The dire warning from Birx, a member of the White House coronavirus task force, is at odds with public comments made by President Donald Trump in the closing days of the presidential election, who is falsely claiming the US is “turning the corner” on the pandemic while pressuring Democratic governors to “open” their states despite surging cases nationwide.
“We are entering the most concerning and most deadly phase of this pandemic … leading to increasing mortality,” Birx wrote in an internal report Monday, obtained by the Post. “This is not about lockdowns — It hasn’t been about lockdowns since March or April. It’s about an aggressive balanced approach that is not being implemented.” “ (A)
“All pretense of Donald Trump getting along with Dr. Anthony Fauci, who has advised six presidents in his nearly four decade tenure as head of the National Institute of Allergy and Infectious Diseases, is gone after the president hinted that he may fire the long-serving official after the November 3 election at a rally Sunday.
At a packed Florida rally late Sunday night, the president’s fifth in as many states that day, Trump told supporters chanting “fire Fauci” to “wait until a little bit after the election,” hinting that he would soon fire the long-serving official.” (B)
“President Trump’s repeated assertions the United States is “rounding the turn” on the novel coronavirus have increasingly alarmed the government’s top health experts, who say the country is heading into a long and potentially deadly winter with an unprepared government unwilling to make tough choices.
“We’re in for a whole lot of hurt. It’s not a good situation,” Anthony S. Fauci, the country’s leading infectious-disease expert, said in a wide-ranging interview late Friday. “All the stars are aligned in the wrong place as you go into the fall and winter season, with people congregating at home indoors. You could not possibly be positioned more poorly.”” (C)
I’m old enough to remember the polio epidemic of the late 1940’s when Americans came fully together until a vaccine ended the public health crisis.
At its peak in the 1940s and 1950s, polio would paralyze or kill over half a million people worldwide every year. (R)
In 2009, a new H1N1 (“swine flu) influenza virus emerged, causing the first global flu pandemic in 40 years.
From April 12, 2009 to April 10, 2010, the CDC estimates there were 60.8 million cases, 274,304 hospitalizations, and 12,469 deaths in the United States due to the virus.
By April 21, 2009, CDC had begun working to develop a virus that could be used to make a vaccine to protect against the new virus. Following preparation for distribution beginning in June, the first doses were administered in October 2009. (S)
Again we all listened to the public health experts.
With the ominous threats of ZIKA and EBOLA , we were guided by the experts.
But with Coronavirus its politics v. science and if politics prevails or it becomes too late for science we will achieve herd immunity with terrifying consequences.
Here’s what the “battle” looks like today.
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“In a taped interview on April 18, Kushner told legendary journalist Bob Woodward that Trump was “getting the country back from the doctors” in what he called a “negotiated settlement.” Kushner also proclaimed that the U.S. was moving swiftly through the “panic phase” and “pain phase” of the pandemic and that the country was at the “beginning of the comeback phase.”
“That doesn’t mean there’s not still a lot of pain and there won’t be pain for a while, but that basically was, we’ve now put out rules to get back to work,” Kushner said. “Trump’s now back in charge. It’s not the doctors.” The statement reflected a political strategy. Instead of following the health experts’ advice, Trump and Kushner were focused on what would help the president on Election Day. By their calculations, Trump would be the “open-up president.”” (A)
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“More than one-third of healthcare workers hospitalized for COVID-19 were nurses, underscoring the need for continued infection prevention and control practices.
During the early months of the pandemic, nurses and nursing assistants were hit particularly hard, accounting for a large percentage of healthcare workers hospitalized with COVID-19, according to an analysis released by the CDC.
The CDC says it examined 6,760 adult hospitalizations from COVID-19 in 13 states from March to May and found that nearly 6% were healthcare workers.
Of those, 36% were in nursing-related occupations. Nearly 28% of hospitalized healthcare workers were admitted to an intensive care unit, 16% required invasive mechanical ventilation, and 4% died.
Ninety percent of healthcare workers hospitalized had at least underlying condition, according to the analysis.” (B)
“Healthcare workers and their families account for a sixth (17%) of hospital admissions for COVID-19 in the working age population (18-65 years), finds a study from Scotland published by The BMJ today.
Although hospital admission with COVID-19 in this age group was very low overall, the risk for healthcare workers and their families was higher compared with other working age adults, especially for those in “front door” patient facing roles such as paramedics and A&E department staff, say the researchers.
As such, they say these findings have implications for the safety and wellbeing of healthcare workers, and their households.
Many healthcare staff work in high-risk settings for contracting COVID-19 and transmitting it to their household, workplace contacts, or both. Yet the extent of these risks are not well understood, as studies are lacking or have been beset by quality issues…
However, patient-facing healthcare workers were three times more likely to be admitted to hospital for COVID-19, while members of their households were nearly twice as likely to be admitted to hospital for COVID-19 than other working age adults.
Those working in “front door” roles, such as paramedics and A&E department staff, were at the highest risk of hospital admission for COVID-19…” (C)
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“Doctors, nurses and caregivers at smaller and poorer hospitals and medical facilities across the country are still struggling to obtain the protective gear, personnel and resources they need to fight the coronavirus despite President Donald Trump’s repeated assertions that the problems are solved.
Health care workers at all types of facilities scrambled for scarce masks, gloves and other life-protecting gear at the beginning of the pandemic. The White House was letting states wage bidding wars against one another, rather than establish a central national manufacturing, supply and distribution chain.
But now, health care workers say a clear disparity has emerged and persisted. Larger and richer hospitals and practices outbid their smaller peers, sometimes for protective gear, sometimes to fill in staffing gaps. And some of those having the hardest time are precisely where the virus is spreading….
Months ago, city hospitals were fighting over essential medical supplies as Covid cases surged. That’s not happening anymore. But doctors, nurses and caregivers say they’re still struggling with resources.
Health care administrators say the smaller and poorer facilities are also being outbid in the labor market, as providers compete for a limited pool of trained nurses and specialists who can care for Covid-19 patients amid chronic staff shortages and pandemic-induced industry upheaval. Their descriptions illustrate the shortcomings of a federal response that was initially focused on major hospitals while scores of smaller providers fell through the cracks.
The resulting disparities, especially among long-term care providers who often continue to care for patients after they leave the hospital or whose patients don’t require hospitalization but are still infectious, puts an asterisk on Trump’s claim that “they’re very much stocked up, they’re in great shape,” as he put it at one of his recent briefings.
“There’s not a single building I work in that has adequate Covid-19 supplies,” said a nursing home worker in Colorado, who requested anonymity.
The challenges may persist. On Friday, the FDA included surgical gowns, gloves, masks, certain ventilators and various testing supplies on its list of medical devices in shortage, based on manufacturer reports. The agency has required companies to report potential supply disruptions since May under the CARES Act.
The shortages of personal protective gear, or PPE, has taken a toll. Without adequate protection against a contagious pathogen, thousands of health workers have fallen ill, and at least 922 have died, according to a 50-state tracking project by Kaiser Health News and the Guardian…
Health care leaders said these shortages stem from a mismatch of resources, as well as the pandemic’s shifting nature. While Congress made available $175 billion in coronavirus relief payments to help hospitals, doctors, nursing homes and other care providers, much of the initial funding went to well-resourced hospital systems regardless of need, with more targeted funding rounds coming later.
“Unfortunately, at every level of government, there has not been a coordinated response,” said Mark Parkinson, president and CEO of the American Health Care Association (AHCA) and National Center for Assisted Living. “And there have been some public health mistakes that were made. Early on, everyone thought that every hospital in the country was going to be overrun with Covid. So the decision was made to put all the resources in the hospitals.”
That’s not to say PPE shortages are completely resolved in hospitals. Some front-line workers, even at well-resourced hospitals, say ongoing shortages have forced them to clean and reuse masks and gowns that were intended for single use.” (D)
“For weeks, U.S. government officials and hospital executives have warned of a looming shortage of ventilators as the coronavirus pandemic descended.
But now, doctors are sounding an alarm about an unexpected and perhaps overlooked crisis: a surge in Covid-19 patients with kidney failure that is leading to shortages of machines, supplies and staff required for emergency dialysis.
In recent weeks, doctors on the front lines in intensive care units in New York and other hard-hit cities have learned that the coronavirus isn’t only a respiratory disease that has led to a crushing demand for ventilators.
The disease is also shutting down some patients’ kidneys, posing yet another series of life-and-death calculations for doctors who must ferry a limited supply of specialized dialysis machines from one patient in kidney failure to the next. All the while fearing they may not be able to hook up everyone in time to save them.
It is not yet known whether the kidneys are a major target of the virus, or whether they’re just one more organ falling victim as a patient’s ravaged body surrenders. Dialysis fills the vital roles the kidneys play, cleaning the blood of toxins, balancing essential components including electrolytes, keeping blood pressure in check and removing excess fluids. It can be a temporary measure while the kidneys recover, or it can be used long-term if they do not. Another unknown is whether the kidney damage caused by the virus is permanent….
Outside of New York, the growing demand nationwide for kidney treatments is fraying the most advanced care units in hospitals at emerging hot spots like Boston, Chicago, New Orleans and Detroit.
Kidney specialists now estimate that 20 percent to 40 percent of I.C.U. patients with the coronavirus suffered kidney failure and needed emergency dialysis, according to Dr. Alan Kliger, a nephrologist at Yale University School of Medicine who is co-chairman of a Covid-19 response team for the American Society of Nephrology…
The shortages involved not only the machines, but also fluids and other supplies needed for the dialysis regimen. Having enough trained nurses to provide the treatment has also been a bottleneck. Hospitals said they have called on the federal government to help prioritize equipment, supplies and personnel for the areas of the country that most need it, adding that manufacturers had not been fully responsive to the higher demand…
Some hospitals are also struggling to find enough nurses and technicians to provide dialysis, especially after some who were most skilled at providing the therapy fell sick with the virus themselves. “We did lose nurses to illness,” Dr. Murphy of Mount Sinai said. “We’re just getting some of those nurses back, but it’s been a challenge. We’ve exhausted every avenue that we have within the state with regards to being able to increase nursing.” (E)
“An ICU nurse in Las Vegas said that staffing levels at her small hospital fell noticeably while elective procedures were paused, and did not fully rebound when they resumed. She described the harrowing experience of caring for multiple unstable patients in the dead of night without the ability to call for backup because of thin staffing.
“The feeling you have when no one shows up to help you, it’s like ice in your veins, you never forget it,” she said. She added that while other nearby hospitals had bolstered nursing staff with $1,000 hiring bonuses, her workplace has not.
Adequate nurse staffing was already a contentious issue before the pandemic — for years, nursing unions have pushed for policies that mandate a minimum ratio of nurses-to-patients. California was the only state to enact such a mandate, but hospitals in the state since March have been able to apply for temporary waivers excusing them from the requirement…
Many hospitals that did have funds to hire nonetheless struggled to find staff with specialist training and experience dealing with a highly contagious respiratory disease.
“You have people going there that in many cases had literally no idea what they are doing,” said Sunny Jha, an anesthesiologist at the University of Southern California. “They’ve never worked in an ICU, they’ve never worked in a disaster field, they had never worked with Covid patients, and in some cases they had never worked period — this was their first job out of school.”” (F)
‘New Mexico hospitals face staffing shortages as COVID hospitalizations continue to rise
“What I’m told by the leaders of the university, Presbyterian, Lovelace, St. Vincent is that they really are facing staffing challenges right now,” Dr. Srase said.
Dr. Scrase said nursing staff levels dropped in late summer, but did not specify by how much.
“We all know that almost 1,000 New Mexicans have died, and most of them have died on the watch of these what I would call health care heroes in intensive care units, hospital floors that are taking care of these people— so, that takes a toll,” he said.
Dr. Scrase said he does not want to use field hospitals or the old Lovelace Hospital on Gibson because of staffing difficulties.
Amid the challenges at hospitals, Dr. Scrase also said New Mexico is seeing a record number of new cases across all age groups
“That’s particularly worrisome because it’s the 50 and older group that has a much higher hospitalization rate, and that’s where pressure comes in on hospital beds, ICU beds and staffing,” he said.” (G)
“COVID-19 cases are surging in rural places across the Mountain States and Midwest, and when it hits health care workers, ready reinforcements aren’t easy to find.
In Montana, pandemic-induced staffing shortages have shuttered a clinic in the state’s capital, led a northwestern regional hospital to ask employees exposed to COVID-19 to continue to work and emptied a health department 400 miles to the east.
“Just one more person out and we wouldn’t be able to keep the surgeries going,” said Dr. Shelly Harkins, chief medical officer of St. Peter’s Health in Helena, a city of roughly 32,000 where cases continue to spread. “When the virus is just all around you, it’s almost impossible to not be deemed a contact at some point. One case can take out a whole team of people in a blink of an eye.”
In North Dakota, where cases per resident are growing faster than any other state, hospitals may once again curtail elective surgeries and possibly seek government aid to hire more nurses if the situation gets worse, North Dakota Hospital Association President Tim Blasl said.
“How long can we run at this rate with the workforce that we have?” Blasl said. “You can have all the licensed beds you want, but if you don’t have anybody to staff those beds, it doesn’t do you any good.”
The northern Rocky Mountains, Great Plains and Upper Midwest are seeing the highest surge of COVID-19 cases in the nation, as some residents have ignored recommendations for curtailing the virus, such as wearing masks and avoiding large gatherings. Montana, Idaho, Utah, Wyoming, North Dakota, South Dakota, Nebraska, Iowa and Wisconsin have recently ranked among the top 10 U.S. states in confirmed cases per 100,000 residents over a seven-day period, according to an analysis by The New York Times.
Such coronavirus infections — and the quarantines that occur because of them — are exacerbating the health care worker shortage that existed in these states well before the pandemic. Unlike in the nation’s metropolitan hubs, these outbreaks are scattered across hundreds of miles. And even in these states’ biggest cities, the ranks of medical professionals are in short supply. Specialists and registered nurses are sometimes harder to track down than ventilators, N95 masks or hospital beds. Without enough care providers, patients may not be able to get the medical attention they need.
Hospitals have asked staffers to cover extra shifts and learn new skills. They have brought in temporary workers from other parts of the country and transferred some patients to less-crowded hospitals. But, at St. Peter’s Health, if the hospital’s one kidney doctor gets sick or is told to quarantine, Harkins doesn’t expect to find a backup.
“We make a point to not have excessive staff because we have an obligation to keep the cost of health care down for a community — we just don’t have a lot of slack in our rope,” Harkins said. “What we don’t account for is a mass exodus of staff for 14 days.”
Some hospitals are already at patient capacity or are nearly there. That’s not just because of the growing number of COVID-19 patients. Elective surgeries have resumed, and medical emergencies don’t pause for a pandemic.
Some Montana hospitals formed agreements with local affiliates early in the pandemic to share staff if one came up short. But now that the disease is spreading fast — and widely — the hope is that their needs don’t peak all at once.
Montana state officials keep a list of primarily in-state volunteer workers ready to travel to towns with shortages of contact tracers, nurses and more. But during a press conference on Oct. 15, Democratic Gov. Steve Bullock said the state had exhausted that database, and its nationwide request for National Guard medical staffing hadn’t brought in new workers…
Back in Helena, Harkins said St. Peter’s Health had to close a specialty outpatient clinic that treats chronic diseases for two weeks at the end of September because the entire staff had to quarantine.
Now the hospital is considering having doctors take turns spending a week working from home, so that if another wave of quarantines hits in the hospital, at least one untainted person can be brought back to work. But that won’t help for some specialties, like the hospital’s sole kidney doctor.
Every time Harkins’ phone rings, she said, she takes a breath and hopes it’s not another case that will force a whole division to close.
“Because I think immediately of the hundreds of people that need that service and won’t have it for 14 days,” she said.” (H)
“The healthcare industry, long challenged by a shortage of physicians, nurses and other well-qualified staff, is facing even more of a dire need to the COVID-19 pandemic.
A new challenge are disruptors that are looking at the same pool of talent. Companies that formerly represented no competition to healthcare organizations, such as Amazon, Uber and Apple, are now well integrated into the industry, and they’re targeting both future and current employees.
“This is why it’s imperative for organizations to create a culture and employee experience that negates expensive and time-consuming tasks that push your company out of the market,” said Chas Fields, a human capital management strategic advisor at Kronos in the HIMSS20 Digital session, “HCM for the modern workforce: Becoming the employer of choice.”
To prevent employee turnover and improve their commitment to the workplace, organizations must curate an exceptional employee experience, Fields said.
To do this, four challenges need to be addressed: the talent shortage, competition among workplaces, creating a culture that matters and disruptors to the industry.
Talent shortages are especially prevalent among nurses and physicians. In fact, 40% of registered nurses are over the age of 50, meaning they will soon retire. Many physicians are also close to retirement age, which adds to the shortage among workers.” (I)
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“Health policy specialists questioned White House officials’ claim that federal rules on essential workers allow Vice President Mike Pence to continue to campaign and not quarantine himself after being exposed to the coronavirus.
Campaigning is not an official duty that might fall under the guidelines meant to ensure that police, first responders and key transportation and food workers can still perform jobs that cannot be done remotely, the health experts said.
A Pence aide said Sunday that the vice president would continue to work and travel, including for campaigning, after his chief of staff and some other close contacts tested positive. Pence tested negative on Sunday and decided to keep traveling after consulting White House medical personnel, his aides said.
Pence’s chief of staff, Marc Short, was among those who tested positive. President Donald Trump, said early Sunday that Short was quarantining.
That usually means isolating oneself for 14 days after exposure in case an infection is developing, to prevent spreading the virus to others.
Pence was holding a rally Sunday in North Carolina, events in Minnesota and Pennsylvania on Monday and more events in North Carolina and South Carolina on Tuesday. The most recent numbers show COVID-19 cases are rising in 75% of the country.
On Sunday, National Security Advisor Robert O’Brien told reporters that Pence “is following all the rules” from federal health officials. He called Pence “an essential worker” and said, “essential workers going out and campaigning and voting are about as essential as things we can do as Americans.”
However, the guidelines on essential workers from the U.S. Centers for Disease Control and Prevention are aimed at folks like police, first responders and key transportation and food workers.
The Department of Homeland Security spells out 16 categories of critical infrastructure workers, including those at military bases, nuclear power sites, courthouses and public works facilities like dams and water plants.
“I don’t see campaigning on the list,” said Dr. Joshua Sharfstein, vice dean for public health practice at Johns Hopkins University and former Maryland state health department chief. “Anything that does not have to be done in person and anything not related to his job as vice president would not be considered essential.”..
If Pence’s official work as vice president was considered essential, the CDC guidelines say he should be closely monitored for COVID-19 symptoms, stay at least 6 feet from others and wear a mask “at all times while in the workplace.” (J)
“A man in the United States has caught Covid twice, with the second infection becoming far more dangerous than the first, doctors report.
The 25-year-old needed hospital treatment after his lungs could not get enough oxygen into his body.
Reinfections remain rare and he has now recovered.
But the study in the Lancet Infectious Diseases raises questions about how much immunity can be built up to the virus.
The man from Nevada had no known health problems or immune defects that would make him particularly vulnerable to Covid…
Scientists say the patient caught coronavirus twice, rather than the original infection becoming dormant and then bouncing back. A comparison of the genetic codes of the virus taken during each bout of symptoms showed they were too distinct to be caused by the same infection.
“Our findings signal that a previous infection may not necessarily protect against future infection,” said Dr Mark Pandori, from the University of Nevada.
“The possibility of reinfections could have significant implications for our understanding of Covid-19 immunity.”
He said even people who have recovered should continue to follow guidelines around social distancing, face masks and hand washing.
Scientists are still grappling with the thorny issue of coronavirus and immunity.
Does everyone become immune? Even people with very mild symptoms? How long does any protection last?
These are important questions for understanding how the virus will affect us long-term and may have implications for vaccines and ideas such as herd immunity.” (K)
“Cases of patients testing positive for both flu and COVID-19 have emerged in California and Tennessee as experts warn of a “twindemic” this winter….
In California, Solano County announced Thursday that its first resident had tested positive for COVID-19 and seasonal influenza at the same time. The patient is under age 65, the county said in a news release.
The case appears to be one of California’s first reported flu and COVID-19 co-infections this flu season.
Information about the interplay between influenza and COVID-19 remains limited because the latter is a novel virus, but both are respiratory diseases that weaken the immune system, especially in older adults, and each can result in hospitalization in severe cases.” (L)
“The shortage of medical equipment, including gowns and gloves, triggered by the coronavirus outbreak may be helping to spread dangerous germs within health care facilities, according to officials who warned of a potentially deadly fungus in a Los Angeles County health care facility.
L.A. County officials are warning about multiple reports of the fungus, known as Candida auris, in health care facilities; there is also an increase in reports of the fungus in Orange County.
At least one outbreak has been identified at a facility in L.A. County, according to an advisory, intended for health care professionals, issued by the Department of Public Health.
C. auris is a fungus that was first identified in 2009 in Japan but since has been declared by the U.S. Centers for Disease Control and Prevention a “serious global health threat.” The yeast “can cause bloodstream infections and even death, particularly in hospital and nursing home patients with serious medical problems,” the CDC said, noting that the fungus causes death in more than 1 in 3 patients who suffer from an invasive infection, such as one affecting the blood, heart or brain.
C. auris is considered particularly dangerous because antifungal medications are often ineffective against it. The fungus can live on surfaces for several weeks and can spread through hospitals and nursing homes by contact with infected people and contaminated surfaces and equipment.
The fungus can survive many routinely used disinfectants, county officials said.” (M)
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“Trump first said in a virtual Nevada tele-rally on Aug. 31 that the U.S. was “rounding the final turn” on the virus, repeating the line again at a Sep. 3 Pennsylvania rally “we are rounding that turn, and vaccines are coming along great.”
The biggest gap came when Trump contracted the virus himself at the beginning of October and briefly receded from public view, though he began saying it once again on Oct. 8.
“I say that all the time,” Trump said of the line earlier this month, calling those who disagree “cynics and angry partisans and professional pessimists,” and later declaring the U.S. is “rounding the turn with or without the vaccine,” even as the country reported a daily record of over 85,000 cases that day.
Trump has said the phrase every day for the last 15 days, even as daily average cases of the virus have risen sharply over the same period, hitting new records beyond the previous peak in July.
“Until November 4th., Fake News Media is going full on Covid, Covid, Covid,” Trump tweeted early Tuesday morning, adding “We are rounding the turn. 99.9%,” an incorrect reference to the survival rate of people who have contracted the disease, which has killed over 225,000 Americans, according to the CDC.
Trump has taken issue with using cases as a measure of the pandemic’s severity, arguing that increased testing accounts for the spike despite U.S. testing lagging compared to cases and deaths ticking up by 14% over the last 14 days, according to the New York Times.
The U.S. has since logged more than 43,000 deaths from the virus since Trump began saying the U.S. is “rounding the final turn” on Aug. 31, according to data from Johns Hopkins University’s Coronavirus Resource Center.
Trump has readily admitted his willingness to play down the realities of the pandemic to avoid panic, even if it means concealing the truth about its severity. After telling Washington Post reporter Bob Woodward in February the virus is “deadly stuff,” Trump nonetheless told him in March, “I wanted to always play it down. I still like playing it down, because I don’t want to create a panic.” (N)
“White House coronavirus coordinator Dr Deborah Birx has reportedly boycotted Donald Trump’s coronavirus task force due to misinformation.
The leading physician was said to have walked out of a meeting of the White House coronavirus task force this summer, and decided never to return again.
CNN reported that Dr Birx, who advised the US president over many months, decided to deliver messages directly to the public, in part due to the appointment of Dr Scott Atlas.
She told colleagues that she would side-step any meetings with Dr Atlas, a controversial White House adviser without any background in infectious diseases or public health.
Mr Trump appointed him to the coronavirus taskforce in August, after appearing on Fox News for several months to challenge lockdowns, masks and other preventative measures.
“I hate to use the term doctor shopping, but it almost feels like if this is what President Trump did until he found someone in the medical field that agrees with him,” said CNN’s Kate Bennett on the report.
Dr Atlas had suggested last week that masks did not work to control the coronavirus’s spread, in a Twitter post that was censored as misinformation.
He also previously said there was “zero reason to panic” when Mr Trump was hospitalised with Covid-19, and pushed a herd immunity approach to end the pandemic – in what experts predict would cause an exceptionally high death toll…
Dr Birx has reportedly travelled more than 20,000 miles and visited 40 states since August, conducting meetings with local health officials to advise on how to combat the pandemic.” (O)
“Dr. Deborah Birx emerged from a meeting at the White House one day in late summer with a new resolution: Never again would she sit in a meeting with Dr. Scott Atlas and listen to him pontificate on the pandemic. CNN’s Kate Bennett reports.” (P)
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“Hospitals in Utah are full and poised to start rationing care. They’re also filling up in Montana and Idaho. Colorado is trying to avoid those states’ fate.
As new COVID-19 cases surge across the country, hospitals in Rocky Mountain states are among those struggling to keep up. In Utah, hospital leaders have told the governor they’re on the cusp of rationing access to intensive care beds. Idaho and Montana doctors are having trouble finding places to treat infected patients. John Daley, reporter at Colorado Public Radio, is watching this unfold from Denver, joins us now to explain. And, John, I want to get right into that warning from Utah, which I think is very striking for people. What does it mean for hospitals to consider rationing care?
JOHN DALEY, BYLINE: Well, Audie, in Salt Lake, that means they’re approaching that point where the number of patients simply overwhelms the ability of providers to care for them as they normally would. The hospitals there say they’ve prepared what are called crisis standards of care. This is essentially an emergency triage type of posture where tough decisions would have to be made about who gets care. In practical terms, that’s essentially a system of grading patients, of rationing care based on things like age, overall health and ability to survive. Doctor Estelle Harris at the university hospital said Utah’s hospitals are now seeing five or six times more COVID-19 patients than a few months ago.
ESTELLE HARRIS: I do think that although we currently are operating over 100% capacity of our normal ICU beds with COVID, we do have some good plans in place if we have to use them. But that will come with an enormous strain on the COVID care providers.” (Q)
O.White House coronavirus adviser Dr Birx boycotting Covid task force over misinformation, by Gino Spocchia, https://www.bing.com/search?q=White+House+coronavirus+adviser+Dr+Birx+boycotting+Covid+task+force+over+misinformation&form=ANNNB1&refig=eadc81cd62f148108b8e558218acd80f&sp=-1&pq=&sc=8-0&qs=n&sk=&cvid=eadc81cd62f148108b8e558218acd80f
PART 1. January 21, 2020. CORONAVIRUS. “The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.”
PART 2. January 29, 2020. CORONAVIRUS. “If it’s not contained shortly, I think we are looking at a pandemic..”….. “With isolated cases of the dangerous new coronavirus cropping up in a number of states, public health officials say it is only a matter of time before the virus appears in New York City.”
PART3. February 3, 2020. “The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe…”..Trump appeared to downplay concerns about the flu-like virus …We’re gonna see what happens, but we did shut it down..” (D)
PART 4. February 9, 2020. Coronavirus. “A study published Friday in JAMA found that 41% of the first 138 patients diagnosed at one hospital in Wuhan, China, were presumed to be infected in that hospital.….
PART 5. February 12, 2020. CORONAVIRUS. “In short, shoe-leather public health and basic medical care—not miracle drugs—are generally what stop outbreaks of emerging infections..”
POST 6. February 18, 2020. Coronovirus. “Amid assurances that the (ocean liner) Westerdam was disease free, hundreds of people disembarked in Cambodia…” “ One was later found to be infected”…. “Over 1,000… passengers were in…transit home”…. “This could be a turning point””
PART 7. February 20, 2020. CORONAVIRUS. With SARS preparedness underway in NJ LibertyHealth/ Jersey City Medical Center, where I was President, proposed that our 100 bed community hospital with all single-bedded rooms, be immediately transformed into an EMERGENCY SARS ISOLATION Hospital.
PART 8. February 24, 2020. CORONAVIRUS. “…every country’s top priority should be to protect its health care workers. This is partly to ensure that hospitals themselves do not become sites where the coronavirus is spread more than it is contained.”
PART 9. February 27, 2020. CORONAVIRUS. Responding to a question about the likelihood of a U.S. outbreak, President Trump said, “I don’t think it’s inevitable…”It probably will. It possibly will,” he continued. “It could be at a very small level, or it could be at a larger level.”
Part 10. March 1, 2020. CORONAVIRUS. Stop Surprise Medical Bills for Coronavirus care. (&) Lessons Learned (or not) In California and Washington State from community acquired cases.
PART 11. March 5, 2020. CORONAVIRUS. “Gov. Andrew Cuomo… would require employers to pay workers and protect their jobs if they are quarantined because of the coronavirus.”
Part 12. March 10, 2020. CORONAVIRUS. “Tom Bossert, Donald Trump’s former homeland security advisor…(said) that due to the coronavirus outbreak, “We are 10 days from the hospitals getting creamed.”
Part 13.. March 14, 2020. CORONAVIRUS. “If I’m buying real estate in New York, I’ll listen to the President….If I’m asking about infectious diseases, I’m going to listen to Tony Fauci,”
PART 14. March 17, 2020. CORONAVIRUS. “ “Most physicians have never seen this level of angst and anxiety in their careers”…. One said “I am sort of a pariah in my family.”
PART 15. March 22, 2020. CORONAVIRUS. “…Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration….in a series of exercises that ran from last January to August.
PART 16. March 27, 2020. CORONAVIRUS. I am not a clinician or a medical ethicist but articles on Coronavirus patient triage started me Googling………to learn about FUTILE TREATMENT
PART 17. April 2, 2020. CORONAVIRUS. Florida allows churches to continue holding services. Gun stores deemed “essential.” “New York’s private and public hospitals unite to manage patient load and share resources.
PART 18. April 9, 2020. CORONAVIRUS. “The federal government’s emergency stockpile of personal protective equipment (PPE) is depleted, and states will not be receiving any more shipments, administration staff told a House panel.
PART 19. April 13, 2020 CORONOAVIRUS. “…overlooked in the United States’ halting mobilization against the novel coronavirus: the personal aides, hospice attendants, nurses and occupational or physical therapists who deliver medical or support services to patients in their homes.”
POST 22. April 29, 2020. CORONAVIRUS. ..the “ACS released a list of 10 issues that should be addressed before a healthcare organization resumes elective surgeries[JM1] ….”
POST 23. May 3, 2020. CORONAVIRUS. … what Dr. Fauci really wants,…”is just to go to a baseball game. That will have to wait. The level of testing for the virus is not adequate enough to allow for such mass gatherings.’ (K)
POST 24. May 7, 2020. CORONAVIRUS. Former New Jersey governor Chris Christie said: “there are going to be deaths no matter what”… but that people needed to get back to work.
POST 25. May 10, 2020, CORONAVIRUS. “It is scary to go to work,” said Kevin Hassett, a top economic adviser to the president. “I think that I’d be a lot safer if I was sitting at home than I would be going to the West Wing.”
POST 26. May 14, 2020. CORONAVIRUS, “Deep cleaning is not a scientific concept”….”there is no universal protocol for a “deep clean” to eradicate the coronavirus”
POST 27. May 19, 2020. CORONAVIRUS. “Hospital…executives…are taking pay cuts…to help offset the financial fallout from COVID-19.” As “front line” layoffs and furloughs accelerate…
POST 28. May 23, 2020. CORONAVIRUS. ““You’ve got to be kidding me,”..”How could the CDC make that mistake? This is a mess.” CDC conflates viral and antibody tests numbers.
PART 29. May 22, 2020. CORONAVIRUS. “The economy did not close down. It closed down for people who, frankly, had the luxury of staying home,” (Governor Cuomo). But not so for frontline workers!
POST 30. June 3,202. CORONAVIRUS. “The wave of mass protests across the United States will almost certainly set off new chains of infection for the novel coronavirus, experts say….
Post 32. June 16, 2020. CORONAVIRUS. Could the Trump administration be pursuing herd immunity by “inaction”? “ If Fauci didn’t exist, we’d have to invent him.”
POST 34. June 26, 2020. CORONAVIRUS. CDC Director Redfield… “the number of coronavirus infections…could be 10 times higher than the confirmed case count — a total of more than 20 million.” As Florida, Texas and Arizona become eipicenters!
POST 35. June 29, 2020. CORONAVIRUS. Pence: “We slowed the spread. We flattened the curve. We saved lives..” While Dr. Fauci “warned that outbreaks in the South and West could engulf the country…”
POST 36. July 2, 2020. CORONAVIRUS. “There’s just a handful of interventions proven to curb the spread of the coronavirus. One of them is contact tracing, and “it’s not going well,” (Dr. Anthony Fauci)..
POST 37. June 8, 2020. CORONAVIRUS. When “crews arrive at a hospital with a patient suspected of having COVID-19, the hospital may have a physical bed open for them, but not enough nurses or doctors to staff it.”
POST 38. July 15, 2020. CORONAVIRUS. Some Lessons Learned, or not. AdventHealth CEO Terry Shaw: I wouldn’t hesitate to go to Disney as a healthcare CEO — based on the fact that they’re working extremely hard to keep people safe,” (M)
POST 39. July, 23,2020. CORONAVIRUS. A Tale of Two Cities. Seattle becomes New York (rolls back reopening) while New York becomes Seattle (moves to partial phase 4 reopening)
POST 40. July 27, 2020. CORONAVIRUS.” One canon of medical practice is that you order a test only if you can act on the result. And with a turnaround time of a week or two, you cannot. What we have now is often not testing — it’s testing theater.”
POST 41. August 2, 2020. CORONAVIRUS. “Whenever a vaccine for the coronavirus becomes available, one thing is virtually certain: There won’t be enough to go around. That means there will be rationing.”
POST 44. September 1, 2020. CORONAVIRUS. “The CDC…modified its coronavirus testing guidelines…to exclude people who do not have symptoms of Covid-19.” (While Dr. Fauci was undergoing surgery.) A White House official said: “Everybody is going to catch this thing eventually..”
POST 45. September 9, 2020. CORONAVIRUS. Trump on Fauci. ‘You inherit a lot of people, and you have some you love, some you don’t. I like him. I don’t agree with him that often but I like him.’
POST 46. September 17, 2020. CORONAVIRUS. “Bill Gates used to think of the US Food and Drug Administration as the world’s premier public-health authority. Not anymore. And he doesn’t trust the Centers for Disease Control and Protection either….”
POST 47. September 24, 2020. CORONAVIRUS. “Perry N. Halkitis, dean of the School of Public Health at Rutgers University…called New York City’s 35 percent rate for eliciting contacts “very bad.” “For each person, you should be in touch with 75 percent of their contacts within a day,” he said”
POST 48. October 1, 2020. “…you can actually control the outbreak if you do the nonpharmaceutical interventions (social distancing and masks). In the United States we haven’t done them. We haven’t adhered to them; we’ve played with them.” (A)
POST 49. October 4, 2020. CORONAVIRUS. RAPID RESPONSE. “The possibility that the president and his White House entourage were traveling superspreaders is a nightmare scenario for officials in Minnesota, Ohio, New Jersey and Pennsylvania…”
POST 50. October 6, 2020. CORONAVIRUS. Monday October 5th will go down as one of the most fraught chapters in the history of American public Health (and national security).
POST 51. October 12, 2020. Rather than a hodge-podge of Emergency Use Authorizations, off-label “experimentation”, right-to-try arguments, and “politicized” compassionate use approvals maybe we need to designate REGIONAL EMERGING VIRUSES REFERRAL CENTERS (REVRCs).
POST 52. October 18, 2020. ZIKA/ EBOLA/ CANDIDA AURIS/ SEVERE FLU/ Tracking. “… if there was a severe flu pandemic, more than 33 million people could be killed across the world in 250 days… Boy, do we not have our act together.” —”- Bill Gates. July 1, 2018
POST 54. October 22, 2020. CORONAVIRUS. POST 54A. New Jersey’s Coronavirus response, led by Governor Murphy and Commissioner of Health Persichilli started with accelerated A+ traditional, evidence-based Public Health practices, developed over years of experience with seasonal flu, swine flu, Zika, and Ebola.
POST 55. October 26, 2020. CORONAVIRUS. The Testing Conundrum: “ It’s thus very possible to be antigen negative but P.C.R. positive, while still harboring the virus in the body..”
TWITTER @jonathan_metsch FACEBOOK Jonathan M. Metsch LINKEDIN Jonathan Metsch
#CoronavirusTracker #CoronavirusRapidResponse
I wouldn’t be surprised if a lot of people testing negative don’t even know which test they had and what that means for them.
An example of a best practice CDC recommends the following (U)
“Employees undergoing testing should receive clear information on:
the manufacturer and name of the test, the type of test, the purpose of the test, the reliability of the test, any limitations associated with the test, who will pay for the test, and how the test will be performed, and
how to understand what the results mean, actions associated with negative or positive results, who will receive the results, how the results may be used, and any consequences for declining to be tested.”
Let’s assume you’re just worried and have a choice between rapid, 15-minute tests and a PCR tests. Which should you get?
At the end of this POST see “Considerations for who should get tested?” and the link to the CDC CORONAVIRUS SELF-CHECKER
To read Posts 1-55 in chronological order, highlight and click on
The TV news shows very long lines of people in their cars, in line for Coronavirus testing. Is this “panic” testing, that is a rush to get tested without knowing which test is being given and is it the right one at the right time?
As part of my recent annual physical I had a Coronavirus test – SARS COV2 S1/S2 AB IGG. It was negative.
From “googling” I found that:
“Results are for the detection of SARS CoV-2 antibodies. IgG antibodies to SARS-CoV-2 are generally detectable in blood several days after initial infection, although the duration of time antibodies are present post-infection is not well characterized. Individuals may have detectable virus present for several weeks following seroconversion…
Negative results do not preclude acute SARS-CoV-2 infection. If acute infection is suspected, direct testing for SARSCoV-2 is necessary.
False positive results for LIAISON® SARS-CoV-2 S1/S2 IgG may occur due to cross-reactivity from pre-existing antibodies or other possible causes.” (A)
So the negative result didn’t give me any useful information. Best I could tell is I had no antibodies.
Next I tried to sort this all out….
“During a “town hall” in the White House Rose Garden aired on Thursday, the president was asked about the outbreak that’s resulted in the deaths of at least 221,000 Americans.
“With COVID, is there anything that you think you could have done differently, if you had a mulligan or a do-over of the way you handled it, what would it be?” asked Eric Bolling, the moderator for the pre-taped Sinclair Broadcasting Network event.
“Not much,” Trump shot back.
“Look, it’s all over the world, you have a lot of great leaders, a lot of smart people it’s all over the world,” he said, adding: “It came out of China. China should have stopped it.”” (R)
“President Donald Trump’s COVID-19 diagnosis is raising fresh questions about the White House’s strategy for testing and containing the virus for a president whose cavalier attitude about the coronavirus has persisted since it landed on American shores…
The Trump administration has increasingly pinned its coronavirus testing strategy for the nation on antigen tests, which do not need a traditional lab for processing and quickly return results to patients. But the results are less accurate than those of the slower PCR tests.
An early Abbott test used by the White House was plagued with problems, with multiple researchers finding that it was less accurate than rival companies’ tests in picking up positive cases. But the new antigen test the White House is using has not been independently evaluated for accuracy and reliability. Moreover, the Trump administration recently shipped antigen tests from Abbott and other manufacturers to thousands of nursing homes to test residents and staff.
Testing “isn’t a ‘get out of jail free card,’” said Dr. Alan Wells, medical director of clinical labs at the University of Pittsburgh Medical Center and creator of its test for the novel coronavirus. In general, antigen tests can miss up to half the cases that are detected by polymerase chain reaction tests, depending on the population of patients tested, he said.”” (B)
“In a flurry of memos released this week and last, the White House physician, Dr. Sean Conley, stated that President Trump no longer posed a transmission risk to others — an assessment, he noted, that was largely precipitated by the results of a bevy of “advanced diagnostics.” The declarations have helped clear Mr. Trump to return to the campaign trail, including a town-hall-style event hosted by NBC News on Thursday evening.
Outside experts have also said that Mr. Trump, who reportedly began feeling sick about two weeks ago, is probably no longer infectious. But most have based such assessments on the trajectory of the president’s symptoms — not the results of his tests.
There exists no test that can definitively determine whether someone who caught the coronavirus is still contagious. “We do not have a test for cure, and we do not have a test for infectiousness,” said Omai Garner, a clinical microbiologist at the University of California, Los Angeles.
Experts have criticized the administration’s overreliance on tests to keep the coronavirus out of Mr. Trump’s inner circle. Now, they said, the White House appears to be leaning too heavily on tests to break the president out of isolation.
Not all coronavirus tests are designed to detect the same parts of the virus. And a negative on one test does not necessarily guarantee a negative on another.
“We don’t just look at these tests in the context of ‘Coronavirus, yes or no,’” said Karissa Culbreath, a clinical microbiologist at TriCore Reference Laboratories in New Mexico. “Each test looks for a different aspect of the virus.”..
Guidelines published by the Centers for Disease Control and Prevention stipulate that symptoms — not test results — should be the primary motivator for ending a person’s isolation. People with mild or moderate Covid-19 should isolate for least 10 days after their symptoms start. That timeline could extend up to 20 days if their symptoms are severe.”(K)
“With nine days until Election Day, the White House again faces the coronavirus in its ranks.
Two top advisers to Vice President Pence have tested positive for the virus in recent days, as Pence — who tested negative on Saturday and Sunday — crisscrosses the country for rallies in swing states as he and President Trump fight to win reelection.
Marc Short, Pence’s chief of staff, tested positive for the coronavirus on Saturday.
Marty Obst, a Pence political adviser, has also tested positive for the virus, according to a person familiar with the matter who asked for anonymity on Sunday to discuss Obst’s health.
The White House says Pence will continue to campaign. He is expected to travel to North Carolina for a rally on Sunday. His wife, Karen, who also tested negative for the coronavirus on Sunday, is slated to travel to the state for a campaign event on Monday.
Short did not travel with Pence on Saturday to rallies in Lakeland and Tallahassee, Fla. Spokesman Devin O’Malley said Short “began quarantine” on Saturday and was “assisting in the contact tracing process.” Aides deemed to have had close contact with Short were pulled from the trip before departure, White House reporters who traveled with Pence were later told.
But Pence — who is considered to have had close contact with his most senior adviser — decided to “maintain his schedule in accordance with the CDC guidelines for essential personnel,” O’Malley said in a statement, noting that Pence had consulted with White House physicians.
The Centers for Disease Control and Prevention’s guidelines for essential workers who have had close contact with an infected person include wearing a mask for 14 days “at all times while in the workplace.”
Pence did not wear a mask at his outdoor rally.” (P)
“White House chief of staff Mark Meadows said Sunday that the US is “not going to control” the coronavirus pandemic, as cases surge across the country and nearly 225,000 Americans have died from the virus.
“We are not going to control the pandemic. We are going to control the fact that we get vaccines, therapeutics and other mitigation areas,” Meadows told CNN’s Jake Tapper on “State of the Union.”
At least 5 people in Pence’s orbit, including chief of staff Marc Short, are positive for coronavirus
Pressed by Tapper on why the US isn’t going to get the pandemic under control, Meadows said: “Because it is a contagious virus just like the flu.” He added that the Trump administration is “making efforts to contain it.”…
“What we need to do is make sure that we have the proper mitigation factors, whether it’s therapies or vaccines or treatments to make sure that people don’t die from this,” Meadows said.” (Q)
“There are two different types of tests – diagnostic tests and antibody tests.
A diagnostic test can show if you have an active coronavirus infection and should take steps to quarantine or isolate yourself from others. Currently there are two types of diagnostic tests which detect the virus – molecular tests, such as RT-PCR tests, that detect the virus’s genetic material, and antigen tests that detect specific proteins on the surface of the virus.
An antibody test looks for antibodies that are made by your immune system in response to a threat, such as a specific virus. Antibodies can help fight infections. Antibodies can take several days or weeks to develop after you have an infection and may stay in your blood for several weeks or more after recovery. Because of this, antibody tests should not be used to diagnose an active coronavirus infection. At this time researchers do not know if the presence of antibodies means that you are immune to the coronavirus in the future.” (C)
“How are COVID-19 tests used?
The RT-PCR, antigen, and other tests that are being developed to detect the presence of the virus can be used for diagnostic, screening, or surveillance purposes. Diagnostic tests are focused on the experience, needs, and history of a single individual and are often used for those with COVID-19 symptoms.
Diagnostic tests may also be used to detect the virus in people without symptoms (asymptomatic individuals), typically after exposure to an infected individual. When applied to a population without regard to exposure history, the tests are considered screening or surveillance tests, which are essential tools in controlling the virus’s spread. The Food and Drug Administration (FDA) has issued standards for when each of these terms should be used and the acceptable levels of sensitivity and specificity for each.
Diagnostic tests are intended to determine with a high level of confidence whether an individual is currently infected with the virus. These tests could be used for individuals who are suspected of having COVID-19 because of their symptoms, asymptomatic individuals who have been exposed to a confirmed case of COVID-19, or individuals in particularly high-risk groups who have participated in large gatherings. Diagnostic tests must demonstrate high sensitivity and high specificity, because the intent is to use those results to make treatment decisions or quarantine recommendations for individuals. Diagnostic tests may be ordered by a health care provider or obtained directly by an individual. Diagnostic tests must be run in a lab that has been certified by the Centers for Medicare & Medicaid Services to be able to run high-complexity tests.
Screening tests are given to asymptomatic individuals for the purpose of making decisions based on that person’s test results. Examples of common uses of screening tests include testing everyone in a nursing home, testing students upon their arrival on a college campus, or requiring a negative test before admitting someone back to an office. In screening tests, all individuals are often told of their results and those individuals who test positive for the virus are typically asked to take additional steps to protect their health and those around them through quarantine or other actions.
Surveillance testing refers to broad, typically nonidentified testing of populations to inform public health actions. Examples of surveillance testing include assaying wastewater or surfaces to detect presence of the virus or testing a large number of people and looking at aggregate results to determine the prevalence of the virus in a community. In true surveillance testing, there is usually no intention to return individual results to those tested.” (D)
“How do medical researchers’ measure the accuracy of these tests?
In the realm of science, there are several ways to evaluate the reliability of tests. Some of the most common metrics are called “Accuracy”, “Precision”, “Sensitivity(Recall)”, and “Specificity”….
A confusion matrix is a table to classify if a single test was accurate or not. The table is split into four grids —
A test accurately predicts if a person has coronavirus (TP)
A test accurately predicts if the person doesn’t have the coronavirus (TN)
A test falsely predicts if a person has coronavirus (FP)
A test falsely predicts if a person doesn’t have coronavirus (FN)…
Accuracy
Simply, accuracy answers out of all the people in the sample, how many people’s tests showed a correct result?
Precision
Precision helps you answer, out of the people that tested positive, how many of those people actually had the coronavirus?
Sensitivity aka Recall
Sensitivity/Recall helps you answer, out of people that had coronavirus, how many of those people tested positive?
Specificity
Specificity helps you answer, how well do you want the test to correctly predict that a person DOES NOT have the coronavirus?
Summary
These are all important questions medical decision-makers have to ask themselves. I’m not sure if all medical tests can be perfect, so if you start seeing news about how these tests are not working correctly. Look back at this article and try to guess what the medical researcher tried to optimize for. If I were a doctor, I would think recall is the most important one even if we have to optimize that metric at the expense of falsely positives — false test results that tell some healthy people they have the coronavirus. Also, news articles will start reporting accuracy numbers. Make sure to understand how reliable these tests are by doing some research yourself.” (E)
“In the high-stakes world of coronavirus testing, one mistake has taken center stage: the dreaded false negative, wherein a test mistakenly deems an infected person to be virus-free.
These troublesome results, experts have said, can deprive a person of treatment and embolden them to mingle with others, hastening the spread of disease.
But false negatives are not the only errors bedeviling coronavirus diagnostics. False positives, which incorrectly identify a healthy person as infected by the virus, can have serious consequences as well, especially in places where the virus is scarce….
Some rapid tests, which forgo sophisticated laboratory equipment and can deliver results in under an hour, have been criticized for returning high numbers of false positives, especially when used to screen people without symptoms. Even laboratory tests that rely on a very reliable technique called polymerase chain reaction, or P.C.R., have been known to return the occasional false positive…
A positive result on a coronavirus test sets off a cascade of consequences. According to guidelines published by the Centers for Disease Control and Prevention, people who test positive should immediately isolate for at least 10 days after their symptoms start (if they experience symptoms at all).
That is 10 days spent away from friends and family, and 10 days of potential productivity in a school or workplace lost….
False positives can also be disastrous from a treatment standpoint, said Linoj Samuel, a clinical microbiologist at Henry Ford Health System in Detroit. People with the flu or Covid-19, for example, often show similar symptoms, but may only be tested for one of them at a time. If a patient is given an incorrect diagnosis of Covid-19, that person could be deprived of treatment that could alleviate their illness, or be given a costly therapy that does little to speed their recovery.” (T)
“At the end of August, the US Food and Drug Administration (FDA) granted emergency-use approval to a new credit-card-sized testing device for the coronavirus that costs US$5, gives results in 15 minutes and doesn’t require a laboratory or a machine for processing. The United States is spending $760 million on 150 million of these tests from health-care company Abbott Laboratories, headquartered in Abbott Park, Illinois, which plans to ramp up production to 50 million per month in October…
Antigen assays are much faster and cheaper than the gold-standard tests that detect viral RNA using a technique called the polymerase chain reaction (PCR). But antigen tests aren’t as sensitive as the PCR versions, which can pick up minuscule amounts of the SARS-CoV-2 virus that causes COVID-19…
The high-sensitivity PCR tests are almost 100% accurate in spotting infected people, when they are administered properly. But such tests generally require trained personnel, specific reagents and expensive machines that take hours to provide results…
A typical antigen test starts with a health-care professional swabbing the back of a person’s nose or throat — although companies are developing kits that use saliva samples, which are easier and safer to collect than a swab. The sample is then mixed with a solution that breaks the virus open and frees specific viral proteins. The mix is added to a paper strip that contains an antibody tailored to bind to these proteins, if they’re present in the solution. A positive test result can be detected either as a fluorescent glow or as a dark band on the paper strip.
Antigen tests give results in less than 30 minutes, don’t have to be processed in a lab and are cheap to produce. Yet that speed comes with a cost in sensitivity. Whereas a typical PCR test can detect a single molecule of RNA in a microlitre of solution, antigen tests need a sample to contain thousands — probably tens of thousands — of virus particles per microlitre to produce a positive result1. So, if a person has low amounts of virus in their body, the test might give a false-negative result.” (F)
“People are getting the results of coronavirus tests in the U.S. faster than they were in the spring, but testing still takes far too long to help with effective disease control measures such as contact tracing and quarantining, according to the results of a large national survey…
Among that group, the average wait time for results was 2.7 days in September, down from four days in April, the researchers found. In addition, the proportion of people getting their results back within 24 hours increased from 23% to 37%.
While that’s an improvement, the turnaround time is still “too slow in most cases to support a successful strategy of contact tracing,” and most people are still waiting far too long, the researchers wrote…
To keep outbreaks from occurring, people who are infected need to be contacted quickly, ideally within 24-36 hours to make sure they don’t infect other people and find out who they may have come into contact with so those people can be told to quarantine and get tested.
In fact, only 56% of those who tested positive were contacted by a health worker to get contact tracing information, the researchers found…
The average person who got tested in the August and September surveys was tested within 2.5 days and waited 3.7 days for the results of the test. That means it took a total of 6.2 days between deciding on a test and receiving results, the researchers wrote.
“So even with the improvement in results, people are waiting about week. And by that point much of the harm that could occur in spreading through that person’s social network has already occurred,” Lazer says. “What you want to do is cut that to within 24 hours to 36 hours.”” (G)
“After struggling to ramp up coronavirus testing, the U.S. can now screen several million people daily, thanks to a growing supply of rapid tests. But the boom comes with a new challenge: keeping track of the results.
All U.S. testing sites are legally required to report their results, positive and negative, to public health agencies. But state health officials say many rapid tests are going unreported, which means some new COVID-19 infections may not be counted.
And the situation could get worse, experts say. The federal government is shipping more than 100 million of the newest rapid tests to states for use in public schools, assisted living centres and other new testing sites.
“Schools certainly don’t have the capacity to report these tests,” said Dr. Jeffrey Engel of the Council of State and Territorial Epidemiologists. “If it’s done at all it’s likely going to be paper-based, very slow and incomplete.”
Early in the outbreak, nearly all U.S. testing relied on genetic tests that could only be developed at high-tech laboratories. Even under the best circumstances, people had to wait about two to three days to get results. Experts pushed for more “point-of-care” rapid testing that could be done in doctors offices, clinics and other sites to quickly find people who are infected, get them into quarantine and stop the spread…
Large hospitals and laboratories electronically feed their results to state health departments, but there is no standardized way to report the rapid tests that are often done elsewhere. And state officials have often been unable to track where these tests are being shipped and whether results are being reported…
One of the challenges to an accurate count: States have wildly different approaches. Some states lump all types of tests together in one report, some don’t tabulate the quick antigen tests at all and others don’t publicize their system. Because antigen tests are more prone to false negatives and sometimes require retesting, most health experts say they should be recorded and analyzed separately. Currently only 10 states do that and post the results online, according to the COVID Tracking Project.
The federal government is allocating the tests to states based on their population, rather than helping them develop a strategy based on the size and severity of their outbreaks.
“That’s just lazy” said Dr. Michael Mina of Harvard University. “Most states won’t have the expertise to figure out how to use these most appropriately.”
Instead, Mina said the federal government should direct the limited supplies to key hot spots around the country, driving down infections in the hardest-hit communities. Keeping tighter control would also ensure test results are quickly reported.” (H)
“President Trump heralded new rapid coronavirus tests on Monday as game changers — fast, cheap and easy to use. But his administration’s deployment of the new tests to nursing homes has been plagued by poor communication, false results and a frustrating lack of planning, state leaders say.
Health officials in several states say they have been allowed no say in where the new tests are being sent and sometimes don’t know which nursing homes will receive them until the night before a shipment arrives. That has left some facilities ill-trained in how to use the tests and what to do with results. And it may be contributing to false-positive test results — when people are identified as being infected but aren’t.
The lack of federal planning also has left states with no standardized way to capture results from the new tests and include them in daily counts of infections and tests. Consequently, as the rapid tests become more widely distributed, the data and dashboards being used each day to guide the nation’s coronavirus response are becoming more inaccurate.
“This is data we need, and there’s just no way of capturing it,” Pennsylvania Health Secretary Rachel Levine said. “We need a reporting structure and not just hundreds of faxes being randomly sent from nursing homes and other facilities.”
Many states are trying to create their own way to capture and classify the new data. Epidemiologists say that piecemeal approach could result in differing data sets, making it harder to pinpoint where infections are growing most this winter when infections are expected to spike.
Fueling such problems, public health officials say, is the White House’s continued refusal to take responsibility for leading the country through the pandemic and to lay out an overarching strategy on testing, instead of repeatedly pushing that onus onto the states.
“It’s the utter lack of planning and guidance that’s creating problems,” said one state official, speaking on the condition of anonymity for fear that federal officials might retaliate by giving the state less aid. “Their approach is to just throw things over the fence to the states and to say, ‘Take this, and deal with the problem.’ ”…
Similarly, Giroir dismissed the lack of a standardized reporting system as a result of the administration moving swiftly to implement testing.
“If we wanted to get everything perfect, we would have waited months to do that. The important thing was to get these out to nursing homes now,” he said. “We’d rather save lives.”
On Monday, after receiving repeated complaints from state officials, the Trump administration said governors will be given more discretion to decide where future test shipments go…
Adding to the confusion, state officials say shipments have arrived with little guidance for those facilities about the circumstances in which the antigen tests can be used most effectively.
“There’s been little national guidance to say, ‘These are the best places to use them, this is what you do under various circumstances if you get positives and this is how to report the data,’ ” said Michael Fraser, chief executive of the Association of State and Territorial Health Officials, which represents state health departments. “We are still waiting to reach consensus on when and where health departments should use these tests.”..
That problem is likely to grow as the new rapid tests become more widely used in schools, doctor’s offices, workplaces and private businesses. Some states don’t report positive antigen test results, resulting in an incomplete portrait of the disease’s spread. Others have begun to categorize them as “probable” rather than confirmed infections.
Companies are developing antigen tests people can take at home. If they become widely available, Americans could administer the test themselves weekly or even daily, experts say. That could be a powerful weapon to stop transmission. But it would be a nightmare for recording data if a nationally standardized system is not established.
Without that data, the country would be flying blind as it navigates later stages of the pandemic, experts say…” (I)
“Twice a week, students at Williams College in Williamstown, Mass., go to a parking garage to blow their noses…
Once the testing site closes each day, Rita Coppola-Wallace , Williams’s executive director of planning, design and construction, gathers the bounty—up to 1,100 test tubes—and loads them into a waiting car. The samples are whisked off to Cambridge, Mass., 150 miles away, and processed alongside tens of thousands of others overnight at the Broad Institute of MIT and Harvard, a biomedical and genomics research center.
A primary reason many colleges in Massachusetts, New York, Maine and Vermont have experienced few coronavirus outbreaks this fall has been frequent, widespread testing. At 108 colleges and universities, that testing is being done within a carefully orchestrated system run by the Broad Institute.
The testing, along with strict, state-level quarantine orders and low levels of community spread in the region, has helped keep infection rates at schools working with Broad below 0.2%.” (J)
“However, Mara Aspinall, a biomedical diagnostics professor at Arizona State University’s College of Health Solutions, makes the case that the U.S. cannot break the chain of transmission if the coronavirus outpaces public health efforts.
What’s needed is a “paradigm shift from exquisitely accurate-but-slow tests to fast-and-good enough to quarantine,” she said. “Slow and accurate works for clinical management, but this virus is a sprinter not a marathoner. We need fast and frequent tests just to keep up.”
That approach has been endorsed by top U.S. health officials, including National Institutes of Health Director Francis Collins and federal testing czar Brett Giroir.
Earlier this month, FDA granted emergency use authorization to BD’s rapid, point-of-care coronavirus antigen test, making it only the second such diagnostic to receive a nod from the regulatory agency… (K)
When it comes to diagnostic testing, “easy, fast, and cheap” is also what the Rockefeller Foundation is advocating to bring tests to the U.S. market at a national scale needed to effectively respond to the pandemic. The organization envisions point-of-care antigen tests costing $5 to $10 per test, with same-day test results for schools and workplaces, and even faster turnaround times for mobile testing in communities.
“Today the country conducts almost zero such [screening] tests, and we need at least 25 million per week for schools, health facilities, and essential workers to function safely,” wrote Rajiv Shah, president of the Rockefeller Foundation, in the organization’s proposed national testing plan.
The U.S. will need at least another $75 billion in federal funding for testing to reach the plan’s goal of 30 million tests per week by October, including at least 25 million fast, inexpensive antigen tests for asymptomatic Americans, according to the Rockefeller Foundation…
However, the Rockefeller Foundation argues that despite testing advancements such as sample pooling, the commercial labs “cannot come close to fulfilling the nation’s screening test needs.”
Lab tests “aren’t convenient, simple, or inexpensive enough to use at the scale needed,” the report says, calling for a ramp-up in antigen testing in schools, offices and beyond.
The Rockefeller Foundation also believes it is critical for the U.S. to look beyond commercial laboratories such as LabCorp and Quest that are overwhelmed and tap the testing resources of other underutilized labs, recruiting academic and other labs.
However, time is of the essence, according to Shah. “We will soon enter a new cold and flu season with potentially 100 million cases of flu-like symptoms that stand to overwhelm our current testing capacity.”” (L)
Michael mina is a professor of epidemiology at Harvard, where he studies the diagnostic testing of infectious diseases. He has watched, with disgust and disbelief, as the United States has struggled for months to obtain enough tests to fight the coronavirus. In January, he assured a newspaper reporter that he had “absolute faith” in the ability of the Centers for Disease Control and Prevention to contain the virus. By early March, that conviction was in crisis. “The incompetence has really exceeded what anyone would expect,” he told The New York Times. His astonishment has only intensified since…
Why has testing failed so completely? By the end of March, Mina had identified a culprit: “There’s little ability for a central command unit to pool all the resources from around the country,” he said at a Harvard event. “We have no way to centralize things in this country short of declaring martial law.” It took several more months for him to find a solution to this problem, which is to circumvent it altogether. In the past several weeks, he has become an evangelist for a total revolution in how the U.S. controls the pandemic. Instead of restructuring daily life around the American way of testing, he argues, the country should build testing into the American way of life.
The wand that will accomplish this feat is a thin paper strip, no longer than a finger. It is a coronavirus test. Mina says that the U.S. should mass-produce these inexpensive and relatively insensitive tests—unlike other methods, they require only a saliva sample—in quantities of tens of millions a day. These tests, which can deliver a result in 15 minutes or less, should then become a ubiquitous part of daily life. Before anyone enters a school or an office, a movie theater or a Walmart, they must take one of these tests. Test negative, and you may enter the public space. Test positive, and you are sent home. In other words: Mina wants to test nearly everyone, nearly every day…
We must out-volume the virus, and what will matter is not the strength of any one individual ship, but the strength of the system it is part of. When the FDA regulates tests, though, it looks at the sensitivity and specificity of a single test—how well the test identifies illness in an individual—not at how the test is part of a testing regimen meant to protect society. For this reason, Mina proposes that the FDA make room for the CDC or the NIH to oversee the use of contagiousness tests. “I think the CDC could potentially create a certification process really simply. They are the public-health agency, and could say, ‘We will evaluate different manufacturers. None of these will be fully regulated by law, but here are the ones you should or should not choose.’”” (M)
The AAMC noted in July 2020, as daily cases were falling, that the United States would need to test at least 2.3 million people per day to decrease the rate of positive tests below 3%.3 Our failure to contain the spread of the virus in the first several months of the pandemic has resulted in a much higher number of tests needed now. The AAMC’s assertion that a pandemic response currently requires 9 million people per day to be tested represents an estimation of the need for immediate testing in the categories below…
Up to 800,000 diagnostic tests are needed for:
Each person who is symptomatic.
Close contacts of every positive case identified (whether symptomatic or asymptomatic).
Over 8 million screening tests are needed for:
Every person who enters a health care facility for an inpatient admission or outpatient surgery.
Routine testing of all health care providers in hospital settings.
Routine testing of first responders (law enforcement officers, paramedics, and EMTs).
Strategic sampling of residents in nursing homes and assisted living facilities.
Strategic sampling of incarcerated individuals.
Strategic sampling of residents and staff in homeless shelters.
Routine testing of every K-12 teacher.
Strategic sampling of K-12 students.
Strategic sampling of college and university students, faculty, and staff.
This is not an exhaustive list of the categories of individuals that should be routinely tested. Additional testing is needed for other essential workers and individuals such as contact tracers, delivery and retail personnel, employees of agricultural and meatpacking businesses, and public transportation employees…
Any testing approach must make a clear distinction between the number of tests needed to determine whether a specific person has COVID-19 for purposes of making further recommendations about that person’s health (diagnostic testing) and the number of tests needed to not only test asymptomatic individuals suspected of being exposed but also to test large numbers of people on a routine basis through screening and surveillance testing. As vaccination increases, those tests may shift to antibody testing to measure population-level immunity levels.
Strategic use of testing technologies means using the most appropriate tests for each purpose. In general, the more important it is to get accurate results for a single test, the more sensitive a test should be. Such tests are often, but not always, more costly and resource-intensive to run. The use of highly sensitive tests for surveillance purposes or less accurate tests for diagnostic or critical screening purposes could be misdirecting resources and could have negative impacts on individual or public health.” (N)
Fast at-home coronavirus tests could help bring the United States’ surging outbreak under control — if companies developing the tests can convince regulators that the public can be trusted to use them correctly.
Several firms are vying to be the first to market a test that Americans could buy over the counter with results delivered in minutes at a bedside or a breakfast table. That could allow people to screen themselves before heading to the office or school, relieving pressure on overburdened testing laboratories and quickly identifying new infections.
But concerns about the tests’ reliability, how consumers might react to their results and how public health departments will track them have slowed their development.
Companies formulating such tests say they won’t seek emergency authorization from the Food and Drug Administration until later this year or early next — in part because the agency wants them to prove that adults of different ages, education levels and English proficiency can successfully use their products.
Public health experts say FDA’s caution is warranted, because a test that’s unreliable or hard to use could help the virus spread. There is also a risk that many people will interpret a negative result as an all-clear; in reality, even the best test will produce some false negatives. And even a true negative does not guarantee that a person is not in the early stages of infection.
“If this was a disease that only impacted the individual, then it wouldn’t be such a problem,” said Georges Benjamin, executive director of the American Public Health Association. “The problem is that there will be a cohort of people who will take the test, find out that they are presumably negative, but they really weren’t, and go out and infect other people.”
A false negative result could be especially dangerous if “people use it to decide whether to go to parties,” said Heather Pierce, senior director for science policy at the Association of American Medical Colleges. “You’ve got infected people feeling like they have a passport to not engage in the other public health measures that we need to suppress the virus.”
False positive results are also a concern, because some people could isolate for up to two weeks, missing work or school for no reason. But that risk could be lowered with follow-up lab-based testing, and pales in comparison to at-home tests’ potential to prevent Covid-19 spread, said HHS testing czar Brett Giroir…
The agency said in July that any at-home test should be able to diagnose at least 90 percent of infections in people with and without symptoms, and should have a false positive rate of 1 percent or less. Companies must also prove to regulators that people will be able to perform the test on their own, without help from a health professional, and provide consumers clear information about when to use the tests and how to interpret the results…
FDA’s willingness to be flexible is welcome, but not enough, says Michael Mina, an epidemiologist at the Harvard T.H. Chan School of Public Health and a leading advocate for frequent, rapid testing. Mina says that at-home coronavirus testing should be used for surveillance — to detect new clusters of infection — but people should not rely solely on these tests to make medical decisions.
“We really need to have the FDA start to have a little bit of imagination with regard to how these tests are being evaluated,” Mina said. “We continue to see the FDA only approve tests through a clinical diagnostic lens.”
He said that positive results from at-home tests should be confirmed with a second test that uses a different approach to detect the virus — reducing the risk of false positives that could erode public confidence in at-home testing.
Another challenge for test developers is how to ensure results from at-home screening reach state and local health departments.
Automatic electronic reporting of results to public health authorities when an at-home test is run would be ideal, according to Mara Aspinall, a professor of biomedical diagnostics at Arizona State University. “We need to focus on as quickly as possible having that interconnectivity so that we can get an accurate count of both positives and negatives from these tests,” she said….(O)
Considerations for who should get tested (S)
People who have symptoms of COVID-19
People who have had close contact (within 6 feet of an infected person for a total of 15 minutes or more) with someone with confirmed COVID-19.
People who have been asked or referred to get testing by their healthcare provider, local
external icon or state health department.
Not everyone needs to be tested. If you do get tested, you should self-quarantine/isolate at home pending test results and follow the advice of your health care provider or a public health professional.
Coronavirus Self-Checker
Coronavirus Self-Checker is a tool to help you make decisions on when to seek testing and appropriate medical care.
Take steps to protect yourself
Whether you test positive or negative for COVID-19, you should take preventive measures to protect yourself and others.
How to get a viral test
A viral test checks samples to find out if you are currently infected with COVID-19. The time it takes to process these tests can vary.
You can visit your state or local health department’s website to look for the latest local information on testing.
If you have symptoms of COVID-19 and want to get tested, call your healthcare provider first.
If you have symptoms of COVID-19 and are not tested, it is important to stay home. Find out what to do if you are sick.
What to do after a viral test
To get your test result, please check with the group that performed your test, such as your healthcare provider or health department. How long it will take to get your test results depends on the test used.
If you test positive for COVID-19, know what protective steps to take if you are sick.
Most people have mild COVID-19 illness and can recover at home without medical care. Contact your healthcare provider if your symptoms are getting worse or if you have questions about your health.
If you test negative for COVID-19, you probably were not infected at the time your sample was collected. This does not mean you will not get sick:
A negative test result only means that you did not have COVID-19 at the time of testing or that your sample was collected too early in your infection.
You could also be exposed to COVID-19 after the test and then get infected and spread the virus to others.
If you have symptoms later, you may need another test to determine if you are infected with the virus that causes COVID-19.
Coronavirus Self-Checker
Updated Sept. 10, 2020
The Coronavirus Self-Checker is an interactive clinical assessment tool that will assist individuals ages 13 and older, and parents and caregivers of children ages 2 to 12 on deciding when to seek testing or medical care if they suspect they or someone they know has contracted COVID-19 or has come into close contact with someone who has COVID-19.
The online, mobile-friendly tool asks a series of questions, and based on the user’s responses, provides recommended actions and resources.
To get to the Coronavirus Self-Checker highlight and click on
PART 1. January 21, 2020. CORONAVIRUS. “The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.”
PART 2. January 29, 2020. CORONAVIRUS. “If it’s not contained shortly, I think we are looking at a pandemic..”….. “With isolated cases of the dangerous new coronavirus cropping up in a number of states, public health officials say it is only a matter of time before the virus appears in New York City.”
PART3. February 3, 2020. “The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe…”..Trump appeared to downplay concerns about the flu-like virus …We’re gonna see what happens, but we did shut it down..” (D)
PART 4. February 9, 2020. Coronavirus. “A study published Friday in JAMA found that 41% of the first 138 patients diagnosed at one hospital in Wuhan, China, were presumed to be infected in that hospital.….
PART 5. February 12, 2020. CORONAVIRUS. “In short, shoe-leather public health and basic medical care—not miracle drugs—are generally what stop outbreaks of emerging infections..”
POST 6. February 18, 2020. Coronovirus. “Amid assurances that the (ocean liner) Westerdam was disease free, hundreds of people disembarked in Cambodia…” “ One was later found to be infected”…. “Over 1,000… passengers were in…transit home”…. “This could be a turning point””
PART 7. February 20, 2020. CORONAVIRUS. With SARS preparedness underway in NJ LibertyHealth/ Jersey City Medical Center, where I was President, proposed that our 100 bed community hospital with all single-bedded rooms, be immediately transformed into an EMERGENCY SARS ISOLATION Hospital.
PART 8. February 24, 2020. CORONAVIRUS. “…every country’s top priority should be to protect its health care workers. This is partly to ensure that hospitals themselves do not become sites where the coronavirus is spread more than it is contained.”
PART 9. February 27, 2020. CORONAVIRUS. Responding to a question about the likelihood of a U.S. outbreak, President Trump said, “I don’t think it’s inevitable…”It probably will. It possibly will,” he continued. “It could be at a very small level, or it could be at a larger level.”
Part 10. March 1, 2020. CORONAVIRUS. Stop Surprise Medical Bills for Coronavirus care. (&) Lessons Learned (or not) In California and Washington State from community acquired cases.
PART 11. March 5, 2020. CORONAVIRUS. “Gov. Andrew Cuomo… would require employers to pay workers and protect their jobs if they are quarantined because of the coronavirus.”
Part 12. March 10, 2020. CORONAVIRUS. “Tom Bossert, Donald Trump’s former homeland security advisor…(said) that due to the coronavirus outbreak, “We are 10 days from the hospitals getting creamed.”
Part 13.. March 14, 2020. CORONAVIRUS. “If I’m buying real estate in New York, I’ll listen to the President….If I’m asking about infectious diseases, I’m going to listen to Tony Fauci,”
PART 14. March 17, 2020. CORONAVIRUS. “ “Most physicians have never seen this level of angst and anxiety in their careers”…. One said “I am sort of a pariah in my family.”
PART 15. March 22, 2020. CORONAVIRUS. “…Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration….in a series of exercises that ran from last January to August.
PART 16. March 27, 2020. CORONAVIRUS. I am not a clinician or a medical ethicist but articles on Coronavirus patient triage started me Googling………to learn about FUTILE TREATMENT
PART 17. April 2, 2020. CORONAVIRUS. Florida allows churches to continue holding services. Gun stores deemed “essential.” “New York’s private and public hospitals unite to manage patient load and share resources.
PART 18. April 9, 2020. CORONAVIRUS. “The federal government’s emergency stockpile of personal protective equipment (PPE) is depleted, and states will not be receiving any more shipments, administration staff told a House panel.
PART 19. April 13, 2020 CORONOAVIRUS. “…overlooked in the United States’ halting mobilization against the novel coronavirus: the personal aides, hospice attendants, nurses and occupational or physical therapists who deliver medical or support services to patients in their homes.”
POST 22. April 29, 2020. CORONAVIRUS. ..the “ACS released a list of 10 issues that should be addressed before a healthcare organization resumes elective surgeries[JM1] ….”
POST 23. May 3, 2020. CORONAVIRUS. … what Dr. Fauci really wants,…”is just to go to a baseball game. That will have to wait. The level of testing for the virus is not adequate enough to allow for such mass gatherings.’ (K)
POST 24. May 7, 2020. CORONAVIRUS. Former New Jersey governor Chris Christie said: “there are going to be deaths no matter what”… but that people needed to get back to work.
POST 25. May 10, 2020, CORONAVIRUS. “It is scary to go to work,” said Kevin Hassett, a top economic adviser to the president. “I think that I’d be a lot safer if I was sitting at home than I would be going to the West Wing.”
POST 26. May 14, 2020. CORONAVIRUS, “Deep cleaning is not a scientific concept”….”there is no universal protocol for a “deep clean” to eradicate the coronavirus”
POST 27. May 19, 2020. CORONAVIRUS. “Hospital…executives…are taking pay cuts…to help offset the financial fallout from COVID-19.” As “front line” layoffs and furloughs accelerate…
POST 28. May 23, 2020. CORONAVIRUS. ““You’ve got to be kidding me,”..”How could the CDC make that mistake? This is a mess.” CDC conflates viral and antibody tests numbers.
PART 29. May 22, 2020. CORONAVIRUS. “The economy did not close down. It closed down for people who, frankly, had the luxury of staying home,” (Governor Cuomo). But not so for frontline workers!
POST 30. June 3,202. CORONAVIRUS. “The wave of mass protests across the United States will almost certainly set off new chains of infection for the novel coronavirus, experts say….
Post 32. June 16, 2020. CORONAVIRUS. Could the Trump administration be pursuing herd immunity by “inaction”? “ If Fauci didn’t exist, we’d have to invent him.”
POST 34. June 26, 2020. CORONAVIRUS. CDC Director Redfield… “the number of coronavirus infections…could be 10 times higher than the confirmed case count — a total of more than 20 million.” As Florida, Texas and Arizona become eipicenters!
POST 35. June 29, 2020. CORONAVIRUS. Pence: “We slowed the spread. We flattened the curve. We saved lives..” While Dr. Fauci “warned that outbreaks in the South and West could engulf the country…”
POST 36. July 2, 2020. CORONAVIRUS. “There’s just a handful of interventions proven to curb the spread of the coronavirus. One of them is contact tracing, and “it’s not going well,” (Dr. Anthony Fauci)..
POST 37. June 8, 2020. CORONAVIRUS. When “crews arrive at a hospital with a patient suspected of having COVID-19, the hospital may have a physical bed open for them, but not enough nurses or doctors to staff it.”
POST 38. July 15, 2020. CORONAVIRUS. Some Lessons Learned, or not. AdventHealth CEO Terry Shaw: I wouldn’t hesitate to go to Disney as a healthcare CEO — based on the fact that they’re working extremely hard to keep people safe,” (M)
POST 39. July, 23,2020. CORONAVIRUS. A Tale of Two Cities. Seattle becomes New York (rolls back reopening) while New York becomes Seattle (moves to partial phase 4 reopening)
POST 40. July 27, 2020. CORONAVIRUS.” One canon of medical practice is that you order a test only if you can act on the result. And with a turnaround time of a week or two, you cannot. What we have now is often not testing — it’s testing theater.”
POST 41. August 2, 2020. CORONAVIRUS. “Whenever a vaccine for the coronavirus becomes available, one thing is virtually certain: There won’t be enough to go around. That means there will be rationing.”
POST 44. September 1, 2020. CORONAVIRUS. “The CDC…modified its coronavirus testing guidelines…to exclude people who do not have symptoms of Covid-19.” (While Dr. Fauci was undergoing surgery.) A White House official said: “Everybody is going to catch this thing eventually..”
POST 45. September 9, 2020. CORONAVIRUS. Trump on Fauci. ‘You inherit a lot of people, and you have some you love, some you don’t. I like him. I don’t agree with him that often but I like him.’
POST 46. September 17, 2020. CORONAVIRUS. “Bill Gates used to think of the US Food and Drug Administration as the world’s premier public-health authority. Not anymore. And he doesn’t trust the Centers for Disease Control and Protection either….”
POST 47. September 24, 2020. CORONAVIRUS. “Perry N. Halkitis, dean of the School of Public Health at Rutgers University…called New York City’s 35 percent rate for eliciting contacts “very bad.” “For each person, you should be in touch with 75 percent of their contacts within a day,” he said”
POST 48. October 1, 2020. “…you can actually control the outbreak if you do the nonpharmaceutical interventions (social distancing and masks). In the United States we haven’t done them. We haven’t adhered to them; we’ve played with them.” (A)
POST 49. October 4, 2020. CORONAVIRUS. RAPID RESPONSE. “The possibility that the president and his White House entourage were traveling superspreaders is a nightmare scenario for officials in Minnesota, Ohio, New Jersey and Pennsylvania…”
POST 50. October 6, 2020. CORONAVIRUS. Monday October 5th will go down as one of the most fraught chapters in the history of American public Health (and national security).
POST 51. October 12, 2020. Rather than a hodge-podge of Emergency Use Authorizations, off-label “experimentation”, right-to-try arguments, and “politicized” compassionate use approvals maybe we need to designate REGIONAL EMERGING VIRUSES REFERRAL CENTERS (REVRCs).
POST 52. October 18, 2020. ZIKA/ EBOLA/ CANDIDA AURIS/ SEVERE FLU/ Tracking. “… if there was a severe flu pandemic, more than 33 million people could be killed across the world in 250 days… Boy, do we not have our act together.” —”- Bill Gates. July 1, 2018
POST 54. October 22, 2020. CORONAVIRUS. POST 54A. New Jersey’s Coronavirus response, led by Governor Murphy and Commissioner of Health Persichilli started with accelerated A+ traditional, evidence-based Public Health practices, developed over years of experience with seasonal flu, swine flu, Zika, and Ebola.
POST 55. October 26, 2020. CORONAVIRUS. The Testing Conundrum: “ It’s thus very possible to be antigen negative but P.C.R. positive, while still harboring the virus in the body..”
TWITTER @jonathan_metsch FACEBOOK Jonathan M. Metsch LINKEDIN Jonathan Metsch
#CoronavirusTracker #CoronavirusRapidResponse
Followed by:
– immediate adherence to ever-evolving CDC and FDA guidelines.
– rapid implementation of Lessons Learned from the preceding New York experience.
– a mobile app, in collaboration with New York and Pennsylvania, that notifies users when they have been exposed to another user who has tested positive for COVID-19.
– and every day 24/7 working with hospitals and nursing homes to make sure preparedness for the next surge is at the highest level.
______________________________________________
On the radio this morning, former Governor Christie acknowledged his lapse in mask wearing during debate preparation in the White House. Everyone in the prep group tested negative before each meeting but everyone in the group contracted Coved-19. Governor Christie then unnecessarily spent seven days in the ICU.
“Interestingly, The Centers for Disease Control and Prevention has broadened the definition of what it means to be a “close contact” of a person with COVID-19.Previous language defined a close contact as someone who spent at least 15 minutes within 6 feet of a person with a confirmed case. The CDC now defines a close contact as someone who was within 6 feet of an infected person for a total of 15 minutes or more over a 24-hour period.” (J)
By comparison, Governor Murphy self-quarantined after contact with a staff member tested positive for COVID-19.
‘Dr. Scott Gottlieb is warning that the United States is about “a week away from seeing a rapid acceleration in cases” of Covid-19 as the number of coronavirus infections and hospitalizations surge.
In an interview on CNBC’s “The News with Shepard Smith” on Monday evening, the former FDA chief in the Trump administration said the country no longer has any pandemic backstops.
“The summer was a backstop, of sorts, to the spring surge, and we have no therapeutic backstop,” Gottlieb said. “The fall and winter season is when this coronavirus is going to want to spread.”
Echoing similar comments from Dr. Anthony Fauci, the nation’s top infectious disease expert, Gottlieb said the holiday season and family gatherings are especially precarious for the spread of coronavirus because that’s when people let their guard down.” (A)
“Dr. Francis Collins, director of the National Institutes of Health, says “it was all sadly somewhat predictable.”
Hospitalizations are up in more than 40 states. The rising number of cases has not led to a corresponding rise in the number of deaths — yet.
But Collins tells NPR’s Steve Inskeep on Morning Edition that an increase in the number of fatalities will soon follow, as it has previously when cases and hospitalizations went up.
“All of this, I’m afraid, happens because we have not succeeded in this country in introducing really effective public health measures, those simple things that we all could be doing,” he says. “Wear your mask, keep that 6-foot distance and don’t congregate indoors whatever you do, and wash your hands. It’s so simple. And yet people are tired of it. And yet the virus is not tired of us.”” (B)
“U.S. Surgeon General Jerome Adams said Wednesday that a “herd immunity” approach to combating COVID-19 could “lead to many complications/deaths.”
Adams posted the comment on his official Twitter account, along with a link to a recent article from The Journal of the American Medical Association entitled “What is Herd Immunity?”
“The summary: Large numbers of people would need to be infected to achieve herd immunity without a vaccine; this could overwhelm health care systems and lead to many complications/deaths,” Adams tweeted. “So far, there is no example of a large-scale successful intentional infection-based herd immunity strategy.”
Instead, Adams urged people to “wear masks,” “wash hands” and “watch distances.”
The surgeon general’s comments come after the White House embraced a controversial declaration by a group of scientists calling for an approach that relies on “herd immunity.”” (C)
“A frustrated and at times foul-mouthed President Donald Trump claimed on a campaign call that people are tired of hearing about the deadly pandemic which has killed more than 215,000 Americans and trashed Dr. Anthony Fauci as a “disaster” who has been around for “500 years.”
Referring to Fauci and other health officials as “idiots,” Trump declared the country ready to move on from the health disaster, even as cases are again spiking and medical experts warn the worst may be yet to come.
Baselessly claiming that if Fauci was in charge more than half a million people would be dead in the United States, Trump portrayed the recommendations offered by his own administration to mitigate spread of the disease as a burdensome annoyance.
“People are tired of Covid. I have the biggest rallies I’ve ever had, and we have Covid,” Trump said, phoning into a call with campaign staff from his namesake hotel in Las Vegas, where he spent two nights amid a western campaign swing. “People are saying whatever. Just leave us alone. They’re tired of it. People are tired of hearing Fauci and all these idiots.”
“Fauci is a nice guy,” Trump went on. “He’s been here for 500 years.”” (D)
“Hospitals across the United States are starting to buckle from a resurgence of COVID-19 cases, with several states setting records for the number of people hospitalized and leaders scrambling to find extra beds and staff. New highs in cases have been reported in states big and small — from Idaho to Ohio — in recent days.
The rise in cases and hospitalizations was alarming to medical experts.
Around the world, disease trackers have seen a pattern: First, the number of cases rises, then hospitalizations and finally there are increases in deaths. Seeing hospitals struggling is alarming because it may already be too late to stop a crippling surge.
“By the time we see hospitalizations rise, it means we’re really struggling,” said Saskia Popescu, an epidemiologist at George Mason University.”” (E)
“Coronavirus cases in New Jersey, an early epicenter of the pandemic, are on the rise again, doubling over the last month to an average of more than 900 new positive tests a day, a worrisome reversal of fortune for a state that had driven transmission rates to some of the nation’s lowest levels.
After an outbreak several weeks ago in a heavily Orthodox Jewish town near the Jersey Shore, cases are now rising in counties across the state, driven, officials say, by indoor gatherings.
The state’s health commissioner has said there are signs of “widespread community spread” for the first time since New Jersey successfully slowed the spread of a virus that has claimed the lives of more than 16,000 residents. A small, densely packed state, New Jersey has the highest virus fatality rate in the country…/..
State government and hospital officials said they have stockpiled months’ worth of masks, gowns and gloves — the critical personal protective equipment, or PPE, that was in short supply early in the pandemic — and are amassing medications to treat COVID-19 patients. Some acute-care facilities are signing advance contracts with staffing agencies in case they need to supplement their existing workforce…
State Health Commissioner Judy Persichilli said Monday that her team holds daily calls with hospital leaders to check on bed capacity and other resources, including staff — a protocol that has continued, unabated, since the pandemic began.
“We’ve never stopped working with the hospitals. We never considered the (first) wave to be over,” she said. “It’s an everyday event. We’re working with the hospitals and preparing with them every step of the way.”
The state DOH worked with the hospital association to create a database for all providers to report their PPE capacity; the department also requires hospitals to keep 90 days’ worth of surge-level supplies in stock, according to a spokesperson. Persichilli said the state is also stockpiling protective gear and some medicines — in particular Remdesivir, which appears to benefit some patients.
“My anticipation is that our biggest struggle will be staffing as we experience community spread,” Persichilli said Monday as she urged the public to keep up with infection control measures. “People that work in hospitals and in long-term care facilities also are members of a community.”
“These are very valuable individuals that we need, but if they fall ill, backup will be difficult … because every other state in the nation is having the same difficulties we’re having,” she said. In the spring, other states then relatively spared by the pandemic sent backup staff to help New Jersey.” (F)
“It’s no longer just a few hotspot counties causing the virus to spread in New Jersey. The problem is now widespread, from north Jersey to south.
But experts say a second wave is here.
“This is not something we didn’t expect. We expected a second wave to happen in the fall. But the question is how bad it gets. That means peak, and how quickly we get to that peak,” said Dr. Shereef Elnahal, president and CEO of University Hospital, Newark.
Dr. Elnahal says the hospital is already nearly at capacity with non-COVID patients. Now the COVID hospitalizations are increasing again.
“Signs are pointing that this is about to get worse,” Dr. Elnahal told CBS2’s John Dias. “When you start to hit levels of 3 or 4% positivity, you can expect even more admissions. And most concerningly, John, we did have one COVID-19 death last week for the first time in many weeks.”
“The other patients will have to delay their care even more,” Dr. Elnahal added….
New Jersey and Connecticut now technically qualify for the Tri-State travel advisory list, where travelers from states with rising infection rates must quarantine for two weeks.” (G)
“As the coronavirus races across the country, it has reached every corner of a nursing home in Kansas, infecting all 62 residents inside. There are so few hospital beds available in North Dakota that patients sick with the virus are being ferried by ambulance to facilities 100 miles away. And in Ohio, more people are hospitalized with the virus than at any other time during the pandemic.
After weeks of warnings that cases were again on the rise, a third surge of coronavirus infection has firmly taken hold in the United States. The nation is averaging 59,000 new cases a day, the most since the beginning of August, and the country is on pace to record the most new daily cases of the entire pandemic in the coming days.
But if earlier surges were defined by acute and concentrated outbreaks — in the Northeast this spring, and in the South during the summer — the virus is now simmering at a worrisome level across nearly the entire country. Colorado, Illinois, Kentucky, Michigan, Montana, New Mexico, North Dakota, Ohio, South Dakota, Utah, Wisconsin and Wyoming each set seven-day case records on Tuesday. Even New Jersey, once a model for bringing the virus under control, has seen cases double over the past month…
The latest wave threatens to be the worst of the pandemic yet, coming as cooler weather is forcing people indoors and as many Americans report feeling exhausted by months of restrictions. Unlike earlier waves, which were met with shutdown orders and mask mandates, the country has shown little appetite for widespread new restrictions…
The newest surge sets the stage for a grueling winter that will test the discipline of many Americans who have spent warmer months gathering in parks and eating outdoors, where the virus is known to spread less easily. At the current rate of growth, new daily confirmed cases could soon surpass 75,687, the record set on July 16.
The rising case count has so far not translated to increased deaths: About 700 people are dying on average each day, a high but steady rate. So far, more than 220,000 Americans have died from the virus.
The latest developments represent a serious new level of spread. Deaths are considered a lagging indicator of new infection, and experts believe the daily toll is likely to rise in the coming months. Nationwide, hospitalizations, the most accurate gauge of how many people are currently sick from the virus, are already trending upward, at a pace slightly lower than new infections.” (H)
“On Tuesday, local health authorities issued an emergency stay-at-home order for the campus in Ann Arbor, Mich., mostly restricting undergraduates to their residences unless they’re getting food, doing an essential job or going to class.
Athletics, though, are exempt — meaning that the Wolverines’ football team will keep preparing for a road game in Minnesota on Saturday and an Oct. 31 home opener against rival Michigan State University. Although the Michigan stadium won’t feature a large crowd, some officials worry that the home game will fuel new cases anyway because of Spartan fans who travel to Ann Arbor and Michigan supporters who gather for watch parties.” (I)
PART 1. January 21, 2020. CORONAVIRUS. “The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.”
PART 2. January 29, 2020. CORONAVIRUS. “If it’s not contained shortly, I think we are looking at a pandemic..”….. “With isolated cases of the dangerous new coronavirus cropping up in a number of states, public health officials say it is only a matter of time before the virus appears in New York City.”
PART3. February 3, 2020. “The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe…”..Trump appeared to downplay concerns about the flu-like virus …We’re gonna see what happens, but we did shut it down..” (D)
PART 4. February 9, 2020. Coronavirus. “A study published Friday in JAMA found that 41% of the first 138 patients diagnosed at one hospital in Wuhan, China, were presumed to be infected in that hospital.….
PART 5. February 12, 2020. CORONAVIRUS. “In short, shoe-leather public health and basic medical care—not miracle drugs—are generally what stop outbreaks of emerging infections..”
POST 6. February 18, 2020. Coronovirus. “Amid assurances that the (ocean liner) Westerdam was disease free, hundreds of people disembarked in Cambodia…” “ One was later found to be infected”…. “Over 1,000… passengers were in…transit home”…. “This could be a turning point””
PART 7. February 20, 2020. CORONAVIRUS. With SARS preparedness underway in NJ LibertyHealth/ Jersey City Medical Center, where I was President, proposed that our 100 bed community hospital with all single-bedded rooms, be immediately transformed into an EMERGENCY SARS ISOLATION Hospital.
PART 8. February 24, 2020. CORONAVIRUS. “…every country’s top priority should be to protect its health care workers. This is partly to ensure that hospitals themselves do not become sites where the coronavirus is spread more than it is contained.”
PART 9. February 27, 2020. CORONAVIRUS. Responding to a question about the likelihood of a U.S. outbreak, President Trump said, “I don’t think it’s inevitable…”It probably will. It possibly will,” he continued. “It could be at a very small level, or it could be at a larger level.”
Part 10. March 1, 2020. CORONAVIRUS. Stop Surprise Medical Bills for Coronavirus care. (&) Lessons Learned (or not) In California and Washington State from community acquired cases.
PART 11. March 5, 2020. CORONAVIRUS. “Gov. Andrew Cuomo… would require employers to pay workers and protect their jobs if they are quarantined because of the coronavirus.”
Part 12. March 10, 2020. CORONAVIRUS. “Tom Bossert, Donald Trump’s former homeland security advisor…(said) that due to the coronavirus outbreak, “We are 10 days from the hospitals getting creamed.”
Part 13.. March 14, 2020. CORONAVIRUS. “If I’m buying real estate in New York, I’ll listen to the President….If I’m asking about infectious diseases, I’m going to listen to Tony Fauci,”
PART 14. March 17, 2020. CORONAVIRUS. “ “Most physicians have never seen this level of angst and anxiety in their careers”…. One said “I am sort of a pariah in my family.”
PART 15. March 22, 2020. CORONAVIRUS. “…Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration….in a series of exercises that ran from last January to August.
PART 16. March 27, 2020. CORONAVIRUS. I am not a clinician or a medical ethicist but articles on Coronavirus patient triage started me Googling………to learn about FUTILE TREATMENT
PART 17. April 2, 2020. CORONAVIRUS. Florida allows churches to continue holding services. Gun stores deemed “essential.” “New York’s private and public hospitals unite to manage patient load and share resources.
PART 18. April 9, 2020. CORONAVIRUS. “The federal government’s emergency stockpile of personal protective equipment (PPE) is depleted, and states will not be receiving any more shipments, administration staff told a House panel.
PART 19. April 13, 2020 CORONOAVIRUS. “…overlooked in the United States’ halting mobilization against the novel coronavirus: the personal aides, hospice attendants, nurses and occupational or physical therapists who deliver medical or support services to patients in their homes.”
POST 22. April 29, 2020. CORONAVIRUS. ..the “ACS released a list of 10 issues that should be addressed before a healthcare organization resumes elective surgeries[JM1] ….”
POST 23. May 3, 2020. CORONAVIRUS. … what Dr. Fauci really wants,…”is just to go to a baseball game. That will have to wait. The level of testing for the virus is not adequate enough to allow for such mass gatherings.’ (K)
POST 24. May 7, 2020. CORONAVIRUS. Former New Jersey governor Chris Christie said: “there are going to be deaths no matter what”… but that people needed to get back to work.
POST 25. May 10, 2020, CORONAVIRUS. “It is scary to go to work,” said Kevin Hassett, a top economic adviser to the president. “I think that I’d be a lot safer if I was sitting at home than I would be going to the West Wing.”
POST 26. May 14, 2020. CORONAVIRUS, “Deep cleaning is not a scientific concept”….”there is no universal protocol for a “deep clean” to eradicate the coronavirus”
POST 27. May 19, 2020. CORONAVIRUS. “Hospital…executives…are taking pay cuts…to help offset the financial fallout from COVID-19.” As “front line” layoffs and furloughs accelerate…
POST 28. May 23, 2020. CORONAVIRUS. ““You’ve got to be kidding me,”..”How could the CDC make that mistake? This is a mess.” CDC conflates viral and antibody tests numbers.
PART 29. May 22, 2020. CORONAVIRUS. “The economy did not close down. It closed down for people who, frankly, had the luxury of staying home,” (Governor Cuomo). But not so for frontline workers!
POST 30. June 3,202. CORONAVIRUS. “The wave of mass protests across the United States will almost certainly set off new chains of infection for the novel coronavirus, experts say….
Post 32. June 16, 2020. CORONAVIRUS. Could the Trump administration be pursuing herd immunity by “inaction”? “ If Fauci didn’t exist, we’d have to invent him.”
POST 34. June 26, 2020. CORONAVIRUS. CDC Director Redfield… “the number of coronavirus infections…could be 10 times higher than the confirmed case count — a total of more than 20 million.” As Florida, Texas and Arizona become eipicenters!
POST 35. June 29, 2020. CORONAVIRUS. Pence: “We slowed the spread. We flattened the curve. We saved lives..” While Dr. Fauci “warned that outbreaks in the South and West could engulf the country…”
POST 36. July 2, 2020. CORONAVIRUS. “There’s just a handful of interventions proven to curb the spread of the coronavirus. One of them is contact tracing, and “it’s not going well,” (Dr. Anthony Fauci)..
POST 37. June 8, 2020. CORONAVIRUS. When “crews arrive at a hospital with a patient suspected of having COVID-19, the hospital may have a physical bed open for them, but not enough nurses or doctors to staff it.”
POST 38. July 15, 2020. CORONAVIRUS. Some Lessons Learned, or not. AdventHealth CEO Terry Shaw: I wouldn’t hesitate to go to Disney as a healthcare CEO — based on the fact that they’re working extremely hard to keep people safe,” (M)
POST 39. July, 23,2020. CORONAVIRUS. A Tale of Two Cities. Seattle becomes New York (rolls back reopening) while New York becomes Seattle (moves to partial phase 4 reopening)
POST 40. July 27, 2020. CORONAVIRUS.” One canon of medical practice is that you order a test only if you can act on the result. And with a turnaround time of a week or two, you cannot. What we have now is often not testing — it’s testing theater.”
POST 41. August 2, 2020. CORONAVIRUS. “Whenever a vaccine for the coronavirus becomes available, one thing is virtually certain: There won’t be enough to go around. That means there will be rationing.”
POST 44. September 1, 2020. CORONAVIRUS. “The CDC…modified its coronavirus testing guidelines…to exclude people who do not have symptoms of Covid-19.” (While Dr. Fauci was undergoing surgery.) A White House official said: “Everybody is going to catch this thing eventually..”
POST 45. September 9, 2020. CORONAVIRUS. Trump on Fauci. ‘You inherit a lot of people, and you have some you love, some you don’t. I like him. I don’t agree with him that often but I like him.’
POST 46. September 17, 2020. CORONAVIRUS. “Bill Gates used to think of the US Food and Drug Administration as the world’s premier public-health authority. Not anymore. And he doesn’t trust the Centers for Disease Control and Protection either….”
POST 47. September 24, 2020. CORONAVIRUS. “Perry N. Halkitis, dean of the School of Public Health at Rutgers University…called New York City’s 35 percent rate for eliciting contacts “very bad.” “For each person, you should be in touch with 75 percent of their contacts within a day,” he said”
POST 48. October 1, 2020. “…you can actually control the outbreak if you do the nonpharmaceutical interventions (social distancing and masks). In the United States we haven’t done them. We haven’t adhered to them; we’ve played with them.” (A)
POST 49. October 4, 2020. CORONAVIRUS. RAPID RESPONSE. “The possibility that the president and his White House entourage were traveling superspreaders is a nightmare scenario for officials in Minnesota, Ohio, New Jersey and Pennsylvania…”
POST 50. October 6, 2020. CORONAVIRUS. Monday October 5th will go down as one of the most fraught chapters in the history of American public Health (and national security).
POST 51. October 12, 2020. Rather than a hodge-podge of Emergency Use Authorizations, off-label “experimentation”, right-to-try arguments, and “politicized” compassionate use approvals maybe we need to designate REGIONAL EMERGING VIRUSES REFERRAL CENTERS (REVRCs).
POST 52. October 18, 2020. ZIKA/ EBOLA/ CANDIDA AURIS/ SEVERE FLU/ Tracking. “… if there was a severe flu pandemic, more than 33 million people could be killed across the world in 250 days… Boy, do we not have our act together.” —”- Bill Gates. July 1, 2018
POST 54. October 22, 2020. CORONAVIRUS. “Hospitals across the USA are starting to buckle from a resurgence of COVID-19 cases…” ““U of Michigan hit with emergency stay-at-home order…. But the football team will play on..” (I)
