“I will not make criminals out of business owners, single moms, and otherwise healthy individuals for exercising their constitutional rights.” Riverside County (CA) Sheriff Chad Bianco
“I find it outrageous and out of touch that during a national pandemic, a judge in a county that actually released hardened criminals for fear of contracting COVID-19, would jail a mother for operating her hair salon in an attempt to put food on her family’s table.” Texas Attorney General Paxton
- Recent Developments and Headlines
- Numbers and Trends
- Potential Treatments
- New Scientific Findings
- Study claims Vitamin D levels may impact COVID-19 mortality rates
- University of Hong Kong study finds eyes are ‘important route’ for coronavirus, up to 100 times more infectious than Sars
- Sperm containing coronavirus raises possibility of sexually transmitted C19
- Report on face masks’ effectiveness for Covid-19 divides scientists
- Full Body Assault
- It’s Safer Outside
- New York City Was Primary Gateway For US Outbreaks
- New PPE
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A. Recent Developments and Headlines
Note: All changes noted in this Update are since the 5/7 Update
Sources: New York Times Coronavirus Updates, New York Post Coronavirus Updates, Zero Hedge Coronavirus Updates, Drudge, Breitbart, Wall Street Journal, Coronavirus White House Task Force Briefing, NY Governor Daily Briefing, and Worldometers
- ‘Operation Warp Speed’ Pushing for 100,000,000 Vaccine Doses by the Fall
- CNN says 43 states will be ‘partially or mostly open’ by next week
- SF breaks with Bay Area, says will allow businesses to reopen for curbside on Friday
- Coronavirus has now put 33 million Americans out of work
- JPMorgan: 10 years before employment returns to pre-virus levels
- Economic Impact Of Lockdown Will Cause More Deaths Than COVID-19
- President Trump: People Won’t Stand For Our Country Being Closed
- Yale Scientist: Reopening America Is ‘Awfully Close to Genocide’
- US Senator Rand Paul blasts nationwide lockdowns, says they’re ironically making US even more dependent on China
- Michigan Gov. Gretchen Whitmer extends stay-at-home order until May 28
- Florida. To Begin Mass Antibody Testing
- Texas’ Anti-Climactic Reopening: Malls & Restaurants Empty, Beaches & Parks Packed
- Reopen The Economy, No More Imaginary Money
- Texas Supreme Court Orders Immediate Release of Jailed Hair Salon Owner
- California Sheriff: ‘I Refuse to Make Criminals Out of Business Owners’
- Gov. Charlie Baker Backs Down, Reopens Golf Courses in Massachusetts
- Suicide Rise from Lockdowns to Kill More than Coronavirus in Australia
- Tesla May Be Gearing Up to Defy Lockdown and Resume Production
- Businesses Need Fast ‘Point-of-Care’ Coronavirus Testing Because We Might Not Get a Vaccine or ‘Sustained Immunity’
- Ex-Hong Kong Health Chief: Wearing Mask About ‘Manners,’ Being ‘Polite’
- U.K. Lockdown Could Start Lifting Monday
- ‘Quarantine Kills’ Protests in Ukraine
- Israel’s Soccer League to Resume, but Without Fans
- Russia overtakes Germany and France, becomes fifth largest outbreak
- France to keep borders closed until mid-June
- One of Trump’s valets tests positive for COVID-19
- Trump and Pence will be tested daily after contact with infected aide
- NYT says COVID-19 spread to NYC first, then the rest of the country
- Rite Aid says expanding virus testing
- Belgium prepares to reopen most shops Monday
- Brazilian villages slam lack of lifesaving medical equipment
- Japan grants emergency approval to remdesivir
- Nigeria extends flight ban
- Vietnam still hasn’t reported a single death from COVID-19
- San Francisco provides free marijuana and alcohol to homeless
- Furor Erupts Over San Francisco Giving Drugs To Homeless Addicts As Businesses Prepare To Reopen
- Planned Parenthood CEO: At-Home Tele-Abortions ‘Silver Lining’ of Pandemic
- Democratic congressman said opening California beaches was ‘reckless.’ Then he was seen at a private beach.
- New York City was the primary source of coronavirus infections in the US, experts find
- One of Trump’s personal valets has tested positive for COVID-19
- Illinois churches can’t exceed 50 attendees until there’s a coronavirus vaccine, medicine, or no new cases
- NY officials allowed COVID-positive workers to stay on the job at nursing homes — the facilities account for 25% of deaths in the state
- 20,000 ‘disease detectives’ to track, isolate, and perhaps quarantine California residents exposed to COVID-19, Gov. Newsom says
- TX Gov. Abbott and AG Paxton condemn jailing of salon owner Shelly Luther: A shameful abuse of discretion
- The man behind Sweden’s no-lockdown approach says the country’s high death toll really came as a surprise
- Wisconsin says, due to lockdown, it will give driver’s licenses to teens without making them take a road test
- Mike Rowe blasts Gov. Cuomo over his calloused attitude for out-of-work Americans: ‘Cookie-cutter bromides and platitudes’
- Former NYT report Alex Berenson slams lockdown governors: “They are fools who haven’t read the data”
- ‘The very definition of tyranny’: Judge blasts Wisconsin Democratic governor’s strict lockdown order
- NYC police union warns the ‘city will fall apart’ if cops are made to enforce social distancing
- New York City May Limit Crowds at Parks to Fight Spread of Coronavirus
- Tx Gov. Abbott issues executive order retroactively eliminating jail time for citizens who violate the state’s stay-at-home rules
- NJ cops using batons, pepper spray to break up crowd
- Walla Walla County officials recall claims people were hosting coronavirus parties
- Doctors lambaste federal process for distributing Covid-19 drug remdesivir
- Trump administration buries detained CDC advice on reopening
- 3 McDonald’s workers hurt after customer attack over coronavirus limits, Oklahoma police say
- Coronavirus MIGHT be sexually transmitted, study finds – even after symptoms have cleared
- There’s No Escape From the Virus in a Cockpit at 30,000 Feet
- As Restaurants Remain Shuttered, American Cities Fear the Future
- Adults use kiddie pools as quarantine meets L.A. heat
- Mayor says Moscow’s real coronavirus case tally is more than triple the official
- Fears grow as coronavirus bears down on Mexico City
- He fought to protect sex workers from COVID-19 and much more. Then the virus came for him
- France Limits Paris Lockdown Easing Over Virus Fears
- Islands prove safe ports in virus storm
- ‘What’s the point of staying?’: Middle East faces expatriate exodus
- 5G coronavirus conspiracy theory results in 77 mobile towers burned
- Cell Tower Fires Have Finally Made Their Way To Canada
- Airfares could soar up to 50% with new social-distancing regulations
- There will not be a COVID-19 baby boom, study says
- Family of Philadelphia meat worker who died of coronavirus sues factory
- Amtrak will require face masks for all passengers beginning next week
- Prisoners getting coronavirus relief checks should return them, IRS says
- Disney World entertainment complex to reopen while theme parks, hotels remain closed
- Social media networks scrambling to remove viral ‘Plandemic’ conspiracy video
- Airbus eyeing ‘smell sensors’ capable of detecting coronavirus on planes
- Nail salon was source of first coronavirus community spread case in California
- Most who recover from coronavirus carry antibodies, study finds
- The most extreme lockdowns plainly don’t pass constitutional sniff test
- New York eviction moratorium extended, new tenant protections issued
- Coronavirus patient in first vaccine trial proud to be ‘helpful to humanity’
- NYC homeless services workers forced to wear trash bags as coronavirus PPE
- One-third of Americans may refuse coronavirus vaccine, according to poll
- Sweden sees higher coronavirus death rate than US after refusing lockdown
- Greece declares victory over coronavirus, plans to slowly reopen
- Over 100 ‘unemployed’ Thai elephants return home amid coronavirus
- Fired USS Theodore Roosevelt captain reassigned
- China gave Europe coronavirus supplies in exchange for praise
- NYC health care workers catch coronavirus at below-average rate: Gov. Cuomo
- NYPD enlists school safety agents to scold social distance violators
- Michigan barber says he won’t close shop ‘unless they handcuff me’
- Dining in post-coronavirus NYC will include gloves, masks and lots of space
- Ohio health officials hiring ‘contact tracers’ to help stop spread of coronavirus
- City to limit number of people in some parks amid coronavirus: de Blasio
- De Blasio: NYC making ‘progress’ as coronavirus hospitalizations fall
- Fourth Amazon warehouse worker dies from coronavirus
- Some states considering house arrest tech to keep coronavirus patients home
- Coronavirus cases in Russia reach over 177,000 in new one-day record
- Town told to go on a diet — but residents say ‘fat chance’
- The rich are sheltering from coronavirus in luxury retreats with guns
- Sixteen workers crushed by a train in India are the latest deaths resulting from a rush to reopen
- Australia outlines a three-step plan for reopening the country
- Britain is developing an app that will track coronavirus cases in a centralized database
- Not waiting for state action, Russia’s oligarchs have become central to the coronavirus fight
- The abrupt halt in air travel could impair weather forecasting as the Atlantic hurricane season nears
B. Numbers & Trends
Note: The numbers in this update only include cases that have been (i) confirmed through testing, and (ii) reported. The actual number of cases may be materially higher than confirmed cases, which means that the number of actual deaths from COVID-19 and recoveries may both be materially higher than reported.
1. Confirmed Total Cases, New Cases and Tests
- Total Cases = 3,916,244 (+2.5%)
- New Cases = 96,401 (+1.1%) (+1,076)
- New Cases (5 day avg) = 86,979 (+3.2%) (+2,705)
- Total Cases = 1,292,623 (+2.3%)
- New Cases = 25,531 (+16.0%) (+4,071)
- New Cases (5 day avg) = 26,370 (-0.2%) (-43)
- Number of Tests = 8,297,562
- Worldwide Deaths = 270,426 (+2.1%)
- New Deaths = 5,589 (-17.9%) (-1,221)
- New Deaths (5 day avg) = 5,153 (1.5%) (+75)
- US Deaths = 76,926 (+2.8%)
- New Deaths = 2,129 (-15.9%) (-401)
- New Deaths (5 day avg) = 1,896 (+4.8%) (+87)
- 5 Countries with Largest Number of Confirmed Deaths:
|Country||Total Deaths||Deaths Per 1M Population|
|US||76,926 (+2,129)||232 (+6)|
|UK||30,615 (+539)||451 (+18)|
|Italy||29,958 (+274)||495 (+4)|
|Spain||26,070 (+213)||558 (+5)|
|France||25,987 (+178)||398 (+3)|
- 5 Countries = 71.2% of Worldwide Total Confirmed Deaths
- US = 28.4% of Worldwide Total Confirmed Deaths
- 5 States with Largest Number of Confirmed Deaths:
|Country||Total Deaths||Deaths Per 1M Population|
|New York||26,365 (+409)||1,334|
|New Jersey||8,834 (+262)||995|
|Pennsylvania||3,529 (245)||398 (+3)|
- 5 States = 62.4% of US Total Confirmed Deaths
- NY = 34.5% of US Total Confirmed Deaths
3. Countries/States To Watch
- Total Cases = 24,623 (+705)
- Deaths = 3,040 (+99)
- New Deaths (3 day avg) = 2,945 (+3.2%) (+90)
- Deaths per 1M population = 301 (+10)
- Total Cases = 31,580 (+841)
- Deaths = 1,348 (+21)
- New Deaths (3 day avg) = 34 (-33.3%) (-17)
- Deaths per 1M population = 131 (+2)
C. Potential Treatments
1. Moderna Gets OK to Start Larger Trial for a Coronavirus Vaccine
- One of the first biotech companies to begin human trials of an experimental vaccine for the coronavirus is now ready to move onto the next phase of testing.
- On Thursday, Moderna announced that the Food and Drug Administration had cleared its application to proceed to a clinical trial involving about 600 people.
- “The imminent Phase 2 study start is a crucial step forward,” Stéphane Bancel, Moderna’s chief executive, said in a statement.
- The main goal of this set of tests is to find out if the vaccine is safe and if positive results from the first few dozen volunteers in the first phase can be replicated in a much larger group. If it is successful, later studies, known as Phase 3 trials, will determine exactly how well the vaccine works.
- More than a dozen companies, including known vaccine producers like Johnson & Johnson, or Sanofi, are involved in a global race to develop a vaccine to tamp down the highly infectious coronavirus that has killed more than a quarter-million people around the world.
- Four Chinese companies have started testing their potential vaccines on humans, including CanSino Biologics, which announced the beginning of Phase 2 trials in early April. A few others, such as Pfizer and its German partner, BioNTech, are enrolling volunteers for combined Phase 1 and 2 trials.
- Moderna’s vaccine candidate, called mRNA-1273, relies on genetic material known as messenger RNA, which carries the recipe for making proteins to tiny ribosome chefs inside cells. The vaccine is written with a very specific recipe — in this case for making the spike protein of the coronavirus.
- Because the virus typically uses this protein as a key to unlock and take over lung cells, the vaccine could train a healthy immune system to produce antibodies to fight off an infection before someone gets sick.
- Moderna’s vaccine is one of many using this unusual technology. Its first tests in humans were conducted in 45 healthy adults in Seattle, funded by the National Institutes of Health. Since then, other companies, using different approaches, have also joined the race to find a coronavirus vaccine.
- The F.D.A. said its policy was not to comment on phases of any drug trial, and Moderna did not release results from the first phase.
- In its first-quarter update on Thursday, Moderna appeared to be speeding up its timeline for a coronavirus vaccine, stating that the next phase would begin “shortly.” The company is also gearing up for a Phase 3 trial in the summer, and hopes to have the final vaccine approved “as soon as 2021.”
- The biotech firm is also accelerating plans for manufacturing a vaccine so it can start building a stockpile as soon as this July. Last week, the firm announced a 10-year collaboration with the Swiss contract drugmaker Lonza to manufacture up to one billion doses per year for worldwide distribution, if the vaccine proves successful.
2. Blood thinners show promise for boosting the survival chances of the sickest C19 patients
- Treating coronavirus patients with blood thinners could help boost their prospects for survival, according to preliminary findings from physicians at New York City’s largest hospital system that offer another clue about treating the deadly condition.
- The results of an analysis of 2,733 patients, published Wednesday in the Journal of the American College of Cardiology, are part of a growing body of information about what has worked and what has not during a desperate few months in which doctors have tried dozens of treatments to save those dying of C19, the disease caused by the novel coronavirus.
- Valentin Fuster, a physician in chief at Mount Sinai Hospital and one of the study’s authors, said in an interview that the observations are based only on a review of medical records and that more rigorous, randomized studies are needed to draw broader conclusions, but that the results are promising.
- “My opinion is cautious, but I must tell you I think this is going to help,” he said. “This is the opening of the door for what drugs to use and what questions to answer.”
- Since March, when the pandemic hit Europe and the United States, doctors have been reporting mysterious blood clots, which can be gel-like or even semisolid, in a significant subset of coronavirus patients. Autopsies of patients who died of respiratory arrest have shown that some had unusual microclots in their lungs rather than the typical damage expected. And last month, doctors reported in the New England Journal of Medicine on five unusual cases of C19-positive people in their 30s and 40s experiencing large strokes.
- The Mount Sinai study focused on hospitalized patients treated at its 5 branches from March 14 through April 11. Among patients who were not on ventilators, those treated with blood thinners died at similar rates to those who did not get blood thinners. But they lived longer — a median of 21 days compared to 14 days.
- For patients on ventilators, the difference was more significant. About 63 percent of patients who did not receive the medications died compared with 29 percent who received the treatment.
- Another critical finding of the study is that giving blood thinners to these patients appears to be relatively safe. There was not a significant difference in the most dangerous side effect of anticoagulants — bleeding — in those who were on the drugs vs. those who were not.
- As a result of the analysis, Fuster said, the hospital system changed its treatment protocols several days ago to begin giving patients with C19 higher doses of blood thinners.
- Deepak Bhatt, a professor at Harvard Medical School who specializes in interventional cardiology, called the paper “a very important study” with the blood issues in C19 patients having evolved from just a suspicion to a well-recognized complication of the virus. “What we are figuring now is what do we do now that we know” in terms of treatments, he said.
- Thomas W. Wakefield, head of vascular surgery for Michigan Medicine, said the anticoagulant heparin, which was used in some patients, probably has “two mechanisms among others that contribute to the good results seen in the study.”
- He said some data suggest heparin may interfere with entry of the virus into cells through spike proteins, and that heparin may also be able to decrease the inflammatory effects of the “cytokine storm” in patients with severe infection.
- Anticoagulants — first discovered more than 100 years ago and available in pills, injections and IVs — have been a key building block of treatment plans for weeks at many medical centers, prompted by discoveries about how the virus attacks the human body and an increasing recognition of blood-related complications in coronavirus patients.
- A number of medical societies, including the International Society on Thrombosis and Haemostasis and the American Society of Hematology, have put out guidance recommending use of blood thinners for some C19 patients, but the advice has taken a conservative approach.
- “It’s a delicate balance between clotting and bleeding, especially when patients are as sick as some of the ones who have C19,” said Geoffrey Barnes, an assistant professor at the University of Michigan who works in cardiovascular medicine.
- “A week ago, we were making some educated guesses on how to prevent blood clots,” he said. “This is the first time we have seen data that says higher doses may possibly be effective and safe.”
- Fuster said Mount Sinai is beginning a trial this week that will include 5,000 patients who will be randomized into treatment groups to try to get more definitive information. Many unknowns remain about the blood thinners, including the best dosage and timing, and whether patients with C19 who are not sick enough to be hospitalized and are dealing with their illness at home would benefit from taking the medication.
D. New Scientific Findings & Other Advances
1. Vitamin D levels may impact C19 mortality rates
- Researchers have discovered a strong correlation between vitamin D deficiency and mortality rates from the novel coronavirus, a new study reveals.
- A research team led by Northwestern University analyzed data from hospitals and clinics across China, France, Germany, Italy, Iran, South Korea, Spain, Switzerland, the United Kingdom and the United States.
- Patients from countries with high C19 mortality rates, such as Italy, Spain and the United Kingdom, had lower levels of vitamin D compared to patients in countries that were not as severely affected, according to the study.
- The researchers also found a strong correlation between vitamin D levels and cytokine storm, which is a hyperinflammatory condition caused by an overactive immune system.
- “Cytokine storm can severely damage lungs and lead to acute respiratory distress syndrome and death in patients,” Ali Daneshkhah, a postdoctoral research associate at Northwestern’s McCormick School of Engineering, said in a statement. “This is what seems to kill a majority of C19 patients, not the destruction of the lungs by the virus itself. It is the complications from the misdirected fire from the immune system.”
- However, the scientists also cautioned against hoarding vitamin D supplements.
- “While I think it is important for people to know that vitamin D deficiency might play a role in mortality, we don’t need to push vitamin D on everybody,” said Northwestern’s Vadim Backman, who led the research, in a statement. “This needs further study, and I hope our work will stimulate interest in this area. The data also may illuminate the mechanism of mortality, which, if proven, could lead to new therapeutic targets.”
- Scientists said they need to conduct much more research to understand how vitamin D could be used to protect against C19 complications.
2. Eyes are ‘important route’ for coronavirus, up to 100 times more infectious than SARS
- The eyes are an important route for the coronavirus into the human body, according to University of Hong Kong research which found the strain was up to 100 times more infectious than severe acute respiratory syndrome (SARS) and bird flu in two facial orifices tested by the public health experts.
- Laboratory tests revealed the “virus level” of the coronavirus is far greater than for SARS in the upper respiratory airways and conjunctiva, the cells lining the surfaces of the eyes.
- The team led by Dr Michael Chan Chi-wai, from HKU’s school of public health, became among the first researchers worldwide to provide evidence the coronavirus can infect humans through both entry points when it published its findings in the latest issue of The Lancet Respiratory Medicine.
- “We culture tissues from the human respiratory tract and eyes in the laboratory and applied them to study the coronavirus, comparing it with SARS and H5N1. We found that the coronavirus is much more efficient in infecting the human conjunctiva and the upper respiratory airways than SARS, with virus level some 80 to 100 times higher,” Dr Chan said.
- “This explains the higher transmissibility of C19 than that of SARS. This study also highlights the fact that eyes may be an important route of the coronavirus human infection,” added Dr Chan.
- The study reinforces advice to the public not to touch their eyes and to wash hands regularly to avoid infection, after the university researchers previously found the coronavirus could survive as long as seven days on stainless steel surfaces and plastic.
- The findings from Dr. Chan’s team and others challenge the widely held assumption in the earliest stages of the health crisis that medical staff would be adequately protected with N95 masks and protective clothing, without the need for specialist glasses.
3. Coronavirus in sperm raises possibility of sexually transmitted C19
- Chinese researchers have found C19 in the sperm of a small number of men, raising the possibility that the virus could be spread via sex.
- The study by physicians at China’s Shangqiu Municipal Hospital looked at only 38 men at the hospital who had tested positive with disease, and of that already small group found that a minority – only six – were found to have coronavirus in their semen.
- “The virus responsible for C19 has been detected in stool, gastrointestinal tract, saliva and urine samples,” the researchers’ report said. “However, little is known about coronavirus in semen.”
- While the study published by JAMA Network Open – an online, open-access medical journal – was small and hardly definitive, researchers say it points to the need for further research into how the virus is spread and how likely it is to be transmitted sexually.
- “If it could be proved that coronavirus can be transmitted sexually … [that] might be a critical part of the prevention,” the team wrote in the JAMA, “especially considering the fact that coronavirus was detected in the semen of recovering patients.”
- Their findings come as other similar-sized studies have found that minor or no traces of the virus remain in infected men’s sperm, giving experts pause, with researchers cautioning that the findings are only preliminary and far from conclusive.
- “This study is limited by the small sample size and the short subsequent follow-up,” wrote the doctors, “therefore, further studies are required.”
- Even if coronavirus is found to be present in sperm more broadly, that doesn’t necessarily mean that it is sexually transmissible, Allan Pacey, a professor of andrology at Britain’s Sheffield University, said in an interview with Reuters.
- “We should not be surprised if the virus which causes C19 is found in the semen of some men,” said Pacey, “since this has been shown with many other viruses such as Ebola and Zika.”
4. Report on face masks’ effectiveness for C19 divides scientists
- A row has erupted among scientists over a new report into the use of face masks by the general public as an approach to managing the spread of C19 in the community.
- The report from a multidisciplinary group convened by the Royal Society called Delve – Data Evaluation and Learning for Viral Epidemics – has weighed up the evidence and come out in favour of the public wearing face masks, including homemade cloth coverings, in a bid to tackle Covid-19.
- “Our analysis suggests that their use could reduce onward transmission by asymptomatic and pre-symptomatic wearers if widely used in situations where physical distancing is not possible or predictable, contrasting to the standard use of masks for the protection of wearers,” the report notes. “If correctly used on this basis, face masks, including homemade cloth masks, can contribute to reducing viral transmission.”
- The conclusion is based on analysis of three key considerations, including the role of droplets as a route of transmission, and whether masks can help to reduce dispersal of droplets. However the authors note there are only a small number of studies.
- But the report prompted other scientists to express their reservations, warning that it amounted to no more than opinion and overstated the available evidence.
- Dr Simon Clarke, associate professor in cellular microbiology at the University of Reading, said the report “falls short of delivering new evidence and too casually dismisses precautionary principle when addressing the possibility that masks and coverings could have negative effects on people’s behaviors”.
- He added: “Until more evidence is delivered in either direction, that’s all advice can be based on – opinions.”
- Dr Ben Killingley, consultant in acute medicine and infectious diseases at University College London hospital, was also critical.
- “The report is overly optimistic about the value of face coverings and it is incorrect to conclude that the evidence shows that face covering can reduce viral transmission in the community,” he said. “There is in fact no good evidence that face coverings achieve this.”
- Killingley added that the report largely ignored real-world data, which suggests low effectiveness, albeit for protection of the wearer.
- “This is not to say that face coverings might not be helpful,” he said, noting, face mask studies have not been carried out during a pandemic or in the context of a novel virus. “Nevertheless, the report, in my view, does not accurately represent the evidence on face coverings that currently exists,” he said.
- Dr Antonio Lazzarino of the Department of Epidemiology and Public Health at University College London, agreed.
- “That is not a piece or research. That is a non-systematic review of anecdotical and non-clinical studies,” he said.
- “The evidence we need before we implement public interventions involving billions of people, must come ideally from randomized controlled trials at population level or at least from observational follow-up studies with comparison groups,” said Lazzarino noting that will allow experts to look at the pros and cons of wearing masks.
- “Based on what we now know about the dynamics of transmission and the pathophysiology of C19, the negative effects of wearing masks outweigh the positive,” he said.
E. Full Body Assualt
1. Coronavirus Hijacks the Body From Head to Toe, Perplexing Doctors
- Garvon Russell was having trouble breathing when he arrived sick with C19 at a New York City emergency room. By the time he left the hospital two weeks later, he had battled the new coronavirus all over his body.
- His lungs were inflamed, their tiny air sacs filled with fluid that made it hard for oxygen to get into his bloodstream. His kidneys failed with Mr. Russell in septic shock from his infection.
- Then, when it looked like he had turned the corner, his bedside nurse noticed his left leg was swollen. Doctors found a blood clot in a deep vein.
- Mr. Russell, a 67-year-old retiree, said he feels lucky to have survived: “It’s nothing to play with.”
- As the number of C19 patients grows, doctors are learning its damage can extend well beyond the lungs, where infection can lead to pneumonia and acute respiratory distress syndrome, the sometimes fatal condition Mr. Russell had.
- The disease can also affect the brain, kidneys, heart, vascular and digestive system. Some patients have sudden strokes, pulmonary embolisms or heart-attack symptoms. Others have kidney failure or inflammation of the gut.
- Infection can affect the nervous system, causing seizures, hallucinations or a loss of smell and taste. It may affect pregnancies, though the science is nascent: The placenta of a patient who miscarried during her second trimester tested positive for the virus and showed signs of inflammation, according to a paper published April 30 in the Journal of the American Medical Association.
- The coronavirus replicates rapidly in lungs, damaging tiny air sacs. Immune cells set off an inflammatory response against the infection, but too much inflammation can damage lung cells and blood vessels. In blood vessels, inflammation can activate proteins that form blood clots.
- Clots in large blood vessels can lead to stroke or pulmonary embolisms. Microclots can make it hard for lungs to oxygenate blood; less oxygen can lead to multi-organ-system failure.
- Some patients suffer heart-lining inflammation, heart attacks or abnormal heart rhythms.
- Clots can cause painful, purplish swelling in the toes.
- Some studies have found the coronavirus in cerebrospinal fluid. Patients have lost smell and taste. Some patients experience seizures, which are caused by abnormal brain activity, and hallucinations. Even young patients have suffered strokes, caused by clots reaching the brain.
- Some patients report mild muscle and joint aches; others’ pain is severe. The CDC recently added muscle pain to its symptoms list.
- Some patients report gastrointestinal issues, including diarrhea. Stool samples have tested positive for the coronavirus.
Throat, nose, eyes
- The CDC recently added sore throat to its symptoms list. Some patients report runny noses. Reports suggest conjunctivitis is a symptom; eye-fluid samples have tested positive for viral RNA.
- Blood clots in capillaries may prevent blood from getting to kidneys, leading to acute kidney injury. Shock or a direct attack by the virus can also cause kidney injury.
- The virus’s strange effects go beyond anything doctors say they usually see with other viral infections. “It seems to strike so many systems,” said Maya Rao, a nephrologist at New York-Presbyterian/Columbia University Irving Medical Center in New York who is treating C19 patients with acute kidney failure. “We don’t understand who gets it.”
- “Sometimes with very severe infections you can see things similar to this,” said Magdy Selim, a neurologist at Beth Israel Deaconess Medical Center in Boston, who is treating C19 patients who have had strokes. “But not all this combination of things in one patient. These are really sick patients.”
- Some patients are young and otherwise healthy. Some children, who generally don’t get very sick with C19, have been hospitalized with symptoms similar to Kawasaki disease—an inflammatory condition typically affecting young children—with acute inflammation in their hearts and intestines.
- The extreme inflammation that is a hallmark of the most severe C19 cases is likely at play, doctors said. Inflammation can also cause blood clots, which doctors believe may be a common denominator spanning several complications. Physicians describe stunningly extensive and swift clotting leading to the strokes and pulmonary embolisms seen in even otherwise young, healthy patients.
- Figuring out how to treat patients with C19 is difficult because the virus is new, identified just at the beginning of this year, and its effects differ from those of other coronaviruses that infect humans. Patients are often admitted to the hospital when already very sick, significantly narrowing the window to save them, and there aren’t any medications approved to specifically treat infection with the new coronavirus. Some of these complications ultimately will be considered rare but appear more common now because so many people have gotten sick at once, doctors say.
- Scientists are combing through piles of studies, and doctors are sharing experiences in real-time on Facebook and WhatsApp groups.
- The inflammation at play in many complications is starting to come into focus. Immune-system cells rush in to kill infected cells. They also release molecules known as cytokines and chemokines that promote inflammation. The inflammation’s goal is to cordon off infected tissue, but too much can promote extra damage and create a “cytokine storm.”
- Inflammation in the lungs can starve the blood of oxygen, depriving other organs, as it did with Mr. Russell, who spent eight days on a ventilator. Inflammation of the heart muscle, called myocarditis, can cause chest pain, shortness of breath and heart-rhythm disorders and scar the heart tissue.
- Genetic sequencing showed some patients have gene variants associated with a hyperactive immune response to viral infections, he said, yielding one possible clue into why some people develop serious complications, though such evidence is preliminary.
- Researchers are also studying complications possibly caused by a direct attack by the virus. A recent study in the journal The Lancet found evidence the virus attacks endothelial cells, which form a layer lining blood vessels and the heart. That makes C19 a vascular disease as well as a lung disease, said Mandeep Mehra, executive director of the Center for Advanced Heart Disease at Brigham and Women’s Hospital in Boston, an author of the study.
- “It might be that this is a disease that requires a combination of therapy that attacks the virus and that also stabilizes the vasculature,” he said.
- Among the strangest and most worrisome complications is how prone to clotting the blood of some C19 patients seems to be. “Every time you have hyper-inflammation, you’re more prone to clotting,” said Andre Goy, a hematology oncologist and chair of the John Theurer Cancer Center at Hackensack University Medical Center. “This is not new…but what’s amazing is the extent of it.”
- A study in the Netherlands found 49% of patients in ICUs developed clotting complications, mostly pulmonary embolisms but also some strokes. The risk of death for these patients with these complications was 5.4 times the risk for those without those complications, according to the study, published in the journal Thrombosis Research. “We were very much surprised by what we saw,” said Erik Klok, an internist and vascular-medicine specialist at Leiden University Medical Center, and lead author of the study. “We’re not used to this in patients with the normal flu.”
- Doctors have seen some patients’ blood clot during dialysis, or while circulating in life-support machines, clogging the circuits. “They’re clotting off things that don’t usually clot,” said Lee Schwamm, executive vice chairman of neurology at Massachusetts General Hospital in Boston. “It’s as if you had sludge in your garden hose.”
- At Mount Sinai Hospital in New York, a 44-year-old stroke patient’s blood started visibly clotting while surgeons were trying to remove a clot from his brain despite infusion with clot-busting drugs, according to Thomas Oxley, the interventional neurologist who treated the patient. The patient can’t speak or move his right side, he said.
- Strokes happen when large clots in large blood vessels make their way to the brain, cutting off vital oxygen. About 5% of C19 patients develop them, according to a study of 221 patients in China.
- Patients are presenting not just with the more-common large clots that can lead to strokes and pulmonary embolisms, but also a constellation of small clots that block blood flow through the tiny blood vessels, known as capillaries, that deliver blood to all organs throughout the body. Some suffer from “Covid toe,” a painful, purplish swelling caused by clots in small blood vessels.
- The International Society on Thrombosis and Haemostasis now recommends that any patient admitted to the hospital be evaluated for the risk of clotting and be given anticoagulants like heparin, according to Jeffrey Weitz, the organization’s president-elect. Thrombosis is the medical term for blood clots that form in blood vessels.
- How C19 infection makes blood more clot-prone isn’t entirely understood. But a growing body of studies suggests some patients have elevated levels of d-dimer, a protein produced when the body breaks down clots. D-dimer levels are a reliable indicator of C19 severity, several doctors said. A study published by Chinese researchers in March in The Lancet found patients who died had higher d-dimer levels than survivors.
- Clinicians think clots may be forming along walls of tiny and major blood vessels due to damage caused by inflammation or the virus itself. When the coronavirus reaches the lung, it replicates rapidly, damaging cells of tiny air sacs called alveoli. That damage triggers inflammation, which leads the blood to coagulate, clinicians say. The damaged cells also release substances that activate coagulation.
- A study of 3 patients who died from C19 published in The Lancet showed evidence the virus can infect walls of capillaries that feed several organs, including the kidneys and small intestine. Pro-clotting proteins flood in to patch up the damage in a process similar to what happens when a scab forms—except the wounding persists internally, promoting more clotting.
- “The high levels of d-dimer indicate the body is trying its darndest to break down the clot,” said Dr. Weitz. But “the forces to generate clots are overwhelming the capacity of the body to get rid of them.”
- This runaway process wreaks havoc on the entire body. When micro-clots form in tiny blood vessels, they create a traffic jam. Blood can’t flow through the lungs’ alveoli, where blood picks up oxygen.
- Clots can lead to heart problems, including reduced blood flow in coronary arteries. Some patients show signs of heart problems a week or so after developing blood clots that start in the lung, said Gian Paolo Rossi, chair of internal medicine at the University of Padua in Italy. The heart damage develops slowly, he said. “They do very badly.”
- Clots are also one suspect in acute kidney failure, which is caused by inadequate blood flow and oxygen. Blood clots in capillaries may prevent blood from getting to the kidneys, said Dr. Rao, of Columbia. Other possible causes of acute kidney injury are shock or a direct attack by the virus, because the kidneys have the ACE2 receptor to which the coronavirus binds to enter cells, she said. Patients include people who had healthy kidneys, she said.
- As many as 30% of C19 patients in the ICU at her hospital have required dialysis or consultation from a nephrologist, Dr. Rao said. That doesn’t include patients with kidney injuries that aren’t severe, she said. “We have seen an enormous amount of this in patients who are in the ICU with C19,” she said.
- Some people will fully recover. Others will need dialysis the rest of their lives, she said. “We’re not seeing a lot of recovery in the kidneys,” she said, “but we hope in the longer term people will get better.”
- A study published Wednesday by Mount Sinai researchers in the Journal of the American College of Cardiology found that treating hospitalized patients with blood-thinning drugs improved their chances of survival.
- In a span of two weeks, Mount Sinai treated five C19 patients under age 50 who had experienced a major stroke. None had clotting disorders, though one had a previous history of stroke. Normally, the hospital sees less than one such patient on average during that same period, according to a paper published in the New England Journal of Medicine in April.
- PATIENTS ARE OFTEN UNSURE WHEN TO CALL FOR HELP WHEN THEY START EXPERIENCING SYMPTOMS SUCH AS NUMBNESS ON ONE SIDE OF THE BODY AND TROUBLE SPEAKING, NEUROLOGISTS SAID. SOME ARE WAITING MORE THAN A DAY TO CALL. THE REASON: PATIENTS ARE BEING ADVISED TO CALL FOR HELP ONLY IF FEVERS OR SHORTNESS OF BREATH WORSEN.
F. Its Safer Outside
1. Evidence mounts that outside is safer when it comes to C19
- Health experts say people are significantly less likely to get the coronavirus while outside, a fact that could add momentum to calls to reopen beaches and parks closed during the C19 pandemic.
- Being outside shouldn’t be seen as completely safe, health experts say. People should continue to avoid crowds and maintain six feet of distance from others to keep away from the virus.
- But experts are increasingly confident in evidence showing that the coronavirus spreads much more readily indoors than outdoors, a finding that could help guide policymakers seeking to figure out ways to end lockdowns that have shuttered much of the nation’s economy.
- “Parks, beaches — as long as they’re not cheek to jowl, cycling, walking, this is good,” said Tom Frieden, the former director of the Centers for Disease Control and Prevention. “Enjoy nature. It’s good for us, and it has very low risk of spreading the virus.”
- Maryland Gov. Larry Hogan (R) on Wednesday said coronavirus figures suggested the state might be able to begin reopening next week. If it does, he said it would include opening state parks and beaches and allowing outdoor gym classes and religious services.
- “Studies suggest activities held outdoors as temperatures warm pose lower COVID risk than those done in confined indoor spaces,” tweeted Scott Gottlieb, the former Food and Drug Administration commissioner. “As we re-open, states should look to ease rules to allow more recreational, religious, and business activities to occur outside.”
- Some cities are already considering options that might help local businesses while keeping people safe.
- Hartford, Conn., is one of the cities exploring allowing restaurants to expand their outdoor seating options into parking lots or other outdoor spaces.
- Vilnius, the capital of Lithuania, has gone further by opening its central square and other outdoor areas to restaurant seating.
- “We need creative solutions, and I think things like closing down streets and having some dispersed [seating] from restaurants is a nice creative solution,” said Eleanor Murray, a professor at Boston University School of Public Health.
- “We can’t continue this lockdown indefinitely,” she said. “It’s just not going to be psychologically or economically feasible.”
- Gottlieb pointed to a study, which has not yet been peer-reviewed, that examined outbreaks in 320 Chinese cities outside Hubei province, where the coronavirus is believed to have originated, between Jan. 4 and Feb. 11 and found only one outbreak that occurred outdoors.
- Experts warned that people are not completely safe outdoors and that it is important to stay six feet away from people outside.
- “You don’t want to be in a crowd, regardless of where that crowd is,” Murray said.
- Murray said that even outside on the beach, people who do not live together should stay six feet apart and that activities such as beach volleyball should be avoided because multiple people touching the same equipment can spread the virus.
- That means playgrounds also are a danger, she said.
- “While it’s great to have parks and beaches, you probably don’t want playground equipment open,” Murray said.
- The virus is harder to transmit outdoors because the droplets that spread it are more easily disturbed or dispersed outside in the elements than in a closed, confined, indoor setting.
- “It definitely spreads more indoors than outdoors,” said Roger Shapiro, a professor at Harvard University’s T.H. Chan School of Public Health. “The virus droplets disperse so rapidly in the wind that they become a nonfactor if you’re not really very close to someone outdoors — let’s say within six feet.”
- As people go outside for their daily exercise and pass by one another, experts offered reassurance that simply passing someone for a split second outdoors presents a low risk.
- “The virus can’t magically teleport,” said Amesh Adalja, a senior scholar at the Johns Hopkins University Center for Health Security. “It needs a cough or sneeze or something, singing, talking, spitting. … It’s not magnetism or something like that.”
- Adalja said some of the decisions around activities such as sitting closer than six feet away from a friend outside on the grass have to do with how much risk someone is personally willing to accept.
- “There’s not some kind of black or white answer to all of this stuff,” he said. “People are going to have to make a lot of decisions about what risk tolerance they have.”
- Indoor spaces such as barbershops are certainly higher risk, though. There are more shared surfaces that could transmit the virus, such as the barber’s chair. Another danger, especially in the summer, is air conditioning, which can circulate the virus through the air.
- “If you’re in an indoor space that has the air conditioning blasting … that air conditioning might be blowing the droplets straight at you,” said Murray, the Boston University professor.
G. New York City Was Primary Gateway For US Outbreaks
1. Travel From New York City Seeded Wave of U.S. Outbreaks
- New York City’s coronavirus outbreak grew so large by early March that the city became the primary source of new infections in the United States, new research reveals, as thousands of infected people traveled from the city and seeded outbreaks around the country.
- The research indicates that a wave of infections swept from New York City through much of the country before the city began setting social distancing limits to stop the growth. That helped to fuel outbreaks in Louisiana, Texas, Arizona and as far away as the West Coast.
- The findings are drawn from geneticists’ tracking signature mutations of the virus, travel histories of infected people and models of the outbreak by infectious disease experts.
- “We now have enough data to feel pretty confident that New York was the primary gateway for the rest of the country,” said Nathan Grubaugh, an epidemiologist at the Yale School of Public Health.
- Early analysis of genetic samples indicates that more infections across the country came from a line of the virus associated with the outbreak in New York City, shown in red (below), than from a line associated with the outbreak in Washington State, shown in yellow (below).
Note: Scientists have thus far sequenced only a small fraction of total infections, so the distribution of genetic lines could change as more samples are analyzed. States with fewer than 10 samples were left off the chart. Georgia, Illinois, Maryland, Massachusetts, New Jersey, Oregon and Wyoming all had fewer than 20 samples. Percentages may not add up to 100 because additional genetic lines are omitted. Source: Nextstrain By Derek Watkins
- The central role of New York’s outbreak shows that decisions made by state and federal officials — including waiting to impose distancing measures and to limit international flights — helped shape the trajectory of the outbreak and allowed it to grow in the rest of the country.
- The city joins other densely populated urban hot spots around the world, starting with Wuhan, China, and then Milan, that have become vectors for the virus’s spread.
- Travel from other American cities also sparked infections across the country, including from an early outbreak centered in the Seattle area that seeded infections in more than a dozen states, researchers say. Even if New York had managed to slow the virus, it probably would have continued to spread from elsewhere, they say.
- But the Seattle outbreak proved to be a squall before the larger storm gathering in New York, where, at the end of February, thousands of infected people packed trains and restaurants, thronged tourist attractions and passed through its three major airports.
- During crucial weeks in March, New York’s political leaders waited to take aggressive action, even after identifying hundreds of cases, giving the virus a head start. And by mid-March, when President Trump restricted travel from Europe, the restrictions were essentially pointless, the data suggest, as the disease was already spreading widely within the country.
- “It means that we missed the boat early on, and the vast majority in this country is coming from domestic spread,” said Kristian Andersen, a professor in the department of immunology and microbiology at Scripps Research. “I keep hearing that it’s somebody else’s fault. That’s not true. It’s not somebody else’s fault, it’s our own fault.”
- A lack of testing obscured the true extent of the outbreak for months, and officials acted on incomplete and sometimes conflicting information. The enormous growth of New York’s outbreak partly reflects its volume of international visitors, especially from Europe, where most of its infections came from.
- Dani Lever, communications director for Gov. Andrew M. Cuomo, criticized federal authorities, describing an “enormous failure by the federal government to leave New York and the East Coast exposed to flights from Europe, while at the same time instilling a false sense of security by telling the State of New York that we had no Covid cases throughout the entire month of February.”
- A White House spokesman, Judd Deere, said that Mr. Trump had acted quickly. The president blocked most visitors from Europe starting on March 13, more than a month after he restricted travel from China.
- “Just as he acted early on to cut off travel from the source of the virus, President Trump was advised by his health and infectious disease experts that he should cut off travel from Europe — an action he took decisively without delay to save lives while Democrats and the media criticized him and the global health community still did not fully comprehend the level of transmission or spread,” Mr. Deere said.
- The travel that helped spread the virus includes New York residents who left the city and non-New Yorkers who visited or passed through the city. Now that infections are dispersed around the country, travel from New York is no longer a main factor shaping the progression of the epidemic, researchers said.
- As states around the nation begin to relax their restrictions, the findings demonstrate that it is difficult, if not impossible, to prevent those actions from affecting the rest of the nation.
- Geneticists have analyzed and shared more than 2,000 samples of the virus from infected people. As the virus infects new people and replicates, it picks up mutations along the way. These mutations typically do not change the behavior of the virus, but they can provide a signature of a virus’s origin.
- Other scientists said that they would like to see more samples before calculating precise figures. But they agreed that New York’s prominence in seeding the national spread appears to have begun in early March, two weeks before stay-at-home orders were put in place.
- “New York acted as the Grand Central Station for this virus, with the opportunity to move from there in so many directions, to so many places,” said David Engelthaler, head of the infectious disease branch of the Translational Genomics Research Institute in Arizona.
- The most commonly detected viruses tied to New York have a distinct genetic signature linking them to outbreaks in Europe. Those spreading from Washington State have a signature linking them directly to China.
- Benjamin M. Branham, a spokesman for the Port Authority of New York and New Jersey, which controls the airports, said that before the flight restrictions from Europe, the federal government’s Customs and Border Protection “only screened passengers from China,” not from Europe.
- At this stage, scientists say, genetic fingerprints alone are not sufficient for pinpointing the source of the viruses. But travel patterns and case histories of early known cases support the idea, they said.
- “It is a combination, still, of what genomic epidemiology and shoe-leather epidemiology is going to tell us,” Dr. Engelthaler said.
- Scientists modeling the progression of the disease nationally said the prominence of New York as a national hub was broadly consistent with their findings, although the picture was still emerging.
- “I would say this is not surprising in a sense,” said Alessandro Vespignani, director of the Network Science Institute at Northeastern University in Boston. “The picture emerging is consistent with numerical models.”
- Earlier research by Dr. Vespignani showed just how rapidly, and invisibly, the outbreak exploded in New York. By March 1, when the first coronavirus case was confirmed in New York, the city probably had over 10,000 undetected infections, his research group showed.
- New York and Washington State are not the only sources of the outbreak. Other large domestic hubs contributed to the spread, scientists believe, and a more diverse genetic mix is still seen in some places around the country, particularly in the Midwest and parts of the South.
H. New PPE
1. New respirator protects health care workers from coronavirus
- To protect health care workers and first responders from C19, Ford is now mass-producing a powered air-purifying respirator (PAPR) of its own design. The device protects a person from breathing in contaminants. The automaker’s version went from initial idea to working prototype in less than 40 days. It’s loosely based on an existing 3M design. But in terms of product development, the engineers moved at the speed of light.
- People fighting on the front lines of the coronavirus pandemic are already benefiting from the automaker’s swift action. The Virginia Mason Medical Center in Seattle, Washington, is the first customer to take delivery of these new PAPRs. “They ordered one pallet of them, 24 [in total],” Marcy Fisher, Ford’s director of global body exterior and interior engineering, told Roadshow on Tuesday. Fisher is heavily involved in the development of the respirators.
- Ford’s PAPR production began in the middle of April at a facility near Flat Rock, Michigan. The automaker has the capacity to build 100,000 or more of these devices.
What is a PAPR?
- A PAPR looks like something an astronaut would wear. And in some ways, it is a lot like a spacesuit. But instead of shielding its occupant from vacuum, temperature extremes or dangerous radiation, Ford’s new PAPR is designed specifically to protect against the coronavirus.
- A PAPR provides the wearer with filtered air delivered under positive pressure to protect them from outward contaminants. In this case, the system is designed to prevent the spread of infectious disease, but similar respirators have other applications. For instance, they can be used while welding or painting to keep harmful fumes away.
- “The air pressure comes from up over the top of the hood and down,” Fisher explained. This prevents any outside contaminants from getting in. “[It] keeps that filtered air in front to the health care worker at all times.”
- There are several major components to a PAPR. With Ford’s design, the most obvious is that brightly colored hood with an integrated face shield. It slips over the wearer’s head and fits firmly to the face with an elastic band. The seal here is snug, but not airtight, as it doesn’t need to be. A flexible hose connects to the back of that hood and runs to the main body of the respirator, which contains a battery, a blower fan and the all-important HEPA filter to keep those nasty viruses out. In a typical hospital setting, Fisher said Ford is estimating the filter will last for years.
- The PAPR uses an off-the-shelf battery you can buy at Home Depot, and the blower fan motor is similar to what you’d find in an F-150 pickup truck.
- Ford engineers wanted to use an existing filter design, but 3M couldn’t build enough of them. So, Fisher explained the company went to Mann+Hummel, one of its automotive supply partners in Germany, which was able to create a filter specifically for this application.
- “And that’s what really helped us move fast,” Fisher said, knowing how to leverage Ford’s existing supply base that it would normally use to build cars. The PAPR’s tube, for instance, is provided by a company called TI Fluids, which normally makes fuel tanks, among other things. Seat suppliers are sewing the hoods. Really, it’s a team effort.
- Ford partnered with 3M while creating this device and both companies worked with the Centers for Disease Control during development. Ford’s PAPR is approved by the National Institute for Occupational Safety and Health for limited use to help during the C19 crisis.
- The official name of Ford’s PAPR is the Limited Use Public Health Emergency Powered Air-Purifying Respirator. Internally, employees refer to it as the “Scrappy PAPR” since it was made as quickly as possible and out of an unusual collection of components. “That’s the idea,” Fisher said. “It needs to be scrappy.”
1. As California reopens, nail salons, gyms and hair salons will not be allowed to open due to risk
- Community spread of the coronavirus in California began in a nail salon, Gov. Gavin Newsom said Thursday, as other states allow their manicurists to reopen.
- Newsom has announced a four-phase plan to reopening the state’s economy that begins on Friday. Unlike some other states that have announced reopenings, California nail salons won’t be allowed to reopen until the state’s phase 3. It’s currently shifting from phase 1 to phase 2.
- “This whole thing started in the state of California, the first community spread, in a nail salon,” Newsom said at a news briefing. “I’m very worried about that.”
- State health directors have put some “red flags” on nail salons as a high-risk business, Newsom added, likening them to gyms and hair salons. He announced Monday that the state will allow some low-risk businesses, including bookstores, warehouses, florists and more, to begin reopening with modifications and offering curbside pickup as soon as Friday.
- He has not offered a timeline for when other businesses such as nail salons can reopen, which will likely depend on the local containment of the outbreak in different parts of the state.
- Other states haven’t been as cautions when it comes to reopening personal care locations like nail salons. Texas Gov. Greg Abbott announced earlier this week hair and nail salons, barber shops and tanning salons will be allowed to reopen with modifications on Friday.
- As states reopen in various ways and to different degrees, epidemiologists are eagerly watching the data to try to glean some results. However, in the absence of a comprehensive coronavirus test and trace program, researchers say it will likely be weeks after reopening until the policy decisions are evident in the data.