure, and watching the exponential rise of case counts, Abbott issued a mask order for most of the state. Accompanying it was the fine after a warning that he had previously prohibited local officials from issuing.

To public health experts, and to many of the governors critics on the left, it was the right decision, but it had come far too late.

Jenkins, who was the first in the state to issue a stay-at-home mandate for his county, said he expects that pattern to repeat itself.

The crush of new cases and the continual unfortunate bad news that were getting every day will force the governor to listen to the doctors recommendations, Jenkins said. The key thing is how fast will that happen? Because every day that we wait is more damage to our economy, more people getting sick, and the longer its gonna take to pull out of the tail spin.

While some Republican state lawmakers have become more vocal against Abbotts response, the governor still has defenders in the Legislature.

We have a Governor who uses facts, not fear, to drive decision-making, and thats never been a more critical leadership attribute than during this challenging season, state Sen. Kelly Hancock, R-North Richland Hills, told The Texas Tribune.

But some conservatives question Abbotts authority to issue sweeping disaster orders. At least six county GOPs have censured him for his handling of the pandemic, including those in Montgomery and Denton Counties, two of the partys biggest strongholds. Many of those resolutions have called for delegates to the state GOP convention to consider a broader censure of the governor a striking but largely symbolic move.

Republican lawmakers have begun to agitate for more say in the states response, with some pushing for a special session of the Legislature to consider coronavirus responses.

"It should not be the sole responsibility of one person to manage all of the issues related to a disaster that has no end in sight, state Sen. Charles Perry, R-Lubbock, wrote last week.

Patrick Svitek contributed reporting.

Disclosure: The University of Texas System and Rice University have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.

Tensions are breaking out on beaches and tourists from Lombardy have reported instances of discrimination as Italys first holiday season since the coronavirus outbreak gets under way.

Residents of Codogno, in Lodi province, the first town in the countrys badly affected Lombardy region to be quarantined, have claimed attempts to book holidays elsewhere in Italy were rebuffed after they revealed they would be travelling from a former red zone.

Among them was Davide Passerini, who lives in Codogno but is mayor of the small town of Fombio, another area quarantined early. His accommodation booking for a weekend away in Tuscany was rejected after the owner discovered he was from Codogno.

Even if these are rare episodes, the prejudice leaves you feeling very bitter, Passerini said. It is the result of ignorance among those who dont understand that people coming from the first red zones are today probably less likely to bring the virus because the level of contagion in these places is now close to zero and has been for a long time. But in the minds of some people, Codogno remains synonymous with infectious disease.

During a phone-in to an Italian radio show last week, a couple from another area hard-hit by the virus spoke about being turned away at a hotel reception with the excuse that the establishment was fully booked.

At the same time, tempers are rising as people jostle for space on packed public beaches, where safety rules are rarely observed. On a beach in Ostia, near Rome, last weekend a 20-year-old woman was slapped after she asked a fellow beachgoer to move his towel because there was no safe distance between them.

Marina Marzari, a psychologist from Veneto, said her recent experience at a beach in the Marche region went from paradise to hell within a few hours as large groups descended throughout the day.

It was the most dense crowd Ive ever experienced, she said. There were no masks and not even the slightest distancing being respected. Its really dangerous.

Marzari called the local police several times but she said nobody came to patrol the beach. Weve all made sacrifices in recent months but feel taken for a ride after having stayed at home for so long, as when we go out situations like this arent made safe. If I get sick due to something similar I will press charges against the state.

Safety rules at privately run establishments, where people can rent loungers and umbrellas, have been easier to maintain.

Even though requirements are similar for free beaches people can gather in groups of no more than four people, maintaining a 1.5-metre distance from others, and beach games are banned they have been more difficult to enforce.

But some areas are starting to take action. Authorities on Ischia, an island off Naples, last week imposed an exclusion law, known as a daspo in Italy, that will ban those who flout safety regulations from the beach for the rest of the summer season.

Enzo Ferrandino, the mayor of Ischia, told local newspapers: The right to go to the beach in safety must be defended. We owe it to those who deserve a little more respect in an island that sometimes lets itself be overwhelmed by selfishness.

In Bordighera, a beach town in Liguria, stewards have been hired to patrol public beaches, and a similar move is being planned by authorities in Salerno, Campania.

The coronavirus transmission rate in Italy has slowed considerably since lockdown restrictions began to be eased in May, despite the emergence of clusters across the country that have mostly been due to imported infections. People have been able to travel between regions since early June.

But as they adapt to living alongside the virus, judgments over the risk have polarised peoples attitudes and behaviour.

When there is strong social anxiety, this is typical, said Giuseppe Pantaleo, a social psychologist at Vita-Salute San Raffaele University in Milan. So we either treat everyone as a potential source of infection, which has some justification as the data is still so awful in other countries, or we go to the opposite extreme and totally deny the risk.

For the Fourth of July weekend, a new analysis of cell phone data suggests even more people hit the road among 10 coronavirus hotspots, despite warnings from health experts.

Mobility, experts say, is one driver of transmission of the novel coronavirus.

For the Fourth of July holiday weekend, the data show that the numbers of people traveling were generally higher overall than Memorial Day weekend. The July 4 weekend was generally recognized as Friday, Saturday and Sunday, while Memorial Day weekend in May was Saturday, Sunday and Monday.

Cuebiq focused on the number of visitors to and from 10 metro area hotspots from a week prior to the July 4 weekend.

The metropolitan areas had been ranked by the percent positive Covid-19 tests the week prior in a presentation by the White House Coronavirus Task Force. The analysis included the Houston; Austin, Texas; Phoenix; Dallas; San Antonio; Orlando; Tampa, Florida; Charleston, South Carolina; Miami; and Atlanta areas.

Local leaders were concerned that gatherings over the July 4 holiday could spread the virus. States put an end to some celebrations. California Gov. Gavin Newsom urged cities struggling with the virus to cancel fireworks. Beaches and parks in Miami were closed over the holiday. Some beaches in South Carolina canceled their fireworks shows. In Texas, tubing was canceled on some rivers. Some places celebrated with livestreamed events.

Still, the draw of a three-day summer weekend with long-awaited get-togethers and newly reopened attractions worried health experts.

"It's set up a perfect storm: the combination of travel, the combination of reopening -- perhaps in some cases, too early -- and the combination of people not necessarily following some of these preventive guidelines," Dr. Joshua Barocas, an infectious disease physician at Boston Medical Center, said before the holiday.

Metro areas with the most movement

Despite the warnings, nearly all of the metro areas Cuebiq analyzed saw an increase in the proportion of visitors over the Fourth of July weekend, when compared to either Memorial Day weekend or the two-week prior average. The sole exception was the Phoenix area, which saw a slightly higher percentage of visitors during Memorial Day weekend, but whose locals traveled elsewhere in greater numbers over Fourth of July weekend.

Among them, two hotspot cities saw the highest proportions of vacationers: Orlando saw the largest increase in visitors compared to the weeks leading up to the holiday weekend and Charleston saw the highest percentage of visitors among the 10 metro areas. In both areas, roughly 1 in 5 devices was determined to be a visitor, according to Cuebiq's analysis. Visits have been steadily increasing in Charleston through June, the company's data showed.

Travelers tended to visit cities in their own state or region, but some traveled further. About 3.7% of visitors to the Miami area came from New York, and another 3.9% came from the Atlanta area. Of the people who visited Phoenix, 16.3% came from just three metro areas in Southern California -- those including Los Angeles, Riverside and San Diego. Others came from areas around Chicago and Dallas -- about 2% of Phoenix visitors in each case.

Of these 10 areas, Atlanta area residents were the most likely to travel. About 20% of the resident devices the company tracked had left the state and traveled to another city during the July 4 weekend. Many went to Florida.

'When we see social mobility going up ... we see a rise in cases'

Mobility doesn't equal infection; maintaining physical distance and wearing masks can reduce the risk of the coronavirus spreading. It could be weeks before states notice an increase in cases linked to holiday getaways, if they happen. But with travel, there are a lot more opportunities for people to come into contact with someone who can make them sick.

"When we see social mobility going up, in seven to ten days later, we see a rise in cases, and then we see a bigger rise, as we are starting from a higher starting point. These models are really useful to help us prepare," Salgado said.

She said Charleston is a beautiful tourist destination and she understands why so many people would want to visit. Plus, it is "pretty much wide open," as far as restaurants and bars. People are asked to wear a mask when they can't social distance.

"Some people are being very responsible, but some aren't unfortunately," she said. "I have always sort of said, human beings, if things are open for them, they will go do them."

Salgado said there have been moments in the pandemic when she has been proud of people for staying home, but she has also felt some disappointment and frustration.

"I worry mostly about the vulnerable population who don't have a choice and are somewhat victims of what other people decide to do," Salgado said.

She said she can see why sometimes people will see that more is reopening and start to think it is safe to go out or to travel, especially in the summer vacation season. But she said they definitely have seen mini outbreaks tied to travel.

"We sure will keep a close eye on it every day," Salgado said. Typically, hospitalizations won't spike for another few weeks.

"It's still quite early, but we'll prepare and be ready for it."

CNN's Michael Nedelman contributed to this report.

Manasquan has suspended its recreation programs for a week after several employees tested positive for the coronavirus, a borough official said in a video posted online Saturday.

A recreation counselor, junior guards counselor and several other employees tested positive for COVID-19, Councilman and Beach and Recreation Chair Michael Mangan said in the video. He did not provide details on their conditions.

Mangan said the town will pause its recreation programs to assess how many people were infected and who each person was in contact with. The beach will remain open, though Mangan reminded people to practice social distancing.

I know that the parents of young children in this town are all anxious to get their kids back involved in organizations where they socialize with each other. Thats crucial to their development. But we cant do that at the risk of public safety, Mangan said.

Right now, we can trace all the contacts for the cases we have, he said. If we have more positive cases, we will continue to release that information. As a parent, I can tell you the only thing I know is everyone wants to make sure they have all the information they need to make decisions for their own families.

To date, Monmouth County has reported 9,620 positive cases of coronavirus, 37 of which were in Manasquan. The state has slowly been allowing businesses to reopen in phases over the past month after the number of new cases hit its peak in April.

The boroughs decision not to shut down its recreation programs entirely was a measured approach, Mangan said. He said officials want to allow children to participate in activities while also keeping the population safe.

However, he said, if the health department cannot determine who was exposed and how many were exposed to the virus, then the programs would be canceled.

This virus is going to be with us for a while. This is not something thats going to go away this summer or even this fall as much as we want it to and we have to figure out a way to live with it and a way to deal with these cases as they come up, Mangan said. Were going o have to figure out a way to continue our society while seeing these cases of positive tests come back.

Our journalism needs your support. Please subscribe today to NJ.com.

Avalon Zoppo may be reached at azoppo2@njadvancemedia.com. Follow her on Twitter @AvalonZoppo.

Editors note: The Salt Lake Tribune is providing free access to critical stories about the coronavirus. Sign up for our Top Stories newsletter, sent to your inbox every weekday morning. To support journalism like this, please donate or become a subscriber.

Sometimes it seems like every article about the coronavirus is trying to scare you.

Thats especially true for articles about the long-term impacts of COVID-19. They tend to start the same way: introducing you to someone whose life was terrific before the virus and terrible now, due to some unexpected remaining symptom. Theres a transition sentence But Chad isnt alone telling you that other people have this happen to them too. Doctors are interviewed about how likely this is, studies are referenced to the degree possible. Finally, the article returns to Chad, who just wishes he hadnt gone to that get-together where he caught the virus in the first place.

Stories like this grab your attention, then fill in the details. But I think sometimes they can lack context, too. If we zoom in on one tree, we can miss some pretty important facts about the forest.

So how do we describe what we know about the forest? I found the format of a Reddit post really helpful, which riffed off of something then Defense Secretary Donald Rumsfeld once said. We can split up the forest into known knowns, known unknowns, and unknown unknowns.

Known knowns are the things we know about the forest through careful observation and study.

Known unknowns are the things we know we need to learn more about the forest. A cloud might be covering an overhead view, so we need to send an explorer over there to find out whats going on.

Unknown unknowns are the things that might happen that we arent even considering. A giant meteor might strike. Thatd change our opinion of the forest pretty drastically.

Just over six months since we discovered the coronavirus, we can use that same approach to discussing where we are in terms of discovering its long-term impacts.

We know how long peoples coronavirus symptoms normally last. The COVID Symptom Study is a joint project from researchers at Kings College of London and Massachusetts General Hospital. Essentially, they developed an app that asks those with COVID to take one minute every day to describe the symptoms theyre facing. Theyve had a huge response rate: 3,984,380 contributors so far.

The study found that most people do recover completely within 14 days, although even that is a relatively long time for most people when they think about recovering from a disease. But theres also this long tail for people who seem to have symptoms for 25, 30, 35, or 40 days, perhaps longer. They conclude that about one in 10 people still have symptoms after three weeks. This is the long COVID group.

What kind of symptoms are these? They range from mild to severe.

Sense of smell. You probably know that coronavirus tends to make people lose their sense of smell for a while; various studies have estimated the percentage of coronavirus patients that lose smell to be anywhere from 30% to 98%. In Salt Lake County, 38% of cases have reported loss of smell.

An Italian study checked in on 202 patients who lost their smell to see how long it lasted. Four weeks from when the symptoms started, 49% reported complete resolution, 41% reported an improvement in the severity, and 10% reported that their smell was unchanged or worse. Interestingly, there wasnt any correlation between how long these people lost their sense of smell and how long they had other COVID-19 symptoms.

Post intensive care syndrome. Up to 75 percent of people who become critically ill and stay at an ICU develop this. It includes neurological, physical, and psychological symptoms.

Blood clot issues. Remember, some of what hurts people isnt the virus itself, but the bodys immune response to it. In particular, one quirk of the immune response is that it can create inflammation in some places in the body and blood clots in others. Blood clots can cause all sorts of problems everywhere in the body with COVID-19, from kidney failure to limb amputation.

Lung damage. People who have pneumonia or need to go on a ventilator often have long-term lung scarring as a result. The elderly are more likely to experience scarring, but whoever experiences it does see diminished lung capacity and exercise capacity. In addition, the blood clots can cut off circulation in the lungs: studies have found that 23% to 30% of those with severe COVID-19 have this occur. That also creates long-term impacts on lung function.

Strokes. If one of those blood clots causes a stroke, that obviously has long-term impact. Stokes have been seen in both young and old due to coronavirus. Young people dont die that frequently, but they are permanently effected: studies have found between 42% and 53% of young stroke victims are able to return to work.

Because weve only known about coronavirus for such a short period of time, theres much we want to know more about, but just havent had the time to figure it out yet. The National Institutes of Health is creating the CORAL study, which will take a look at the long-term health of 3,000 coronavirus patients. Countries all over the world are doing the same thing. Here are some of the questions those studies are trying to figure out.

Who gets long-term symptoms and why? Youd expect that it was people who faced severe symptoms that lasted longer: the taller the mountain, the longer it takes to get up and down it, right? But according to the COVID Symptom Study researchers, people with mild cases of the disease are more likely to have a variety of strange symptoms that come and go over a more extended period.

Why is that? One hypothesis is that those who are hospitalized receive medication to prevent the blood clotting and inflammation issues that can cause some of the unexpected symptoms, but we dont know if that is true. Of course, that doesnt explain the number of hospitalized people who get unexpected symptoms anyway.

How permanent is most lung damage? We know that severe lung damage is known to have long-term effects, but what about mild lung damage? For example, one study looked at 58 people who had tested positive who were completely asymptomatic except they had visible lung damage on their CT scans. When doctors look for lung damage, theyre looking for translucent spots.

Every study participant had literal pneumonia, but only 16 of the 58 people ever showed symptoms from the disease; 22 of the 58 showed complete repair after a week; and 21 showed at least visible improvement in their lungs. Most of the time, the body repairs itself relatively quickly. But what happens to those with medium-severity lung damage?

A study of hospital patients in the original SARS outbreak found that even young people who avoided the ICU had problems. In particular, when patients who had SARS were asked to walk normally for six minutes, they walked significantly shorter distances than people who hadnt had SARS. But given what we know about comorbidities, its possible that being hospitalized was enough to lower these peoples walk distance even before SARS. Whats really going on here?

Is COVID-19 really triggering diabetes in people? We know that diabetes is a preexisting condition that tends to make COVID-19 worse. But there are a growing number of cases in which diabetes is seemingly being triggered by the virus, even mild cases. That sounds crazy, but there are a number of viruses that have shown the ability to do that before, including H1N1. How often does this happen? Does this form of diabetes stay around, or do people get better? Who is at risk?

What in the world is going on in peoples brains? Somewhere between two-thirds and three-quarters of people who go to ICUs as a result of COVID-19 end up facing delirium which may be related to that post-intensive-care syndrome mentioned above. But ICU doctors are seeing symptoms which go above and beyond typical ICU problems: repeated headache, confusion, seizures they arent use to seeing at that frequency.

People who arent in ICUs, with even mild coronavirus, are also experiencing weird mental symptoms. Is this just because their brains are getting less oxygen? Will it get better? It clearly does in some people, but others are still experiencing effects from a disease that started months ago. Some doctors worry that the virus can break the barrier between blood and brain cells; if true, thats no uniquely bad.

What long-term impact does coronavirus have on the immune system? Studies say people who were infected still have wild immune cell numbers four to 11 weeks after recovery a number limited only by how much time the study had.

There are some people where lots of really important cells are completely depleted and disappeared from the blood. And there are other people, perhaps people who were more mildly affected, where all the cells look terribly turned on and terribly aggressive and terribly activated, Danny Altmann, a professor of immunology at Imperial College London, said on a Guardian podcast.

Are the high levels why many mild cases experience long-term fatigue? How much longer is the immune system out of wack? What consequences do these levels of immune system cells have on other infection? We have to start figuring that out.

I think some of the scariest coronavirus articles have focused on some really unlikely possibilities. For example, some have worried about how the virus, like chicken pox or herpes, stays in your body your whole life. That it could result in symptoms decades later. Theres no evidence that coronaviruses of any sort do that, so itd be pretty illogical if this one did.

Likewise, some are worried about the disease mutating into something more severe. Viral mutations happen all the time, but typically they move in the direction of less deadly rather than more deadly. Viruses want to infect as many hosts as possible, and dead bodies are terrible at going to bars and restaurants and spreading the disease.

Its just not worth it to spend your whole life worrying about the really unlikely stuff. Theres plenty of real worries above without having to get into sci-fi territory.

We tend to put cases in two buckets people who die or people who will recover. Heck, the state of Utah explicitly does that: they just add anyone who hasnt died within three weeks of their positive test to the recovered tally in their official stats every day. Long-term impacts, those 10% of cases that last longer, muddy that clean split. Recovered doesnt mean 100%.

As a relatively young and healthy person, Im very unlikely to die from the virus. But I dont want my ongoing quality of life to be hurt, either. I want to be able to play soccer and tennis when all of this is over, and hopefully just as well. Itd be terrific if my brain was at 100%, and if I had my full array of immune system functions.

Its just another thing to consider before engaging in risky behavior. Do I live my life in fear? No. But am I taking basic precautions everywhere I go? Absolutely.

Andy Larsen is a Tribune sports reporter who covers the Utah Jazz. During this crisis, he has been assigned to dig into the numbers surrounding the coronavirus. You can reach Andy at alarsen@sltrib.com or on Twitter at @andyblarsen.

Wait. I can catch Covid twice? my 50-year-old patient asked in disbelief. It was the beginning of July, and he had just tested positive for SARS-CoV-2, the virus that causes Covid-19, for a second time three months after a previous infection.

While theres still much we dont understand about immunity to this new illness, a small but growing number of cases like his suggest the answer is yes.

Covid-19 may also be much worse the second time around. During his first infection, my patient experienced a mild cough and sore throat. His second infection, in contrast, was marked by a high fever, shortness of breath, and hypoxia, resulting in multiple trips to the hospital.

Recent reports and conversations with physician colleagues suggest my patient is not alone. Two patients in New Jersey, for instance, appear to have contracted Covid-19 a second time almost two months after fully recovering from their first infection.

It is possible, but unlikely, that my patient had a single infection that lasted three months. Some Covid-19 patients (now dubbed long haulers) do appear to suffer persistent infections and symptoms.

My patient, however, cleared his infection he had two negative PCR tests after his first infection and felt healthy for nearly six weeks.

I believe it is far more likely that my patient fully recovered from his first infection, then caught Covid-19 a second time after being exposed to a young adult family member with the virus. He was unable to get an antibody test after his first infection, so we do not know whether his immune system mounted an effective antibody response or not.

Regardless, the limited research so far on recovered Covid-19 patients shows that not all patients develop antibodies after infection. Some patients, and particularly those who never develop symptoms, mount an antibody response immediately after infection only to have it wane quickly afterward an issue of increasing scientific concern.

Whats more, repeat infections in a short time period are a feature of many viruses, including other coronaviruses. So if some Covid-19 patients are getting reinfected after a second exposure, it would not be particularly unusual.

In general, the unknowns of immune responses to SARS-CoV-2 currently outweigh the knowns. We do not know how much immunity to expect once someone is infected with the virus, we do not know how long that immunity may last, and we do not know how many antibodies are needed to mount an effective response. And although there is some hope regarding cellular immunity (including T-cell responses) in the absence of a durable antibody response, the early evidence of reinfections puts the effectiveness of these immune responses in question as well.

Also troubling is that my patients case, and others like his, may dim the hope for natural herd immunity. Herd immunity depends on the theory that our immune systems, once exposed to a pathogen, will collectively protect us as a community from reinfection and further spread.

There are several pathways out of this pandemic, including safe, effective, and available therapeutics and vaccines, as well as herd immunity (or some combination thereof).

Experts generally consider natural herd immunity a worst-case scenario back-up plan. It requires mass infection (and, in the case of Covid-19, massive loss of life because of the diseases fatality rate) before protection takes hold. Herd immunity was promoted by experts in Sweden and (early on in the pandemic) in the UK, with devastating results.

Still, the dream of herd immunity, and the protection of a Covid-19 infection, or a positive antibody test, promise to provide, have taken hold among the public. As the collective reasoning has gone, the silver lining of surviving a Covid-19 infection (without debilitating side effects) is twofold: Survivors will not get infected again, nor will they pose a threat of passing the virus to their communities, workplaces, and loved ones.

While recent studies and reports have already questioned our ability to achieve herd immunity, our national discourse retains an implicit hope that herd immunity is possible. In recent weeks, leading medical experts have implied that the current surge in cases might lead to herd immunity by early 2021, and a July 6 opinion piece in the Wall Street Journal was similarly optimistic.

This wishful thinking is harmful. It risks incentivizing bad behavior. The rare but concerning Covid parties, where people are gathering to deliberately get infected with the virus, and large gatherings without masks, are considered by some to be the fastest way out of the pandemic, personally and as a community. Rather than trying to wish ourselves out of scientific realities, we must acknowledge the mounting evidence that challenges these ideas.

In my opinion, my patients experience serves as a warning sign on several fronts.

First, the trajectory of a moderate initial infection followed by a severe reinfection suggests that this novel coronavirus might share some tendencies of other viruses such as dengue fever, where you can suffer more severe illness each time you contract the disease.

Second, despite scientific hopes for either antibody-mediated or cellular immunity, the severity of my patients second bout with Covid-19 suggests that such responses may not be as robust as we hope.

Third, many people may let their guard down after being infected, because they believe they are either immune or incapable of contributing to community spread. As my patients case demonstrates, these assumptions risk both their own health and the health of those near them.

Last, if reinfection is possible on such a short timeline, there are implications for the efficacy and durability of vaccines developed to fight the disease.

I am aware that my patient represents a sample size of one, but taken together with other emerging examples, outlier stories like his are a warning sign of a potential pattern. If my patient is not, in fact, an exception, but instead proves the rule, then many people could catch Covid-19 more than once, and with unpredictable severity.

With no certainty of personal immunity nor relief through herd immunity, the hard work of beating this pandemic together continues. Our efforts must go beyond simply waiting for effective treatments and vaccines. They must include continued prevention through the use of medically proven face masks, face shields, hand washing, and physical distancing, as well as wide-scale testing, tracing, and isolation of new cases.

This is a novel disease: Learning curves are steep, and we must pay attention to the inconvenient truths as they arise. Natural herd immunity is almost certainly beyond our grasp. We cannot place our hopes on it.

D. Clay Ackerly, MD, MSc is an internal medicine and primary care physician practicing in Washington, DC.

Support Voxs explanatory journalism

Every day at Vox, we aim to answer your most important questions and provide you, and our audience around the world, with information that has the power to save lives. Our mission has never been more vital than it is in this moment: to empower you through understanding. Voxs work is reaching more people than ever, but our distinctive brand of explanatory journalism takes resources particularly during a pandemic and an economic downturn. Your financial contribution will not constitute a donation, but it will enable our staff to continue to offer free articles, videos, and podcasts at the quality and volume that this moment requires. Please consider making a contribution to Vox today.

Presented by Alaska Native Tribal Health Consortium

At this point, everyone is familiar with the steps to take to guard against COVID-19: Wash your hands well with soap and water. Stay six feet from others outside your home. Cover your cough. Avoid touching your face.

Heres one that you dont hear as much: Stop smoking.

While some COVID-19 risk factors have to do with age, chronic illness or immunocompromisation, theres one thats tied directly to a different kind of medical concern -- addiction to cigarettes. While smoking cigarettes doesnt necessarily make you more likely to become infected with the novel coronavirus, smokers who do contract COVID-19 may be more likely to have serious or fatal cases than non-smokers.

Why might COVID be harder on smokers? The answer lies in the lungs.

COVID-19 and your breathing health

Not everyone is affected equally by COVID-19, said Dr. Thomas Kelley, a pulmonologist at the Alaska Native Medical Center.

While about 80 percent of patients experience mild to moderate symptoms, others develop a devastating lung infection, according to Kelley. These infections inflame the alveoli, fine sacs in the deepest portions of the lungs. This inflammation interferes with the bodys ability to take in the oxygen it needs and expel the carbon dioxide it doesnt.

This can cause the development of viral pneumonia that may show up as ground-glass opacities on chest X-rays and CAT scans of the lungs, Kelley said. Ground-glass opacities, which indicate that a lung is sick, are often also seen in scans of patients with diseases like congestive heart failure and viral pneumonia.

About 14 percent of COVID-19 patients come down with severe cases, usually affecting both lungs. When this happens, the alveoli can fill with fluid and debris. And about 5 percent of patients develop critical cases of acute respiratory distress syndrome (ARDS), which can damage lungs -- extensively, permanently, and sometimes fatally.

Patients this sick usually require admission to an intensive care unit, where they are often provided higher concentrations of supplemental oxygen and closely monitored for further deterioration, Kelley said. If they do get worse, they may be placed on mechanical ventilation.

This is where the danger to smokers comes in.

What it comes down to is: COVID-19 is a disease that attacks your respiratory system, said Crystal Meade, program manager for the Alaska Native Tribal Health Consortiums Tobacco Prevention Program. So if youre a tobacco user or vaper, youre already at increased risk of respiratory infections.

Preliminary research also suggests that smoking provides COVID-19 additional points of entry into the lungs. COVID-19 infections start when the virus binds itself to the ACE2 receptor, a protein found on the surface of the lung. Researchers have found that smokers have more ACE2 receptors -- meaning a smokers lungs have more spots where the virus can attach and begin its destructive work.

Think of your immune system, Meade said. Think of it being weakened by tobacco use already. With COVID-19, there are certain populations that are at higher risk. If you take these comorbidities and then you add them together and take COVID-19 and put it on top of that When you start adding in all these health disparities, its definitely harder to fight it off.

Even for patients who survive severe cases, the damage from ARDS can be lasting or even permanent.

Some patients likely will experience some recovery to their lung function over time and others may not, Kelley said. We do know that patients with ARDS often require weeks to months of rehabilitation to get their strength back. These patients often experience shortness of breath and fatigue months and even years out from their original infection.

Additionally, while there is currently no evidence about the relationship between electronic cigarettes and COVID-19, what we already know about vaping is enough to indicate that vape users are probably also at higher risk for harm from the virus, according to Kelley.

Intuitively, given that existing evidence indicates that e-cigarettes are harmful and increase the risk of heart disease and lung disorders, (it) would appear that their use also increases the risk of developing severe infection and death in vapers exposed to the COVID-19 virus, Kelley said.

No better time than now to quit

Its definitely on peoples minds, she said. Weve had comments like, Ive been contemplating quitting for a while, but this was the motivation I needed.

In response to hunker down orders this spring, ANTHCs free tobacco cessation program adapted quickly to ensure it would still be able to help anyone who is ready to quit.

Weve had to make quite a bit of adjustments in how we offer our treatment, but we are super lucky that we have the technology and the means to offer the treatment still, Meade said. We are able to do consultations over the phone, and then were actually in the process of being able to do virtual consultations using telehealth.

Whether or not the motivation to quit comes from the threat of COVID, its important that it comes from the smoker themselves, Kelley said.

The bottom line is that despite all the evidence of the dangers of smoking and how smoking may increase the risk of COVID-19 infection severity and death related to it, smokers will quit when they feel that they are ready to quit, he said. As physicians, we can and should encourage them to quit at every visit.

Some patients may find that the choice is made for them. During the weeks or even months that an ARDS patient is in the ICU and then a rehabilitation center, they wont be able to smoke at all -- a sort of forced smoking cessation, as Kelley described it.

This is not the kind of approach I would want to take to smoking cessation if I were a smoker, he added.

For Meade, the motivation -- and empathy -- to help others try to quit is rooted in a personal loss. Her mother was diagnosed with lung cancer in 2014 and passed away the following spring, seven years after she defeated a cigarette addiction that had lasted more than four decades.

That was her way of dealing with stress, Meade said. It was her outlet. It was her break. I get that now.

That experience helps Meade stay driven to help Alaskans quit -- and stay quit. The yearlong program she leads at ANTHC is designed to help participants develop strategies for the times when theyre likely to struggle.

Maybe sometimes you can quit cold turkey, and youre quit a month or two and something happens, she said. All of a sudden you have a very stressful situation that you havent prepared for as far as your tobacco use. What we really aim to do is talk with the patient and come up with what we call a quit plan.

Nationally, less than 10 percent of smokers successfully quit each year, but ANTHCs program typically sees about 40 percent of participants make it to the six-month mark, according to Meade.

With COVID-19 still circulating in Alaska, she said she hopes more smokers will use the virus as motivation to kick the habit for good.

Theres really no better time than now to quit your tobacco use, Meade said.

ANTHCs Tobacco Prevention Program offers free tobacco cessation services to ANTHC employees and patients of the Alaska Native Medical Center. To enroll in the program, call (907) 729-4343. If you are not enrolled in the Tribal health system, you can find free smoking cessation resources through Alaskas Tobacco Quit Line at AlaskaQuitLine.com or by phone at 1-800-QUIT-NOW.

This story was sponsored by Alaska Native Tribal Health Consortium, a statewide nonprofit Tribal health organization designed to meet the unique health needs of more than 175,000 Alaska Native and American Indian people living in Alaska.

This story was produced by the creative services department of the Anchorage Daily News in collaboration with Alaska Native Tribal Health Consortium. The ADN newsroom was not involved in its production.