Month: March 2022

The World Health Organization (WHO) on Friday announced changes to its guidelines on who should wear a mask during the Covid-19 pandemic and where they should wear it.

The new guidance recommends that the general public wear cloth masks made from at least three layers of fabric “on public transport, in shops, or in other confined or crowded environments.” It also says people over 60 or with preexisting conditions should wear medical masks in areas where there’s community transmission of the coronavirus and physical distancing is impossible, and that all workers in clinical settings should wear medical masks in areas with widespread transmission.

It’s a major update to the agency’s April 6 recommendations, which said members of the general public “only need to wear a mask if you are taking care of a person with Covid-19” or “if you are coughing or sneezing.” And it’s important advice for countries around the world battling the virus, especially those in South America, the Middle East, and Africa, where the rate of Covid-19 transmission appears to be accelerating.

At a WHO press conference on June 3, Michael Ryan, an infectious disease epidemiologist and the executive director of the WHO’s Health Emergencies Programme, said WHO still believes that masks should primarily be used “for purposes of source control — in other words, for people who may be infectious, reducing the chances that they will infect someone else.”

And on Friday, WHO Director-General Tedros Adhanom Ghebreyesus offered a few words of warning as part of the announcement: “Masks can also create a false sense of security, leading people to neglect measures, such as hand hygiene and physical distancing. I cannot say this clearly enough: Masks alone will not protect you from Covid-19.”

But the changes finally bring the WHO in line with many countries around the world that have made masks mandatory in crowded public spaces, including Cuba, France, Cameroon, Vietnam, Slovakia, and Honduras. While it has not made masks a requirement, the US Centers for Disease Control and Prevention (CDC) has since April 3 suggested “wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain.”

Many health experts have wondered why it’s taken this long for the WHO to update its mask guidelines, given the accumulation of evidence that they may be helpful and have few downsides.

Eric Topol, a research methods expert and director of the Scripps Research Translational Institute, calls WHO’s delay “preposterous.” He adds, “I have great respect for the World Health Organization — but they got the mask story all wrong, and we have lost people because of it.” Lawrence Gostin, director of the O’Neill Institute for National and Global Health Law at Georgetown University, agrees, saying, “Everyone should be wearing a mask.”

Here’s what the research suggests and why experts think WHO has now revised its guidelines.

Why wear a mask?

The WHO didn’t cite any particular research for its dramatic change, noting only that it “developed this guidance through a careful review of all available evidence and extensive consultation with international experts and civil society groups.”

But there have been a number of recent studies that experts point to as the best evidence for mask use in the general public to reduce Covid-19 transmission. And a growing number of doctors, scientists, and public health experts have been calling for universal masking in indoor public spaces and crowded outdoor spaces.

One meta-review published in Lancet waded through 172 studies on Covid-19, SARS, and MERS, from 16 countries and six continents. Its authors determined that masks — as well as physical distancing and eye protection — helped protect against Covid-19.

The studies reviewed evidence both in health care and non-health care settings and then adjusted the data so they could be directly compared. The researchers found that your risk of infection when wearing a mask was 14 percent less than if you weren’t wearing a mask, although N95 masks “might be associated with a larger reduction in risk” than surgical or cloth masks.

Other literature reviews have not been as favorable. Paul Hunter, professor in medicine at the University of East Anglia, coauthored one such preprint review in early April. “In evidence-based medicine, randomized-controlled trials are supposed to trump observational studies,” he says, “And randomized-controlled trials have all been pretty much negative on face masks in the community.” The Lancet piece, he notes, gives more consideration to observational studies with surgical masks.

A few recent observational studies on mask use by the public in this pandemic, however, support general mask usage to prevent the spread of Covid-19. One from Hong Kong concluded, “mass masking in the community is one of the key measures that controls transmission during the outbreak in Hong Kong and China.” Another concluded that if 80 percent of a population were to wear masks, the number of Covid-19 infections would drop by one-twelfth, or about 8.3 percent, based on observations from several Asian countries where mask-wearing is common.

There’s been some debate over the efficacy of homemade cloth masks and surgical masks (especially compared to N95 masks, which have more evidence behind them) for the general public. But one recent article, published in the Annals of Internal Medicine, found that even cloth masks block some viral particles from escaping.

The general consensus is that masks are better at keeping your viral particles from spreading to others than keeping someone else’s from spreading to you. Catherine Clase, the lead author of the Annals of Internal Medicine piece and an associate professor of medicine at McMaster University, says one study she reviewed found even a single layer of cotton tea towel tested against a virus aerosol reduced transmission of the virus by 72 percent. “One thing to remember,” she says, “is that a mask doesn’t need to be perfect” to bring down the average number of people being infected by one sick person. “It just has to reduce the probability of transmission to some degree.”

William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center, notes that previous data on masks and viruses came out of the SARS and MERS epidemics, which involved viruses that weren’t as transmissible. “Masks were thought of then as more personal protection as opposed to community protection,” he said, helping explain why masks weren’t widely regarded as particularly effective.

But with Covid-19, the rate of asymptomatic patients may be as high as 40 percent, requiring a shift in thinking about masks from protecting the wearer to protecting the community. Clase concludes that while cloth masks may not protect you from inhaling someone else’s germs, “the evidence that they reduce contamination [from sick people] of air and surfaces is convincing, and should suffice to inform policy decisions on their use in this pandemic.”

Clase adds, “The pandemic is not going particularly well. So this is probably worth employing now and doing the additional research later.”

Why the WHO may have had trouble reaching consensus on universal masking

The WHO generally does rigorous reviews of evidence, as the whole world’s health rides on their recommendations. This may explain their delay in recommending the general public wear masks.

The agency used to largely base its decisions around expert advice, says Hunter. “They would get together a group, and they would use these experts to drive WHO guidelines.” But in 2007, a Lancet paper criticized the agency for not following evidence-based medicine, which prioritizes randomized controlled trials.

As a result, Hunter says, “WHO went through a major upheaval in its guideline development practices. Now, it has to base its recommendations on systematic reviews,” and its guideline development committees now have methodologists.

“I think [the delay] reflects a general principle often followed by scientists, which is not to change practice until the evidence is strong and definitive,” Trish Greenhalgh, a professor of primary care sciences at the University of Oxford, wrote in an email interview. “Whilst many people (including me) believe that is already the case, some scientists on WHO committees have been waiting for additional evidence to strengthen the case.”

Greenhalgh argued in early April that it was time to apply the precautionary principle to pandemic response and that the public should wear masks “on the grounds that we have little to lose and potentially something to gain.”

Click Here:

But David Heymann, a professor of infectious disease epidemiology at the London School of Hygiene and Tropical Medicine and a member of WHO’s Strategic and Technical Advisory Group for Infectious Hazards (STAG-IH) advisory board, says the agency “is very cautious to only use evidence when we have it. We don’t make any precautionary measures if we don’t have any contributing evidence.”

STAG-IH was asked to look into the evidence for and against mask use in early May and compiled a report for the WHO that was made public on May 25. The finding “supports mask use by the general public in the community to decrease the risk of infection,” the WHO said in a statement to Vox, noting that in updating their guidance, they took the STAG-IH advice into consideration.

Cliff Lane, the clinical director at the National Institute of Allergy and Infectious Diseases at the National Institutes of Health and another member of STAG-IH, says the WHO is ”very good at trying to get a diverse set of opinions before making recommendations.” But he admits he doesn’t know why the WHO has timed its recommendations for masks the way it has.

He is one of many experts Vox interviewed who said it’s difficult to conduct a randomized, double-blind controlled study of mask use in the general public. Because of ethics and practicality, “much of the epidemiologic data on the impact is inferred,” he says. This magnifies a general problem he sees: “Any guideline you make does an assessment of risk and benefit, and you want to get as much information as you can.” For example, if wearing a mask provides a sense of false security and encourages people to stop social distancing, then consequences may not be worth it. “It’s not a trivial decision,” he says.

Heymann says the WHO’s delay in recommendation comes in part from needing to consider evidence from around the world. “WHO takes longer because there’s a need to obtain consensus from global experts and inform six regional offices.”

Hunter added that nation-states can make decisions based in part on politics or educated guesses. “But WHO cannot take political decisions like that. It has to try to get consensus opinion among scientists, because people look to WHO to make decisions on hard evidence wherever possible.”

As Heymann sees it, “WHO is just the gold standard. Countries many times are ahead of WHO — there’s no need for them to wait for WHO to make recommendations.”

Topol, on the other hand, says the best reason he can think of for the WHO not recommending everyone wear masks is because of the worry over a global shortage of masks, particularly in the US. Perhaps, he says, “They didn’t want to have masks maldistributed, because of the dire need for, and lack of, PPE for health care personnel.”

But, he adds, “That’s not the reason to say you don’t need masks — that’s the reason to say we desperately need to make masks.”

“The world needs the WHO — and it needs it now more than ever”

The WHO has been under a lot of scrutiny since the beginning of the pandemic. And it recently got worse: At the end of May, President Trump announced that the US would pull out of the WHO altogether, potentially withdrawing a significant portion of the agency’s funding.

But the WHO isn’t alone in being slow to suggest mask use. Countries like Venezuela made masks mandatory on March 14, and the Czech Republic made the move on March 18. But the US CDC also originally recommended against masks for the public, only changing its guidance to universal masking on April 3.

Richard Besser, president of the Robert Wood Johnson Foundation and former acting director of the CDC, explains that during an emergency, experts have to look at new information and evaluating decisions. He led the emergency planning and response at the CDC for four years, and says, “When guidance went up, it was always interim. Early on, what you don’t know always exceeds what you do know, and as you learn more, you make changes.”

Sometimes those changes are minor, and sometimes, as in the case of the CDC’s mask guidance, they are significant. “In order for that to make sense to the public, you need to have something that we’re lacking right now: direct communication,” Besser says. “That’s valuable because it engenders trust in settings of crisis, where there are things people should do to protect their health. They’re much more likely to do them if they trust the messenger.”

Unlike the CDC, which has been roundly criticized for its lack of press briefings, the WHO is still holding daily conference calls during the pandemic.

“The WHO, like the CDC, is far from perfect, and is flawed in many ways,” says Gostin, the Georgetown public health law expert. “Having worked with WHO for 30 years, I can say they can be maddeningly bureaucratic and unresponsive. But the world needs the WHO — and it needs it now more than ever.”

Lois Parshley is a freelance investigative journalist and the 2019-2020 Snedden Chair of Journalism at the University of Alaska Fairbanks. Follow her Covid-19 reporting on Twitter @loisparshley.

As someone with asthma, Meredith Blake was very worried about getting sick in the pandemic. With Covid-19 spreading across America, she stayed inside her home in Boston for 12 weeks, isolating from others as much as possible.

Her self-quarantine ended on June 1. After George Floyd’s killing at the hands of police in Minneapolis, she was compelled to march in the streets with a large crowd of other Bostonians, in close proximity. She wore a face mask and used lots of hand sanitizer wipes.

“I was definitely a little nervous,” about catching Covid-19 in the crowd, says Blake, a researcher at the Harvard Humanitarian Initiative. But showing up and speaking out was more important to her in this moment: “I have a vested interest in the protection of black and brown people, not only professionally, but personally,” she says. She felt like she could no longer prioritize her personal safety from the coronavirus.

Blake works with public health professionals and ER doctors every day, and knew joining a crowd was dangerous — for both herself and the community. But she made a careful calculation: Covid-19 is a huge risk, and to her, the protests were worth it.

On the right, some commentators have accused public health experts of hypocrisy around the protests, for endorsing them after months of telling people to stay home to prevent the spread of the coronavirus.

Some of those commentators asked: Is it fair if the grieving can’t hold funerals for loved ones while others are marching en masse? Why should businesses stay closed when several high-profile experts say the protests are worthwhile? Author J.D. Vance, for one, fears public health expert endorsements of the protests will erode trust in expert opinion. “I’m still amazed at how quickly the moral scolding ceased as soon as elite-favored protests began taking place,” Vance tweeted.

I’ve talked to several public health experts who support the protests — both black and white — asking them what they wish people like Vance could accept.

Here’s what they say: Protesters are more afraid of doing nothing in the aftermath of George Floyd’s killing than the pandemic. And centuries of systemic racism, lifetimes of discrimination, and years of watching black people die needlessly drive those fears.

“It is hard for me as a public health professional, who also knows my history, to blanketly tell someone to take all these people off the street when they are protesting against 400 years of a different pandemic that happens to not be infectious,” Zinzi Bailey, a social epidemiologist at the University of Miami, says. “It’s not something that potentially a white person is going to catch. Right?”

People are going out into the streets because they feel like their lives depend on it, because one in every 1,000 black men could die at the hands of police. Because they fear an officer of the state will kill them for something petty, like being suspected of possessing a counterfeit $20 bill, as Floyd was. They are going out because of the systemic reasons Covid-19 has harmed black people in higher numbers, and because black people are more likely to suffer the worst course of illness.

“People are in the streets because they have to be,” Rhea Boyd, a pediatrician who works in California’s Bay Area, says. “Because that is how dire things are. Even in the setting of a pandemic, where it seems like being out there risks your life. There are so many risks on your life. You’ve got to be out there to try to protect it. People need, and black folks in particular, need a ton of changes to happen immediately.”

Missing a funeral is painful. Keeping a business closed is painful and causes real harm. No one doubts that. The question is: Can you live with the consequences?

And what if on the other hand, you feel like your life, and the lives of people you care for, depend on protesting?

Make no mistake: Protesting during a pandemic can spread Covid-19

Many protesters are following public health advice while demonstrating: wearing masks, distancing, using hand sanitizer, and getting tested for Covid-19. But it also must be said that there’s no perfectly safe way to demonstrate in huge gatherings during a pandemic, and the threat of new waves of Covid-19 is still very real.

New cases of Covid-19, nationally, have been declining from a peak, but the national numbers obscure smaller outbreaks that are on the rise in some areas. Things may be looking better, but there are still around 20,000 new Covid-19 cases each day. And that’s just the people who are getting tested. According to Ashish Jha, a professor of global health at Harvard, the real number of new daily infections in the US may be closer to 125,000.

The protests are also occurring at a deeply uncertain time during the pandemic. The overall situation appears to be improving, but a new wave could be brewing under the surface as states reopen. The incubation period of the virus, combined with limited resources for testing, means people can’t have real-time knowledge of the state of the outbreak.

No one knows what’s going to happen next, or how big the next wave might be. There are so many unknowns about how the virus will spread in a country with a patchwork system of response and varying levels of adherence to social distancing and mask-wearing.

That said, the virus’s deadly potential is still great. We’re still looking at dealing with Covid-19 on a timescale of months, if not years.

We also know mass gatherings are risky, even if people take precautions. Yes, it’s safer that the protests are outside (there are very few documented cases of outdoor coronavirus transmission). Yes, it’s safer when people wear masks; it’s safer when people try to distance themselves from one another. But there’s no such thing as zero risk with this virus. And the math of exponential growth means it doesn’t take a big spark to create an outbreak that numbers in the thousands.

“I get very concerned, as do my colleagues in public health, when they see these kinds of crowds,” Dr. Anthony Fauci, the head of the National Institute of Allergy and Infectious Diseases and a top White House adviser on the pandemic, told WTOP on Friday. “There certainly is a risk. I can say that with confidence.”

It’s possible Covid-19 will spread among those marching, shouting out respiratory droplet-laden cries for justice. It’s also possible Covid-19 will spread due to the law enforcement response, throwing tear gas into crowds, making people cough, forcing them into smaller and smaller spaces, and then arresting them and confining them in small jail cells. It’s possible the infection will spread both ways.

This is not lost on the public health experts, nor is the fact that the next wave of cases may disproportionately impact the minority communities protesting. They’re more likely to get sick, more likely to be labeled essential workers if new lockdown orders come.

“I definitely worry about the potential spread of SARS-CoV-2 and how the protests that are going on may contribute to a second wave of Covid-19, which would be disproportionately affecting the black community again,” Jaime Slaughter-Acey, an epidemiologist at the University of Minnesota, says. “Being a black epidemiologist … the way that I see this is that those who are out there protesting are saying that the life of George Floyd, that black lives, matter, and that they’re prioritizing black life over their own individual life. And there is nothing more unselfish than that.”

Why some public health experts say the protests are “essential”

Some journalists have smelled a whiff of hypocrisy in epidemiologists endorsing the protests. These same public health experts did not support anti-lockdown protesters who were arguing for reopening the economy. They decried mass gatherings of people in a large swimming pool. The argument is that health experts have been changing their recommendations, now that there’s a protest that aligns with their social justice politics.

“One thing I’ve been telling people is that the guidance hasn’t really changed from a public health perspective,” Eleanor Murray, a Boston University epidemiologist, says. “It’s always been ‘stay home as much as possible, except for essential activities.’ But the definition of essential is not a scientific one — it’s a sociological one. … Protesting police violence is an essential activity for a lot of people.”

(It’s not surprising a lot of epidemiologists feel this way. When not dealing with a pandemic, they often study societal inequities and the social determinants of health. Because of this work, we now know a lot about systemic racism and its impacts on health.)

Alison Bateman-House, a medical ethicist at NYU, says we need to think carefully about the costs and benefits of each type of protest.

“Your desire for a haircut is not sufficient to counterbalance the potential of harm that you are imposing on others” during a pandemic, Bateman-House says. It’s also true that the stifling of the economy during the pandemic has made life worse for a lot of people. But opening the economy back up was never the only answer. The government could have been more generous in its support for people out of work.

Now think about the costs and benefits of the mass racial justice protests.

“For people of color and black folks, their cost of not doing something is a lot greater than potentially getting a virus,” says Aisha Langford, a health communications researcher at NYU. “I could die as a black person in America — literally just living as a black person in America is a risk factor for dying, potentially at the hands of police, and potentially on national TV. And history has shown that a lot of times, people [the perpetrators] aren’t even brought to justice. So it’s almost like your life is discarded. If I’m quiet, and I do absolutely nothing, I could die because I exist.”

As Boyd put it in a recent American Medical Association panel, “Protest saves lives. The Black liberation movement, queer liberation movement, women’s liberation movement — all built on protest.”

If you believe the protests are essential, “then I would say your social priority is to do harm reduction,” Bateman-House says. For protesters, that means wearing masks and eye protection, avoiding shouting, keeping distance from others, and being tested for Covid-19 (if possible) after returning from the protests, and maintaining social distance in other aspects of life.

Law enforcement could do harm reduction too, as these crowds don’t appear to be going away. That means not using tear gas and not placing people in crowded holding cells, as we know confined indoor spaces are the greatest place of risk of all. In New York, Gothamist reports, hundreds of protesters were locked up for more than a day in cramped cells — a perfect place for the coronavirus to spread. BuzzFeed has estimated at least 11,000 have been arrested nationwide during the protests.

What’s worse: More people dying of Covid-19, or sustained systemic racism?

The debate about pandemic protests raises a question: What is the greater cost to society: exacerbating the spread of Covid-19 or not protesting for racial justice in this moment?

“I would say is that that is the wrong question to be asking, and that is almost a distraction,” Bailey says. “A lot of people are thinking on a very short time horizon. The protesters are not there just for themselves. They’re there for generations to come. They’re there for their children and grandchildren to live in a different society. Right? So I don’t think that it is a distraction to try to quantify what that looks like.” She worries that people who are bringing up Covid-19 risks are really just trying to silence the protest movement.

It’s difficult to make a direct comparison of the two threats, of racism, and of new Covid-19 cases.

Epidemiologists can model what happens when people get closer together during a pandemic. They can tell us Covid-19 is more likely to spread when people convene, that more infections and deaths may result. But they can’t easily model what happens to disparities in society, when a mass protest movement changes anti-racist attitudes for the better.

The protest is fueled by the faith that it will be worth it: that forcing a reckoning on society will be enough to save more lives in the future. And not just saving lives but easing the burden of systemic racism at all levels in society.

“If there are places that immediately are divesting in their police force, I think that makes it worth it,” Boyd, the pediatrician, says. She mentions how Lego has pulled its marketing of police-themed playsets. “And I think that is huge — that there’s a cultural shift about how we think about policing, that it’s not a toy, that it’s a very lethal and dangerous system we’ve built that has racist implications in our society,” she says.

And already, the protests may have had an impact on racial attitudes in America. Support for Black Lives Matter is at an all-time high, according to the survey company Civiqs.

What is the worth of that cultural change compared to the pandemic? What is the worth of all the Instagram posts I’ve been seeing, of white people sharing guides for other white people to talk to their families about systemic racism? What is the worth of this protest movement and its potential impact on the November elections? What is the worth of showing how law enforcement can confront peaceful protesters with brutal means on live television? Might all of this jolt society into taking the health and well-being of black people and minorities more seriously?

Already there have been some changes. Minneapolis is dismantling its police department and transforming it. Voter registrations are surging. But the larger cultural shifts are harder to quantify, harder to know how, if, and when they could make life better for black communities, and save lives.

This is the problem: How can we really compare the death and destruction of the pandemic with all that? They don’t operate in the same dimensions. Yes, both racism and the pandemic could lead to death. But comparing deaths to deaths feels off. Racism is so much more multidimensional, and harming in a baffling array of ways.

Just look at the pandemic and how it has disproportionately impacted black and minority communities. There are structural reasons for this.

Many racial and ethnic minorities, law professors Ruqaiijah Yearby and Seema Mohapatra explain, have been classified as “essential workers” and are unable to work from home, leave their job, or access paid sick leave. They live in denser housing and more often polluted communities than whites — a result of years of racist housing policy that puts them at greater risk during a pandemic. And when they do get sick, their access to health care is often limited (as is their ability to pay for it).

“Especially in the beginning of this pandemic, in order to get tested, you needed a referral in a lot of places from a primary care physician,” Mohapatra says. “And many people of color, because of where they live, and you can trace it back to redlining … really don’t have access.” That’s just one example of how structural racism is a superseding problem that is made clear when a pandemic arrives.

In the face of the worst-case Covid-19 scenario, the protest movement shows there’s hope for a better America

It’s easy to think about the worst-case scenarios.

The protests could spread Covid-19, and since many protesters are black, it could exacerbate the toll on black communities. The protesters could embolden others to stop social distancing. The protests could continue to hurt the pandemic response; already some testing sites have closed amid the unrest.

If Covid-19 cases spike some weeks after the protests, we won’t immediately know why — was it the police tactics, the tear gas? Was it simply the crowds? Was it the jailing? Was it the general “reopening” of our economy that is occurring at the same time? Before and during the protests, states were reopening without adequate measures like testing and contact tracing in place. It’s possible that many locations were set up for a new wave of infections, protests or not.

In the absence of clear information, fingers will point. People will blame the new wave on whichever group they like the least. The discourse will grow more polarized. It’s possible the credibility of public health professionals will be strained, as conservatives blame them for giving the green light to the protests.

I’m scared about the pandemic. I’m scared about a new wave exploding. But as a white man of some privilege, I feel it’s not for me to judge if the protests are worth it.

There are real, deadly risks. But these protests aren’t about cowering in fear of risks. They’re about hope for change. Hope is hard to quantify and hard to dismiss.

“It’s hope that this type of mass movement has the same impact of other civil rights actions,” Blake says. “I hope that policymakers, legislators, elected officials are paying attention to the calculated risk a lot of us are making, because it would be tragic, not only if there was a spike in Covid infections and deaths, but also if no policies were changed after this.”

Click Here:

When states had strict stay-at-home orders and lockdowns in place, many decisions about the risk of getting the coronavirus were simple. People didn’t have to think about whether dining in a restaurant is safe if the restaurant was closed.

Now, that states are opening up — with varying degrees of precautions and adherence in place — individuals will need to weigh some risks on their own.

It isn’t easy; information about what’s safe, and what’s not, can be contradictory and confusing. A state may allow restaurants to reopen and concerts to resume, but should you really go? Is it safer if people are only allowed to dine outside?

The hunger for guidance is clear: On May 6, infectious disease expert Erin Bromage posted a blog post summarizing the evidence of coronavirus transmission risks, and 17 million people have since read it, he says. The CDC didn’t post its own updated guidance for individuals and events venturing out into a post-lockdown world until June 12. Perhaps a bit too late, as new cases and hospitalizations are currently rising in several states.

As Bromage conveys, the scientific understanding of how the virus transmits in public is improving. Contact tracing studies around the world have taken a magnifying glass to the “superspreading” events, where one person ends up infecting dozens of others. These studies shine a light on the key risk factors that create dangerous situations.

From these studies, one thing is clear: The main way people are getting sick with SARS-CoV-2 is from respiratory droplets spreading between people in close quarters. The risk of catching the coronavirus, simply put, “is breathing in everybody’s breath,” says Charles Haas, an environmental engineer at Drexel University. Droplets fly from people’s mouths and noses when they breathe, talk, or sneeze. Other people can breathe them in. That’s the main risk, and that’s why face masks are an essential precaution (they help stop the droplets from spewing far from a person’s mouth or nose).

The Centers for Disease Control and Prevention (CDC) emphasizes the risk of close contact over other modes of transmission. “The virus does not spread easily in other ways,” the CDC writes. It’s still possible that a person can catch it from touching a contaminated surface (more on that below.). But it’s “not thought to be the main way the virus spreads,” the CDC states.

As Bromage put it in his piece, “We know most people get infected in their own home,” from housemates or family members who caught the virus in the community.

So how can we assess the risk of going places outside the home?

The story is a little more complicated than the simple “stay 6 feet away” guidelines. Coronavirus risk is simply not one-dimensional. We need to think about risk in four dimensions: distance to other people, environment, activity, and time spent together.

Let’s walk through them.

A simple suggestion: Imagine people are smoking, or farting really bad, and try to avoid breathing it in

It’s easy to get into the weeds talking about the risk of catching and spreading the coronavirus as people reenter communal spaces in society. We can talk about the number of viral-laden droplets expelled by a single breath (a lot, perhaps 100 or more), by a person talking (10 times more than breathing), about how far a sneeze can propel those droplets (much farther than 6 feet), how long those viral droplets linger in the air (around eight to 14 minutes, at least in a controlled indoor lab setting).

But really, what all this means is that the greatest Covid-19 risk is being around breathing, laughing, coughing, sneezing, talking, people.

It’s still hard to visualize the risk, though, as the respiratory droplets are invisible to our eyes.

Perhaps helpful: Imagine everyone is smoking, as Ed Yong reported in the Atlantic, and you’d like to avoid inhaling as much smoke as possible. In a cramped indoor space, that smoke is going to get dense and heavy fast. If the windows are open, some of that smoke will blow away. If fewer people are in the space, less smoke will accumulate, and it might not waft over to you if you’re standing far enough away. But spend a lot of time in an enclosed space with those people, and the smoke grows denser.

The denser the smoke, the more likely it is to affect you. It’s the same with this virus: The more of it you inhale, the more likely you are to get sick.

An alternative image to thinking about this risk: “With my kids, I just sort of joke around that if you can smell their farts, you need to move farther apart,” Bromage says. So if not smoking, imagine everyone is farting. Keep this in mind and surely you’ll realize outdoor activities are better than indoor ones. “This tells you the gradient of risk,” Bromage says. “The closer you are, the more it’s gonna smell, the more dangerous it is.“

At a barbecue, you can still imagine being close enough to people to smell their farts. So even in outdoor spaces, we need to limit our contacts.

A crowded indoor place, then, with poor ventilation, filled with people talking, shouting, or singing for hours on end will be the riskiest scenario. A sparsely populated indoor space with open windows is less risky (but not completely safe). Running quickly past another jogger outside is on the other end of the spectrum; minimal risk.

There are many scenarios in between. “In general, outdoors is lower risk,” Muge Cevik, a physician and virology expert at the University of St. Andrews, says. But “if you have a gathering or a barbecue outside, and you spent all day together with your friends, your risk is still higher.”

What recent contact tracing studies can teach us about risk

Scientists pointed out a few recent contact tracing studies that nicely illustrate the dimensions of Covid-19 risk.

In China, 8,437 shoppers and employees of a supermarket were tracked in late January after one of the employees was confirmed positive with Covid-19 while working in the store.

The risk for infection was much higher for the workers than for the shoppers. Around 9 percent of the supermarket employees (11 out of 120 employees) got sick as a result. But just 0.02 percent of the shoppers (2 out of 8,224 shoppers) got sick.

What does this show?

The employees are at a much larger risk due to the time they spent working in the store. Both the employees and shoppers were in the same physical space, but their risk was not the same. (The study did not note whether the shoppers and customers were wearing masks in the store.) The employees may have interacted more with their colleagues, but they also had a greater chance of breathing in the virus.

What we should learn from this: If we have to spend time with people indoors, try to make it quick.

Another recent study out of China investigated an outbreak that started at a Buddhist temple event.

Two buses brought people to the function. On one of the buses, there was a person who later tested positive for the coronavirus who had not yet started to feel symptoms. The other bus was free of infected people.

Both buses brought people to the same temple, where they mixed and mingled outdoors*. But who was most at risk of getting sick? Those who rode the bus with the infected person. Twenty-four out of 67 people on that bus got sick. No one on the other bus did. The event was attended by another 172 people who arrived by other transportation. Only seven of these people got sick.

The lesson? The confines of a bus are a much riskier environment for viral spread than a larger outdoor space, like at the temple. The risk at the temple was not zero. But it was much reduced compared to the confines of the bus. And it appears those who were exposed at the temple were in close contact with the infected person.

“When you look at public transport, work spaces, restaurants — places where we’re just trying to fit many people in a small confined space — respiratory viruses like those spaces,” Cevik says. It’s “just common sense.”

There’s no set time that’s safe to be in these places. “Generally, for droplet transmission, we say 15 minutes,” Cevik says. “So if you spend 15 minutes face to face with somebody, you’re close contact [and at high risk], but that doesn’t mean if you spend 14 minutes your risk is zero.” And if you have to choose between a big open indoor space and a smaller one, choose the larger one, where people can spread out.

It’s not just the location or the time spent together: The activity people are engaged in matters, too.

In Washington state, a person with the virus attended a choir practice, and more than half of the other singers subsequently got sick. This was labeled a “superspreading” event, as one infection led to 32 others. Why was this so risky?

“The superspreading event is about the behavior of the person involved,” Cevik says. There are many reasons why a person could become a “superspreader”: Some people shed more of the virus than others, and it appears people shed most of it when they are just starting to feel symptoms.

But what made this event so risky was the convergence of many risk factors: the singing activity (during which the infected person released viral particles into the air), the time spent together (the practice was 2.5 hours), and the interaction between the choir members in an enclosed space (not only did they all practice together, they also split up into smaller groups and shared cookies and tea).

In a new paper published by CDC, researchers in Japan identified 61 clusters (five or more cases stemming from a common event) of Covid-19 cases. The researchers found most commonly the clusters originated in health care facilities. But outside of that they note “many Covid-19 clusters were associated with heavy breathing in close proximity, such as singing at karaoke parties, cheering at clubs, having conversations in bars, and exercising in gymnasiums,” the scientists wrote.

Notably, too, were the ages of the people who instigated spread outside of the health care settings. “Half … were 20–39 years of age,” the report finds. Which is a reminder: younger people can catch the virus, survive, but at the same time spread it to others who may die from it.

What about touching something with infected droplets? Is that still a risk?

According to the CDC, the coronavirus does not often spread from people touching surfaces. That is, if someone with Covid-19 touches a hand railing, does that make that hand railing dangerous for other people to touch? The CDC is now saying that such events are not a huge risk for Covid-19 transmission.

But, there’s a catch: It is still the case that surface transmission is possible. Scientists believe the virus can remain viable on a hard, non-porous surface like plastic or steel for around three days, and a rough surface like cardboard for about a day. You could, conceivably, touch a contaminated surface, and then touch your face, and get sick. (The good news is that even though some virus can remain on a surface for a day or more, the amount of virus on a given surface drops by half after several hours, and then continues dropping.)

Bromage cautions it’s just really hard to study surface transmission. In contact tracing studies, it’s much easier to ask people who they’ve been in contact with than to have them remember every surface they’ve touched.

“I agree with this [CDC] statement,” Cevik says, agreeing that surfaces aren’t the most significant mode of transmission. “But this does not mean it does not happen.” Cevik points me to a contact tracing study that suggests (with a good deal of uncertainty) that some people caught the infection in a mall via the restroom. “Bottom line,” she says, “it’s still important to maintain personal hygiene and wash hands.”

Also consider how scientists recently found live Covid-19 virus in feces. So good bathroom hygiene is still as important as ever.

Click Here:
There are no magic numbers to eliminate risk

It would be great if there were very specific numbers and guidelines we could follow to minimize coronavirus risk to zero.

But there aren’t. While 6 feet away from another person, it’s not like the virus will immediately decide to drop dead. That’s why we need to think of risk in terms of many dimensions: so we can each think critically and not fall back on rules that are too simplified.

“When I first said restaurants were risks, people interpreted that as ‘every restaurant is a risk,’” Bromage says. “Each restaurant has its own unique environment, its own unique challenges that need to be worked out. If you’ve got a large open-seating area, and you can open up the windows and doors … the risk there is much lower than a boutique restaurant with five tables that creates that really intimate atmosphere.”

When we venture out into the world, we need to remember we can reduce risk, but never eliminate it.

“Wearing a mask is not going to completely reduce your risk, hand-washing is not going to completely reduce your risk, and staying a distance away from people in an enclosed space is not going to completely reduce your risk,” Haas, the Drexel professor, says. “But the concurrent use of all those strategies will hopefully reduce your risk down to a lower level. We can never get to zero. There’s no such thing as zero risk.”

And we still need more data, and follow-up on potential exposures. A hair salon in Missouri made headlines when a couple of their hair stylists were reportedly back at work after testing positive for Covid-19. Both hairdressers wore masks, and so did their clients, and a follow-up investigation by their county health department revealed no new infections among the 140 clients they saw.

This data point is a bit anecdotal. “I think they got lucky,” Bromage says. “But it does highlight the importance of masks.” Perhaps more data will reveal that getting a haircut while everyone is wearing a mask is a low-risk activity.

Contact tracing studies have taught us a lot so far. But as of now, most of this work has been done in Asian countries, which may have different expectations around mask-wearing, among other differences.

“Contact tracing, testing, isolating — these are the building blocks to understand where the transmission is occurring,” Cevik says. And the more we learn, the more power we have to stop the spread of this pandemic.

*This piece was updated to clarify the temple event occured outdoors.

Several states are now seeing a surge in new Covid-19 coronavirus infections and hospitalizations. And the states with more alarming outbreaks — Arizona, North Carolina, South Carolina, Texas, Utah, Arkansas, Florida, and Tennessee — generally saw few cases early in the pandemic.

Many of these states have started to relax the restrictions on movement, businesses, and public gatherings that were meant to control the spread of Covid-19. But with infections rising, there will be more illnesses, deaths, and financial hardships for people who have already suffered immensely from this pandemic.

If cases continue to rise and threaten to overwhelm the health system, officials may be faced with a daunting prospect: another round of shutdowns, requiring businesses that have reopened to close, public gatherings to be banned again, and stay-at-home orders to go back in effect.

Some local officials are already talking about this possibility. The city of Houston, Texas, for instance, is weighing another stay-in-place order. (It may ultimately be prohibited from having stricter rules than the state government.)

Thanks to several studies, including two recent scientific papers in the journal Nature, there’s now more certainty these measures dramatically lower the case count and save lives. However, the shutdowns also drove a massive spike in unemployment and caused huge social strains as people were forced to stay apart.

Asked about the prospect of further lockdowns, Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told Science Friday last week it depends on how well other public health strategies are deployed.

“Whether those infections turn into a real resurgence of infections and a rebound will depend on how effectively we’re able to identify, isolate, and contact trace,” Fauci said.

Other public health experts are debating the viability of additional lockdowns, noting it may be harder for leaders to muster the political will for them now, and that citizens may be less likely to comply with them.

What’s clear is that it will be difficult to get quick, satisfying results from shutdowns at this stage of the pandemic. And while there are other ways to protect public health that don’t require such sacrifices from the public, they require investment, coherent public messaging, and political will. Unfortunately, it doesn’t appear every state has these elements in place.

The US is in a much different place than it was at the start of the Covid-19 pandemic

The United States is now the epicenter of Covid-19, with 2.16 million confirmed cases and 118,000 deaths as of June 16.

This growth is evident in states like Arizona, now a hot spot for the virus with daily cases climbing rapidly in the last two weeks. Will Humble, former director of the Arizona Department of Health Services, said the shutdowns worked when they were implemented on March 31. Arizonans largely complied with stay-at-home orders. Businesses closed. People maintained social distance.

But there was little transmission at that point. “The first stay-at-home order was done when we just had a couple hundred cases a day,” Humble said. Then on May 15, Arizona Gov. Doug Ducey allowed the order to expire, replacing it with an executive order that suggested guidelines for how people should behave, but no enforcement. It’s likely that this relaxation contributed to the rise in cases.

“We’re blowing the doors off now with 1,500. … We’d be going into a stay-at-home order under very different circumstance than back in April,” Humble said.

A reimposition of shutdown measures at this point, if they were obeyed, would still reduce the number of new infections. But that reduction would be in proportion to a higher baseline. New cases would drop, but it would take much longer to reach the levels seen after the first round of shutdowns.

When starting from a higher number of cases, there is more transmission baked in. For instance, there will likely be more cases of household spread among family members under a stay-at-home order. And when there are a higher number of overall infections, there are likely to be even more undetected infections that may continue to worsen the pandemic.

And as states saw during their first brush with shutdowns, it can take a while for pandemic control policies to show up in the data. “We can expect those lags and timings would operate in a similar way,” said Joshua Salomon, a professor of medicine at the Stanford University School of Medicine who studies disease models and public health interventions. “It takes a few weeks after you change people’s interactions and contacts for that to translate into a reduction in the number of cases.”

Perhaps the biggest unknown for a second shutdown is how well people will adhere to the orders. Already, people in some parts of the country are gathering en masse, flocking to reopened businesses, and flouting guidance to wear masks in public places.

“We are starting to notice a lot of people across South Carolina are not doing the social distancing or not avoiding group gatherings and wearing masks in public the way, especially, that they were earlier on,” Brannon Traxler, the physician consultant for the South Carolina state health department, told ABC News. Public officials are also facing intense political pressure to ease restrictions.

Hannah Druckenmiller, a doctoral student at the University of California Berkeley, co-authored a recent paper looking at the effectiveness of shutdown measures. She and her team found that across the US, such tactics averted 4.8 million more confirmed cases of Covid-19 and up to 60 million infections in total.

But the results also showed that these policies had different effects in different parts of the world because some governments took the policies more seriously than others.

“This is likely a result of the fact that populations have different cultures and governments enforced the policies to varying degrees,” said Druckenmiller, in an email. “One interpretation of this result is that if a second round of lockdowns was less strictly enforced and had lower levels of compliance, these containment measures may not be as effective as they were in March and April.”

With states taking so many different approaches to the pandemic, however, the US is likely to experience a patchwork of different outcomes from further school closures, public gathering bans, and shelter-in-place orders.

There are alternatives to shutdowns, but the US hasn’t invested in them enough

Economic and social shutdowns are effective, but they’re expensive. They weren’t meant to stay in place indefinitely, but were aimed at slowing the spread of the virus to prevent hospitals from being overwhelmed with patients.

The more targeted strategy for containing Covid-19 is testing, tracing, and isolation. With a robust system of testing, health officials can identify people who are infected and spreading the disease, even before they feel sick. Then they can trace the contacts of the infected to test other people who may have been exposed. And the people who test positive can be directed to isolate themselves. All the while, the general public should maintain social distance and minimize exposure as they take calculated risks in going about their lives.

Such an approach would break the chain of transmission of the virus. It would also only require a handful of people to stay home rather than large swaths of the population. But it demands a lot of infrastructure to deploy tests and trace contacts, and it takes time to set up.

“Shutdowns really had two goals. One was to stop the uncontrolled spread, which they did,” said Salomon. “The other was to try to buy us time to set up the public health infrastructure to do testing and tracing and isolation at scale. And we really failed to make use of that time.”

Another round of closures and stay-at-home orders could still be availed to build up the testing and tracing capacity. The more testing and tracing is available, the less strict shutdowns need to be. And building a system for testing millions of people would still be cheaper than an indefinite pause of the economy.

At this point in the pandemic, public health officials also have a better understanding of the spectrum of risk for the virus. Rather than issuing blanket orders to stay home, more nuanced guidance about what kinds of public spaces are safe and what precautions are necessary could ease the acceptance of pandemic control measures. But that requires careful and nuanced public messaging, and given the mixed messages the public has received on tactics like wearing masks, health officials would have to rebuild trust.

“What we really want to do is get as much benefit as we can from lockdowns in a way that’s more targeted and doesn’t demand as much sacrifice,” Salomon said. He added that policies like paid sick leave and building up work-from-home capabilities would also be important steps to helping people avoid unnecessary exposure to Covid-19.

As for when states can relax, that remains a fraught question. Some of the guidelines from the federal government for reopening have been confusing, and some states have gone ahead and established their own.

More recently, the Centers for Disease Control and Prevention put out a list of best practices to reduce Covid-19 risk as shutdowns relax. Measures include wearing masks and maintaining distance from other people.

However, with cases spiking in several states, it may still be too soon to think about relaxing, and efforts may still be needed for containment. But with the most blunt yet effective public health tool losing strength, it’s more urgent than ever to fight the pandemic without such drastic measures.

Click Here:

Texas broke records for Covid-19 hospitalizations six times last week, including a record 2,504 hospitalizations in a single day on June 10.

South Carolina, North Carolina, Alaska, Florida, Mississippi, and Arkansas have also all broken records of new cases reported in a single day. Alabama saw a 92 percent increase in its seven-day average of new cases, and more than a quarter of Arizona’s total Covid-19 cases have been reported in the last week. Overall, 21 states have seen an increase in their daily average cases.

As these states have loosened lockdowns and people have come back into close contact, the virus is spreading rapidly again, and hospital ICUs are filling up. And public health experts say health care providers and essential workers remain at high risk of infection for the same reason they have since March: there’s a shortage of critical supplies, including personal protective equipment (PPE).

As of April 14, the Centers for Disease Control and Prevention (CDC) estimated that 9,200 medical professionals had been infected in the US; it’s not known how many have died.

An ongoing problem with PPE is that supplies still aren’t being distributed equally around the country and even within hot spots. Better-resourced hospitals have more supplies while other facilities struggle to find enough.

The federal Centers for Medicare and Medicaid say that one in five Florida nursing homes do not have a one-week supply of gowns or the N95 masks needed to care for Covid-19 patients and prevent transmission. According to WCNC Charlotte, North Carolina ran perilously low on gowns and masks in May even before its recent surge in cases, receiving only 99,000 of the 27 million N95 masks it had ordered. An internal report from the Federal Emergency Management Agency (FEMA) suggests “[t]he demand for gowns outpaces current U.S. manufacturing capabilities” and that the government plans to continue to ask medical staff to reuse N95 masks and surgical gowns intended to be disposed of after one use into July.

Val Griffeth is an emergency and critical care physician in Oregon and the co-founder of Get Us PPE, a grassroots organization that finds and donates PPE to health care workers who don’t have enough. (Project N95 is another organization that works with institutions who can afford to buy supplies but are having trouble procuring them.) Griffeth says Get Us PPE has seen a recent uptick in requests, particularly for gowns and gloves.

“I worry there hasn’t been a true fix to the supply-chain issues,” Griffeth says. “Our government has basically said that we’re going to allow the free economy to fix the issues. Unfortunately, it takes time and capital to ramp up production, and because the government has not devoted capital to helping solve the situation, we’re seeing a delay in its resolution.”

Griffeth argues the Defense Production Act (DPA), which Trump has deployed selectively, could be used more broadly to increase production of essential protective gear. The lack of federal leadership and coordination, the lack of a central agency prioritizing distribution based on need, Griffeth says, has led to difficulty procuring supplies, with states and hospitals often bidding against each other and elevating prices.

Now, as cases surge in several states, grassroots efforts are filling the vacuum. Here’s a closer look at a few of the country’s hot spots, and the people organizing to try to help protect their communities.

Why is PPE important?

A May preprint study, conducted by researchers at Massachusetts General Hospital, King’s College London, and Zoe Global Ltd., looked at data from the Covid Symptom Tracker app. It found that front-line health care workers were at nearly 12 times higher risk of testing positive for Covid-19 compared with members of the public, and those workers with inadequate access to PPE had an even higher risk.

“The limited availability of adequate PPE, such as masks, gowns, and gloves, has raised concerns about whether our health care system is able to fully protect our health care workers,” said senior author Andrew Chan, chief of the Clinical and Translational Epidemiology Unit at Mass General, in a statement.

Carri Chan, an associate professor at the Columbia Business School and an expert in hospital operations management, explains that PPE is essential not just to reduce transmission in hospital settings but because studies have shown that in a respiratory disease pandemic, trained health care workers are the bottleneck. If they get sick, patient care suffers. “You can have all the ventilators in the world, and if you don’t have specially trained people to provide care, it doesn’t matter how many machines you have,” she says.

It’s not only hospitals that need more staff and PPE; many other areas of health care do too, including primary care facilities, homes for the disabled, and nursing homes — a fifth of which reported at the end of May that they had less than a week’s supply of critical PPE. Chan notes that other essential workers, including grocery store clerks, delivery workers, and those “who don’t have the luxury to work from home” also need PPE to protect themselves and others.

Click Here:

Because a large portion of the masks, gowns, and gloves the US uses come from China, and because of the overnight global demand, supply chains have been disrupted. “Due to limited access, as hot spots grow, some more underserved communities could be again hit disproportionately,” she says.

This is yet another area where the lack of federal leadership hindered the Covid-19 response. As a New York City resident, Chan compares Elmhurst — a hospital in Queens that saw “apocalyptic conditions” — to better-resourced and well-connected facilities in other parts of the city, saying that “because of the decentralized manner in which PPE procurement occurred, some [hospitals] were much worse off than others.”

In her hospital, Griffeth is currently given one N95 respirator mask and one face shield per day. She wears the face shield both as eye protection and to decrease droplets contaminating the respirator. N95s are placed in a paper bag between uses while face shields are cleaned with sanitizing wipes between patients. Best practices would involve using a new mask and face shield with each potentially infectious patient. “Both masks and respirators continue to be an issue,” she says, “despite falling out of the nightly news cycle.”

Chan says, so far, there have been few national efforts to ensure PPE is distributed equally. “At Elmhurst, people were dying just waiting to get access to care. There’s a lot of imbalances about the way the system is set up.”

Florida: “Left out to the wolves”

Rebekah Jones, a scientist and former manager of data and surveillance at Florida’s Department of Health, says that, back in January, the CDC told the department it needed to prepare for a widespread pandemic.

Jones was in charge of the state’s public tracking of Covid-19 cases until May 19, when she allegedly refused a superior’s request to alter numbers so that the coronavirus positivity rating would drop below the state’s threshold to reopen. Before she was fired, Jones says she saw requests for PPE rolling in from around the state — requests for shoe covers and hand sanitizer and masks — suggesting many places in Florida still didn’t have the equipment they needed to stay safe. Since mid-May, 24 health care workers in St. Petersburg have been infected, prompting at least one nurse to quit, and firefighters and first responders in Immokalee recently reported they are running out of PPE.

Desiree Ann Wood, a truck driver and founder and president of Real Women In Trucking, says that Florida’s need for PPE extends far beyond hospital doors. She’s been organizing donations of PPE for truck drivers, who have struggled to maintain the country’s supply chains during lockdown.

Wood reports that rest stops truckers normally rely on to go to the bathroom, sleep, and eat have been closed, and many drivers are no longer allowed inside the places they deliver. “You’re like a social pariah,” she says, but “we are part of the logistical supply chain, and no one’s thought that the people restocking shelves are being left out of the equation.” She says with the temporary suspension of regulations limiting long-haul driving hours, “Drivers can drive more for less money, and for less services, and no one ever thought, ‘What about them?’ It doesn’t even occur to you to give them a mask, too.”

Wood started handing out donated masks in early March. “I couldn’t get permission initially. I’d just show up at a truck stop and pass masks out till I was asked to leave.” But though she’s met skepticism — truckers “assume I’m going to hassle them, or I’m a working girl in the parking lot” — the Real Women in Trucking network has now handed out more than 8,000 masks, gloves, and bottles of hand sanitizer.

Thanks in part to a donation by Uber Freight, as well as donated supplies and a cash donation from the freight company DDC FPO, Wood is now handing out PPE in Florida, Kentucky, Mississippi, Iowa, Georgia, and Michigan.

Jones, the former Florida state data scientist, has also developed her own dashboard, which, unlike the state’s, shows the total number of positive cases for everyone tested in Florida regardless of their legal address. “If you live here and are sick here and die here, your information should be included,” she says.

Wood agrees that it doesn’t seem as though the state is considering everyone. “We see this over and over again,” she says. “We’ve really been left out to the wolves.”

Georgia: “We’re not united anymore.”

On June 11, Georgia saw a single-day increase in Covid-19 cases of more than 26 percent. The increase in cases isn’t surprising to Edward Aguilar, Shourya Seth, and Manu Suresh, juniors in high school in a suburb of Atlanta. They’ve been busy after school, building software to get PPE to hospitals that needed it.

“It’s been frustrating seeing cases rise, and the lack of government response,” says Aguilar. “It really does point out the weak points of the whole supply chain,” Seth says. “It’s almost like a confederacy. We’re not united anymore.”

After talking to Seth’s cousin who works at Emory University Hospital, the teens called five maker spaces — collaborative workspaces that often have shared tools — in early March to see if they could find a way to get additional PPE to medical workers. They created a grassroots organization, Paralink, and since April 1 have delivered donated PPE supplies, primarily face shields, to health care providers around the South. “FEMA has delivered 180,000 face shields to Georgia,” says Aguilar. “We’ve delivered 190,000.”

At first, the teens were calling hospitals to make a list of who needed what, but now the group uses Get Us PPE’s database to prioritize shipments. It’s been a crash course in logistics: Paralink now coordinates more than 50 maker spaces to 3D-print face shields, and relies on 150 volunteer drivers to distribute them.

Aguilar recalled one shipment of 3,000 face shields that urgently needed to get to Albany, New York; within a day, they used Facebook groups to find seven volunteers, who each drove the shipment for several hours in a human chain between Georgia and New York.

As they’ve scaled up, the teens have run into some of the same stop-and-go problems as larger corporations. While Georgia was locked down, there was a drop in requests for PPE, so Paralink called some of the volunteers to tell them their help was no longer needed making face shields. “Now we need to call back and say we need more,” Aguilar says. “We’ve had some really tough conversations.”

Paralink’s requests for face shields have recently doubled. “It’s scary to see we’re not able to keep up production — and we know we can move faster than the federal government. What happens when the government has to make these phone calls to massive companies? How do you tell [manufacturers] that after retooling, they have to stop, or then start again? The backlash won’t be in favor of the manufacturers,” says Aguilar.

“People call us and say we’re inspiring — and it’s scary. The focus, as it should be, has been on health care workers, but a lot of [them] are in the same position now and aren’t getting any help,” Aguilar says. “It’s not just people in hospitals. Everyone needs this protection.”

Arizona: “It’s been heartbreaking”

Over the last week, Arizona’s Covid-19 cases surged by 54 percent. Saskia Popescu, a senior infection prevention epidemiologist at the University of Arizona, says she was “surprised and deeply worried when the state opened so prematurely. We’re seeing the fallout of that right now.”

Northern Arizona in particular has been hard-hit, seeing hospitals approach capacity, and the largest care system in the state, Banner Health, warned that the number of patients on ventilators has quadrupled since May 15. The Arizona Department of Health Services told hospitals to “fully activate” their emergency plans.

Because it’s so hot in Arizona — it hit 112 degrees Fahrenheit in Phoenix twice in late May after the stay-at-home order lifted — it’s more difficult to follow recommendations to socialize outside instead of inside. That may help explain why Arizona’s case numbers have been spiking after lockdown was lifted, says Popescu.

But it’s not just increased transmission that’s putting a strain on the state’s PPE supplies. The Arizona Department of Health Services has recently allowed elective surgeries to restart, adding traffic to hospitals and creating what Popescu calls “a perfect storm for rapid case growth, and a very stressed health care system.”

Popescu says that she’s seen a widespread shortage of even basic supplies like disinfecting wipes, as well as disposable stethoscopes and laryngoscope blades — “things people don’t think are big deals, but that show that the supply chain problem is not resolved.”

Watching people become increasingly lax about prevention while knowing that hospitals are increasingly full has “been heartbreaking,” Popescu says.

Lois Parshley is a freelance investigative journalist and the 2019-2020 Snedden Chair of Journalism at the University of Alaska Fairbanks. Follow her Covid-19 reporting on Twitter @loisparshley.

The Centers for Disease Control and Prevention (CDC) on Friday reversed changes to its Covid-19 testing guidelines, once again recommending that people without symptoms get tested for the coronavirus if they have come into close contact with someone known to be infected.

The CDC’s new guidelines now state, “If you have been in close contact, such as within 6 feet of a person with documented SARS-CoV-2 infection for at least 15 minutes and do not have symptoms. You need a test. … Because of the potential for asymptomatic and pre-symptomatic transmission, it is important that contacts of individuals with SARS-CoV-2 infection be quickly identified and tested.” It also calls for such people to self-isolate for 14 days, even if the test comes back negative.

Recent guidelines suggested that people without symptoms who have come into close contact with others known to be infected “do not necessarily need a test.” The new guidance, in effect, returns the CDC to a recommendation for more testing.

Public health experts and officials criticized the previous revisions. They noted that people without symptoms can still spread the coronavirus, and, in fact, people may be at greatest risk of spreading the virus before they develop symptoms. For those without symptoms, the test may be the only way to confirm an infection — and, as a result, get people to isolate to stop further spread of the disease.

The previous changes to not recommend testing, however, appeared to be politically motivated. President Donald Trump, arguing that more tests make the US look bad by exposing more Covid-19 cases, previously said that he told his people to “slow the testing down, please.” Media reports confirmed the White House and Trump’s Department of Health and Human Services forced and oversaw the previous changes to recommend less testing — even as CDC officials objected. That fell into broader efforts by the Trump administration to muzzle and warp the CDC to downplay Covid-19 and Trump’s botched response.

The latest revisions to the guidelines amount to the CDC rebuking Trump and his officials’ politically motivated efforts.

Since the start of September, the number of people getting tested for Covid-19 in the US has stalled out and even fallen. Some experts said that the previous revisions to the CDC guidelines were partly to blame.

Testing is crucial to stopping Covid-19 outbreaks. When paired with contact tracing, tests allow officials to isolate the sick, track down close contacts and get them to isolate as well, and deploy other public health measures as necessary. Aggressive testing and tracing were key to controlling Covid-19 outbreaks in other countries, such as Germany and South Korea.

The US, however, has struggled to build up its testing capacity. In the spring, the country was slow to do so due to a mix of federal screw-ups and bureaucratic hurdles, resulting in a “lost month” for confronting Covid-19. In the months after, testing did increase. But then, when cases started to spike nationwide in the summer, there were more testing shortages as some labs reported delays for results as long as weeks. Starting this month, testing appeared to decline again.

The testing failures are one reason the US, which is now nearing 200,000 confirmed Covid-19 deaths, has struggled so much to contain the virus. While the US hasn’t seen the most coronavirus deaths of wealthy nations, it’s in the bottom 20 percent for deaths since the pandemic began, and reports seven times the deaths as the median developed country. If the US had the same death rate as, say, Canada, 115,000 more Americans would likely be alive today.

The recent drop in testing is particularly concerning now: The fall and winter threaten another wave of rising Covid-19 cases — as people return to school, the holidays bring families and friends close together, the cold pushes people into indoor spaces where the virus is more likely to spread, and a flu season looms.

At least with its new guidance, the CDC is pushing for the kind of testing that could help America get control over future outbreaks and, hopefully, prevent them from becoming dire.

Click Here:

Back in March, Michigan’s Covid-19 cases exploded — leaping from zero to 3,657 in just two weeks. Detroit’s three big automakers closed factories temporarily, and the state’s largest health care system warned it was reaching capacity.

In the midst of this crisis, Joseph Roche, an associate professor in the physical therapy program at Wayne State University, had an idea.

From his research into muscular dystrophies, Roche understood that inflammation can do significant damage to the body. When he read that in severe Covid-19 cases, runaway inflammation was causing damage to tissues and organ failure, he dove into the data as well as older research on SARS.

Initially, it appeared that the virus might cause immune cells to overproduce molecules called cytokines, causing a severe inflammatory response known as a cytokine storm. But what Roche suspected as he sifted through early case studies was that it wasn’t the immune system’s cytokines causing so much of the damage but an entirely different pathway in the circulatory system knocked off balance by the virus: bradykinin signaling.

He believed that an accumulation of two peptides, des-Arg(9)-bradykinin, abbreviated to DABK, and bradykinin — both part of a system that regulates blood pressure and other functions — were starting a feedback loop of inflammation and tissue injury. By stopping this reaction, he argued in an open letter to the scientific community in April and in a May paper published in the Journal of the Federation of American Societies of Experimental Biology, doctors could prevent some of Covid-19’s worst effects.

Several months later and 500 miles away, a group of researchers unaware of Roche’s work started feeding the world’s second-fastest computer data from about 17,000 genetic samples from 1,300 Covid-19 patients. The team, based at the Oak Ridge National Laboratory in Tennessee, asked the $200 million computer to look for patterns in how Covid-19 was changing genes and impacting different systems in the body.

After almost a week of data crunching, the supercomputer landed on something they found surprising: bradykinins. “I was literally at home on a Sunday afternoon looking at different visualizations, and it just jumped out at me,” Daniel Jacobson, a computational systems biologist at Oak Ridge, says.

He calls these haywire reactions a “bradykinin storm,” and like Roche, believes they may help researchers treat severely ill Covid-19 patients, possibly staving off damage to organ systems or even preventing deaths. Outside researchers agree: Elements of the supercomputer’s analysis have been corroborated since it was published in July, and researchers say it could help lead the way to more effective treatments.

Here’s a deep dive into what has been published on bradykinin signaling since the pandemic began, and what we know about how this compound might be instigating some of the worst Covid-19 damage.

Why bradykinin signaling might be making Covid-19 so much worse

How Covid-19 can prompt an inflammatory cascade gets complicated, but Roche and other experts now think bradykinin might be the key to the vascular changes, lung damage, and even neurological symptoms the disease can cause.

The virus usually enters the body through the airways and lands on cells, where a protein called ACE2 functions as a doorway. As the virus replicates in the body, it finds other cells that have ACE2 receptors, such as those in the lungs, hearts, intestines, kidneys, and brain.

“The virus not only uses ACE2 as an entryway into cells but also tells that cell’s nucleus to start reducing ACE2 expression,” Roche says. This causes an accumulation of an enzyme called DABK, which creates conditions for inflammation.

This is where bradykinin might come in. When the virus binds with ACE2 receptors, DABK piles up, and bradykinin levels increase—causing an inflammatory cascade. “It creates a vicious feedback loop,” Roche says, amplifying inflammatory processes, including producing more cytokines.

Scientists initially thought that Covid-19 caused the immune system to release an overwhelming flood of cytokines — as often happens in response to a viral infection. In fact, promising treatments like remdesivir lower cytokine production. But recent evidence suggests that Covid-19 patients may not have particularly elevated levels of cytokines compared to people critically ill with other respiratory conditions, and other interventions attempting to lower cytokine production failed to reduce mortality — suggesting something else is going on.

That something, says Jacobson, might be a bradykinin storm instead. This hypothesis fits with a surprising number of Covid-19’s bizarre symptoms.

Researchers have observed many vascular symptoms, but previously blamed cytokine storms’ inflammation or direct damage from the virus. But bradykinin can impact how your blood coagulates — possibly explaining the strange clotting problems reported in Covid-19 patients and the high percentage of Covid-19 deaths from heart attacks, strokes, and deep vein thrombosis. As the virus causes bradykinin to accumulate in the cells it has hijacked, it makes your blood vessels permeable, letting your blood leak out. This could also explain the “Covid toes,” that have been linked to blood circulation.

In the lungs, increasing gaps in the cells of blood vessels can spell further damage. Lungs are covered in capillaries, so these gaps start leaking blood and immune cells into the interior surface of the lungs, potentially providing the reason for Covid-19 patients’ respiratory distress.

To make things worse, according to the supercomputer analysis, the virus might also increase the natural production of hyaluronic acid—a biopolymer familiar to skincare aficionados, as it can absorb more than 1,000 times its weight in water. As bradykinin causes blood vessels to leak water into your lungs, it hits the hyaluronic acid in your lungs and forms a hydrogel. “It’s like trying to breathe through Jell-O,” Jacobson says. “At that point, unfortunately no matter how much oxygen you’re pumping through a ventilator, you can’t get a gas exchange through the hydrogel.”

Bradykinin dysregulation may also be behind the thyroid problems some Covid-19 patients are reporting. Previous research has found that, in addition to influencing the circulatory system, bradykinin is an important regulator of thyroid hormones.

Ilaria Muller, an endocrinologist at the Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico in Milan, and colleagues recently found that many patients who were hospitalized had abnormally low levels of thyroid-stimulating hormones, suggesting thyrotoxicosis and at least temporary thyroid damage. She says this damage could come from direct damage from the virus through the thyroid’s ACE2 receptors or from systemic inflammation.

More surprisingly, bradykinin storms also help offer an explanation for some of Covid-19’s neurological symptoms — from headaches to long-term nerve damage — which in one study afflicted 57 percent of Covid-19 patients. High levels of bradykinin in particular can cause the blood-brain barrier to break down, potentially allowing the virus into the brain and causing inflammation and damage.

Finally, as Elemental reports, the theory may even explain why men seem to be more likely to have worse cases of Covid-19. Some aspects of the RAS systems have receptors on the X chromosome, meaning that women have twice the levels of these stop-gap proteins, possibly giving them extra protection against the virus.

The supercomputer model also found different gene expression patterns in the lavage fluid from the lungs of COVID-19 patients. This is rare data, in part because getting that fluid can be dangerous to healthcare professionals, who may get infected while taking the samples, so this procedure is no longer carried out. A clinical trial measuring actual bradykinin levels in samples from Covid-19 patients’ lungs would provide a lot of valuable information but is unlikely to happen because of the transmission risk.

When something like a virus tweaks part of the body’s intertwined systems, you often end up with rippling consequences—in this case, a dire trend toward inflammation, possibly through both bradykinin pathways and cytokine production. Essentially, the bradykinin pathway gets off the track—and then it’s like a runaway train, potentially causing damage in many locations around your body.

What do bradykinin storms mean for possible Covid-19 treatments?

After finding the potential role of bradykinins in severe Covid-19 in March, Roche went looking for a way to halt this inflammatory cascade. “It’s like a set of gear wheels—inflammation, injury, inflammation—and you’re trying to jam up the wheels,” he says. Along with his wife, Renuka Roche, an assistant professor in occupational therapy at Eastern Michigan University, he started to explore potential treatments that were ready to use.

As clinicians trained to pay a lot of attention to recovery through rehabilitation, he says, “We know that health care does not end with just saving a person’s life.” Roche says life quality is important too, meaning any intervention that could minimize damage would be a true advancement in the fight against Covid-19’s ravages.

Treatment targeting bradykinin signaling wouldn’t have to be perfect to improve lung damage and long-term outcomes. “If you’re able to even dampen the cycle by 50 percent, that means that much tissue may be spared,” Roche says.

In the medical literature, the Roches found a medication called icatibant that is both known to be safe and inhibits bradykinin signaling. It was already approved by the FDA, with the added benefit of an expired patent, meaning generic versions could be made much more affordably. They reached out to the Canadian and Indian governments about starting rapid research on icatibant in late March, wrote an open letter to the scientific community in April, and published a paper on their hypothesis in May.

At the same time, Frank van de Veerdonk, an infectious disease specialist at Radboud University Medical Center in the Netherlands, was reaching similar conclusions. He knew that ACE2 is an important part of the RAS, and in April, hypothesized that a dysregulated bradykinin system was causing blood vessels to leak into Covid-19 patients’ lungs.

More recently, “We published data in patients with icatibant targeting bradykinin in Covid-19 as a treatment,” van de Veerdonk wrote Vox in an email. While not a controlled clinical trial, van de Veerdonk published a study where nine hospitalized patients were treated with icatibant and matched to similar Covid-19 patients who were not; the patients who’d received icatibant needed less supplemental oxygen and experienced no adverse effects from the drug.

In the US, Quantum Leap Healthcare Collaborative has started a clinical trial of five potential treatments, including icatibant. (They are still currently enrolling patients.) “The safety of the drug is well understood, and it’s fast-acting,” says Paul Henderson, director of collaboration at Quantum Leap.

In general, he says bradykinin receptors are interesting because they are upstream of most of the inflammatory response, including cytokines. If proven effective, he says, these treatments will probably also be useful for influenza and other diseases that cause acute respiratory distress.

Henderson doesn’t discount cytokines’ inflammatory impact altogether but suggests that interventions targeting cytokines may have been “taking out too little of all the processes going on to have much impact.” Imagine how much easier it is to dam a river at its headwater than closer to its mouth—similarly, interventions further “upstream” in biological pathways could have a larger impact.

In some ways, this work could be as important as finding a vaccine. “Reducing the burden on the health care system and preventing the very sickest from dying is really important,” Henderson says.

But he also cautions that, like with cancer, there is unlikely to be one “magic bullet drug.” Instead, it’s more likely a combination therapy, including anti-inflammatory medications and antivirals, will be necessary. “You’ll likely need different interventions in different stages of infection,” he says. “It is extremely complicated.”

Nevertheless, since Jacobson’s paper came out, his hypotheses have been supported by other research. For example, vitamin D is known to regulate RAS, and vitamin D deficiencies have been associated with severe cases of Covid-19.

This fits with a part of the supercomputer analysis that suggested the virus activates genes that break down more vitamin D. Lo and behold, at the end of August, a clinical trial in Spain on vitamin D found that it significantly reduced the need for ICU treatment in Covid-19 patients.

Similarly, another analysis, run by the World Health Organization, which incorporates seven different clinical trials, found that corticosteroids, which inhibit a protein activated by the bradykinin receptor, reduced the risk of Covid-19 death — fitting the computer model’s prediction neatly.

Bradykinin storms may also have implications for long-haul Covid-19 patients. Jacobson is now collaborating with Covid patient groups to gather data. “We’re looking at the top 100 symptoms and trying to map them to this mechanism,” he says, adding that several of his fellow researchers are long-haulers.

He says one of the next questions they hope to address is whether bradykinin dysfunction continues even after the virus has cleared, if the virus itself is persisting in different organ systems or some combination of both.

When new information raises more questions

The notion of bradykinin storms are appealing because they offer a tantalizingly unified theory that would explain so many of Covid-19’s inscrutable impacts. Joshua Zimmerberg, a biophysical virologist at the Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health, who was not involved in any of the bradykinin research, says the evidence is now compelling. “When you have independent confirmation, when people come to the same conclusion for different reasons—that’s very good evidence.”

But he warns against raising hopes for immediate treatments. “We all crave simple pathways and simple ideas, but inflammation is really complicated. There are still a lot of inflammatory diseases without good treatments.” Dampening bradykinin production too much, or at the wrong time—for example, early in the infection, when the natural inflammation cycle is needed to fight the virus—might actually be harmful.

Roche says the next steps are for large-scale randomized placebo-controlled clinical trials on potential drugs that inhibit bradykinin. “The hypothesis, [Jacobson’s] gene expression data, [van de Veerdonk’s] small-scale case series—these won’t move the needle,” he says. Data is needed to add drugs to doctors’ arsenal against the pandemic. But he’s gracious about more widespread attention only being directed toward bradykinin now, after he’s spent months trying to raise its profile.

“The pandemic has exposed key weaknesses in health care itself,” he says. “We need to empower ourselves with as much knowledge as we can, so we can serve our patients and protect ourselves.”

Lois Parshley is a freelance investigative journalist. Follow her Covid-19 reporting on Twitter @loisparshley.

Click Here:

America is now in the middle of a big experiment: reopening schools and colleges during the Covid-19 pandemic. And so far, how things are going depends on which type of school is involved.

At the K-12 level, while there have been some outbreaks, reopenings haven’t led to the explosion of cases that some feared. Still, this comes with a big caveat: Many schools haven’t fully opened up yet, partly or entirely limiting teaching to virtual sessions. And for schools that have opened, we still don’t have very good data on K-12 schools’ reopenings, and there’s still a lot we simply don’t know about how kids transmit the coronavirus.

According to the Covid Monitor, there have been more than 52,000 cases in K-12 schools as of October 15. That’s significant, but a small portion of the 3 million coronavirus cases in the US since August. At the very least, K-12 schools don’t seem to be a primary driver of Covid-19 in the US right now.

“It hasn’t been as chaotic as I had anticipated,” Tara Smith, an epidemiologist at Kent State University, told me. “I expected things would be worse by now, but it’s been going all right so far in general.”

But at colleges and universities, reopening appears to be going much worse, with multiple big outbreaks over the past few months. The problem so far doesn’t seem to be transmission within classrooms so much as transmission outside of them — in dorms, fraternities, sororities, bars, restaurants, and other indoor spaces used to congregate, party, eat, and drink.

The outbreaks spawned almost immediately as colleges and universities reopened. In September, a USA Today analysis found college towns comprised 19 of the 25 biggest coronavirus outbreaks in the US. Outbreaks have forced some colleges and universities to change plans and permanently or temporarily move classes online across the country, from California to Michigan to North Carolina.

The college outbreaks have resulted in deaths. In September, 19-year-old Appalachian State University student Chad Dorrill died, despite friends and family describing him as a “super healthy” athlete with a lack of known preexisting conditions. Dorrill seemingly contracted the coronavirus while living off-campus — leading to neurological complications, potentially caused by undetected Guillain-Barré syndrome, that ultimately killed him.

“It’s not a hoax, that this virus really does exist,” Emma Crider, a student at Appalachian State, told the New York Times. “Before this, the overall mentality was ‘out of sight, out of mind.’”

Some colleges and universities are trying to prevent and counter these outbreaks with extremely aggressive testing regimes, testing each student on campus up to twice a week. The hope is that this will catch any new coronavirus cases before they lead to massive outbreaks — mirroring the kind of strategy employed in Germany, New Zealand, and South Korea to control their respective epidemics. But it’s too early to say how this will work in a higher education setting, especially in communities that have big Covid-19 epidemics outside their schools.

How this all plays out could help decide whether America sees a much-feared coronavirus surge this fall and winter. Coupled with the holidays bringing people together and changing weather pushing some parts of the country indoors, experts worry that school reopenings could lead to a big spike in Covid-19 in the coming months. While the holidays and weather remain in play, mitigating the spread from schools could stop at least one point of concern.

There are consequences beyond Covid-19, too. There’s already solid evidence that remote learning isn’t good enough to make up for the benefits of in-person teaching, meaning kids fall further and further behind as long as schools don’t fully reopen. And when kids aren’t sent off to school, it’s tremendously disruptive to entire families — forcing parents to stay home, often having to supervise their kids to make sure they’re actually logging on to their classes.

“We’re really not acknowledging how much work and strain it is on families when you have a kindergartner doing virtual learning,” Saskia Popescu, an infectious disease epidemiologist, told me.

A failure to get Covid-19 under control and reopen schools, then, doesn’t just mean more coronavirus cases and deaths — on top of the more than 210,000 deaths the US has already seen — but impacts that will cascade over the short and long term across American society.

K-12 reopenings seem to be going fine overall, but there’s a lot we don’t know

It’s still unclear how many K-12 schools, exactly, have fully reopened. Given the country’s sprawling network of school districts, each under varying levels of state and local control, we simply don’t have a good way to track what every school is doing at a national level.

According to Education Week, four states have ordered schools to reopen. Seven, along with Washington, DC, and Puerto Rico, have mandated partial or full closures. The remaining 39 states have by and large left it up to individual school districts or local governments to decide.

Schools can try to fully restart in-person learning, go remote only, or follow a hybrid model. Among those allowing in-person teaching, some require masks for teachers and students. Some are putting students into cohorts or pods — meaning they have to stick to the same group of peers while in school. Some have spread out desks or limited capacity in classes, and have shifted schedules to reduce how many people are in the building at any moment. A few have taken more aggressive measures, like improving ventilation systems in schools, holding at least some classes outside, or instituted aggressive testing programs.

So far, there doesn’t seem to have been a massive surge of Covid-19 due to K-12 schools reopening for in-person instruction. Confirmed cases in K-12 schools make up less than 2 percent of all cases reported in the US since August.

One caveat: A lot of states and districts still aren’t reporting Covid-19 cases in K-12 schools. The Covid Monitor, as an independent group, collects public and media reports on top of the official data to try to fill in the gaps. But it’s certainly missing a lot of cases, meaning its number is a minimum estimate.

Still, it certainly seems like the massive epidemics many feared haven’t happened (at least yet). A USA Today analysis of Florida’s school reopenings, for example, concluded, “Among the counties seeing surges in overall cases, it’s college-age adults — not schoolchildren — driving the trend.” In California, officials similarly reported that they so far had found no link between K-12 schools reopening and increased coronavirus transmission.

“There are some reasons to be hopeful,” Katherine Auger, a health policy researcher at Cincinnati Children’s Hospital, told me. “We aren’t hearing of huge outbreak stories in the news.”

Experts cautioned, however, that the results are early. And they shouldn’t be used as an excuse to open recklessly or without proper safety measures like social distancing, masking, testing, and contact tracing.

Part of the problem is there’s still a lot we don’t know about K-12 schools’ ability to spread Covid-19. For one, we still don’t know for certain how much children, especially younger kids, spread the coronavirus.

What we do know with more certainty is that there seem to be differences in how sick kids get from Covid-19, depending on age. A recent study from the Centers for Disease Control and Prevention found that adolescents ages 12 to 17 were roughly twice as likely as children ages 5 to 11 years old to have a confirmed coronavirus infection. Whether that means younger children are less likely to get and transmit the coronavirus, or merely less likely to develop significant symptoms and get tested, is still an open question.

The testing component is particularly important. As the New York Times reported, it can be very difficult to get a coronavirus test for younger children. If kids can’t get tested, then new infections simply aren’t going to get caught and recorded. Some schools are taking steps to test their staff and students, but many are not — blinding them to potential outbreaks.

Still, some experts have cited data like this to argue that at least K-3, K-5, or K-8 schools could open safely, with few, if any, serious outbreaks. “Those are the kids who need the in-person learning, need the social interaction,” Auger said. “It makes sense developmentally that college students and high school students would be able to learn more readily in a remote setting.”

One concern is that, even if the coronavirus doesn’t seem to transmit among children or hurt them as much, the same isn’t necessarily true for teachers. That fear has led a lot of teachers, backed by powerful unions, to resist full or even partial reopenings.

Colleges and universities seem to be going worse — with some exceptions

Colleges and universities have taken a variety of approaches in reopening. Some are trying to fully reopen, many are sticking to online only, and others are doing a hybrid model. Some allow students to live on campus, although typically at a reduced capacity. Many of the schools are taking a fairly hands-off approach to what students do — merely recommending social distancing and masking — although some have adopted very aggressive testing and masking regimes.

So far, the experience has ranged from mostly fine to outright disasters, with major outbreaks forcing some universities and colleges across the country to move classes back online temporarily or permanently, sometimes after just weeks of reopening.

The outbreaks don’t appear to originate in classrooms, but rather in places where students tend to work, socialize, and party. A recent CDC study backed this up, concluding that Covid-19 clusters in an unnamed North Carolina university were likely fueled by “student gatherings and congregate living settings, both on and off campus.”

To put it another way, the outbreaks seem to be coming from dorms, fraternities, sororities, bars, and restaurants. It’s in these kinds of indoor spaces, where college students work, party, eat, and drink, that Covid-19 has spread. Experts have described large parties, indoor dining, and bars as especially risky: People are close together for long periods of time; they can’t wear masks as they eat or drink; the air can’t dilute the virus like it can outdoors; and alcohol could lead people to drop their guards further.

This was predictable: As Smith said, “This is what you would expect from college students.”

For young people, a big consideration is that Covid-19 is simply less threatening to them than to older adults. That may make them feel like they can party and socialize without major consequences.

But young people can still get sick and die from Covid-19 — and some have. Young people also eventually socialize with their parents, grandparents, teachers, and other older peers. Another CDC study found this to be a consistent trend over the summer: Outbreaks would start among the young, eventually spreading to older populations — leading to many more cases and deaths as a result. That could be particularly bad for colleges and universities if students carry the virus around the country when they go back home for holidays or breaks, potentially triggering epidemics not just locally at or near their campuses but nationwide.

To avoid such outbreaks, some colleges and universities have embraced very aggressive testing regimes — testing all students as they get on campus, then testing each of them two times a week after. By constantly testing, these schools hope to stop a few cases from turning into a big outbreak.

On top of testing and tracing, colleges and universities have taken various steps to get their students to follow other basic Covid-19 precautions, such as social distancing and masking. Some universities have outright prohibited their students, with the threat of suspension or expulsion, from going to parties or other gatherings, or even interacting with anyone outside of their dorm and classes.

Whether all of that works remains to be seen. For testing and tracing, the early results seem promising, with several of the most aggressive schools reporting few, if any, Covid-19 cases. And it follows the kind of model that’s helped other places, including whole nations, control their epidemics.

Some experts are worried that the aggressive testing regimes could lead to a false sense of security. They pointed to the White House, where very aggressive testing has been used to justify relaxing on social distancing and masking. That seemed to contribute to the ongoing outbreak at the White House, spanning from President Donald Trump to a presidential valet.

Aggressive testing “is not a replacement for all the other measures,” Lauren Ancel Meyers, a mathematical biologist at the University of Texas Austin, told me. “It’s just a needed addition to armament of intervention strategies that we have.”

A recent New York Times story showed that false sense of security in action, reporting that “students like Logan Morrione can wander on and off the Waterville, Maine, [Colby College] campus, attend most classes in person and even do without masks in some social situations.”

Truly reopening schools requires getting Covid-19 under control

Setting aside whatever is happening within classrooms, the biggest problem for schools is that America still has a lot of coronavirus cases. In the past week, the US reported more than double the cases per person a day as Canada and at least 100 times the cases per person a day as South Korea, Australia, and New Zealand.

With so many cases across the US, and especially in educational settings where students are coming in from around the country, there are simply more chances that the virus will end up on campus. Meyers emphasized this is the No. 1 factor any school should consider before reopening.

This is why many experts spent much of the summer calling for America to suppress the coronavirus: If cases were driven to a low enough level, that could allow schools, from K-12 to colleges and universities, to open much more safely.

But despite experts’ warnings, many states reopened bars and indoor dining — fueling large outbreaks. Some places were slow to mandate masks, with 17 states still not requiring them. The US, in effect, prioritized a false sense of normalcy and the reopening of bars and indoor dining over the reopening of schools. Universities are seeing this directly as bars and indoor dining lead to a surge of coronavirus cases on campus.

“It’s something we really should have seen coming,” Popescu said.

The bad outcomes within some schools could set up the US for a broader vicious cycle: If colleges and universities lead to Covid-19 spikes, they could make it more difficult for K-12 schools to reopen. That, some experts argued, would be a backward outcome. “It’s much easier to do virtual learning for universities and for high schools,” Popescu argued.

So it’s the problem of community transmission, experts say, that must take priority over all other safety precautions within schools. As long as the US doesn’t get its whole coronavirus epidemic under control — whether due to incompetence from the Trump administration or other officials — schools are, just like other public settings, going to be at risk for Covid-19.

That’s not to say schools can’t take steps to make themselves safer. They can still embrace social distancing, masking, testing, and tracing. They can try to have fewer people on their campuses — by staggering schedules, or reducing the numbers of people in classrooms or dorms. They can encourage or mandate students to only socialize within a small group of people — by establishing a pod or cohorting, or by limiting students to people that they live or go to class with. They could try to improve ventilation in buildings, or hold more classes and events outside.

But these precautions aren’t going to be consistently effective if the virus is raging in the broader community.

If this isn’t taken seriously, it could, when paired with the holidays and people going inside to avoid the cold, contribute to a surge in coronavirus cases this fall and winter. America’s already bad Covid-19 epidemic, then, would get even worse.

Click Here:

TIPPERARY STAR HURLER Pádraic Maher says that his decision to retire from the sport was made to ensure a greater quality of life going forward.

Paudie Maher on the ball for Tipperary.

Source: Ryan Byrne/INPHO

The three-time All-Ireland winner made the shock announcement during the week, saying that he had received medical advice to step away from contact sport due to a neck injury.

Click Here:

Maher had previously indicated his intentions to return for a 14th season with the Premier County, but will now be bringing the curtain down on his decorated career with both Tipperary and his club Thurles Sarsfields.

Speaking to the media today, the six-time All-Star elaborated on some of the details of his neck injury. He began by explaining how he was prompted to seek medical advice after he mistook some headaches and neck pain for possible having Covid-19 symptoms.

“I still have to meet one or two more lads about it to determine how old it is but at the moment from what I know I only got the symptoms from around the time of the county final when my neck was at me and I was getting a few headaches.

“That’s when it arose but again it could have been an accumulation of things, I don’t know. That’s why I’m hoping to meet one or two more specialists tomorrow and at the start of next week and hopefully they’ll be able to give me a bit more information as regards how old it is, how it happened, but there is a fair chance from what I told it happened in training or something between the county semi-final and final because the symptoms arose a few days before the county final.

“I said I wasn’t feeling great. At the time, I thought ‘am I getting Covid?’, I didn’t know what was going on. But then we got to the root of it recently and thankfully we did because if the doc didn’t send me for a scan I could be in training and could have been making it a lot worse unbeknownst to myself. Very unlucky but very lucky at the same time.

“So there is a fair chance I took a knock at training, noticed it myself. The way we train with Sarsfields is fairly physical so there is a fair chance I got a knock there and whether it ruptured something then or made an old injury worse I don’t know but hopefully I’ll get a lot of answers in the following weeks.”

Maher added that he was reassured by the doctor that eliminating the risk now means he can look forward to a healthy life away from hurling. He’s also clear to continue working for An Garda Síochána.

All forms of contact sport are no longer available to him, but individual pursuits like running, swimming and cycling are still safe options.

He has also recently opened the Heyday coffee house in Thurles with his Tipp team-mate Séamus Callanan, which will give him a new focus.

“He [the doctor] only listed off what the damage could be,” says Maher, “especially when you are working in the head and neck area, he put it to me, do you want your girlfriend lifting you off the couch to put you to bed every night? It was that extreme so when he started talking like that, I said, this is a fairly black and white decision for me.

“Thankfully, the risk has been taken away, please God, and with the bit of guidance from the medics going forward I will have a perfectly healthy life to live.

“It’s going to be some void to fill alright, being gone four or five nights a week and building up to big games at the weekend. So it’s going to be strange.

“I don’t know if I can be twisting or turning or moving my neck too sharply but there’s still loads for me to do between work and the coffee shop.”

Source: James Crombie/INPHO

Maher departs as one of Tipperary’s greatest ever players, who won three senior All-Ireland titles throughout the course of a decade. He also enjoyed success at underage level and was part of an exciting group of emerging talents that broke through to the senior ranks in 2010.

He added that the outpouring of appreciation for his contribution to hurling has been “amazing” and that he didn’t expect the huge volume of messages.

Tipperary will get their Division 1B campaign underway this weekend when they travel to face Laois in Portlaoise. Maher’s brother Ronan is still a key player for the county, and he wants to get started on adjusting to the role of supporter.

“I’m actually thinking this morning I might go down to Portlaoise to get it out of the system. It will be strange alright but get to the first one or two games and I’ll be as much a supporter as anyone.

“Ronan is involved there as well and I need to support him as well and yeah, sure, we’ll see we might go down to Portlaoise on Saturday evening and a few pints on the way home. Life has changed a lot in the last few days, it’s very strange.”

– First published 13.59, 3 February

The42 is on Instagram! Tap the button below on your phone to follow us!

MARK KEANE FELT the timing was right to pursue a hurling career with Cork after his decision last month to bring his time in the AFL to a close.

Source: Seb Daly/SPORTSFILE

The 21-year-old departed his Aussie Rules club Collingwood after being based with the Melbourne side since 2018.

His sporting focus has returned to his GAA roots in Ireland but despite starring for Cork football underage sides and famously scoring the goal for the senior team that secured a dramatic win over Kerry in November 2020, he has linked up with Kieran Kingston’s hurling squad for the year ahead.

Mark Keane is focused on Cork hurlers in 2022.

Source: Laszlo Geczo/INPHO

“Football was always kind of my love, I played hurling all the way up as well,” says Keane.

“I played minor and U20 at football level, would’ve played both if I could have. I just thought it was the right time to give hurling a go. It’s a dream for everyone really to play both codes, play Cork hurling and football. Since I’ve done the football, I just wanted to give hurling a go. I just feel like it’s the right time.

“I’ve been working closely with the selectors above in Cork senior hurling. They’ve been great and very supportive, trying to get the best out of me.

“It’s a very young crop of good players coming through, training sessions are very high intensity and very enjoyable. That’s all thanks I suppose to Kieran with Noel Furlong and Pat Mulcahy, they’ve been super. Even the training sessions are a great buzz, going up and meeting all the lads.”

Keane has a strong underage hurling track record and will link up with some colleagues from those teams now on the senior stage with Cork.

“I’ve a Munster medal and All-Ireland medal in hurling from U15 and U16 under John Meyler. Winning with the likes of Darragh Connery, Tommy O’Connell, Sean Twomey, and seeing them playing with Cork senior hurling. Seeing the Cork footballers win the U20 final (in 2019), my fellow clubmate Cathal O’Mahony win the U20 title as well. That was devastating for me as well, and I felt I could have been a part of it, if I was at home.”

Cork’s league campaign may be commencing on Saturday against Clare but Keane has a more significant assignment. His form for his club Ballygiblin has rekindled his interest in hurling, a series of powerful displays have helped propel them into the AIB All-Ireland junior final against Kilkenny’s Mooncoin.

He may have played at the MCG in Australia but this will be his first time gracing the Croke Park stage.

Mark Keane in action for Collingwood.

Source: AAP/PA Images

“It’s everyone’s dream to be in Croke Park with your club, definitely (didn’t think I would) with Ballygiblin. It’s an unbelievable buzz in fairness, it’s only a small country club outside of Mitchelstown. I couldn’t speak highly enough of Brian Molan and Liam Doc (O’Doherty), our chairman and secretary, they’ve been unreal. They’re just great characters and you just want to play and win for them any day of the week.”

After opting to close out his AFL days, Keane has no regrets at the end of a sporting chapter that saw him make five appearances for Collingwood.

“I went back over for five or six weeks for a pre-season (at the end of 2021). When I came home I just wasn’t ready to go back. Just in my own head, I’ve always went back without a bother but this time just felt it wasn’t the same and wasn’t ready to go back and commit to it.

“I suppose I always wanted to come home and play for Cork in either hurling or football. I just felt like it was the right time to come home.

“It’s always a tough decision when you’re leaving the AFL. I just had to ring the head coach and general manager and had a few conversations with them and they were very supportive of it as well, looked after me very well with my transition back to home.

Click Here:

“When I was over there I was always invested in it, whenever I was training, I trained to the best of my ability and stuff like that, but in the back of my mind GAA was always there. I’ve tried loads of times to ignore the GAA back here at home, but unfortunately I couldn’t get it out of my head.”

Mark Keane.

Source: AAP/PA Images

The restrictions enforced by Covid-19 made life difficult off the pitch over the past couple of years.

“I wasn’t able to get my parents and girlfriend over for my AFL debut. There were special moments like that you weren’t able to do. You weren’t able to come home as easy as you were.

“There were restrictions put on the AFL boys, even though there weren’t in Melbourne – you weren’t ablet to go to restaurants and stuff like, just to keep the AFL season up and running.

“AFL PA, and the Gaelic Players Association, have been super with helping me. AFL PA, even though you are retired, they’ll still help you for three years post-retirement, which is very good.

“The transiton has been good. It’s definitely been easier with there being a good buzz around the place, around Mitchelstown and Ballygiblin.”

When living in Australia, hurling was initially parked in Keane’s list of priorities. He then availed of an O’Neills depot in Adelaide to get himself a hurley so he could puck around with his housemate, Meath’s Cian McBride, and took in the odd training session with Melbourne club Garryowen.

Since last autumn he has become immersed in the sport again, only missing one of Ballygiblin’s matches when they played a Munster semi-final. He’s keeping an eye on Cork’s league trip to Tullamore on Sunday week against Offaly and gearing himself up for an All-Ireland club final.

The aim is achieve more than just that memorable goal for Cork in Páirc Uí Chaoimh in 2020.

“It’s always good when you’re knocking Kerry out of championship – you can’t beat them enough. I was just glad that we got to the Munster final, but we didn’t finish it off when we should have. I don’t want to be remembered just for that.

“I want to be remembered for other things: Playing with Cork hurling this year, aiding and helping Ballygiblin to get to an All-Ireland final, being around Mitchelstown in county finals, playing in the AFL as well.”

Buy The42’s new book, Behind The Lines, here: