A virus testing site in Beijing in June. Kevin Frayer/Getty Images. The New York Times. Live Coronavirus Updates: Global Death Toll Surpasses Half a Million. The worldwide toll is continuing to rise, with more than 10 million confirmed cases. More than a quarter of deaths have been in the United States.
Even before a coronavirus vaccine becomes available, some activists are ready to attack it; this woman attended a Reopen Virginia protest in Richmond in April.
By Warren CornwallJun. 30, 2020 , 4:25 PM
Sciences COVID-19 reporting is supported by the Pulitzer Center.
Within days of the first confirmed novel coronavirus case in the United States on 20 January, antivaccine activists were already hinting on Twitter that the virus was a scampart of a plot to profit from an eventual vaccine.
Nearly half a year later, scientists around the world are rushing to create a COVID-19 vaccine. An approved product is still months, if not years, away and public health agencies have not yet mounted campaigns to promote it. But health communication experts say they need to start to lay the groundwork for acceptance now, because the flood of misinformation from antivaccine activists has surged.
Such activists have kicked into overdrive, says Neil Johnson, a physicist at George Washington University who studies the dynamics of antivaccine groups on social networks. He estimates that in recent months, 10% of the Facebook pages run by people asking questions about vaccines have already switched to antivaccine views.
Recent polls have found as few as 50% of people in the United States are committed to receiving a vaccine, with another quarter wavering. Some of the communities most at risk from the virus are also the most leery: Among Black people, who account for nearly one-quarter of U.S. COVID-19 deaths, 40% said they wouldnt get a vaccine in a mid-May poll by the Associated Press and the University of Chicago. In France, 26% said they wouldnt get a coronavirus vaccine.
The Centers for Disease Control and Prevention (CDC) is now working on a plan to boost vaccine confidence as part of the federal effort to develop a vaccine, Director Robert Redfield told a Senate committee this week. Advocates urge campaigns that include personal messages and storytelling. We better use every minute we have between now and when that vaccine or vaccines are ready, because its real fragile ground right now, says Heidi Larson, an anthropologist and head of the Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine (LSHTM).
Even before the pandemic, public health agencies around the world were struggling to counter increasingly sophisticated efforts to turn people against vaccines. With vaccination rates against measles and other infectious diseases falling in some locations, the World Health Organization (WHO) in 2019 listed vaccine hesitancy as one of 10 major global health threats.
Any coronavirus vaccine will face additional hurdles, especially the lack of a long-term safety record, Johnson says. The frenetic pace of vaccine development may play into that concern. Even advocates have worried that the rush for a vaccine raises the risk it could be ineffective or have harmful side effects. Consider the very name for the U.S. vaccine initiative, Operation Warp Speed, says Bruce Gellin, president of the nonprofit Sabin Vaccine Institute. What is a worse name for something thats supposed to give you trust in a product that you want everybody to take?
For some in the United States, the answer is no, according to a survey of 1056 people in mid-May.
OverallUnder age 60Age 60 and olderWhiteBlackHispanic493120403523672112562716253240373723YesNot sureNoDid not answer
(GRAPHIC) V. ALTOUNIAN/SCIENCE; (DATA) Associated PressNORC Center for Public Affairs Research at the University of Chicago
Del Bigtree, a U.S.-based vaccine critic, claims scientists are pursuing one of the most dangerous vaccines ever attempted, for a virus that poses little risk to most people. He says he spreads his message through an online talk show, Twitter, and presentations, and that we have seen incredible growth since the pandemic started.
In addition to safety concerns, activists have embraced a plethora of other antivaccine messages. In May, a documentary-style video, Plandemic, purporting that COVID-19 related deaths were exaggerated and a vaccine could kill millions, got more than 7 million views on YouTube before it was removed because of its unsubstantiated claims. U.S. activists in late April hosted an online Freedom Health Summit featuring antivaccine leaders and railing against medical tyranny during shutdowns. Other outlandish claims include that vitamin C can cure COVID-19 and that the disease is a conspiracy involving philanthropist Bill Gates. Statements by French doctors that coronavirus vaccines might be tested in Africa led to fears of Africans being exploited in trials.
Social media posts that create the impression of a real debate over vaccine safety can tap into psychological habits that make people think doing nothing is safer than taking action, says Damon Centola, a sociologist at the University of Pennsylvania. He fears such concerns could spread more easily among people already suspicious of medical authority, including minority communities. For example, many Black people are keenly aware of the history of medical experiments such as the infamous federal Tuskegee Study, which failed to treat Black men with syphilis. That, to me, is the major issue of the day that Im very worried about, Centola says.
Accuracy and authority are at a disadvantage in a media environment that favors speed, emotion, and memorable stories, says Peter Sheridan Dodds, a complex systems scientist at the University of Vermont who studies how ideas move through social media. Antivaccine activists have used those factors to attract followers, Dodds says. In the end, its story wars.
Vaccine promoters say they need to start now to counter all this, because epidemiologists estimate that to break the pandemic, 70% of the population may need to develop immunity, either by getting a vaccine or becoming infected. Health communication experts suggest taking some pages from the antivaccine playbook. When more than40 experts from around the world gathered online for a strategy session organized by experts with the City University of New York and LSHTM, a top recommendation was to develop faster, more creative ways to communicate with the public that speak more directly to the emotions.
Traditional messages promoting vaccinationauthoritative and fact-filledjust dont cut it with people worried about vaccine safety, says Larson, who helped organize the 20 May meeting. We dont have enough flavors of messages, adds Larson, whose book about vaccine rumors is about to be released. Ive had people say to me, All these social media platforms can send us to WHO or CDC. Weve been there, but it doesnt have the answers to the questions we have.
Some current initiatives have pioneered a more story-based approach. The National HPV Vaccination Roundtable, which promotes vaccination against the human papillomavirus, a leading cause of cervical cancer, uses YouTube videos of women who survived cervical cancer. We need to get better at storytelling, says Noel Brewer, a behavioral scientist at the University of North Carolina, Chapel Hill, and chair of the HPV roundtable. We need to carry positive stories and also negative stories about the harms of not vaccinating. The downsides of refusing a coronavirus vaccine might include not visiting grandparents and continuing to traverse the produce aisle as if it were a minefield.
In West Africa, officials are deploying the same tools that spread rumors about vaccines to counter them, says Thabani Maphosa, who oversees operations in 73 countries for Gavi, the Vaccine Alliance, which supplies and promotes vaccines around the world. In Liberia, for example, officials are using Facebooks WhatsApp messaging app to survey people and to address the rumors behind a drop in routine vaccinations. We need to use this as a teachable moment, Maphosa says.
In the United States, the nonprofit Public Good Projects plans to recruit volunteers to swarm outbreaks of vaccine misinformation online and eventually develop memes and videos, says CEO Joe Smyser.
But the most effective tools may lie outside the digital realm. Real-world nudges and infrastructure, such as phone call reminders to come in for a shot, may be more powerful than any social media campaign, Brewer says. Social media doesnt have as much of an effect as you would imagine from the noise its generating, he adds.
Public health agencies should consider taking vaccinations out of medical settings and into places where people work or shop, adds Monica Schoch-Spana, a medical anthropologist at Johns Hopkins University. That also means talking to leaders in various communities to understand their views. Such outreach could prove particularly important with minority communities. You really do have to meet people where they are both figuratively and literally, she says.
Carmen Quintero works as a supervisor at a distribution center for N95 masks. She owes $1,840 for other care she received when she tried to get a coronavirus test. Heidi de Marco/KHN hide caption
Carmen Quintero works as a supervisor at a distribution center for N95 masks. She owes $1,840 for other care she received when she tried to get a coronavirus test.
Carmen Quintero works an early shift as a supervisor at a 3M distribution warehouse that ships N95 masks to a nation under siege from the coronavirus. On March 23, she had developed a severe cough, and her voice, usually quick and enthusiastic, was barely a whisper.
A human resources staff member told Quintero she needed to go home.
"They told me I couldn't come back until I was tested," said Quintero, who was also told that she would need to document that she didn't have the virus.
Her primary care doctor directed her to the nearest emergency room for testing because the practice had no coronavirus tests.
The Corona Regional Medical Center is just around the corner from her house in Corona, Calif. They didn't have any tests either, but there a nurse tested her breathing and gave her a chest X-ray. For testing, the nurse told her to go to Riverside County's public health department. There, a public health worker gave her an 800 number to call to schedule a test. The earliest the county could test her was April 7, more than two weeks later.
At the hospital, Quintero got a doctor's note saying she should stay home from work for a week and she was told to behave as if she had COVID-19, the disease caused by the coronavirus, isolating herself from vulnerable household members. That was difficult Quintero lives with her grandmother and her girlfriend's parents but she managed. No one else in her home got sick, and by the time April 7 came, she felt better and decided not to get the coronavirus test.
Then the bill for the ER visit came.
The patient: Carmen Quintero, 35, a supervisor at a 3M distribution warehouse who lives in Corona, Calif. She has an Anthem Blue Cross health insurance plan through her job with a $3,500 annual deductible.
Total bill: Corona Regional Medical Center billed Quintero $1,010, and Corona Regional Emergency Medical Associates billed an additional $830 for physician services for her visit attempting to get a test. She also paid $50 at Walgreens to fill a prescription for an inhaler.
Service provider: Corona Regional Medical Center, a for-profit hospital owned by Universal Health Services, a company based in King of Prussia, Pa., which is one of the largest health care management companies in the nation. The hospital contracts with Corona Regional Emergency Medical Associates, part of Emergent Medical Associates.
Medical service: Quintero was evaluated in the emergency room for symptoms consistent with COVID-19: a wracking cough and difficulty breathing. She had a chest X-ray and a breathing treatment and was prescribed an inhaler.
What gives: Quintero knew she had a high-deductible plan yet felt she had no choice but to follow her doctor's advice and go to the nearest emergency room to get tested. She assumed she would get the test and not have to pay. Congress had passed the CARES Act just the week before, with its headlines saying coronavirus testing would be free.
That legislation turned out to be riddled with loopholes, especially for people like Quintero who needed and wanted a coronavirus test but couldn't get one early in the pandemic.
Insurers do have to cover tests, but when a patient goes to see a doctor to be checked out for COVID-19 symptoms, if no test is ordered or administered, insurers aren't required to cover the appointment without cost sharing.
So Quintero was on the hook for the copay.
"I just didn't think it was fair because I went in there to get tested," she said.
Some insurance companies are voluntarily reducing copayments for coronavirus-related emergency room visits. But Quintero said her insurer, Anthem Blue Cross, would not reduce her bill. Anthem would not discuss the case until Quintero signed its own privacy waiver; it would not accept a signed standard waiver KHN uses. The hospital would not discuss the bill with a reporter unless Quintero could also be on the phone, something that has yet to be arranged around Quintero's workday, which begins at 4 a.m. and ends at 3:30 p.m.
Three states have gone further than Congress to waive cost sharing for testing and diagnosis of pneumonia and influenza, given these illnesses are often mistaken for COVID-19. California is not one of them, and because Quintero's employer is self-insured the company pays for health services directly from its own funds it is exempt from state directives anyway. The U.S. Department of Labor regulates all self-funded insurance plans. In 2019, nearly 2 in 3 covered workers were in these types of plans.
Related health care hurdle: On that day in late March when her body shook from coughing, Quintero's immediate worry was infecting her family, especially her girlfriend's parents, both older than 65, and her 84-year-old grandmother.
"If something was to happen to them, I don't know if I would have been able to live with it," said Quintero.
Quintero wanted to isolate in a hotel, but she could hardly afford to for the week that she stayed home. She had only three paid sick days and was forced to take vacation time until her symptoms subsided and she was allowed back at work. At the time, few places provided publicly funded hotel rooms for sick people to isolate, and Quintero was not offered any help.
As lockdown restrictions ease and coronavirus cases rise around the country, public health officials say quickly isolating sick people before the virus spreads through families is essential.
But isolation efforts have gotten little attention in the U.S. Nearly all local health departments, including Riverside County where Quintero lives, now have these programs, according to the National Association of County and City Health Officials. Many were designed to shelter people experiencing homelessness but can be used to isolate others.
Raymond Niaura, interim chairman of the Department of Epidemiology at New York University, said these programs are used inconsistently and have been poorly promoted to the public.
"No one has done this before and a lot of what's happening is that people are making it up as they go along," said Niaura. "We've just never been in a circumstance like this."
Resolution:
The bills have been a constant worry. Quintero called the hospital and her insurance company and complained that she should not have to pay since she was seeking a test on her doctor's orders. Neither budged, and the bills labeled "payment reminders" soon became "final notices." She reluctantly agreed to pay $100 a month toward her balance $50 to the hospital and $50 to the doctors.
"None of them wanted to work with me," Quintero said. "I just have to give the first payment on each bill so they wouldn't send me to collections."
On top of that, Quintero still worries about bringing the virus home to her family and fears being in the same room with her grandmother. Quintero returns from work every day now, puts her clothes in a separate hamper and diligently washes her hands before she interacts with anyone.
The takeaways:
At this point in the pandemic, tests are more widely available and federal law is very clearly on your side: You should not be charged any cost sharing for a coronavirus test.
Be wary, though, if your doctor directs you to the emergency room for a test, because any additional care you get there could come at a high price. Ask if there are any other testing sites available.
If you do find yourself with a big bill related to suspected coronavirus, push beyond a telephone call with your insurance company and file a formal appeal. If you feel comfortable, ask your employer's human resources staff to argue on your behalf. Then, call the help line for your state insurance commissioner and file a separate appeal. Press insurers and big companies that offer self-insured plans to follow the spirit of the law, even if the letter of the law seems to let them off the hook.
If you suspect you have COVID-19 and need to isolate to protect vulnerable members of your household, call your local public health department. Most counties have isolation and quarantine programs, but these resources are not well known. You may be placed in a hotel, recreational vehicle or other type of housing while you wait out the infection period. You do not need to have a positive coronavirus test to qualify for these programs and can use these programs while you await your test result. But this is an area in which public health officials repeatedly offer clear guidance 14 days of isolation which most people find impossible to follow.
Bill of the Month is a crowdsourced investigation by Kaiser Health News and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!
More than 125,000 people have died from Covid-19 in the US, and more than 2.5 million Americans have been infected.
American life has been irrevocably altered by the worst pandemic in a century. And as the country struggles to reopen, cases of Covid-19 have surged again -- this time in young people and in states that had previously avoided the brunt of the virus.
Here, in dollars, percentages and most tragically lives, is the pandemic's devastating toll on the US.
More people are infected with and die from coronavirus in the US than anywhere else in the world.
Coronavirus has now killed nearly 126,000 people in the US since the first death was reported in February, according to Johns Hopkins University's case count. That's an average of around 1,039 deaths per day.
The number shot up from the end of May, when an average of fewer than 900 people died every day in the US from Covid-19.
More Americans also have died of coronavirus in less than five months than in all of World War I. That conflict took the lives of 116,516 American soldiers.
With more than 2.5 million official diagnoses in the US, Redfield's estimate could mean more than 25 million Americans have been infected.
The lag in reporting is due in part to limited testing during the first few weeks of the pandemic. Now, as more people are getting tested, it's become clear that a large percentage of those who tested positive did not have any symptoms or had only mild symptoms, Redfield said.
Not all states are reporting infections and deaths in nursing homes and long-term care facilities, so these numbers may be higher on a national scale.
Black Americans' coronavirus death rate is 2.3 times higher than that of White & Asian Americans and twice as high as the death rate for Latinos.
By comparison, White Americans represent over 62% of the US population but account for just about half of all coronavirus deaths. One in 3,600 White Americans has died, the lab reported.
Since mid-March, 47.3 million workers have filed for first-time unemployment benefits.
America's first-quarter GDP, the most expansive measure of the US economy, fell at a 4.8% annualized rate, the US Bureau of Economic Analysis reported in May.
CNN's Ben Tinker, Maggie Fox, Holly Yan, Andrea Kane, Paul LeBlanc, Flora Charner, Stephen Collinson, Marshall Cohen, Anneken Tappe, Zamira Rahim and Veronica Stracqualursi contributed to this report.
About 25% of New York City-area residents have probably been infected with the coronavirus by now, former Food and Drug Administration Commissioner Dr. Scott Gottlieb told CNBC on Tuesday.
Researchers at the Mount Sinai Health System in New York City published a study Monday, which suggested that 19.3% of people in the city had already been exposed to the virus through April 19.
Even if that many people have Covid-19 antibodies in New York City, the initial epicenter of the U.S. outbreak, the researchers noted that would still be well below the estimated 67% needed to achieve herd immunity which is necessary to give the general public broad protection from the virus. The study has not yet been peer-reviewed nor accepted by an official medical journal for publication.
Based on their findings, the researchers concluded that about 0.7% of everyone infected with the virus in New York City died due to Covid-19. However, Gottlieb said the infection-fatality rate,which factors in asymptomatic patients who never develop symptoms,has likely risen since mid-April.
"If you probably took that out to now, you did a seroprevalence study now, you'd probably see that the infection-fatality rate's a little higher because more people succumbed to the infection over the course of time from April to now," he said on CNBC's "Squawk Box." "And you'd probably see that the seroprevalence is a little higher because more people have gotten infected, so my guess is probably around 25% of New York has now been infected with Covid."
The infection-fatality rate is likely lower than the case-fatality rate, which looks at the percent of people who have symptoms and end up dying. Gottlieb said the case-fatality rate might be closer to 1.1% or 1.2%.
The findings of the study are in line with what other researchers, including those for New York state who conducted their own seroprevalence study, have found, Gottlieb said, which helps bolster confidence in such studies.
"We can start to believe that this probably represents an approximation of what the real result is," he said.
The relationship between the presence of antibodies and immunity when it comes to the coronavirus remains unclear. The authors of the study noted that previous research into other coronaviruses has indicated that antibodies confer immunity. However, health officials, including Gottlieb and White House health advisor Dr. Anthony Fauci, have warned that the level and duration of immunity provided by antibodies is still unclear.
The researchers said the antibody test used in the study has a sensitivity rate of 95%, meaning it picks up positive cases 95% of the time, and a specificity of 100%, meaning it accurately reflects negative cases 100% of the time. That means the tests could produce a false negative result, but not a false positive antibody test. All tests were analyzed in a research laboratory setting.The sample of patients used to determine the prevalence of the virus in the general population was composed of patients who presented at Mount Sinai for a regular medical procedure or check up, unrelated to Covid-19.
The authors of the Mount Sinai study acknowledged some factors might have biased their sampling of the general population, but said "it nevertheless provides a window into the extent of seroprevalence in NYC." The study waspartially funded by the National Institute of Allergy and Infectious Diseases, theCollaborative Influenza Vaccine Innovation Centers, the JPB foundation and other donors.
Since April, New York and the tri-state region have managed to significantly drive down their level of spread, which means the "seroprevalence would likely not change significantly unless new infections rise again or vaccines would become available," the researchers said.
Disclosure: Scott Gottlieb is a CNBC contributor and is a member of the boards of Pfizer, genetic-testing start-upTempus and biotech company Illumina.
As protests against racism and police violence swept across the country, drawing massive crowds into the streets amid a pandemic, public health officials worried about what the overall impact would be.
The latest from the coronavirus outbreak in Colorado:
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Would these protests which many health leaders said they support also turn out to be virus super-spreading events?
But a new study by a nationwide research team that includes a University of Colorado Denver professor has found something surprising: The protests may have slowed the overall spread of the coronavirus in cities with large demonstrations, including Denver.
We think that whats going on is its the people who are not going to protest are staying away, said Andrew Friedson, the CU-Denver professor who is one of the papers co-authors. The overall effect for the entire city is more social distancing because people are avoiding the protests.
Friedsons specialty is economics specifically the economics of health care. The field of COVID-19 research now contains a multitude of subspecialties, and it has often been economists leading the way in understanding how people are changing their behaviors in response to the pandemic.
MORE: Coloradans are moving around at nearly pre-pandemic levels. Will a second coronavirus wave follow?
As the protests built, Friedson said he and his colleagues took note of the rising concerns about virus spread. He said they also realized they had the ability to answer that question using official coronavirus case counts and the anonymous, aggregated cell phone data that has become the gold standard for tracking societal shifts in movement.
The team worked quickly and published their findings earlier this month as a National Bureau of Economic Research working paper meaning it has not yet been peer-reviewed.
Im someone who likes to get the answers out, Friedson said. There are a lot of people who say, Well I think it should happen or I think this should happen, and its nice to have some numbers to inform these decision-making processes.
The paper comes as officials in Colorado and other states are concerned about rising infections, especially among young people.
New infections among young people have contributed significantly to Colorados uptick in cases in recent days a rise that reversed a weeks-long trend of falling case numbers and has put Colorado back onto the list of potential coronavirus problem spots. Meanwhile, the number of new infections among older Coloradans has dropped.
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With the July 4 holiday approaching, Gov. Jared Polis and county health officials have pleaded with people to be responsible and avoid large gatherings.
We dont have the direct causation of this uptick, Polis told reporters last week, noting that there is evidence that some young people who are part of an outbreak in Boulder had attended protests while other outbreaks are tied to social gatherings. And we hope this is a trend that is reversed in our state.
On Monday, a spokesman for the Colorado Department of Public Health and Environment said that, while the state has now seen rising numbers of new cases for two consecutive weeks, we have not seen any clear association between the protests and an increase in cases.
The spokesman, Ian Dickson, said the uptick in infections may be partly due to some Coloradans changing their behavior especially socializing in larger groups, sometimes without proper distancing or mask wearing.
Friedson said his paper doesnt try to figure out whether the protests spread the virus among the people at the protest. Instead, he said the research took the bigger-picture view: What did the protests mean for overall transmission of the virus within the entire community?
The study looked at 315 American cities with populations of more than 100,000 and found that 281 of those cities saw protests. The remaining 34 cities that did not see protests which, at the time, included Aurora were used as a control group against which to measure the impact of the protests.
The researchers found that protests correlated with a net increase in overall stay-at-home behavior in cities where they occurred and the increase was larger in cities that saw more sustained protests or reports of violence.
Friedson said he and his colleagues were a bit surprised at first. The protests in many cities, including Denver, were massive, drawing tens of thousands of people out to march. But they occurred in cities with hundreds of thousands to millions of residents.
We started thinking about it a little more and we thought, Oh my gosh were capturing everybody else, he said.
The paper also found that, with greater social distancing, COVID case growth slowed in cities with protests from what would be expected but not by a statistically significant amount. There may be other explanations for the trends, the studys authors note. Overall, though, they say the data show that any resurgence in coronavirus cases cant be pinned entirely on the protests.
Public speech and public health did not trade off against each other in this case, the authors wrote in the paper.
But Friedson said there is one last important thing to keep in mind about this study: Its not a green light for governments to fully reopen bars, concert venues and other places where people gather in large numbers. The key to the researchers conclusions is that the protests, while receiving lots of support, were ultimately things most people decided to avoid. Thats not true of many other large gatherings.
An outdoor wedding doesnt generate avoidance behavior; were measuring avoidance behavior, Friedson said. People dont say, Oh man, theres an outdoor wedding next door, we should stay home.
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In addition to the selected guidance included below, all of WHOs technical guidance on COVID-19 can be found online here.
All events listed below are in the Geneva, Switzerland time zone (CET/CEST). Note that the dates listed for documents are based on when they were finalised and timestamped.
WHOs Country Office in the Peoples Republic of China picked up a media statement by the Wuhan Municipal Health Commission from their website on cases of viral pneumonia in Wuhan, Peoples Republic of China.
The Country Office notified the International Health Regulations (IHR) focal point in the WHO Western Pacific Regional Office about the Wuhan Municipal Health Commission media statement of the cases and provided a translation of it.
WHOs Epidemic Intelligence from Open Sources (EIOS) platform also picked up a media report on ProMED (a programme of the International Society for Infectious Diseases) about the same cluster of cases of pneumonia of unknown cause, in Wuhan.
Several health authorities from around the world contacted WHO seeking additional information.
WHO requested information on the reported cluster of atypical pneumonia cases in Wuhan from the Chinese authorities.
WHO activated its Incident Management Support Team (IMST), as part of its emergency response framework, which ensures coordination of activities and response acrossnthe three levels of WHO (Headquarters, Regional, Country) for public health emergencies.
The WHO Representative in China wrote to the National Health Commission, offering WHO support and repeating the request for further information on the cluster of cases.
WHO informed Global Outbreak Alert and Response Network (GOARN) partners about the cluster of pneumonia cases in the Peoples Republic of China. GOARN partners include majornpublic health agencies, laboratories, sister UN agencies, international organizations and NGOs.
Chinese officials provided information to WHO on the cluster of cases of viral pneumonia of unknown cause identified in Wuhan.
WHO tweeted that there was a cluster of pneumonia cases with no deaths in Wuhan, Hubei province, Peoples Republic of China, and that investigations to identify the cause were underway.
WHO shared detailed information about a cluster of cases of pneumonia of unknown cause through the IHR (2005) Event Information System, which is accessible to all Member States. The event notice provided information on the cases and advised Member States to take precautions to reduce the risk of acute respiratory infections.
WHO also issued its first Disease Outbreak News report. This is a public, web-based platform for the publication of technical information addressed to the scientific and public health communities, as well as global media. The report contained information about the number of cases and their clinical status; details about the Wuhan national authoritys response measures; and WHOs risk assessment and advice on public health measures. It advised that WHOs recommendations on public health measures and surveillance of influenza and severe acute respiratory infections still apply.
WHO reported that Chinese authorities have determined that the outbreak is caused by a novel coronavirus.
WHO convened the first of many teleconferences with global expert networks, beginning with the Clinical Network.
The Global Coordination Mechanism for Research and Development to prevent and respond to epidemics held its first teleconference on the novel coronavirus, as did the Scientific Advisory Group of the research and development (R&D) Blueprint, a global strategy and preparedness plan that allows the rapid activation of research and development activities during epidemics.
The Director-General spoke with the Head of the National Health Commission of the Peoples Republic of China. He also had a call to share information with the Director of the Chinese Center for Disease Control and Prevention.
WHO published a comprehensive package of guidance documents for countries, covering topics related to the management of an outbreak of a new disease:
Chinese media reported the first death from the novel coronavirus.
WHO convened the first teleconference with the diagnostics and laboratories global expert network.
The Ministry of Public Health in Thailand reported an imported case of lab-confirmed novel coronavirus from Wuhan, the first recorded case outside of the Peoples Republic of China.
WHO publishes first protocol for a RT-PCR assay by a WHO partner laboratory to diagnose the novel coronavirus.
14 January 2020
WHO held a press briefing during which it stated that, based on experience with respiratory pathogens, the potential for human-to-human transmission in the 41 confirmed cases in the Peoples Republic of China existed: it is certainly possible that there is limited human-to-human transmission.
WHO tweeted that preliminary investigations by the Chinese authorities had found no clear evidence of human-to-human transmission. In its risk assessment, WHO said additional investigation was needed to ascertain the presence of human-to-human transmission, modes of transmission, common source of exposure and the presence of asymptomatic or mildly symptomatic cases that are undetected.
The Japanese Ministry of Health, Labour and Welfare informed WHO of a confirmed case of a novel coronavirus in a person who travelled to Wuhan. This was the second confirmed case detected outside of the Peoples Republic of China. WHO stated that considering global travel patterns, additional cases in other countries were likely.
The Pan American Health Organization/WHO Regional office for the Americas (PAHO/AMRO) issued its first epidemiological alert on the novel coronavirus. The alert included recommendations covering international travellers, infection prevention and control measures and laboratory testing.
WHO convened the first meeting of the analysis and modelling working group for the novel coronavirus.
The WHO Western Pacific Regional Office (WHO/WPRO) tweeted that, according to the latest information received and WHO analysis, there was evidence of limited human-to-human transmission.
WHO published guidance on home care for patients with suspected infection.
WHO conducted the first mission to Wuhan and met with public health officials to learn about the response to the cluster of cases of novel coronavirus.
WHO/WPRO tweeted that it was now very clear from the latest information that there was at least some human-to-human transmission, and that infections among health care workers strengthened the evidence for this.
The United States of America (USA) reported its first confirmed case of the novel coronavirus. This was the first case in the WHO Region of the Americas.
WHO convened the first meeting of the global expert network on infection prevention and control.
The WHO mission to Wuhan issued a statement saying that evidence suggested human-to-human transmission in Wuhan but that more investigation was needed to understand the full extent of transmission.
The WHO Director-Generalconvenedan IHR Emergency Committee (EC) regarding the outbreak of novel coronavirus. The EC was comprised of 15 independent experts from around the world and was charged with advising the Director-General as to whether the outbreak constituted a public health emergency of international concern (PHEIC).
The Committee was not able to reach a conclusion on 22 January based on the limited information available. As the Committee was not able to make a recommendation, the Director-General asked the Committee to continue its deliberations the next day. The Director-General held a media briefing on the novel coronavirus, to provide an update on the Committees deliberations.
The EC met again on 23 January and members were equally divided as to whether the event constituted a PHEIC, as several members considered that there was still not enough information for it, given its restrictive and binary nature (only PHEIC or no PHEIC can be determined; there is no intermediate level of warning). As there was a divergence of views, the EC did not advise the Director-General that the event constituted a PHEIC but said it was ready to be reconvened within 10 days. The EC formulated advice for WHO, the Peoples Republic of China, other countries and the global community.
The Director-General accepted the advice of the Committee and held a second media briefing, giving a statement on the advice of the EC and what WHO was doing in response to the outbreak.
France informed WHO of three cases of novel coronavirus, all of whom had travelled from Wuhan. These were the first confirmed cases in the WHO European region (EURO).
WHO held an informal consultation on the prioritization of candidate therapeutic agents for use in novel coronavirus infection.
The Director of the Pan American Health Organization (PAHO) urged countries in the Americas to be prepared to detect early, isolate and care for patients infected with the new coronavirus, in case of receiving travelers from countries where there was ongoing transmission of novel coronavirus cases. The Director spoke at a PAHO briefing for ambassadors of the Americas to the Organization of American States (OAS) in Washington.
The WHO Regional Director for Europe issued a public statement outlining the importance of being ready at the local and national levels for detecting cases, testing samples and clinical management.
WHO released its first free online course on the novel coronavirus on its OpenWHO learning platform.
The WHO Regional Director for South-East Asia issued a press release that urged countries in the Region to focus on their readiness for the rapid detection of imported cases and prevention of further spread.
A senior WHO delegation led by the Director-General arrived in Beijing to meet Chinese leaders, learn more about the response in the Peoples Republic of China, and to offer technical assistance. The Director-General met with President Xi Jinping on 28 January, and discussed continued collaboration on containment measures in Wuhan, public health measures in other cities and provinces, conducting further studies on the severity and transmissibility of the virus, continuing to share data, and a request for China to share biological material with WHO. They agreed that an international team of leading scientists should travel to China to better understand the context, the overall response, and exchange information and experience.
On his return to Switzerland from China, the Director-General presented an update to Member States on the response to the outbreak of novel coronavirus infection in China, at the 30th Meeting of the Programme, Budget and Administration Committee (PBAC) of the Executive Board. He informed the PBAC that he had reconvened the Emergency Committee on the novel coronavirus under the IHR (2005), which would meet the following day to advise on whether the outbreak constituted a PHEIC.
The Director-General also held a press briefing on his visit to China and announced the reconvening of the EC the next day. The Director-General based the decision to reconvene on the deeply concerning continued increase in cases and evidence of human-to-human transmission outside China, in addition to the numbers outside China holding the potential for a much larger outbreak, even though they were still relatively small. The Director-General also spoke of his agreement with President Xi Jinping that WHO would lead a team of international experts to visit China as soon as possible to work with the government on increasing the understanding of the outbreak, to guide global response efforts.
WHO held the first of its weekly informal discussions with a group of public health leaders from around the world, in line with its commitment to conducting listening exercises and outreach beyond formal mechanisms.
The United Arab Emirates reported the first cases in the WHO Eastern Mediterranean Region. The Regional Director affirmed that the Regional Office continued to monitor disease trends and work with Member States to ensure the ability to detect and respond to potential cases.
The Pandemic Supply Chain Network (PSCN) created by WHO, in collaboration with the World Economic Forum, held its first meeting. The mission of PSCN is to create and manage a market network allowing for WHO and private sector partners to access any supply chain functionality and asset from end-to-end anywhere in the world at any scale.
WHO published advice on the use of masks in the community, during home care and in health care settings.
WHO held a Member State briefing to provide more information about the outbreak.
The WHO Director-General reconvened the IHR Emergency Committee (EC).
The EC advised the Director-General that the outbreak now met the criteria for a PHEIC. The Director-General accepted the ECs advice and declared the novel coronavirus outbreak a PHEIC. At that time there were 98 cases and no deaths in 18 countries outside China. Four countries had evidence (8 cases) of human-to-human transmission outside China (Germany, Japan, the United States of America, and Viet Nam).
The EC formulated advice for the Peoples Republic of China, all countries and the global community, which the Director-General accepted and issued as Temporary Recommendations under the IHR. The Director-General gave a statement, providing an overview of the situation in China and globally; the statement also explained the reasoning behind the decision to declare a PHEIC and outlined the EC's recommendations.
WHOs Regional Director for Africa sent out a guidance note to all countries in the Region emphasising the importance of readiness and early detection of cases.
First dispatch of RT-PCR lab diagnostic kits shipped to WHO Regional Offices.
WHO finalised its Strategic Preparedness and Response Plan (SPRP), centred on improving capacity to detect, prepare and respond to the outbreak. The SPRP translated what had been learned about the virus at that stage into strategic action to guide the development of national and regional operational plans. Its content is structured around how to rapidly establish international coordination, scale up country preparedness and response operations, and accelerate research and innovation.
The WHO Director-General asked the UN Secretary-General to activate the UN crisis management policy, which held its first meeting on 11 February.
During the 146th Executive Board, WHO held a technical briefing on the novel coronavirus. In his opening remarks, the Director-General urged Member States to prepare themselves by taking action now, saying We have a window of opportunity. While 99% of cases are in China, in the rest of the world we only have 176 cases.
Responding to a question at the Executive Board, the Secretariat said, it is possible that there may be individuals who are asymptomatic that shed virus, but we need more detailed studies around this to determine how often that is happening and if this is leading to secondary transmission.
WHO's headquarters began holding daily media briefings on the novel coronavirus, the first time that WHO has held daily briefings by the Director-General or Executive Director of the WHO Health Emergencies Programme.
WHO deployed an advance team for the WHO-China Joint Mission, having received final sign-off from the Peoples Republic of China that day. The mission had been agreed between the Director-General and President Xi Jinping during the WHO delegations visit to China at the end of January. The advance team completed five days of intensive preparation for the Mission, working with Chinas National Health Commission, the Chinese Center for Disease Control and Prevention, local partners and related entities and the WHO China Country Office.
WHO announced that the disease caused by the novel coronavirus would be named COVID-19. Following best practices, the name of the disease was chosen to avoid inaccuracy and stigma and therefore did not refer to a geographical location, an animal, an individual or group of people.
WHO convened a GlobalResearch and Innovation Forum on the novel coronavirus, attended in person by more than 300 experts and funders from 48 countries, with a further 150 joining online.Participants came together to assess the level of knowledge, identify gaps and work together to accelerate and fund priority research, with equitable access as a fundamental principle underpinning this work.
Topics covered by the Forum included: the origin of the virus, natural history, transmission, diagnosis; epidemiological studies; clinical characterization and management; infection prevention and control; R&D for candidate therapeutics and vaccines; ethical considerations for research; and the integration of the social sciences into the outbreak response.
The Forum was convened in line with the WHO R&D Blueprint, which was activated to accelerate diagnostics, vaccines and therapeutics for this novel coronavirus.
Supplementing the SPRP with further detail, WHO published Operational Planning Guidelines to Support Country Preparedness and Response, structured around the eight pillars of country-level coordination, planning, and monitoring; risk communication and community engagement; surveillance, rapid response teams, and case investigation; points of entry; national laboratories; infection prevention and control; case management; and operational support and logistics. These guidelines operationalised technical guidance, such as that published on 10-12 January.
WHOs Digital Solutions Unit convened a roundtable of 30 companies in Silicon Valley to help build support for WHO to keep people safe and informed about COVID-19.
Based on lessons learned from the H1N1 and Ebola outbreaks, WHO finalised guidelines for organizers of mass gatherings, in light of COVID-19.
The Director-General spoke at the Munich Security Conference, a global forum dedicated to issues of international security, including health security, where he also held several bilateral meetings
In his speech, the Director-General made three requests of the international community: use the window of opportunity to intensify preparedness, adopt a whole-of-government approach and be guided by solidarity, not stigma. He also expressed concern at the global lack of urgency in funding the response.
The WHO-China Joint Mission began its work. As part of the mission to assess the seriousness of this new disease; its transmission dynamics; and the nature and impact of Chinas control measures, teams made field visits to Beijing, Guangdong, Sichuan and Wuhan.
The Mission consisted of 25 national and international experts from the Peoples Republic of China, Germany, Japan, the Republic of Korea, Nigeria, the Russian Federation, Singapore, the United States of America and WHO, all selected after broad consultation to secure the best talent from a diversity of geographies and specialties. It was led by a Senior Advisor to the WHO Director-General, with the Head of Expert Panel of COVID-19 Response at the China National Health Commission (NHC) as co-lead.
Throughout the global outbreak, WHO has regularly sent missions to countries to learn from and support responses, at the request of the affected Member State. Particularly in the early stages of the worldwide COVID-19 response, missions went to countries facing relatively high levels of community transmission, such as the Islamic Republic of Iran, Italy, and Spain.
Weekly WHO Member State Briefings on COVID-19 began, to share the latest knowledge and insights on COVID-19.
The WHO Director-General appointed six special envoys on COVID-19, to provide strategic advice and high-level political advocacy and engagement in different parts of the world:
The Team Leaders of the WHO-China Joint Mission on COVID-19 held a press conference to report on the main findings of the mission.
The Mission warned that "much of the global community is not yet ready, in mindset and materially, to implement the measures that have been employed to contain COVID-19 in China.
The Mission stressed that to reduce COVID-19 illness and death, near-term readiness planning must embrace the large-scale implementation of high-quality, non-pharmaceutical public health measures, such as case detection and isolation, contact tracing and monitoring/quarantining and community engagement.
Major recommendations were developed for the Peoples Republic of China, countries with imported cases and/or outbreaks of COVID-19, uninfected countries, the public and the international community. For example, in addition to the above, countries with imported cases and/or outbreaks were recommended to "immediately activate the highest level of national Response Management protocols to ensure the all-of-government and all-of-society approach needed to contain COVID-19".
Success was presented as dependent on fast decision-making by top leaders, operational thoroughness by public health systems and societal engagement.
In addition to the Mission press conference, WHO published operational considerations for managing COVID-19 cases and outbreaks on board ships, following the outbreak of COVID-19 during an international voyage.
Confirmation of the first case in WHO's African Region, in Algeria. This followed the earlier reporting of a case in Egypt, the first on the African continent. The Regional Director for Africa called for countries to step up their readiness.
WHO published guidance on the rational use of personal protective equipment, in view of global shortages. This provided recommendations on the type of personal protective equipment to use depending on the setting, personnel and type of activity.
The Report of the WHO-China Joint Mission was issued, as a reference point for countries on measures needed to contain COVID-19.
WHO published considerations for the quarantine of individuals in the context of containment for COVID-19. This described who should be quarantined and the minimum conditions for quarantine to avoid the risk of further transmission.
WHO issued a call for industry and governments to increase manufacturing by 40 per cent to meet rising global demand in response to the shortage of personal protective equipment endangering health workers worldwide.
This call fits within a broader scope of ongoing engagement with industry, through WHOs EPI-WIN network and via partners, such as the International Chamber of Commerce and World Economic Forum, the latter of which has supported COVID-19 media briefings at the regional level.
WHO published the Global Research Roadmap for the novel coronavirus developed by the working groups of the Research Forum.
The Roadmap outlines key research priorities in nine key areas. These include the natural history of the virus, epidemiology, diagnostics, clinical management, ethical considerations and social sciences, as well as longer-term goals for therapeutics and vaccines.
To mark the number of confirmed COVID-19 cases surpassing 100 000 globally, WHO issued a statement calling for action to stop, contain, control, delay and reduce the impact of the virus at every opportunity.
WHO issued a consolidated package of existing guidance covering the preparedness, readiness and response actions for four different transmission scenarios: no cases, sporadic cases, clusters of cases and community transmission.
The Global Preparedness Monitoring Board, an independent high-level body established by WHO and the World Bank, responsible for monitoring global preparedness for health emergencies, called for an immediate injection of $8 billion for the COVID-19 response to: support WHO to coordinate and prioritize support efforts to the most vulnerable countries; develop new diagnostics, therapeutics, and vaccines; strengthen unmet needs for regional surveillance and coordination; and to ensure sufficient supplies of protective equipment for health workers.
WHO, UNICEF and the International Federation of Red Cross and Red Crescent Societies (IFRC) issued guidance outlining critical considerations and practical checklists to keep schools safe, with tips for parents and caregivers, as well as children and students themselves.
Deeply concerned both by the alarming levels of spread and severity, and by the alarming levels of inaction, WHO made the assessment that COVID-19 could be characterized as a pandemic.
The Trump administration has taken steps to limit patients out-of-pocket costs for coronavirus testing and treatment, using relief funds to reimburse providers for uninsured patients bills. Insurers are required to cover patients coronavirus tests with no cost-sharing or co-payments. Alex Azar, the health and human services secretary, reiterated that commitment in a Sunday interview on CNN, saying, If you are uninsured, it will be covered by us.
The testing experience of the Texas group suggests that it doesnt always work out that way. Some emergency rooms charge cash prices and tack on testing fees that insurers are not required to cover. In this case, the patient who paid cash actually got the best deal. Mr. Harvey has health insurance but felt it would be a hassle to use it for the coronavirus test. So he paid for his test with two $100 bills after receiving the nasal swab, and was on his way.
Updated June 30, 2020
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise comes with issues of potential breathing restriction and discomfort and requires balancing benefits versus possible adverse events. Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. In my personal experience, he says, heart rates are higher at the same relative intensity when you wear a mask. Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who dont typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the countrys largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was very rare, but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus whether its surface transmission or close human contact is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nations job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
If youve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
Ms. LeBlanc let the emergency room take a photograph of her insurance card. She ended up with $6,408 in charges, mostly from an outside lab called Genesis Laboratory that handled her testing. She received explanation-of-benefit statements suggesting she would owe more than $1,000.
Jay Lenner, who also got a drive-through test from the same provider, used his insurance and received a similarly long list of charges. He recalls a provider saying hed be tested only for coronavirus, but bill records show he was also screened for Legionnaires disease, herpes and enterovirus, among other things.
The emergency room also charged him $1,684 for using its facility and $634 to see one of its doctors. All told, he ended up with $5,649 in bills, of which his insurance plan paid $4,914. Mr. Lenner didnt end up on the hook for any of it, but hes still frustrated. Ultimately, we pay for this in higher premiums, he said.
Michelle Tribble, a spokeswoman for Austin Emergency Center, said it needed to charge high prices because insurers often pay only a small share of their fees.
For emergency room visits, the reimbursement to us by insurance companies is typically a fifth or a third of total charges, she said. If an insurance company were to bill a patient for an out-of-network visit to our emergency room, our billing company would go to bat for that patient and would appeal on their behalf.
Coronavirus patients are showing up in emergency rooms after calling 911 from the US-Mexico border.
"They'll literally come to the border and call an ambulance," says Van Gorder, president and CEO of Scripps Health, a hospital system in southern California.
The rise in ambulance traffic from the border, which several officials described to CNN, is a symptom of the pandemic's spread in the region -- and a sign of the many connections between communities in both countries.
"There just is not a wall for viruses at the border," says Josiah Heyman, director of the Center for Inter-American and Border Studies at the University of Texas at El Paso. "The wall is an illusion, because the two sides are really woven together."
An increase in cross-border coronavirus cases, which began getting public attention in May, overwhelmed some California hospitals and spurred the state to create a new patient transfer system to help.
"It's an unprecedented surge across the border," says Carmela Coyle, president and CEO of the California Hospital Association.
In the past five weeks, more than 500 patients have been transferred to hospitals across the state from California's Imperial County, which has the state's highest per capita rate of coronavirus cases -- and, according to officials, has seen a large number of patients crossing from Mexico.
But Van Gorder, Coyle and other officials in California say this isn't an immigration issue.
Most of the coronavirus patients crossing the border, they say, are Americans.
In a call with state hospital leaders earlier this month, the head of California's emergency medical services authority, Dr. David Duncan, described the steady stream of patients coming to Imperial County as "gas on the fire."
"We've got this continual flow of Covid coming across the border in the form of US citizens that carry and continue to escalate and fuel the Covid pressures that we see," Duncan said.
The view from the border
Officials estimate about a quarter of a million US citizens live across the border in the Mexican state of Baja California. Many work in the US and have family members there. Some regularly go to US hospitals when they need medical attention. Others decided to cross this time because Mexican hospitals were overwhelmed by a crush of coronavirus cases.
"What has happened as the situation has worsened on the Mexican side of the line is that a number of the US citizens are returning to the United States to seek care for Covid-19," says Coyle of the California Hospital Association.
Sergio A. Beltrn, US Customs and Border Protection's officer in charge for the Calexico ports of entry, said in a statement to CNN that he started to see an increasing flow of people coming across the border for medical care a few months ago.
"While it varies from day to day, and shift to shift, we have experienced a significant increase in medical-related calls at the Calexico ports of entry that can be directly linked to the COVID-19 pandemic over the last couple of months," he said. "We're definitely seeing people on a daily basis. And we still have our regular medical-related calls that aren't COVID-related from people in accidents or having other medical issues and are coming for medical treatment in the US."
Sometimes people walk to the port of entry or drive themselves to the border crossing, then call for an ambulance to get them to a US medical facility when they arrive. And sometimes, he said, travelers arrive at the border in Mexican ambulances and have already arranged for US ambulances to meet them there.
What happened in California hospitals as more coronavirus patients crossed
At El Centro Regional Medical Center in Imperial County, coronavirus cases started to climb in early May as the situation across the border in Mexicali worsened, says Adolphe Edward, the hospital's CEO.
"That uptick just took a fast, escalating move," Edward says.
At one point that month, the 161-bed hospital saw so many coronavirus cases that it had to stop accepting any new patients in its emergency room.
Edward says he heard first-hand from his own staff one reason the numbers were going up.
"I've got over 60 staff members that travel back and forth every day. They live in Mexicali, but they come to work here," he says. "They told me it took Mexicali a while to get to the point where they put (social distancing) restrictions. I think that's one reason why the number is as high as it is now."
About 90 miles to the west, Scripps Mercy Hospital Chula Vista, which is across the border from Tijuana, was also seeing cases starting to climb.
Officials began tracking the travel histories of patients there, and quickly spotted a trend: Many had recently been in Mexico.
"About half the patients that are testing positive are indicating they've crossed the border within the previous week," Van Gorder says.
"The patients that cross the border appear to be sicker than the patients that we've normally been seeing," he says. "It may be that they waited in Mexico too long, or they went to a Mexican hospital and decided to get their care here."
'It's almost like a waterfall cascading'
The flow of patients across the border has been steady for weeks, says Coyle of the California Hospital Association. And now hospitals across the state -- including as far north as Sacramento -- are taking in coronavirus patients from Imperial County as part of a new patient transfer system set up to ease the pressure, Coyle said.
A challenge across the region, she says, is that so many patients are sick with the same condition, requiring the same equipment for treatment, at the same time.
"That is what driving the shortages of service and supply in Mexicali, driving these expats back to the United States and then driving a very unique movement of patients into and more broadly across the state of California," she says. "It's almost like a waterfall cascading."
Van Gorder says he's concerned that officials are moving too quickly towards reopening.
"We still don't have our arms completely around Covid and the Covid spread," he says. "And as a border community, I think we have a double risk."
What's happening in other parts of the border
Heyman, of the University of Texas at El Paso, says there's one thing that's important to remember about coronavirus -- and other issues -- along the vast US-Mexico border.
"The two sides can't be kept separate," he says. "If there's a problem on one side of the border, it flows to the other side."
In earlier days of the pandemic, Mexican officials expressed concern about travelers from the US bringing coronavirus into the country.
"I don't know what they thought they were doing," says Arturo Garino, the mayor of the sister city on the US side of the border, Nogales, Arizona. But Garino says he's concerned about the flow of people traveling across the border, too.
While coronavirus cases are surging, particularly in two Arizona counties along the border -- Santa Cruz and Yuma -- Garino says officials haven't pinpointed the cause.
"It has to do a lot with social distancing. It has to do a lot with gatherings," he says. "And I know a lot of residents here go into Mexico and vice versa."
Garino, who recently signed an order requiring people in his city to wear masks in public places, says he's worried about the frequent cross-border travel that's a part of daily life there intensifying the spread of the virus.
"I'm concerned because of the spike in cases that we have," he says. "We're trying to do our best to curb this virus, and we continuously keep on going up and up and up."
CNN's Cheri Mossburg contributed to this report.
The F.B.I. has issued a warning about scammers who advertise fraudulent Covid-19 antibody tests as a way to obtain personal information that can be used for identity theft or medical insurance fraud.
The warning, issued Friday, is the latest in a series of alerts from the federal government about fraudulent exploitation of the coronavirus pandemic.
Scammers are advertising the fake or unapproved tests which could provide false results online, through social media or email, or in person or over the phone, the F.B.I. said. They could claim that the tests were approved by the Food and Drug Administration, as well as advertise free Covid-19 antibody tests or provide incentives for testing.
The Federal Bureau of Investigation recommends that those looking to take an antibody test which is used to determine whether a person has had the coronavirus consult a list of tests and testing companies that the Food and Drug Administration has approved. These tests have been evaluated in a study performed at the National Institutes of Healths cancer institute or by another F.D.A. designated government agency.
People should also consult with their primary care physician before taking any Covid-19 antibody test at home, the F.B.I. says. It also warned against sharing personal or health information with anyone who is not a known and trusted medical professional, as well as checking medical bills for suspicious claims and reporting those claims to health insurance providers.
Among the methods fraudulent marketers use to obtain crucial personal information is calling people and telling them that theyre working with the government or that government officials are requiring them to take a Covid-19 antibody test. They sometimes also offer to perform the test for cash.
The goal is to seek personal data, like a persons name, date of birth, Social Security number, Medicare and health insurance information. This can later be used for identity theft or medical insurance fraud.
The fraudulent tests, the authorities say, are just another way for scammers to capitalize on peoples fear and uncertainty from the coronavirus pandemic.
Last Wednesday, the Federal Trade Commission warned of scammers pretending to be contact tracers. In early June, the Internal Revenue Service alerted people about fraud surrounding government stimulus coronavirus payments.
Back in April, the F.B.I. issued a similar warning related to Covid-19 testing and scammers looking to sell false coronavirus cures, treatments and vaccines. Federal officials also warned last week about fake cards that were being sold that claimed to exempt people from wearing face masks.
