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)

To read Posts 1-48 in chronological order, highlight and click on https://doctordidyouwashyourhands.com/2020/09/coronovirus-tracking-links-to-parts-1-48/

“Less than 10 percent of Americans have antibodies to the new coronavirus, suggesting that the nation is even further from herd immunity than had been previously estimated, according to a study published Friday in The Lancet.

The study looked at blood samples from 28,500 patients on dialysis in 46 states, the first such nationwide analysis.

The results roughly matched those of an analysis to be released next week by the Centers for Disease Control and Prevention, which found that about 10 percent of blood samples from sites across the country contained antibodies to the virus.

Dr. Robert R. Redfield, the director of the C.D.C., was referring to that analysis when he told a congressional committee this week that 90 percent of all Americans were still vulnerable to the virus, a C.D.C. spokeswoman said.” (B)

“Covid-19 infections were trending upward again Monday in the United States as thousands of students returned to New York City classrooms and public health experts warned that a “twindemic” could be on the horizon as we head into flu season.

Two days after the U.S. recorded its 200,000 Covid-19 fatality, the number of confirmed cases in the country was closing in on 7 million and accelerating, according to the latest NBC News figures.

The seven-day average of new coronavirus cases in the U.S. dipped below 40,000-per-day for the first time since June on Sept. 11, the day America marked the 19th anniversary of the Al Qaeda terrorist attacks.

By Friday it was back over 40,000 again, according to an NBC News tally.

That’s still far less than the record 70,000-plus infections that were being logged in June. But the upcoming flu season could derail progress made in bringing down the coronavirus infection rate, experts warned.

“As the United States and the rest of the globe tries to gain its footing with a pandemic that has already killed nearly a million people and sickened almost 30 million, it faces another virus this fall that could devastate our progress thus far: the season flu,” Johns Hopkins University warned in a press release in advance of a conference of public health experts Tuesday that will address the issue. “That is, unless we take action now to minimize cases with effective, widespread vaccination.”

Before the pandemic, only about half the U.S. population heeded the advice of most doctors and got a flu vaccine during the 2018-19 season, according to the federal Centers for Disease Control and Prevention.

While President Donald Trump appears determined to unveil a Covid-19 vaccine before Election Day —even if experts and FDA officials might object — “the cold reality is that we should plan for a winter in which vaccination is not part of our lives,” The Atlantic reported.

“We must, over the next few weeks, get that baseline of infections down to 10,000 per day, or even much less if we want to maintain control of this outbreak,” Dr. Anthony Fauci, the nation’s leading expert on infectious diseases, said in an email to the magazine.” (C)

“As COVID-19 cases tick up in Massachusetts, no one is eyeing the numbers more keenly than the hospital leaders who will have to respond to a second surge.

Hospitals officials are watching the case counts daily, with memories still fresh of legions of sick people filling wards in the spring. The number of people hospitalized with COVID-19 around the state remains low, but has been inching up in certain places in the past couple of weeks. So, too, has the rate of positive COVID-19 tests reported statewide. And any increase in cases in the community will eventually reach the hospital doors.

“We are very concerned about the rising [infection] rates that we have seen,” said Dr. Paul Biddinger, director for emergency preparedness at Mass General Brigham, the hospital group formerly known at Partners HealthCare.

Hospitals in Springfield and Boston reported slight upticks in COVID-19 patients, but Mass General Brigham, the largest hospital group, had only 49 cases on Tuesday and has not seen an increase in recent weeks. Statewide, COVID-19 hospitalizations have held relatively steady since July 24, with 396 reported on Wednesday, compared with nearly 4,000 on May 1.

A total of 338 new confirmed cases were reported Wednesday and two deaths.

The percentage of positive COVID-19 tests in Massachusetts rose to 2.2 percent, up from the mid-July low of 1.7 percent, according to Wednesday’s report from the state Department of Public Health.

Usually hospitalizations start to spike about two weeks after positive tests results go up, and intensive care unit admissions increase two weeks after that.

“The key is to recognize changes so that we can act quickly,” Biddinger said.

In the spring, hospitals cobbled together the space and staff to care for hundreds of severely ill patients — in many cases more than ever before seen — and the lessons on how to do that will guide the response to whatever the fall brings. Advances in understanding how to treat the illness might lead to shorter lengths of stay or fewer admissions. And improved testing capacity means hospitals are no longer in the dark about how many patients might show up at their doorstep….

“If you look historically at pandemics, there is almost always a second surge,” Biddinger said. He has no idea when that second surge might occur, but sees two factors that could bring it on: a “loss of vigilance” against the virus as people tire of staying apart and wearing masks, and the tendency to gather inside as temperatures cool…

And two critical problems linger from the spring: inadequate testing and the continuing struggle to obtain enough personal protective equipment or PPE — the gowns, face shields, masks, and gloves that staffers need to avoid infection.

Testing is essential to determine when hospital employees can return to work, and whether patients need to be isolated and cared for only by people in full PPE.

Baystate Health does not “have the capability to do point-of-care, rapid-turnaround testing,” said Artenstein, who called for a coordinated federal response. “We have not yet received the equipment or reagents to do that kind of testing. Without that, we don’t have the ability to make decisions quickly.”” (D)

“As the school year starts up again and sunset gets earlier and earlier, local hospitals are quietly preparing for the possibility of another crisis that could transpire this fall and winter.

It’s referred to is as a “twindemic,” a simultaneous flareup of the coronavirus and the flu, two deadly viruses that have a similar range of symptoms.

Though local hospital executives are hopeful that a twindemic won’t actually befall New Jersey, they’re readying for the possibility that it does and instituting measures in an effort to prevent it.

Those measures include readying tests that would screen for both COVID-19 and influenza with a single swab and rolling out flu vaccinations and encouraging the most vulnerable members of the population to get shots this year…

First-hand experience with coronavirus patients in the spring has made local hospitals more confident about how to respond if a second wave occurs, the doctors said. And now, preparing for a potential onslaught of patients is more of a familiar routine — stocking up on personal protective equipment, readying staff and continuing to check their temperatures daily.” (E)

“Forty percent of healthcare workers with COVID-19 were not showing symptoms when they were diagnosed, according to a new meta-analysis published in the American Journal of Epidemiology.

Researchers examined 97 studies published in 2020, including 230,398 healthcare workers across 24 countries.

The analysis found the estimated prevalence of infection was 11 percent among healthcare workers using polymerase chain reaction testing, and 7 percent of healthcare workers were positive by antibody tests.

Nearly half (48 percent) of healthcare workers testing positive for COVID-19 were nurses, and 25 percent were physicians, according to the analysis. Twenty-three percent were other healthcare workers.

Forty-three percent of COVID-19 positive medical personnel were working in hospitalization/non-emergency wards during the screening, the analysis found. Twenty-four percent of them were working in the operating room, 16 percent were working in the emergency room and 9 percent were working in the intensive care unit. Twenty-nine percent reported “other” locations…

Dr. Muka said: “Healthcare workers suffer a significant burden from COVID-19. A significant proportion of healthcare workers are positive for COVID-19 while asymptomatic, which might lead to the silent transmission of the disease within hospitals and in the community. The symptoms associated with COVID-19 in HCW could be used as an indicator for screening in settings with limited testing capacities.”

Co-author Professor Oscar Franco, MD, PhD, from the Institute of Social and Preventive Medicine, University of Bern, Switzerland, concluded in a news release: “Because we might miss a large proportion of COVID-19 cases if screening targets only symptomatic HCW, universal screening for all exposed HCW regardless of symptoms should be the standard strategy. While more research is needed to understand specific interventions that can help reducing SARS-CoV-2 infection among healthcare personnel, it is clear that providing healthcare workers with adequate personal protective equipment and training is essential.”” (F)

“Roughly nine weeks’ of previously unpublished federal data provided to the Wall Street Journal shows an average of 120 patients a day contracted the new coronavirus inside U.S. hospitals.

The figure comes from data reported by half of U.S. hospitals to the CDC between May 14 and July 14, after which data is unavailable because the government changed its data collection system and dropped the question about new cases of hospital-acquired COVID-19.

In that timeframe, more than 7,400 patients likely caught COVID-19 in hospitals where they sought care for other conditions. The CDC data didn’t track infections among hospital staff.

Ashish Jha, MD, dean of Brown University’s School of Public Health in Providence, R.I., told the WSJ the data shows the need for federal authorities to revive reporting requirements for new cases of hospital-acquired COVID-19. “We need to know this,” he said.”  (G)

“Even with relaxed social distancing practices, national and local healthcare experts are still predicting and preparing for a second wave of COVID-19 this fall, according to Health News Hub. Dr. Ajay Kumar, Chief Clinical Officer for Hartford Healthcare said during a media briefing, “Social distancing is the only thing we have to decrease the spread of this disease… (The disease) is still as lethal as it was in February, March and April.”

During the current lull in coronavirus cases in several states across the U.S., healthcare facilities are doing what they can to best prepare themselves for the looming second wave. Below are some tools and preparedness strategies hospitals are doing to best fight the spread of COVID-19, as per Health News Hub:

Stocking up on personal protective equipment (PPE) and making sure there is enough on hand to protect staff and patients.

Optimizing contact tracing efforts to identify those who have has contact with somebody who has tested positive for COVID-19.

Maintaining hospital and healthcare facilities so that they are safe for patients who need treatment for the coronavirus, or for patients who need help for other healthcare concerns.

Streamlining communication plans to make sure staff and patients are kept updated on hospital COVID-19 protocols through a mass notification solution.

Maintaining capacity so that teams can easily scale operations up or down to meet the demand for care anticipated in a second wave.

Healthcare facilities are also leveraging the technology tools they have in place to help with hospital operations throughout the pandemic. SMS opt-in has been extremely helpful for patients and visitors entering a healthcare facility. Those who opt-in will receive targeted notifications on a specific topic, COVID-19 for example, and they can easily opt-out of these notifications after leaving the hospital.

Mass notification solutions with polling capabilities have also been extremely useful for sending wellness checks out to internal staff to ensure they are feeling safe and well. Polling has also been used to fill vacant shifts to make sure hospitals and healthcare facilities are not understaffed. This will be crucial in the case of the second wave.” (H)

“France and the UK on Thursday set all-time records for daily coronavirus infections.

Other European countries are seeing their highest cases since the continent’s peak earlier this year.

The EU’s health commissioner said that in “some member states, the situation is now even worse than during the peak in March.”

Much of Europe was devastated during the first wave of the pandemic, which was followed by a marked lull.

Better testing systems and infrastructure could go someway to explaining the new high figures — but experts agree that a resurgence is underway.

France and the UK recorded their highest daily COVID-19 cases since the global outbreak began, and the EU warned that some of its countries now have worse outbreaks than they had in March.

Stella Kyriakides, the EU’s health commissioner, warned on Thursday that in “some member states, the situation is now even worse than during the peak in March.”

Taken together, the developments point to the feared second wave of the pandemic having arrived in Europe.” (I)

“In Munich, normally brimming with boisterous crowds for Oktoberfest this month, the authorities just banned gatherings of more than five people. In Marseille, France, all bars and restaurants will be closed next Monday. And in London, where the government spent weeks urging workers to return to the city’s empty skyscrapers, it is now asking them to work from home.

Summer ended in Europe this week with a heavy thud amid ominous signs that a spike in coronavirus cases may send another wave of patients into hospitals. Officials across the continent fear a repeat of the harrowing scenes from last spring, when the virus swamped intensive care units in countries like Italy and Spain. Already in Spain, some hospitals are struggling with an influx of virus patients.

“I’m sorry to say that, as in Spain and France and many other countries, we’ve reached a perilous turning point,” Prime Minister Boris Johnson said on Tuesday, as he imposed new restrictions — including shutting pubs and restaurants at 10 p.m. — to prevent Britain’s National Health Service from becoming overwhelmed.

But just how imminent is the peril?

As they weigh actions to curb a second wave of the virus, Mr. Johnson and other European leaders are dealing with a confusing, fast-changing situation, with conflicting evidence on how quickly new cases are translating into hospital admissions — and how severe those cases will end up being…

Other experts, however, warn against being lulled into complacency: the gap between case numbers and hospital admissions, they say, is mainly a reflection of the fact that more people are being tested, and more quickly.

“Deaths and hospitalizations are a lagging indicator,” said Devi Sridhar, director of the global health governance program at the University of Edinburgh. “There was no lag back in March because we only tested people who were already in the hospital. At a certain point, your I.C.U.’s are going to fill up.”

The uncertainty about hospitalizations and deaths is another example of how mysterious the virus remains, even after 10 months of intense study. And that uncertainty complicates the task for political leaders who are balancing the need to protect their citizens with a desire to avoid imposing more lockdowns.

In France, where the government has adopted a philosophy of learning to live with the virus, President Emmanuel Macron has bucked pressure to impose new national restrictions and left it to cities to impose tighter curbs on public gatherings.

France currently has more than 5,700 people hospitalized with Covid-19. Roughly 900 of them are in intensive care. That is more than during the summer, when hospitalizations dropped to about 4,500 people, but it is far less than during the peak last April, when more than 32,000 were hospitalized…

There are worrying signs: Hospitals in Paris will postpone 20 percent of surgeries, starting this weekend, because of the increase in virus patients, who now account for 20 percent of all patients in intensive care.”  (J)

“UK Prime Minister Boris Johnson on Friday told reporters that the UK is “now seeing a second wave coming in” and that it was “inevitable.”

“Obviously we’re looking very carefully at the spread of the pandemic as it evolves over the last few days,” Johnson said. “There’s no question, as I’ve said for weeks now, that we could (and) are now seeing a second wave coming in. We are seeing it in France, in Spain, across Europe. It has been absolutely inevitable we will see it in this country.

“I don’t want to go into second national lockdown. The only way we can do that is if people follow the guidance.”

British Health Minister Matt Hancock said Sunday that the country was “at a tipping point” following a new rise in cases on Saturday, when Britain registered 4,422 new cases, the highest number since early May.

“People must follow the rules and if they don’t, we will bring in this much more stringent measures,” Matt Hancock said in a BBC interview. When asked about re-imposing a second national lockdown, the minister said: “I don’t rule it out. I don’t want to see it.”…

The UK announced Sunday that anyone who tests positive for coronavirus or has been traced as a close contact will be required by law to self-isolate from September 28 or face fines from £1,000 ($1,300) to £10,000 ($13,000) for repeat offenders. Those with lower incomes will be supported by a £500 ($650) payment, according to a government statement….

New restrictions were also announced on Friday in Madrid, which accounts for approximately a third of all new cases in Spain, according to the Spanish Health Ministry. The country reported a record 12,183 daily cases on September 11, and has the highest number of cases in Europe at more than 600,000, with more than 30,000 deaths….

WHO Europe director Hans Kluge warned this week of “alarming rates of transmission” and a “very serious situation” in the region, adding that weekly cases have exceeded those reported during the March peak.” (K)

“Prime Minister Justin Trudeau is warning Canadians that the second wave has arrived in many parts of the country.

“We’re on the brink of a fall that could be much worse than the spring,” Trudeau said Wednesday during a 12-minute takeover of suppertime television. “It’s all too likely we won’t be gathering for Thanksgiving [Oct. 12], but we still have a shot at Christmas.”

During the height of the pandemic last spring, Trudeau took questions from reporters almost every day for weeks — briefings that networks covered voluntarily. On Wednesday evening, he took the rare step, for a Canadian prime minister, of requesting airtime on major TV networks.

For Canada’s four largest provinces, Trudeau said the second wave of Covid-19 is underway.

With kids at home and classes online, students are extra reliant on technology. But that’s not an easy lift in lower-income districts that lack funding and resources.

The increasingly grim backdrop: Trudeau’s warning comes as Canadian Covid-19 cases climb higher, a setback that follows the country’s success in flattening the curve earlier in the pandemic.

Trudeau noted that back on March 13 when the country went into lockdown there were 47 new cases of the virus. “Yesterday alone, we had well over 1,000,” said Trudeau, who appeared on TV screens in a dark suit and tie, standing in front of four Canadian flags and a desk.

Canada’s top doctor warned this week that the only way to prevent the acceleration of the spread is if everyone works to put on the brakes.

“My message today is the time is now,” Chief Public Health Officer Theresa Tam said. “Our actions right now are what matters for keeping epidemic growth under control.”

On Wednesday, officials said Canada saw an average of 1,123 cases reported daily during the past seven days, compared to just 380 cases reported per day in mid-August.” (L)

“Florida Gov. Ron DeSantis says he is lifting all restrictions on businesses statewide that were imposed to control the spread of the virus that causes COVID-19. Most significantly, that means restaurants and bars in the state can now operate at full capacity.

Up to now, restaurants and bars in Florida could serve customers indoors at 50% of legal occupancy. DeSantis said his new executive order lifts that restriction statewide, though local governments can keep additional limits in place if they’re justified for health or economic reasons.

“Every business has the right to operate,” DeSantis said. “Some of the locals can do reasonable regulations. But you can’t just say no.”

DeSantis also said his order would stop cities and counties from fining people for not wearing mandated face coverings. He said fines and other penalties imposed so far would be suspended.

Currently, Miami-Dade, Broward and other counties in South Florida have locally imposed limits on the hours restaurants and bars can operate and how many customers they can serve indoors.

Broward County Mayor Dale Holness told NPR member station WLRN on Friday, “We’re hoping that the governor will allow us to have deeper restrictions than the rest of the state. We have a greater spread of the virus in South Florida than other parts of the state.”

Miami-Dade officials said they were still assessing what the order means for the county. Mayor Carlos Giménez told The Miami Herald that he believed the county would still be able to enforce its face covering mandate but “will have to speak to our attorneys about [our] ability to enforce individual fines.”

The number of coronavirus cases in Florida has dropped steadily since the peak in mid-July. Since then, DeSantis said, “we’ve actually seen more economic activity, more interaction. Schools have opened, all the theme parks are open, more people have visited.”

Hospitalizations for COVID-19 statewide are down 76% from the peak, the governor said.

DeSantis said he’s seen no signs of a possible “second wave” of infections but said that hospitals have plenty of capacity and the state is ready to respond if one emerges.

There are no restrictions on the number of people who can attend outdoor sporting events in Florida, according to the governor, who added the state hopes to host what he called “a full Super Bowl” in Tampa in February.” (N)

“Florida added 2,795 coronavirus cases Saturday, bringing the total number of infections statewide to 698,682 cases.

The state also announced 107 coronavirus deaths. Since the first coronavirus case was found in Florida, 14,190 people have died from the virus. Among the deaths was a 12-year-old girl in Duval County, the ninth death of a child because of coronavirus in Florida.

The weekly death average increased to about 106 people announced dead per day. The peak death average came in early August, when about 185 deaths were announced per day.

Cases that resulted in a hospitalization increased by 171 admissions.

Hospitalizations: About 2,100 people across Florida are hospitalized with a primary diagnosis of coronavirus, according to the Agency for Health Care Administration. About 420 are in the Tampa Bay area.

Statewide, about 24 percent of hospital beds are open and 22 percent of ICU beds are open. In Tampa Bay, about 20 percent of hospital beds and 14 percent of ICU beds are available.

The largest area hospital, Tampa General Hospital, had no ICU beds available as of Saturday morning.” (O)

“When Dr. Shereef Elnahal walked through his New Jersey hospital in April, he couldn’t believe what he was seeing.

There were 300 patients being treated for Covid-19, filling hospital rooms and spilling out into the halls of the emergency room. The trauma center, once used for gunshot wounds and car crash victims, was now filled with people on ventilators.

“It was really like nothing we’ve ever seen before,” said Elnahal, president and CEO of University Hospital in Newark.

“I have memories of walking around and I would look inside the rooms where that was possible. Almost every person was a person of color,” he told NBC News.

Elnahal’s hospital is one of the more than 100 major medical centers that treat America’s most vulnerable patients: communities of color who have been disproportionately harmed by Covid-19. Data has increasingly shown that Black and Hispanic patients are more likely to be hospitalized with the virus and, in many cases, more likely to die from it.

“We’re learning more and more that it’s these vulnerable communities being hit harder by the pandemic,” said Beth Feldpush, senior vice president of policy and advocacy for America’s Essential Hospitals, a group representing the more than 300 hospitals that treat uninsured patients. “Our hospitals are absolutely serving those hardest-hit communities.”

A second surge of Covid-19 this fall and winter could be catastrophic for the U.S., and it’s not just more sick people that doctors worry about. The very hospitals that treat lower-income patients could be forced to shut down or cut crucial services.

“We would absolutely be at risk of closing,” Elnahal said. “It would be a public health disaster for this community.”

The pandemic hit all U.S. hospitals with a financial “triple whammy,” said Aaron Wesolowski, the American Hospital Association’s vice president for policy research, analytics and strategy. Costs increased dramatically, while revenues plummeted.

The hospitals were forced to cover the exorbitant costs of buying extra personal protective equipment like N95 masks, as well as convert wards to treat Covid-19 patients and more uninsured patients. At the same time, they had to stop performing revenue-generating procedures like elective surgeries.

By the end of 2020, hospitals across the U.S. will lose about $300 billion, according to the American Hospital Association. But for major medical centers like University Hospital in Newark, the financial hit of a second wave of Covid-19 would be especially devastating.

“Where there are already cracks in the system, those cracks become earthquakes,” said Dr. Chris Pernell, University Hospital’s chief of strategic integration and health equity officer.

That’s because these safety net hospitals are nonprofit and promise care for all patients, regardless of insurance coverage. Even before the pandemic, they operated on shaky budgets. Jackson Health System in Miami, for example, only has enough cash on hand to operate for 50 days. Private hospitals typically have more than triple that amount of cash in reserve…

In the meantime, hospitals are preparing for the second wave, stocking up on PPE despite lingering shortages and implementing lessons learned from the first surges, especially when it comes to treatment.” (P)

“The pandemic has shown us the importance of vigilant EM planning. When viruses of the past have run their course, EM plans often go back on the shelf and aren’t revisited until the next crisis. This is not to say that organizations always need to have incident command readiness. However, aspects of an emergency command structure and communication should be a constant part of daily workflow and the risk of an outbreak should be a consideration in everyday meetings and reports. For example, assuring that incident command roles are assigned daily and distributing a daily briefing, such as an email, will go a long way in promoting readiness. Ultimately, all organizations should move ahead conservatively – watch the data and evaluate what new trends mean, plan out next steps as new information unfolds, and be flexible to scale up or down accordingly…

“The next surge – whether COVID-19 or something new – will come. Flexibility may be the key to future surge response. While options and plans need to be tailored to each institution or site, here are some ideas to consider based on lessons learned:

• Assure a flexible, but robust, communication structure for use during surge events. This structure should be easily embedded in the incident command response once a decision is made to activate a command center, but flexible enough to assure daily use when the command center is closed.

• Develop options to enable a quicker expansion or conversion to support defined patient care spaces and the required staffing. These alternative care areas may include converting or repurposing existing space into temporary critical care areas or using temporary external structures as we have seen during COVID-19. Alternative staffing models also need to be agreed upon to support these possible new care areas.

• Develop plans for rapidly updating staff, including education on new care guidelines and new care area assignments as well as new communication models to ensure staff is aware of PPE guidelines, technology updates and other changes.

• Create room flexibility using carts or rail systems. This can allow for rapid repurposing of rooms to accommodate specific needs.

• Create plans for “clean” and “infectious” corridors to minimize comingling of likely infectious and likely non-infectious patients.” (Q)

“With a growing tally of more than 7 million COVID-19 cases and over 200,000 deaths from the virus in the United States, the country’s top infectious disease expert is warning that the nation needs to prepare as fall and winter loom.

“Given the fact that we have never got down to a good baseline, we are still in the first wave,” Dr. Anthony Fauci told CNN.

During the 1918 pandemic, the number of cases plummeted before exploding during the colder months later in the year.

“Rather than say, ‘A second wave,’ why don’t we say, ‘Are we prepared for the challenge of the fall and the winter?’” Fauci said.

Among other preventative measures, Fauci says Americans need to wear face coverings, wash their hands and avoid crowds to avoid “surges” in cities and states across the country.

Another precaution that could help first line medical workers dealing with COVID-19 patients is the flu shot. The more people vaccinate this year, the less patients sick with the flu will divert hospital resources away from coronavirus patients…

Fauci warns life may not be ‘normal’ until end of 2021

“We feel cautiously optimistic that we will be able to have a safe and effective vaccine, although there is never a guarantee of that,” Dr. Fauci told a Senate committee this week…

How we got here.

More than 200,000 Americans have died from COVID-19 so far this year, and in many states, infections still are climbing. The U.S. is confirming an average of 41,968 new daily cases, up 13% compared with the average two weeks ago.

Fauci was blunt: More lives could have been saved if everyone in the country better followed recommendations to wear masks, avoid crowds and keep 6 feet apart.

“We know some states did a good job. Some states did not so good a job. Some states tried to do a good job but people didn’t listen,” he said, singling out mask-less crowds in bars. Going forward, “we need uniformity throughout the country.””  (M)

“As Germany cleared away spent fireworks and slept off its hangovers on New Year’s Day, Christian Drosten got a sobering wake-up call: A member of his team—he heads the virology department at Berlin’s Charité hospital—reported that a strange pneumonia was spreading in the Chinese city of Wuhan.

For Drosten, a leading developer of tests for emerging viruses, there was an element of déjà vu. As a doctoral student in Hamburg in 2003, he’d discovered that the outbreak of severe acute respiratory syndrome, or SARS, then terrifying Asia was caused by a coronavirus. Although it was unclear whether a coronavirus was responsible for the Wuhan outbreak, Drosten fully understood the danger. While the viruses are common pathogens known to cause colds, some discovered in recent decades are highly lethal.

He alerted his staff to get ready for the possibility of a deadly pandemic. When Chinese researchers confirmed that the culprit was indeed a coronavirus and on Jan. 10—a Friday—published its genome sequence, the Charité scientists sprang into action. Working through the weekend, they pulled together samples of the SARS virus and other coronaviruses, aiming to make a test that could detect the new threat. Late on Saturday a team member tweeted, “Lab days are happy days! #Wuhan #Coronavirus.”

By Monday they had a test that could confirm whether someone had been infected by the novel coronavirus. Drosten shared the details with the World Health Organization, which published them on its website, and the test was soon deployed around the world. One place that declined to use Drosten’s test was the U.S.; it came up with its own diagnostic tool, which turned out to be flawed and left the country blind for two months as the virus raged. Germany’s test confirmed the country’s first case on Jan. 27. There were 13 more in the coming days, at the time constituting the largest known cluster outside of China. Authorities sequestered Covid-19 patients, tracked down their recent contacts, and slowed infections.”

…..Since developing the test, the 48-year-old scientist…has led a research team at Charité that’s explored how the virus spreads and affects people differently. He’s shared thoughts with colleagues around the world, offered insights at press conferences alongside Germany’s health minister, and advised Chancellor Angela Merkel—a role some have compared to that played by Dr. Anthony Fauci in the U.S.” (R)

“Robert Redfield was overheard by an employee of NBC News on a flight from Atlanta to Washington. According to NBC, Redfield criticized Scott Atlas, a radiologist and Fox News talking head added to the taskforce last month.

“Everything he says is false,” Redfield said about Atlas, NBC reported. Redfield later confirmed he had been talking about Atlas.

Atlas, who has no background in infectious diseases but who appears to have the best current access to Trump of any medical adviser, has been frequently criticized by the scientific and medical communities for offering what public health professionals say is bad advice about coronavirus.

On Monday afternoon, the top US public health expert and infectious diseases lead on the taskforce, Anthony Fauci, chimed in to tell CNN he was concerned that Atlas was at times providing misleading or incorrect information on the pandemic to Trump.

“Well, yeah, I’m concerned that sometimes things are said that are really taken either out of context or are actually incorrect,” Fauci, the head of the National Institute of Allergy and Infectious Diseases, said when asked in an interview if he was worried Atlas was sharing misleading information.” (S)

The United States Postal Service had planned to distribute 650 million face coverings for the Trump administration in April to help curb the spread of the coronavirus, according to newly obtained internal documents reviewed by CNN.

But those plans were scrapped by the White House because it didn’t want to spark “concern or panic” among Americans, senior administration officials told The Washington Post.

“There was concern from some in the White House Domestic Policy Council and the office of the vice president that households receiving masks might create concern or panic,” one administration official told the Post.

The documents obtained by the transparency group American Oversight show the Postal Service was doing this in partnership with the White House Coronavirus Task Force, the Department of Health and Human Services and “a consortium of textile manufacturers.”

USPS was planning to ship the masks in April and was going to prioritize areas “which HHS has identified as experiencing high transmission rates of Covid-19,” according to a draft USPS release. Louisiana’s Orleans and Jefferson parishes were going to be sent masks first, followed by King County, Washington; Wayne County, Michigan; and New York…” (T)

“Top White House officials pressured the Centers for Disease Control and Prevention this summer to play down the risk of sending children back to school, a strikingly political intervention in one of the most sensitive public health debates of the pandemic, according to documents and interviews with current and former government officials.

As part of their behind-the-scenes effort, White House officials also tried to circumvent the C.D.C. in a search for alternate data showing that the pandemic was weakening and posed little danger to children.

The documents and interviews show how the White House spent weeks trying to press public health professionals to fall in line with President Trump’s election-year agenda of pushing to reopen schools and the economy as quickly as possible. The president and his team have remained defiant in their demand for schools to get back to normal, even as coronavirus cases have once again ticked up, in some cases linked to school and college reopenings.

The effort included Dr. Deborah L. Birx, the White House’s coronavirus response coordinator, and officials working for Vice President Mike Pence, who led the task force. It left officials at the C.D.C., long considered the world’s premier public health agency, alarmed at the degree of pressure from the White House.” (U)

“Fauci also discussed Dr. Scott Altas, a White House coronavirus task force member with whom CDC director Robert Redfield has questioned for sharing misleading information with President Trump, according to CNN.

Fauci called Atlas an “outlier,” saying that most members of the task force are working together.

“My difference is with Dr. Atlas, I’m always willing to sit down and talk with him and see if we could resolve those differences,” he said.” (V)

• A.What the 1918 flu pandemic can teach us about coronavirus, By Kristen Rogers, https://www.cnn.com/2020/09/25/health/1918-flu-pandemic-lessons-coronavirus-wellness/index.html
• B.Under 10 Percent of Americans Have Covid-19 Antibodies, Study Finds, https://www.nytimes.com/2020/09/25/world/covid-coronavirus.html?referringSource=articleShare
• C.Experts warn of ‘twindemic’ as Covid cases rise and flu seasons looms, By Corky Siemaszko, https://www.nbcnews.com/news/us-news/experts-warn-twindemic-covid-cases-rise-flu-seasons-looms-n1240623
• D.In calm before the storm, hospitals prepare for second wave of COVID-19, By Felice J. Freyer and Kay Lazar,  https://www.bostonglobe.com/2020/08/05/metro/calm-before-storm-hospitals-prepare-second-wave-covid-19/
• E.Hospitals ready flu vaccines, duel-testing to prepare for potential ‘twindemic’, By Teri West, https://www.nj.com/hudson/2020/09/hospitals-ready-flu-vaccines-duel-testing-to-prepare-for-potential-twindemic.html
• F.40% of healthcare workers asymptomatic when testing positive for COVID-19, analysis finds, by Kelly Gooch, https://www.beckershospitalreview.com/workforce/40-of-healthcare-workers-asymptomatic-when-testing-positive-for-covid-19-analysis-finds.html
• G.Public health expert says new CDC data shows need for hospital-acquired COVID-19 reporting, Molly Gamble, https://www.beckershospitalreview.com/public-health/public-health-expert-says-new-cdc-data-shows-need-for-hospital-acquired-covid-19-reporting.html
• H.Is There a Second Wave of COVID-19 Coming and What Can Hospitals do to Prepare?, By Tara Gibson, https://www.ravemobilesafety.com/blog/second-wave-of-covid-19-what-can-hospitals-do-to-prepare
• I.Europe’s second wave is here: France and the UK recorded their highest daily COVID-19 cases ever, and the EU warned that some countries have worse outbreaks than in March, by Sinéad Baker, https://www.businessinsider.com/europe-sees-new-coronavirus-peaks-countries-all-time-case-records-2020-9
• J.As Virus Cases Surge in Europe, Hospitalizations Lag. But for How Long?, By Mark Landler, https://www.nytimes.com/2020/09/24/world/europe/covid-europe-hospitals-lockdowns.html?referringSource=articleShare
• K.How it all went wrong (again) in Europe as second wave grips continent, By Emma Reynolds, https://www.cnn.com/2020/09/19/europe/europe-second-wave-coronavirus-intl/index.html
• L.Trudeau: Canada already in second wave of coronavirus, By ANDY BLATCHFORD, https://www.politico.com/news/2020/09/23/trudeau-coronavirus-second-wave-420857
• M.Dr. Fauci: U.S. still in the first wave, seasonal ‘challenge’ lies ahead, https://www.nxsttv.com/nmw/news/coronavirus/dr-fauci-u-s-still-in-the-first-wave-seasonal-challenge-lies-ahead/
• N.Florida Gov. Ron DeSantis, here during a news conference last month, says his state is ready to respond if a surge of coronavirus infections emerges., by Chris O’Meara/AP, https://www.npr.org/sections/coronavirus-live-updates/2020/09/25/916969969/floridas-governor-lifts-all-covid-19-restrictions-on-businesses-statewide
• O.Florida adds 2,795 coronavirus cases, 107 deaths, By Romy Ellenbogen, https://www.tampabay.com/news/health/2020/09/26/florida-adds-2795-coronavirus-cases-107-deaths/
• P.Second Covid-19 wave could turn cracks in the hospital system into ‘earthquakes’, By Lauren Dunn, https://www.nbcnews.com/news/us-news/second-covid-19-wave-could-turn-cracks-hospital-system-earthquakes-n1240859
• Q.ot an ‘if’ but a ‘when’: Emergency preparedness lessons from COVID-19, By John Davanzo, https://www.dotmed.com/news/story/52585?p_begin=0
• R.Germany Has Its Own Dr. Fauci—and Actually Follows His Advice, by Tim Loh, https://www.bloomberg.com/news/features/2020-09-28/christian-drosten-germany-s-dr-fauci-worries-about-second-wave-of-covid
• S.CDC director takes aim at Trump’s Covid adviser: ‘Everything he says is false’, by Tom McCarthy and Joan E Greve, https://www.theguardian.com/us-news/2020/sep/28/covid-coronavirus-cdc-director-robert-redfield-trump-adviser-scott-atlas
• T.Washington Post: WH nixed plan to distribute 650 million face masks through USPS, By Paul P. Murphy and Devan Cole,  https://www.cnn.com/2020/09/18/politics/postal-service-face-masks-coronavirus-trump-administration/index.html
• U.Behind the White House Effort to Pressure the C.D.C. on School Openings, By Mark Mazzetti, Noah Weiland and Sharon LaFraniere, https://www.nytimes.com/2020/09/28/us/politics/white-house-cdc-coronavirus-schools.html?referringSource=articleShare
• V.Dr. Fauci Calls Out ‘Outlandish’ Fox News Reporting on Coronavirus Pandemic, By Jordan Moreau, https://variety.com/2020/tv/news/fauci-fox-news-coronavirus-1234785786/