Category: Corona Virus

Covid-19 symptoms vary widely, and undertesting in many countries means that many people may have already had the coronavirus without having received a positive diagnosis. Is it possible to find out, and how should you behave if you think you may have been infected?

Dr William Hillmann: Antibody tests are being developed but are not in widespread clinical use yet. The antibody testing would allow us to check blood samples for antibodies against coronavirus to tell whether somebody has had it. I, and I think many others, are anxiously awaiting for those to become available.

Hillmann: Coronavirus is actually quite a significant spectrum of symptoms, from people who are entirely asymptomatic and would have no idea that they have it to people with very mild, cold-like symptoms runny nose, congestion, sore throat to people with more flu-like symptoms high fevers, muscle aches, shortness of breath and cough. Loss of smell and taste are also symptoms. All the way up to people with severe illness, who were seeing in the hospital with respiratory failure, requiring ICU care.

Its impossible right now to say what the true prevalence of the disease in the US is since we are still prioritizing testing for people who are sick or in the hospital or who are healthcare workers. Were not doing widespread testing that South Korea and some European countries have done to get a sense of how many people are asymptomatic or have such minimal symptoms that they attribute it to allergies or something else.

Hillmann: A significant proportion of people who are totally asymptomatic are contagious for some portion of time. We just dont know [for how long] at this point, because we dont have the kind of testing available to screen for asymptomatic infections.

When people are symptomatic, theyre contagious. A day or two before they become symptomatic, theyre likely contagious as well. A virus builds up and starts to shed, and then after symptoms resolve, people can still be contagious for a couple of days. We have some evidence of viral shed even a couple of weeks after symptoms are resolved. Its hard to know if thats actual live virus, which is still able to infect somebody, or if thats just dead virus that the body is shedding.

Dr David Buchholz: We all have to be role models. If were all in it together, we all should be doing social distancing.

Hillmann: Since theres no real way to know at this point who might have had it, unless youre symptomatic, you get a swab and are definitively diagnosed with it, I would just act as if you hadnt had it. Keep doing all of those things that we all should be doing at this point: social distancing and hand hygiene. I think universal mask-wearing in public is a reasonable recommendation based on what we know about the wide spectrum of symptoms, and the fact that people can be asymptomatic and still be shedding the virus.

Buchholz: I would, absolutely. Im in New York, and it was definitely in the community before we knew it. So, yeah, any family members and close friends, maybe somebody you work next to, I think I would just alert them, especially if it was in the last 14 days. If its been more than 14 days, they would have gotten sick by now if they had significant exposure.

Hillmann: Its up to every individual about what they feel is right. That being said, with the surge in infections that were seeing in places like New York, if you were symptomatic at one point but were not tested, and you were in close contact with somebody, I think you should tell them.

Buchholz: Theres not been any evidence that anyones gotten it more than once. Someone with a normal immune system that can react to the virus and get better should have immunity for quite some time, at least a year, if not lifelong.

There have been reports out of China suggesting people are testing positive for Covid-19 a second time. Most scientists think it is an issue around the inaccuracy of the testing and not that people are having two separate cases of the disease.

Experts

Dr David Buchholz, senior founding medical director, primary care, assistant professor of pediatrics, Columbia University Irving medical center

Dr William Hillmann, associate inpatient physician director at Massachusetts general hospital

Due to the unprecedented and ongoing nature of the coronavirus outbreak, this article is being regularly updated to ensure that it reflects the current situation at the date of publication. Any significant corrections made to this or previous versions of the article will continue to be footnoted in line with Guardian editorial policy.

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Have I already had coronavirus? How would I know and what should I do? - The Guardian

As of noon Sunday, April 12, 2020, there were at least 901 documented cases of the novel coronavirus in Long Beach-area communities, according to the Los Angeles County Department of Public Health.

Totals for Long Beach are provided by the citys health department. The rest are from LA County.

Between Thursday and Sunday, there were 129 new cases in Long Beach-area communities.

The Long Beach-area communities with the most cases of COVID-19 are the city of Long Beach with 350, Downey with 101, and South Gate with 96.

MAP: This map shows how coronavirus has struck much of LA County

Outside of the Long Beach area, communities in the South Bay have a total of 1,059 cases.

There could be more cases in any of these areas. The county is still investigating 688 possible COVID-19 cases and hasnt yet released information on where those patients live in the county.

And due to the limited availability of COVID-19 tests, officials have said there are many more people infected with the novel coronavirus than are represented in these numbers.

As of noon Sunday across Los Angeles County, the health departments of LA County and the cities of Pasadena and Long Beach have recorded 9,210 confirmed cases of COVID-19, the disease caused by the novel coronavirus.

Of the 9,210 patients with positive COVID-19 tests, 2,246 have been hospitalized.

There have been 302 deaths in the county due to the virus.

For complete totals, check the health departments coronavirus location page at http://publichealth.lacounty.gov/media/Coronavirus/locations.htm and the Pasadena and Long Beach health department sites.

April 9, 2020: 772 coronavirus cases in the Long Beach area

April 8, 2020: 716 coronavirus cases in the Long Beach area

April 7, 2020: 652 coronavirus cases in the Long Beach area

April 5, 2020: 533 coronavirus cases in the Long Beach area

April 2, 2020: 308 coronavirus cases in the Long Beach area

April 1, 2020: 275 coronavirus cases in the Long Beach area

March 31, 2020: 245 coronavirus cases in the Long Beach area

March 30, 2020: 207 coronavirus cases in the Long Beach area

March 27, 2020: 121 coronavirus cases in the Long Beach area

March 25, 2020: 65 coronavirus cases in the Long Beach area

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901 coronavirus cases in the Long Beach area: Which communities have the most? - Long Beach Press Telegram

Many Americans have been living under lockdown for a month or more. Were all getting antsy. The president is talking about a light at the end of the tunnel. People are looking for hope and reasons to plan a return to something anything approximating normalcy. Experts are starting to speculate on what lifting restrictions will look like. Despite the relentless, heroic work of doctors and scientists around the world, theres so much we dont know.

We dont know how many people have been infected with Covid-19.

We dont know the full range of symptoms.

We dont always know why some infections develop into severe disease.

We dont know the full range of risk factors.

We dont know exactly how deadly the disease is.

We dont have answers to more detailed questions about how the virus spreads, including: How many virus particles does it even take to launch an infection? How far does the virus travel in outdoor spaces, or in indoor settings? Have these airborne movements affected the course of the pandemic?

We dont know for sure how this coronavirus first emerged.

We dont know how much China has concealed the extent of the coronavirus outbreak in that country.

We dont know what percentage of adults are asymptomatic. Or what percentage of children are asymptomatic.

We dont know for certain if the virus will subside as the Northern Hemisphere enters the warmer months of spring and summer, as other viruses do. The director of the Centers for Disease Control and Prevention is bullish. Other experts, not so much.

We dont know the strength and duration of immunity. Though people who recover from Covid-19 likely have some degree of immunity for some period of time, the specifics are unknown.

We dont yet know why some whove been diagnosed as fully recovered from the virus have tested positive a second time after leaving quarantine.

We dont know why some recovered patients have low levels of antibodies.

We dont know the long-term health effects of a severe Covid-19 infection. What are the consequences to the lungs of those who survive intensive care?

We dont yet know if any treatments are truly effective. While there are many therapies in trials, there are no clinically proven therapies aside from supportive care.

We dont know for certain if the virus was in the United States before the first documented case.

We dont know when supply chains will strengthen to provide health care workers with enough masks, gowns and face shields to protect them.

In America, we dont know the full extent to which black people are disproportionately suffering. Fewer than a dozen states have published data on the race and ethnic patterns of Covid-19.

We dont know if people will continue to adhere to social distancing guidelines once infections go down.

We dont know when states will be able to test everyone who has symptoms.

We dont know if the United States could ever deploy the number of tests as many as 22 million per day needed to implement mass testing and quarantining.

We dont know when well be able implement full-scale serological testing.

We dont know if full-scale serological testing will accurately determine immunity.

We dont know if we can implement test and trace contact tracing at scale.

We dont know whether smartphone location tracking could be implemented without destroying our privacy.

We dont know if or when researchers will develop a successful vaccine.

We dont know how many vaccines can be deployed and administered in the first months after a vaccine becomes available.

We dont know how a vaccine will be administered who will get it first?

We dont know if a vaccine will be free or costly.

We dont know if a vaccine will need to be updated every year.

We dont know how, when we do open things up again, we will do it.

We dont know if people will be afraid to gather in crowds.

We dont know if people will be too eager to gather in crowds.

We dont know what socially distanced professional sports will look like.

We dont know what socially distanced workplaces will look like.

We dont know what socially distanced bars and restaurants will look like.

We dont know when schools will reopen.

We dont know what a general election in a pandemic will look like.

We dont know what effects lost school time will have on children.

We dont know if the United Statess current and future government stimulus will stave off an economic collapse.

We dont know whether the economy will bounce back in the form of a v curve

Or whether itll be a long recession.

Or whether itll be a Great Depression.

Or whether itll be a Greater Depression.

We dont know when we might be able to return to a new normal.

We dont know when any of this will end for good.

There is, at present, no plan from the Trump White House on the way forward.

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What We Don't Know About the Coronavirus - The New York Times

The men who beat Mehboob Ali did so without mercy. Dragging him to a field in the village of Harewali, on the fringes of north-west Delhi, the group hit him with sticks and shoes until he bled from his nose and ears. Ali was a Muslim, recently returned home from a religious gathering, and the Hindu mob was quite certain he was part of a so-called Islamic conspiracy to spread coronavirus to Hindus nationwide. His attackers believed the devout 22-year-old must be punished before he carried out corona jihad.

The allegations were entirely false, but according to video footage and his family, the men who beat Ali on 5 April were in little doubt of his guilt, demanding: Tell us who else is behind this conspiracy. Ali was then taken to a nearby Hindu temple and told to renounce Islam and convert to Hinduism before they would allow him to go to hospital.

Five days after the attack Alis family was still in fear of also being accused of spreading the virus. If we file a police case, the Hindus will not let us live in the village, said one family member, who asked not to be named. Police confirmed that due to his attendance at a Muslim convention in Bhopal a few weeks back, Ali was being held in the isolation ward of Lok Nayak Jai Prakash Narayan hospital in Delhi as a corona suspect, though he had no symptoms.

The attack on Ali is symptomatic of the growing demonisation of Indias Muslim community, who are being accused, without any basis, of conducting a malevolent campaign to spread Covid-19 to the Hindu majority.

Already a minority under attack it is just weeks since Hindu mobs attacked Muslims in religious riots in Delhi Muslims have now seen their businesses across India boycotted, volunteers distributing rations called coronavirus terrorists, and others accused of spitting in food and infecting water supplies with the virus. Posters have appeared barring Muslims from entering certain neighbourhoods in states as far apart as Delhi, Karnataka, Telangana and Madhya Pradesh.

The troubles began when the gathering of an Islamic missionary organisation, Tablighi Jamaat, held in mid-March in the south Delhi neighbourhood of Nizamuddin, was singled out by police and government as being responsible for the spread of coronavirus across India. The convention, which had been given the go-ahead by the Delhi authorities, was attended by about 8,000 people, including hundreds of foreigners. It soon became apparent that many at the convention had unknowingly picked up Covid-19 and brought it back to towns and villages across India.

Across the country, police were ordered to round up anyone associated with the organisation. So far, more than 27,000 Tablighi Jamaat members and their contacts have been quarantined in about 15 states. In Uttar Pradesh, the police offered up to 10,000 rupees (105) for information on anyone who had attended the gathering.

In a statement this week, the Indian Scientists Response to Covid-19 group said the available data does not support the speculation that the blame for the coronavirus epidemic in India lies mainly with Tablighi Jamaat. The scientists emphasised that while testing for coronavirus is extremely low across India, a disproportionate number have been of members of Tablighi Jamaat, as per a government order, therefore heavily skewing the figures.

Yet the test results were swiftly seized upon by members of the ruling ruling Hindu nationalist Bharatiya Janata party (BJP), who claimed Tablighi Jamaat members had intended to infect millions as part of an Islamic conspiracy and were carrying out corona terrorism.

Senior BJP leaders accused Tablighi Jamaat of carrying out a Talibani crime, described their members as human bombs, but in the guise of coronavirus patients, and called for Tablighi Jamaat leaders to be both hanged and shot. Kapil Mishra, a local BJP leader notorious for hate speeches, tweeted: Tablighi Jamaat people have begun spitting on the doctors and other health workers. Its clear, their aim is to infect as many people as possible with coronavirus and kill them.

Though quickly debunked, the rumours of Tablighi Jamaat members refusing to go into quarantine, assaulting hospital staff and throwing bottles of urine at Hindus quickly spread.

Hashtags such as coronaJihad, CoronaTerrorism and CoronaBombsTablighi began to trend on Twitter in India. Mainstream Indian media repeatedly asserted that Tablighi Jamaat members were coronavirus superspreaders.

Dr Zafarul-Islam Khan, chairman of the Delhi Minorities Commission, said that while Tablighi Jamaat had been shortsighted in holding the convention, there were dozens of examples of government, political parties and other religious groups who also flouted the coronavirus restrictions and gathered in large numbers.

He added: But the whole focus is being directed only on Muslims. In the past few days, we have noted a new wave of attacks on Muslims across the country. There is talk of social boycott of Muslims, harassment of Muslims by Hindutva groups and Muslims are even being harassed by police in various areas.

There has been a concentration of attacks against Muslims in Karnataka, where a BJP MP, Anant Kumar Hegde, has denounced Tablighi Jamaat as terrorists. Shortly after, an audio clip began to be shared widely over WhatsApp, urging people not to allow Muslim fruit and vegetable sellers into their areas, claiming they were spreading the virus through their produce.

Sayed Tabrez, 23, and his mother, Zareen Taj, 39, were among seven Muslim volunteers who were assaulted by a gang of local BJP members on 4 and 6 April, as they tried to distribute food to impoverished people in the Marathahalli and Dasarahalli districts of Karnataka.

Some 20 local BJP members came on motorbikes and started shouting at us, saying, You are not allowed to give out rations you are Muslims so you all are terrorists spreading the disease. We know you are spitting in the rations and have come from Tablighi Jamaat to spread the virus, said Tabrez. Two days later, about 25 local BJP members followed them in vehicles before attacking Tabrez, his mother and the other volunteers with bats. Police have since arrested two people.

It is not an isolated incident. Manohar Elavarthy of the NGO Swaraj Abhiyan, which has been distributing lockdown rations, said dozens of attacks had been carried out against their Muslim volunteers in the past few days, including some by police.

In Mangalore this week, posters started appearing that said Muslims were no longer allowed in certain neighbourhoods. No Muslim trader will be allowed access to our hometown until the coronavirus is completely gone, read a sign in Alape. In the Hindu-dominated village of Ankanahalli, a video seen by the Guardian shows Mahesh, the village panchayat president, issuing a warning that if any Hindu in the village is caught fraternising with a Muslim you will be fined 500 to 1,000 rupees.

The hijacking of coronavirus as an excuse for discrimination comes after a growing state-sponsored campaign to turn Muslims into second-class citizens in India, as part of the BJPs agenda of Hindu nationalism. Attacks on Muslims have become commonplace and the recent citizenship amendment act, passed by the BJP in December, prompted millions to take to the streets in protest, saying it discriminated against Muslims.

The situation got so bad last week that it prompted Equality Labs, a US-based south Asian human rights organisation researching Islamophobic hate speech, to release a statement urging the World Health Organization to issue further guidelines against Covid-19 hate speech and disconnect it to religious communities.

Just weeks after the Delhi pogrom where hundreds of Muslim houses and shops were vandalised, an uptick in misinformation and harmful communal language are leading to violence, said Equality Labs executive director, Thenmozhi Soundararajan. The threat of another pogrom still looms.

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Coronavirus conspiracy theories targeting Muslims spread in India - The Guardian

AMSTERDAM For tulip growers in the Netherlands, Friday the 13th of March this year was a true horror show. When tulip stems came up at the countrys largest flower market in Aalsmeer, the prices stalled over and over again at zero.

Frank Uittenbogaard, a director of JUB Holland, a 110-year-old family farm in Noordwijkerhout, made the tough decision to destroy his tulip stems 200,000 of them.

That hurt a lot, he said in a telephone interview on Thursday. Its very painful because you start in July with digging the bulbs and you have to give them the right treatment to plant them in October, and later move them to the greenhouse. We had very good quality tulips this year. I took my bike and went cycling when they did it because I couldnt handle it.

He wasnt the only grower who had to dump tulips: About 400 million flowers, including 140 million tulip stems, were destroyed over the past month, estimates Fred van Tol, manager of international sales for Royal FloraHolland, the largest cooperation of flower and plant producers in the Netherlands.

Demand for tulips dropped precipitously as flower shops around the globe have shut down because of the outbreak, consumers have gone into lockdown and celebrations have been canceled.

This virus hit us right in the middle of the tulip sales, Mr. van Tol said. In total, four weeks out, the turnover is still 50 percent lower than last year.

Usually, the period from March through May including the weeks in which International Womens Day, Easter and Mothers Day fall is the Dutch flower industrys strongest season. It pulls in 7 billion euros ($7.6 billion), with an average of $30 million in flowers sold daily. Tulip growers put their wares up for sale starting in March, when the flowers begin to bloom. Tulip season usually lasts about eight weeks.

Some parts of the industry have been hit harder than others because of the coronavirus outbreak, said Mr. van Tol, depending on the market that producers or distributors serve, with losses from about 10 percent up to about 85 percent.

The Netherlands, which has recorded more than 24,400 coronavirus cases and 2,643 deaths, has put in place a moderate social policy to combat the spread of the virus without going into a full lockdown. Schools, restaurants, bars, museums, sports facilities and gyms are closed until April 28. Most events of more than 30 people have been banned until June 1.

Small shops, however, such as florists and garden shops, can remain open as long as customers maintain a social distance of 1.5 meters (just under 5 feet) from each other and shop employees.

While growers and distributors that primarily serve the local market are still able to sell flowers and plants domestically, those flower businesses that rely on international trade are worse off.

Jan de Boer, the general director and owner of Barendsen, a global flower export company based in the Dutch village of Aalsmeer, said that he had lost 90 percent of his seasonal revenues so far. He typically has 60 full-time employees this time of year, and now, he says, he has work for only six. The Dutch government is paying those salaries, he said, so that hasnt hurt his business for the moment.

What is my biggest problem? he said. My client Viking River Cruises is not going to have one American customer on a boat this year. I will lose all of the business with them, so for me thats half a million or a million euros.

He has also lost all business to countries where florists are closed, including Italy, Spain and France.

At the same time, millions of visitors who trek annually to the blooming tulip fields in the flower-growing region of Lisse have canceled trips, and the effects have rippled out to related businesses. The Keukenhof, the largest flower park in the Netherlands, typically welcomes 1.5 million visitors a year during its eight-week opening that coincides with the blooming of the tulips.

But this year, because of the governments anti-coronavirus measures, the park has been shut down from its scheduled opening day, March 21, until its scheduled closing date, May 10. That will cost it an estimated $25 million in revenues.

Nature doesnt listen to all the regulations, said Bart Siemerink, managing director of the Keukenhof. We have a splendid spring in the Netherlands, and now the park is really looking beautiful. Were doing our best to bring that to people stuck at home.

People can still view the untrammeled gardens online, via Keukenhof Virtually Open, until the flowers bloom again next year.

The 25 staff gardeners, meanwhile, continue to maintain the park. Mr. de Boer said he expected Dutch flowers to bounce back.

Im optimistic because people will always need flowers, to connect, to be together, to tell a story, he said. Im optimistic about the flowers, but Im not optimistic about how to finance the gap. If you cant make up for the losses, youre out of the game. So I will do my utmost to survive.

Its more than money, he added. Its a passion.

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Where Have 140 Million Dutch Tulips Gone? Crushed by the Coronavirus - The New York Times

K.J. Seung is surprised to be hiring and training new workers in Boston.

His public health nonprofit, Partners in Health, specializes in helping the poorest people in developing nations tracking down contacts of Ebola patients in Liberia and Sierra Leone; running child health and HIV clinics in Haiti; and operating tuberculosis control programs in Peru. But now it is advertising for 500 people to help do whats known as contact tracing to try to control Covid-19 in Massachusetts.

Its the first step in the next stage of fighting the pandemic. Boston-based Partners in Health has trained 12,000 community health workers in countries including Malawi, Mexico, and Rwanda and now it will help train a battalion of workers in Massachusetts to interview everyone diagnosed with Covid-19 and find other people who may have been infected by them. This old-fashioned, shoe-leather public health approach contained the SARS outbreak in 2003 and 2004, and public health experts agree it will be vital to eventual control of the new disease.

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We never thought we would be doing this kind of work here, Seung, senior health and policy adviser for tuberculosis at Partners In Health, told STAT. We never thought we would be in a once-in-100-year pandemic, either.

Combined with more widespread testing, contact tracing is seen as an essential part of the strategy for keeping the coronavirus in check after the first wave recedes and the economy reopens. But the work is highly labor-intensive, and public health departments across the U.S. have been woefully underfunded for years.

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This is going to test the capacity of the existing public health system, said Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials. I dont know if we have enough staff in public health departments to do that.

Hence the hiring spree kicking off in Massachusetts and a few other places.

Partners in Health is working with state officials in Massachusetts, who say they will eventually deploy nearly 1,000 people to do contact tracing.

In San Francisco this weekend, three dozen volunteer nurses, medical students, and librarians started training at the University of California, San Francisco the first of an expected 100 people who will supplement the citys 10-person contact-tracing workforce.

We are providing the people to make phone calls, we are working on standard scripts, we are working on IT solutions, training, and we are fielding teams of contact tracers, said George Rutherford, UCSFs head of disease and global epidemiology.

This will be the only way to contain further spread of Covid-19 once the initial surge is past, and get into the suppression phase, argues Tom Frieden, a former director of the Centers for Disease Control and Prevention. We need an army of 300,000 people, he told STAT.

The current CDC director, Robert Redfield, said last week that a substantial expansion of public health fieldworkers will be needed to undertake aggressive contact tracing what I call block and tackle.

Speaking to NPR on Thursday, he said it would be premature to say how CDC would expand contact tracing but that planning was far along.

But Frieden said he doubted the federal government would help much immediately. Until the federal response is more coherent, each state is going to be on its own, he said.

Normally, the CDC would be taking the lead, Plescia added. Right now, they are pretty maxed out. It is the state and local governments who will have to train people and have a system that works.

The $2 trillion stimulus package signed into law last month creates a $150 billion Coronavirus Relief Fund for states and local and tribal governments, plus gives $4.3 billion via the CDC to help in responding to the pandemic. The money is not earmarked for epidemiology but states could, in theory, use some of the money for hiring workers to do contact tracing.

It will require a much larger effort than the mass deployment that eventually conquered SARS.

Unlike SARS, Covid-19 has spread easily and quickly from person to person. It took SARS more than a year to infect 8,000 people, killing close to 800 of them. Since December, Covid-19 has been diagnosed in more than in the United States alone.

We are going to have to handle it with an extreme amount of effort, said Frieden, who is now president and CEO of the nonprofit Resolve to Save Lives. I think of it as a four key actions: test, isolate the infected, contact trace, and then follow up the contacts. And each of those four things needs to be going really, really well and at a massive scale.

Right now, countries, cities, and states are struggling just to treat the onslaught of Covid-19 patients. Most are relying on shelter-in-place, stay-at-home, and social isolation orders to prevent spread. The idea is to bend the curve of infection, spreading out new infections over a greater time so that hospitals and clinics can cope better.

But bending the curve doesnt mean transmission will stop. Only a small percentage of the population anywhere will have been infected and presumably immune in the coming months, Frieden noted.

We are not going to get herd immunity soon, he said. It will come back. Even in the worst hot spots, only 5% to 10% of people will have been infected.

A usable vaccine is likely a year or longer from the market, and groups are only beginning to test potential treatments. Until we develop a vaccine or viable treatment strategy, ongoing testing, isolation, monitoring, and contact tracing will be a necessary to contain the epidemic and prevent another spike, Plescia said.

So Frieden and others are pressing for an army of public health workers armed with diagnostic tests to track down every case quickly.

We are going to have to be able to test every patient with pneumonia in the country within minutes or hours, Frieden said.

The concept is once you get down to a manageable number of cases and scale up the public health system, then you will be able to pounce on any case or cluster to proactively identify cases, identify contacts, and follow up on those contacts. And when you get those things done, you can prevent the clusters from becoming outbreaks, prevent outbreaks from becoming epidemics, and prevent the epidemics from driving us into our homes again.

This approach may have helped Hong Kong and South Korea get a quick handle on their epidemics, said David Holtgrave, dean of the School of Public Health at the University at Albany in New York.

They didnt do so much of physical distancing by shutting down whole cities and whole regions. They did more in the way of using testing data and contact tracing data to see who should be quarantining themselves or isolating themselves, Holtgrave said.

David Harvey, executive director of the National Coalition of STD Directors, has seen a steady drop in the number of staff in state and local health agencies trained to track down contacts of patients with sexually transmitted diseases, even as STD rates have soared. These same workers would have been immediately available to work on coronavirus. Now states will have to hire a fresh corps. We need to radically increase the numbers of these positions in order to help the country recover, he said.

Twenty years ago, this workforce had a high of 5,000 or 6,000 people, Harvey told STAT. Today it is only 1,600. The reality is that we at least need a work force of 30,000 people.

Frieden puts the needed number at 10 times that.

Luckily, potential workers are right at hand, with so many jobs lost to Covid-19 over the past weeks. There are a lot of people out there, Frieden said. There are college graduates, people working at social service agencies, social workers, child health workers, people doing Meals on Wheels.

Technology can help, and numerous apps are being developed to speed up the process of tracking down contacts. But public health experts said such tools wont eliminate the need for thousands of new workers.

Costs would be relatively low maybe $720 million for 30,000 workers, said Harvey.

States are not even close to having enough workers, and most state health departments contacted by STAT said they had not begun to think that far ahead. Florida, a state with the one of the smallest epidemiology work forces, hired 100 people in one weekend last month, according to the Tampa Bay Times.

Plus, there are other barriers, Holtgrave noted. To diagnose cases, many more tests are needed. And any in-person contact will require personal protective equipment, also in short supply.

Thats why Partners in Health plans to start workers out on the back end, interviewing patients who have already been diagnosed to find their contacts.

We are not knocking on doors, Seung said. People are working in their homes and they are making phone calls.

One piece of good news its not hard to find people who want to do the work. Seung says his office has received more than 5,000 applications for the 500 jobs.

People are really grasping to do something, he said.

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'We need an army': Hiring of coronavirus trackers is likely set to soar - STAT

A man runs over London's Millennium Bridge, as life in Britain continues during the nationwide lockdown to combat the coronavirus pandemic. Glyn Kirk/AFP via Getty Images hide caption

A man runs over London's Millennium Bridge, as life in Britain continues during the nationwide lockdown to combat the coronavirus pandemic.

On this broadcast of The National Conversation, an infectious disease expert answers your questions on the transmission and containment of the coronavirus. We'll also hear about the global fight against the pandemic and efforts to continue to slow the spread.

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Answering Your Coronavirus Questions: Transmission And The Global Fight - NPR

Comparing how the Covid-19 outbreak is playing out in Ireland and the UK is a complex task, researchers have said after a Twitter thread by a former historian on the issue went viral.

Writer and researcher Dr Elaine Doyle penned a series of tweets comparing the situations in the UK and Ireland, noting that both countries had similar numbers of intensive care beds per 100,000 people before the crisis began.

But, she wrote, as of Saturday 11 April, there have been 6.5 deaths per 100,000 people in Ireland. There have been 14.81 deaths per 100,000 people in the UK. Doyle went on to suggest that the difference in the way the pandemic is progressing in the two countries is that Ireland took stronger action sooner.

While Boris [Johnson] was telling the British people to wash their hands, our taoiseach was closing the schools. While Cheltenham was going ahead, and over 250,000 people were gathering in what would have been a massive super-spreader event, Ireland had cancelled St Patricks Day, she wrote, adding that watching British media was like living in bizarro-world compared with the messages on Irish TV news.

In the UK, the government urged against socialising, mass gathering and non-essential travel from 16 March and went into full lockdown on 23 March.

Technically, the UK went into lockdown *before* Ireland; but thats not a fair comparison, as we were already operating our delay phase from 12-27 March, Doyle wrote.

She also noted that, at the time of her post, figures suggested Ireland had performed 8.69 tests per 1,000 people, while the UK had performed four tests per 1,000 people with 269,598 people tested in total as of 11 April in the UK.

Dr William Hanage, an associate professor of epidemiology at Harvard University, said Doyle had made some good points, noting that he and many of his colleagues had been concerned about the UKs early response to coronavirus, but cautioned that it was still too early to draw definitive conclusions.

We are early on in the pandemic and it will remain to be seen how this will all pan out. However, it is unquestionable that major events such as the Cheltenham festival were major opportunities for super-spreading to occur, he told the Guardian. And the resulting surge can reasonably be expected to have been more severe than it would have been otherwise.

But Prof Sheila Bird, a former programme leader at the MRC Biostatistics Unit, stressed there were many factors to consider when attempting to compare countries, including whether deaths were reported in the same way, and whether delays in reporting deaths had been taken into account.

Third, she said, [is] urbanisation versus rurality of the respective populations 83% urban for UK, 63% for Ireland. In other words, a greater proportion of people in the UK live in towns or cities, which may contribute to the spread of a disease.

Bird said it was also important to consider how well people adhered to social distancing and lockdowns in different countries, while age was also a factor: older people are known to be at greater risk of death from Covid-19. In the UK, Bird noted, 18% of the population was aged 65 or older, compared with only 13% in Ireland.

Paul Hunter, a professor in medicine at the University of East Anglia, said the UK might have had proportionately more cases, which would mean more deaths. While he accepted that the later implementation of social distancing measures in the UK might have contributed to the different outcomes, he said there were other factors to consider, including that the UK had a higher proportion of people from BAME communities who have been found to be at higher risk from coronavirus and that the UK was also more densely populated, had many areas of high poverty, and hospitals in London were stretched.

Keith Neal, an emeritus professor in epidemiology of infectious diseases at the University of Nottingham, added that the UK probably encountered its first infections earlier.

The risk of introduction is related to the number of travellers coming back with an infection, he said. Although Ireland may have the same number of international travellers per head of population, your risk of first introductions is related to the number of travellers. The UK is 13 times larger in population than Ireland and London is much more of an international centre and hub than Dublin.

That, said Neal, could be significant: With doubling times of every two to three days, even a later introduction of the first infections by a week can have a very large effect.

Professor Samuel McConkey, an infectious disease expert at RCSI University of Medicine and Health Sciences in Dublin, said it was premature to compare Ireland and the UK. Id reserve judgment on this for two or three years, he said.

He said Irelands earlier adoption of restrictions, as well as Londons population density, may partly explain greater mortality rates in the UK. We closed restaurants, pubs, creches, schools weeks before the UK. We had quite significant political cohesion. We had our national leader tell us, folks this is really bad.

Sen LEstrange, a University College Dublin sociologist who has compared international testing figures, challenged Irelands claim to be in the top tier. Ireland claimed to follow South Koreas model of test, track, trace, isolate but was in fact uncomfortably close to countries most removed from the strategy, such as the UK, he said.

There are very clear differences between the ROI and UK responses. They are not, however, as large or as pronounced as Irish authorities imagine and would like its public to believe.

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Experts divided over comparison of UK and Ireland's coronavirus records - The Guardian

When will life return to normal, or at least a new normal? A major answer to the question of when and how Americans can return to public places like work and school could depend on something called an antibody test, a blood test that determines whether someone has ever been infected with the coronavirus.

People who are believed to be immune may be able to safely return to work. It would be especially important to know which health care workers are protected from getting infected and could continue to care for sick people.

The Centers for Disease Control and Prevention recently announced that it would begin using antibody tests to see what proportion of the population has already been infected. On Friday, the National Institutes of Health announced it would test 10,000 healthy volunteers around the country for the presence of antibodies.

Within a period of a week or so, we are going to have a rather large number of tests that are available, Dr. Anthony Fauci, the leading infectious disease expert in the U.S., said Friday morning on CNN.

He said the White House coronavirus task force was discussing the idea of certificates of immunity, which could be issued to people who had previously been infected.

As we get to the point of considering opening the country, Fauci said, it is very important to understand how much that virus has penetrated society. Immunity certificates, he said, had some merit under certain circumstances.

The idea of providing proof of immunity to allow workers to return to their jobs is being considered in many countries, including Britain and Italy. But as with any test, they are not perfect, and there have been problems with their accuracy.

Heres what we know and dont know about these tests.

What exactly is a serology test?

A serology test looks for signs of an immune response in this case, to the new coronavirus.

When your body encounters a virus, it takes some time for it to recognize the invader and begin to scale up an immune response. Immune molecules called antibodies are a crucial part of this response.

The first type of antibody to appear is called immunoglobulin M, or IgM, and its levels spike within a few days of infection. But IgM is a generic fighter. To target and destroy a specific virus, the body refines it into a second type of antibody, called immunoglobulin G, or IgG, that can recognize that virus.

As IgG levels rise, IgM levels drop; IgG levels peak around 28 days after the onset of infection.

There is a third type of antibody, called IgA, which is present in mucosal tissues like the inner lining of the lung. IgA is known to be important for fighting respiratory infections such as influenza and is likely to be central in coronavirus infections, too.

Many of the tests being developed look for levels of all three antibodies; some look for just IgM and IgG, and still others test for only one type.

What can these tests tell us? And what cant they?

Lets begin with what they cant tell us. Because the antibodies come up so late, these tests are not helpful for diagnosing an early infection. For that they are useless, said Dr. Florian Krammer, a virologist at the Icahn School of Medicine at Mount Sinai in New York.

The tests are more effective at detecting the presence of antibody responses across large numbers of people, not just to determine who is immune but how widely the virus has spread in the population.

Between 25 per cent and 50 per cent of people who become infected may never develop symptoms, and some may become only mildly ill. Others may have known they were sick but could not get tested. Serology tests would be able to identify these people and help scientists better estimate the death rate of COVID-19, the disease caused by the virus.

We dont currently have good numbers for the numbers of people who are infected now, much less people who were infected before who were never tested, said Dr. Angela Rasmussen, a virologist at Columbia University in New York. So its really important from an epidemiological perspective to do these types of serology assays.

Governments around the world are also hopeful that serology tests can tell them which people are protected from reinfection and can safely go back to work. Knowing the full scope of the pandemic would help them decide when to end social isolation measures and allow businesses and schools to reopen.

Tracking the rise and fall of antibody levels may also enable scientists to back-calculate the dates of infection and help them predict whether the virus shows seasonal fluctuations.

Im pretty sure I had the coronavirus already. Can I take a test and go back to work?

Not yet. Most of the tests being developed offer a simple yes-no answer to the question of who has antibodies and who was exposed to the virus. But simply having antibodies is no guarantee of immunity.

Being immune means that if youre exposed to the virus, your immune system will clear the virus out before it can establish a productive infection, Rasmussen said.

Some people because they had mild or no symptoms, for example might have developed antibodies that are too weak to prevent reinfection. Conversely, others who have low levels of IgG may still be protected.

Thats because antibodies are just one well-understood piece of the immune response. Immune cells called T-cells may also be involved. A lot less is known about how these different parts of the immune system work together to provide protective immunity, Rasmussen said.

Some tests, like one developed by Krammer, offer not just a yes-no answer but a clearer picture of the antibodies ability to neutralize the virus.

Plasma from people who have strong antibodies is being used to treat people who are unable to mount an immune response.

When will serology tests be widely available?

Some are already available and being used, but its the early days, and its unclear how good they are. Last week, the Food and Drug Administration granted an emergency use authorization to one such test. But others are being used in research projects and by hospitals.

But serological tests are plagued with issues, Rasmussen said, and problems are surfacing even as these tests proceed.

In the U.K., for example, the tests are plagued with false negatives (not picking up antibodies when theyre present) and with false positives (indicating antibodies when there are none). Some of the tests may not be specific enough to the new coronavirus; they may pick up a signal from antibodies made in response to infections with the coronaviruses that cause common colds.

False positives in particular are dangerous because they can lull people into believing they are immune when they are not and becoming exposed to the virus. Certainly if somebody thinks that theyre protected and theyre not, that would be a problem, Rasmussen said.

If someone is immune to the virus, how long will the immunity last?

We dont know. This is a new virus, and so we have no way of knowing exactly how long immunity to the virus will last. Our best guess comes from looking at its cousins, the common cold coronaviruses as well as the more dangerous ones that caused severe acute respiratory syndrome and Middle East respiratory syndrome. Immunity to these viruses persists anywhere from one to eight years.

The best way to find out, Krammer said, is to follow people with and without the antibodies and see when they might become re-infected. Those are the studies that are now needed, he said. They will take time.

Apoorva Mandavilli and Katie Thomas c.2020 The New York Times Company

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Will a Coronavirus Antibody Test Allow Us to Go Back to School or Work? - News18

I believe the last option is our best option. Heres what that will require from us:

The C.D.C. leads the world in the classic disease detective work that is needed to understand and contain Covid-19.

Yes, the agencys initial test kits failed. But for nearly two months C.D.C. has provided working tests to public health laboratories throughout the country; this doesnt meet the need for testing in local communities, doctors offices or hospitals. The White House, many parts of the federal government, and commercial labs and hospitals need to make testing much more widely available. In a structured response, one knowledgeable and trusted spokesperson would regularly provide systematic information not only on the number of tests but the actual turnaround time from test to results. Its now unacceptably slow in many areas.

In hospitals and communities, we are weeks if not months away from having sufficient test capacity. Testing for antibodies may help, particularly if people who recover from Covid-19 are immune from repeat infection and can safely work and travel. The C.D.C.s National Center for Immunization and Respiratory Diseases, which Dr. Messonnier leads, has the laboratories, epidemiologists and experience to help determine the accuracy, role and implications of antibody testing.

Health care workers are the front line of our response, and theyre being sickened in droves. C.D.C.s division of health care quality promotion has the worlds leading experts in health care safety. They can figure out how disease is spreading to these workers and collaborate with the Centers for Medicare and Medicaid Services and hospitals on how to stop it. They can also guide efforts to secure safe and attractive spaces to isolate infected people and others they may have infected if they dont require hospitalization and cannot be safely cared for at home.

The C.D.C. should also guide what must become a giant public health effort to trace and track contacts of Covid-19 patients. In Wuhan, China, there were 1,800 contact tracing teams of five people, each led by an epidemiologist. The U.S. equivalent would number 300,000, working in the communities they live in and led by public health specialists. Recruits could include Peace Corps volunteers who were brought home when the pandemic spread, furloughed public employees, phone bank staff (since so much tracing work is done by phone), workers from health organizations, social service and nonprofit agencies, and recent graduates. Community and religious organizations, Meals-on-Wheels programs, businesses and others are well placed to provide services for cases and contacts who must remain in isolation or quarantine.

If this sounds like assembling an army, it is. Dr. Robert Redfield, the C.D.C.s director, notes that the agency has begun this work, an encouraging sign. But the agency will need to accelerate its effort to establish the protocols, structure and supervision of this army and begin training the recruits now.

Disease surveillance is wartime intelligence, and C.D.C. conducts surveillance better than any other agency in the world. Its relevant centers, working with its Center for Surveillance, Epidemiology and Laboratory Services, began releasing more of this information recently, including emergency department visits, test results, hospitalizations and deaths. The C.D.C. needs to continuously improve the quality, geographic precision and timeliness of this information, including by publicly sharing data on emergency room visits an early indicator of changing disease rates.

The rest is here:

What the CDC Can Do to Slow the Coronavirus - The New York Times