A Reminder of COVID-19 Symptoms

Monkeys steal Covid-19 test samples from health worker in India | India | The Guardian

Monkeys eating fruit on a street in Delhi

Blood samples later recovered undamaged after fears incident could have helped spread virus

Agence France-PresseFri 29 May 2020 10.06 EDT

Monkeys mobbed an Indian health worker and made off with blood samples from coronavirus tests, prompting fears they could have spread the virus in the local area.

After making off with the three samples this week in Meerut, near Delhi, the monkeys scampered up nearby trees and one then tried to chew its plunder.

The sample boxes were later recovered and had not been damaged, the Meerut medical college superintendent, Dheeraj Raj, told AFP on Friday after footage of the incident went viral on social media.

https://d-20527234781725149654.ampproject.net/2005151844001/frame.html

“They were still intact and we don’t think there is any risk of contamination or spread,” Raj said. He said the three people whose samples were stolen had been retested for the virus.https://interactive.guim.co.uk/2020-embeds/2020/03/country/embed/main.html?country=India#amp=1

Coronavirus has been detected in animals, though there has been no confirmation that the disease can be passed to humans from them.

India’s coronavirus death toll passed that of neighbouring China on Friday, with 175 new deaths in 24 hours taking the total to 4,706, according to official data.

India, home to some of the world’s most densely populated cities and a creaking healthcare system, is emerging as a new hotspot with record jumps in new cases in recent days.

In many rural areas, farmers regularly lose crops to monkey populations and have demanded local governments intervene to check their populations.

City authorities in Delhi have used long-tailed langur monkeys to scare away smaller primates from around the Indian parliament.

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Pennsylvania is SLOWLY Coming Back to Life

The COVID-19 shutdown will cost Americans millions of years of life | TheHill

By Scott W. Atlas, John R. Birge, Ralph L Keeney and Alexander Lipton, Opinion Contributors — 05/25/20 08:00 AM EDT 886 The views expressed by contributors are their own and not the view of The Hill 12,263

Our governmental COVID-19 mitigation policy of broad societal lockdown focuses on containing the spread of the disease at all costs, instead of “flattening the curve” and preventing hospital overcrowding. Although well-intentioned, the lockdown was imposed without consideration of its consequences beyond those directly from the pandemic. 

The policies have created the greatest global economic disruption in history, with trillions of dollars of lost economic output. These financial losses have been falsely portrayed as purely economic. To the contrary, using numerous National Institutes of Health Public Access publications, Centers for Disease Control and Prevention (CDC) and Bureau of Labor Statistics data, and various actuarial tables, we calculate that these policies will cause devastating non-economic consequences that will total millions of accumulated years of life lost in the United States, far beyond what the virus itself has caused.

Pandemics have afflicted humankind throughout history. They devastated the Roman and Byzantine empires, Medieval Europe, China and India, and they continue to the present day despite medical progress. null

The past century has witnessed three pandemics with at least 100,000 U.S. fatalities: The “Spanish Flu,” 1918-1919, with between 20 million and 50 million fatalities worldwide, including 675,000 in the U.S.; the “Asian Flu,” 1957-1958, with about 1.1 million deaths worldwide, 116,000 of those in the U.S.; and the “Hong Kong Flu,” 1968-1972,  with about 1 million people worldwide, including 100,000 in the U.S. So far, the current pandemic has produced almost 100,000 U.S. deaths, but the reaction of a near-complete economic shutdown is unprecedented.

The lost economic output in the U.S. alone is estimated to be 5 percent of GDP, or $1.1 trillion for every month of the economic shutdown. This lost income results in lost lives as the stresses of unemployment and providing basic needs increase the incidence of suicide, alcohol or drug abuse, and stress-induced illnesses. These effects are particularly severe on the lower-income populace, as they are more likely to lose their jobs, and mortality rates are much higher for lower-income individuals.   

Statistically, every $10 million to $24 million lost in U.S. incomes results in one additional death. One portion of this effect is through unemployment, which leads to an average increase in mortality of at least 60 percent. That translates into 7,200 lives lost per month among the 36 million newly unemployed Americans, over 40 percent of whom are not expected to regain their jobs. In addition, many small business owners are near financial collapse, creating lost wealth that results in mortality increases of 50 percent. With an average estimate of one additional lost life per $17 million income loss, that would translate to 65,000 lives lost in the U.S. for each month because of the economic shutdown. 

In addition to lives lost because of lost income, lives also are lost due to delayed or foregone health care imposed by the shutdown and the fear it creates among patients. From personal communications with neurosurgery colleagues, about half of their patients have not appeared for treatment of disease which, left untreated, risks brain hemorrhage, paralysis or death.

Here are the examples of missed health care on which we base our calculations: Emergency stroke evaluations are down 40 percent. Of the 650,000 cancer patients receiving chemotherapy in the United States, an estimated half are missing their treatments. Of the 150,000 new cancer cases typically discovered each month in the U.S., most – as elsewhere in the world – are not being diagnosed, and two-thirds to three-fourths of routine cancer screenings are not happening because of shutdown policies and fear among the population. Nearly 85 percent fewer living-donor transplants are occurring now, compared to the same period last year. In addition, more than half of childhood vaccinations are not being performed, setting up the potential of a massive future health disaster.

The implications of treatment delays for situations other than COVID-19 result in 8,000 U.S. deaths per month of the shutdown, or about 120,000 years of remaining life. Missed strokes contribute an additional loss of 100,000 years of life for each month; late cancer diagnoses lose 250,000 years of remaining life for each month; missing living-donor transplants, another 5,000 years of life per month — and, if even 10 percent of vaccinations are not done, the result is an additional 24,000 years of life lost each month. 

These unintended consequences of missed health care amount to more than 500,000 lost years of life per month, not including all the other known skipped care.

If we only consider unemployment-related fatalities from the economic shutdown, that would total at least an additional 7,200 lives per month. Assuming these deaths occur proportionally across the ages of current U.S. mortality data, and equally among men and women, this amounts to more than 200,000 lost years of life for each month of the economic shutdown. 

In comparison, COVID-19 fatalities have fallen disproportionately on the elderly, particularly in nursing homes, and those with co-morbidities. Based on the expected remaining lifetimes of these COVID-19 patients, and given that 40 percent of deaths are in nursing homes, the disease has been responsible for 800,000 lost years of life so far. Considering only the losses of life from missed health care and unemployment due solely to the lockdown policy, we conservatively estimate that the national lockdown is responsible for at least 700,000 lost years of life every month, or about 1.5 million so far — already far surpassing the COVID-19 total.

Policymakers combatting the effects of COVID-19 must recognize and consider the full impact of their decisions. They need to be aware of the devastating effects in terms of lost life from shutting down significant parts of the economy. The belated acknowledgement by policy leaders of irreparable harms from the lockdown is not nearly enough. They need to emphatically and widely inform the public of these serious consequences and reassure them of their concern for all human life by strongly articulating the rationale for reopening society. https://ebd4fc279229bb5cc4164421271babeb.safeframe.googlesyndication.com/safeframe/1-0-37/html/container.html

To end the loss of life from the economic lockdown, businesses as well as K-12 schools, public transportation, parks and beaches should smartly reopen with enhanced hygiene and science-based protection warnings for any in the high-risk population. For most of the country, that reopening should occur now, without any unnecessary fear-based restrictions, many of which repeat the error of disregarding the evidence. By following a thoughtful analysis that finally recognizes all available actions and their consequences, we can save millions of years of American life. 

When the next pandemic inevitably arises, we need to remember these lessons and follow policies that consider the lives of all Americans from the outset.

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https://thehill.com/opinion/healthcare/499394-the-covid-19-shutdown-will-cost-americans-millions-of-years-of-life

600 Physicians Say Lockdowns Are A ‘Mass Casualty Incident’

forbes.com

Grace-Marie Turner 6-7 minutes


224,476 views|May 22, 2020,12:00pm EDT

More than 600 of the nation’s physicians sent a letter to President Trump this week calling the coronavirus shutdowns a “mass casualty incident” with “exponentially growing negative health consequences” to millions of non COVID patients. 

“The downstream health effects…are being massively under-estimated and under-reported. This is an order of magnitude error,” according to the letter initiated by Simone Gold, M.D., an emergency medicine specialist in Los Angeles. 

“Suicide hotline phone calls have increased 600%,” the letter said. Other silent casualties:  “150,000 Americans per month who would have had new cancer detected through routine screening.”

From missed cancer diagnoses to untreated heart attacks and strokes to increased risks of suicides, “We are alarmed at what appears to be a lack of consideration for the future health of our patients.”  

Patients fearful of visiting hospitals and doctors’ offices are dying because COVID-phobia is keeping them from seeking care. One patient died at home of a heart attack rather than go to an emergency room. The number of severe heart attacks being treated in nine U.S hospitals surveyed dropped by nearly 40% since March. Cardiologists are worried “a second wave of deaths” indirectly caused by the virus is likely.

The physicians’ letter focuses on the impact on Americans’ physical and mental health.  “The millions of casualties of a continued shutdown will be hiding in plain sight, but they will be called alcoholism, homelessness, suicide, heart attack, stroke, or kidney failure. In youths it will be called financial instability, unemployment, despair, drug addiction, unplanned pregnancies, poverty, and abuse.

“It is impossible to overstate the short, medium, and long-term harm to people’s health with a continued shutdown,” the letter says. “Losing a job is one of life’s most stressful events, and the effect on a person’s health is not lessened because it also has happened to 30 million [now 38 million] other people.  Keeping schools and universities closed is incalculably detrimental for children, teenagers, and young adults for decades to come.” 

While all 50 states are relaxing lockdowns to some extent, some local officials are threatening to keep stay-at-home orders in place until August.  Many schools and universities say they may remain closed for the remainder of 2020.

“Ending the lockdowns are not about Wall Street or disregard for people’s lives; it about saving lives,” said Dr. Marilyn Singleton, a California anesthesiologist and one of the signers of the letter. “We cannot let this disease change the U.S. from a free, energetic society to a society of broken souls dependent on government handouts.” She blogs about the huge damage the virus reaction is doing to the fabric of society

Dr. Jane Orient, executive director of the Association of American Physicians and Surgeons, also warns that restrictions are having a huge negative impact on non-COVID patients. 

“Even patients who do get admitted to hospital, say for a heart problem, are prisoners. No one can be with them. Visitation at a rare single-story hospital was through closed outside window, talking via telephone,” she wrote us.  “To get permission to go to the window you have to make an appointment (only one group of two per day!), put on a mask, get your temperature taken, and get a visitor’s badge of the proper color of the day.”

How many cases of COVID-19 are prevented by these practices? “Zero,” Dr. Orient says.  But the “ loss of patient morale, loss of oversight of care, especially at night are incalculable.”

Virtually all hospitals halted “elective” procedures to make beds available for what was expected to be a flood of COVID-19 patients.  Beds stayed empty, causing harm to patients and resulting in enormous financial distress to hospitals, especially those with limited reserves. 

Even states like New York that have had tough lockdowns are starting to allow elective hospital procedures in some regions.  But it’s more like turning up a dimmer switch. In Pennsylvania, the chair of the Geisinger Heart Institute, Dr. Alfred Casale, said the opening will be slow while the facility is reconfigured for COVID-19 social distancing and enhanced hygiene.  

Will patients come back?  COVID-phobia is deathly real.

Patients still are fearful about going to hospitals for heart attacks and even for broken bones and deep lacerations. Despite heroic efforts by physicians to deeply sanitize their offices, millions have cancelled appointments and are missing infusion therapies and even chemotherapy treatments. This deferred care is expected to lead to patients who are sicker when they do come in for care and more deaths from patients not receiving care for stroke, heart attacks, etc. 

NPR reported about a Washington state resident who had what she described as the “worst headache of her life.”

She waited almost a week before going to the hospital where doctors discovered she had a brain bleed that had gone untreated.  She had multiple strokes and died. “This is something that most of the time we’re able to prevent,” said her neurosurgeon, Dr. Abhineet Chowdhary, director of the Overlake Neuroscience Institute in Bellevue, Wash. 

As the number of deaths from the virus begin to decline, we are likely to awaken to this new wave of casualties the 600 physicians are warning about. We should be listening to the doctors, and heed their advice immediately.

Get the best of Forbes to your inbox with the latest insights from experts across the globe.

https://www.forbes.com/sites/gracemarieturner/2020/05/22/600-physicians-say-lockdowns-are-a-mass-casualty-incident/amp/?__twitter_impression=true

Social distancing one week earlier could have saved 36,000 lives in US, study suggests

https://media.fox43.com/embeds/mobile/video/65-cadece88-8f64-4973-9ba3-4d5e16f5cc0d/amp#amp=1 coronavirus

Researchers say the new models show how even small differences in timing could have prevented the worst exponential growth of coronavirus cases. Author: TEGNA Published: 5:39 AM EDT May 21, 2020

New modeling shows that if the U.S. adopted coronavirus social distancing measures one week earlier in March, the country could have saved nearly 36,000 additional lives from COVID-19. Researchers say its a sign of how quickly the virus can spread when no measures are in place.

The estimates are from the Columbia University Mailman School of Public Health. It’s based on modeling that looks at how reduced contact between people starting in mid-March slowed transmission, according to The New York Times. null

On March 16, President Donald Trump announced guidelines from the White House coronavirus task force aimed at slowing the spread of the virus. He asked Americans to avoid discretionary travel, avoid gathering in large groups and encouraged schools to teach remotely.

Columbia researchers say that had such measures been enacted on March 8, the number of total deaths, as of May 3, could have dropped by nearly 36,000. If the restrictions had gone into effect March 1, the researchers projected that the number of deaths could be 54,000 less, as of May 3. 

The leader of the research team told the New York Times that even small differences in timing could have prevented the worst exponential growth, which by April had already hit New York City, New Orleans and other towns. 

The team estimated that in New York City alone, the number of coronavirus deaths reported on May 3 could have dropped by nearly 15,000 to just 2,838. The researchers’ findings have yet to be peer-reviewed and were shared online to the preprint site medrxiv

RELATED: Repeating 50-day strict lockdown, 30-day relaxing could solve pandemic, study suggests

RELATED: CDC says coronavirus ‘does not spread easily’ on surfaces, objects

As of early Thursday morning, there were more than 1.5 million confirmed cases of COVID-19 in the U.S., according to Johns Hopkins University. That includes more than 93,000 deaths.

RELATED: 5 million cases: World COVID-19 count reaches new milestone

RELATED: CDC says coronavirus ‘does not spread easily’ on surfaces, objects

In response to the new estimates, the White House released a statement late Wednesday night to the New York Times that reiterated the president’s “assertion that restrictions on travel from China in January and Europe in mid-March slowed the spread of the virus.”

The new coronavirus causes mild or moderate symptoms for most people. For some, especially older adults and people with existing health problems, it can cause more severe illness or death.

https://www.fox43.com/amp/article/news/health/coronavirus/social-distance-earlier-more-lives-saved-models-columbia/507-53295ef6-fd24-4830-b854-a55d4c7a661c?__twitter_impression=true

VIDEO China Admits to Destroying Early Coronavirus Samples, Insists It’s Not a Cover-up – Infected person carried into market

MyLegalHelpUSA

Landmark study claims virus didn’t come from animals in Wuhan market

China’s claims that the pandemic emerged from a wild animal market in Wuhan last December have been challenged by a landmark scientific study.

The Mail on Sunday can reveal that analysis of the coronavirus by specialist biologists suggests that all available data shows it was taken into the market by someone already carrying the disease.

The article goes on to state the following:

They also say they were ‘surprised’ to find the virus was ‘already pre-adapted to human transmission’, contrasting it to another coronavirus that evolved rapidly as it spread around the planet in a previous epidemic.

“The publicly available genetic data does not point to cross-species transmission of the virus at the market,” said Alina Chan, a molecular biologist, and Shing Zhan, an evolutionary biologist, according to the report.

“The possibility that a non-genetically engineered precursor could have…

View original post 1,133 more words

High SARS-CoV-2 Attack Rate Following Exposure at a Choir Practice …

cdc.gov

Weekly / May 15, 2020 / 69(19);606–610 21-26 minutes


On May 12, 2020, this report was posted online as an MMWR Early Release.

Lea Hamner, MPH1; Polly Dubbel, MPH1; Ian Capron1; Andy Ross, MPH1; Amber Jordan, MPH1; Jaxon Lee, MPH1; Joanne Lynn1; Amelia Ball1; Simranjit Narwal, MSc1; Sam Russell1; Dale Patrick1; Howard Leibrand, MD1 (View author affiliations)

View suggested citation

Summary

What is already known about this topic?

Superspreading events involving SARS-CoV-2, the virus that causes COVID-19, have been reported.

What is added by this report?

Following a 2.5-hour choir practice attended by 61 persons, including a symptomatic index patient, 32 confirmed and 20 probable secondary COVID-19 cases occurred (attack rate = 53.3% to 86.7%); three patients were hospitalized, and two died. Transmission was likely facilitated by close proximity (within 6 feet) during practice and augmented by the act of singing.

What are the implications for public health practice?

The potential for superspreader events underscores the importance of physical distancing, including avoiding gathering in large groups, to control spread of COVID-19. Enhancing community awareness can encourage symptomatic persons and contacts of ill persons to isolate or self-quarantine to prevent ongoing transmission.

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The figure shows representation of 52 people who became sick after exposure to one symptomatic person with text describing ways to reduce the spread of COVID-19.

On March 17, 2020, a member of a Skagit County, Washington, choir informed Skagit County Public Health (SCPH) that several members of the 122-member choir had become ill. Three persons, two from Skagit County and one from another area, had test results positive for SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). Another 25 persons had compatible symptoms. SCPH obtained the choir’s member list and began an investigation on March 18. Among 61 persons who attended a March 10 choir practice at which one person was known to be symptomatic, 53 cases were identified, including 33 confirmed and 20 probable cases (secondary attack rates of 53.3% among confirmed cases and 86.7% among all cases). Three of the 53 persons who became ill were hospitalized (5.7%), and two died (3.7%). The 2.5-hour singing practice provided several opportunities for droplet and fomite transmission, including members sitting close to one another, sharing snacks, and stacking chairs at the end of the practice. The act of singing, itself, might have contributed to transmission through emission of aerosols, which is affected by loudness of vocalization (1). Certain persons, known as superemitters, who release more aerosol particles during speech than do their peers, might have contributed to this and previously reported COVID-19 superspreading events (25). These data demonstrate the high transmissibility of SARS-CoV-2 and the possibility of superemitters contributing to broad transmission in certain unique activities and circumstances. It is recommended that persons avoid face-to-face contact with others, not gather in groups, avoid crowded places, maintain physical distancing of at least 6 feet to reduce transmission, and wear cloth face coverings in public settings where other social distancing measures are difficult to maintain.

Investigation and Findings

The choir, which included 122 members, met for a 2.5-hour practice every Tuesday evening through March 10. On March 15, the choir director e-mailed the group members to inform them that on March 11 or 12 at least six members had developed fever and that two members had been tested for SARS-CoV-2 and were awaiting results. On March 16, test results for three members were positive for SARS-CoV-2 and were reported to two respective local health jurisdictions, without indication of a common source of exposure. On March 17, the choir director sent a second e-mail stating that 24 members reported that they had developed influenza-like symptoms since March 11, and at least one had received test results positive for SARS-CoV-2. The email emphasized the importance of social distancing and awareness of symptoms suggestive of COVID-19. These two emails led many members to self-isolate or quarantine before a delegated member of the choir notified SCPH on March 17.

All 122 members were interviewed by telephone either during initial investigation of the cluster (March 18–20; 115 members) or a follow-up interview (April 7–10; 117); most persons participated in both interviews. Interviews focused on attendance at practices on March 3 and March 10, as well as attendance at any other events with members during March, other potential exposures, and symptoms of COVID-19. SCPH used Council of State and Territorial Epidemiologists case definitions to classify confirmed and probable cases of COVID-19 (6). Persons who did not have symptoms at the initial interview were instructed to quarantine for 14 days from the last practice they had attended. The odds of becoming ill after attending each practice were computed to ascertain the likelihood of a point-source exposure event.

No choir member reported having had symptoms at the March 3 practice. One person at the March 10 practice had cold-like symptoms beginning March 7. This person, who had also attended the March 3 practice, had a positive laboratory result for SARS-CoV-2 by reverse transcription–polymerase chain reaction (RT-PCR) testing.

In total, 78 members attended the March 3 practice, and 61 attended the March 10 practice (Table 1). Overall, 51 (65.4%) of the March 3 practice attendees became ill; all but one of these persons also attended the March 10 practice. Among 60 attendees at the March 10 practice (excluding the patient who became ill March 7, who also attended), 52 (86.7%) choir members subsequently became ill. Some members exclusively attended one practice; among 21 members who only attended March 3, one became ill and was not tested (4.8%), and among three members who only attended March 10, two became ill (66.7%), with one COVID-19 case being laboratory-confirmed.

Because illness onset for 49 (92.5%) patients began during March 11–15 (Figure), a point-source exposure event seemed likely. The median interval from the March 3 practice to symptom onset was 10 days (range = 4–19 days), and from the March 10 practice to symptom onset was 3 days (range = 1–12 days). The odds of becoming ill after the March 3 practice were 17.0 times higher for practice attendees than for those who did not attend (95% confidence interval [CI] = 5.5–52.8), and after the March 10 practice, the odds were 125.7 times greater (95% CI = 31.7–498.9). The clustering of symptom onsets, odds of becoming ill according to practice attendance, and known presence of a symptomatic contagious case at the March 10 practice strongly suggest that date as the more likely point-source exposure event. Therefore, that practice was the focus of the rest of the investigation. Probable cases were defined as persons who attended the March 10 practice and developed clinically compatible COVID-19 symptoms, as defined by Council of State and Territorial Epidemiologists (6). The choir member who was ill beginning March 7 was considered the index patient.

The March 10 choir rehearsal lasted from 6:30 to 9:00 p.m. Several members arrived early to set up chairs in a large multipurpose room. Chairs were arranged in six rows of 20 chairs each, spaced 6–10 inches apart with a center aisle dividing left and right stages. Most choir members sat in their usual rehearsal seats. Sixty-one of the 122 members attended that evening, leaving some members sitting next to empty seats. Attendees practiced together for 40 minutes, then split into two smaller groups for an additional 50-minute practice, with one of the groups moving to a smaller room. At that time, members in the larger room moved to seats next to one another, and members in the smaller room sat next to one another on benches. Attendees then had a 15-minute break, during which cookies and oranges were available at the back of the large room, although many members reported not eating the snacks. The group then reconvened for a final 45-minute session in their original seats. At the end of practice, each member returned their own chair, and in the process congregated around the chair racks. Most attendees left the practice immediately after it concluded. No one reported physical contact between attendees. SCPH assembled a seating chart of the all-choir portion of the March 10 practice (not reported here because of concerns about patient privacy).

Among the 61 choir members who attended the March 10 practice, the median age was 69 years (range = 31–83 years); 84% were women. Median age of those who became ill was 69 years, and 85% of cases occurred in women. Excluding the laboratory-confirmed index patient, 52 (86.7%) of 60 attendees became ill; 32 (61.5%) of these cases were confirmed by RT-PCR testing and 20 (38.5%) persons were considered to have probable infections. These figures correspond to secondary attack rates of 53.3% and 86.7% among confirmed and all cases, respectively. Attendees developed symptoms 1 to 12 days after the practice (median = 3 days). The first SARS-CoV-2 test was performed on March 13. The last person was tested on March 26.

Three of the 53 patients were hospitalized (5.7%), including two who died (3.8%). The mean interval from illness onset to hospitalization was 12 days. The intervals from onset to death were 14 and 15 days for the two patients who died.

SCPH collected information about patient signs and symptoms from patient interviews and hospital records (Table 2). Among persons with confirmed infections, the most common signs and symptoms reported at illness onset and at any time during the course of illness were cough (54.5% and 90.9%, respectively), fever (45.5%, 75.8%), myalgia (27.3%, 75.0%), and headache (21.2%, 60.6%). Several patients later developed gastrointestinal symptoms, including diarrhea (18.8%), nausea (9.4%), and abdominal cramps or pain (6.3%). One person experienced only loss of smell and taste. The most severe complications reported were viral pneumonia (18.2%) and severe hypoxemic respiratory failure (9.1%).

Among the recognized risk factors for severe illness, the most common was age, with 75.5% of patients aged ≥65 years. Most patients (67.9%) did not report any underlying medical conditions, 9.4% had one underlying medical condition, and 22.6% had two or more underlying medical conditions. All three hospitalized patients had two or more underlying medical conditions.

Public Health Response

SCPH provided March 10 practice attendees with isolation and quarantine instructions by telephone, email, and postal mail. Contacts of patients were traced and notified of isolation and quarantine guidelines. At initial contact, 15 attendees were quarantined, five of whom developed symptoms during quarantine and notified SCPH.

Before detection of this cluster on March 17, Skagit County had reported seven confirmed COVID-19 cases (5.4 cases per 100,000 population). At the time, SCPH informed residents that likely more community transmission had occurred than indicated by the low case counts.* On March 21, SCPH issued a press release to describe the outbreak and raise awareness about community transmission. The press release emphasized the highly contagious nature of COVID-19 and the importance of following social distancing guidelines to control the spread of the virus.

Discussion

Multiple reports have documented events involving superspreading of COVID-19 (25); however, few have documented a community-based point-source exposure (5). This cluster of 52 secondary cases of COVID-19 presents a unique opportunity for understanding SARS-CoV-2 transmission following a likely point-source exposure event. Persons infected with SARS-CoV-2 are most infectious from 2 days before through 7 days after symptom onset (7). The index patient developed symptoms on March 7, which could have placed the patient within this infectious period during the March 10 practice. Choir members who developed symptoms on March 11 (three) and March 12 (seven) attended both the March 3 and March 10 practices and thus could have been infected earlier and might have been infectious in the 2 days preceding symptom onset (i.e., as early as March 9). The attack rate in this group (53.3% and 86.7% among confirmed cases and all cases, respectively) was higher than that seen in other clusters, and the March 10 practice could be considered a superspreading event (3,4). The median incubation period of COVID-19 is estimated to be 5.1 days (8). The median interval from exposure during the March 10 practice to onset of illness was 3 days, indicating a more rapid onset.

Choir practice attendees had multiple opportunities for droplet transmission from close contact or fomite transmission (9), and the act of singing itself might have contributed to SARS-CoV-2 transmission. Aerosol emission during speech has been correlated with loudness of vocalization, and certain persons, who release an order of magnitude more particles than their peers, have been referred to as superemitters and have been hypothesized to contribute to superspeading events (1). Members had an intense and prolonged exposure, singing while sitting 6–10 inches from one another, possibly emitting aerosols.

The findings in this report are subject to at least two limitations. First, the seating chart was not reported because of concerns about patient privacy. However, with attack rates of 53.3% and 86.7% among confirmed and all cases, respectively, and one hour of the practice occurring outside of the seating arrangement, the seating chart does not add substantive additional information. Second, the 19 choir members classified as having probable cases did not seek testing to confirm their illness. One person classified as having probable COVID-19 did seek testing 10 days after symptom onset and received a negative test result. It is possible that persons designated as having probable cases had another illness.

This outbreak of COVID-19 with a high secondary attack rate indicates that SARS-CoV-2 might be highly transmissible in certain settings, including group singing events. This underscores the importance of physical distancing, including maintaining at least 6 feet between persons, avoiding group gatherings and crowded places, and wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain during this pandemic. The choir mitigated further spread by quickly communicating to its members and notifying SCPH of a cluster of cases on March 18. When first contacted by SCPH during March 18–20, nearly all persons who attended the practice reported they were already self-isolating or quarantining. Current CDC recommendations, including maintaining physical distancing of at least 6 feet and wearing cloth face coverings if this is not feasible, washing hands often, covering coughs and sneezes, staying home when ill, and frequently cleaning and disinfecting high-touch surfaces remain critical to reducing transmission. Additional information is available at https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html.

Acknowledgments

Patients described in this report; health care personnel who cared for them; Skagit County Public Health staff members and leaders, particularly the Communicable Disease investigators; Washington State Department of Health.


1Skagit County Public Health, Mount Vernon, Washington.

References

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  2. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020;323:1061–9. CrossRef PubMed
  3. McMichael TM, Currie DW, Clark S, et al. Epidemiology of COVID-19 in a long-term care facility in King County, Washington. N Engl J Med 2020;NEJMoa2005412. CrossRef PubMed
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  5. South Korean city on high alert as coronavirus cases soar at ‘cult’ church. The Guardian, US Edition. February 20, 2020. https://www.theguardian.com/world/2020/feb/20/south-korean-city-daegu-lockdown-coronavirus-outbreak-cases-soar-at-church-cult-cluster
  6. Council of State and Territorial Epidemiologists. Interim-20-ID-01: standardized surveillance case definition and national notification for 2019 novel coronavirus disease (COVID-19). Atlanta, GA: Council of State and Territorial Epidemiologists; 2020. https://cdn.ymaws.com/www.cste.org/resource/resmgr/2020ps/interim-20-id-01_covid-19.pdf
  7. He X, Lau EHY, Wu P, et al. Temporal dynamics in viral shedding and transmissibility of COVID-19. Nat Med 2020;26:672–5. PubMed
  8. Lauer SA, Grantz KH, Bi Q, et al. The incubation period of coronavirus disease 2019 (COVID-19) from publicly reported confirmed cases: estimation and application. Ann Intern Med 2020;172:577. CrossRef PubMed
  9. van Doremalen N, Bushmaker T, Morris DH, et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med 2020;382:1564–7. CrossRef PubMed
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TABLE 1. Number of choir members with and without COVID-19–compatible symptoms (N = 122)* and members’ choir practice attendance — Skagit County, Washington, March 3 and 10, 2020

Attendance No. (row %) March 3 practice March 10 practice Total Symptomatic Asymptomatic Total Symptomatic Asymptomatic Attended 78 51 (65.4) 27 (34.6) 61 53§ (86.9) 8 (13.1) Did not attend 40 4 (10.0) 36 (90.0) 61 3 (4.9) 58 (95.1) Attendance information missing 4 1 (25.0) 3 (75.0) 0 0 (—) 0 (—) Attended only one practice 21 1 (4.8) 20 (95.2) 3 2 (66.7) 1 (33.3)

Abbreviation: COVID-19 = coronavirus disease 2019.
* No choir members were symptomatic at the March 3 practice.
Thirty-seven choir members attended neither practice; two developed symptoms, and 35 remained asymptomatic.
§ Includes index patient; if the index patient excluded, 52 secondary cases occurred among the other 60 attendees (attack rate = 86.7%).

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FIGURE. Confirmed* and probable cases of COVID-19 associated with two choir practices, by date of symptom onset (N = 53) — Skagit County, Washington, March 2020
The figure is a histogram, an epidemiological curve showing 53 confirmed and probable cases of COVID-19 associated with two choir practices in Skagit County, Washington, by date of symptom onset, during March 2020.

Abbreviation: COVID-19 = coronavirus disease 2019.

* Positive reverse transcription–polymerase chain reaction test result.

Attendance at the March 10 practice and clinically compatible symptoms as defined by the Council of State and Territorial Epidemiologists, Interim-20-ID-01: Standardized surveillance case definition and national notification for 2019 novel coronavirus disease (COVID-19). https://cdn.ymaws.com/www.cste.org/resource/resmgr/2020ps/interim-20-id-01_covid-19.pdf.

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TABLE 2. Signs and symptoms reported at the onset of COVID-19 illness and during the course of illness among persons infected at a choir practice (N = 53)* — Skagit County, Washington, March 2020

Sign or symptom No. (%) no./No. (%) Reported at onset of illness Reported during course of illness All cases
(N = 53) Confirmed cases
(N = 33) All cases
(N = 53) Confirmed cases
(N = 33) Cough 27 (50.9) 18 (54.5) 47/53 (88.7) 30/33 (90.9) Fever 28 (52.8) 15 (45.5) 36/53 (67.9) 25/33 (75.8) Myalgia 13 (24.5) 9 (27.3) 34/52 (65.4) 24/32 (75.0) Headache 10 (18.9) 7 (21.2) 32/53 (60.4) 20/33 (60.6) Chills or rigors 7 (13.2) 6 (18.2) 23/51 (45.1) 16/31 (51.6) Congestion 4 (7.5) 2 (6.1) 25/52 (48.1) 15/32 (46.9) Pharyngitis 2 (3.8) 2 (6.1) 12/52 (23.1) 8/32 (25.0) Lethargy 4 (7.5) 2 (6.1) 5/52 (9.6) 3/32 (9.4) Fatigue 3 (5.7) 1 (3.0) 24/52 (46.2) 15/32 (46.9) Aguesia (loss of taste) 1 (1.9) 1 (3.0) 11/48 (22.9) 5/28 (17.9) Anosmia (loss of smell) 1 (1.9) 1 (3.0) 10/48 (20.8) 5/28 (17.9) Chest congestion or tightness 1 (1.9) 1 (3.0) 5/52 (9.6) 4/32 (12.5) Weakness 1 (1.9) 1 (3.0) 3/52 (5.8) 2/32 (6.3) Eye ache 1 (1.9) 1 (3.0) 1/52 (1.9) 1/32 (3.1) Dyspnea 0 (—) 0 (—) 8/51 (15.7) 8/31 (25.8) Diarrhea 0 (—) 0 (—) 8/52 (15.4) 6/32 (18.8) Pneumonia 0 (—) 0 (—) 6/53 (11.3) 6/33 (18.2) Nausea 0 (—) 0 (—) 3/52 (5.8) 3/32 (9.4) Acute hypoxemic respiratory failure 0 (—) 0 (—) 3/53 (5.7) 3/33 (9.1) Abdominal pain or cramps 0 (—) 0 (—) 2/52 (3.8) 2/32 (6.3) Malaise 1 (1.9) 0 (—) 1/52 (1.9) 0/32 (—) Anorexia 0 (—) 0 (—) 1/52 (1.9) 0/32 (—) Vomiting 0 (—) 0 (—) 0/52 (—) 0/32 (—)

Abbreviation: COVID-19 = coronavirus disease 19.
* Including the index patient.

Suggested citation for this article: Hamner L, Dubbel P, Capron I, et al. High SARS-CoV-2 Attack Rate Following Exposure at a Choir Practice — Skagit County, Washington, March 2020. MMWR Morb Mortal Wkly Rep 2020;69:606–610. DOI: http://dx.doi.org/10.15585/mmwr.mm6919e6.

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https://www.cdc.gov/mmwr/volumes/69/wr/mm6919e6.htm

Atlantic City casinos will look very different once they reopen. Here’s their new plan.

nj.com

By Jonathan D. Salant | NJ Advance Media for NJ.com 4-5 minutes


Atlantic City - coronavirus
Borgata Hotel Casino & Spa, left, and The Water Club Hotel, right, are dark after Gov. Phil Murphy ordered the casinos to close Monday to help stop the spread of the coronavirus.Lori M. Nichols | NJ Advance Media for NJ.com

No eating on the casino floor. Contactless check-ins for hotel rooms. And wear a mask unless you’re drinking while gambling.

MGM Resorts, owner of the Borgata, released the health and safety plan its casino properties will follow once state officials allow them to reopen during the coronavirus pandemic.

“Our properties will not look the way they used to for a while, and that’s not only okay, it’s critically important,” said Bill Hornbuckle, acting president and chief executive.

Gov. Phil Murphy ordered Atlantic City’s casinos closed in March. He said Monday that he hoped to provide “hard dates” as early as this week on when the state’s economy could begin reopening.

CORONAVIRUS RESOURCES: Live map tracker | Newsletter | Homepage

The MGM plan released Tuesday offered a first look at how Atlantic City casinos plan to operate to protect both employees and guests from the coronavirus.

The new rules include:

— Daily temperature checks for all employees, as well as screening measures to determine whether they have infection symptoms and where they are in contact with those who have been infected, such as someone in their household or someone they care for.

— Guests who think they may have been exposed will be “strongly encouraged” to stay at home and not travel.

— All employees must wear masks, and all guests will be encouraged to do so in public areas. The casino will hand out free masks to guests.

— Workers will be trained on proper cleaning procedures and other steps to protect against the virus.

— Employees who handle food, clean public areas and enter guest rooms must wear gloves. Other workers also may required to wear personal protective equipment.

— Guests still will be able to order beverages but not food on the casino floor, and can remove their masks to drink.

— Frequent cleaning and disinfecting of slot machines, tables and kiosks.

— Stations for handwashing and hand sanitizing in high-traffic areas.

— A six-foot social distancing policy will be followed whenever possible, with signs and floor guides to help separate patrons. In areas where the distancing policy cannot be followed, plexiglass barriers will be installed or employees will be given eye protection.

— Poker rooms may not reopen when the rest of the casino does, depending on guidance from state officials and medical experts.

— Plexiglass barriers throughout the casino and lobbies.

— Medical personnel on staff to respond in case a guest or employee tests positive for COVID-19. Exposed areas will be sanitized and efforts will be made for contact tracing, notifying those who may have been in contact with the individual.

— Limits on how many people can share an elevator cab.

— Allowing guests to check in to their hotel rooms digitally without having contact with anyone at the front desk.

— Digital menus and text notifications when tables are ready, eliminating the need to wait in line.

It remains to be seen if the steps are sufficient to win the approval of Unite Here, the union that represents 10,600 Atlantic City workers. Their plan called for having the state gaming commission ensure that the casinos were taking the necessary steps to protect employees and guests.

The union said that the six-foot distance between customers needed to be followed at slot machines and table games, dice and chips needed to be frequently sanitized, buffets needed to be suspended and spas and pools needed to close temporarily.

“It’s good that the company is talking about it, but we need them to work in partnership with frontline workers to come up with a full plan to protect guest and workers,” said Mayra Gonzalez, a line server at Borgata and a member of Unite Here.

Our journalism needs your support. Please subscribe today to NJ.com.

Jonathan D. Salant may be reached at jsalant@njadvancemedia.com.

Note to readers: if you purchase something through one of our affiliate links we may earn a commission.

https://www.nj.com/coronavirus/2020/05/atlantic-city-casinos-will-look-very-different-once-they-reopen-heres-their-new-plan.html

Updates on the COVID-19 in your state

‘Grim Reaper’ attorney haunts Florida beaches to protest their premature reopening

Positive Outlooks Blog

Published by Farah R. | Positive Outlooks 


The grim reaper attorney haunts beaches.

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Florida residents are more than happy to trade their stay-at-home outfits for their swim gear now that some beaches in the state have reopened. After a month-long lockdown because of the COVID-19 outbreak, many Floridians are getting their dose of sunshine by the seaside.

Daniel Uhlfelder, an attorney from the state, is hitting the beaches, too, but he isn’t there to take a dip; he’s there to protest their reopening, which he believes is premature. And he’s doing so complete with a Grim Reaper costume: a raggedy black robe, a black cloth to cover his face, and a scythe.Twitter

The macabre outfit was his way of making people reconsider going to the beach.

“The Grim Reaper represents death. This is a deadly virus. It’s a global pandemic,” he told ABC13.

Uhlfelder is an advocate for public beach access in Florida, even clashing with former Arkansas Governor Mike Huckabee, whose Panhandle home was parked on a private beach. This time, however, he thinks allowing anyone on the beach amid a pandemic is a dangerous mistake.

“We aren’t at the point now where we have enough testing, enough data, enough preparation for what’s going to be coming to our state from all over the world from this pandemic,” he told CNN.10247393_305896546226047_7655357214415001829_n(2)

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Wielding a scythe, Uhlfelder traveled to the beaches around Walton County, Florida, that have reopened ahead of the state’s planned May 4 “Phase 1“ reopening. This initial reopening will allow restaurants and retailers to operate at 25% capacity. Bars, salons, and gyms will remain closed until further announcement.

He said the beaches he visited last Friday were “very crowded”.

“I know how beautiful and attractive our beaches are. But if we don’t take measures to control things, this virus is going to get really, really out of control,” he said.

Aside from urging people to go home, the protest is also an effort to bring in funds for the campaigns of Democratic candidates, Phil Ehr and Christy Smith.

On March 20, the ‘grim reaper’ attorney filed a suit against Florida Governor Ron DeSantis explaining that the leader’s unwillingness to issue a statewide mandate closing down beaches put Floridians at risk of being infected with the coronavirus. However, this was dismissed by Leon County Circuit Judge Kevin Carroll in April. He said that it’s in the governor’s discretion how he would handle emergencies, according to the state’s constitution.EW-Iz36XgAM2cQ3(2)

Twitter 

This isn’t the first time the attorney has pulled a stunt to get people off the beaches during a pandemic. Last month, he traveled to Florida wearing a less grim outfit – a paintball costume – to promote social distancing, according to NBC News.

He said a woman told him that he was “scaring people,” to which he responded, “OK, that’s good.”

“If people are scared, then they’ll leave. I want to go back to normal as soon as possible, too, but opening our beaches too early is not the way to do this,” he reasoned.TwitterEW9N0xoX0AIL_c5(2)

There are nearly 35,000 coronavirus cases and 1,314 deaths recorded in the state of Florida, according to Johns Hopkins University.

DeSantis defended the reopening of beaches, citing a study conducted by the Department of Homeland Security about sunlight’s ability to kill the virus.

“The DHS study said that sunlight rapidly killed the virus in aerosols, and it said that outdoor daytime environments are lower risk for transmission of the virus than indoor environments,” he said. “In terms of surfaces, when a virus may be left on a surface DHS study concluded that sunlight kills the virus quickly, and that the virus is less stable overall at higher temperatures and higher humidity.”

There is no written report in existence for this study yet, although the results are being submitted for peer review and publication in scientific journals.

Watch the interview of the attorney in the video below.

Stop killing dogs in Ukraine

sosvox.org

Stop killing dogs in Ukraine Because of the coronavirus, human stupidity, misinformation, and false information have killed thousands of cats and dogs in many countries around the world, including China, blaming them for the pandemic. Fortunately, it has been proven that animals do not transmit the virus, but many people do not know it and animals continue to suffer from torture and are killed in the worst possible ways. In China they have already stopped with the murder of dogs in their vast majority, but in countries like Ukraine they still think that they are responsible for or transmitters of the coronavirus, so they are shot, poisoned or beaten to death. They are captured, locked up in small cages where they all live piled high, and then killed without mercy, out of simple ignorance. We must ask the Ukrainian government and its President to do everything humanly possible to protect the lives of the dogs that are being brutally killed, because it has been shown that they do not transmit the virus nor are they responsible for the pandemic, on the contrary, they are as victims as us, or even more.

https://www.sosvox.org/en/petition/stop-killing-dogs-in-ukraine.html?fl

Please listen to this important video about COVID-19…it can save a loved one’s life and take notes!!!

Numbers don’t lie…

https://realclimatescience.com/wp-content/uploads/2020/04/Image493.png

“Dr. Erickson COVID-19 Briefing, Pt. 2”

“Dr. Erickson COVID-19 Briefing”

 

Business continuity and the Chinese virus #coronavirus

Iowa Climate Science Education

By Christopher Monckton of Brenchley

Early in 2001, an international corporation?s chief financial officer conducted a business-continuity appraisal of the entire business. All insurances were reviewed and brought up to date. The pension fund was audited to make sure it could meet its obligations. Health, safety and business-risk assessments of every kind were conducted.

The United States headquarters of the corporation were in a prominent New York skyscraper. The cautious finance officer decided that if one of the many totalitarian regimes worldwide that hate democracy and, therefore, have a particular loathing for the United States were to mount a terrorist attack, the building might be vulnerable. At some cost, he turned in the lease and, notwithstanding some grumbling from the board, moved the entire operation to somewhere less prominent.

The building was No. 1, World Trade Center.

The CFO was my brother-in-law, which is how I know the story. As…

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Petition to Allow EBT recipients to order groceries online during COVID-19 pandemic.

change.org Erin Fickas started this petition to United States Department of Agriculture (USDA) and 2 others

I think during this crisis all the food delivery services like Instacart and Shipt should accept EBT as a form of payment for the food, and offer EBT customers reduced or free shipping. Most of us people on food assistance are disabled and at high risk for catching COVID-19. Some states allow EBT recipients to order groceries on Amazon, but most states don’t have this option. Please share so people with disabilities can also get food safely!! It’s a problem when the people most in need of grocery delivery cannot access this much needed service and use their EBT card to pay for their food. Offering a waived or reduced delivery fee would help ease the burden of the most vulnerable population of our society. My husband and I are both disabled and at risk for catching COVID. We have a toddler as well who would suffer greatly if I brought home this terrible illness. My physical limitations also make grocery shopping difficult and incredibly painful. Offering grocery delivery services to people who are on EBT helps us to continue being responsible and practicing social distancing.

https://www.change.org/p/instacart-allow-ebt-recipients-to-order-groceries-online-during-covid-19-pandemic