WASHINGTON Dr. Anthony Fauci, the nation's top infectious disease expert, warned lawmakers the United States is headed in the "wrong direction" with COVID-19 and could soon reach 100,000 new cases per day if the country does not get a handle on the pandemic.
Speaking before the Senate Health, Education, Labor and Pensions Committee on Tuesday, Fauci encouraged Americans to social distance, wear masks and follow the gradual re-opening guidelines that federal health officials released.
"We're going in the wrong direction if you look at the curves of new cases," said Fauci, who is director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health. "We need to do something about that, and we need to do it very quickly."
Across the country, the United States is now logging 40,000 new cases of COVID-19 per day, surpassing previous records.
"I would not be surprised if they go up to 100,000 a day if this does not turn around and so I am very concerned," Fauci told lawmakers.
Minnesota had 444 new confirmed cases Monday, according to the June 30 update from the state Department of Health, for a total of 36,303 positive cases.
Other states have seen a bigger surge: Texas, Arizona, Florida and California are the new hotspots, leading the nation in new COVID-19 cases and hospitalizations.
Fauci declined to estimate potential COVID-19 deaths but said the situation "could get very bad."
"It is going to be very disturbing, I will guarantee you that, because when you have an outbreak in one part of the country, even though in other parts of the country they're doing well, they are vulnerable," Fauci said.
Some states have paused some parts of their re-opening. Fauci, who wore a red cloth Washington Nationals mask that he removed to answer questions, recommended people avoid crowds and wear masks.
"If you look at what's going on and just look at some of the film clips that you've seen of people congregating, often without masks, of being in crowds and jumping over and avoiding and not paying attention to the guidelines that we very carefully put out, we're going to continue to be in a lot of trouble, and there's going to be a lot of hurt if that does not stop," Fauci said.
Dr. Robert Redfield, the director of the Centers for Disease Control and Prevention, also joined in the plea for Americans to wear face-coverings, saying he hopes young people, in particular, can be more careful about transmission of the disease.
"We are not defenseless against this disease. We have powerful tools: social distancing, wearing a face-covering when you are in public and being disciplined about frequent hand-washing," Redfield told lawmakers. "It is critical that we all take the personal responsibility to slow the transmission of COVID-19 and embrace the universal use of face-coverings."
President Donald Trump has been critical of masks, making fun of them on his Twitter feed and refusing to wear one in public. But Republicans have started to come out more vocally in favor of face masks.
Republican Sen. Lamar Alexander of Tennessee even opened the hearing with a plea for Trump to occasionally wear a mask, even if it is not necessary for him to do so.
"Unfortunately this simple lifesaving practice has become part of a political debate that says: If you're for Trump, you don't wear a mask. If you're against Trump, you do," Alexander said. "The president has millions of admirers. They would follow his lead. It would help end this political debate. The stakes are too high for it to continue."
Last month, Alexander was exposed to a staffer who tested positive for the virus but he never became ill. He credits the mask the staffer wore for protecting him.
Fauci told lawmakers he hopes a vaccine for COVID-19 may be available as soon as early 2021 while cautioning them that there is still a long path in the scientific process to make sure the vaccine works and is safe for all people.
"There is no guarantee that we will have a safe and effective vaccine but we are cautiously optimistic that we will at least know the extent of the efficacy sometime in the winter and early part of next year," Fauci said. "Hopefully doses will be available by the beginning of next year."
Other scientists and researchers have also expressed confidence in the development of a vaccine due to both the structure of the virus and the number of scientists and pharmaceutical companies working on the effort.
"These are the things we feel aspirationally hopeful about, and we will continue to pursue this," Fauci said of the vaccine development.
Minnesota Democrat Tina Smith asked if political pressure would be brought to bear on federal agencies to announce a new vaccine in advance of the presidential election, even if the science is not actually ready.
"What I am worried about is that there is some sort of October surprise, and that there is pressure put on the decision makers here to announce the vaccine in October of 2020," Smith said.
Dr Stephen Hahn, the head of the Food and Drug Administration, said his agency would follow the science.
"I want the American people to hear me when I say we will use the science and data from the trials and we will ensure that our high levels of standards for safety and efficacy are met," Hahn said.
The FDA released new guidance on Tuesday for approval of a COVID-19 vaccine. The guidance requires a vaccine be at least 50 percent more effective than a placebo in preventing the disease. The agency also said it would not approve a vaccine unless the developers have "clearly demonstrated" proof of its safety and efficacy through a clinical trial.
Smith also grilled federal officials on whether a vaccine developer could be released from liability to fast-track approval of the vaccine and how Americans can trust the safety of the vaccine if it is developed in a relatively short time frame.
Hahn said the FDA would not release drug-makers from liability for the vaccines. And Fauci said the large clinical trials of 30,000 or more people should help build confidence in the vaccine's safety.
The Minnesota Reformer is an independent, nonprofit news organization dedicated to keeping Minnesotans informed and unearthing stories other outlets can't or won't tell..
Most of us wont need Covid-19 vaccine: Oxford expert explains how the pandemic is likely to end - india news - Hindustan Times "; forYoudata += ""; forYoudata += ""; forYoudata += ""; count++; if (i === 7) { return false; } }); forYouApiResponse=forYoudata; $(forutxt).html('Recommended for you'); $(foruContent).html(forYoudata); } } }); } else if(forYouApiResponse!=''){ $(forutxt).html('Recommended for you'); $(foruContent).html(forYouApiResponse); } } function getUserData(){ $.ajax({ url:"https://www.hindustantimes.com/newsletter/get-active-subscription?usertoken="+user_token, type:"GET", dataType:"json", success: function(res){ if(res.length>0) { $("[id^=loggedin]").each(function(){ $(this).hide(); }); } } }); } function postUserData(payLoad, elm){ var msgelm=$(elm).parents(".subscribe-update").nextAll("#thankumsg"); $.ajax({ url:"https://www.hindustantimes.com/newsletter/subscribe", type:"POST", data:payLoad, contentType: "application/json", dataType: "json", success: function(res){ if(res.success===true){ $(msgelm).show(); 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A stretch of DNA linked to Covid-19 was passed down from Neanderthals 60,000 years ago, according to a new study.
Scientists dont yet know why this particular segment increases the risk of severe illness from the coronavirus. But the new findings, which were posted online on Friday and have not yet been published in a scientific journal, show how some clues to modern health stem from ancient history.
This interbreeding effect that happened 60,000 years ago is still having an impact today, said Joshua Akey, a geneticist at Princeton University who was not involved in the new study.
This piece of the genome, which spans six genes on Chromosome 3, has had a puzzling journey through human history, the study found. The variant is now common in Bangladesh, where 63 percent of people carry at least one copy. Across all of South Asia, almost one-third of people have inherited the segment.
Elsewhere, however, the segment is far less common. Only 8 percent of Europeans carry it, and just 4 percent have it in East Asia. It is almost completely absent in Africa.
Its not clear what evolutionary pattern produced this distribution over the past 60,000 years. Thats the $10,000 question, said Hugo Zeberg, a geneticist at the Karolinska Institute in Sweden who was one of the authors of the new study.
One possibility is that the Neanderthal version is harmful and has been getting rarer over all. Its also possible that the segment improved peoples health in South Asia, perhaps providing a strong immune response to viruses in the region.
One should stress that at this point this is pure speculation, said Dr. Zebergs co-author, Svante Paabo, the director of the Max Planck Institute for Evolutionary Anthropology in Leipzig, Germany.
Researchers are only beginning to understand why Covid-19 is more dangerous for some people than others. Older people are more likely to become severely ill than younger ones. Men are at more risk than women.
Social inequality matters, too. In the United States, Black people are far more likely than white people to become severely ill from the coronavirus, for example, most likely due in part to the countrys history of systemic racism. It has left Black people with a high rate of chronic diseases such as diabetes, as well as living conditions and jobs that may increase exposure to the virus.
Genes play a role as well. Last month, researchers compared people in Italy and Spain who became very sick with Covid-19 to those who had only mild infections. They found two places in the genome associated with a greater risk. One is on Chromosome 9 and includes ABO, a gene that determines blood type. The other is the Neanderthal segment on Chromosome 3.
But these genetic findings are being rapidly updated as more people infected with the coronavirus are studied. Just last week, an international group of scientists called the Covid-19 Host Genetics Initiative released a new set of data downplaying the risk of blood type. The jury is still out on ABO, said Mark Daly, a geneticist at Harvard Medical School who is a member of the initiative.
The new data showed an even stronger link between the disease and the Chromosome 3 segment. People who carry two copies of the variant are three times more likely to suffer from severe illness than people who do not.
After the new batch of data came out on Monday, Dr. Zeberg decided to find out if the Chromosome 3 segment was passed down from Neanderthals.
About 60,000 years ago, some ancestors of modern humans expanded out of Africa and swept across Europe, Asia and Australia. These people encountered Neanderthals and interbred. Once Neanderthal DNA entered our gene pool, it spread down through the generations, long after Neanderthals became extinct.
Most Neanderthal genes turned out to be harmful to modern humans. They may have been a burden on peoples health or made it harder to have children. As a result, Neanderthal genes became rarer, and many disappeared from our gene pool.
But some genes appear to have provided an evolutionary edge and have become quite common. In May, Dr. Zeberg, Dr. Paabo and Dr. Janet Kelso, also of the Max Planck Institute, discovered that one-third of European women have a Neanderthal hormone receptor. It is associated with increased fertility and fewer miscarriages.
Dr. Zeberg knew that other Neanderthal genes that are common today even help us fight viruses. When modern humans expanded into Asia and Europe, they may have encountered new viruses against which Neanderthals had already evolved defenses. We have held onto those genes ever since.
Dr. Zeberg looked at Chromosome 3 in an online database of Neanderthal genomes. He found that the version that raises peoples risk of severe Covid-19 is the same version found in a Neanderthal who lived in Croatia 50,000 years ago. I texted Svante immediately, Dr. Zeberg said in an interview, referring to Dr. Paabo.
Dr. Paabo was on vacation in a cottage in the remote Swedish countryside. Dr. Zeberg showed up the next day, and they worked day and night until they posted the study online on Friday.
Its the most crazy vacation Ive ever had in this cottage, Dr. Paabo said.
Tony Capra, a geneticist at Vanderbilt University who was not involved in the study, thought it was plausible that the Neanderthal chunk of DNA originally provided a benefit perhaps even against other viruses. But that was 40,000 years ago, and here we are now, he said.
Its possible that an immune response that worked against ancient viruses has ended up overreacting against the new coronavirus. People who develop severe cases of Covid-19 typically do so because their immune systems launch uncontrolled attacks that end up scarring their lungs and causing inflammation.
Dr. Paabo said the DNA segment may account in part for why people of Bangladeshi descent are dying at a high rate of Covid-19 in the United Kingdom.
Its an open question whether this Neanderthal segment continues to keep a strong link to Covid-19 as Dr. Zeberg and other researchers study more patients. And it may take discoveries of the segment in ancient fossils of modern humans to understand why it became so common in some places but not others.
But Dr. Zeberg said that the 60,000-year journey of this chunk of DNA in our species might help explain why its so dangerous today.
Its evolutionary history may give us some clues, Dr. Zeberg said.
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Recent protests in Philadelphia and across the country have drawn young people. But for most of the pandemic, youth have been quarantined and away from their social circles, which could make depression and other mental illness worse. Cory Clark/NurPhoto via Getty Images hide caption
Recent protests in Philadelphia and across the country have drawn young people. But for most of the pandemic, youth have been quarantined and away from their social circles, which could make depression and other mental illness worse.
Audrey just turned 18 and relishes crossing into adulthood: She voted for the first time this year, graduated high school and is college-bound next month. The honors student typically wakes up "a bundle of nerves," she says, which had fueled her work volunteering, playing varsity sports and leading student government.
But for years, she also struggled with anxiety, depression and obsessive compulsive disorder all of which drove her to work harder.
"I was spending so much time on my homework, I felt like I was losing my friends so my thoughts would race over and over again about my friends," says Audrey. "And then I would have the difficult thoughts about suicide and some scarier stuff." (NPR agreed to use only her first name to protect her medical privacy.)
Audrey's psychological struggles landed her in mental health treatment last fall. There, she says, the coping skills she learned gave her perspective on quarantine: "I know all about how seeing friends and seeing people outside and social interaction is vital for survival."
There is a simmering tension between young people's desire to gather socially, and the growing threat from the coronavirus in the United States. The virus is now infecting more people in their teens and 20s than it had earlier in the pandemic, and that's contributing to outbreaks, especially in states in the South and West. As a result, public health officials are imploring young adults to limit social contact and take precautions to help protect their more vulnerable elders. But many young people see continued social isolation as a much greater risk than COVID-19 to their own mental health.
It's not that Audrey isn't worried about the pandemic; in fact, confirmed cases of the coronavirus are spiking in her hometown of Charlotte, N.C. So Audrey wears masks, washes her hands and stays 6 feet from friends. But for her generation, she says, infection isn't the primary threat.
"A lot of people are calling attention to coronavirus because it's right in front of us," she says. "But at the same time, teens' depression rate it's a silent threat."
The health risks of infection differ by generation. For many young adults, life lived at a social distance, with a lack of peer support, comes at a high cost to mental health. The Centers for Disease Control and Prevention says nearly half of people between 18 and 29 report feeling symptoms of anxiety or depression. That's significantly higher that the rate for both their parents and their grandparents. Suicide is the second leading cause of death for people under 35.
Yet somehow, says Audrey, that's not talked about as much.
"We haven't seen the government or adults as passionate about the things we really care about, like mental health and climate issues," she says.
It might be tempting to think that FaceTime and Zoom provide substitutes for in-person social outlets, especially for a generation of digital natives who grew up with smartphones. But, therapists say, talking by small screen offers no replacement for a calming hug and can miss the subtleties of a compassionate expression.
Audrey's complaint is a common refrain among the adolescent and young adult patients whom psychologist Lisa Jacobs counsels. It is not that they aren't concerned about the risks of COVID-19, she says; it's just that their risk calculations differ.
"They are appropriately realizing that isolation is a risk for them as well it's a risk factor for depression, and depression is a risk factor for suicide," Jacobs says. "And 8% of American teens attempt suicide each year."
Jacobs says many of her young patients complain older generations failed to address the young people's fears of school shootings and climate change, for example.
"After not being protected, after not being taken seriously, they were asked to take extreme measures to protect other groups and to put themselves at risk by doing so," Jacobs says.
There is a biological basis for young people's need for socialization. Scientists say bonding isn't a luxury; it's critical for development.
Young brains need social connection to feel secure about their identity and place in the world, says Gregory Lewis, who studies the neurobiology of social interaction at Indiana University.
"We expect as a human being to have other people there to share the stressful times and to be our backup, and when they're not there physically, that in of itself tells our nervous system 'you're in a dangerous environment because you don't have these people here,' " he says.
That is less of an issue among older adults, Lewis says, who have had more time to develop their social networks both at work and around their community and more time to find partners who can help ground them emotionally. By contrast, he says, "younger people are missing a larger percentage of what previously was there to buffer them."
So the societal challenge, he says, is to find ways to help community members of all ages balance the risks of infection against the need to foster those essential social bonds.
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As Alaskans commemorated Independence Day, the state reported another death associated with COVID-19 and 55 more cases among residents and nonresidents.
The 16th reported death of an Alaskan with COVID-19 involved an Anchorage man in his 70s with underlying health conditions, Alaska Department of Health and Social Services spokesman Clinton Bennett said Saturday. The man died in Alaska, though Bennett was not immediately able to clarify when his death occurred.
The state on Friday reported a 15th resident death involving an Anchorage man in his 80s who died in early June. In that case, the virus was listed as a contributing cause of death, the state health department said in a statement.
We are thinking of the loved ones of the person who died, the states chief medical officer, Dr. Anne Zink, said in statement Friday. We are concerned about Alaskas sharp rise in cases and hope everyone takes this as a warning call to limit contacts this weekend, stay six feet apart from non-household members, wear a face mask and wash your hands often.
If you are sick, even with mild COVID-19 symptoms, please isolate yourself and seek testing. We need all Alaskans working together to break infection chains.
Forty-eight residents and seven non-Alaskans newly tested positive for the illness caused by the coronavirus as of Saturday, according to the state health departments COVID-19 dashboard. Since the start of the pandemic, 1,111 Alaskans and 230 nonresidents have tested positive. Of those, 551 resident cases and 174 nonresident cases are active, meaning they are not considered to be recovered from COVID-19.
The new cases reported Saturday continue a surge in daily case counts and active cases since the state lifted most pandemic-related restrictions on businesses and social gatherings in late May. State officials have said they expect coronavirus case numbers to rise as people mix together, but they believed the state had the health care capacity and supply of personal protective equipment to manage an increase in cases.
The influx of new cases has strained the states ability to swiftly conduct contact tracing, however, with new cases now involving dozens or hundreds of contacts as opposed to just a few contacts per case, which was more often the situation earlier in the pandemic. In the states largest city, health officials this week said Anchorage had reached its maximum capacity to conduct contact tracing.
Investigating recent cases and tracking their contacts is a key component in helping limit the spread of the virus.
Three more Alaskans confirmed to be infected with the virus required hospitalization, bringing that total to 72 since the coronavirus was first detected in the state. There were 23 people with suspected or confirmed cases of the illness currently in the hospital, according to state data Saturday, which is down two from the previous day.
Fourth of July celebrations were canceled across the state, prompting Alaskans to celebrate on a smaller scale this weekend and organize their own festivities. Ahead of the holiday, state officials including Gov. Mike Dunleavy urged Alaskans to wear face coverings and maintain a physical distance of 6 feet from other people to avoid spreading the coronavirus.
Southcentral Alaska saw the bulk of new cases reported by the state Saturday. The new cases involve 32 residents of Anchorage, where the city health department confirmed COVID-19 exposure at more than a dozen establishments on specific dates in June. Health officials urged anyone who visited those businesses mostly bars at the specified times to monitor themselves for COVID-19 symptoms and get tested.
Elsewhere in Southcentral, four residents of Wasilla, one in Palmer, two in Willow and one in Soldotna also were confirmed to have COVID-19, according to state data.
The state reported no new cases out of Seward among test results returned Friday, but the city said four new cases emerged there Saturday. (The state reports new virus cases daily based on test results returned the previous day, and the new Seward cases will likely be included in the states count Sunday.) Officials in Seward this week limited gathering sizes, required masks in indoor public spaces and restricted capacity at businesses in an effort to contain an outbreak involving a couple dozen people.
The state on Saturday also reported four cases among residents of Fairbanks, one in Petersburg and one each in smaller communities in the Yukon-Koyukuk Census Area, Bethel Census Area and Bristol Bay plus Lake and Peninsula boroughs. The state doesnt report the name of communities smaller than 1,000 people as a means of privacy protection.
The Bristol Bay Area Health Corp. said in a statement that a Bristol Bay-area resident who developed symptoms of COVID-19 after traveling to Anchorage tested positive Friday. That person is self-isolating and several close contacts of theirs were instructed to remain in strict quarantine, the health corporation said, adding that the City of Dillingham and the affected village have also been notified of this new index case.
New nonresident cases include a seafood industry worker and another person in Anchorage, two seafood industry workers in Valdez, two people in Fairbanks and one individual in Juneau. The vast majority of nonresident cases confirmed in the state involve workers in Alaskas seafood industry, whose employees from out of state are generally required to undergo COVID-19 testing or quarantine before being allowed to work here.
On Friday 2,524 tests were run, out of 122,732 tests processed since the start of the pandemic, according to state data. Testing data reflects individual tests that were run, and not necessarily the number of individuals who have been tested.
Alaska health officials continue to urge Alaskans to maintain a distance of 6 feet from non-household members; frequently wash their hands; wear a mask in places where physical distancing is difficult to maintain; wipe down and sanitize frequently touched surfaces; stay home if they feel sick; and get a COVID-19 test if theyre experiencing symptoms of the illness.
Anchorage Daily News reporter Morgan Krakow contributed.
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TheWest Virginia Department of Health and Human Resources (DHHR)reports as of 10:00 a.m., on July 3, 2020, there have been 179,995 totalconfirmatory laboratory results receivedfor COVID-19, with 3,077 total cases and 93 deaths.
In alignment with updated definitions fromthe Centers for Disease Control and Prevention, the dashboard includes probablecases which are individuals that have symptoms and either serologic (antibody)or epidemiologic (e.g., a link to a confirmed case) evidence of disease, but noconfirmatory test.
CASES PER COUNTY (Case confirmed by lab test/Probable case):Barbour(15/0), Berkeley (444/18), Boone (20/0), Braxton (3/0), Brooke (8/1), Cabell(139/6), Calhoun (2/0), Clay (10/0), Fayette (67/0), Gilmer (13/0), Grant(15/1), Greenbrier (60/0), Hampshire (42/0), Hancock (21/3), Hardy (44/1),Harrison (66/0), Jackson (143/0), Jefferson (230/5), Kanawha (323/9), Lewis(19/1), Lincoln (8/0), Logan (26/0), Marion (61/3), Marshall (40/1), Mason (19/0),McDowell (6/0), Mercer (46/0), Mineral (55/2), Mingo (19/3), Monongalia(181/14), Monroe (13/1), Morgan (19/1), Nicholas (12/1), Ohio (100/1),Pendleton (12/1), Pleasants (4/1), Pocahontas (28/1), Preston (68/15), Putnam(59/1), Raleigh (54/1), Randolph (161/1), Ritchie (2/0), Roane (11/0), Summers(2/0), Taylor (16/1), Tucker (6/0), Tyler (4/0), Upshur (20/1), Wayne (114/1),Wetzel (10/0), Wirt (4/0), Wood (102/8), Wyoming (7/0).
As case surveillance continues at thelocal health department level, it may reveal that those tested in a certaincounty may not be a resident of that county, or even the state as an individualin question may have crossed the state border to be tested.Such is the case of Kanawha County in this report.
Please visit thedashboard at www.coronavirus.wv.gov for more information.
Noting the mild winter on the East Coast, Sapi says, "We do have a bad year for the ticks."
Hikers, campers and anyone else eager for an escape could "just explode into the outdoors. And there may not be the same thoughtful approach" to preventing exposure, explains Dr. Sorana Segal-Maurer, director of the Dr. James J. Rahal, Jr. Division of Infectious Diseases at NewYork-Presbyterian Queens health care system.
"I'm a little nervous that their guard may be down just a slight bit," she adds.
Outdoor crowds were so big around Memorial Day weekend, that parks from southern California to North Carolina had to close early after hitting capacity.
Last year, the Centers for Disease Control and Prevention announced a rise in Lyme and other tick-borne diseases, with seven additional germs identified in the US in the last two decades, while the "lone star tick" expanded its footprint beyond the southeast to northern states and the Midwest.
But ignoring basic steps that reduce the risk of tick and vector-borne illnesses to focus solely on Covid-19 prevention is just one danger. Another is the possibility of confusing the symptoms if you start feeling sick.
Lyme disease and Covid-19: a tale of similar symptoms
Warning signs for tick-borne illnesses are "very similar to the severity that we've seen with Covid-19, which is that fever, the muscle aches, the headaches, the severe fatigue," says Dr. Segal-Maurer.
She believes a unique difference is that breathing problems are common in coronavirus patients, but not with those infected by tick diseases. Yet even that distinction is up for debate.
"Pulmonary involvement, even to a fatal degree, has been documented in a range of tick-borne infections," Dr. Steven Phillips of the Bay Area Lyme Foundation tells CNN. "Although serious pulmonary involvement with vector-borne infections is relatively uncommon, non-specific pulmonary complaints, such as shortness of breath, are extremely common."
Even if you follow the Covid-19 tips, heeding the advice to avoid bites is just as important. Dr. Segal-Maurer describes a "realistic" scenario if you're on a crammed hiking trail: "You're all going to be pushing into the vegetation ... you're going to be just a little bit off the path."
Ticks "hang off the very tip of the blade of grass or the leaf or the vegetation, and they have these little feelers that they ... sort of shake out there. So, the second you brush by, they latch on."
Last month, Pennsylvania Secretary of Health Dr. Rachel Levine announced an increase in emergency room visits over the past several months "related" to tick bites. "Some symptoms of Lyme disease, such as fever, chills and headache, are similar to symptoms of COVID-19," Dr. Levine said in a statement, reiterating what other experts say.
Head outside -- but responsibly
Dr. Segal-Maurer says health care professionals always need to ask patients about their travel and other activities. "You have to cover all your bases... we don't want to be Covid-blinded."
Patients, in turn, should also be asking about both possibilities.
And when it comes to guarding yourself from ticks, she says, "You need to use DEET. It's gotta be 30%. You need to watch where you hike. And then you need to do a body check when you get back inside."
Dr. Phillips prefers Permethrin, which he says is stronger, but "can only be sprayed on clothes, not skin, and should be allowed to dry overnight before wearing."
Other tips include putting on hats, light-colored clothing to make ticks easier to spot, placing socks over your pants and choosing long-sleeved shirts to block ticks from getting near your skin.
That, of course, is in addition to wearing a mask to fight coronavirus spread.
Yet even with the extra hassle for a safer summer getaway, Dr. Segal-Mauer encourages people to head outside this summer because she believes "it's been such a traumatic several months. I think the great outdoors is a very healing place."
Since then, similar scenes have played out across Latin America, which has seen an explosive spread of the coronavirus. In Guayaquil, Ecuador's largest city, coffins were fashioned from cardboard boxes as bodies were left uncollected. In the Chilean capital Santiago, public hospitals were overwhelmed as lockdown was eased too soon.
The head of the Pan American Health Organization (PAHO), Dr. Carissa Etienne, said this week: "The region of the America is clearly the current epicenter of the Covid-19 pandemic."
There are many reasons for Covid-19's outsize impact on Latin America: high levels of inequality, the vast "gray" economy of informal workers, a lack of sanitation in crowded urban slums, as well as slow and uneven responses by governments.
Alejandro Gaviria, a former Colombian health minister, told CNN: "Latin America is very heterogeneous. In some cities, health infrastructure is similar to what you find in developed countries; in rural areas, infrastructure is poor in general. It is like having Europe and Africa in the same continent."
Latin American states have had dramatically different experiences with Covid-19. Uruguay, which has a well-funded public health system, embarked on an aggressive tracking and testing program when the pandemic arrived. Despite a change of government in the middle of the crisis, it has had a consistent policy on lockdown. Nearly 20% of the population downloaded a government app with guidance on the virus.
Paraguay, which is much poorer than Uruguay, appears to have benefited from an early lockdown. It also enforced quarantine measures for people entering the country from Brazil, the epicenter of infections in Latin America.
Crowded living conditions in poorer urban areas, where basic hygiene and social distancing are next to impossible, threaten the region with a growing tide of infections. As Dr. Marcos Espinal, chief of the Department of Communicable Diseases and Health Analysis at PAHO, told CNN: "In the barrios of Lima it's going to be very difficult to do social distancing."
Espinal noted that in some countries only a third of the population have a fridge, meaning people must shop daily.
Low Investment
Gaviria says there are many differences between countries, "but most people have access to some type of care. In Colombia, for example, coverage is close to 100%."
Quality is a different issue, though, he says -- a point echoed by Espinal at PAHO. All but five or six governments fall well short of the WHO target of spending 6% of GDP on health, he says. Peru, for example, spends 3.3%.
Some Amazon towns in Brazil are more than 500 kilometers from the nearest ICU bed. In 2016, there were fewer than three beds per 100,000 inhabitants in some northern states in Brazil, but more than 20 beds per 100,000 in the wealthier south-east. The PAHO has warned that the region won't overcome the virus unless it improves care for marginalized communities, such as indigenous peoples in the Amazon. CNN reported a surge of infections this week among the Xavante people in the north-east of the Brazilian state of Mato Grosso.
Coronavirus is just one of multiple health crises in Latin America. Studies shown that poorer people in the region have higher levels of diabetes, obesity, hypertension and heart disease, all of which make them more vulnerable to Covid-19. This is especially problematic in Mexico and Brazil.
Fabiana Ribeiro, a Brazilian researcher currently at the University of Luxembourg, told CNN that a recent study showed the lowest survival rates were for rural patients of 68 and older, and for patients who were Black, illiterate or had previous conditions such as heart disease and diabetes.
The winter months in the southern hemisphere bring other sicknesses, including flu and pneumonia. Francesco Rocca, president of the International Red Cross, said this week that Latin America's health emergency could worsen "with the arrival of the southern winter, the flu season in South America, and especially the hurricane season in the Caribbean."
Some governments -- Chile for example -- have warned private providers that they may take over beds as public hospitals buckle under the strain. Gaviria notes that in Colombia the government now controls access to ICU beds in both the private and public sectors -- "and decide where each new patient should go. They want to avoid rationing based on type of insurance or financial considerations."
The Pan American Health Organization has said that in the coming months robust testing and tracing programs will be critical. There are a few promising signs -- such as the mobile teams in Costa Rica checking on infections and quarantine. And in much of the region there is already a large network of labs established to test for flu that are being mobilized.
But testing capacity is hugely variable across the region. As of June 29, Chile had done nearly 5,800 tests per 100,000 population, according to the PAHO. Panama had done just under 3,000. But Brazil had done 230 -- and Guatemala 45.
"In Nicaragua, we don't even know how many tests are being done," says Espinal.
The impact of coronavirus in Latin America is likely to leave deep scars. The World Bank believes that more than 50 million people will see their incomes fall below the $5.50 a day poverty line. Some economists fear the economic damage may be on a par with the "lost decade" of the 1980s.
In the midst of a deep recession that may shrink the region's economy by one-tenth this year, the necessary investment in public health may not materialize. Espinal thinks that would be a big mistake. "There's no way," he told CNN, "countries can justify continuing investing at the same level even if the economy suffers."
Alejandro Gaviria, Colombia's former health minister and now rector of the University of the Andes, is apprehensive about what the rest of 2020 will bring. "Three problems overlap," he says, "a growing pandemic, a social devastation and an increasing fatigue with lockdowns. New lockdowns will only be possible with strict and repressive enforcement measures."
Passengers are tested for COVID-19 at Beirut International Airport on July 1. Anwar Amro/AFP via Getty Images hide caption
Passengers are tested for COVID-19 at Beirut International Airport on July 1.
I've been stranded in Kenya since March, trying to get a "repatriation" flight to return home to the United States. I was finally able to book a flight but I'm still not sure I'll be able to board at the scheduled departure time a week from Saturday. Not only are cancellations part of the new normal for international flights, but passengers in some countries need to present evidence they're likely not infected with the novel coronavirus before being allowed to board.
In Kenya, that means going to a private laboratory chain within 72 hours of my scheduled departure time and undergoing a COVID-19 test, which will cost about 8,000 shillings about $80. The lab will provide documentation of my test results which I must present to airline staff at check-in.
As governments worldwide ease lockdown restrictions and lift bans on international travel, travelers will have lots of questions about how to proceed. Whether you are an expatriate hoping to return to your home country, a traveler with an urgent personal or business matter that requires an international trip or a tourist willing to consider a holiday in another country, here is what you need to know.
First: Flight schedules remain uncertain with frequent and last-minute cancellations and changes in departure dates and times, mainly because airlines can't fill enough seats on the plane to make it financially worth it. To make life less painful for passengers in these uncertain times, many airlines have dropped fees for changing flights and are even honoring unused but expired tickets.
Second: Some destinations have only opened their borders to travelers from select countries where there is a low or declining number of new COVID-19 cases. Those in countries such as the U.S., Brazil and Russia, where outbreaks are still surging, will not be permitted to enter any European country that has recently opened its borders, for instance. Cyprus will only allow incoming flights from about 35 mostly European countries, and Thailand will only allow in certain groups of foreigners such as students studying at Thai schools, those with valid work permits or spouses of Thai nationals.
Third: Many airlines and destination countries are now requiring passengers to undergo COVID-19 testing prior to boarding a flight and to provide a variety of paperwork proving they do not have the respiratory illness. Kenyan citizens returning home from India, for instance, are required to provide an electronic note from a physician confirming they have tested negative for the virus before they are allowed to fly. Those flying Kenya Airways have to arrange for a COVID-19 PCR test, which determines if a person is contagious within 72 hours of their flight and present negative test results to airline staff at check-in. Emirates airline has been conducting rapid COVID-19 blood tests at the airport, which take 10 minutes to return a result, for passengers flying through Dubai to destination countries that require documentation that you're COVID-19-free. Other airlines similarly require passengers to be tested between 2 to 7 days before their scheduled departure.
Dr. Lin Chen, an associate professor at Harvard Medical School and president of the International Society of Travel Medicine, says that requiring passengers to show proof of their virus-free status is, overall, a good step to help prevent the transmission of the disease both during the flight and once passengers reach their destination.
However, these new measures are not perfect. Prospective travelers may test negative for COVID-19 days before their flight but can still be exposed to the virus between the time they go for testing and the time they board.
Moreover, COVID-19 testing is not foolproof. Testing may not be done properly and even if it is, there can be false negatives which might allow contagious individuals to board a flight. Another consideration: Depending on your country of residence, it may be difficult to get tested if there is a shortage of testing centers, health-care staff or testing equipment. And in some countries, expats may not be eligible to receive care from public health services while private health insurance policies may not cover the cost of testing if the test is not considered medically necessary.
Apart from logistical challenges, the looming question remains: is it safe to travel?
Scientific studies and outbreak investigations have found that COVID-19 transmission in crowded, indoor spaces such as cruise ships, churches and factories can be explosive.
But according to Chen, transmission of COVID-19 between passengers on airplanes is rare.
On one January flight from China to Canada, a passenger with a symptomatic case of COVID-19 did not infect any of the 350 passengers on board, according to a brief report by Canadian researchers. Similarly, on a flight from New York to Taipei, a passenger with COVID-19 also did not infect anyone else on board, according to Chen.
The U.S. Centers for Disease Control and Prevention also asserts that the risk of getting an infectious disease on a flight is low while the United Nation's International Civil Aviation Organization states on its website that restricting international travel is not an effective means of containing outbreaks.
Yet despite these reassurances, there are documented cases of transmission of COVID-19 on an airplane. On a March 2 flight from London to Vietnam, a woman who was infected with the virus went on to infect at least 13 other passengers, according to Vietnam's Ministry of Health.
The IATA, International Civil Aviation Organization, World Health Organization, and the US Federal Aviation Association have all released guidelines for travel during the pandemic, and many airlines have adapted them and introduced protective measures to keep crew and passengers safe. For example, many airlines have stopped giving passengers reusable items such as blankets, magazines and headphones and have increased layover times and time between flights to allow for more thorough cleaning of the cabins. Most, if not all,airlines have also installed high efficiency particulate air, or HEPA, filtration systems which are better at cleaning the air than most systems used in hospital isolation rooms, Chen says. Airlines provide information about their air filtration systems on their websites.
Chen says that passengers can further protect themselves by following all the anti-virus guidelines they would follow outside of the plane including wearing a mask, washing hands and practicing social distancing as much as possible. In addition, Dr. Chen recommends passengers avoid crowded areas of the airport, carry hand wipes, sanitize or avoid "high-touch" areas and bring their own food.
In addition, says Chen, travelers should research the current COVID-19 situation in their prospective destination country and the country's capacity to test and treat people with the viral illness. She also suggests finding out if the destination country has policies requiring people to wear masks in public or encouraging hand-washing and practicing social distancing while on public transit, grocery stores and other public-gathering places. Prospective travelers can find this information on national and international health agency websites including the World Health Organization and CDC and from health ministries, immigration offices and embassies in destination countries.
And then there are questions, if travel is optional, that only you can answer."For tourism or adventure travel, the individual traveler has to consider their own personal risk and whether they tolerate that potential risk of getting infected and whether they might bring it home to their family or community especially if they have older family members who are more susceptible to severe disease," Chen says.
