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….
The virus seems to spread the most when people yell (such as to chant a slogan), sneeze (to expel pepper spray), or cough (after inhaling tear gas). It is transmitted most efficiently in crowds and large gatherings, and research has found that just a few contagious people can infect hundreds of susceptible people around them. The virus can spread especially easily in small, cramped places, such as police vans and jails.
As such, for the past several days, the virus has found new environments in which to spread across the United States. At least 75 cities have seen widespread demonstrations and social unrest as Americans have gathered to protest systemic racism and the killing of George Floyd, the black man who died last week under the knee of a Minneapolis police officer…
The pandemic and unrest together have trapped the country in a bind. The demonstrations oppose police brutality. But peaceful, masked protesters—and the journalists covering them—have sometimes been met with an overly aggressive police response.
“I don’t think there’s a question of whether there will be spikes in cases in 10 to 14 days,” Mark Shrime, a public-health researcher at Harvard, told me. “With so many protests happening, that are getting so much bigger, I don’t think it’s a question of if, but when and where.”
Maimuna Majumder, a computational epidemiologist at Boston Children’s Hospital and Harvard Medical School, agrees. “All things considered, there’s little doubt that these protests will translate into increased risk of transmission for COVID-19,” she told me by email.” (A)
“As nationwide protests sparked by the death of a black man in police custody stretched into their sixth day, current and former government officials warned Sunday that the mass demonstrations could lead to new waves of coronavirus infections.
“There’s going to be a lot of issues coming out of what’s happened in the last week, but one of them is going to be that chains of transmission will have become lit from these gatherings,” former Food and Drug Administration commissioner Scott Gottlieb said in an interview on CBS News’s “Face the Nation.”” (B)
“While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus…
In Los Angeles, where demonstrations led to the closing of virus testing sites on Saturday, Mayor Eric Garcetti warned that the protests could become “super-spreader events,” referring to the types of gatherings, usually held in indoor settings, that can lead to an explosion of secondary infections.
Gov. Larry Hogan of Maryland, a Republican, expressed concern that his state would see a spike in cases in about two weeks, which is about how long it takes for symptoms to emerge after someone is infected, while Atlanta’s mayor, Keisha Lance Bottoms, advised people who were out protesting “to go get a Covid test this week.”…
…Dr. Howard Markel, a medical historian who studies pandemics, likened the protest crowds to the bond parades held in American cities like Philadelphia and Detroit in the midst of the 1918 influenza pandemic, which were often followed by spikes in influenza cases.
“Yes, the protests are outside, but they are all really close to each other, and in those cases, being outside doesn’t protect you nearly as much,” Dr. Markel said. “Public gatherings are public gatherings — it doesn’t matter what you’re protesting or cheering. That’s one reason we’re not having large baseball games and may not have college football this fall.”
Though many protesters were wearing masks, others were not. SARS-CoV-2, the virus that causes the Covid-19 disease, is mainly transmitted through respiratory droplets spread when people talk, cough or sneeze; screaming and shouting slogans during a protest can accelerate the spread, Dr. Markel said.
Tear gas and pepper spray, which police have used to disperse crowds, cause people to tear up and cough, and increase respiratory secretions from the eyes, nose and mouth, further enhancing the possibility of transmission. Police efforts to move crowds through tight urban areas can result in corralling people closer together, or end up penning people into tight spaces.
And emotions have been running high, Dr. Markel said. “People get lost in the moment, and they lose awareness of who is close to them, who’s not, who’s wearing a mask, who’s not,” he said.
The biggest concern is the one that has bedeviled infectious disease experts since the pandemic began, and it’s the coronavirus’s secret weapon: that it can be transmitted by people who don’t display any symptoms and feel healthy enough to participate in protests.” (C)
“Because of delays between exposure to the virus and symptoms, the effects of the protests on the spread of the virus will not be known for several weeks. But epidemiologists said the protests would almost certainly lead to more cases.
Health experts know that the virus is far less likely to be spread outdoors than indoors. And masks reduce the chance of transmitting respiratory droplets that contain the virus. But yelling, shouting and singing can increase how far those droplets are projected. Crowds also increase the risk of transmission. Police tactics such as spraying tear gas — which causes people to cough — herding protesters into smaller areas for crowd control and placing arrested individuals in buses, vans and holding cells also increase the risk of infection.
Tay Anderson, a protest leader and city school board member in Denver, said he had been worried about the disparate effects of the virus on black Colorado residents as thousands marched through the city and rested shoulder to shoulder on the lawn of the State Capitol in silent demonstrations to decry Mr. Floyd’s death.
He put out a call on social media for all protesters to join him in getting tested for the virus on Saturday morning at the Pepsi Center, a concert arena where Denver has been running free, large-scale testing.
“WE ARE STILL IN A PANDEMIC,” he wrote on Twitter.” (D)
““We are still in the middle of a pandemic,” Minnesota Gov. Tim Walz (D) reminded demonstrators in a news conference where he announced the full mobilization of the state National Guard to control the violent unrest.
Warning that hospitals were “on the verge of being overrun,” Walz said “demonstrators should wear masks and try to practice social distancing.”..Two to four weeks after many states began lifting restrictions on restaurants, bars and larger gatherings, cases are rising in areas that had previously dodged the worst of the virus’s impact. Arizona, Mississippi, South Carolina, Utah and Wisconsin all set record highs for new cases reported Friday. Restaurants, gyms, and other businesses have been allowed open for at least two weeks in all of the states.
The five are among 18 states that continue to see increases in their rolling seven-day case averages as of Friday, according to Washington Post data, as has Puerto Rico. Some of the places, such as Washington state, California and parts of Virginia, had imposed stringent stay-at-home measures and had been cautious in their reopening procedures. Other states experiencing case increases, such as Alabama, Missouri and Tennessee, have been more aggressive in their push to reopen.” (E)
“Several health systems in Chicago canceled elective procedures June 1 after a weekend packed with public transit disruptions and protests following the death of George Floyd, according to The Chicago Tribune.
For example, University of Chicago Medicine closed its outpatient centers June 1 in six Chicago neighborhoods, including Orland Park, South Loop, River North, River East, South Shore and Hyde Park.
It also closed its COVID-19 testing sites and canceled elective surgeries at some facilities, according to the report.” (F)
Mass protests that have erupted over police brutality toward black people in America are raising concerns about the risk of spreading the coronavirus. But some health experts, even as they urge caution, said they support the demonstrations — because racism also poses a dire health threat…
Health experts urged protesters not to sing and shout to reduce the threat of person-to-person transmission. And they cautioned that police tactics such as tear gas and pepper spray could exacerbate the situation by prompting people to cough and gasp for air.
The New York City Department of Health and Mental Hygiene issued a list of tips for demonstrators to lower their risk of contracting COVID-19, such as covering their faces and staying in small groups.
“Don’t yell; use signs & noise makers instead,” the department advised…
But the risks of congregating during a global pandemic shouldn’t keep people from protesting racism, according to dozens of public health and disease experts who signed an open letter in support of the protests.
“White supremacy is a lethal public health issue that predates and contributes to COVID-19,” the letter said…
Local governments should not break up crowded demonstrations “under the guise of maintaining public health,” the experts said in their open letter. They urged law enforcement agencies not to use tear gas, smoke and other irritants, saying they could make people more susceptible to infection and worsen existing health conditions.
The medical professionals also acknowledged the potential for COVID-19 cases to rise in the days to come, and they called for public health agencies to boost access to care and testing in affected communities.” (G)
“Mass protests over police brutality have shuttered coronavirus testing sites, complicated efforts to track people who have been exposed and set off fears among local officials that the unrest could spark fresh waves of virus infection.
Testing sites in Pennsylvania, Florida, California and Illinois closed after violence broke out over the weekend, limiting cities’ ability to track the virus just as thousands of people participate in crowded demonstrations across the country.
It comes at a risky time. Public health officials are already worried about caseloads rising and hospitals filling as states reopen and people venture out — sometimes in defiance of ongoing social distancing guidelines. And many of the neighborhoods affected by the violence are already bearing a disproportionate burden of the epidemic, as black Americans are getting sick and dying at far higher rates than white Americans…
Those concerns were palpable in hard-hit New York, where a few private testing sites closed or reduced hours amid the protests. Gov. Andrew Cuomo and Mayor Bill de Blasio imposed an 11 p.m. curfew in New York City, one week before it was finally set to start reopening.
“We spent all this time closing down, locked down, masks, social distancing and then we turn on the television and you see mass gatherings that could potentially be infecting hundreds and hundreds of people after everything we’ve done,” Cuomo said Monday. “We have to take a minute and ask ourselves what are we doing here?”…
“We don’t have a vaccine. We don’t have medication,” said Dr. Umair Shah, who heads the Harris County Health Department in Texas. “We’re relying on people to socially distance and wear facial coverings and avoiding large crowds. When you put those elements straight into protests — it’s completely antithetical to each other.”…
“If people have been protesting, they might not want to share with the health department where they were, especially if there were incidents in that area,” Dr. Jeffrey Klausner, a professor at UCLA’s public health school and a former health official for San Francisco, said. “There’s a brick wall [preventing information sharing] between health departments and any criminal justice efforts, but people don’t know that, so they may be reluctant to answer their phone and be completely forthcoming about their behaviors and movements.”
Those fears could be exacerbated, other health leaders fear, by Minnesota Public Safety Commissioner John Harrington using the term “contact tracing” in a weekend press conference to describe his efforts to find people who took part in looting and rioting over the weekend.
“To weaponize contact tracing — which is critical to help safely reopen our economy and ensure those most impacted by Covid-19 such as low-income communities and communities of color are safe — is unconscionable and undercuts any efforts to end this pandemic,” said David Harvey, who heads the National Coalition of STD Directors. He called it a “gross and dangerous mischaracterization of an essential public health function.”” (H)
“Republicans said Tuesday night that they were moving President Trump’s convention speech out of Charlotte, N.C., and to another city, after coming to a stalemate with Democratic officials in the state about safety and crowd size restrictions because of the coronavirus.” (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….
“All those essential workers have to get up every morning to put food on the shelves and go to the hospitals to provide healthcare under extraordinary circumstances,”
N.Y. will pay benefits for workers who died fighting the pandemic.
There are 62,344 cases of COVID-19 among healthcare personnel in the U.S., and 291 have died, new data from the CDC shows. (L)
to read PARTS 1-29 in chronological order, highlight and click on
Throughout the Coronavirus pandemic I have worried non-stop about the staff at Jersey City Medical Center. I was President and CEO of the Medical Center for seventeen years and saw first-hand, time after time, how JCMC’s courageous staff of “front-liners” always responded to the challenges of inconceivable emergencies.
JCMC is a regional, safety-net, level II trauma center, teaching hospital. Rapid Response is part of the hospital’s DNA. For example:
The first World Trade Center bombing was in 1993. As a nearby EMS service we sent all our ambulances through the Holland Tunnel into Manhattan. They got caught in the gridlock, were useless, and we didn’t get them back for three days and had to rely on Mutual Assist to cover our home turf.
In the mid 1990’s we had a 4-alarm arson fire in the hospital. The extraordinary efforts of the JCFD saved the day and 400 patients as we were evacuating the smoke-filled hospital, hampered by archaic elevators and narrow, dark stairways.
And on September 11th 2001, the Medical Center was the lead New Jersey responder to the World Trade Center attacks, as thousands of evacuees were ferried across the Hudson River to Jersey City.
While I was not involved in Super Storm Sandy in 2015, the new Jersey City Medical Center opened in 2004 was hard hit even though it had been built to withstand the “100 year flood plain.” JCMC persevered while the hospitals in nearby Hoboken and North Bergen were totally evacuated.
So these “front-liners” deserve unique recognition as they stand in harms way to protect us during the most challenging of emergencies.
An article today about contact tracers in Paterson, New Jersey, reminded me that others are essential as well, even if working from home.
“States and cities around the country have begun with varying degrees of success to ramp up efforts to put contact tracing in place on a large scale. Last week, Gov. Philip D. Murphy of New Jersey said that his state would hire up to several thousand contact tracers to assist the 800 now working for local and county health departments.
In New York, Gov. Andrew M. Cuomo of New York has announced that the state will build an army of up to 17,000 contact tracers. A political tangle between agencies has complicated efforts to expand tracing in New York City, the epicenter of the pandemic in the United States, but Mayor Bill de Blasio said on Sunday that he hoped to have 1,000 tracers in place by June.
Twenty miles to the west of New York City, Paterson, a poor, largely nonwhite city of about 150,000, has been tracing the virus at a level that could be the envy of larger cities. The team has been able to successfully investigate and trace about 90 percent of the more than 5,900 positive virus cases in Paterson, said the city’s top health officer, Dr. Paul Persaud…
As of Saturday, 306 Paterson residents have died, giving the city a death rate of 5.1 percent among those who have tested positive, compared to 7 percent statewide…
When the first cases began to appear in Paterson in mid-March, the Board of Health added two dozen employees who had been trained in communicable disease investigation last year to join their regular team of two disease detectives.
Since then, the full team, which the board calls its Covid-19 strike force, has grown to nearly 50 of the 60 board employees. Joining a dozen public health nurses are clerical staff, translators and health inspectors…
The contact-tracing team mostly works from their homes, making calls and entering their interview results into the state’s communicable disease reporting system. Once a week, they put on their masks and come to the city’s small public health headquarters to confer about the crush of cases.
During last week’s meeting, Andre Sayegh, the city’s mayor, handed out a sheet showing a line curve that tracked the city’s progress: From a high of about 260 daily positives on April 15, the city is now at about 50 to 70 cases per day, a level not seen since March….
After gathering the list of contacts, the case investigator then hands most cases off to a support staff of 20 other workers, who call each contact, tell them they have been exposed and ask them to self-quarantine for two weeks from the date of exposure.
The monitors do daily check-ins with all the contacts and the original patient during quarantine to see how they are feeling and monitor their compliance.
In Paterson, the work has gone on through nights and weekends, and the tracers said it can be tedious and emotionally grueling.
The goal may be to get information from each patient, but just as vital, the tracers said, is to develop enough trust so that their advice is followed.
“Usually, I start the call by saying, ‘I see you had a Covid test, can you tell me why you went?’” Ms. Bertolero said. “One woman said to me, ‘Because my brother died.’ I just had to stop for a bit and tell her how sorry I was.” (B)
ESSENTIAL WORKERS? Of course they are!
“…Frontline workers include, but are not limited to, healthcare workers, protective service workers (police and EMTs), cashiers in grocery and general merchandise stores, production and food processing workers, janitors and maintenance workers, agricultural workers, and truck drivers…
Healthcare workers represent 20 percent of all frontline workers. This includes the relatively high-paying, highly educated group comprised of healthcare practitioners and those in technical occupations (e.g. doctors, registered nurses and pharmacists – about three quarters of all healthcare workers) as well as health-support workers (e.g nursing assistants and home health aides – about one-quarter of this group).” (C)
“We insist that many making minimum wage or close are essential enough that we need them to keep working, but we haven’t found a way yet to properly compensate them for the risk they are taking on when they clock in.
Those essential workers who show up at jobs like grocery stores and fast food chains may only see small financial rewards, such as an extra $2 per hour in hazard pay during this pandemic. Employers are not required to offer it though, so only some workers have received the bump, which may only add up to an extra $80 or so weekly for a full-time worker anyway.
Meanwhile, the CARES Act is allowing for those on unemployment to receive an extra $600 per week in addition to their regular benefit. So a full-time grocery store worker who was taking home $700 every two weeks might now be making $860 with their hazard pay benefit, or perhaps a little more with an increase in hours. Compare with a person on unemployment who could be taking home a benefit of $600 every two weeks plus an extra $600 per week for a total of $1800 over that same pay period.
Some workers feel they are being treated unfairly for being expected to show up to these jobs only to take home less pay than those who are sitting safely at home making unemployment. In a way, the essential workers are trapped. They can’t get unemployment if they quit, but their jobs won’t fire them so long as they’re needed. What this means is that while essential businesses are booming, their employees are receiving none of the gains while taking on most of the risk.” (D)
“Frontline workers have always been the lifeblood of our city. Nurses, janitors, grocery clerks, childcare staff, bus and truck drivers. Every single day, crisis or no crisis, these are the essential workers in our city, our economy, and our society. The COVID-19 crisis does little to change that reality, it only brings into sharper relief these vital New Yorkers, who number more than one million workers amid today’s crisis, or 25 percent of the city’s workforce.
And yet, these same workers whom we trust with our health, our nourishment, our loved ones, and our lives are too often ignored, underpaid, and overworked. They very often lack healthcare, have to travel long distances to get to get to work, and struggle with childcare. Many in New York City are also undocumented, meaning they do all of the above while living in fear of deportation under the current federal administration.
If there is any collateral benefit to the COVID-19 tragedy, it is that the labor and contribution of those in our social service, cleaning, delivery and warehouse, grocery, healthcare, and public transit industries have finally received the attention and respect that they are due. How well we protect, compensate, and care for these workers, then, will be the ultimate litmus test for what we’ve learned from this global pandemic.” (E)
‘New York Gov. Andrew Cuomo said Monday the federal government should pay bonuses to front line coronavirus workers.
According to The Hill, Cuomo made the comments during his daily coronavirus press conference, saying essential workers don’t have the “luxury of staying home.” As a result, Cuomo believes essential workers should receive a 50% bonus over what they’re currently being paid.
“We all say ‘boy they did a great job, the healthcare workers did a great job, the police — they’re heroes,’” Cuomo said. “Yes, they are, but you know? Thanks is nice but also recognition of their efforts and their sacrifice is also appropriate. They are the ones carrying us through this crisis and this crisis is not over.”…
“Senate Democrats unveiled a proposal Tuesday that would boost the pay of essential workers on the frontlines of the battle against the coronavirus pandemic by potentially tens of thousands of dollars.
As much as $25,000 in hazard pay would be afforded over a period of time to those deemed essential, including employees in health care, drug stores, grocery stores, sanitation workers, truck drivers, transportation workers and all federal employees with frontline positions, such as Postal Service workers.
“Not all heroes wear capes,” Senate Minority Leader Chuck Schumer (D-N.Y.) told reporters on a conference call Tuesday. “For these Americans, working from home is not an option. Social distancing is not an option.”
The raise would be equivalent to $13 per hour and would apply retroactively from the start of the health crisis emergency on January 27 until the end of the year, Schumer said.
Health care workers also could receive a one-time premium of up to $15,000 as part of a program to recruit and retain certain medical employees in fields experiencing shortages. The benefits would be applied retroactively for those already working on the frontlines and to the families of health care workers who’ve died as a result of coronavirus.
“We are asking these workers to take on great risk. They should be compensated for it,” Schumer said. “These Americans are the true heroes of this pandemic, and we need to make sure they are taken care of. They are there for us, so we must be there for them.”” (G)
Heroes among us: Cincinnati essential workers who are battling on the frontlines” (H)
“Marching into the White House briefing room for a hastily called announcement, Mr. Trump declared places of worship “essential” operations that should hold services in person this weekend regardless of state quarantine orders stemming from the coronavirus pandemic that has killed nearly 96,000 people in the United States.
“The governors need to do the right thing and allow these very important, essential places of faith to open right now for this weekend,” Mr. Trump said, reading from a prepared text before leaving after just about a minute without taking questions. “If they don’t do it, I will override the governors. In America, we need more prayer, not less.”” (J)
“New York’s state and local governments will provide death benefits to the families of essential workers who died while fighting the coronavirus pandemic, Gov. Andrew M. Cuomo said on Monday.
“We want to make sure that we remember them, and we thank our heroes of today, and they’re all around us,” Mr. Cuomo said at his daily news briefing.
As people paused on Memorial Day to remember military personnel who died while serving the country, Mr. Cuomo linked the fallen service members to New York’s front-line workers, whom he called today’s “heroes.”
The public employees whose families would receive death benefits included health workers, police officers, firefighters, transit workers and emergency medical workers, the governor said. The benefits would be paid out of state and local pension funds.” (K)
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!
“ The Centers for Disease Control and Prevention is conflating the results of two different types of coronavirus tests, distorting several important metrics and providing the country with an inaccurate picture of the state of the pandemic. We’ve learned that the CDC is making, at best, a debilitating mistake: combining test results that diagnose current coronavirus infections with test results that measure whether someone has ever had the virus. The upshot is that the government’s disease-fighting agency is overstating the country’s ability to test people who are sick with COVID-19. The agency confirmed to The Atlantic on Wednesday that it is mixing the results of viral and antibody tests, even though the two tests reveal different information and are used for different reasons.
This is not merely a technical error. States have set quantitative guidelines for reopening their economies based on these flawed data points.” (A)
“Virginia, Texas, Georgia, and Vermont have said they’ve been adding two numbers to their totals: viral test results and antibody test results.
Viral tests are taken by nose swab or saliva sample, and look for direct evidence someone currently has Covid-19. By contrast, antibody tests use blood samples to look for biological signals that a person has been exposed to the virus in the past.
Combining the two tests’ results into one total could provide an inaccurate picture of where and when the virus spread. It could also overstate a state’s ability to test and track active infections — a key consideration as states ease coronavirus restrictions. Experts have consistently emphasized that for states to reopen safely, adequate testing and tracing is needed.
“You only know how many cases you have if you do a lot of testing,” said Elizabeth Cohen, CNN’s senior medical correspondent. “If you put the two tests together, you fool yourself into thinking you’ve done more testing than you have.”’…
Texas, Virginia and Vermont have said they’ve recognized the data issue and moved to fix it in the past few days. In Georgia, health officials said they’ve been adding antibody tests to their “total tests” number in line with methodology from the Centers for Disease Control and Prevention.” (B)
Viral tests — commonly referred to as PCR tests as most of them use a process known as polymerase chain reaction — are used by health professionals to determine whether or not a person is currently infected with the disease. During the pandemic, viral tests have been the most effective way of being able to diagnose a positive case of COVID-19. They are what state governments have been counting to track the number of confirmed cases of the virus they have.
Antibody, or serology, tests serve a different purpose. Unlike viral tests that are taken by nose swab or saliva sample, antibody tests examine a person’s blood to see if their immune system has created antibodies to combat COVID-19. These tests allow doctors to see if someone has previously been exposed to the virus. As the push for widespread testing in the U.S. has strengthened, antibody tests have been widely produced, many experts have balked at saying that antibodies equate to immunity from COVID-19. Serology tests are also less accurate than PCR tests, increasing the chances for a false negative.
Moreover, a negative test means different things for either test. A negative PCR test indicates to physicians that the patient isn’t currently ill with the disease. But, a negative serology test means that the patient has most likely not been exposed to or infected with COVID-19.
“The viral testing is to understand how many people are getting infected, while antibody testing is like looking in the rearview mirror. The two tests are totally different signals,” Jha told The Atlantic.” (C)
“The Atlanta-based Centers for Disease Control and Prevention and Georgia’s state health department will alter their website data to separate testing data combining antibody and diagnostic test totals.
Wednesday evening, Channel 2 Action News learned Georgia included 57,000 antibody tests in their tally of the number of Georgians who had been tested for COVID-19. That accounted for roughly 15% of the Georgians who were reportedly tested for the virus. When removed from the positive case data, it increased the rate of infected Georgians by 2%.
Simply put, the data inflated the number of Georgians who have been tested for COVID-19. That figure stands around 3%.
The inclusion of the data also offered an “apples-to-oranges” look at the testing. Antibody tests give you a window into the past. COVID-19 test results are used to determine current trends and infections…
Thursday, a CDC spokeswoman told Channel 2 investigative reporter Nicole Carr that the agency would also change its online reporting data in the coming weeks.
“Initially, when CDC launched its website and its laboratory test reporting, viral testing (tests for current infection) were far more commonly used nationwide than serology testing (tests for past infection),” the statement read. “Now that serology testing is more widely available, CDC is working to differentiate those tests from the viral tests and will report this information, differentiated by test type, publicly on our COVID Data Tracker website in the coming weeks.”..
…experts here in Georgia explained the problems that arise from the conclusions drawn when that data is mixed. This comes days after Georgia began removing antibody positives out of case counts.
“When you only count the positives from the viral test, it’s going to look like the number of people who are testing positive as a percentage of all tests is going down, when it, in fact, that may not be the case, or at least it’s exaggerating that effect,” …
“It gets more complicated than that because these tests have different accuracy levels,”… “The percentage of false positives and false negatives is going to be different with each test, so why do you would mix them together? It just clouds what you know about the situation.”…
“In the realization yesterday that that total testing number was almost impossible to interpret called, really, those numbers into question and all the policies that have been based on those numbers into question,”…“And I think rightfully raises concerns in the minds of many Georgians.”
“We really need one coordinated public health response,” he added.” (D)
“In addition, combining antibody testing with diagnostic testing could reduce the number of tests that appear to be producing positive results, lowering the overall “positivity rate.” That’s another important benchmark. The World Health Organization has recommended a positivity rate of 10% or less as a signal of whether enough testing is taking place.” (E)
“How CDC explained its actions: The inflated totals resulted from states reporting their data to the agency in that format, a CDC spokesperson told POLITICO’s Brianna Ehley. Some states are still using a simplified submission form CDC created early on that combines both types of tests, meaning they get bunched together in the federal numbers too.
The agency is now shifting states to a more detailed form that should eliminate that issue, and it plans to break out figures for the two types of tests in the next week or so.
Some questions are still unanswered. CDC wouldn’t say how long it’s been combining the two tests, and it wasn’t until Wednesday — amid questions about its practices — that CDC deleted an assertion on its website that the totals “represent only viral tests.” It’s also unclear how significantly the practice has inflated the testing totals.” (F)
““This is not an intentional misuse of information — it’s part of the fog of the infectious disease war,” said Michael T. Osterholm, a University of Minnesota professor and former state epidemiologist who was sharply critical of the disease control centers early in the pandemic. “We’ve done surveillance for cases, and now we’re all trying to do testing, and it presents unique challenges.”
Whatever the reason, the numbers are fueling Mr. Trump’s frequent — and inaccurate — boasts that the United States is doing more testing “than all other countries combined,” a claim that the fact-checking website PolitiFact has declared “pants on fire wrong.” Governors rely on testing in deciding how far to go in reopening their economies. With all 50 states moving to reopen, accurate tracking is essential.
“We’re like the blind epidemiologists trying to understand the elephant,” said Michael Levy, a professor of epidemiology at the University of Pennsylvania. Health officials, he said, need good reporting to “understand the relationship between the epidemic that we can’t see, and the data that we can see.”
Scott J. Becker, the executive director of the Association of Public Health Laboratories, said there was another reason states were tracking testing: Mr. Trump wants the numbers.
“We’ve never needed to capture test volume. That is what the White House wanted to know, how many tests were being done,” Mr. Becker said, adding, “Ordinarily this all works through the public health system, but in this response, there’s been a drive to have data numbers, at multiple levels.”” (G)
“According to The Atlantic’s COVID Tracking Project, COVID-19 testing capacity in the U.S. has more than doubled over the past month, increasing from about 147,000 tests a day in mid-April to more than 413,000 tests a day as of May 20. Simultaneously, the proportion of positive tests recorded each week fell from 10% to 6% of total tests conducted. Both trends appear encouraging at face value, but given that diagnostic and antibody tests are sometimes being lumped together, it’s impossible to know whether the data reflects reality, The Atlantic reported.
When asked about the mess-up, CDC spokesperson Kristen Nordlund said that the agency “hopes” to separate the data on their COVID Data Tracker within the next few weeks.” (H)
Prequel
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)
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.
