A sober assessment.
This development is even scarier than we could have anticipated… More innocents lost from an unpredictable virus and very concerning to schools, children and families, or just about everyone.
China standing up to T, and refuting the politicized assertions that China created and unfurled this virus in a sternly written rebuttal. Even bringing in Lincoln’s words as a kicker to T’s audacity.
Oh my…where do we begin to untangle the truth here? T’s full-of-lies and CYA’s are just that. China is testing us as we are testing them. Wished we had some skilled diplomats to handle this and not some flame throwers like we do have in this administration.
China refutes 24 ‘lies’ by U.S. politicians over coronavirus
BEIJING (Reuters) - China has issued a lengthy rebuttal of what it said were 24 “preposterous allegations” by some leading U.S. politicians over its handling of the new coronavirus outbreak.
The Chinese foreign ministry has dedicated most of its press briefings over the past week to rejecting accusations by U.S. politicians, especially Secretary of State Mike Pompeo, that China had withheld information about the new coronavirus and that it had originated in a laboratory in the city of Wuhan.
A 30-page, 11,000-word article posted on the ministry website on Saturday night repeated and expanded on the refutations made during the press briefings, and began by invoking Abraham Lincoln, the 19th century U.S. president.
“As Lincoln said, you can fool some of the people all the time and fool all the people some of the time, but you cannot fool all the people all the time,” it said in the prologue.
The article also cited media reports that said Americans had been infected with the virus before the first case was confirmed in Wuhan. There is no evidence to suggest that is the case.
Keen to quash U.S. suggestions that the virus was deliberately created or somehow leaked from the Wuhan Institute of Virology, the article said that all evidence shows the virus is not man-made and that the institute is not capable of synthesising a new coronavirus.
This is pretty dark…going to Funeral homes in hopes of getting correct counts of coronavirus from nursing homes…to correct any undercounting, or no counting because the nursing homes are mostly private facilities. Digging for the correct death counts, via the funeral homes, is a new phenomenon in this pandemic.
Nursing homes account for at least a third of the nation’s 76,000 Covid-19 fatalities, and in 14 states they’re more than half the total
Amid governors’ push for better data, missed cases turn up
Operators’ group says testing scarcity led to under-counting
Connecticut is swabbing corpses at funeral homes. Maryland is testing all nursing-home residents and staff, symptomatic or not. Coast to coast, governors have intensified efforts to get accurate death counts at the facilities as investigations suggest far more devastation than initially recorded.
In New York and New Jersey, tallies of deaths from the novel coronavirus surged in recent days after the states began disclosing more data on nursing-home residents. On Sunday, New York Governor Andrew Cuomo added a requirement that all positive test results for staff must be reported to the state health department by the next day.
Nursing homes account for at least a third of the nation’s 76,000 Covid-19 fatalities, and in 14 states they’re more than half the total, according to Kaiser Family Foundation data from Thursday. Those numbers, though, are woefully incomplete because 18 states aren’t disclosing such data and those that are provide varying levels of information. As officials struggle to measure and understand the true toll, the virus continues to victimize the frail and elderly in even the best-run facilities, said Elizabeth Dugan, associate professor of gerontology at the University of Massachusetts in Boston.
“They’re almost like sitting ducks,” said Dugan, whose research team warned of imminent widespread nursing-home infections in early March.
Around the same time, one of the first major U.S. outbreaks of Covid-19 took place at the Life Care Center in Kirkland, Washington. Since then, the number of deaths linked to that facility has more than tripled, to 45 as of Thursday.
The Centers for Medicare and Medicaid Services on April 19 started requiring long-term care facilities to report Covid-19 cases. And the U.S. Centers for Disease Control and Prevention has said it will penalize nursing facilities that don’t submit weekly infection updates.
Some states have been forced to do their own detective work. Connecticut’s chief medical examiner, Dr. James Gill, sent investigators on the trail of vague death certificates, going so far as to swab the deceased as their bodies awaited cremation. Of 65 dead nursing-home residents his staff tested at funeral homes, 54 were newly found to be positive, he said.
“‘Acute respiratory failure’ isn’t a cause of death – it means the person’s dead, and you have to answer why they had acute respiratory failure,” Gill said in an interview. As of Wednesday, more than 1,200 Covid-19 deaths were confirmed at Connecticut nursing homes and another 399 were probable.
In California, autopsies detected coronavirus in two individuals who had died at home, pushing back Santa Clara County’s first known cases to February, almost a month earlier than previously reported. On April 30, the CDC made recommendations specifically for coronavirus testing during postmortem exams.
In New York, a tally of nursing- and adult-care home deaths jumped to 5,215 as of Wednesday with both confirmed and presumed cases being counted. That’s up from a total of 3,653 deaths the state had reported as of April 28. New Jersey on April 30 reported 458 deaths, its biggest daily tally, which added earlier fatalities newly ruled as virus-related. Officials said the new figure included nursing-home residents, but they didn’t know how many.
Both states are conducting broad inquiries amid reports of improperly stored bodies, scarce personal protective-equipment and poor communication with families and officials.
About 70% of the nation’s more than 15,000 nursing homes are run by companies, including Life Care Centers of America Inc. and HCR Manorcare, which each operate more than 200; and publicly traded Genesis HealthCare, which has more than 300, and whose founder died in April after a long-term illness and Covid-19 complications.
All of the homes are regulated by federal and state laws, while care is funded by a mix of Medicaid, Medicare, private insurance and individuals. Though President Donald Trump’s administration previously had worked to ease government regulation of the nursing-home industry, it said after the first virus outbreaks in U.S. facilities that its inspections oversight would emphasize infection control.
The American Health Care Association and National Center for Assisted Living, representing most of the nation’s long-term homes, acknowledges that not all coronavirus deaths have been counted, and says its members “are being as responsive as they can with the resources they have been given.”
“Without additional testing, our nation’s providers have no way of knowing who has or may have succumbed to the virus, especially those who are asymptomatic,” Cristina Crawford, a spokesperson for the groups, said in an email. “Therefore, non-reporting is not necessarily due to a lack of willingness, but a lack of accessibility to tests.”
At least 15 states have enacted shields against coronavirus-related lawsuits involving long-term care facilities, and the organization was urging more to do the same.
“It is critical that states provide the necessary liability protection staff and providers need to provide care during this difficult time without fear of reprisal,” Crawford said.
Nursing homes and adult-care facilities account for more than 25% of the 21,000 deaths in New York, the hardest-hit state. As more information comes in, he said, the numbers will change, Governor Andrew Cuomo said Wednesday at a press briefing.
Some nursing homes previously were combining presumed deaths with confirmed, according to Cuomo adviser Jim Malatras.
“Now we’re putting up both categories so people can clearly see, because some of the facilities were reporting both together and it was difficult to tease out,” Malatras said. “So we’ve asked them to report clearly that line of confirmed and presumed.”
FDLE releases list of COVID-19 deaths. Top medical examiner calls it a sham.
Trump eyes federal retirement plan investments as part of showdown with China over coronavirus
President Trump’s intensifying showdown with China over its handling of the coronavirus pandemic is expanding to a new battlefield: the retirement portfolios of 5.9 million federal employees and U.S. service members.
In recent days, White House officials have moved to seize control of a little-known board that administers the $557 billion federal retirement program for most active and retired federal employees and military members, with some aides eager to halt the flow of billions of dollars into an index fund that includes Chinese companies, according to two White House officials and an outside Trump adviser involved in the discussions.
Trump on Monday nominated three members to replace the majority on the Federal Retirement Thrift Investment Board, made up of five investment experts who oversee the retirement plan. All of their four-year terms have expired, and Senate Majority Leader Mitch McConnell (R-Ky.) and House Speaker Nancy Pelosi (D-Calif.) have not replaced those serving in the two seats they control.
With its new nominees, the White House is taking steps to block the plan’s $40 billion international fund from investing in a fund that contains about 11 percent of China-based stocks, according to people familiar with the strategy.
“Obviously, the president doesn’t want this investment to take place and is looking for other alternatives,” said a senior administration official who was not authorized to speak about the nominations. “These individuals will be key to making that happen.”
The move comes as Trump has sought to put the blame on China for the coronavirus pandemic and senior U.S. officials have begun explore proposals to punish or demand financial compensation from the country.
The effort to block any Chinese investment by the retirement plan, the largest defined contribution program in the world, comes as the current board is preparing to transfer assets to the new fund. The board has said it is following a responsible investment strategy — recommended twice by an outside consultant — that will allow its members to accrue potential gains from China’s growing economy.
A TSP spokeswoman, Kim Weaver, told The Washington Post last month the shift in strategy “is not about China, from our perspective.”
Advocates for federal workers say reversing the strategy could hurt millions of employees saving for retirement by walling off investments that are widely available in other 401(k)-type plans.
“Participants want investment options that pass the fiduciary responsibility test — not any political test,” said Jacqueline Simon, policy director for the American Federation of Government Employees, the largest union representing federal workers.
Investment in the international stock fund is voluntary and investors could put their money instead in a range of other options, she added.
In recent weeks, China hard-liners close to Trump have made the case to the president and senior administration leaders that the country’s influence in American stock portfolios must be reduced, taking advantage of retaliatory mood toward Beijing, according to people familiar with their lobbying.
Roger Robinson, who served on the National Security Council under President Ronald Reagan, said he began meeting with top White House officials last summer to alert them that the Thrift Savings Plan’s new investment strategy could be seen as undercutting national security by subsidizing Chinese companies involved in weapons manufacturing and other interests detrimental to the United States.
“The Thrift Savings Plan issue is a microcosm of the broader problems of U.S.-sanctioned Chinese companies and other corporate bad actors in our capital markets and Beijing’s noncompliance with federal securities laws,” said Robinson, who is chairman of the Prague Security Studies Institute, a think tank focused on democracies in post-communist states.
The Chinese Embassy in Washington did not reply to a request for comment.
The White House is working on a backup plan if it is unable to get its nominees to the board confirmed quickly by the Senate, according to the people familiar with the strategy, who spoke on the condition of anonymity to describe internal discussions.
Trade adviser Peter Navarro is drafting a possible executive order that could block the plan from investing in any Chinese funds, a third administration official said. The White House Office of Legal Counsel is reviewing the order, which could face legal hurdles since the retirement plan is governed by an independent board.
The effort to remake the board and reorient its investment strategy has intensified tensions inside the administration about the appropriate approach toward China.
Treasury Secretary Steven Mnuchin has privately waved the president off sweeping action against the retirement plan, concerned that restricting investment could hurt financial markets and threaten the first phase of the China trade deal, a White House official said.
But Trump and other top aides — including Navarro, deputy national security adviser Matthew Pottinger and chief of staff Mark Meadows — want action against the Chinese, furious at the government’s lack of transparency as the coronavirus spread across the globe, according to people familiar with their views.
They’ve been encouraged by outside China critics, including former Trump campaign strategist Stephen K. Bannon and other conservative activists. Last month, eight former senior military leaders issued a letter objecting to the China investment strategy in an effort coordinated with a group led by Bannon and others.
The stakes are high and could affect the performance of the Thrift Savings Plan, which resembles a private-sector 401(k) plan and is managed by BlackRock.
In 2017, the board hired an outside consultant, Aon Hewitt, which advised shifting its investments to a fund that includes shares of emerging market companies.
The idea was to diversify its portfolio and allow fund participants to get higher returns. The board, whose members are experienced pension benefit plan investors, voted in October of that year to expand the reach of its international fund to more broadly represent international stock markets. Preparations for the changeover have been underway since and it is projected to take effect in the coming months.
“The spin that is being placed on it is that all these funds are going to be invested into the Chinese market is absolutely false,” said Clifford Dailing, an official with the National Rural Letter Carriers’ Association who leads a council of a dozen federal employee organizations that advise the board.
“It’s politically motivated,” Dailing said of the White House move. “I would hope that any of the individuals that come on to the board would not come on with a political mission to undo what a previous board has in place.”
Trump’s nominees to the board are Frank Dunlevy, counselor to the chief executive officer of the U.S. International Development Finance Corporation; Christopher Bancroft Burnham, chairman and co-founder of Cambridge Global Capital, a District-based investment firm, and John M. Barger, managing director at NorthernCross Partners, an investment firm in Los Angeles.
Burnham declined to comment. Dunlevy and Barger did not immediately respond to requests for comment.
Weaver, the spokeswoman for the plan, said in a statement that “it is the President’s responsibility to appoint board members. We look forward to working with the nominees.”
The retirement board’s plan to offer an index fund with Chinese companies had drawn condemnation from China hard-liners in Congress for months. But only in recent weeks did their lobbying campaign reach the president, who has been taking a more aggressive stand toward China amid the pandemic.
Trump announced last week that he is restricting use of electrical equipment in the domestic grid with links to “a foreign adversary” — a reference to China.
In private, Trump and aides have discussed stripping China of its “sovereign immunity,” with the goal is allowing the U.S. government or virus victims to sue China for damages, The Post previously reported.
Asked at the White House this week if he plans to impose tariffs on China as a punishment or because of trade violations, Trump said, “I don’t want to talk about that now. We’re in the midst of some very big things.”
White House aides were not initially aware that federal employee retirement savings plan was overseen by a board, let alone the details of the board’s investment strategy, according to one White House adviser.
Robinson said he contacted lawmakers on Capitol Hill last summer to urge a pressure campaign against the board. Sens. Marco Rubio (R-Fla.) and Jeanne Shaheen (D-N.H) introduced legislation to block the new investment strategy. The House effort was led by Meadows, then still a congressman.
They didn’t get far, Robinson said. Still, the board requested a second report from Aon in response to the opposition. It reached the same conclusions as the first. In November, the board voted to reaffirm an earlier decision to move forward with the new investment strategy.
Then came the pandemic. Amid the focus on China, Robinson, who said he was worried that the fund was preparing to shift its investments, said he stepped up his outreach to the White House and some friends of the president whom he declined to name.
Several of the president’s favorite news outlets also began running segments on the obscure board and its investment strategy, including Fox News. Sinclair Broadcast Group ran a report on April 30 that said the president had instructed top aides to “rein in” the retirement savings plan before it expanded its investment portfolio to include Chinese-held entities that U.S. officials believe are tied “directly to the Chinese military and to the country’s global intelligence apparatus.”
The report described Trump as “incredulous over the looming prospect of U.S. service members seeing their paychecks deducted for the purpose of funding the Chinese military.”
Gov. Doug Ducey fires the scientists who warn he’s making a mistake by reopening Arizona
She was a nurse. She was an immigrant. She was a hero. Trump ignored her. Hospital administrators tried to deny what happened to her. When she raced to treat a ‘code blue’ patient, she had no N95 mask. 14 days later, she was dead.
Remember Celia Marcos.
It has become increasingly clear that black Americans are dying at alarmingly high rates of Covid-19. But absent national statistics, the picture remains incomplete. Piecemeal data trickling out of cities and states have shown disproportionate death rates among African Americans, with an analysis of available state-provided figures by APM Research Lab putting the black death rate at 2.6 times higher than that of whites.
A look at countrywide data adds another troubling statistic to the growing pile of evidence that the virus is ravaging black communities. Counties with the highest proportion of black residents are also seeing the highest death rates. The larger the share of black residents, the worse the health outcomes get.
In places where African Americans exceed 13.4% of the population, the proportion they make up of the U.S., the death rate is roughly double the national average, an analysis of Johns Hopkins University and Census Bureau data by Bloomberg News found. In majority black counties, deaths from coronavirus are more than triple. The disparities have only grown as the death toll has climbed to more than 70,000 over the last 10 weeks.
Along party lines, reactions due Coronavirus presents different responses.
Democrats’ pessimism seems to be rooted in a different coronavirus experience. They’re more likely to know someone who has gotten the coronavirus – 47% compared to 39% for independents and 37% for Republicans.
Pandemic has bigger impact on Democrats’ jobs and households
Republicans much more hopeful about return to normalcy
Democrats and Republicans see the coronavirus threat in starkly different terms, with Democrats more likely to have been personally affected by the pandemic and Republicans more confident of a return to normalcy.
The differences, revealed in a new poll from Monmouth University Monday, shed light on the political ramifications of the virus but also show how voters see the world in starkly different terms.
“Partisan tribalism is the most obvious explanation,” said Patrick Murray, director of the Monmouth poll. “That’s how strong the filters are, reinforced by exposure to information sources that stick to different narratives.”
Those narratives are reflected in the major-party candidates for president themselves: President Donald Trump has played down the death tolls and promised an economic rebound later this year. He has also urged states to reopen businesses and ease lockdowns even as many Americans remain wary.
His Democratic challenger, Joe Biden, has criticized Trump for moving too fast to reopen the economy and warned of more damage if the government doesn’t take steps to prepare for the next pandemic.
Democrats’ pessimism seems to be rooted in a different coronavirus experience. They’re more likely to know someone who has gotten the coronavirus – 47% compared to 39% for independents and 37% for Republicans. And Democrats are more likely to be working from home, losing income, getting groceries delivered, and struggling to pay bills.
And they’re much more worried about getting the virus themselves: 60% of Democrats are “very concerned,” compared with 38% for independents and 25% for Republicans.
Those differences can be partly explained by geography. The virus has hit densely populated urban centers, which tend to be Democratic, especially hard. And with some exceptions, like Ohio and Maryland, Republican governors have generally been quicker to ease restrictions on economic activity.
But the poll also shows different degrees of optimism between the two parties, with 79% of Republicans confident the country will limit the effects of the outbreak within the next few weeks. Just 30% of Democrats are similarly confident.
Republicans are also much more optimistic about a post-coronavirus world: 80% of Republicans are very hopeful that their lives will return to normal, compared with 53% for Democrats.
The national poll was conducted by telephone April 30 to May 4 and has a margin of error of 3.5 percentage points.
Another new ad:
Worth a watch – the short clip speaks louder than words:
The Navajo Nation is one of the largest tribes in the U.S.
The coronavirus pandemic has decimated it, with more cases per capita than any state in America.
Doctors Without Borders dispatches team to the Navajo Nation
It would seem being in the top 1% isn’t the protection some thought if that means coming into contact with the Trump regime. Ironic.
Doctors keep discovering new ways the coronavirus attacks the body
Damage to the kidneys, heart, brain — even ‘covid toes’ — prompts reassessment of the disease and how to treat it
Watch: White House Coronavirus Task Force Members Testify on Coronavirus Response and Reopening Phases
Dr. Anthony Fauci, Dr. Robert Redfield and other members of the White House Coronavirus Task Force testified on the response and reopening phases before the Senate Health Committee.
Some comments regarding this WH Coronavirus Task Force Members discussion with Dr. Fauci -
I am posting this as I got it from a friend when ended up hospitalized with Covid-19 for 13 days. My friend is doing ok now, but there has been a lot of fall-out with getting stamina back and not feeling quite right.
We are in the beginnings of really knowing what to do when trying to really assess how safe we are…and what kinds of situations to avoid. His example of a viral spread was carried on a news station in Boston today, so will post this as well.
From a a Comparative Immunologist and Professor of Biology (specializing in Immunology) at the University of Massachusetts Dartmouth.
The Risks - Know Them - Avoid Them
Updated: 2 hours ago
It seems many people are breathing some relief, and I’m not sure why. An epidemic curve has a relatively predictable upslope and once the peak is reached, the back slope can also be predicted. We have robust data from the outbreaks in China and Italy, that shows the backside of the mortality curve declines slowly, with deaths persisting for months. Assuming we have just crested in deaths at 70k, it is possible that we lose another 70,000 people over the next 6 weeks as we come off that peak. That’s what’s going to happen with a lockdown.
As states reopen, and we give the virus more fuel, all bets are off. I understand the reasons for reopening the economy, but I’ve said before, if you don’t solve the biology, the economy won’t recover.
There are very few states that have demonstrated a sustained decline in numbers of new infections. Indeed, as of May 3rd the majority are still increasing and reopening. As a simple example of the USA trend, when you take out the data from New York and just look at the rest of the USA, daily case numbers are increasing. Bottom line: the only reason the total USA new case numbers look flat right now is because the New York City epidemic was so large and now it is being contained.
So throughout most of the country we are going to add fuel to the viral fire by reopening. It’s going to happen if I like it or not, so my goal here is to try to guide you away from situations of high risk.
Where are people getting sick?
We know most people get infected in their own home. A household member contracts the virus in the community and brings it into the house where sustained contact between household members leads to infection.
But where are people contracting the infection in the community? I regularly hear people worrying about grocery stores, bike rides, inconsiderate runners who are not wearing masks… are these places of concern? Well, not really. Let me explain.
In order to get infected you need to get exposed to an infectious dose of the virus; based on infectious dose studies with other coronaviruses, some estimate that as few as 1000 SARS-CoV2 viral particles are needed for an infection to take hold. Please note, this still needs to be determined experimentally, but we can use that number to demonstrate how infection can occur. Infection could occur, through 1000 viral particles you receive in one breath or from one eye-rub, or 100 viral particles inhaled with each breath over 10 breaths, or 10 viral particles with 100 breaths. Each of these situations can lead to an infection.
How much Virus is released into the environment?
A Bathroom : Bathrooms have a lot of high touch surfaces, door handles, faucets, stall doors. So fomite transfer risk in this environment can be high. We still do not know whether a person releases infectious material in feces or just fragmented virus, but we do know that toilet flushing does aerosolize many droplets. Treat public bathrooms with extra caution (surface and air), until we know more about the risk.
A Cough : A single cough releases about 3,000 droplets and droplets travels at 50 miles per hour. Most droplets are large, and fall quickly (gravity), but many do stay in the air and can travel across a room in a few seconds.
If a person is infected, the droplets in a single cough or sneeze may contain as many as 200,000,000 (two hundred million) virus particles which can all be dispersed into the environment around them.
A breath : A single breath releases 50 - 5000 droplets. Most of these droplets are low velocity and fall to the ground quickly. There are even fewer droplets released through nose-breathing. Importantly, due to the lack of exhalation force with a breath, viral particles from the lower respiratory areas are not expelled.
Unlike sneezing and coughing which release huge amounts of viral material, the respiratory droplets released from breathing only contain low levels of virus. We don’t have a number for SARS-CoV2 yet, but we can use influenza as a guide. Studies have shown that a person infected with influenza can releases up to 33 infectious viral particles per minute. But I’m going to use 20 to keep the math simple.
Remember the formula: Successful Infection = Exposure to Virus x Time
If a person coughs or sneezes, those 200,000,000 viral particles go everywhere. Some virus hangs in the air, some falls into surfaces, most falls to the ground. So if you are face-to-face with a person, having a conversation, and that person sneezes or coughs straight at you, it’s pretty easy to see how it is possible to inhale 1,000 virus particles and become infected.
But even if that cough or sneeze was not directed at you, some infected droplets–the smallest of small–can hang in the air for a few minutes, filling every corner of a modest sized room with infectious viral particles. All you have to do is enter that room within a few minutes of the cough/sneeze and take a few breaths and you have potentially received enough virus to establish an infection.
But with general breathing, 20 viral particles minute into the environment, even if every virus ended up in your lungs (which is very unlikely), you would need 1000 viral particles divided by 20 per minute = 50 minutes.
Speaking increases the release of respiratory droplets about 10 fold; ~200 virus particles per minute. Again, assuming every virus is inhaled, it would take ~5 minutes of speaking face-to-face to receive the required dose.
The exposure to virus x time formula is the basis of contact tracing. Anyone you spend greater than 10 minutes with in a face-to-face situation is potentially infected. Anyone who shares a space with you (say an office) for an extended period is potentially infected. This is also why it is critical for people who are symptomatic to stay home. Your sneezes and your coughs expel so much virus that you can infect a whole room of people.
What is the role of asymptomatic people in spreading the virus?
Symptomatic people are not the only way the virus is shed. We know that at least 44% of all infections–and the majority of community-acquired transmissions–occur from people without any symptoms (asymptomatic or pre-symptomatic people). You can be shedding the virus into the environment for up to 5 days before symptoms begin.
Infectious people come in all ages, and they all shed different amounts of virus. The figure below shows that no matter your age (x-axis), you can have a little bit of virus or a lot of virus (y-axis). (ref)
The amount of virus released from an infected person changes over the course of infection and it is also different from person-to-person. Viral load generally builds up to the point where the person becomes symptomatic. So just prior to symptoms showing, you are releasing the most virus into the environment. Interestingly, the data shows that just 20% of infected people are responsible for 99% of viral load that could potentially be released into the environment (ref)
So now let’s get to the crux of it. Where are the personal dangers from reopening?
When you think of outbreak clusters, what are the big ones that come to mind? Most people would say cruise ships. But you would be wrong. Ship outbreaks, while concerning, don’t land in the top 50 outbreaks to date.
Ignoring the terrible outbreaks in nursing homes, we find that the biggest outbreaks are in prisons, religious ceremonies, and workplaces, such as meat packing facilities and call centers. Any environment that is enclosed, with poor air circulation and high density of people, spells trouble.
Some of the biggest super-spreading events are:
- Meat packing: In meat processing plants, densely packed workers must communicate to one another amidst the deafening drum of industrial machinery and a cold-room virus-preserving environment. There are now outbreaks in 115 facilities across 23 states, 5000+ workers infected, with 20 dead. (ref)
- Weddings, funerals, birthdays: 10% of early spreading events
- Business networking: Face-to-face business networking like the Biogen Conference in Boston in late February.
As we move back to work, or go to a restaurant, let’s look at what can happen in those environments.
Restaurants : Some really great shoe-leather epidemiology demonstrated clearly the effect of a single asymptomatic carrier in a restaurant environment (see below). The infected person (A1) sat at a table and had dinner with 9 friends. Dinner took about 1 to 1.5 hours. During this meal, the asymptomatic carrier released low-levels of virus into the air from their breathing. Airflow (from the restaurant’s various airflow vents) was from right to left. Approximately 50% of the people at the infected person’s table became sick over the next 7 days. 75% of the people on the adjacent downwind table became infected. And even 2 of the 7 people on the upwind table were infected (believed to happen by turbulent airflow). No one at tables E or F became infected, they were out of the main airflow from the air conditioner on the right to the exhaust fan on the left of the room. (Ref)
Workplaces : Another great example is the outbreak in a call center (see below). A single infected employee came to work on the 11th floor of a building. That floor had 216 employees. Over the period of a week, 94 of those people became infected (43.5%: the blue chairs). 92 of those 94 people became sick (only 2 remained asymptomatic). Notice how one side of the office is primarily infected, while there are very few people infected on the other side. While exact number of people infected by respiratory droplets / respiratory exposure versus fomite transmission (door handles, shared water coolers, elevator buttons etc.) is unknown. It serves to highlight that being in an enclosed space, sharing the same air for a prolonged period increases your chances of exposure and infection. Another 3 people on other floors of the building were infected, but the authors were not able to trace the infection to the primary cluster on the 11th floor. Interestingly, even though there were considerable interaction between workers on different floors of the building in elevators and the lobby, the outbreak was mostly limited to a single floor (ref). This highlights the importance of exposure and time in the spreading of SARS-CoV2.
Choir : The community choir in Washington State. Even though people were aware of the virus and took steps to minimize transfer; e.g. they avoided the usual handshakes and hugs hello, people also brought their own music to avoid sharing, and socially distanced themselves during practice. They even went to the lengths to tell choir members prior to practice that anyone experiencing symptoms should stay home. A single asymptomatic carrier infected most of the people in attendance. The choir sang for 2 1/2 hours, inside an enclosed rehearsal hall which was roughly the size of a volleyball court.
Singing, to a greater degree than talking, aerosolizes respiratory droplets extraordinarily well. Deep-breathing while singing facilitated those respiratory droplets getting deep into the lungs. Two and half hours of exposure ensured that people were exposed to enough virus over a long enough period of time for infection to take place. Over a period of 4 days, 45 of the 60 choir members developed symptoms, 2 died. The youngest infected was 31, but they averaged 67 years old. (corrected link)
Indoor sports : While this may be uniquely Canadian, a super spreading event occurred during a curling event in Canada. A curling event with 72 attendees became another hotspot for transmission. Curling brings contestants and teammates in close contact in a cool indoor environment, with heavy breathing for an extended period. This tournament resulted in 24 of the 72 people becoming infected. (ref)
Birthday parties / funerals : Just to see how simple infection-chains can be, this is a real story from Chicago. The name is fake. Bob was infected but didn’t know. Bob shared a takeout meal, served from common serving dishes, with 2 family members. The dinner lasted 3 hours. The next day, Bob attended a funeral, hugging family members and others in attendance to express condolences. Within 4 days, both family members who shared the meal are sick. A third family member, who hugged Bob at the funeral became sick. But Bob wasn’t done. Bob attended a birthday party with 9 other people. They hugged and shared food at the 3 hour party. Seven of those people became ill. Over the next few days Bob became sick, he was hospitalized, ventilated, and died.
But Bob’s legacy lived on. Three of the people Bob infected at the birthday went to church, where they sang, passed the tithing dish etc. Members of that church became sick. In all, Bob was directly responsible for infecting 16 people between the ages of 5 and 86. Three of those 16 died.
The spread of the virus within the household and back out into the community through funerals, birthdays, and church gatherings is believed to be responsible for the broader transmission of COVID-19 in Chicago. (ref)
Commonality of outbreaks
The reason to highlight these different outbreaks is to show you the commonality of outbreaks of COVID-19. All these infection events were indoors, with people closely-spaced, with lots of talking, singing, or yelling. The main sources for infection are home, workplace, public transport, social gatherings, and restaurants. This accounts for 90% of all transmission events. In contrast, outbreaks spread from shopping appear to be responsible for a small percentage of traced infections. (Ref)
Importantly, of the countries performing contact tracing properly, only a single outbreak has been reported from an outdoor environment (less than 0.3% of traced infections). (ref)
So back to the original thought of my post.
Indoor spaces, with limited air exchange or recycled air and lots of people, are concerning from a transmission standpoint. We know that 60 people in a volleyball court-sized room (choir) results in massive infections. Same situation with the restaurant and the call center. Social distancing guidelines don’t hold in indoor spaces where you spend a lot of time, as people on the opposite side of the room were infected.
The principle is viral exposure over an extended period of time. In all these cases, people were exposed to the virus in the air for a prolonged period (hours). Even if they were 50 feet away (choir or call center), even a low dose of the virus in the air reaching them, over a sustained period, was enough to cause infection and in some cases, death.
Social distancing rules are really to protect you with brief exposures or outdoor exposures. In these situations there is not enough time to achieve the infectious viral load when you are standing 6 feet apart or where wind and the infinite outdoor space for viral dilution reduces viral load. The effects of sunlight, heat, and humidity on viral survival, all serve to minimize the risk to everyone when outside.
When assessing the risk of infection (via respiration) at the grocery store or mall, you need to consider the volume of the air space (very large), the number of people (restricted), how long people are spending in the store (workers - all day; customers - an hour). Taken together, for a person shopping: the low density, high air volume of the store, along with the restricted time you spend in the store, means that the opportunity to receive an infectious dose is low. But, for the store worker, the extended time they spend in the store provides a greater opportunity to receive the infectious dose and therefore the job becomes more risky.
Basically, as the work closures are loosened, and we start to venture out more, possibly even resuming in-office activities, you need to look at your environment and make judgments. How many people are here, how much airflow is there around me, and how long will I be in this environment. If you are in an open floorplan office, you really need to critically assess the risk (volume, people, and airflow). If you are in a job that requires face-to-face talking or even worse, yelling, you need to assess the risk.
If you are sitting in a well ventilated space, with few people, the risk is low.
If I am outside, and I walk past someone, remember it is “dose and time” needed for infection. You would have to be in their airstream for 5+ minutes for a chance of infection. While joggers may be releasing more virus due to deep breathing, remember the exposure time is also less due to their speed. Please do maintain physical distance, but the risk of infection in these scenarios are low. Here is a great article in Vox that discusses the low risk of running and cycling in detail.
While I have focused on respiratory exposure here, please don’t forget surfaces. Those infected respiratory droplets land somewhere. Wash your hands often and stop touching your face!
As we are allowed to move around our communities more freely and be in contact with more people in more places more regularly, the risks to ourselves and our family are significant. Even if you are gung-ho for reopening and resuming business as usual, do your part and wear a mask to reduce what you release into the environment. It will help everyone, including your own business. This article was inspired by a piece written by Jonathan Kay in Quillete
About the author
Erin S. Bromage, Ph.D ., is an Associate Professor of Biology at the University of Massachusetts Dartmouth . Dr. Bromage graduated from the School of Veterinary and Biomedical Sciences James Cook University, Australia where his research focused on the epidemiology of, and immunity to, infectious disease in animals. His Post-Doctoral training was at the College of William and Mary, Virginia Institute of Marine Science in the Comparative Immunology Laboratory of late Dr. Stephen Kaattari.
Dr. Bromage’s research focuses on the evolution of the immune system, the immunological mechanisms responsible for protection from infectious disease, and the design and use of vaccines to control infectious disease in animals. He also focuses on designing diagnostic tools to detect biological and chemical threats in the environment in real-time.
Dr. Bromage joined the Faculty of the University of Massachusetts Dartmouth in 2007 where he teaches courses in Immunology and Infectious disease , including a course this semester on the Ecology of Infectious Disease which focused on the emerging SARS-CoV2 outbreak in China.
I read this article this weekend.
My daughter in law is presumed to have post viral fatigue. She has not recovered from whatever she had in March. Since she didn’t have cough or fever or been to China, she couldn’t get tested. It would be nice to know if she has antibodies, but that’s not available for her either. They’ve ruled out the lungs, been checking heart & will be seeing a neuro physisiologist next. If she exerts herself her hands curl up & her whole body tingles and she gets short of breath. Not fun.
I’m so sorry to read this. I truly hope she recovers.
Jared Kushner is pushing the idea of postponing the election, sparking long-held fears. This is pure distraction, designed to prey on our fears to help distract from the things Trump himself fears right now.
Kushner, Law Aside, Doesn’t Rule Out Delaying 2020 Election
The opinion of a White House staff member has no bearing on when the election is held, but his comment played into the concerns of President Trump’s detractors.
New US coronavirus hotspots appear in Republican heartlands
Surge in infections in red state towns and rural communities
Rise in cases contradicts Trump assertion of rapid decline
Ousted health official to warn “window of opportunity is closing” for virus response
A top vaccine doctor who was ousted from his position in April is expected to testify Thursday that the Trump administration was unprepared for the coronavirus, and that the U.S. could face the “darkest winter in modern history” if it doesn’t develop a national coordinated response, according to prepared testimony first obtained by CNN.
The big picture: Rick Bright, the former head of the Biomedical Advanced Research and Development Authority (BARDA), will tell Congress that leadership at the Department of Health and Human Services ignored his warnings in January, February and March about a potential shortage of medical supplies.
- He will testify that HHS “missed early warning signals” and “forgot important pages from our pandemic playbook,” early on — but that “for now, we need to focus on getting things right going forward.”
- Bright’s testimony also reiterates claims from a whistleblower report he filed last week that alleges he was ousted over his attempts to limit the use of hydroxychloroquine — an unproven drug touted by President Trump — to treat the coronavirus.
What he’s saying: Bright will testify he urged HHS to ramp up production of
masks, respirators and medical supplies as far back as January. Those warnings were dismissed, Bright says, and he was “cut out of key high-level meetings to combat COVID-19.”
- “I continue to believe that we must act urgently to effectively combat this deadly disease. Our window of opportunity is closing. If we fail to develop a national coordinated response, based in science, I fear the pandemic will get far worse and be prolonged, causing unprecedented illness and fatalities.”
Bright will call for a national strategy to combat the virus, including “tests that are accurate, rapid, easy to use, low cost, and available to everyone who needs them.”
- “Without clear planning and implementation of the steps that I and other experts have outlined, 2020 will be darkest winter in modern history.”