EDINBURGH, Scotland There was nothing particularly festive about Nicola Sturgeons recent visit to the Cold Town House, a newly reopened Edinburgh pub, but maybe that was the point. Sipping coffee and surveying plexiglass dividers, Ms. Sturgeon, the leader of Scotlands government, warned customers not to expect the jolly, sweaty intimacy of nightlife before the coronavirus pandemic.
No beer garden or cafe should feel the same as it did before, she said as a drenching rain fell, obscuring the stony ramparts of Edinburgh Castle that tower above this once-teeming establishment.
As Scotland emerges from a three-month lockdown, it is moving more carefully than neighboring England, a divergence that owes a lot to Ms. Sturgeons cautious style and her conviction that England, under its more freewheeling leader, Boris Johnson, is taking too many risks in a headlong rush to resume public life.
For now, Scotlands approach has made it a bright spot in coronavirus-ravaged Britain. New cases have dwindled to a handful a day, and deaths to a trickle. If Scotland maintains this progress a big if, given its open border it could stamp out the epidemic by the fall, public health experts say. Such a goal seems fanciful in England, which is still reporting hundreds of new cases and dozens of deaths every day.
But what happens in England inevitably spills over into Scotland. In the case of the virus, the stark contrast in daily numbers has reanimated old grievances for the Scots, who voted against leaving the United Kingdom in 2014 but overwhelmingly rejected Britains vote to leave the European Union two years later.
Nationalist sentiment has surged during the pandemic: Fifty-five percent of Scots now favor independence, according to a recent poll a solid majority that analysts said reflected a perception that Scotlands nationalist-led government has handled the crisis better than Mr. Johnson and his pro-Brexit ministers have.
Scotland imposed its lockdown on March 23, the same day as England did, but has lifted the restrictions more selectively. It kept pubs closed a few days longer. It requires people to wear face masks in shops, which England does not. And unlike England, it left Spain, a popular holiday destination, off a list of countries to which Scots can travel without isolating themselves when they return.
Were quite stubborn and steadfast because Nicola has handled it elegantly and weve seen how England is flapping around, said Katy Koren, the artistic director of Gilded Balloon, a company that stages outdoor performances during the Edinburgh Festival, which has been canceled this summer.
So far, she said, Scots have given Ms. Sturgeon, 49, the benefit of the doubt because she has been willing to make tough decisions and has convinced people that her overriding goal is the public health. Her no-nonsense briefings have become a reassuring daily ritual, even providing grist for comedians.
Ms. Sturgeons fans liken her to New Zealands prime minister, Jacinda Ardern, who has come closer than perhaps any other leader to stamping out the virus. The unspoken contrast is to Mr. Johnson, who has been all over the map in his response and has often seemed reluctant to deliver bad news.
Men like to be popular, said Ms. Korens mother, Karen, who runs the festival company with her daughter. For women, its not about ego.
But it is, inescapably, about politics.
Ms. Sturgeons Scottish National Party is committed to independence and a return to the European Union. As she has diverged from the British government a process that broke into the open in late May when she stuck with the slogan Stay Home and rejected Mr. Johnsons more permissive Stay Alert she is building a powerful new case for Scotlands ability to go it alone.
Under the terms of limited self-government in the United Kingdom, the Scottish authorities are responsible for matters like health and education, while the British government handles immigration, foreign policy and, crucially, the fiscal rescue packages to protect those who lost their jobs in the lockdown.
That has enabled Ms. Sturgeon to slow-walk Mr. Johnsons steps to ease the lockdown, which she complains are often foisted on her without advance notice. She clucked over pictures of revelers jamming the streets of Soho in London after he opened pubs a spectacle that she avoided by scheduling Scotlands reopening for a Monday rather than a Saturday.
To some, particularly those who do not share her nationalist politics or are eager to get their businesses running again, there is more than a whiff of point-scoring.
She is a fantastic politician, said Nic Wood, the owner of the Cold Town House, who invited her to visit his pub. But a lot of what she now does is all about getting independence. Her talents would be better used if she could just lead the country.
Hotel and restaurant owners were alarmed when Ms. Sturgeon declined to rule out a quarantine for visitors from England after Mr. Johnson lifted a 14-day quarantine for people traveling to and from 59 countries. She expressed concern that visitors could carry the virus into Scotland from third countries.
We cant afford any inference that the English arent welcome in Scotland, said Marc Crothall, the chief executive of the Scottish Tourism Alliance, who noted that 70 percent of Scotlands tourism revenue comes from visitors within the United Kingdom.
Ms. Sturgeons threat also provoked Mr. Johnson, who typically says the differences between Scotland and England are overblown. He described it as astonishing and claimed, There is no such thing as a border between England and Scotland.
Over the last three months, Ms. Sturgeon, who declined a request for an interview for this article, has developed strong ideas about how to combat the pandemic. She convened a group of scientific advisers separate from the British governments panel, and they consulted a German health official for best practices.
Scotland honed its test-and-protect program, which is less dependent on private contractors than the system in England and recruits its contact tracers from communities all of which, officials say, make it more effective.
Weve been really pleased to see the case numbers fall the way they have, said Dr. Janet Stevenson, who coordinates the program for the Edinburgh region, though she acknowledged that it will be harder to control cases as more outsiders start flowing into Scotland from England. Its a leaky old border, she said.
Devi Sridhar, who runs the global health governance program at the University of Edinburgh, noted that the two countries took radically different approaches from the start: Englands priority was to prevent its hospitals from being overrun, while Scotlands was to drive cases down to zero. If not for imported cases from the south, Dr. Sridhar said, Scotland could come close to that goal by the end of the summer.
If we were an island, we could eliminate it entirely, she said. Thats why cooperation is needed in global health.
Other experts say elimination is a quixotic target under any circumstances. To achieve it, Scotland would have to keep in place measures that are economically untenable and would cause other health-related problems. Even New Zealand has been struck with new cases imported from England, as it happens.
Some also question whether Scotlands performance is all that remarkable compared with Europe as a whole.
Its reported death rate of 46 per 100,000 is far lower than the 71 per 100,000 in England. But it is on a par with France and higher than Northern Ireland. England has 56 million people, compared with Scotlands 5.4 million. It is sparsely populated, without a metropolis like London, where the outbreak exploded in early March. Fortunate timing may have spared it the worst.
Scotland was six or seven days behind London, said Mark Woolhouse, a professor of epidemiology at the University of Edinburgh. That is a very long time, if the epidemic is doubling every three or four days. Scotlands experience, he added, was not particularly better or worse than other European countries.
For many in Scotland, however, what matters is not how their country fared relative to the rest of the world, but how it stacks up to England. Ms. Sturgeons approval ratings have risen to above 80 percent, while Mr. Johnsons ratings have declined. That could embolden her to press him to allow another independence referendum something he has so far ruled out.
They might still say no, said Nicola McEwen, a professor of politics at the University of Edinburgh. But it will be more difficult. She is emerging from this, at least so far, with more authority and more respect.
At the Cold Town House, where a handful of customers sipped pints on a chilly day earlier this week, there was a stoic pride in Scotlands disciplined response to the pandemic. The cobbled streets of Edinburghs Royal Mile, which usually throb with festival goers at this time of the year, were nearly deserted. From the castles ghostly ramparts, residents contemplated their becalmed city.
Theres a conservatism in Scotland, where doing the sensible, rational stuff outweighs the more emotional response to things, said Tom Harries, an entrepreneur who is originally from Bristol, England, and runs a start-up that has helped businesses find ways to survive during the lockdown.
There is also, he said, one-upmanship.
As an Englishman, I myself am thinking, What a mess, he said. How does this reflect on England? It feels a bit shameful.
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With cases of the new coronavirus and related hospitalizations rising at alarming rates, Gov. Greg Abbott expanded his ban on elective medical procedures Thursday to cover more than 100 counties across much of the state.
Surgeries and other procedures that are not immediately, medically necessary which have already been on hold in many of the states biggest cities and several South Texas counties are now barred in much of the state, from far West Texas to much of Central Texas, Southeast Texas and the Gulf Coast.
Those procedures can still take place in some, mostly rural parts of the state, including the Panhandle and the South Plains, as well as much of North and Northeast Texas, excluding Dallas County.
"We are freeing up more resources to address upticks in COVID-19 related cases, Abbott said in a statement. The State of Texas will continue to do everything we can to mitigate the spread of this virus and support our hospitals and health care professionals as they care for their fellow Texans.
Abbott's order makes an exception for procedures that, "if performed in accordance with the commonly accepted standard," would not deplete hospital capacity needed for battling the coronavirus.
As of Wednesday, the number of confirmed COVID-19 patients hospitalized with the virus had reached a record high of 9,610 twice as many as there were June 25. But the pressure on hospitals is not evenly distributed around the state. Hospital capacity is most taxed around the states biggest cities, as well as most of South Texas.
Earlier this spring, when Abbott first barred elective procedures in an effort to conserve medical resources, Texas Attorney General Ken Paxton interpreted that order as prohibiting abortions a position that sparked a federal lawsuit. The state's near-ban on abortions disappeared when hospitals proved to have plenty of capacity and the elective procedure ban was lifted.
Abbott's new ban on elective procedures, first issued in late June as cases began to surge and expanded this week to dozens more counties, has so far not sparked a similar legal battle over abortion. The governor's March order applied broadly to "all licensed health care professionals and all licensed health care facilities," whereas the more recent order more specifically targets hospitals.
A tiny fraction 3% of Texas abortions were provided at hospitals in 2017, according to the reproductive rights research organization the Guttmacher Institute.
The governors new order on elective procedures applies to 11 of the states 22 trauma service areas: J, K, M, O, P, Q, R, S, T, U and V, as well as Dallas County.
A surge in coronavirus cases in and around Tulsa, Okla., is probably connected to the campaign rally President Trump held there last month, the citys top health official said on Wednesday.
Tulsa County reported 206 new confirmed cases on Tuesday and 261 a record high on Monday, and Dr. Bruce Dart, the director of the Tulsa Health Department, said at a news conference that it was reasonable to link the spike to the rally and related events.
The past two days weve had almost 500 cases, and we know we had several large events a little over two weeks ago, which is about right, Dr. Dart said. So I guess we just connect the dots.
The county has more infections right now than any other in Oklahoma, and weve had some significant events in the past few weeks that more than likely contributed to that, he added.
Dr. Dart spent much of the news conference pleading with Tulsans to wear face masks which most attendees at Mr. Trumps rally did not and said the department would recommend requiring masks if we continue to see an exponential rise in cases, which frankly we expect over the next few days.
Asked whether contact tracing had confirmed a link between the rally and the increase in cases, Leanne Stephens, a spokeswoman for the health department, said it will not publicly identify any individual or facility at risk of exposure, or where transmission occurred.
Ms. Stephens said this week that contact tracers had been completely inundated trying to track down dozens of close contacts for thousands of confirmed cases, a task that can take hours for each person.
Karen Keith, a county commissioner in Tulsa who oversees the area where the rally occurred, said in an interview on Wednesday that contact tracers were struggling to persuade people to reveal where they had been, frustrating local officials.
She added that a surge in cases in rural parts of the state was most likely another indication that the rally could be responsible for the most recent outbreaks. Dr. Dart told The Tulsa World newspaper that he had examined Google mobility data for rally attendees, which offered a ballpark idea of where they had settled after the event.
The countys seven-day rolling average of new cases dipped briefly at the end of June before rising again, and has been increasing fairly steadily since July 2. Mr. Trump held his rally on June 20, and because of the incubation period between when people are infected and when they start showing symptoms, it can take around two weeks for a change in infection rates to become apparent.
Health officials were worried from the start about Mr. Trumps decision to hold a large rally indoors a much riskier environment than outdoors in terms of coronavirus transmission in a state where coronavirus cases were already spiking.
A few days before the event, Dr. Dart urged the president to cancel, calling the rally a perfect storm of potential over-the-top disease transmission.
When he said that, Tulsa County had just recorded 89 new cases in a day, a record high at the time. This week, the daily totals have been more than twice that.
Lt. Travis Stokes, a firefighter in Richmond, Va., is helping to lead an effort to distribute protective equipment to residents of low-income and minority neighborhoods. Sarah McCammon/NPR hide caption
Lt. Travis Stokes, a firefighter in Richmond, Va., is helping to lead an effort to distribute protective equipment to residents of low-income and minority neighborhoods.
Around the country, communities of color continue to be among the hardest hit by the coronavirus pandemic. So in many of these communities, local leaders are stepping in to try to help solve a problem they say is years in the making.
In Richmond, Va., crews of local firefighters and volunteers have been fanning out across the city, going door to door with plastic bags filled with masks, hand sanitizer and information about staying healthy.
Local health officials say African Americans and Latinos make up the lion's share of positive cases here, and 23 out of 29 local deaths from the virus so far have been among those groups.
On a recent visit to a public housing complex, Lt. Travis Stokes with Richmond's fire department said that result was sadly and entirely predictable.
"It's always gonna affect the lower-income communities and the minorities, just for the simple matter of fact that they've been dealing with things for many, many years," Stokes said. "It hasn't gone away; it's still here."
Richmond's coronavirus data mirrors national statistics that show the vastly disproportionate impact of the coronavirus on communities of color. According to Centers for Disease Control and Prevention data, Black Americans are hospitalized at about five times the rate of white Americans. For Hispanics, the rate is four times that of whites.
Stokes, who recently completed a doctoral degree in health sciences, is helping lead the effort, which targets areas with high rates of poverty and preexisting health conditions and with significant numbers of residents who are racial minorities. All are groups considered at heightened risk for the coronavirus.
Richmond is partnering with the Commonwealth of Virginia to distribute tens of thousands of bags of personal protective equipment to help address the racial gaps.
Dr. Danny Avula, Richmond's public health director, said another goal is building trust with people who might be fearful of government officials after a long history of oppression.
"Our response to that was, OK, we've got to be on the ground more; we've got to engage in more face-to-face conversation, and we have to find credible voices and faces in those communities to be able to carry the message," Avula said.
Leaders and activists around the country are grappling with similar challenges as they try to reach the people at greatest risk.
In Massachusetts, officials are hiring local workers from community health centers to work as contact tracers who can, in many cases, literally speak the language of the people they're trying to reach.
Michael Curry, an official with the Massachusetts League of Community Health Centers and a member of the NAACP's national board of directors, said that's important at a time when many people are trying to navigate complicated and sometimes conflicting messages from health officials.
"It's all so confusing and it makes people very distrustful even more so distrustful of the system hence why you need to be very intentional about who communicates with them," Curry said.
In Mississippi, NAACP leaders say they've been distributing masks to people living in hot spots for the virus.
Dr. Oliver Brooks, president of the National Medical Association, a group representing Black physicians, said efforts like these are a good start.
"It's really important, because literally right now, people are dying, so you need to have an acute response," Brooks said.
But Brooks said preventing another crisis like this one will require substantial, systemic changes to improve access to food, housing, employment and health care for people of color.
"We have to address the social determinants of health. That is what is putting us at higher risk for poor outcomes," he said. "It's the same old story, but that's what needs to be done."
Angel Dandridge-Riddick, 34, has worked as a nurse and sometimes visits her mother in the public housing complex in Richmond called Creighton Court. On the day of the supply distribution, she said she appreciated the effort to provide protective equipment to people here, but cautioned that it's only a small start.
Creighton Court, a public housing complex in Richmond, is among the neighborhoods targeted for distribution of masks, hand sanitizer and leaflets with information about staying healthy during the coronavirus pandemic. Sarah McCammon/NPR hide caption
Creighton Court, a public housing complex in Richmond, is among the neighborhoods targeted for distribution of masks, hand sanitizer and leaflets with information about staying healthy during the coronavirus pandemic.
"What they're doing is great but to have one hand sanitizer and a few masks if you have three other people in their home that work in different areas, they're gonna need their own hand sanitizer. One bottle's probably gonna last you a week," Dandridge-Riddick said.
What's more, she said, it's hard for many of her neighbors to stay healthy during a pandemic, when they often lack basic health care.
"I'm just being honest. A lot of people out here in Creighton Court don't know anything about health care coverage; all they know is Medicaid," she said. "And if they can't get it, they don't have anything."
Richmond Mayor Levar Stoney said the problems that have compounded this pandemic for many people of color have been around for a long time, and without major structural changes, they will still be around when the pandemic is over. Stoney said he hopes this crisis gives way to long-term change.
"We can't go back to where we were pre-COVID-19; we've gotta go to a different place that ensures that each and every citizen of this country gets the best," Stoney said. "No matter what neighborhood they live, or the color of their skin."
The BDN is making the most crucial coverage of the coronavirus pandemic and its economic impact in Maine free for all readers. Click here for all coronavirus stories and here for the free collection. You can join others committed to safeguarding this vital public service by purchasing a subscription or donating directly to the newsroom.
Another 13 cases of the new coronavirus have been detected in Maine, health officials said Friday.
There have now been 3,499 cases across all of Maines counties since the outbreak began here in March, according to the Maine Center for Disease Control and Prevention. Thats up from 3,486 on Thursday.
Of those, 3,110 have been confirmed positive, while 389 are likely positive, according to the Maine CDC.
No new deaths were reported Friday, leaving the statewide death toll at 111. Nearly all deaths have been in Mainers over age 60.
So far, 366 Mainers have been hospitalized at some point with COVID-19, the illness caused by the coronavirus. Of those, 15 people are currently hospitalized, with seven in critical care and four on ventilators.
Meanwhile, 30 more people have recovered from the coronavirus, bringing total recoveries to 2,931. That means there are 457 active and likely cases in the state, down from 474 on Thursday.
Heres the latest on the coronavirus and its impact on Maine.
An inmate at the York County Jail has tested positive for the new coronavirus. The Portland Press Herald reports that the person was arrested Wednesday and tested after being admitted into the Alfred facility. The test came back positive on Thursday. Its the second positive coronavirus case to appear in Maines county jails since the start of the outbreak here in March. The other case was discovered in the Cumberland County Jail in Portland on June 29. Christopher Burns, BDN
This week Gov. Janet Mills issued an executive order to prevent the spread of the new coronavirus. The goal is to boost enforcement of a previous statewide order to wear face coverings in public when physical distancing is difficult. The order requires businesses to enforce the face covering mandate, but it applies only to certain businesses in certain counties and cities. Some Mainers who work in health care say the patchwork approach does not go far enough. Patty Wight, Maine Public
Maine has made strides in its ability to test people for the coronavirus since the pandemic first arrived here in March, but state health officials still see a need to keep expanding that capacity so that new outbreaks of the infection can be quickly detected and contained. Charles Eichacker, BDN
For some Mainers who found themselves stuck at home, cleaning out attics, closets and more was a good way to pass time this spring. However, the same pandemic that was keeping them at home had also led thrift shops and relief agencies to temporarily shut their doors and stop accepting donated items. If you are one of those who now has piles of clothing, furniture, toys, dishes or other household items ready to be donated, you arent alone. But you can do something about it now. Julia Bayly, BDN
As of Friday evening, the coronavirus has sickened 3,163,505 people in all 50 states, the District of Columbia, Puerto Rico, Guam, the Northern Mariana Islands and the U.S. Virgin Islands, as well as caused 133,885 deaths, according to Johns Hopkins University of Medicine.
Sporting Kansas City confirmed Friday that one of its players has tested positive for COVID-19. At least 22 players from four teams have tested positive since entering Major League Soccers quarantine bubble on June 27.
SKC was among the last teams to arrive in Orlando, checking into the league hotel on July 5. In accordance with MLS protocol, the player who tested positive has been moved to an isolation area of the hotel where he will remain in his room, and be monitored and tested daily.
SKC is scheduled to open group play in the 51-game MLS Is Back tournament Sunday against Minnesota United.
Two teams, FC Dallas (an original MLS club) and Nashville SC (an expansion franchise), withdrew from the tournament earlier this week after multiple players tested positive. Dallas had 11 players and at least two staff members test positive. Nashville had nine players test positive.
More results will be coming since about half the teams in the MLS quarantine bubble arrived less than a week ago, meaning they are still within the incubation period for COVID-19.
Only around days five to seven does a test have a reasonable chance of identifying someone as infected, said Dr. Anne W. Rimoin, a professor of epidemiology at UCLA and director of the schools Center for Global and Immigrant Health.
As we have seen with the current sports experiment, keeping this virus at bay even with elaborate planning can be difficult. It hinges on perfect behavior and testing, both of which are hard to achieve.
The tests that are currently available are imperfect and do not guarantee that someone who tests negative is actually negative. They are designed to identify people who are acutely infected and are less accurate at identifying asymptomatic individuals or people who have a very low level of virus at the earliest stages of infection.
In fact, the probability of testing negative in the first few days of infection are extremely high.
LAFC and the Galaxy, who arrived in Florida on Monday, have not reported a positive test. Both teams open play July 13, the Galaxy against the Portland Timbers and LAFC with the Houston Dynamo.
Gov. Jared Polis said Coloradans need to be better about limiting their exposure to other people as he announced Thursday that the incidence of coronavirus is growing in the state.
The latest from the coronavirus outbreak in Colorado:
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Polis said there has been an increase in cases over 11 of the past 14 days in Colorado. The states R naught number, the rate of the virus spread, is now more than one, meaning that each infected person is, on average, spreading the disease to more than one other person.
The bottom line: The number of people with COVID-19 in Colorado is growing, Polis said.
We need to be more responsible, Polis said at a news conference at the governors mansion in Denver. We need to wear masks more. We need to avoid gatherings more.
He added: We need to make changes in the way we live.
Polis said this will be the summer of no parties as he encouraged people younger Coloradans, in particular to gather only in small groups or not at all. At most, he said, people should be gathering with three or four others.
MORE: Colorado counties plead for compliance as coronavirus cases rise among younger people across the state
The statereported 452 cases between Tuesday and Wednesdayand the percentage of people tested who test positive for the virus reached its highest level 5.1% since June 1 on Tuesday.
Coronavirus hospitalizations, at 202 on Thursday, are at their highest level since June 7.
We are losing right now in Colorado, Polis said. Were not losing as bad as our country. Were not losing as bad as hotspots in Arizona and Texas.
The governor said, however, that between 50,000 and 100,000 Texans and Arizonans visited Colorado last weekend for the July 4 holiday.
Polis warned that if the trend of increasing cases continues, restrictions on Coloradans movement could be put back in place.
Hopefully we can reverse this trend here before it gets so bad that larger changes and actions are needed, he said.
As of Thursday the states R naught value was between 1.2 and 1.3, Polis said. Hed like to see that drop down to 0.9, which is where it was at the start of June as cases in Colorado were going down.
This is a small, mid-course correction, Polis said. People have to do a little better. We dont have to radically change how we live, we just have to go back to how we were in early June and hopefully well be OK.
Polis applauded the move by counties and cities across Colorado to implement mask requirements, but he once more stopped short of issuing a statewide mandate himself.
I dont think theres too many people sitting around saying: I wont wear a mask until theres a piece of paper,' he said, adding that he doesnt think the state could enforce such a requirement.
Polis made a similar argument against issuing a statewide stay-at-home order in late March before reversing course and locking Colorado down for more than a month.
A growing number of states, including Texas, which has resisted coronavirus restrictions, have implemented statewide mask-wearing rules.
Polis said he could not be more clear that people should be wearing a mask whenever they are in public and that it shouldnt take a mandate for Coloradans to cover their faces.
Wear a damn mask, he said emphatically.
MORE: Colorados governor thinks its stupid to not wear a mask. So why isnt he requiring you to do it?
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Polis decision not to mandate mask-wearing has clearly irked members of the medical community, as seen during a Thursday meeting of a medical advisory group to the Governors Expert Emergency Epidemic Response Committee.
The advisory group mostly made up of doctors and other health professionals had gathered online to discuss plans for how to fairly distribute emerging coronavirus medications and vaccines.
But, by the end of the meeting, the members had shifted to debating whether they should ask the full GEEERC to recommend a statewide mask mandate to Polis.
Most members of the group were adamantly in favor, decrying the tomfoolery one members word of people refusing to wear masks. But Dr. Matthew Wynia, the the director of the Center for Bioethics and Humanities at the University of Colorado Anschutz Medical Campus, offered a counterpoint. Though Wynia said he would ultimately be in favor of a mask mandate, he said there is research to suggest that mandates may not be as effective as strong, consistent encouragement.
When something is mandated, Wynia said, people may reflexively rebel and push for the mandate to end as soon as possible. When strongly encouraged but not forced to wear a mask, people may feel it is their choice to make the right decision.
The governors approach is not entirely irrational, Wynia said.
The advisory group adjourned without making a decision on a mandate recommendation, vowing to continue the discussion before taking it to the full GEEERC, which is made up of health leaders from across the state who provide guidance to Polis on how to respond to the epidemic.
Polis would not commit either way on a mask mandate and he sidestepped a question about whether a recommendation from GEERC would lead him to enact a statewide requirement.
I havent ruled anything out, he said.
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PITTSBURGH (KDKA) With increased demand for testing, the wait times for results are increasing, too.
After getting tested because of an exposure at work, Wayne Jackson was told it would take three to five days.
Weve had such an increase in the influx of people wanting to get tested, says Rick Rickman, CRNP, of the AHN Mobile Testing Unit. Its kind of overloaded the system.
At the Allegheny Health Network, results come back in three to five days.
Even though we are saying three to five days, we are getting them much quicker than that, says Rickman. We are calling the positives first. The negatives are getting sent back to the providers that ordered the test, and they are making the call.
At Lab Corp, it had been one to two days, but with the higher demand, its now four to six days.
At MedExpress, the demand has pushed results to seven to 10 days.
Quest has a one day turnaround for hospitalized and preoperative patients and healthcare workers with symptoms, and a three to five day average for everyone else.
St. Clair Hospital can do a one-hour in-house test for patients in the hospital, but also sends some out to the Mayo Clinic, with an average wait time of two days.
UPMC can get results in a matter of hours for sick inpatients or healthcare workers, but usually expects a 12 to 48 hour wait.
While people are waiting for results, they and other members of their household must isolate.
You want to confine yourself as much as possible to a specific room in the house, Rickman says, We separate ourselves, we wear masks. You dont want to go to the store. Youll also want to monitor your symptoms. If your symptoms start to progress, you want to call your physician immediately.
I cant go back to work until its done, says Jackson, But other than that, its good.
Demand has gone up so much, some places are only testing people with symptoms now, so people needing tests to go back to work after a vacation exposure might have a harder time.
"We know more now about how it makes people sick," said infectious disease expert Dr. William Schaffner, a professor of preventive medicine and infectious diseases at Vanderbilt University School of Medicine in Nashville.
Fever, cough and shortness of breath are still key signs that you might have Covid-19, but experts now know there are other red flags signaling infection. Some mimic a typical cold; others mirror the flu; and a few are just downright bizarre.
"We've learned about Covid toes, the loss of taste and smell," Schaffner said."We've learned that it can actually produce delirium we're not entirely sure how it affects the central nervous system yet, but it's clear that some of these people have delirium."
"We think the average incubation period is shorter," he said. "It's five to seven days now, and occasionally it can go longer."
If there are any symptoms at all. That's yet another thing science has learned: Many of us can be asymptomatic, or at least think we are, and spread the virus without knowing it.
In fact, Schaffner said, most studies are finding that a third or more of people who test positive are without symptoms or have very mild symptoms they may not even notice.
"You and I feel perfectly well, and we could be sitting opposite each other at a table having this discussion, but I can't prove to you that I don't have the virus. And you can't prove to me that you don't," Schaffner said.
"That's the whole rationale for mask wearing by everybody," he added. "And that's another thing we've learned masks really do offer protection for the wearer as well as others. That's important for people to understand, because a lot of people have said, 'Well, if I'm not sick, I don't need to wear this mask.' And that's unwise."
Unusual symptoms
If there was ever a disease that has figured out a way to tackle the body in weird and widespread ways, Covid-19 is it. It appears to be able to invade nearly every major organ. It clots blood, often in dangerous ways. It attacks our sense of smell, our eyes, even our skin.
Because new, rarer symptoms continue to pop up as more and more of us experience Covid-19, this is not an exhaustive list. Still, here are a few of the bizarre symptoms we might experience.
A new loss of taste or smell: The CDC recently added this unusual symptom to its list of top signs that you might have Covid-19. It can occur without any prior warning, not even a stuffy nose.
It appears to be more prevalent in mild or moderate cases of Covid-19, and tends to appear at the beginning of the illness. It may be even be one of the first signs that you are sick.
"Anosmia, in particular, has been seen in patients ultimately testing positive for the coronavirus with no other symptoms," according to the American Academy of Otolaryngology-Head and Neck Surgery.
Any respiratory virus, such as cold or flu, will temporarily impact smell and taste, and in rare cases, the loss can be permanent. So the loss of those senses are not a definitive diagnosis of Covid-19.
Still, "it's clearly something to look out for sometimes these early symptoms aren't the classic ones," Gupta said.
Covid toes and blood clots: At first glance, the swollen red or purple toes look like a case of frostbite. But it's just another example of the strange ways that Covid-19 primarily a respiratory disease affects the body.
What's really going on? The virus is creating tiny blood clots in the smallest blood vessels in the feet. And while colorful toes may not be a cause for alarm, experts say, the discovery that Covid-19 is clotting blood throughout the body is a dangerous development.
Doctors are finding blood clots of all sizes throughout the body, even in people who are young and healthy. Those clots are often lodging in the limbs of the body, where they can break away and clog the lungs, heart, kidneys and liver. There the clots cause inflammation, immune complications and even deadly or debilitating strokes and pulmonary embolisms, the medical name for blood clots in the lungs.
Signs of a potential clot in a limb include unusual tenderness or pain, a red or blue tinge to the area, warmth or itchiness or cramping in the lower calf or leg. The clot may have moved to lungs or heart if you have chest pain, dizziness, a bad cough or trouble breathing.
Pink eye: Early research from China, South Korea and other parts of the world found about 1% to 3% of people with Covid-19 also had conjunctivitis, commonly known as pink eye.
Conjunctivitis, a highly contagious condition when caused by a virus, is an inflammation of the thin, transparent layer of tissue, called conjunctiva, that covers the white part of the eye and the inside of the eyelid.
But SARS-CoV-2 is just one of many viruses that can cause conjunctivitis, so it came as no real surprise to scientists that this newly discovered virus would do the same.
Still, a pink or red eye could be one more sign that you should call your doctor if you also have other telltale symptoms of Covid-19, such as fever, cough or shortness of breath.
Sudden confusion, even delirium: The World Health Organization lists altered consciousness or confusion as a possible early symptom of Covid-19, in some cases presenting even before fever and cough. Delirium and hallucinations can appear, which can have long-term impact slowing recovery and increasing the risk for dementia, depression or post-traumatic stress.
Because signs of encephalopathy any damage or disease that affects the brain can lead to serious illness, the CDC says that any sudden confusion or an inability to wake up and be alert is a serious symptom.
10 typical symptoms
Some of the more well-known and commons signs of Covid-19 can be just as dangerous.
An inability to take a deep breath: Shortness of breath is not usually an early symptom of Covid-19, but it is the most serious. It can occur on its own, without a cough. If your chest becomes tight or you begin to feel as if you cannot breathe deeply enough to fill your lungs with air, that's a sign to immediately call your doctor or a local urgent care, experts say.
"If the shortness of breath is severe enough, you should call 911," said American Medical Association president Dr. Patrice Harris.
Get medical attention immediately, the CDC says, if you experience a "persistent pain or pressure in the chest," or have "bluish lips or face," a possible sign of a lack of oxygen.
A rising temperature: Fever is a key sign of Covid-19. But don't fixate on a number on the thermometer. Many people have a core body temperature that is above or below the typical 98.6 degrees Fahrenheit (37 degrees Celsius).
CNN anchor Chris Cuomo, who battled the virus in late March and early April from his home in New York, is one of those people.
Most children and adults, however, will not be considered feverish until their temperature reaches 100 degrees Fahrenheit (37.7 degrees Celsius).
"There are many misconceptions about fever," said Dr. John Williams, chief of the division of pediatric infectious diseases at the University of Pittsburgh Medical Center Children's Hospital of Pittsburgh.
"We all actually go up and down quite a bit during the day as much as half of a degree or a degree," Williams said, adding that for most people "99.0 degrees or 99.5 degrees Fahrenheit is not a fever."
Don't rely on a temperature taken in the morning, Schaffner advised, because temperature varies during the day. Instead, take your temperature in the late afternoon and early evening.
"One of the most common presentations of fever is that your temperature goes up in the late afternoon and early evening. It's a common way that viruses produce fever."
A debilitating cough: Coughing is another common symptom, but it's not just any cough, Schaffner said. The cough is bothersome, one that you feel deep in your chest.
"It's not a tickle in your throat. You're not just clearing your throat. It's not just irritated," Schaffner explained. "It's coming from your breastbone or sternum, and you can tell that your bronchial tubes are inflamed or irritated."
Chills and body aches: "The beast comes out at night," said Cuomo, referencing the chills, body aches and high fever that visited him on April 1.
"I was hallucinating. My dad was talking to me. I was seeing people from college, people I haven't seen in forever, it was freaky," Cuomo said.
Not everyone will have such a severe reaction, experts say. Some may have no chills or body aches at all. Others may experience milder flu-like chills, fatigue and achy joints and muscles.
Of course that makes it difficult to know if you have the flu or have been exposed to the novel coronavirus. One possible sign that you might have Covid-19 is if your symptoms don't improve after a week or so but actually worsen.
Just a few days into his quarantine, Cuomo was already drained by the fevers and body aches the disease brings.
Fatigue may continue long after the virus is gone. Anecdotal reports from people who have recovered from Covid-19 have said exhaustion and lack of energy continue well past the standard recovery period of a few weeks. Some continue to experience fatigue and other symptoms for months. As more cases of lengthy illness appear, these unlucky victims of the virus are now being described as "long-timers."
"In a study out of China where they looked at some of the earliest patients, some 200 patients, they found that digestive or stomach GI (gastrointestinal) symptoms were actually there in about half the patients," Gupta said on CNN's "New Day" news program.
Researchers have now found that SARS-CoV-2 can infect cells in the intestine and multiply there. That's likely because, like the lungs, the intestinal lining is loaded with ACE2 receptors, the sweet spot where the spokes of the SARS-CoV-2 virus attach and enter the body's cells.
Sore throat, headache and nasal congestion: The early WHO report also found nearly 14% of the almost 6,000 cases of Covid-19 in China had symptoms of headache and sore throat, while almost 5% had nasal congestion.
While cough, shortness of breath or difficulty breathing are key red flags of Covid-19, the council recommended headache and sore throat fall into a second tier of symptoms that may trigger doctors to consider testing for Covid-19.
That tier kicks in when patients present with two of the following clinical signs: Chills or shivers, fever, muscle pain, headache, sore throat or new loss of taste and smell. If there is no other more appropriate diagnosis, the guidelines say doctors should report those patients as potentially infected with Covid-19.
Who is most at risk?
Everyone every man, woman and child in the world is equally at risk of being infected with Covid-19. How the disease will then impact you or your loved one depends on many variables, including some that science does not yet understand.
Why do some people even the elderly have few or no obvious symptoms? Why do others despite being young and healthy quickly collapse, go into a cytokine storm and die? Why do a rare subset of children who have recovered from Covid-19 present weeks later with a deadly toxic shock-like illness called "pediatric multisystem inflammatory syndrome"?
No one yet knows.
Age appears to play a role most children and young adults appear to weather the virus more successfully, but not all. Older adults appear to be the most fragile, but that's likely due to their weaker immune systems and chronic conditions.
One thing is very clear: The highest risk of severe illness and death is for anyone with an underlying health condition. The list includes diabetes, chronic lung disease or asthma, cardiovascular disease, cancer (or are undergoing chemotherapy), organ transplants, sickle cell anemia, kidney disease with dialysis, poorly controlled HIV infection, any autoimmune disorder or a body mass index (BMI) over 30 (obese).
To put that in context: More than 40% of the American population have a BMI of over 30 and are considered obese, while an estimated 60% of American adults have at least one chronic medical condition, according to the CDC.
"Older patients and individuals who have underlying medical conditions or are immunocompromised should contact their physician early in the course of even mild illness," the CDC advises.
To be clear, you are at higher risk even if you are young if you have underlying health issues.
Pregnancy is also a risky time, science has discovered. Early in the pandemic, the CDC didn't think Covid-19 would raise the risk for either expecting mother, fetus or newborn.
How to be evaluated
Think you might have signs of the novel coronavirus? With the explosion of cases this summer across the United States, many hospitals are again bursting at the seams. Unless you are experiencing emergency signs of Covid-19, which include trouble breathing, persistent chest pain or pressure, new confusion, an inability to wake or stay awake or a bluish tinge to lips or face, you should call your health provider first. If you do have any alarming symptoms, call 911.
"If you have insurance and you're looking for a provider or someone to call or connect with, there's always a number on the back of your insurance card; or if you go online, there is information for patients," said the AMA's Harris.
"If you don't have insurance, you can start with the state health department or the local community health centers, those are officially known as federally qualified health centers," Harris advised, adding that some states have a 1-800 hotline number to call.
"If there is a testing and assessment center near you, you can go there directly," said Vanderbilt's Schaffner. "It's always good to notify them that you're coming. Otherwise, you need to call your healthcare provider and they will direct you what to do."
CNN's Jacqueline Howard and Maggie Fox contributed to this report.
The World Health Organization (WHO) said today that the global number of COVID-19 cases has more than doubled over the last 6 weeks, and there's a lot of work ahead.
Meanwhile, a WHO team is on its way to China to meet with researchers to plan a joint mission to probe the zoonotic source of the virus, and health officials are looking into a pneumonia surge in Kazakhstan. The global COVID-19 total today grew to 12,376,147 cases, and 556,895 people have died from their infections, according to the Johns Hopkins online dashboard.
At a WHO media briefing today, Director-General Tedros Adhanom Ghebreyesus, PhD, said the pandemic is testing people across all walks of life to their limits. "For those in poverty, with little or no access to quality health services, it's not only COVID-19 that threatens lives and livelihoods," he said, adding that other diseases like measles, polio, and malaria thrive when immunization is paused and drug supply chains are interrupted.
Some countries are experiencing exponential growth in COVID-19 cases, while others are starting to see cases rise after loosening their restrictions, Tedros said, but the underlying message is that aggressive action with national unity and global solidarity can turn the pandemic around. "We need leadership, community participation, and collective solidarity."
Tedros said there are many examples of countries turning their outbreaks around, even when activity was very intense. Alongside Italy, Spain, and South Korea, he highlighted Dharavi, a densely packed part of Mumbai. "A strong focus on community engagement and the basics of testing, tracing, isolating and treating all those that are sick is key to breaking the chains of transmission and suppressing the virus."
In another development, Tedros said two WHO experts are en route to China to learn about progress in investigating the zoonotic source and how the virus jumped to humans. He also said the experts and Chinese scientists will lay the groundwork for a WHO-led mission into the outbreak's origin.
The mission is part of a multipart resolution passed by WHO member countries in May at the World Health Assembly.
Meanwhile, Mike Ryan, MD, head of the WHO's health emergencies program, said the WHO is aware of reports based on Chinese embassy social media posts about a surge of pneumonia in Kazakhstan that is deadlier than COVID-19. He said the country has reported a big spike in lab-confirmed COVID-19 cases, more than 10,000 over the past 7 days.
Kazakhstan's government has dismissed the Chinese report as being incorrect, Reuters reported.
Ryan said atypical pneumonia cases can arise anywhere in the world, and though WHO officials are keeping an open mind, most cases are believed to be COVID-19.
He said one possibility is incorrectly diagnosed cases and that the WHO will review patient lung x-rays and illness patterns to see if they are consistent with the pandemic virus.
Kazakhstan recently reimposed restrictions for 2 weeks following a surge in cases, and COVID-19 activity has also picked up again in some other countries in central Asia.
In a separate WHO development today, the group announced the launch of the Access Initiative for Quitting Tobacco, which has a goal of helping tobacco users quit during the pandemic. Smokers are more vulnerable to severe COVID-19 illness than their nonsmoking peers.
The initiative includes resources to quit tobacco, including 40,000 nicotine patches donated by Johnson & Johnson and a digital health worker named Florence who helps people form a personalized quit plan and dispels myths surrounding COVID-19 and tobacco.
Cases in Hong Kong have significantly increased in the past week, and today officials reported 38 more cases, all but 6 thought to reflect local transmission. In a related development, education officials citing an exponential growth in COVID-19 cases over the past 2 days announced the closure of schools, which had reopened in May.
On Twitter today, Ben Cowling, PhD, professor in the School of Public Health at the University of Hong Kong, said there are worrying signs that a second wave of activity is under way in Hong Kong. His group estimates that the reproductive number is close to 3which means each patient will infect three othersa number he said is concerning. "It will take a lot of effort to bring down such a high reproductive number."
He added that clusters have been reported in a nursing home, public housing, and restaurants, despite a test-and-trace strategy and universal mask use, similar to the first wave.
Measures such as telecommuting, closing bars and other public spaces, and enhancing social distancing in restaurants were needed to control the first wave and may be needed to stop the second wave, Cowling said.
Though it's not clear how the new wave started, the absence of cases for about 3 months hints at more recent introductions, he said, adding that the uptick in cases underscores the importance of effective testing and quarantine of people entering Hong Kong.
