Coronavirus

(Reuters) - The highly contagious novel coronavirus that has exploded into a global pandemic can remain viable and infectious in droplets in the air for hours and on surfaces up to days, according to a new study that should offer guidance to help people avoid contracting the respiratory illness called COVID-19.

Scientists from the National Institute of Allergy and Infectious Diseases (NIAID), part of the U.S. National Institutes of Health, attempted to mimic the virus deposited from an infected person onto everyday surfaces in a household or hospital setting, such as through coughing or touching objects.

They used a device to dispense an aerosol that duplicated the microscopic droplets created in a cough or a sneeze.

The scientists then investigated how long the virus remained infectious on these surfaces, according to the study that appeared online in the New England Journal of Medicine on Tuesday.

The tests show that when the virus is carried by the droplets released when someone coughs or sneezes, it remains viable, or able to still infect people, in aerosols for at least three hours.

On plastic and stainless steel, viable virus could be detected after three days. On cardboard, the virus was not viable after 24 hours.

A couple of weeks ago, Italy was much like us, with 107 deaths on March 4. But things were already rapidly getting worse; by March 10, more than 600 people were dead, and today more than 3,400 are. That makes Italy the epicenter of coronavirus fatalities in the world, with more deaths than even China, where the outbreak started. Hospitals have been pushed to the breaking point, with doctors and nurses without adequate protective equipment collapsing at work and other doctors reporting that patients won’t all get lifesaving care because there isn’t enough of it to go around.

What’s scary about Italy’s experience is that Italy wasn’t exactly passive in its response to the virus. The country did act, quarantining a dozen towns in northern regions on February 23, urging the public to engage in social distancing, and ordering the closure of all schools nationwide on March 4.

But case numbers kept growing. On March 8, Italy locked down the north of the country, and on March 9 it extended the lockdown to the whole country. Now, it looks like these extreme efforts might have slowed the rate of growth of cases. On March 15, there were 3,590 new cases. On March 16, 3,233. On the 17th, 3,526. And on the 18th, 4,207. That’s not exponential growth, suggesting the lockdown really did help — but those still aren’t good numbers, especially when Italy’s hospitals are already overwhelmed.

Italy has been devastated by the virus because the action it took was just a little too moderate, a little too restrained, and a little too slow. The country took measures that were substantial and costly but nonetheless insufficient to actually bring the epidemic to a halt. (This was the message hammered home in a recent project where Italians sent video messages to themselves 10 days ago.)

the bottom line remains that there’s no real reason to think that measures that didn’t suffice in Italy will suffice here.

The lesson from Italy isn’t just that you have to act before your hospitals are overwhelmed. It’s that you have to take steps that appear in the moment to be an exceptional overreaction — because by the time it looks like the steps you’re taking are appropriate, it will have been too late.

One chart that should worry Americans
Now, when public health experts say the US is on Italy’s trajectory, what exactly does that mean?

It means that the US and most European countries are seeing early coronavirus growth numbers that look like the ones from Italy. Our confirmed cases are increasing at about the rate theirs did. That gives us every reason to think our health systems will eventually be overwhelmed like theirs were, unless we take strong measures sooner than they did.

So far, we’ve taken some strong measures — which is good! But it’s not clear that we’re acting that much faster than Italy did — and remember, Italy wasn’t fast enough.

The frightening chart above compares the US’s reactions to Italy’s. It shows confirmed case numbers in Italy and in the US, starting on the day when each country passed 100 confirmed cases. It shows the points at which Italy took various precautionary measures. To break away from Italy’s trajectory, we need to take measures that are stronger than the ones it took, or take measures sooner on the trajectory than it did.

The US passed the 13,000 confirmed case mark on Thursday. Italy locked down the northern half of the country on the day it reached 13,000 cases and extended the lockdown to the southern half one day later.

To be sure, there are a lot of problems with using confirmed case data for these trajectory estimates. Italy is likely substantially undertesting, as is the US. Confirmed cases are a poor reflection of overall cases. Sometimes, growth in confirmed cases is due to increases in testing capacity, not increases in the virus’s spread.

But even with those caveats, confirmed case data isn’t worthless. “They lag behind reality,” Dr. Caitlin Rivers at Johns Hopkins University told me on Monday, but they’re still our best window into what is going on.

And looking through that window, the picture looks bleak for the US. Taking the drastic steps some parts of the country are now taking, like the California stay-at-home order, gives us a chance — not a guarantee, to be clear — to veer from the Italian trajectory.

“You are always behind where you think you are”
In a press conference on March 16, the National Institutes of Health’s Dr. Anthony Fauci, who has played a major role in leading the US response, explained to Americans why the strong measures the government was taking were not an overreaction.

“Some will look and say, well, maybe we’ve gone a little bit too far,” he said. “The thing that I want to reemphasize, and I’ll say it over and over again, when you’re dealing with an emerging infectious diseases outbreak, you are always behind where you think you are if you think that today reflects where you really are.”

Italy took strong measures. Its mistake was not that it didn’t react at all — it’s that it kept being a little bit behind the ball. Each measure was appropriate to the situation the Italians observed. But the real situation was always much worse. So things kept worsening until they pulled out all the stops with a countrywide lockdown.

“It will always seem that the best way to address [the virus] would be to be doing something that looks like it might be an overreaction,” Fauci said. “It isn’t an overreaction. It’s reaction we feel is commensurate [with what] is actually going on in reality.”

To break away from Italy’s trajectory, we have to respond with stronger measures than Italy. We have to respond in ways that feel like an overreaction. In the past few days, we’ve seen the first US steps that are stronger than Italy’s responses at a similar point in the outbreak — steps like the Bay Area’s shelter-in-place order, the follow-up extending it to all of California, New York’s similar order Friday, and state orders shutting down restaurants and bars. That’s what it will take to give ourselves a chance at a different curve.

JetBlue passenger receives lifetime ban for flying with COVID-19

https://www.cbsnews.com/news/jetblue-bans-passenger-flew-positive-coronavirus-nyc-jfk-palm-beach-flight/

https://abcnews.go.com/US/jetblue-plane-passenger-diagnosed-coronavirus-landing-florida/story?id=69553619

It looks like we have no idea how many cases there are in the US because we can't test for them.

Birx: Anyone who has left New York should self-quarantine

Experts on the White House Coronavirus Task Force expressed alarm on Tuesday over infection rates
in New York City, and advised that people who have passed through or left the city should place
themselves into 14-day quarantine.

Dr. Deborah Birx, the coronavirus response coordinator, said new infection hot spots on Long Island
indicate that people leaving the city are already spreading the virus.

N.J. man charged with terroristic threats after coughing on grocery store worker and saying he had coronavirus

A man in Missouri was arrested after licking a row of products on a Walmart shelf and filming it, then posting it to social media.
Before licking the items he said, "Who's scared of the coronavirus?"

Here’s how that looks in chart form, with the line chart representing excess flu deaths and the black and gray bars below showing when social distancing measures were in place. The highest peak comes after social distancing measures were lifted, with the death rate falling only after they were reinstituted.



This did not just happen in St. Louis. Analyzing data from 43 cities, the JAMA study found this pattern repeatedly across the country. Howard Markel, an author of the study and the director of the University of Michigan’s Center for the History of Medicine, described the results as a bunch of “double-humped epi curves” — officials instituted social distancing measures, saw flu cases fall, then pulled back the measures and saw flu cases rise again.

A California man who peddled prevention pills and a bogus injectable cure for novel coronavirus infections on social media has been arrested on a federal fraud charge.

Keith Lawrence Middlebrook, 53, was arrested by the FBI yesterday evening after posting multiple videos to Instagram claiming he had developed treatment for anyone suffering from COVID-19. He allegedly solicited financial investments for a company he claimed was developing the medicine.

The study, which used pandemic data gathered in China, Italy, and South Korea, has been lauded by epidemiologists around the world as the most comprehensive prediction of what the US could be facing in the coming months. But it also paints some bleak pictures, including millions of deaths if little is done.

To understand how mitigation or suppression would play out, the Imperial College team, led by Neil Ferguson, OBE, ran a model based on three scenarios. In the first, US officials do nothing to mitigate the spread of COVID-19, schools and businesses are kept open, and the virus is allowed to move through the population.

This would result in 81% of the US population, about 264 million people, contracting the disease. Of those, 2.2 million would die, including 4% to 8% of Americans over age 70. More important, by the second week in April, the demand for critical care beds would be 30 times greater than supply.

If mitigation practices are put in place, including a combination of case isolation, home quarantine, and social distancing of those most at risk (over age 70), the peak critical care demand would reduce by 60%, and there would be half the number of deaths. But this scenario still produces an eightfold demand on critical care beds above surge capacity.

In order to suppress the pandemic to an R0 of below 1, a country would need to combine case isolation, social distancing of the entire population, and either household quarantine or school and university closure, the authors found. These measures "are assumed to be in place for a 5-month duration," they wrote.

In addition, the authors said, these measures may have to be put back into place if restrictions are lifted and cases surge again.

CDC estimates that the burden of illness during the 2018–2019 season included an estimated 35.5 million people getting sick with influenza, 16.5 million people going to a health care provider for their illness, 490,600 hospitalizations, and 34,200 deaths from influenza