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"title": "Coronavirus: See If Your State Is Doing Enough Testing to Safely Phase Out Social Distancing",
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"content": "\u003cp>To safely phase out social distancing measures, the U.S. needs more diagnostic testing for the coronavirus, experts say. But how much more?\u003c/p>\n\u003cp>[pullquote]Adequate testing is one key component, public health experts say, in assessing whether a state is ready to relax its social distancing measures. Here’s how each state is doing in terms of its current daily testing versus a target amount prescribed by one model. [/pullquote]The Trump administration said on April 27 that the U.S. will soon have enough capacity to conduct double the current amount of testing for active infections. The country has done nearly 248,000 tests daily on average in the past seven days, according to the nonprofit COVID Tracking Project. Doubling that would mean doing about 496,000 a day.\u003c/p>\n\u003cp>Will that be enough? What benchmark should states try to hit?\u003c/p>\n\u003cp>One prominent research group, Harvard’s Global Health Institute, proposes that the U.S. should be doing more than 900,000 tests per day as a country. This projection, released Thursday, May 7, is a big jump from its earlier projection of testing need, which had been between 500,000 and 600,000 daily.\u003c/p>\n\u003cp>Harvard’s testing estimate increased, says Ashish Jha, director of the Global Health Institute, because the latest modeling shows that the outbreak in the United States is worse than projected earlier.\u003c/p>\n\u003cp>“Just in the last few weeks, all of the models have converged on many more people getting infected and many more people [dying],” he says.\u003c/p>\n\u003cp>But each state’s specific need for testing varies depending on the size of its outbreak, explains Jha. The bigger the outbreak, the more testing is needed.\u003c/p>\n\u003cp>On Thursday, Jha’s group at Harvard published a simulation that estimates the amount of testing needed in each state by May 15.\u003c/p>\n\u003cp id=\"responsive-embed-covid-testing-states-20200429\" data-pym-loader=\"\" data-child-src=\"https://apps.npr.org/dailygraphics/graphics/covid-testing-states-20200429/\">Loading…\u003c/p>\n\u003cp>\u003cscript src=\"https://pym.nprapps.org/npr-pym-loader.v2.min.js\">\u003c/script>\u003c/p>\n\u003cp>\u003cstrong>Two ways to assess whether testing is adequate\u003c/strong>\u003c/p>\n\u003cp>To make their state-by-state estimates, the Harvard Global Health Institute group started from a model of future case counts. It calculated how much testing would be needed for a state to test all infected people and any close contacts they may have exposed to the virus. (The simulation estimates testing 10 contacts on average.)\u003c/p>\n\u003cp>“Testing is outbreak control 101, because what testing lets you do is figure out who’s infected and who’s not,” Jha says. “And that lets you separate out the infected people from the noninfected people and bring the disease under control.”\u003c/p>\n\u003cp>This approach is how communities can prevent outbreaks from flaring up. First, test all symptomatic people, then reach out to their close contacts and test them, and finally ask those who are infected or exposed to isolate themselves.\u003c/p>\n\u003cp>Our chart also shows another testing benchmark for each state: the ratio of tests conducted that come back positive. Communities that see about 10% or fewer positives among their test results are probably testing enough, the World Health Organization advises. If the rate is higher, they’re likely missing a lot of active infections.\u003c/p>\n\u003cp>What is apparent from the data we present below is that many states are far from both the Harvard estimates and the 10% positive benchmark.\u003c/p>\n\u003cp>Just nine states are near or have exceeded the testing minimums estimated by Harvard; they are mostly larger, less populous states: Alaska, Hawaii, Montana, North Dakota, Oregon, Tennessee, Utah, West Virginia and Wyoming.\u003c/p>\n\u003cp>Several states with large outbreaks — New York, Massachusetts and Connecticut, among others — are very far from the minimum testing target. Some states that are already relaxing their social distancing restrictions, such as Georgia, Texas and Colorado, are far from the target too.\u003c/p>\n\u003cp>Jha offers several caveats about his group’s estimates.\u003c/p>\n\u003cp>\u003cstrong>Estimates are directional, not literal\u003c/strong>\u003c/p>\n\u003cp>Researchers at the Global Health Initiative at Harvard considered three different models of the U.S. coronavirus outbreak as a starting point for their testing estimates. They found that while there was significant variation in the projections of outbreak sizes, all of the models tend to point in the same direction, i.e., if one model showed that a state needed significantly more testing, the others generally did too.\u003c/p>\n\u003cp>The model they used to create these estimates is the Youyang Gu \u003ca href=\"https://urldefense.com/v3/__https:/covid19-projections.com/about/__;!!Iwwt!EPgZcyoMCKatS48-X1OvhJTkdvyloEkPTmp4-PEgTbIMvkBkuBTEb3tO-T90%24\" target=\"_blank\" rel=\"noopener noreferrer\">COVID-19 Forecasts\u003c/a>, which they say has tracked closely with what’s actually happened on the ground. Still, the researchers caution, these numbers are not meant to be taken literally but as a guide.\u003c/p>\n\u003cp id=\"responsive-embed-covid-testing-states-20200429-models\" data-pym-loader=\"\" data-child-src=\"https://apps.npr.org/dailygraphics/graphics/covid-testing-states-20200429/models.html\">Loading…\u003c/p>\n\u003cp>\u003cscript src=\"https://pym.nprapps.org/npr-pym-loader.v2.min.js\">\u003c/script>\u003c/p>\n\u003cp>\u003cstrong>If social distancing is relaxed, testing needs may grow\u003c/strong>\u003c/p>\n\u003cp>The Harvard testing estimates are built on a model that assumes that states continue social distancing through May 15. And \u003ca href=\"https://www.kff.org/health-costs/issue-brief/state-data-and-policy-actions-to-address-coronavirus/#socialdistancing\" target=\"_blank\" rel=\"noopener noreferrer\">about half of states have already started lifting\u003c/a> some of those.\u003c/p>\n\u003cp>Jha says that without the right measures in place to contain spread, easing up could quickly lead to new cases.\u003c/p>\n\u003cp>“The moment you relax, the number of cases will start climbing. And therefore, the number of tests you need to keep your society, your state from having large outbreaks will also start climbing,” warns Jha.\u003c/p>\n\u003cp>\u003cstrong>Testing alone is not enough\u003c/strong>\u003c/p>\n\u003cp>A community can’t base the decision that it’s safe to open up on testing data alone. States should also see a consistent decline in the number of cases, of two weeks at least, according to White House guidance. If their cases are instead increasing, they should assume the number of tests they need will increase too.\u003c/p>\n\u003cp>And, Jha warns, testing is step one, but it won’t contain an outbreak by itself. It needs to be part of “a much broader set of strategies and plans the states need to have in place” when they begin to reopen.\u003c/p>\n\u003cp>In fact, his group’s model is built on the assumption that states are doing contact tracing and have plans to support isolation for infected or exposed people.\u003c/p>\n\u003cp>“I don’t want anybody to just look at the number and say, we meet it and we’re good to go,” he says. “What this really is, is testing capacity in the context of having a really effective workforce of contact tracers.”\u003c/p>\n\u003cp>\u003cstrong>The targets are floors, not goals\u003c/strong>\u003c/p>\n\u003cp>States that have reached the estimated target should think of that as a starting point.\u003c/p>\n\u003cp>“We’ve always built these as the floor, the bare minimum,” Jha says. More testing would be even better, allowing states to more rapidly tamp down case surges.\u003c/p>\n\u003cp>In fact, other experts have proposed that the U.S. do even more testing. Paul Romer, a professor of economics at New York University, proposed in a recent white paper that if the U.S. tested every resident, every two weeks, isolating those who test positive, it could stop the pandemic in its tracks.\u003c/p>\n\u003cp>Jha warns that without sufficient testing, and the infrastructure in place to trace and isolate contacts, there’s a real risk that states — even those with few cases now — will see new large outbreaks. “I think what people have to remember is that the virus isn’t gone. The disease isn’t gone. And it’s going to be with us for a while,” he says.\u003c/p>\n\u003cp>\u003cem>Daniel Wood contributed to this report.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2020 NPR. To see more, visit https://www.npr.org.\u003cimg decoding=\"async\" src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=U.S.+Coronavirus+Testing+Still+Falls+Short.+How%27s+Your+State+Doing%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>To safely phase out social distancing measures, the U.S. needs more diagnostic testing for the coronavirus, experts say. But how much more?\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "Adequate testing is one key component, public health experts say, in assessing whether a state is ready to relax its social distancing measures. Here’s how each state is doing in terms of its current daily testing versus a target amount prescribed by one model. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>The Trump administration said on April 27 that the U.S. will soon have enough capacity to conduct double the current amount of testing for active infections. The country has done nearly 248,000 tests daily on average in the past seven days, according to the nonprofit COVID Tracking Project. Doubling that would mean doing about 496,000 a day.\u003c/p>\n\u003cp>Will that be enough? What benchmark should states try to hit?\u003c/p>\n\u003cp>One prominent research group, Harvard’s Global Health Institute, proposes that the U.S. should be doing more than 900,000 tests per day as a country. This projection, released Thursday, May 7, is a big jump from its earlier projection of testing need, which had been between 500,000 and 600,000 daily.\u003c/p>\n\u003cp>Harvard’s testing estimate increased, says Ashish Jha, director of the Global Health Institute, because the latest modeling shows that the outbreak in the United States is worse than projected earlier.\u003c/p>\n\u003cp>“Just in the last few weeks, all of the models have converged on many more people getting infected and many more people [dying],” he says.\u003c/p>\n\u003cp>But each state’s specific need for testing varies depending on the size of its outbreak, explains Jha. The bigger the outbreak, the more testing is needed.\u003c/p>\n\u003cp>On Thursday, Jha’s group at Harvard published a simulation that estimates the amount of testing needed in each state by May 15.\u003c/p>\n\u003cp id=\"responsive-embed-covid-testing-states-20200429\" data-pym-loader=\"\" data-child-src=\"https://apps.npr.org/dailygraphics/graphics/covid-testing-states-20200429/\">Loading…\u003c/p>\n\u003cp>\u003cscript src=\"https://pym.nprapps.org/npr-pym-loader.v2.min.js\">\u003c/script>\u003c/p>\n\u003cp>\u003cstrong>Two ways to assess whether testing is adequate\u003c/strong>\u003c/p>\n\u003cp>To make their state-by-state estimates, the Harvard Global Health Institute group started from a model of future case counts. It calculated how much testing would be needed for a state to test all infected people and any close contacts they may have exposed to the virus. (The simulation estimates testing 10 contacts on average.)\u003c/p>\n\u003cp>“Testing is outbreak control 101, because what testing lets you do is figure out who’s infected and who’s not,” Jha says. “And that lets you separate out the infected people from the noninfected people and bring the disease under control.”\u003c/p>\n\u003cp>This approach is how communities can prevent outbreaks from flaring up. First, test all symptomatic people, then reach out to their close contacts and test them, and finally ask those who are infected or exposed to isolate themselves.\u003c/p>\n\u003cp>Our chart also shows another testing benchmark for each state: the ratio of tests conducted that come back positive. Communities that see about 10% or fewer positives among their test results are probably testing enough, the World Health Organization advises. If the rate is higher, they’re likely missing a lot of active infections.\u003c/p>\n\u003cp>What is apparent from the data we present below is that many states are far from both the Harvard estimates and the 10% positive benchmark.\u003c/p>\n\u003cp>Just nine states are near or have exceeded the testing minimums estimated by Harvard; they are mostly larger, less populous states: Alaska, Hawaii, Montana, North Dakota, Oregon, Tennessee, Utah, West Virginia and Wyoming.\u003c/p>\n\u003cp>Several states with large outbreaks — New York, Massachusetts and Connecticut, among others — are very far from the minimum testing target. Some states that are already relaxing their social distancing restrictions, such as Georgia, Texas and Colorado, are far from the target too.\u003c/p>\n\u003cp>Jha offers several caveats about his group’s estimates.\u003c/p>\n\u003cp>\u003cstrong>Estimates are directional, not literal\u003c/strong>\u003c/p>\n\u003cp>Researchers at the Global Health Initiative at Harvard considered three different models of the U.S. coronavirus outbreak as a starting point for their testing estimates. They found that while there was significant variation in the projections of outbreak sizes, all of the models tend to point in the same direction, i.e., if one model showed that a state needed significantly more testing, the others generally did too.\u003c/p>\n\u003cp>The model they used to create these estimates is the Youyang Gu \u003ca href=\"https://urldefense.com/v3/__https:/covid19-projections.com/about/__;!!Iwwt!EPgZcyoMCKatS48-X1OvhJTkdvyloEkPTmp4-PEgTbIMvkBkuBTEb3tO-T90%24\" target=\"_blank\" rel=\"noopener noreferrer\">COVID-19 Forecasts\u003c/a>, which they say has tracked closely with what’s actually happened on the ground. Still, the researchers caution, these numbers are not meant to be taken literally but as a guide.\u003c/p>\n\u003cp id=\"responsive-embed-covid-testing-states-20200429-models\" data-pym-loader=\"\" data-child-src=\"https://apps.npr.org/dailygraphics/graphics/covid-testing-states-20200429/models.html\">Loading…\u003c/p>\n\u003cp>\u003cscript src=\"https://pym.nprapps.org/npr-pym-loader.v2.min.js\">\u003c/script>\u003c/p>\n\u003cp>\u003cstrong>If social distancing is relaxed, testing needs may grow\u003c/strong>\u003c/p>\n\u003cp>The Harvard testing estimates are built on a model that assumes that states continue social distancing through May 15. And \u003ca href=\"https://www.kff.org/health-costs/issue-brief/state-data-and-policy-actions-to-address-coronavirus/#socialdistancing\" target=\"_blank\" rel=\"noopener noreferrer\">about half of states have already started lifting\u003c/a> some of those.\u003c/p>\n\u003cp>Jha says that without the right measures in place to contain spread, easing up could quickly lead to new cases.\u003c/p>\n\u003cp>“The moment you relax, the number of cases will start climbing. And therefore, the number of tests you need to keep your society, your state from having large outbreaks will also start climbing,” warns Jha.\u003c/p>\n\u003cp>\u003cstrong>Testing alone is not enough\u003c/strong>\u003c/p>\n\u003cp>A community can’t base the decision that it’s safe to open up on testing data alone. States should also see a consistent decline in the number of cases, of two weeks at least, according to White House guidance. If their cases are instead increasing, they should assume the number of tests they need will increase too.\u003c/p>\n\u003cp>And, Jha warns, testing is step one, but it won’t contain an outbreak by itself. It needs to be part of “a much broader set of strategies and plans the states need to have in place” when they begin to reopen.\u003c/p>\n\u003cp>In fact, his group’s model is built on the assumption that states are doing contact tracing and have plans to support isolation for infected or exposed people.\u003c/p>\n\u003cp>“I don’t want anybody to just look at the number and say, we meet it and we’re good to go,” he says. “What this really is, is testing capacity in the context of having a really effective workforce of contact tracers.”\u003c/p>\n\u003cp>\u003cstrong>The targets are floors, not goals\u003c/strong>\u003c/p>\n\u003cp>States that have reached the estimated target should think of that as a starting point.\u003c/p>\n\u003cp>“We’ve always built these as the floor, the bare minimum,” Jha says. More testing would be even better, allowing states to more rapidly tamp down case surges.\u003c/p>\n\u003cp>In fact, other experts have proposed that the U.S. do even more testing. Paul Romer, a professor of economics at New York University, proposed in a recent white paper that if the U.S. tested every resident, every two weeks, isolating those who test positive, it could stop the pandemic in its tracks.\u003c/p>\n\u003cp>Jha warns that without sufficient testing, and the infrastructure in place to trace and isolate contacts, there’s a real risk that states — even those with few cases now — will see new large outbreaks. “I think what people have to remember is that the virus isn’t gone. The disease isn’t gone. And it’s going to be with us for a while,” he says.\u003c/p>\n\u003cp>\u003cem>Daniel Wood contributed to this report.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2020 NPR. To see more, visit https://www.npr.org.\u003cimg decoding=\"async\" src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=U.S.+Coronavirus+Testing+Still+Falls+Short.+How%27s+Your+State+Doing%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\u003cp>\u003c/p>\u003c/div>",
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"title": "Mystery Inflammatory Syndrome In Kids And Teens Likely Linked To COVID-19",
"headTitle": "Mystery Inflammatory Syndrome In Kids And Teens Likely Linked To COVID-19 | KQED",
"content": "\u003cp>\u003cstrong>Updated May 8 at 11:54 a.m. ET\u003c/strong>\u003c/p>\n\u003cp>Sixty-four children and teens in New York State are suspected of having a mysterious inflammatory syndrome that is believed to be linked to COVID-19, the New York Department of Health said in an alert issued Wednesday. A growing number of similar cases — including at least one death — have been reported in other parts of the U.S. and Europe, though the phenomenon is still not well-understood.\u003c/p>\n\u003cp>Pediatricians say parents should not panic; the condition remains extremely rare. But researchers also are taking a close look at this emerging syndrome, and say parents should be on the lookout for symptoms in their kids that might warrant a quick call to the doctor — a persistent high fever over several days and significant abdominal pains with repeated vomiting, after which the child does not feel better.\u003c/p>\n\u003cp>“If [the child is] looking particularly ill, you should definitely call the doctor,” says \u003ca href=\"https://www.cudoctors.com/Find_A_Doctor/Profile/8599\">Dr. Sean O’Leary,\u003c/a> a pediatric infectious disease specialist at Children’s Hospital Colorado Anschutz Medical Campus and member of the infectious disease committee for the American Academy of Pediatrics.\u003c/p>\n\u003cp>The new condition associated with COVID-19 is called Pediatric Multi-System Inflammatory Syndrome. Symptoms include persistent fever, extreme inflammation and evidence of one or more organs that are not functioning properly, says cardiologist \u003ca href=\"http://www.childrenshospital.org/directory/physicians/n/jane-newburger\">Jane Newburger\u003c/a>, a professor of pediatrics at Harvard Medical School and director of the Kawasaki Program at Boston Children’s Hospital.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“It’s still very rare, but there’s been a wave of cases. Physicians and scientists are working hard to understanding the mechanisms at play, and why only some children are so severely affected,” Newburger says.\u003c/p>\n\u003cp>Some symptoms can resemble features of \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5717875/\">Kawasaki Disease Shock Syndrome\u003c/a>. \u003ca href=\"https://www.cdc.gov/kawasaki/about.html\">Kawasaki disease\u003c/a> is an acute illness in children involving fever with symptoms including rash; conjunctivitis; redness in the lips, tongue and mucous membranes of the mouth and throat; swollen hands and/or feet; and sometimes an enlarged group of lymph nodes on one side of the neck, says Newburger. Some children with the condition develop enlargement of the coronary arteries and aneurysms in those blood vessels.\u003c/p>\n\u003cp>A small percentage of Kawasaki cases go on to develop symptoms of shock, which can include a steep drop in systolic blood pressure and difficulty with sufficient blood supply to the body’s organs. Kawasaki disease and KDSS more often affect young children, although they can sometimes affect teens, Newburger says.\u003c/p>\n\u003cp>Some cases of the new inflammatory syndrome have features that overlap with KD or with KDSS — including rash, conjunctivitis, and swollen hands or feet. The new inflammatory syndrome can affect not only young children but also older children and teens.\u003c/p>\n\u003cp>But patients with the new syndrome have lab results that look very different, in particular, “cardiac inflammation to a greater degree than we typically see in Kawasaki shock syndrome,” which is usually very rare, O’Leary says. In New York City and London, which have seen large numbers of COVID-19 cases, “those types of patients are being seen with greater frequency.”\u003c/p>\n\u003cp>Some patients “come in very, very sick,” with low blood pressure and high fever, O’Leary says. Some children have had coronary artery aneurysms, though most have not, he adds.\u003c/p>\n\u003cp>Other patients exhibit symptoms more similar to \u003ca href=\"https://wwwn.cdc.gov/nndss/conditions/toxic-shock-syndrome-other-than-streptococcal/case-definition/2011/\">toxic shock syndrome\u003c/a>, with abdominal pain, vomiting and diarrhea, and high levels of inflammation in the body, including the heart, O’Leary says. Most cases are treated in the intensive care unit, he says. Treatment includes intravenous immunoglobulin, which can “calm the immune system,” says Newburger, as well as steroids and cytokine blockers.\u003c/p>\n\u003cp>The evidence so far from Europe, where reports of the syndrome first emerged, suggests most children will recover with proper supportive care, says O’Leary, though one adolescent, a 14-year-old boy in London, has died, according to a report published Wednesday in \u003ca href=\"https://www.thelancet.com/lancet/article/s0140-6736(20)31094-1\">The Lancet\u003c/a>.\u003c/p>\n\u003cp>Most children with the syndrome, O’Leary and Newburger note, have either tested positive for a current infection with the coronavirus, or for antibodies to the virus, which would suggest they were infected earlier and recovered.\u003c/p>\n\u003cp>And, according to case reports, some of the kids with the inflammatory syndrome who tested negative on coronavirus tests had been exposed at some point to someone known to have COVID-19. The inflammatory syndrome can appear days to weeks after COVID-19 illness, doctors say, suggesting the syndrome arises out of the immune system’s response to the virus.\u003c/p>\n\u003cp>“One theory is that as one begins to make antibodies to SARS-COV-2, the antibody itself may be provoking an immune response,” says Newburger. “This is only happening in susceptible individuals whose immune systems are built in a particular way. It doesn’t happen in everybody. It’s still a really uncommon event in children.”\u003c/p>\n\u003cp>In late April, the U.K.’s National Health Service issued an alert to pediatricians about the syndrome. Reports have also surfaced in France, Spain and Italy, and probably number in the dozens globally, Newburger and O’Leary say, though doctors still don’t have hard numbers. Newburger says there needs to be a registry where doctors can report cases “so we can begin to generate some statistics.”\u003c/p>\n\u003cp>“Doctors across countries are talking to each other, but we need for there to be some structure and some science so that everybody can interpret,” she says.\u003c/p>\n\u003cp>\u003ca href=\"https://findaprovider.nemours.org/details/1193/deepika-thacker-cardiology-glen_mills-seaford-wilmington\">Dr. Deepika Thacker\u003c/a>, a cardiologist with Nemours Children’s Health System, in Wilmington, Del., says she’s seen three cases in children that fit the profile for the new syndrome. The first case was back in mid-April.\u003c/p>\n\u003cp>“When we first saw that kid, we didn’t know what it was,” she says. But a couple of days later, a pediatrician friend from the U.K. sent her a WhatsApp message about the emerging syndrome. “In retrospect, that’s what it was,” Thacker says now.\u003c/p>\n\u003cp>“He responded beautifully to treatment, so he was already out of the hospital by the time I got bad reports from Europe,” she says. Since then, doctors have gone back to that first patient and tested the boy for antibodies to the coronavirus; they’re still awaiting the results.\u003c/p>\n\u003cp>Earlier this week, the New York City Health Department issued an alert saying 15 children ranging in age from 2 to 15 had been hospitalized with the syndrome. \u003ca href=\"https://nyulangone.org/doctors/1629212592/purvi-s-parikh\">Dr. \u003cstrong>Purvi Parikh\u003c/strong>\u003c/a>\u003cstrong>, \u003c/strong>a pediatric immunologist at NYU Langone Health, says she’s seen three patients with the syndrome in the past week, all of whom are doing well with treatment.\u003c/p>\n\u003cp>“They all present in varying ways,” says Parikh, who is also a spokesperson for \u003ca href=\"https://www.physiciansforpatientprotection.org/about-us/\">Physicians for Patient Protection\u003c/a>. “But the common theme was fever and rash. One had very, very swollen lymph nodes and lymph glands. And then, aside from that, they had markers of inflammation elevated in their blood.”\u003c/p>\n\u003cp>“Up until now, we were mostly seeing these markers of inflammation in adults that were presenting with COVID-19,” Parikh says. “But now we’re also seeing a similar syndrome in children.”\u003c/p>\n\u003cp>A spokesperson for Children’s Healthcare of Atlanta says infectious disease specialists there are evaluating several cases of children who have exhibited Kawasaki-like symptoms and inflammation — to determine if those patients may also have had COVID-19 and to investigate if any association between the two conditions might exist.\u003c/p>\n\u003cp>Newburger says that she’s been contacted about cases in New Jersey and Philadelphia, as well.\u003c/p>\n\u003cp>While the syndrome’s precise connection to the coronavirus isn’t yet clear, O’Leary says the fact that the children in most of these cases are testing positive for exposure to the virus, one way or another, provides one point of evidence. The sheer number of cases — small in absolute terms, but still “much higher than we would expect normally for things like severe Kawasaki or toxic shock syndrome” — provides another, he says.\u003c/p>\n\u003cp>And then there’s the fact that most reports of the syndrome have come out of the U.K. and New York City, places that have been hit with large numbers of COVID-19 cases.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“It’s pure speculation at this point,” he says, “but the U.K. cluster kind of went up about a month after their COVID-19 infections went up, which would suggest that it is some kind of an immune phenomenon.”\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2020 NPR. To see more, visit https://www.npr.org.\u003cimg decoding=\"async\" src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Mystery+Inflammatory+Syndrome+In+Kids+And+Teens+Likely+Linked+To+COVID-19+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"excerpt": "Doctors in the U.S. and Europe are reporting a small wave of cases of what looks like a \"shock syndrome\" in young people. They have low blood pressure, inflamed hearts and other serious symptoms.",
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"description": "Doctors in the U.S. and Europe are reporting a small wave of cases of what looks like a "shock syndrome" in young people. They have low blood pressure, inflamed hearts and other serious symptoms.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>Updated May 8 at 11:54 a.m. ET\u003c/strong>\u003c/p>\n\u003cp>Sixty-four children and teens in New York State are suspected of having a mysterious inflammatory syndrome that is believed to be linked to COVID-19, the New York Department of Health said in an alert issued Wednesday. A growing number of similar cases — including at least one death — have been reported in other parts of the U.S. and Europe, though the phenomenon is still not well-understood.\u003c/p>\n\u003cp>Pediatricians say parents should not panic; the condition remains extremely rare. But researchers also are taking a close look at this emerging syndrome, and say parents should be on the lookout for symptoms in their kids that might warrant a quick call to the doctor — a persistent high fever over several days and significant abdominal pains with repeated vomiting, after which the child does not feel better.\u003c/p>\n\u003cp>“If [the child is] looking particularly ill, you should definitely call the doctor,” says \u003ca href=\"https://www.cudoctors.com/Find_A_Doctor/Profile/8599\">Dr. Sean O’Leary,\u003c/a> a pediatric infectious disease specialist at Children’s Hospital Colorado Anschutz Medical Campus and member of the infectious disease committee for the American Academy of Pediatrics.\u003c/p>\n\u003cp>The new condition associated with COVID-19 is called Pediatric Multi-System Inflammatory Syndrome. Symptoms include persistent fever, extreme inflammation and evidence of one or more organs that are not functioning properly, says cardiologist \u003ca href=\"http://www.childrenshospital.org/directory/physicians/n/jane-newburger\">Jane Newburger\u003c/a>, a professor of pediatrics at Harvard Medical School and director of the Kawasaki Program at Boston Children’s Hospital.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It’s still very rare, but there’s been a wave of cases. Physicians and scientists are working hard to understanding the mechanisms at play, and why only some children are so severely affected,” Newburger says.\u003c/p>\n\u003cp>Some symptoms can resemble features of \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5717875/\">Kawasaki Disease Shock Syndrome\u003c/a>. \u003ca href=\"https://www.cdc.gov/kawasaki/about.html\">Kawasaki disease\u003c/a> is an acute illness in children involving fever with symptoms including rash; conjunctivitis; redness in the lips, tongue and mucous membranes of the mouth and throat; swollen hands and/or feet; and sometimes an enlarged group of lymph nodes on one side of the neck, says Newburger. Some children with the condition develop enlargement of the coronary arteries and aneurysms in those blood vessels.\u003c/p>\n\u003cp>A small percentage of Kawasaki cases go on to develop symptoms of shock, which can include a steep drop in systolic blood pressure and difficulty with sufficient blood supply to the body’s organs. Kawasaki disease and KDSS more often affect young children, although they can sometimes affect teens, Newburger says.\u003c/p>\n\u003cp>Some cases of the new inflammatory syndrome have features that overlap with KD or with KDSS — including rash, conjunctivitis, and swollen hands or feet. The new inflammatory syndrome can affect not only young children but also older children and teens.\u003c/p>\n\u003cp>But patients with the new syndrome have lab results that look very different, in particular, “cardiac inflammation to a greater degree than we typically see in Kawasaki shock syndrome,” which is usually very rare, O’Leary says. In New York City and London, which have seen large numbers of COVID-19 cases, “those types of patients are being seen with greater frequency.”\u003c/p>\n\u003cp>Some patients “come in very, very sick,” with low blood pressure and high fever, O’Leary says. Some children have had coronary artery aneurysms, though most have not, he adds.\u003c/p>\n\u003cp>Other patients exhibit symptoms more similar to \u003ca href=\"https://wwwn.cdc.gov/nndss/conditions/toxic-shock-syndrome-other-than-streptococcal/case-definition/2011/\">toxic shock syndrome\u003c/a>, with abdominal pain, vomiting and diarrhea, and high levels of inflammation in the body, including the heart, O’Leary says. Most cases are treated in the intensive care unit, he says. Treatment includes intravenous immunoglobulin, which can “calm the immune system,” says Newburger, as well as steroids and cytokine blockers.\u003c/p>\n\u003cp>The evidence so far from Europe, where reports of the syndrome first emerged, suggests most children will recover with proper supportive care, says O’Leary, though one adolescent, a 14-year-old boy in London, has died, according to a report published Wednesday in \u003ca href=\"https://www.thelancet.com/lancet/article/s0140-6736(20)31094-1\">The Lancet\u003c/a>.\u003c/p>\n\u003cp>Most children with the syndrome, O’Leary and Newburger note, have either tested positive for a current infection with the coronavirus, or for antibodies to the virus, which would suggest they were infected earlier and recovered.\u003c/p>\n\u003cp>And, according to case reports, some of the kids with the inflammatory syndrome who tested negative on coronavirus tests had been exposed at some point to someone known to have COVID-19. The inflammatory syndrome can appear days to weeks after COVID-19 illness, doctors say, suggesting the syndrome arises out of the immune system’s response to the virus.\u003c/p>\n\u003cp>“One theory is that as one begins to make antibodies to SARS-COV-2, the antibody itself may be provoking an immune response,” says Newburger. “This is only happening in susceptible individuals whose immune systems are built in a particular way. It doesn’t happen in everybody. It’s still a really uncommon event in children.”\u003c/p>\n\u003cp>In late April, the U.K.’s National Health Service issued an alert to pediatricians about the syndrome. Reports have also surfaced in France, Spain and Italy, and probably number in the dozens globally, Newburger and O’Leary say, though doctors still don’t have hard numbers. Newburger says there needs to be a registry where doctors can report cases “so we can begin to generate some statistics.”\u003c/p>\n\u003cp>“Doctors across countries are talking to each other, but we need for there to be some structure and some science so that everybody can interpret,” she says.\u003c/p>\n\u003cp>\u003ca href=\"https://findaprovider.nemours.org/details/1193/deepika-thacker-cardiology-glen_mills-seaford-wilmington\">Dr. Deepika Thacker\u003c/a>, a cardiologist with Nemours Children’s Health System, in Wilmington, Del., says she’s seen three cases in children that fit the profile for the new syndrome. The first case was back in mid-April.\u003c/p>\n\u003cp>“When we first saw that kid, we didn’t know what it was,” she says. But a couple of days later, a pediatrician friend from the U.K. sent her a WhatsApp message about the emerging syndrome. “In retrospect, that’s what it was,” Thacker says now.\u003c/p>\n\u003cp>“He responded beautifully to treatment, so he was already out of the hospital by the time I got bad reports from Europe,” she says. Since then, doctors have gone back to that first patient and tested the boy for antibodies to the coronavirus; they’re still awaiting the results.\u003c/p>\n\u003cp>Earlier this week, the New York City Health Department issued an alert saying 15 children ranging in age from 2 to 15 had been hospitalized with the syndrome. \u003ca href=\"https://nyulangone.org/doctors/1629212592/purvi-s-parikh\">Dr. \u003cstrong>Purvi Parikh\u003c/strong>\u003c/a>\u003cstrong>, \u003c/strong>a pediatric immunologist at NYU Langone Health, says she’s seen three patients with the syndrome in the past week, all of whom are doing well with treatment.\u003c/p>\n\u003cp>“They all present in varying ways,” says Parikh, who is also a spokesperson for \u003ca href=\"https://www.physiciansforpatientprotection.org/about-us/\">Physicians for Patient Protection\u003c/a>. “But the common theme was fever and rash. One had very, very swollen lymph nodes and lymph glands. And then, aside from that, they had markers of inflammation elevated in their blood.”\u003c/p>\n\u003cp>“Up until now, we were mostly seeing these markers of inflammation in adults that were presenting with COVID-19,” Parikh says. “But now we’re also seeing a similar syndrome in children.”\u003c/p>\n\u003cp>A spokesperson for Children’s Healthcare of Atlanta says infectious disease specialists there are evaluating several cases of children who have exhibited Kawasaki-like symptoms and inflammation — to determine if those patients may also have had COVID-19 and to investigate if any association between the two conditions might exist.\u003c/p>\n\u003cp>Newburger says that she’s been contacted about cases in New Jersey and Philadelphia, as well.\u003c/p>\n\u003cp>While the syndrome’s precise connection to the coronavirus isn’t yet clear, O’Leary says the fact that the children in most of these cases are testing positive for exposure to the virus, one way or another, provides one point of evidence. The sheer number of cases — small in absolute terms, but still “much higher than we would expect normally for things like severe Kawasaki or toxic shock syndrome” — provides another, he says.\u003c/p>\n\u003cp>And then there’s the fact that most reports of the syndrome have come out of the U.K. and New York City, places that have been hit with large numbers of COVID-19 cases.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It’s pure speculation at this point,” he says, “but the U.K. cluster kind of went up about a month after their COVID-19 infections went up, which would suggest that it is some kind of an immune phenomenon.”\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2020 NPR. To see more, visit https://www.npr.org.\u003cimg decoding=\"async\" src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Mystery+Inflammatory+Syndrome+In+Kids+And+Teens+Likely+Linked+To+COVID-19+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"title": "The Porn Industry Has A Lot of Safety Tips for the COVID-19 Era",
"headTitle": "The Porn Industry Has A Lot of Safety Tips for the COVID-19 Era | KQED",
"content": "\u003cp>As states and employers furiously develop plans to safely reopen workplaces in the midst of the coronavirus pandemic, they’re grappling with what seems like an endless list of questions: where to test, who to test, and how often to test for the virus? Further complicating matters are issues of workers’ privacy, geography, politics, science, and cost. It’s a difficult mandate. But there is one place to look for guidance — the adult film industry.\u003c/p>\n\u003cp>[pullquote size='medium' citation='Dr. Ashish Jha, Harvard University Global Health Institute']‘What the adult film industry has produced has worked, and really could be the kind of tool we need. People can’t get distracted because it’s from a business they don’t approve of.’[/pullquote]Since the late 1990s, when an outbreak of HIV infections threatened to shutter the multibillion-dollar industry, the mainstream porn community has implemented procedures that require all performers to be tested for HIV and a host of other sexually transmitted infections every 14 days before they can be cleared to work. Any HIV-positive test leads to an immediate shutdown of all U.S. sets, followed by detailed contact tracing before sets can reopen. While not perfect, those in the industry say the nationwide PASS program works to protect thousands of performers, ensures safer workplaces, and curtails the spread of disease.\u003c/p>\n\u003cp>“I don’t think I could be in this industry without it. That would be insane. Bareback sex with strangers 20 times a month? It would be like the most dangerous job in the world,” said Lance Hart, a gay and straight adult film performer and independent pornographer in Las Vegas who runs the production companies Sweet Femdom and Man Up Films.\u003c/p>\n\u003cp>In the 20 years it has been in place, PASS has met, and overcome, many of the same challenges that any large-scale coronavirus testing program might encounter, from issues of keeping databases of private medical information secure, preventing the forging of test results, dealing with false positive results, and educating workers about the need for repeated testing to keep workplaces safe. Those devising strategies to reopen workplaces and the larger economy during the coronavirus pandemic say their plans would involve, at their core, processes of rigorous testing, isolation, and contact tracing similar to those used in the adult film industry.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“In many ways, what they are doing is a model for what we are trying to do with Covid,” said Ashish Jha, a physician who directs Harvard University’s Global Health Institute and has been calling for widespread national testing to contain the coronavirus. “The adult film industry teaches us that as a proof of concept, this can work. We just have to scale it up.”\u003c/p>\n\u003cp>Jha said he could envision a program similar to PASS where Covid-19 test results are put into a secure database that could be checked to verify whether people had recently tested negative for the virus. “You could imagine TSA verifying someone had tested negative before they were allowed on a flight,” he said. “Testing is particularly important for areas that are high risk, like airplanes or meatpacking plants.”\u003c/p>\n\u003cfigure id=\"attachment_1963924\" class=\"wp-caption alignright\" style=\"max-width: 724px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/35/2020/05/adult-film-inline2.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1963924\" src=\"https://ww2.kqed.org/app/uploads/sites/35/2020/05/adult-film-inline2.jpg\" alt=\"\" width=\"724\" height=\"1024\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2020/05/adult-film-inline2.jpg 724w, https://cdn.kqed.org/wp-content/uploads/sites/35/2020/05/adult-film-inline2-160x226.jpg 160w\" sizes=\"(max-width: 724px) 100vw, 724px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">LAS VEGAS, NV – JANUARY 23: Adult film actress Lotus Lain attends the 2016 Adult Video News Awards at the Hard Rock Hotel & Casino on January 23, 2016 in Las Vegas, Nevada. (Photo by Ethan Miller/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>While it did not cite the adult film industry, a “National Covid-19 Testing Action Plan” released by the Rockefeller Foundation last month included the creation of an “infection database” that could be accessed by employers, schools, TSA, and those scanning tickets for entry into sports or music venues.\u003c/p>\n\u003cp>“What the adult film industry has produced has worked, and really could be the kind of tool we need,” Jha said. “People can’t get distracted because it’s from a business they don’t approve of.”\u003c/p>\n\u003cp>Mike Stabile, communications director for the Free Speech Coalition, the adult entertainment trade association that runs PASS, said the adult film industry understands “better than most the discussion that has to happen for businesses to reopen.”\u003c/p>\n\u003cp>Yet for all of that expertise, it would be hard to imagine the Trump administration, or state politicians, reaching out to the porn industry for guidance. Stabile said that while he has not been contacted by any government officials, he would have plenty of advice to share. “It’s going to be an ongoing process. It’s not going to be a binary open or shut,” he said. “But it’s not as heavy a lift as people think. This is something that’s doable.”\u003c/p>\n\u003cp>Stabile, who is closely following coronavirus news, feels most people are unaware of the need for repeat testing that is standard in his industry. “When you look at the world at large, there’s an idea you’ll be tested once and then go back to work, but with coronavirus, it’s not that simple. We’re looking at a series of regular tests until this gets under control,” he said.\u003c/p>\n\u003cp>[pullquote size='medium' citation='Elizabeth “Betz” Halloran, Center for Inference and Dynamics of Infectious Diseases']‘We can’t sit around for 18 months waiting for a vaccine. We have to find a way out without pharmaceuticals, and that’s repeat testing, taking people out of circulation, and then contact tracing, so it’s an interesting analogy.’[/pullquote]Repeat testing will be necessary for the coronavirus, too, because — like with HIV — there is so much asymptomatic spread of the coronavirus, said Elizabeth “Betz” Halloran, a professor of biostatistics at the University of Washington who directs the Center for Inference and Dynamics of Infectious Diseases at the Fred Hutchinson Cancer Research Center in Seattle.\u003c/p>\n\u003cp>“You’ll have to keep testing, maybe every 10 days. We need simpler tests that people can just do at home,” said Halloran, who envisions a low-cost “10-pack” of tests for home use.\u003c/p>\n\u003cp>“We can’t sit around for 18 months waiting for a vaccine. We have to find a way out without pharmaceuticals, and that’s repeat testing, taking people out of circulation, and then contact tracing, so it’s an interesting analogy,” said Halloran, who is working with colleagues to model a plan where the disease could be kept at levels that would not exceed health care capacity and that would require quarantining less than 10% of people.\u003c/p>\n\u003cp>Performers say they have a lot to teach the rest of the post-Covid-19 world. “We’re already used to working in an environment of risk. That’s something the rest of the normal world is just learning to do,” said Lotus Lain, a bisexual adult film actress who works with Stabile’s group as an advocate for other performers.\u003c/p>\n\u003cp>Lain said the porn sets she works on are extremely clean and precautions are taken to limit infectious-disease risk. “All of the things people are looking for right now — gloves, masks, alcohol wipes — we have all those things on sets. It’s standard operating procedure,” she said. “I hope other industries look to our industry not just to learn, but to credit us as well.”\u003c/p>\n\u003cfigure id=\"attachment_1963929\" class=\"wp-caption alignleft\" style=\"max-width: 1135px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/35/2020/05/Adult-film-inline3.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1963929\" src=\"https://ww2.kqed.org/app/uploads/sites/35/2020/05/Adult-film-inline3.jpg\" alt=\"Lance Hart, an adult film performer who also runs two production companies poses in a white shirt, pink tie, and white furry coat at the 2019 XBiz Awards in Los Angeles.\" width=\"1135\" height=\"902\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2020/05/Adult-film-inline3.jpg 1135w, https://cdn.kqed.org/wp-content/uploads/sites/35/2020/05/Adult-film-inline3-160x127.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2020/05/Adult-film-inline3-800x636.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2020/05/Adult-film-inline3-768x610.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2020/05/Adult-film-inline3-1020x811.jpg 1020w\" sizes=\"(max-width: 1135px) 100vw, 1135px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Lance Hart, an adult film performer who also runs two production companies, attends the 2019 XBIZ Awards in Los Angeles. \u003ccite>(Jesse Grant/Getty Images for XBIZ Awards)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>AIDS experts say the testing program within the adult film industry provides insight into how we might build national testing programs to safeguard workplaces, but also helps illustrate the many challenges that lie ahead, in part because the coronavirus has proved so contagious.\u003c/p>\n\u003cp>“HIV is our prior pandemic. Surely we can learn from that,” said Robert Gallo, the virologist who co-discovered HIV and now directs the Institute of Human Virology at the University of Maryland School of Medicine. But Gallo said preventing the spread of HIV in the film industry is a far more tractable problem than reining in the novel coronavirus.\u003c/p>\n\u003cp>“You have to deal with every virus differently,” said Gallo, who in 2011 co-founded the Global Virus Network, a consortium working to prevent and eradicate viral disease. HIV, he said, was difficult to contain because symptoms don’t occur for years, but it was also harder to transmit. “This virus is viciously infectious,” he said. “It’s as infectious as anything I’ve ever heard of.” One key to containment, he added, would be to take time now, before widespread testing begins, to ensure tests are highly accurate and avoid the false positive results caused by cross reactions with other common coronaviruses.\u003c/p>\n\u003cp>Pamina Gorbach, a professor of infectious disease epidemiology at UCLA’s Fielding School of Public Health, has studied the spread of sexually transmitted diseases in the adult film industry. She says the testing program is a step in the right direction to protect the health of performers, but thinks there is room for improvement.\u003c/p>\n\u003cp>[pullquote size='medium' citation='Mike Stabile, Free Speech Coalition']‘We’re asking questions like whether directors and camera people can shoot with N95 masks on. We are actively trying to figure out how to make sets safe, and that means coronavirus as well as HIV.’[/pullquote]Gorbach’s 2017 study of 360 adult film workers showed 24% of performers were infected with either chlamydia or gonorrhea. One-third of those infections were found in the throat or rectum, she said, undetectable by the urine tests the industry uses to screen for sexually transmitted infections and serving as reservoirs for ongoing transmission. The findings show that testing protocols need to be carefully thought through, she said. (Chlamydia and gonorrhea, for example, can be transmitted within the 14-day repeat testing window that was chosen because it works to prevent HIV transmission.)\u003c/p>\n\u003cp>Her study also found more than 20% of film workers were self-treating without medical advice when they had symptoms, hoping to shorten the time they might miss work. Gorbach said she feared the same thing could happen with Covid-19, with people misusing or overusing inappropriate treatments in an attempt to cure themselves or mask symptoms so they won’t miss work. (Porn performers don’t get paid when they can’t get to sets, just like other workers without paid sick leave.)\u003c/p>\n\u003cp>Gorbach said she did see clear lessons that coronavirus testing programs could take from the film industry, including thinking about how to address people who “float,” or work at multiple locations that have vastly different standards for screening or protection. “People in nursing homes float, just like the adult film industry. They float, they work at multiple places with different rules and standards,” she said. “If one place they work screens for infection and one doesn’t, they can take the infection from one place to another.”\u003c/p>\n\u003cp>The film industry deals with this through frequent testing, and Stabile said most performers won’t work with untested partners. While the testing program is voluntary, Stabile said clear test results are a requirement on most mainstream sets.\u003c/p>\n\u003cp>Who would pay for tests is also an issue. In the film industry, performers generally pay the roughly $150 testing fee to be cleared to work. Public health officials argue that workers, especially low-wage workers, should not bear the brunt of coronavirus-testing costs. “In public health, we try to reduce barriers to prevent the spread of disease, especially economic barriers,” said Angela Bazzi, an assistant professor of community health sciences at Boston University School of Public Health who has studied the health of sex workers in Mexico, Kenya, Ghana, and Boston. “If we place this burden on individuals, that’s worrisome.”\u003c/p>\n\u003cp>The geography of testing is also a concern; when permits and condoms were required on film sets in Los Angeles, many producers moved filming to less restrictive locations. Employers might do the same, experts said, to avoid coronavirus testing programs they deem costly or onerous.\u003c/p>\n\u003cp>Bazzi said it was fascinating to think about what could be learned from a program that increased safety for actors in the adult film industry. “It’s informative,” she said. “They’ve clearly gone through a decision-making process.” But she added that coronavirus testing would likely be far trickier for practical reasons. Adult film testing started more than a decade after the HIV outbreak, and only after years of research to improve HIV tests. Coronavirus tests are still a work in progress.\u003c/p>\n\u003cp>“In HIV, we saw this progression of tests that took decades, and there are still new tests being developed,” Bazzi said. “With coronavirus, there are still a lot of unknowns with testing.”\u003c/p>\n\u003cp>Politics will also likely play a role in coronavirus testing programs, if the film industry is an indicator. The testing program continually comes under fire from the AIDS Healthcare Foundation, whose leaders think testing does not do enough to prevent on-set HIV transmission and that condoms should be required. Another issue has been a simmering argument over whether HIV-positive performers who have such low levels of the virus that they cannot transmit it should be allowed to participate in filming. For now, any HIV-positive result, regardless of viral titre, disqualifies a performer from being cleared to film in the PASS program.\u003c/p>\n\u003cp>Now, fears about sexually transmitted infections have faded into the background as those in the film industry grapple with the coronavirus. Performers can obtain the tests they need to be cleared to work because medical clinics remain open, but Stabile said few were participating, mainly because production is on hold due to the coronavirus. (People can still shoot solo videos, or videos with people they are quarantining with.)\u003c/p>\n\u003cp>Like many industries, Stabile’s group is trying to determine when and how it could safely resume work. Like workers across the country, those in the film industry are feeling the economic pain of loss of work — although those who run subscription porn sites say their business is booming during quarantine. “My revenue is through the roof,” said Hart, who, while at home with his wife and four cats, is raising money for makeup artists, production assistants, and other set workers who are struggling.\u003c/p>\n\u003cp>A Free Speech Coalition task force is meeting twice a week by Zoom, grappling with questions like whether they can incorporate Covid-19 in their testing protocols and how to protect camera operators, makeup artists, and other on-set employees that did not require testing before. “We’re asking questions like whether directors and camera people can shoot with N95 masks on,” Stabile said. “We are actively trying to figure out how to make sets safe, and that means coronavirus as well as HIV.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>As states and employers furiously develop plans to safely reopen workplaces in the midst of the coronavirus pandemic, they’re grappling with what seems like an endless list of questions: where to test, who to test, and how often to test for the virus? Further complicating matters are issues of workers’ privacy, geography, politics, science, and cost. It’s a difficult mandate. But there is one place to look for guidance — the adult film industry.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Since the late 1990s, when an outbreak of HIV infections threatened to shutter the multibillion-dollar industry, the mainstream porn community has implemented procedures that require all performers to be tested for HIV and a host of other sexually transmitted infections every 14 days before they can be cleared to work. Any HIV-positive test leads to an immediate shutdown of all U.S. sets, followed by detailed contact tracing before sets can reopen. While not perfect, those in the industry say the nationwide PASS program works to protect thousands of performers, ensures safer workplaces, and curtails the spread of disease.\u003c/p>\n\u003cp>“I don’t think I could be in this industry without it. That would be insane. Bareback sex with strangers 20 times a month? It would be like the most dangerous job in the world,” said Lance Hart, a gay and straight adult film performer and independent pornographer in Las Vegas who runs the production companies Sweet Femdom and Man Up Films.\u003c/p>\n\u003cp>In the 20 years it has been in place, PASS has met, and overcome, many of the same challenges that any large-scale coronavirus testing program might encounter, from issues of keeping databases of private medical information secure, preventing the forging of test results, dealing with false positive results, and educating workers about the need for repeated testing to keep workplaces safe. Those devising strategies to reopen workplaces and the larger economy during the coronavirus pandemic say their plans would involve, at their core, processes of rigorous testing, isolation, and contact tracing similar to those used in the adult film industry.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“In many ways, what they are doing is a model for what we are trying to do with Covid,” said Ashish Jha, a physician who directs Harvard University’s Global Health Institute and has been calling for widespread national testing to contain the coronavirus. “The adult film industry teaches us that as a proof of concept, this can work. We just have to scale it up.”\u003c/p>\n\u003cp>Jha said he could envision a program similar to PASS where Covid-19 test results are put into a secure database that could be checked to verify whether people had recently tested negative for the virus. “You could imagine TSA verifying someone had tested negative before they were allowed on a flight,” he said. “Testing is particularly important for areas that are high risk, like airplanes or meatpacking plants.”\u003c/p>\n\u003cfigure id=\"attachment_1963924\" class=\"wp-caption alignright\" style=\"max-width: 724px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/35/2020/05/adult-film-inline2.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1963924\" src=\"https://ww2.kqed.org/app/uploads/sites/35/2020/05/adult-film-inline2.jpg\" alt=\"\" width=\"724\" height=\"1024\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2020/05/adult-film-inline2.jpg 724w, https://cdn.kqed.org/wp-content/uploads/sites/35/2020/05/adult-film-inline2-160x226.jpg 160w\" sizes=\"(max-width: 724px) 100vw, 724px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">LAS VEGAS, NV – JANUARY 23: Adult film actress Lotus Lain attends the 2016 Adult Video News Awards at the Hard Rock Hotel & Casino on January 23, 2016 in Las Vegas, Nevada. (Photo by Ethan Miller/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>While it did not cite the adult film industry, a “National Covid-19 Testing Action Plan” released by the Rockefeller Foundation last month included the creation of an “infection database” that could be accessed by employers, schools, TSA, and those scanning tickets for entry into sports or music venues.\u003c/p>\n\u003cp>“What the adult film industry has produced has worked, and really could be the kind of tool we need,” Jha said. “People can’t get distracted because it’s from a business they don’t approve of.”\u003c/p>\n\u003cp>Mike Stabile, communications director for the Free Speech Coalition, the adult entertainment trade association that runs PASS, said the adult film industry understands “better than most the discussion that has to happen for businesses to reopen.”\u003c/p>\n\u003cp>Yet for all of that expertise, it would be hard to imagine the Trump administration, or state politicians, reaching out to the porn industry for guidance. Stabile said that while he has not been contacted by any government officials, he would have plenty of advice to share. “It’s going to be an ongoing process. It’s not going to be a binary open or shut,” he said. “But it’s not as heavy a lift as people think. This is something that’s doable.”\u003c/p>\n\u003cp>Stabile, who is closely following coronavirus news, feels most people are unaware of the need for repeat testing that is standard in his industry. “When you look at the world at large, there’s an idea you’ll be tested once and then go back to work, but with coronavirus, it’s not that simple. We’re looking at a series of regular tests until this gets under control,” he said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Repeat testing will be necessary for the coronavirus, too, because — like with HIV — there is so much asymptomatic spread of the coronavirus, said Elizabeth “Betz” Halloran, a professor of biostatistics at the University of Washington who directs the Center for Inference and Dynamics of Infectious Diseases at the Fred Hutchinson Cancer Research Center in Seattle.\u003c/p>\n\u003cp>“You’ll have to keep testing, maybe every 10 days. We need simpler tests that people can just do at home,” said Halloran, who envisions a low-cost “10-pack” of tests for home use.\u003c/p>\n\u003cp>“We can’t sit around for 18 months waiting for a vaccine. We have to find a way out without pharmaceuticals, and that’s repeat testing, taking people out of circulation, and then contact tracing, so it’s an interesting analogy,” said Halloran, who is working with colleagues to model a plan where the disease could be kept at levels that would not exceed health care capacity and that would require quarantining less than 10% of people.\u003c/p>\n\u003cp>Performers say they have a lot to teach the rest of the post-Covid-19 world. “We’re already used to working in an environment of risk. That’s something the rest of the normal world is just learning to do,” said Lotus Lain, a bisexual adult film actress who works with Stabile’s group as an advocate for other performers.\u003c/p>\n\u003cp>Lain said the porn sets she works on are extremely clean and precautions are taken to limit infectious-disease risk. “All of the things people are looking for right now — gloves, masks, alcohol wipes — we have all those things on sets. It’s standard operating procedure,” she said. “I hope other industries look to our industry not just to learn, but to credit us as well.”\u003c/p>\n\u003cfigure id=\"attachment_1963929\" class=\"wp-caption alignleft\" style=\"max-width: 1135px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/35/2020/05/Adult-film-inline3.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1963929\" src=\"https://ww2.kqed.org/app/uploads/sites/35/2020/05/Adult-film-inline3.jpg\" alt=\"Lance Hart, an adult film performer who also runs two production companies poses in a white shirt, pink tie, and white furry coat at the 2019 XBiz Awards in Los Angeles.\" width=\"1135\" height=\"902\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2020/05/Adult-film-inline3.jpg 1135w, https://cdn.kqed.org/wp-content/uploads/sites/35/2020/05/Adult-film-inline3-160x127.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2020/05/Adult-film-inline3-800x636.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2020/05/Adult-film-inline3-768x610.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2020/05/Adult-film-inline3-1020x811.jpg 1020w\" sizes=\"(max-width: 1135px) 100vw, 1135px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Lance Hart, an adult film performer who also runs two production companies, attends the 2019 XBIZ Awards in Los Angeles. \u003ccite>(Jesse Grant/Getty Images for XBIZ Awards)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>AIDS experts say the testing program within the adult film industry provides insight into how we might build national testing programs to safeguard workplaces, but also helps illustrate the many challenges that lie ahead, in part because the coronavirus has proved so contagious.\u003c/p>\n\u003cp>“HIV is our prior pandemic. Surely we can learn from that,” said Robert Gallo, the virologist who co-discovered HIV and now directs the Institute of Human Virology at the University of Maryland School of Medicine. But Gallo said preventing the spread of HIV in the film industry is a far more tractable problem than reining in the novel coronavirus.\u003c/p>\n\u003cp>“You have to deal with every virus differently,” said Gallo, who in 2011 co-founded the Global Virus Network, a consortium working to prevent and eradicate viral disease. HIV, he said, was difficult to contain because symptoms don’t occur for years, but it was also harder to transmit. “This virus is viciously infectious,” he said. “It’s as infectious as anything I’ve ever heard of.” One key to containment, he added, would be to take time now, before widespread testing begins, to ensure tests are highly accurate and avoid the false positive results caused by cross reactions with other common coronaviruses.\u003c/p>\n\u003cp>Pamina Gorbach, a professor of infectious disease epidemiology at UCLA’s Fielding School of Public Health, has studied the spread of sexually transmitted diseases in the adult film industry. She says the testing program is a step in the right direction to protect the health of performers, but thinks there is room for improvement.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Gorbach’s 2017 study of 360 adult film workers showed 24% of performers were infected with either chlamydia or gonorrhea. One-third of those infections were found in the throat or rectum, she said, undetectable by the urine tests the industry uses to screen for sexually transmitted infections and serving as reservoirs for ongoing transmission. The findings show that testing protocols need to be carefully thought through, she said. (Chlamydia and gonorrhea, for example, can be transmitted within the 14-day repeat testing window that was chosen because it works to prevent HIV transmission.)\u003c/p>\n\u003cp>Her study also found more than 20% of film workers were self-treating without medical advice when they had symptoms, hoping to shorten the time they might miss work. Gorbach said she feared the same thing could happen with Covid-19, with people misusing or overusing inappropriate treatments in an attempt to cure themselves or mask symptoms so they won’t miss work. (Porn performers don’t get paid when they can’t get to sets, just like other workers without paid sick leave.)\u003c/p>\n\u003cp>Gorbach said she did see clear lessons that coronavirus testing programs could take from the film industry, including thinking about how to address people who “float,” or work at multiple locations that have vastly different standards for screening or protection. “People in nursing homes float, just like the adult film industry. They float, they work at multiple places with different rules and standards,” she said. “If one place they work screens for infection and one doesn’t, they can take the infection from one place to another.”\u003c/p>\n\u003cp>The film industry deals with this through frequent testing, and Stabile said most performers won’t work with untested partners. While the testing program is voluntary, Stabile said clear test results are a requirement on most mainstream sets.\u003c/p>\n\u003cp>Who would pay for tests is also an issue. In the film industry, performers generally pay the roughly $150 testing fee to be cleared to work. Public health officials argue that workers, especially low-wage workers, should not bear the brunt of coronavirus-testing costs. “In public health, we try to reduce barriers to prevent the spread of disease, especially economic barriers,” said Angela Bazzi, an assistant professor of community health sciences at Boston University School of Public Health who has studied the health of sex workers in Mexico, Kenya, Ghana, and Boston. “If we place this burden on individuals, that’s worrisome.”\u003c/p>\n\u003cp>The geography of testing is also a concern; when permits and condoms were required on film sets in Los Angeles, many producers moved filming to less restrictive locations. Employers might do the same, experts said, to avoid coronavirus testing programs they deem costly or onerous.\u003c/p>\n\u003cp>Bazzi said it was fascinating to think about what could be learned from a program that increased safety for actors in the adult film industry. “It’s informative,” she said. “They’ve clearly gone through a decision-making process.” But she added that coronavirus testing would likely be far trickier for practical reasons. Adult film testing started more than a decade after the HIV outbreak, and only after years of research to improve HIV tests. Coronavirus tests are still a work in progress.\u003c/p>\n\u003cp>“In HIV, we saw this progression of tests that took decades, and there are still new tests being developed,” Bazzi said. “With coronavirus, there are still a lot of unknowns with testing.”\u003c/p>\n\u003cp>Politics will also likely play a role in coronavirus testing programs, if the film industry is an indicator. The testing program continually comes under fire from the AIDS Healthcare Foundation, whose leaders think testing does not do enough to prevent on-set HIV transmission and that condoms should be required. Another issue has been a simmering argument over whether HIV-positive performers who have such low levels of the virus that they cannot transmit it should be allowed to participate in filming. For now, any HIV-positive result, regardless of viral titre, disqualifies a performer from being cleared to film in the PASS program.\u003c/p>\n\u003cp>Now, fears about sexually transmitted infections have faded into the background as those in the film industry grapple with the coronavirus. Performers can obtain the tests they need to be cleared to work because medical clinics remain open, but Stabile said few were participating, mainly because production is on hold due to the coronavirus. (People can still shoot solo videos, or videos with people they are quarantining with.)\u003c/p>\n\u003cp>Like many industries, Stabile’s group is trying to determine when and how it could safely resume work. Like workers across the country, those in the film industry are feeling the economic pain of loss of work — although those who run subscription porn sites say their business is booming during quarantine. “My revenue is through the roof,” said Hart, who, while at home with his wife and four cats, is raising money for makeup artists, production assistants, and other set workers who are struggling.\u003c/p>\n\u003cp>A Free Speech Coalition task force is meeting twice a week by Zoom, grappling with questions like whether they can incorporate Covid-19 in their testing protocols and how to protect camera operators, makeup artists, and other on-set employees that did not require testing before. “We’re asking questions like whether directors and camera people can shoot with N95 masks on,” Stabile said. “We are actively trying to figure out how to make sets safe, and that means coronavirus as well as HIV.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"title": "The Coronavirus Is Mutating. That's Normal. Does That Mean It's More Dangerous?",
"headTitle": "The Coronavirus Is Mutating. That’s Normal. Does That Mean It’s More Dangerous? | KQED",
"content": "\u003cp>This week, the question of mutation has been front and center in coverage of the coronavirus — from controversial claims about changes that make the virus more contagious to reassurances that any mutations are not yet consequential.\u003c/p>\n\u003cp>Here are some of the questions being raised — and what the specialists can (and can’t yet) say to answer them.\u003c/p>\n\u003cp>\u003cstrong>Is the coronavirus mutating?\u003c/strong>\u003c/p>\n\u003cp>Researchers say the coronavirus is \u003ca href=\"https://www.npr.org/sections/goatsandsoda/2020/03/25/820998549/the-coronavirus-is-mutating-but-that-may-not-be-a-problem-for-humans\">making small changes\u003c/a> to itself as they would expect it to — at a relatively predictable and steady rate of around one to two changes per month.\u003c/p>\n\u003cp>“Viruses mutate naturally as part of their life cycle,” says Ewan Harrison, scientific project manager for the\u003ca href=\"https://www.cam.ac.uk/research/news/cambridge-to-spearhead-ps20million-alliance-to-map-spread-of-covid-19-coronavirus\"> COVID-19 Genomics UK Consortium\u003c/a>. The coronavirus is no different.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>When a virus infects a person, it enters their cells and makes copies of itself, which then circulate through the body or are transmitted — respiratory droplets is one method — to other humans.\u003c/p>\n\u003cp>Inevitably, viruses “make mistakes in their genomes” as they copy themselves, Harrison says. Those changes can accumulate and carry over to future copies of the virus. Mutations are akin to typos in text — most typos are nonevents, but some can change the meaning of a word or sentence. Likewise, many mutations will be dead ends with no effect on people who are infected. But some of these mutations in a virus may change how quickly it infects people and replicates, or what kind of damage it does to cells.\u003c/p>\n\u003cp>These small, cumulative changes are useful to researchers, because they act as identification cards that help trace the pathway of the virus through groups of people over time. For instance, in a \u003ca href=\"https://jvi.asm.org/content/early/2020/04/30/JVI.00711-20\">surveillance study\u003c/a> on the Arizona State University campus, researchers found that the people who were showing up sick in mid-March with the coronavirus had different versions of the virus from each other. Comparing the virus genomes helped them figure out that the spike in mid-March cases probably didn’t signify an outbreak on campus; the cases had had likely caught this version of the virus elsewhere, perhaps when they traveled for spring break, and brought it back. So tracking virus genomes is valuable in tracing how and where the virus is spreading.\u003c/p>\n\u003cp>\u003cstrong>Is the coronavirus becoming more transmissible?\u003c/strong>\u003c/p>\n\u003cp>Twitter lit up this week when a \u003ca href=\"https://www.biorxiv.org/content/10.1101/2020.04.29.069054v1\">draft research paper\u003c/a> posted to the preprint server bioRxiv got picked up by the media. The paper suggests in the title that their analysis of coronavirus mutations “reveals the emergence of a more transmissible form of SARS-CoV-2.”\u003c/p>\n\u003cp>The study was conducted by researchers at Los Alamos National Laboratory, The University of Sheffield and Duke. They analyzed publicly available genome sequences from around the world posted on \u003ca href=\"https://www.gisaid.org/\">GISAID\u003c/a>, a global research platform that has amassed over 16,000 coronavirus sequences to date.\u003c/p>\n\u003cp>The researchers found that a version of the virus, which was first detected in Europe in early February, appears to have become the most common strain in the U.S., Australia, parts of Africa — basically, anywhere it spread. The study authors hypothesize that a mutation in this virus strain, which changes one amino acid in the part of the coronavirus that finds and binds to cells, could cause the virus to spread more easily.\u003c/p>\n\u003cp>“I think that it is an important observation,” says \u003ca href=\"https://www.mailman.columbia.edu/research/center-infection-and-immunity/angela-rasmussen-phd\">Angela Rasmussen\u003c/a>, a virologist at Columbia Mailman School of Public Health, “We have seen in other virus epidemics, such as the Ebola epidemic, that there are these mutations that seem to persist and become the dominant form of the virus.”\u003c/p>\n\u003cp>However, Rasmussen says, there’s no clear evidence that the mutation referenced in the paper does anything to change how the virus spreads.\u003c/p>\n\u003cp>Other factors could also account for why the virus from Europe is dominant, says \u003ca href=\"https://vet.uga.edu/person/justin-bahl/\">Justin Bahl\u003c/a>, a computational biologist at University of Georgia. It could possibly be explained by the so-called “founder effect,” where the European version spread rapidly across international borders and established itself as the dominant strain because countries were slow to lock down.\u003c/p>\n\u003cp>To prove whether the mutation identified in the paper causes the virus to spread more easily, researchers want to see experimental evidence: for instance, a study where both strains are tested in live cells, to see if the mutated virus replicates faster. If those results show such signs, they’ll want to see if one virus spreads more readily in lab animals.\u003c/p>\n\u003cp>\u003cstrong>Is the coronavirus mutating to become less harmful?\u003c/strong>\u003c/p>\n\u003cp>Another study, published in \u003ca href=\"https://jvi.asm.org/content/early/2020/04/30/JVI.00711-20\">Journal of Virology\u003c/a>, identified one patient in Arizona who was carrying a version of the virus with a chunk of it missing. The deletion was sizable — 81 nucleotides long, out of the 30,000 or so that make up the coronavirus’ genome sequence (in case you’re wondering, a nucleotide is a molecule that forms the building block of a DNA or RNA strand and is too tiny to be seen under most microscopes). It was also found in a location on the genome which, on the classic SARS virus, helped the virus fight the immune system, according to study co-author \u003ca href=\"https://sols.asu.edu/efrem-lim\">Efrem Lim\u003c/a>, a virologist at Arizona State University.\u003c/p>\n\u003cp>The researchers hypothesize that the deletion “may potentially reduce virus fitness” — a claim Lim says they’re now testing in labs.\u003c/p>\n\u003cp>The paper is based on just one virus genome, out of the 16,000 that have been sequenced and shared, which makes it difficult to generalize to the larger group of circulating versions of the novel coronavirus. “We actually have no idea whether [a virus with this deletion] is transmissible or not,” Bahl says. “We don’t know whether it was just a one-off event or whether these variants are transmitting and becoming more frequent in the population [of people getting coronavirus].”\u003c/p>\n\u003cp>More evidence is needed to see if Lim’s hypothesis holds — and it will emerge as research continues.\u003c/p>\n\u003cp>\u003cstrong>Do the mutations we’re seeing affect the development of treatments and vaccines?\u003c/strong>\u003c/p>\n\u003cp>Not yet. “We’re getting the mutations that we’re kind of expecting here,” says \u003ca href=\"https://microbiology.utmb.edu/faculty/vineet-d-menachery-phd\">Vineet Menachery\u003c/a>, a virologist at the University of Texas Medical Branch, so the research process already accounts for these changes.\u003c/p>\n\u003cp>Menachery says the European mutation tracked in the Los Alamos paper is adjacent to, but not directly on, the receptor binding domain, which is a specific part area on the virus’ protein shell that initiates first contact in attaching to human cells. “If these mutations were there, there’d be a little bit more worry about antibody-based approaches and vaccine approaches,” he says, because the shifts might make it harder for antibodies to recognize the virus. But the mutations are not directly on the receptor binding domain, so researchers aren’t too worried about those specific changes.\u003c/p>\n\u003cp>Vaccines are also developed to target multiple sites on a virus, so it’s unlikely that a few random mutations to the virus can knock out their power completely, Rasmussen says.\u003c/p>\n\u003cp>Versions of the virus that are drug- or vaccine-resistant may crop up once therapies are in use, says Lim. If a particular strain is obliterated by drugs or vaccines, then any viruses that survive will be the ones not affected by those treatments and could go on to infect others. But for now, there’s no pressure on the virus to change in a way that would help it evade measures that haven’t been introduced.\u003c/p>\n\u003cp>\u003cstrong>Why are scientists sharing unproven theories?\u003c/strong>\u003c/p>\n\u003cp>The main scientific purpose of sharing these papers early and often is to alert other researchers to interesting theories and call attention to potentially meaningful mutations, Lim says.\u003c/p>\n\u003cp>“It helps us prioritize what mutations should be studied in the lab, because there are so many mutations out there,” Lim says. By sharing leads and data-backed theories, scientists are highlighting specific mutations that may be affecting the behavior of the virus, in a sea of all the small changes the virus makes.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>So it helps researchers to know that scientists at Los Alamos Lab think that a particular change in the genome is worth additional study, or that a deletion in the virus has been found once and could be found again. The answers may not be definitive, but it feeds the global brain trust of researchers who are all working to understand the coronavirus better and help defeat it.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2020 NPR. To see more, visit https://www.npr.org.\u003cimg decoding=\"async\" src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=The+Coronavirus+Is+Mutating.+That%27s+Normal.+Does+That+Mean+It%27s+More+Dangerous%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>This week, the question of mutation has been front and center in coverage of the coronavirus — from controversial claims about changes that make the virus more contagious to reassurances that any mutations are not yet consequential.\u003c/p>\n\u003cp>Here are some of the questions being raised — and what the specialists can (and can’t yet) say to answer them.\u003c/p>\n\u003cp>\u003cstrong>Is the coronavirus mutating?\u003c/strong>\u003c/p>\n\u003cp>Researchers say the coronavirus is \u003ca href=\"https://www.npr.org/sections/goatsandsoda/2020/03/25/820998549/the-coronavirus-is-mutating-but-that-may-not-be-a-problem-for-humans\">making small changes\u003c/a> to itself as they would expect it to — at a relatively predictable and steady rate of around one to two changes per month.\u003c/p>\n\u003cp>“Viruses mutate naturally as part of their life cycle,” says Ewan Harrison, scientific project manager for the\u003ca href=\"https://www.cam.ac.uk/research/news/cambridge-to-spearhead-ps20million-alliance-to-map-spread-of-covid-19-coronavirus\"> COVID-19 Genomics UK Consortium\u003c/a>. The coronavirus is no different.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>When a virus infects a person, it enters their cells and makes copies of itself, which then circulate through the body or are transmitted — respiratory droplets is one method — to other humans.\u003c/p>\n\u003cp>Inevitably, viruses “make mistakes in their genomes” as they copy themselves, Harrison says. Those changes can accumulate and carry over to future copies of the virus. Mutations are akin to typos in text — most typos are nonevents, but some can change the meaning of a word or sentence. Likewise, many mutations will be dead ends with no effect on people who are infected. But some of these mutations in a virus may change how quickly it infects people and replicates, or what kind of damage it does to cells.\u003c/p>\n\u003cp>These small, cumulative changes are useful to researchers, because they act as identification cards that help trace the pathway of the virus through groups of people over time. For instance, in a \u003ca href=\"https://jvi.asm.org/content/early/2020/04/30/JVI.00711-20\">surveillance study\u003c/a> on the Arizona State University campus, researchers found that the people who were showing up sick in mid-March with the coronavirus had different versions of the virus from each other. Comparing the virus genomes helped them figure out that the spike in mid-March cases probably didn’t signify an outbreak on campus; the cases had had likely caught this version of the virus elsewhere, perhaps when they traveled for spring break, and brought it back. So tracking virus genomes is valuable in tracing how and where the virus is spreading.\u003c/p>\n\u003cp>\u003cstrong>Is the coronavirus becoming more transmissible?\u003c/strong>\u003c/p>\n\u003cp>Twitter lit up this week when a \u003ca href=\"https://www.biorxiv.org/content/10.1101/2020.04.29.069054v1\">draft research paper\u003c/a> posted to the preprint server bioRxiv got picked up by the media. The paper suggests in the title that their analysis of coronavirus mutations “reveals the emergence of a more transmissible form of SARS-CoV-2.”\u003c/p>\n\u003cp>The study was conducted by researchers at Los Alamos National Laboratory, The University of Sheffield and Duke. They analyzed publicly available genome sequences from around the world posted on \u003ca href=\"https://www.gisaid.org/\">GISAID\u003c/a>, a global research platform that has amassed over 16,000 coronavirus sequences to date.\u003c/p>\n\u003cp>The researchers found that a version of the virus, which was first detected in Europe in early February, appears to have become the most common strain in the U.S., Australia, parts of Africa — basically, anywhere it spread. The study authors hypothesize that a mutation in this virus strain, which changes one amino acid in the part of the coronavirus that finds and binds to cells, could cause the virus to spread more easily.\u003c/p>\n\u003cp>“I think that it is an important observation,” says \u003ca href=\"https://www.mailman.columbia.edu/research/center-infection-and-immunity/angela-rasmussen-phd\">Angela Rasmussen\u003c/a>, a virologist at Columbia Mailman School of Public Health, “We have seen in other virus epidemics, such as the Ebola epidemic, that there are these mutations that seem to persist and become the dominant form of the virus.”\u003c/p>\n\u003cp>However, Rasmussen says, there’s no clear evidence that the mutation referenced in the paper does anything to change how the virus spreads.\u003c/p>\n\u003cp>Other factors could also account for why the virus from Europe is dominant, says \u003ca href=\"https://vet.uga.edu/person/justin-bahl/\">Justin Bahl\u003c/a>, a computational biologist at University of Georgia. It could possibly be explained by the so-called “founder effect,” where the European version spread rapidly across international borders and established itself as the dominant strain because countries were slow to lock down.\u003c/p>\n\u003cp>To prove whether the mutation identified in the paper causes the virus to spread more easily, researchers want to see experimental evidence: for instance, a study where both strains are tested in live cells, to see if the mutated virus replicates faster. If those results show such signs, they’ll want to see if one virus spreads more readily in lab animals.\u003c/p>\n\u003cp>\u003cstrong>Is the coronavirus mutating to become less harmful?\u003c/strong>\u003c/p>\n\u003cp>Another study, published in \u003ca href=\"https://jvi.asm.org/content/early/2020/04/30/JVI.00711-20\">Journal of Virology\u003c/a>, identified one patient in Arizona who was carrying a version of the virus with a chunk of it missing. The deletion was sizable — 81 nucleotides long, out of the 30,000 or so that make up the coronavirus’ genome sequence (in case you’re wondering, a nucleotide is a molecule that forms the building block of a DNA or RNA strand and is too tiny to be seen under most microscopes). It was also found in a location on the genome which, on the classic SARS virus, helped the virus fight the immune system, according to study co-author \u003ca href=\"https://sols.asu.edu/efrem-lim\">Efrem Lim\u003c/a>, a virologist at Arizona State University.\u003c/p>\n\u003cp>The researchers hypothesize that the deletion “may potentially reduce virus fitness” — a claim Lim says they’re now testing in labs.\u003c/p>\n\u003cp>The paper is based on just one virus genome, out of the 16,000 that have been sequenced and shared, which makes it difficult to generalize to the larger group of circulating versions of the novel coronavirus. “We actually have no idea whether [a virus with this deletion] is transmissible or not,” Bahl says. “We don’t know whether it was just a one-off event or whether these variants are transmitting and becoming more frequent in the population [of people getting coronavirus].”\u003c/p>\n\u003cp>More evidence is needed to see if Lim’s hypothesis holds — and it will emerge as research continues.\u003c/p>\n\u003cp>\u003cstrong>Do the mutations we’re seeing affect the development of treatments and vaccines?\u003c/strong>\u003c/p>\n\u003cp>Not yet. “We’re getting the mutations that we’re kind of expecting here,” says \u003ca href=\"https://microbiology.utmb.edu/faculty/vineet-d-menachery-phd\">Vineet Menachery\u003c/a>, a virologist at the University of Texas Medical Branch, so the research process already accounts for these changes.\u003c/p>\n\u003cp>Menachery says the European mutation tracked in the Los Alamos paper is adjacent to, but not directly on, the receptor binding domain, which is a specific part area on the virus’ protein shell that initiates first contact in attaching to human cells. “If these mutations were there, there’d be a little bit more worry about antibody-based approaches and vaccine approaches,” he says, because the shifts might make it harder for antibodies to recognize the virus. But the mutations are not directly on the receptor binding domain, so researchers aren’t too worried about those specific changes.\u003c/p>\n\u003cp>Vaccines are also developed to target multiple sites on a virus, so it’s unlikely that a few random mutations to the virus can knock out their power completely, Rasmussen says.\u003c/p>\n\u003cp>Versions of the virus that are drug- or vaccine-resistant may crop up once therapies are in use, says Lim. If a particular strain is obliterated by drugs or vaccines, then any viruses that survive will be the ones not affected by those treatments and could go on to infect others. But for now, there’s no pressure on the virus to change in a way that would help it evade measures that haven’t been introduced.\u003c/p>\n\u003cp>\u003cstrong>Why are scientists sharing unproven theories?\u003c/strong>\u003c/p>\n\u003cp>The main scientific purpose of sharing these papers early and often is to alert other researchers to interesting theories and call attention to potentially meaningful mutations, Lim says.\u003c/p>\n\u003cp>“It helps us prioritize what mutations should be studied in the lab, because there are so many mutations out there,” Lim says. By sharing leads and data-backed theories, scientists are highlighting specific mutations that may be affecting the behavior of the virus, in a sea of all the small changes the virus makes.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>So it helps researchers to know that scientists at Los Alamos Lab think that a particular change in the genome is worth additional study, or that a deletion in the virus has been found once and could be found again. The answers may not be definitive, but it feeds the global brain trust of researchers who are all working to understand the coronavirus better and help defeat it.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2020 NPR. To see more, visit https://www.npr.org.\u003cimg decoding=\"async\" src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=The+Coronavirus+Is+Mutating.+That%27s+Normal.+Does+That+Mean+It%27s+More+Dangerous%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Scientists hope antibodies from the blood of recently recovered patients can help fight off COVID-19 in others.\u003c/p>\n\u003cp>Under the FDA’s \u003ca href=\"https://www.fda.gov/vaccines-blood-biologics/investigational-new-drug-ind-or-device-exemption-ide-process-cber/recommendations-investigational-covid-19-convalescent-plasma\" target=\"_blank\" rel=\"noopener noreferrer\">expanded access authorization\u003c/a>, doctors at UCSF have begun treating some of their sickest COVID-19 patients with blood plasma donated from people who have recovered from the virus.\u003c/p>\n\u003cp>“If you know somebody recovered and was successful, they’re probably going to have the good antibodies in them, which we call neutralizing antibodies,” said Dr. Peter Chin-Hong, an infectious disease specialist at UCSF.\u003c/p>\n\u003cp>Chin-Hong says the science behind plasma infusions has been around for decades and that doctors have been using \u003ca href=\"https://www.mayoclinic.org/diseases-conditions/coronavirus/expert-answers/convalescent-plasma/faq-20484383\" target=\"_blank\" rel=\"noopener noreferrer\">convalescent plasma\u003c/a>, as it’s called, to treat disease since the time of polio.\u003c/p>\n\u003cp>“We don’t really know if it works in COVID-19 just because it works in other infectious diseases, but there is a lot of plausibility,” Chin-Hong said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The five UCSF patients recently given plasma, Chin-Hong says, are on the whole “doing fine,” without any adverse effects. However, clinical trials will be needed to determine if convalescent plasma infusions can effectively treat COVID-19.\u003c/p>\n\u003cp>UCSF plans to launch a controlled clinical study with hospitalized COVID-19 patients in the coming weeks.\u003c/p>\n\u003cp>Chin-Hong says if plasma proves effective at fighting off the virus, it could eventually be used as a preventive treatment to boost immunity in health care workers.\u003c/p>\n\u003cp>It is also potentially easier to produce than other treatments, he says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“This is one of the things that I have the most excitement about. You don’t need a big drug company, you don’t need to spend billions. It’s something that your body makes naturally,” Chin-Hong said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Scientists hope antibodies from the blood of recently recovered patients can help fight off COVID-19 in others.\u003c/p>\n\u003cp>Under the FDA’s \u003ca href=\"https://www.fda.gov/vaccines-blood-biologics/investigational-new-drug-ind-or-device-exemption-ide-process-cber/recommendations-investigational-covid-19-convalescent-plasma\" target=\"_blank\" rel=\"noopener noreferrer\">expanded access authorization\u003c/a>, doctors at UCSF have begun treating some of their sickest COVID-19 patients with blood plasma donated from people who have recovered from the virus.\u003c/p>\n\u003cp>“If you know somebody recovered and was successful, they’re probably going to have the good antibodies in them, which we call neutralizing antibodies,” said Dr. Peter Chin-Hong, an infectious disease specialist at UCSF.\u003c/p>\n\u003cp>Chin-Hong says the science behind plasma infusions has been around for decades and that doctors have been using \u003ca href=\"https://www.mayoclinic.org/diseases-conditions/coronavirus/expert-answers/convalescent-plasma/faq-20484383\" target=\"_blank\" rel=\"noopener noreferrer\">convalescent plasma\u003c/a>, as it’s called, to treat disease since the time of polio.\u003c/p>\n\u003cp>“We don’t really know if it works in COVID-19 just because it works in other infectious diseases, but there is a lot of plausibility,” Chin-Hong said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The five UCSF patients recently given plasma, Chin-Hong says, are on the whole “doing fine,” without any adverse effects. However, clinical trials will be needed to determine if convalescent plasma infusions can effectively treat COVID-19.\u003c/p>\n\u003cp>UCSF plans to launch a controlled clinical study with hospitalized COVID-19 patients in the coming weeks.\u003c/p>\n\u003cp>Chin-Hong says if plasma proves effective at fighting off the virus, it could eventually be used as a preventive treatment to boost immunity in health care workers.\u003c/p>\n\u003cp>It is also potentially easier to produce than other treatments, he says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“This is one of the things that I have the most excitement about. You don’t need a big drug company, you don’t need to spend billions. It’s something that your body makes naturally,” Chin-Hong said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>From the start of this pandemic, science news has unfolded at a dizzying pace and crushing volume. Scientific research, which usually creeps along in the background until publication day and then pops up to say something worthy, is suddenly making breathtaking international news every few days.\u003c/p>\n\u003cp>[pullquote size='medium']‘What could happen here is that the public may begin to doubt the results. And the danger here is that the public may begin to doubt science.’[/pullquote]The speed of science research has gone into overdrive and the media horde is hungry for answers. Science is meant to be a slow process of asking questions, then submitting the answers to the kind of vigorous probing ordinary people devote considerable energy to avoiding. After \u003cem>that\u003c/em> is when the media report the answers—vetted! peer reviewed! confident!—usually with caveats attached: Areas where questions yet unasked are lingering to be sought after.\u003c/p>\n\u003cp>But now, studies on COVID-19 therapies and possible therapies and could-be-someday-down-the-road-if-it-proves-out-in-mice-first-therapies make screaming headlines before the studies are vetted to assess their merits or limitations. As a result, the public has heard some contradictory and confusing results, and some claims that are \u003ca href=\"https://www.kqed.org/news/11814749/bakersfield-doctors-dubious-covid-19-test-conclusions-spread-like-wildfire\" target=\"_blank\" rel=\"noopener noreferrer\">flat-out wrong\u003c/a>.\u003c/p>\n\u003cp>KQED’s Tara Siler spoke with science reporter Danielle Venton about this problem and how to understand the science being reported these days. \u003cem>(Edited for length and clarity.)\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Why are people hearing so much science that’s not ready for prime-time?\u003c/strong>\u003c/p>\n\u003cp>\u003cem>Danielle Venton:\u003c/em> We’re at a time where there’s this brand new problem, a brand new virus. There are so many unanswered questions. There’s a huge need for research and a real desire to get it out quickly. Now, what is also true is that science can be a messy process and things aren’t always correct. Science has a way of correcting itself, but unfortunately, right now, that process is happening in public.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>What do you mean by messy process?\u003c/strong>\u003c/p>\n\u003cp>So many of the normal safeguards have been glossed over in this desire to get findings out quickly. Dr. Irving Steinberg is a professor of clinical pharmacy and pediatrics at USC. He’s been \u003ca href=\"https://www.motherjones.com/politics/2020/04/coronavirus-science-rush-to-publish-retractions/\" target=\"_blank\" rel=\"noopener noreferrer\">talking\u003c/a> and \u003ca href=\"https://theconversation.com/coronavirus-research-done-too-fast-is-testing-publishing-safeguards-bad-science-is-getting-through-134653\" target=\"_blank\" rel=\"noopener noreferrer\">writing\u003c/a> about this \u003ca href=\"https://www.theguardian.com/australia-news/2020/apr/30/australias-chief-scientist-warns-against-claims-of-breakthroughs-on-coronavirus-cures\" target=\"_blank\" rel=\"noopener noreferrer\">issue\u003c/a> a lot, and he uses the analogy of working in a sausage factory where production suddenly had to be doubled because people were so hungry:\u003c/p>\n\u003cblockquote>\u003cp>“You can imagine that there might be some problems that would arise in the back room where science is adjudicated—whether it’s in the lab or whether it’s in the editorial processes—where the sausage is made.\u003c/p>\n\u003cp>What the public is seeing is some of the spilled sausage out of the casing. You’ve got this sort of spillage of raw sausage. You know it’s a food product, but you don’t know what to do with it at that point. It’s on the floor. It’s dirty. I can’t really put it on the grill. Maybe I can put it into a cast iron pan? We’ve left to the public too many things to figure out.”\u003c/p>\u003c/blockquote>\n\u003cp>What could happen here is that the public may begin to doubt the results. And the danger here is that the public may begin to doubt science. Right now, we are in need of good science and for the public to trust it.\u003c/p>\n\u003cp>\u003cstrong>What are some of the big failures in this pandemic, the so-called sausage spillage?\u003c/strong>\u003c/p>\n\u003cp>Early in March, some researchers raised concerns in a letter—not a reviewed study—that ibuprofen could worsen COVID-19 symptoms. It wasn’t based on experimental data, it was a theoretical concern based on how ibuprofen works in cells. Three days later, the French health minister tweeted a message saying to avoid ibuprofen. The World Health Organization did the same thing and then reversed itself a day later. More scientists weighed in, and now it’s thought that it’s fine to take ibuprofen. The original worries were based on an incomplete understanding.\u003c/p>\n\u003cp>[pullquote size='medium' citation='Dr. Irving Steinberg, USC']‘We’re seeing knowledge that is being rushed to the public without being assessed. We’re seeing misapplied wisdom and we’re seeing no perspective.’[/pullquote]A famous example is hydroxychloroquine, which was touted in public as a possible treatment for COVID-19 in an early study. The study was poorly designed and later retracted, but we saw some politicians, notably the president, seize on this and just shoot from the hip.\u003c/p>\n\u003cp>Demand surged for the drug, so that some patients who need it for conditions like lupus and rheumatoid arthritis \u003ca href=\"https://www.kqed.org/science/1960404/at-kaiser-trumps-pharmaceutical-advice-creates-chaos-for-lupus-patients\" target=\"_blank\" rel=\"noopener noreferrer\">couldn’t fill their prescriptions\u003c/a>. But it can have toxic side effects—some people abusing it were \u003ca href=\"https://www.forbes.com/sites/rachelsandler/2020/04/09/hydroxychloroquine-abuse-up-since-trump-first-mentioned-drug-us-poison-centers-say/#6ca40a943071\" target=\"_blank\" rel=\"noopener noreferrer\">poisoned\u003c/a>. That’s \u003cem>not\u003c/em> how science is supposed to work.\u003c/p>\n\u003cp>Steinberg summed these problems up by saying, “We’re seeing knowledge that is being rushed to the public without being assessed. We’re seeing misapplied wisdom and we’re seeing no perspective.”\u003c/p>\n\u003cp>\u003cstrong>Is there basically a tradeoff between speed and accuracy? Is this inevitable during a pandemic?\u003c/strong>\u003c/p>\n\u003cp>Moving more quickly always makes it harder to be careful. But we can improve this flow of information without entirely sacrificing speed. You can think of an expert chef, who can still chop quickly and safely at the same time. Training really helps. Experience helps.\u003c/p>\n\u003cp>There are layers of responsibility. It starts with scientists and researchers, then moves on to scientific journals that publish their work. It also includes policymakers who are trying to interpret results and issue advice to the public. And the \u003ca href=\"https://www.kqed.org/futureofyou/162446/is-health-journalism-doing-more-harm-than-good\" target=\"_blank\" rel=\"noopener noreferrer\">press is very important\u003c/a> in all this as well. Everyone has different incentives along the way. I would say in our field, competition to be first is a big challenge, but the public loses out when there are shortcuts along the way.\u003c/p>\n\u003cp>Bad science generally is corrected in the end, but I do worry about the loss of public trust. So more care, more training, learning from mistakes—these can all help avoid some of the missteps we’ve seen.\u003c/p>\n\u003cp>\u003cstrong>How can readers of science news be more careful? Are there some tips out there?\u003c/strong>\u003c/p>\n\u003cp>There are a couple of questions everyone can keep in the back of their mind when reading science news. Try to maintain some perspective and look for context. Here’s a series of questions to consider:\u003c/p>\n\u003cul>\n\u003cli>Is a finding preliminary?\u003c/li>\n\u003cli>Is it from a study or is it just a question scientists are posing?\u003c/li>\n\u003cli>If it’s a study, was it peer reviewed?\u003c/li>\n\u003cli>What do neutral experts, people who are not involved in the research, say about it?\u003c/li>\n\u003cli>If someone is pushing a claim, do they stand to make any money from it?\u003c/li>\n\u003cli>Is this the first time you’re hearing about something? Or is there a body of work that supports it? Is the finding in cells, in animals or in humans? If it’s in humans, it’s a lot more relevant than if it’s in cells or even mice.\u003c/li>\n\u003c/ul>\n\u003cp>And here’s a great \u003ca href=\"http://www.healthnewsreview.org/about-us/review-criteria/\" target=\"_blank\" rel=\"noopener noreferrer\">tip sheet\u003c/a> on how to evaluate news reports on scientific studies, from the website Health News Review.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>The speed of science research has gone into overdrive and the media horde is hungry for answers. Science is meant to be a slow process of asking questions, then submitting the answers to the kind of vigorous probing ordinary people devote considerable energy to avoiding. After \u003cem>that\u003c/em> is when the media report the answers—vetted! peer reviewed! confident!—usually with caveats attached: Areas where questions yet unasked are lingering to be sought after.\u003c/p>\n\u003cp>But now, studies on COVID-19 therapies and possible therapies and could-be-someday-down-the-road-if-it-proves-out-in-mice-first-therapies make screaming headlines before the studies are vetted to assess their merits or limitations. As a result, the public has heard some contradictory and confusing results, and some claims that are \u003ca href=\"https://www.kqed.org/news/11814749/bakersfield-doctors-dubious-covid-19-test-conclusions-spread-like-wildfire\" target=\"_blank\" rel=\"noopener noreferrer\">flat-out wrong\u003c/a>.\u003c/p>\n\u003cp>KQED’s Tara Siler spoke with science reporter Danielle Venton about this problem and how to understand the science being reported these days. \u003cem>(Edited for length and clarity.)\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Why are people hearing so much science that’s not ready for prime-time?\u003c/strong>\u003c/p>\n\u003cp>\u003cem>Danielle Venton:\u003c/em> We’re at a time where there’s this brand new problem, a brand new virus. There are so many unanswered questions. There’s a huge need for research and a real desire to get it out quickly. Now, what is also true is that science can be a messy process and things aren’t always correct. Science has a way of correcting itself, but unfortunately, right now, that process is happening in public.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>What do you mean by messy process?\u003c/strong>\u003c/p>\n\u003cp>So many of the normal safeguards have been glossed over in this desire to get findings out quickly. Dr. Irving Steinberg is a professor of clinical pharmacy and pediatrics at USC. He’s been \u003ca href=\"https://www.motherjones.com/politics/2020/04/coronavirus-science-rush-to-publish-retractions/\" target=\"_blank\" rel=\"noopener noreferrer\">talking\u003c/a> and \u003ca href=\"https://theconversation.com/coronavirus-research-done-too-fast-is-testing-publishing-safeguards-bad-science-is-getting-through-134653\" target=\"_blank\" rel=\"noopener noreferrer\">writing\u003c/a> about this \u003ca href=\"https://www.theguardian.com/australia-news/2020/apr/30/australias-chief-scientist-warns-against-claims-of-breakthroughs-on-coronavirus-cures\" target=\"_blank\" rel=\"noopener noreferrer\">issue\u003c/a> a lot, and he uses the analogy of working in a sausage factory where production suddenly had to be doubled because people were so hungry:\u003c/p>\n\u003cblockquote>\u003cp>“You can imagine that there might be some problems that would arise in the back room where science is adjudicated—whether it’s in the lab or whether it’s in the editorial processes—where the sausage is made.\u003c/p>\n\u003cp>What the public is seeing is some of the spilled sausage out of the casing. You’ve got this sort of spillage of raw sausage. You know it’s a food product, but you don’t know what to do with it at that point. It’s on the floor. It’s dirty. I can’t really put it on the grill. Maybe I can put it into a cast iron pan? We’ve left to the public too many things to figure out.”\u003c/p>\u003c/blockquote>\n\u003cp>What could happen here is that the public may begin to doubt the results. And the danger here is that the public may begin to doubt science. Right now, we are in need of good science and for the public to trust it.\u003c/p>\n\u003cp>\u003cstrong>What are some of the big failures in this pandemic, the so-called sausage spillage?\u003c/strong>\u003c/p>\n\u003cp>Early in March, some researchers raised concerns in a letter—not a reviewed study—that ibuprofen could worsen COVID-19 symptoms. It wasn’t based on experimental data, it was a theoretical concern based on how ibuprofen works in cells. Three days later, the French health minister tweeted a message saying to avoid ibuprofen. The World Health Organization did the same thing and then reversed itself a day later. More scientists weighed in, and now it’s thought that it’s fine to take ibuprofen. The original worries were based on an incomplete understanding.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>A famous example is hydroxychloroquine, which was touted in public as a possible treatment for COVID-19 in an early study. The study was poorly designed and later retracted, but we saw some politicians, notably the president, seize on this and just shoot from the hip.\u003c/p>\n\u003cp>Demand surged for the drug, so that some patients who need it for conditions like lupus and rheumatoid arthritis \u003ca href=\"https://www.kqed.org/science/1960404/at-kaiser-trumps-pharmaceutical-advice-creates-chaos-for-lupus-patients\" target=\"_blank\" rel=\"noopener noreferrer\">couldn’t fill their prescriptions\u003c/a>. But it can have toxic side effects—some people abusing it were \u003ca href=\"https://www.forbes.com/sites/rachelsandler/2020/04/09/hydroxychloroquine-abuse-up-since-trump-first-mentioned-drug-us-poison-centers-say/#6ca40a943071\" target=\"_blank\" rel=\"noopener noreferrer\">poisoned\u003c/a>. That’s \u003cem>not\u003c/em> how science is supposed to work.\u003c/p>\n\u003cp>Steinberg summed these problems up by saying, “We’re seeing knowledge that is being rushed to the public without being assessed. We’re seeing misapplied wisdom and we’re seeing no perspective.”\u003c/p>\n\u003cp>\u003cstrong>Is there basically a tradeoff between speed and accuracy? Is this inevitable during a pandemic?\u003c/strong>\u003c/p>\n\u003cp>Moving more quickly always makes it harder to be careful. But we can improve this flow of information without entirely sacrificing speed. You can think of an expert chef, who can still chop quickly and safely at the same time. Training really helps. Experience helps.\u003c/p>\n\u003cp>There are layers of responsibility. It starts with scientists and researchers, then moves on to scientific journals that publish their work. It also includes policymakers who are trying to interpret results and issue advice to the public. And the \u003ca href=\"https://www.kqed.org/futureofyou/162446/is-health-journalism-doing-more-harm-than-good\" target=\"_blank\" rel=\"noopener noreferrer\">press is very important\u003c/a> in all this as well. Everyone has different incentives along the way. I would say in our field, competition to be first is a big challenge, but the public loses out when there are shortcuts along the way.\u003c/p>\n\u003cp>Bad science generally is corrected in the end, but I do worry about the loss of public trust. So more care, more training, learning from mistakes—these can all help avoid some of the missteps we’ve seen.\u003c/p>\n\u003cp>\u003cstrong>How can readers of science news be more careful? Are there some tips out there?\u003c/strong>\u003c/p>\n\u003cp>There are a couple of questions everyone can keep in the back of their mind when reading science news. Try to maintain some perspective and look for context. Here’s a series of questions to consider:\u003c/p>\n\u003cul>\n\u003cli>Is a finding preliminary?\u003c/li>\n\u003cli>Is it from a study or is it just a question scientists are posing?\u003c/li>\n\u003cli>If it’s a study, was it peer reviewed?\u003c/li>\n\u003cli>What do neutral experts, people who are not involved in the research, say about it?\u003c/li>\n\u003cli>If someone is pushing a claim, do they stand to make any money from it?\u003c/li>\n\u003cli>Is this the first time you’re hearing about something? Or is there a body of work that supports it? Is the finding in cells, in animals or in humans? If it’s in humans, it’s a lot more relevant than if it’s in cells or even mice.\u003c/li>\n\u003c/ul>\n\u003cp>And here’s a great \u003ca href=\"http://www.healthnewsreview.org/about-us/review-criteria/\" target=\"_blank\" rel=\"noopener noreferrer\">tip sheet\u003c/a> on how to evaluate news reports on scientific studies, from the website Health News Review.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>The Food and Drug Administration has given emergency use authorization to the antiviral drug remdesivir to treat hospitalized patients with the coronavirus, the FDA \u003ca href=\"https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-issues-emergency-use-authorization-potential-covid-19-treatment\" target=\"_blank\" rel=\"noopener noreferrer\">announced\u003c/a> Friday.\u003c/p>\n\u003cp>Gilead CEO Daniel O’Day said remdesivir maker Gilead Sciences is donating 1.5 million vials of the drug and will work with the federal government to distribute it to patients in need.\u003c/p>\n\u003cp>The news comes days after \u003ca href=\"https://www.npr.org/sections/health-shots/2020/04/29/848034963/antiviral-drug-remdesivir-shows-promise-for-treating-coronavirus-in-nih-study\">preliminary results from a study\u003c/a> of the drug showed it can help patients recover faster. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, hailed the findings earlier this week as “quite good news.”\u003c/p>\n\u003cp>The authorization means remdesivir can be distributed in the U.S. and given intravenously to treat COVID-19 patients – both adults and children – who are hospitalized with severe disease, \u003ca href=\"https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-issues-emergency-use-authorization-potential-covid-19-treatment\">the FDA says\u003c/a>. The agency defines that category as “patients with low blood oxygen levels or needing oxygen therapy or more intensive breathing support such as a mechanical ventilator.”\u003c/p>\n\u003cp>Discussing the findings about the drug’s ability to help COVID-19 patients, O’Day cautioned earlier Friday that remdesivir is used to treat advanced cases, in which people are already hospitalized. The recent positive findings, he said, are a starting point in the fight against the respiratory disease.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“We want to continue to see how we can expand remdesivir to more patient populations,” O’Day said on \u003ca href=\"https://on.today.com/3dhvTOP\">NBC’s Today show\u003c/a>. “Clearly with other medicines and vaccines to come, this is part, I think — the beginning of our ability to make an impact on this devastating virus.”\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2020 NPR. To see more, visit https://www.npr.org.\u003cimg decoding=\"async\" src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=FDA+Gives+Emergency+Authorization+For+Some+COVID-19+Patients+To+Use+Remdesivir+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Food and Drug Administration has given emergency use authorization to the antiviral drug remdesivir to treat hospitalized patients with the coronavirus, the FDA \u003ca href=\"https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-issues-emergency-use-authorization-potential-covid-19-treatment\" target=\"_blank\" rel=\"noopener noreferrer\">announced\u003c/a> Friday.\u003c/p>\n\u003cp>Gilead CEO Daniel O’Day said remdesivir maker Gilead Sciences is donating 1.5 million vials of the drug and will work with the federal government to distribute it to patients in need.\u003c/p>\n\u003cp>The news comes days after \u003ca href=\"https://www.npr.org/sections/health-shots/2020/04/29/848034963/antiviral-drug-remdesivir-shows-promise-for-treating-coronavirus-in-nih-study\">preliminary results from a study\u003c/a> of the drug showed it can help patients recover faster. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, hailed the findings earlier this week as “quite good news.”\u003c/p>\n\u003cp>The authorization means remdesivir can be distributed in the U.S. and given intravenously to treat COVID-19 patients – both adults and children – who are hospitalized with severe disease, \u003ca href=\"https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-issues-emergency-use-authorization-potential-covid-19-treatment\">the FDA says\u003c/a>. The agency defines that category as “patients with low blood oxygen levels or needing oxygen therapy or more intensive breathing support such as a mechanical ventilator.”\u003c/p>\n\u003cp>Discussing the findings about the drug’s ability to help COVID-19 patients, O’Day cautioned earlier Friday that remdesivir is used to treat advanced cases, in which people are already hospitalized. The recent positive findings, he said, are a starting point in the fight against the respiratory disease.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“We want to continue to see how we can expand remdesivir to more patient populations,” O’Day said on \u003ca href=\"https://on.today.com/3dhvTOP\">NBC’s Today show\u003c/a>. “Clearly with other medicines and vaccines to come, this is part, I think — the beginning of our ability to make an impact on this devastating virus.”\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2020 NPR. To see more, visit https://www.npr.org.\u003cimg decoding=\"async\" src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=FDA+Gives+Emergency+Authorization+For+Some+COVID-19+Patients+To+Use+Remdesivir+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>\u003cem>Updated May 5\u003c/em>\u003c/p>\n\u003cp>An ingredient found in everyday cold medicine appears to promote infection from the coronavirus, according to a new lab \u003ca href=\"https://www.nature.com/articles/s41586-020-2286-9\" target=\"_blank\" rel=\"noopener noreferrer\">study\u003c/a> looking at the impact of over-the-counter and prescription drugs on the coronavirus, led by virus experts at UCSF and the \u003ca href=\"https://gladstone.org/\">\u003cspan class=\"s1\">Gladstone Institutes\u003c/span>\u003c/a>.\u003c/p>\n\u003cp>Researchers found that dextromethorphan — found in most over-the-counter cough syrups tablets and gel capsules — caused SARS-CoV-2, the virus that causes COVID-19, to grow more in a lab setting.\u003c/p>\n\u003cp>The scientists initially said people who have COVID-19 should be cautious about using cold medication that contains the drug until more studies are conducted.\u003c/p>\n\u003cp>“Obviously, if you have COVID-19, you’re coughing and you’re reaching on the shelf for the cough syrup,” said Nevan Krogan, director of the Quantitative Biosciences Institute at UCSF and a senior investigator at Gladstone Institutes. “We’re throwing out a caveat here, at least in the laboratory setting — in the context of this drug, you actually see increased infection.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Krogan said he, himself, if he had COVID-19, would “think twice about using some of these cough syrups until more information was available to us.”\u003c/p>\n\u003cp>Later, Krogan softened that advice in an interview with NBC’s\u003ca href=\"https://www.today.com/health/coronavirus-cough-medicine-does-dextromethorphan-help-virus-grow-t180535\" target=\"_blank\" rel=\"noopener noreferrer\"> Today show\u003c/a>. “This is information we wanted to responsibly report but tempered with a strong caveat that these results were seen in the lab (and) more tests are needed, especially in humans, before any definite conclusions are drawn.”\u003c/p>\n\u003cp>Alexander Borowsky, a medical doctor and a professor at UC Davis’ Center for Immunology and Infectious Diseases, cautions about reading too much into the findings about dextromethorphan, which were conducted in a lab on animal cells and not as part of a clinical trial. Borowsky said it’s “possible” that within the constraints of the study, the drug “is contributing to a little more viral infectivity, but it’s impossible to know from these data whether that changes the ability of the virus to get into the cells or the ability of the virus to replicate copies of its number in a cell.”\u003c/p>\n\u003cp>“Sorting all that out, obviously, would be important,” he said. “But I just cannot imagine that this has a real impact on patients taking Robitussin.”\u003c/p>\n\u003cp>The Consumer Healthcare Products Association, an industry group representing makers of over-the-counter medications, said in a statement: “It’s important to point out that these preliminary study results demonstrating a pro-viral effect of dextromethorphan are not conclusive. The authors only examined three samples and note further study is required on dextromethorphan in the context of COVID-19.”\u003c/p>\n\u003cp>\u003cstrong>Promising Drugs Found\u003c/strong>\u003c/p>\n\u003cp>The UCSF study, which included 120 scientists from around the world, primarily examined the impact of 47 over-the-counter and prescription drugs on SARS-CoV-2. In the coming weeks, the scientists plan to examine another 28 drugs, or 75 total. Results of the study were published today in the journal \u003cem>\u003cspan class=\"s1\">Nature\u003c/span>\u003c/em>.\u003c/p>\n\u003cp>The team found several drugs already approved by the FDA and other drug compounds that could pave the way for improved treatment of COVID-19. You can read more about the study and which drugs showed promise in the \u003ca href=\"https://www.sfchronicle.com/bayarea/article/New-UCSF-study-finds-potential-drugs-for-treating-15235804.php\" target=\"_blank\" rel=\"noopener noreferrer\">San Francisco Chronicle\u003c/a>.\u003c/p>\n\u003cp>The new findings come on the heels of another promising \u003ca href=\"https://www.kqed.org/science/1963229/government-study-shows-patients-responding-to-coronavirus-treatment-drugmaker-gilead-says\">\u003cspan class=\"s2\">study\u003c/span>\u003c/a> by federal scientists into Gilead’s \u003cspan class=\"s3\">drug remdesivir, which found the median recovery time for patients sick with COVID-19 who took the antiviral medication was 4 days faster compared to those who received a placebo. \u003c/span>\u003c/p>\n\u003cp>“Some of our drugs and compounds are many times more potent than remdesivir, at least in the laboratory setting,” Krogan said. “So we’re very excited not just to look at these drugs and compounds in isolation, but in combination with other drugs like remdesivir.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This post has been edited to add the statements by the industry group and outside researcher.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Updated May 5\u003c/em>\u003c/p>\n\u003cp>An ingredient found in everyday cold medicine appears to promote infection from the coronavirus, according to a new lab \u003ca href=\"https://www.nature.com/articles/s41586-020-2286-9\" target=\"_blank\" rel=\"noopener noreferrer\">study\u003c/a> looking at the impact of over-the-counter and prescription drugs on the coronavirus, led by virus experts at UCSF and the \u003ca href=\"https://gladstone.org/\">\u003cspan class=\"s1\">Gladstone Institutes\u003c/span>\u003c/a>.\u003c/p>\n\u003cp>Researchers found that dextromethorphan — found in most over-the-counter cough syrups tablets and gel capsules — caused SARS-CoV-2, the virus that causes COVID-19, to grow more in a lab setting.\u003c/p>\n\u003cp>The scientists initially said people who have COVID-19 should be cautious about using cold medication that contains the drug until more studies are conducted.\u003c/p>\n\u003cp>“Obviously, if you have COVID-19, you’re coughing and you’re reaching on the shelf for the cough syrup,” said Nevan Krogan, director of the Quantitative Biosciences Institute at UCSF and a senior investigator at Gladstone Institutes. “We’re throwing out a caveat here, at least in the laboratory setting — in the context of this drug, you actually see increased infection.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Krogan said he, himself, if he had COVID-19, would “think twice about using some of these cough syrups until more information was available to us.”\u003c/p>\n\u003cp>Later, Krogan softened that advice in an interview with NBC’s\u003ca href=\"https://www.today.com/health/coronavirus-cough-medicine-does-dextromethorphan-help-virus-grow-t180535\" target=\"_blank\" rel=\"noopener noreferrer\"> Today show\u003c/a>. “This is information we wanted to responsibly report but tempered with a strong caveat that these results were seen in the lab (and) more tests are needed, especially in humans, before any definite conclusions are drawn.”\u003c/p>\n\u003cp>Alexander Borowsky, a medical doctor and a professor at UC Davis’ Center for Immunology and Infectious Diseases, cautions about reading too much into the findings about dextromethorphan, which were conducted in a lab on animal cells and not as part of a clinical trial. Borowsky said it’s “possible” that within the constraints of the study, the drug “is contributing to a little more viral infectivity, but it’s impossible to know from these data whether that changes the ability of the virus to get into the cells or the ability of the virus to replicate copies of its number in a cell.”\u003c/p>\n\u003cp>“Sorting all that out, obviously, would be important,” he said. “But I just cannot imagine that this has a real impact on patients taking Robitussin.”\u003c/p>\n\u003cp>The Consumer Healthcare Products Association, an industry group representing makers of over-the-counter medications, said in a statement: “It’s important to point out that these preliminary study results demonstrating a pro-viral effect of dextromethorphan are not conclusive. The authors only examined three samples and note further study is required on dextromethorphan in the context of COVID-19.”\u003c/p>\n\u003cp>\u003cstrong>Promising Drugs Found\u003c/strong>\u003c/p>\n\u003cp>The UCSF study, which included 120 scientists from around the world, primarily examined the impact of 47 over-the-counter and prescription drugs on SARS-CoV-2. In the coming weeks, the scientists plan to examine another 28 drugs, or 75 total. Results of the study were published today in the journal \u003cem>\u003cspan class=\"s1\">Nature\u003c/span>\u003c/em>.\u003c/p>\n\u003cp>The team found several drugs already approved by the FDA and other drug compounds that could pave the way for improved treatment of COVID-19. You can read more about the study and which drugs showed promise in the \u003ca href=\"https://www.sfchronicle.com/bayarea/article/New-UCSF-study-finds-potential-drugs-for-treating-15235804.php\" target=\"_blank\" rel=\"noopener noreferrer\">San Francisco Chronicle\u003c/a>.\u003c/p>\n\u003cp>The new findings come on the heels of another promising \u003ca href=\"https://www.kqed.org/science/1963229/government-study-shows-patients-responding-to-coronavirus-treatment-drugmaker-gilead-says\">\u003cspan class=\"s2\">study\u003c/span>\u003c/a> by federal scientists into Gilead’s \u003cspan class=\"s3\">drug remdesivir, which found the median recovery time for patients sick with COVID-19 who took the antiviral medication was 4 days faster compared to those who received a placebo. \u003c/span>\u003c/p>\n\u003cp>“Some of our drugs and compounds are many times more potent than remdesivir, at least in the laboratory setting,” Krogan said. “So we’re very excited not just to look at these drugs and compounds in isolation, but in combination with other drugs like remdesivir.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This post has been edited to add the statements by the industry group and outside researcher.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>An experimental drug has proved effective against the new coronavirus in a major study, shortening the time it takes for patients to recover, U.S. government and company officials announced Wednesday. The median recovery time for patients who were taking the antiviral medication remdesivir was 11 days, compared with 15 days for those who received a placebo.\u003c/p>\n\u003cp>The drug from Gilead Sciences is the first treatment to pass such a strict test against the virus, which has killed more than 218,000 people since it emerged late last year in China. Having a treatment could have a profound effect on the global pandemic, especially because health officials say any vaccine is likely a year or more away.\u003c/p>\n\u003cp>The study, run by the National Institutes of Health, tested remdesivir versus usual care in 1,063 hospitalized coronavirus patients around the world. At the White House, NIH’s Dr. Anthony Fauci said the drug reduced the time it takes patients to recover by 31% — 11 days on average versus 15 days for those just given usual care.\u003c/p>\n\u003cp>He also said there was a trend toward fewer deaths among those on remdesivir, and that full results would soon be published in a medical journal.\u003c/p>\n\u003cp>“What it has proven is that a drug can block this virus,” Fauci said. “This will be the standard of care.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>A statement from the Food and Drug Administration says that the agency has been talking with California-based Gilead “regarding making remdesivir available to patients as quickly as possible, as appropriate.”\u003c/p>\n\u003cp>Remdesivir is among many treatments being tested against the coronavirus but was the farthest along in study.\u003c/p>\n\u003cp>The drug is given through an IV and is designed to interfere with the virus’s ability to copy its genetic material. In animal tests against SARS and MERS, diseases caused by similar coronaviruses, the drug helped prevent infection and reduced the severity of symptoms when given early enough in the course of illness. But it is not yet approved anywhere in the world for any use.\u003c/p>\n\u003cp>The NIH study quickly enrolled its original goal of 440 patients and then was expanded to give more answers on questions such as which subgroups may or may not benefit, and other factors that may affect success, such as how early in the course of illness the drug was given.\u003c/p>\n\u003cp>The study’s main goal also was altered. Originally, it was the percentage of patients having various outcomes such as needing a breathing machine, fully recovered or dying 15 days after starting treatment. The new main goal is time to recovery, such as no longer needing oxygen or hospitalization.\u003c/p>\n\u003cp>“We are excited and optimistic,” said one expert, Vanderbilt University’s Dr. Mark Denison. His lab first tested remdesivir against other coronaviruses in 2013 and has done much research on it since, but was not involved in the NIH study.\u003c/p>\n\u003cp>“It’s active against every coronavirus that we’ve ever tested,” he said. “It was very hard for the virus to develop resistance to remdesivir. That means the drug would likely be effective over longer term use.”\u003c/p>\n\u003cp>A less encouraging picture came from partial results from a separate study testing remdesivir in severely ill patients in China, published Wednesday in the British medical journal Lancet. Treatment did not speed recovery in that study, which was stopped after only 237 of a planned 453 patients were enrolled. Researchers gave 158 people the drug and 79 others got usual care.\u003c/p>\n\u003cp>Separately on Wednesday, Gilead announced partial results from its own ongoing study of the drug in severely ill, hospitalized COVID-19 patients. The company said patients treated for five days “achieved similar improvement” in health as others treated for 10 days. However, that result is hard to interpret because there is no comparison group of people getting usual care, so it’s impossible to know how much patients would have improved on their own.\u003c/p>\n\u003cp>The company also said no new safety problems emerged in that study, and that it would publish results in a medical journal soon.\u003c/p>\n\u003cp>Gilead also is testing remdesivir in a separate study of moderately ill coronavirus patients. No results have yet been announced from that study, which does have a comparison group getting usual care.\u003c/p>\n\u003cp>Besides these studies, Gilead also has given remdesivir to more than 1,700 patients on a case-by-case emergency basis.\u003c/p>\n\u003cp>In other treatment-related news this week, two studies gave updates on anti-inflammatory drugs that aim to tamp down the severe inflammation that often develops in later stages of severe COVID-19 and often proves fatal.\u003c/p>\n\u003cp>A French hospital consortium reported success with using Acetemra, a Roche drug sold for rheumatoid arthritis and some other conditions, in a study of 129 coronavirus patients where 65 got the drug and the rest, usual care. No details were released; doctors said they were preparing to publish results.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>A similar drug, Kevzara, did not work as well at low doses in a study of severely ill coronavirus patients, its makers Sanofi and Regeneron said. They’re continuing to test it at higher doses in critically ill patients, though.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>An experimental drug has proved effective against the new coronavirus in a major study, shortening the time it takes for patients to recover, U.S. government and company officials announced Wednesday. The median recovery time for patients who were taking the antiviral medication remdesivir was 11 days, compared with 15 days for those who received a placebo.\u003c/p>\n\u003cp>The drug from Gilead Sciences is the first treatment to pass such a strict test against the virus, which has killed more than 218,000 people since it emerged late last year in China. Having a treatment could have a profound effect on the global pandemic, especially because health officials say any vaccine is likely a year or more away.\u003c/p>\n\u003cp>The study, run by the National Institutes of Health, tested remdesivir versus usual care in 1,063 hospitalized coronavirus patients around the world. At the White House, NIH’s Dr. Anthony Fauci said the drug reduced the time it takes patients to recover by 31% — 11 days on average versus 15 days for those just given usual care.\u003c/p>\n\u003cp>He also said there was a trend toward fewer deaths among those on remdesivir, and that full results would soon be published in a medical journal.\u003c/p>\n\u003cp>“What it has proven is that a drug can block this virus,” Fauci said. “This will be the standard of care.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>A statement from the Food and Drug Administration says that the agency has been talking with California-based Gilead “regarding making remdesivir available to patients as quickly as possible, as appropriate.”\u003c/p>\n\u003cp>Remdesivir is among many treatments being tested against the coronavirus but was the farthest along in study.\u003c/p>\n\u003cp>The drug is given through an IV and is designed to interfere with the virus’s ability to copy its genetic material. In animal tests against SARS and MERS, diseases caused by similar coronaviruses, the drug helped prevent infection and reduced the severity of symptoms when given early enough in the course of illness. But it is not yet approved anywhere in the world for any use.\u003c/p>\n\u003cp>The NIH study quickly enrolled its original goal of 440 patients and then was expanded to give more answers on questions such as which subgroups may or may not benefit, and other factors that may affect success, such as how early in the course of illness the drug was given.\u003c/p>\n\u003cp>The study’s main goal also was altered. Originally, it was the percentage of patients having various outcomes such as needing a breathing machine, fully recovered or dying 15 days after starting treatment. The new main goal is time to recovery, such as no longer needing oxygen or hospitalization.\u003c/p>\n\u003cp>“We are excited and optimistic,” said one expert, Vanderbilt University’s Dr. Mark Denison. His lab first tested remdesivir against other coronaviruses in 2013 and has done much research on it since, but was not involved in the NIH study.\u003c/p>\n\u003cp>“It’s active against every coronavirus that we’ve ever tested,” he said. “It was very hard for the virus to develop resistance to remdesivir. That means the drug would likely be effective over longer term use.”\u003c/p>\n\u003cp>A less encouraging picture came from partial results from a separate study testing remdesivir in severely ill patients in China, published Wednesday in the British medical journal Lancet. Treatment did not speed recovery in that study, which was stopped after only 237 of a planned 453 patients were enrolled. Researchers gave 158 people the drug and 79 others got usual care.\u003c/p>\n\u003cp>Separately on Wednesday, Gilead announced partial results from its own ongoing study of the drug in severely ill, hospitalized COVID-19 patients. The company said patients treated for five days “achieved similar improvement” in health as others treated for 10 days. However, that result is hard to interpret because there is no comparison group of people getting usual care, so it’s impossible to know how much patients would have improved on their own.\u003c/p>\n\u003cp>The company also said no new safety problems emerged in that study, and that it would publish results in a medical journal soon.\u003c/p>\n\u003cp>Gilead also is testing remdesivir in a separate study of moderately ill coronavirus patients. No results have yet been announced from that study, which does have a comparison group getting usual care.\u003c/p>\n\u003cp>Besides these studies, Gilead also has given remdesivir to more than 1,700 patients on a case-by-case emergency basis.\u003c/p>\n\u003cp>In other treatment-related news this week, two studies gave updates on anti-inflammatory drugs that aim to tamp down the severe inflammation that often develops in later stages of severe COVID-19 and often proves fatal.\u003c/p>\n\u003cp>A French hospital consortium reported success with using Acetemra, a Roche drug sold for rheumatoid arthritis and some other conditions, in a study of 129 coronavirus patients where 65 got the drug and the rest, usual care. No details were released; doctors said they were preparing to publish results.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>A similar drug, Kevzara, did not work as well at low doses in a study of severely ill coronavirus patients, its makers Sanofi and Regeneron said. They’re continuing to test it at higher doses in critically ill patients, though.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"title": "Telehealth Is Having a Huge Moment During Coronavirus Crisis",
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"content": "\u003cp>California doctors are diagnosing anything from appendicitis to strep throat with only a phone during the coronavirus pandemic. Video visits and conversations are the closest doctors can get to patients who are sheltering in place and avoiding potential exposure from doctor visits.\u003c/p>\n\u003cp>[pullquote citation=\"Dr. Mark Henderson, UC Davis School of Medicine\"]‘Because of COVID-19…it has accelerated all of these ideas and it’s totally exploded our thinking around what we can do with telemedicine in primary care.’[/pullquote]COVID-19 has catapulted telehealth — those virtual visits — into the mainstream more effectively than years of advocacy and policy-making. Experts and physicians are calling it a rare “silver lining” of the current crisis: An overnight availability of video and phone appointments for medical needs, especially in areas where doctors have been in short supply.\u003c/p>\n\u003cp>“COVID-19 has changed everything,” said Dr. Mark Henderson, professor of internal medicine and associate dean for admissions and outreach at UC Davis School of Medicine. “Because of COVID-19 we have all of this distance and it has accelerated all of these ideas and it’s totally exploded our thinking around what we can do with telemedicine in primary care.”\u003c/p>\n\u003cp>Telehealth has been in use for decades, long before smartphones or tablets, and California already was poised to expand options under several new laws passed last year. Initially, though, it was seen as a tool for rural communities and inner-city areas with a shortage of providers.\u003c/p>\n\u003cp>It took a change in regulations affecting billing during the pandemic to allow a dramatic pivot to telehealth, as much as 40% to 80% of patient visits in some health systems in recent weeks. The Department of Managed Health Care announced March 18 that all health plans must reimburse telehealth medical care at \u003ca href=\"http://www.dmhc.ca.gov/Portals/0/Docs/OPL/APL%2020-009%20(OPL)%20-%20Reimbursement%20for%20Telehealth%20Services%20(3_18_20).pdf?ver=2020-03-18-105612-547\" target=\"_blank\" rel=\"noopener noreferrer\">the same rate\u003c/a> as face-to-face appointments, and California’s Department of Health Care Services \u003ca href=\"https://www.dhcs.ca.gov/Documents/COVID-19/CA-1135-Waiver-COVID-19-031620.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">obtained a federal waiver\u003c/a> to allow similar Medi-Cal reimbursement. The federal government \u003ca href=\"https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet\" target=\"_blank\" rel=\"noopener noreferrer\">eased regulations on March 17\u003c/a> affecting Medicare payments to allow the same flexibility.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Medical providers say telehealth is especially important during the pandemic, allowing doctors to keep tabs on fragile patients, especially those with chronic conditions who are most vulnerable to falling ill from the coronavirus.\u003c/p>\n\u003cp>\u003cstrong>From Convenience to Necessity\u003c/strong>\u003c/p>\n\u003cp>Health systems that serve rural and inner-city areas already were investing in telehealth infrastructure to try to bridge the doctor shortage gap. Riverside County in the Inland Empire has only half the physicians it needs, for instance, so telehealth was one way to provide medical care in far-flung corners of the county.\u003c/p>\n\u003cp>Riverside University Health System, the county’s public health network, had offered limited primary care telehealth for patients facing transportation, childcare and work schedule problems. But telehealth mostly was used by behavioral health teams and those caring for incarcerated patients.\u003c/p>\n\u003cp>That’s changed. In the past week, the system’s medical center and 13 community health centers have handled 5,600 virtual visits by phone or video, accounting for two-thirds of all patient visits.\u003c/p>\n\u003cp>“This challenging situation right now has shown how telehealth can help us provide the right care in the right setting at the right time for people,” said Dr. Geoffrey Leung, chair of the family medicine department and ambulatory medical director at Riverside University Health System. He called the ingenuity behind telehealth “one of those silver linings during this difficult time for all of us.”\u003c/p>\n\u003cp>While Kaiser Permanente has had a telehealth program in place for years, under pandemic restrictions about 80% of the system’s appointments nationally are for video or phone calls.\u003c/p>\n\u003cp>\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1963157 alignright\" src=\"https://ww2.kqed.org/app/uploads/sites/35/2020/04/RS42937_VIRTUAL-MEDICAL-VISITS-graphic-.jpg\" alt=\"\" width=\"550\" height=\"836\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2020/04/RS42937_VIRTUAL-MEDICAL-VISITS-graphic-.jpg 550w, https://cdn.kqed.org/wp-content/uploads/sites/35/2020/04/RS42937_VIRTUAL-MEDICAL-VISITS-graphic--160x243.jpg 160w\" sizes=\"auto, (max-width: 550px) 100vw, 550px\">\u003c/p>\n\u003cp>“In the past, a lot of what we thought of in respect to telehealth was offering our patients choice and convenience,” said Dr. Edward Lee, the physician leader for telehealth at Kaiser Permanente. “Nowadays, because of COVID-19 and the shelter-in-place order, a lot of patients are seeing this as a necessity.”\u003c/p>\n\u003cp>Similarly, at UC San Diego Health, about half of all outpatient visits in recent weeks were through video, said Dr. Christopher Longhurst, chief information officer for the health system. Prior to the coronavirus outbreak, UCSD Health already had a well-established telehealth system in place, but still only about 1% of their outpatient visits were handled virtually.\u003c/p>\n\u003cp>“We did more video visits in the first three days of rolling it out broadly (during pandemic) than we had done in the previous three years,” Longhurst said.\u003c/p>\n\u003cp>Not all providers, however, were as experienced in the world of telehealth as Kaiser or the UC medical centers. Many didn’t have the infrastructure set up, administrators said, and others didn’t get reimbursed for telehealth visits prior to the pandemic. In underserved communities, some health clinics were not allowed to charge Medi-Cal for telehealth appointments until the requirement was waived because of the coronavirus.\u003c/p>\n\u003cp>AltaMed, a health center with sites in Los Angeles and Orange counties, began video and telephone visits on March 16, just days before the state issued its stay-at-home order. AltaMed had to spread the word quickly to let patients know they could keep their appointments, they would just look different.\u003c/p>\n\u003cp>Dr. Efrain Talamantes, medical director for the AltaMed’s Institute for Health Equity, said that for patients who didn’t have this option in the past, telehealth is a big deal.\u003c/p>\n\u003cp>“It’s allowed us to care for people in their own homes, so they can stay safe, they don’t have to take time away from their family or work and we can still make sure they have the care and medication they need,” Talamantes said.\u003c/p>\n\u003cp>A California law starting next year ensures at least some telehealth appointments will continue to be reimbursed at the same rate as in-person visits after the pandemic. Talamantes doesn’t yet know the impact on his clinic, he said, but thinks the coronavirus shows how useful remote services can be in communities with strapped resources and high poverty. Still, it doesn’t work for every type of visit — you can’t really do a physical exam over the phone, you can’t feel a bump or administer vaccines.\u003c/p>\n\u003cp>Henderson, of UC Davis, who described himself as a telehealth skeptic before the coronavirus, has been pleasantly surprised by how much can be done via video, such as examining a skin rash or a healing wound and assessing breathing or the color of a patient’s skin.\u003c/p>\n\u003cp>“I believe strongly in the power of putting your hands on a patient, the connection you form with patients when you lay your hands on them, that to me is something very fundamental and sacred in some ways,” he said. “But that doesn’t mean there isn’t a bigger role for telehealth.”\u003c/p>\n\u003cp>Being able to see the patient via video makes a huge difference, he said.\u003c/p>\n\u003cp>“It’s a whole new world when you can see them and they can see you. There are nonverbal clues that are visible and you can use to make a connection,” he said. “The video visit adds life to it.”\u003c/p>\n\u003cp>Telehealth also helps to screen patients for the coronavirus. UC Davis Health expanded its telehealth capacity as a way to check in with those who might be infected, Henderson said.\u003c/p>\n\u003cp>Medical providers across California have been screening patients suspected of possible COVID-19 infection using video and the phone and, if they meet testing criteria, directing patients to urgent care centers, emergency rooms or testing facilities such as the temporary tents set up in some clinic parking lots.\u003c/p>\n\u003cp>“We didn’t want them to come in, we wanted to figure out what they looked like and if they had symptoms,” Henderson said.\u003c/p>\n\u003cp>\u003cstrong>Keeping Offices Afloat\u003c/strong>\u003c/p>\n\u003cp>Even with the new payment rules for telehealth, medical visits are down across California. Health centers and private practices are struggling to stay open; for them, a drop in appointments means a drop in revenue. The California Primary Care Association, which oversees nearly 1,400 health centers in the state, has said that clinics are \u003ca href=\"https://calmatters.org/california-divide/2020/04/not-enough-patients-community-clinics-california/\" target=\"_blank\" rel=\"noopener noreferrer\">losing about $90 million a week collectively during the pandemic.\u003c/a>\u003c/p>\n\u003cp>Dr. Sumana Reddy runs Acacia Family Medical Group, a private practice with offices in Salinas and Prunedale in Monterey County. She said she’s scrambling to apply for every option to keep her business afloat, from loans for small businesses to advances from insurance providers.\u003c/p>\n\u003cp>“We’re working really hard to do what’s right by our patients and community and yet of course the irony is that it can lead to cash flow challenges,” Reddy said. “We were struggling to meet our payroll this last time.”\u003c/p>\n\u003cp>Full payment for telehealth patient care is a big help, she said.\u003c/p>\n\u003cp>“Without that I’m not sure what we would do,” Reddy said. “We made such a rapid pivot that we went within two weeks of never having even thought of telehealth to doing over 75% of our patients’ visits by telehealth.”\u003c/p>\n\u003cp>But video visits aren’t always the most efficient. Technology can be a barrier, especially with frail patients. Helping patients conduct a video visit is time and labor intensive.\u003c/p>\n\u003cp>“Imagine someone who is 80 years old, with pain, he has to look for an assistant to hold the phone, and we’re asking can you move the phone around to see the area. The entire process is so much slower,” she said. “It sounds like you could just replace a regular visit with a telehealth visit but actually there are many barriers there.”\u003c/p>\n\u003cp>While telehealth is necessary during these times, it can’t solve all of the issues, she said,\u003c/p>\n\u003cp>\u003cstrong>Rural California Still Needs Broadband\u003c/strong>\u003c/p>\n\u003cp>Medical providers in rural California are familiar with the technological barriers. Madera Community Hospital serves a region of California’s San Joaquin Valley with a 106-bed hospital and several community clinics. Telehealth there is mostly in the form of phone calls because many patients don’t have access to a smart phone or computer.\u003c/p>\n\u003cp>“We’re finding many patients don’t have fast enough internet to even do a telehealth visit,” said Karen Paolinelli, CEO of Madera Community Hospital. “When you take care of patients from all walks of life and different age groups, not everyone has the technology.”\u003c/p>\n\u003cp>But for those who can participate in a video visit, it helps with another big issue in rural areas, and that is transportation.\u003c/p>\n\u003cp>Paolinelli said she believes COVID-19 will forever change how they provide care.\u003c/p>\n\u003cp>“I don’t know that we can go back,” she said. “To have different ways to see patients — that’s access to care.”\u003c/p>\n\u003cp>Mei Kwong, executive director of the Center for Connected Health Policy, The National Telehealth Policy Resource Center, said the data from this period about how to use telehealth, when it is best and for whom, will be invaluable in creating a roadmap for the future.\u003c/p>\n\u003cp>“The genie is out of the bottle and you can’t let it back in, people have experienced this,” she said. “Not everybody is going to like it and people are going to want to see their providers but the option should be there.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://calmatters.org/\" target=\"_blank\" rel=\"noopener noreferrer\">CalMatters.org\u003c/a> is a nonprofit, nonpartisan media venture explaining California policies and politics.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California doctors are diagnosing anything from appendicitis to strep throat with only a phone during the coronavirus pandemic. Video visits and conversations are the closest doctors can get to patients who are sheltering in place and avoiding potential exposure from doctor visits.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "‘Because of COVID-19…it has accelerated all of these ideas and it’s totally exploded our thinking around what we can do with telemedicine in primary care.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>COVID-19 has catapulted telehealth — those virtual visits — into the mainstream more effectively than years of advocacy and policy-making. Experts and physicians are calling it a rare “silver lining” of the current crisis: An overnight availability of video and phone appointments for medical needs, especially in areas where doctors have been in short supply.\u003c/p>\n\u003cp>“COVID-19 has changed everything,” said Dr. Mark Henderson, professor of internal medicine and associate dean for admissions and outreach at UC Davis School of Medicine. “Because of COVID-19 we have all of this distance and it has accelerated all of these ideas and it’s totally exploded our thinking around what we can do with telemedicine in primary care.”\u003c/p>\n\u003cp>Telehealth has been in use for decades, long before smartphones or tablets, and California already was poised to expand options under several new laws passed last year. Initially, though, it was seen as a tool for rural communities and inner-city areas with a shortage of providers.\u003c/p>\n\u003cp>It took a change in regulations affecting billing during the pandemic to allow a dramatic pivot to telehealth, as much as 40% to 80% of patient visits in some health systems in recent weeks. The Department of Managed Health Care announced March 18 that all health plans must reimburse telehealth medical care at \u003ca href=\"http://www.dmhc.ca.gov/Portals/0/Docs/OPL/APL%2020-009%20(OPL)%20-%20Reimbursement%20for%20Telehealth%20Services%20(3_18_20).pdf?ver=2020-03-18-105612-547\" target=\"_blank\" rel=\"noopener noreferrer\">the same rate\u003c/a> as face-to-face appointments, and California’s Department of Health Care Services \u003ca href=\"https://www.dhcs.ca.gov/Documents/COVID-19/CA-1135-Waiver-COVID-19-031620.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">obtained a federal waiver\u003c/a> to allow similar Medi-Cal reimbursement. The federal government \u003ca href=\"https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet\" target=\"_blank\" rel=\"noopener noreferrer\">eased regulations on March 17\u003c/a> affecting Medicare payments to allow the same flexibility.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Medical providers say telehealth is especially important during the pandemic, allowing doctors to keep tabs on fragile patients, especially those with chronic conditions who are most vulnerable to falling ill from the coronavirus.\u003c/p>\n\u003cp>\u003cstrong>From Convenience to Necessity\u003c/strong>\u003c/p>\n\u003cp>Health systems that serve rural and inner-city areas already were investing in telehealth infrastructure to try to bridge the doctor shortage gap. Riverside County in the Inland Empire has only half the physicians it needs, for instance, so telehealth was one way to provide medical care in far-flung corners of the county.\u003c/p>\n\u003cp>Riverside University Health System, the county’s public health network, had offered limited primary care telehealth for patients facing transportation, childcare and work schedule problems. But telehealth mostly was used by behavioral health teams and those caring for incarcerated patients.\u003c/p>\n\u003cp>That’s changed. In the past week, the system’s medical center and 13 community health centers have handled 5,600 virtual visits by phone or video, accounting for two-thirds of all patient visits.\u003c/p>\n\u003cp>“This challenging situation right now has shown how telehealth can help us provide the right care in the right setting at the right time for people,” said Dr. Geoffrey Leung, chair of the family medicine department and ambulatory medical director at Riverside University Health System. He called the ingenuity behind telehealth “one of those silver linings during this difficult time for all of us.”\u003c/p>\n\u003cp>While Kaiser Permanente has had a telehealth program in place for years, under pandemic restrictions about 80% of the system’s appointments nationally are for video or phone calls.\u003c/p>\n\u003cp>\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1963157 alignright\" src=\"https://ww2.kqed.org/app/uploads/sites/35/2020/04/RS42937_VIRTUAL-MEDICAL-VISITS-graphic-.jpg\" alt=\"\" width=\"550\" height=\"836\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2020/04/RS42937_VIRTUAL-MEDICAL-VISITS-graphic-.jpg 550w, https://cdn.kqed.org/wp-content/uploads/sites/35/2020/04/RS42937_VIRTUAL-MEDICAL-VISITS-graphic--160x243.jpg 160w\" sizes=\"auto, (max-width: 550px) 100vw, 550px\">\u003c/p>\n\u003cp>“In the past, a lot of what we thought of in respect to telehealth was offering our patients choice and convenience,” said Dr. Edward Lee, the physician leader for telehealth at Kaiser Permanente. “Nowadays, because of COVID-19 and the shelter-in-place order, a lot of patients are seeing this as a necessity.”\u003c/p>\n\u003cp>Similarly, at UC San Diego Health, about half of all outpatient visits in recent weeks were through video, said Dr. Christopher Longhurst, chief information officer for the health system. Prior to the coronavirus outbreak, UCSD Health already had a well-established telehealth system in place, but still only about 1% of their outpatient visits were handled virtually.\u003c/p>\n\u003cp>“We did more video visits in the first three days of rolling it out broadly (during pandemic) than we had done in the previous three years,” Longhurst said.\u003c/p>\n\u003cp>Not all providers, however, were as experienced in the world of telehealth as Kaiser or the UC medical centers. Many didn’t have the infrastructure set up, administrators said, and others didn’t get reimbursed for telehealth visits prior to the pandemic. In underserved communities, some health clinics were not allowed to charge Medi-Cal for telehealth appointments until the requirement was waived because of the coronavirus.\u003c/p>\n\u003cp>AltaMed, a health center with sites in Los Angeles and Orange counties, began video and telephone visits on March 16, just days before the state issued its stay-at-home order. AltaMed had to spread the word quickly to let patients know they could keep their appointments, they would just look different.\u003c/p>\n\u003cp>Dr. Efrain Talamantes, medical director for the AltaMed’s Institute for Health Equity, said that for patients who didn’t have this option in the past, telehealth is a big deal.\u003c/p>\n\u003cp>“It’s allowed us to care for people in their own homes, so they can stay safe, they don’t have to take time away from their family or work and we can still make sure they have the care and medication they need,” Talamantes said.\u003c/p>\n\u003cp>A California law starting next year ensures at least some telehealth appointments will continue to be reimbursed at the same rate as in-person visits after the pandemic. Talamantes doesn’t yet know the impact on his clinic, he said, but thinks the coronavirus shows how useful remote services can be in communities with strapped resources and high poverty. Still, it doesn’t work for every type of visit — you can’t really do a physical exam over the phone, you can’t feel a bump or administer vaccines.\u003c/p>\n\u003cp>Henderson, of UC Davis, who described himself as a telehealth skeptic before the coronavirus, has been pleasantly surprised by how much can be done via video, such as examining a skin rash or a healing wound and assessing breathing or the color of a patient’s skin.\u003c/p>\n\u003cp>“I believe strongly in the power of putting your hands on a patient, the connection you form with patients when you lay your hands on them, that to me is something very fundamental and sacred in some ways,” he said. “But that doesn’t mean there isn’t a bigger role for telehealth.”\u003c/p>\n\u003cp>Being able to see the patient via video makes a huge difference, he said.\u003c/p>\n\u003cp>“It’s a whole new world when you can see them and they can see you. There are nonverbal clues that are visible and you can use to make a connection,” he said. “The video visit adds life to it.”\u003c/p>\n\u003cp>Telehealth also helps to screen patients for the coronavirus. UC Davis Health expanded its telehealth capacity as a way to check in with those who might be infected, Henderson said.\u003c/p>\n\u003cp>Medical providers across California have been screening patients suspected of possible COVID-19 infection using video and the phone and, if they meet testing criteria, directing patients to urgent care centers, emergency rooms or testing facilities such as the temporary tents set up in some clinic parking lots.\u003c/p>\n\u003cp>“We didn’t want them to come in, we wanted to figure out what they looked like and if they had symptoms,” Henderson said.\u003c/p>\n\u003cp>\u003cstrong>Keeping Offices Afloat\u003c/strong>\u003c/p>\n\u003cp>Even with the new payment rules for telehealth, medical visits are down across California. Health centers and private practices are struggling to stay open; for them, a drop in appointments means a drop in revenue. The California Primary Care Association, which oversees nearly 1,400 health centers in the state, has said that clinics are \u003ca href=\"https://calmatters.org/california-divide/2020/04/not-enough-patients-community-clinics-california/\" target=\"_blank\" rel=\"noopener noreferrer\">losing about $90 million a week collectively during the pandemic.\u003c/a>\u003c/p>\n\u003cp>Dr. Sumana Reddy runs Acacia Family Medical Group, a private practice with offices in Salinas and Prunedale in Monterey County. She said she’s scrambling to apply for every option to keep her business afloat, from loans for small businesses to advances from insurance providers.\u003c/p>\n\u003cp>“We’re working really hard to do what’s right by our patients and community and yet of course the irony is that it can lead to cash flow challenges,” Reddy said. “We were struggling to meet our payroll this last time.”\u003c/p>\n\u003cp>Full payment for telehealth patient care is a big help, she said.\u003c/p>\n\u003cp>“Without that I’m not sure what we would do,” Reddy said. “We made such a rapid pivot that we went within two weeks of never having even thought of telehealth to doing over 75% of our patients’ visits by telehealth.”\u003c/p>\n\u003cp>But video visits aren’t always the most efficient. Technology can be a barrier, especially with frail patients. Helping patients conduct a video visit is time and labor intensive.\u003c/p>\n\u003cp>“Imagine someone who is 80 years old, with pain, he has to look for an assistant to hold the phone, and we’re asking can you move the phone around to see the area. The entire process is so much slower,” she said. “It sounds like you could just replace a regular visit with a telehealth visit but actually there are many barriers there.”\u003c/p>\n\u003cp>While telehealth is necessary during these times, it can’t solve all of the issues, she said,\u003c/p>\n\u003cp>\u003cstrong>Rural California Still Needs Broadband\u003c/strong>\u003c/p>\n\u003cp>Medical providers in rural California are familiar with the technological barriers. Madera Community Hospital serves a region of California’s San Joaquin Valley with a 106-bed hospital and several community clinics. Telehealth there is mostly in the form of phone calls because many patients don’t have access to a smart phone or computer.\u003c/p>\n\u003cp>“We’re finding many patients don’t have fast enough internet to even do a telehealth visit,” said Karen Paolinelli, CEO of Madera Community Hospital. “When you take care of patients from all walks of life and different age groups, not everyone has the technology.”\u003c/p>\n\u003cp>But for those who can participate in a video visit, it helps with another big issue in rural areas, and that is transportation.\u003c/p>\n\u003cp>Paolinelli said she believes COVID-19 will forever change how they provide care.\u003c/p>\n\u003cp>“I don’t know that we can go back,” she said. “To have different ways to see patients — that’s access to care.”\u003c/p>\n\u003cp>Mei Kwong, executive director of the Center for Connected Health Policy, The National Telehealth Policy Resource Center, said the data from this period about how to use telehealth, when it is best and for whom, will be invaluable in creating a roadmap for the future.\u003c/p>\n\u003cp>“The genie is out of the bottle and you can’t let it back in, people have experienced this,” she said. “Not everybody is going to like it and people are going to want to see their providers but the option should be there.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://calmatters.org/\" target=\"_blank\" rel=\"noopener noreferrer\">CalMatters.org\u003c/a> is a nonprofit, nonpartisan media venture explaining California policies and politics.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"title": "Analysis: Most U.S. States Will Need a Lot More Testing to Safely Reopen",
"headTitle": "Analysis: Most U.S. States Will Need a Lot More Testing to Safely Reopen | KQED",
"content": "\u003cp>More than half of U.S. states will have to significantly step up their Covid-19 testing to even consider starting to relax stay-at-home orders after May 1, according to a new analysis by Harvard researchers and STAT.\u003c/p>\n\u003cp>The analysis shows that as the U.S. tries to move beyond its months-long coronavirus testing debacle — faulty tests, shortages of tests, and guidelines that excluded many people who should have been tested to mitigate the outbreak — it is at risk of fumbling the next challenge: testing enough people to determine which cities and states can safely reopen and stay open. Doing so will require the ability to catch reappearances of the coronavirus before it again spreads uncontrollably.\u003c/p>\n\u003cp>The White House has repeatedly expressed confidence about states’ ability to do enough testing to begin a phased reopening of the economy. In a briefing last Thursday, President Trump said he \u003ca href=\"https://www.whitehouse.gov/briefings-statements/remarks-president-trump-vice-president-pence-members-coronavirus-task-force-press-briefing-31/\" target=\"_blank\" rel=\"noopener noreferrer\">disagreed with comments\u003c/a> by Anthony Fauci, the top government infectious disease expert, that “\u003ca href=\"https://time.com/5826161/anthony-fauci-covid-19-testing-capabilities/\" target=\"_blank\" rel=\"noopener noreferrer\">we are not there yet\u003c/a>” with the number of tests and the capacity to perform them. “No, I think we’re doing a great job in testing,” the president said.\u003c/p>\n\u003cp>But the new state-by-state review reveals a far more fragmented picture: 31 states and the District of Columbia were doing too little testing last week to identify most infected people in a timely manner. Ten states would need to increase their daily testing totals by at least 10,000 to do so by May 1. New York, for instance, would have to perform more than 100,000 more tests a day, and New Jersey 68,000 more. Nineteen states — all but two in the South or the western half of the country — are already doing enough testing.\u003c/p>\n\u003cp>Most assessments of the amount of testing that will be needed over the next few months are national. But while those are a good starting point, they do not give individual states, let alone cities, much guidance. “You can’t just take the national number and scale it to states by their population,” said Ashish Jha, director of the Harvard Global Health Institute. “You have to base it on the size of the outbreak in a state.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>At STAT’s request, Jha and his colleagues at the institute calculated the number of tests that each state would need to be doing as of May 1. STAT then compared those numbers to each state’s daily testing totals in an average week in mid-April, using data collected by the \u003ca href=\"https://covidtracking.com/data\" target=\"_blank\" rel=\"noopener noreferrer\">Covid Tracking Project\u003c/a>.\u003c/p>\n\u003cp>The results show that states with few COVID-19 cases and deaths so far will need to perform relatively few tests: between 68 and 145 per day in Alaska and between 31 and 156 in Montana, for instance. States harder hit by the pandemic face a much heavier lift: New York would have to do 130,000 to 155,000 tests every day, New Jersey 75,000 to 90,000, and both Massachusetts and Illinois about 30,000 to 35,000.\u003c/p>\n\u003cp>Many hard-hit states are not even close to their goals. New York, for instance, has been averaging barely more than 20,000 tests per day since mid-April. New Jersey has been doing about 7,000, on average. Neither has announced reopening plans or dates, giving them time to ramp up testing. Massachusetts and Illinois are in no better shape, conducting just under 7,000 a day. Michigan, Connecticut, and Colorado are all about 15,000 tests a day below their May 1 targets. Texas, with more than 9,000 tests a day, and Washington state, with more than 3,000, are already doing enough.\u003c/p>\n\u003cp>The more worrisome gap involves states that, despite having thousands of COVID-19 cases, are easing mitigation strategies by, for instance, allowing more businesses and public spaces such as beaches to reopen. To catch hot spots before they turn into wildfires of disease, Georgia must do 9,600 to 10,000 tests per day; it has been averaging around 4,000. Florida will need 16,000; in the last week it has been hitting just above 10,000. South Carolina is a rare bright spot: It will need 1,200 to 1,600 tests per day and has been averaging close to the low end of that, with at least 1,500 tests on several recent days.\u003c/p>\n\u003cp>In the last week, the U.S. as a whole conducted 1.6 million tests, according to the \u003ca href=\"https://covidtracking.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Covid Tracking Project\u003c/a>. The Harvard team says twice that many tests will be needed — at minimum.\u003c/p>\n\u003cp>Performing enough tests is only one of the essential steps before states can reopen, experts say. Test results also have to be returned more quickly, public health workers must identify and contact potentially exposed people, and hospitals and nursing homes require adequate amounts of personal protective equipment and other supplies in case a new wave of seriously ill patients crashes over them.\u003c/p>\n\u003cp>The Harvard institute based its calculations on best-case scenarios. If the goal were not to miss a single new infection, “you would need more than 300 million tests a day,” said Jha — testing nearly every resident of every state every day (or every few days). “That’s an interesting theoretical exercise but since it’s not going to happen, it’s policy-irrelevant. If you say that, people stop listening.”\u003c/p>\n\u003cp>Instead, he said, “we tried to come up with numbers that wouldn’t make governors gag.”\u003c/p>\n\u003cp>Jha and the institute’s Ben Jacobson crunched the numbers two ways for each state. Both start with the number of deaths projected for May 15 by Los Alamos National Laboratory, whose COVID-19 model the Centers for Disease Control and Prevention \u003ca href=\"https://www.cdc.gov/coronavirus/2019-ncov/covid-data/forecasting-us.html\" target=\"_blank\" rel=\"noopener noreferrer\">consults\u003c/a>. Los Alamos projects that, nationally, the death toll on that day will be 545 — but more if states keep easing up on social distancing. For comparison, on April 25, the U.S. reported just over 2,065\u003cb> \u003c/b>new COVID-19 deaths.\u003c/p>\n\u003cp>The researchers then assume that deaths on May 15 will reflect the number of cases on May 1, since two weeks is the average time between infection and death. If 1 out of every 100 people diagnosed with COVID-19 dies (for a “case fatality rate” of 1%), then on May 1 there would be 100 times as many new cases as there would be deaths on May 15; call it 54,500 (545 times 100) cases on May 1 for the country as a whole. The case fatality rate for COVID-19 remains unknown, so if it is lower, perhaps 0.5%, then the number of cases would be greater: 109,000. Jha’s choice of 1% reflects his decision to make recommendations that are within reach of realistic testing capacity, and 1% is the rough consensus of experts now.\u003c/p>\n\u003cp>To control the epidemic, public health workers would need to identify those 54,500 new cases on or around May 1 in order to trace and test their contacts, quarantining those who also test positive. (The “around” is because cases don’t have to be identified right away; probably within two or three days of infection is OK.) The chances of picking precisely the right 54,500 people to test are nil.\u003c/p>\n\u003cp>It’s therefore necessary to test many times more than 54,500 people to find that number of cases. How many more?\u003c/p>\n\u003cp>Jacobson and Jha calculated that using two different methods, which serve as a check on each other.\u003c/p>\n\u003cp>One method is based on the fact that people most likely to be infected with the new coronavirus are also the most likely to be tested. But because of inadequate testing capacity, and because many people don’t even show symptoms, tens of thousands of cases have been missed.\u003c/p>\n\u003cp>Roughly 20% of U.S. tests are positive for the virus. Epidemiologists estimate that for infectious diseases such as influenza and tuberculosis, if more than 3% of people test positive, then the net is not being cast wide enough. South Korea has a 3% positive rate for its coronavirus testing. To achieve that, the U.S. would have to increase its number of daily tests to 2 million by May 1. (It should be 5 million now, but that ship has sailed.) Even 2 million seems beyond reach.\u003c/p>\n\u003cp>But the World Health Organization says a positive rate below 10% “reflects adequate testing,” Jha said. Using that rate, the U.S. would have to be testing 545,000 people per day by May 1 and every day thereafter, until projected deaths two weeks ahead fall.\u003c/p>\n\u003cp>At STAT’s request, Jacobson and Jha then applied the 10% positive rate to each state individually. That yielded an enormous range, from 155,000 a day in New York to just 18 a day in Wyoming. Is it feasible? That will vary by state, but last week California \u003ca href=\"https://www.latimes.com/science/story/2020-04-21/california-first-state-coronavirus-tests-without-symptoms\" target=\"_blank\" rel=\"noopener noreferrer\">said\u003c/a> it aims to conduct 25,000 tests a day by the end of April, up from an average of about 14,000 in recent days. The Harvard team calculated the Golden State needs about 26,000, suggesting that if California hits its goal it could well be on track to safely reopen.\u003c/p>\n\u003cp>As a check on their work, the researchers did the calculation a second way.\u003c/p>\n\u003cp>They again started with Los Alamos’ 545 projected deaths on May 15 and inferred that there were 100 times as many new cases, 54,500, on May 1. That’s a starting point for tracing contacts, which offers the best shot at containing both the current outbreak and any that threaten to erupt after shutdown orders are lifted: “Reopened” cities and states must catch and quarantine cases, then identify and test their contacts before they infect more people.\u003c/p>\n\u003cp>Without social distancing, each case has an estimated 19 close contacts, Jha said. With social distancing, each might have 10, again suggesting roughly half a million tests per day.\u003c/p>\n\u003cp>A lot of assumptions — case fatality rate, test positivity rate, and more — went into these calculations. But other researchers have come up with approximately the same number via different reasoning.\u003c/p>\n\u003cp>Last week, an \u003ca href=\"https://www.rockefellerfoundation.org/national-covid-19-testing-action-plan/\" target=\"_blank\" rel=\"noopener noreferrer\">analysis\u003c/a> by the Rockefeller Foundation concluded that the U.S. should test 3 million people a week. Vital Strategies, the nonprofit headed by former CDC Director \u003ca href=\"https://www.statnews.com/2020/04/13/video-chat-conversation-on-the-coronavirus-with-tom-frieden/\" target=\"_blank\" rel=\"noopener noreferrer\">Tom Frieden\u003c/a>, recommended a minimum of 450,000 tests per day. Researchers arrived at that figure by counting the number of people who have the highest priority for testing: people who are sick and their contacts, of course, but also nursing home and shelter residents, prison inmates, and vital workers in health care and public transit and other infrastructure, said epidemiologist Cyrus Shahpar of Vital Strategies.\u003c/p>\n\u003cp>As in the Harvard calculation, the national testing goal of 450,000 would not be evenly distributed according to state (or city) population, he said.\u003c/p>\n\u003cp>The White House has said that individual states and cities need to do roughly 30 tests per 1,000 people per month, as Deborah Birx, the White House’s COVID-19 response coordinator, \u003ca href=\"https://www.whitehouse.gov/briefings-statements/remarks-president-trump-vice-president-pence-members-coronavirus-task-force-press-briefing-april-17-2020/\" target=\"_blank\" rel=\"noopener noreferrer\">explained\u003c/a> at a recent briefing, citing New Orleans’ 27 tests per 1,000. Birx said that all but three states — Oregon, Maine, and Montana — had the ability to do that many tests and that the administration is working with states to ensure all the potential for testing is “brought to bear.”\u003c/p>\n\u003cp>Both Shahpar’s and Jha’s calculations, however, say the number of needed tests is closer to 45 per 1,000 people per month, but with significant regional variation.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>And that, both say, is the lower bound of what is needed.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>More than half of U.S. states will have to significantly step up their Covid-19 testing to even consider starting to relax stay-at-home orders after May 1, according to a new analysis by Harvard researchers and STAT.\u003c/p>\n\u003cp>The analysis shows that as the U.S. tries to move beyond its months-long coronavirus testing debacle — faulty tests, shortages of tests, and guidelines that excluded many people who should have been tested to mitigate the outbreak — it is at risk of fumbling the next challenge: testing enough people to determine which cities and states can safely reopen and stay open. Doing so will require the ability to catch reappearances of the coronavirus before it again spreads uncontrollably.\u003c/p>\n\u003cp>The White House has repeatedly expressed confidence about states’ ability to do enough testing to begin a phased reopening of the economy. In a briefing last Thursday, President Trump said he \u003ca href=\"https://www.whitehouse.gov/briefings-statements/remarks-president-trump-vice-president-pence-members-coronavirus-task-force-press-briefing-31/\" target=\"_blank\" rel=\"noopener noreferrer\">disagreed with comments\u003c/a> by Anthony Fauci, the top government infectious disease expert, that “\u003ca href=\"https://time.com/5826161/anthony-fauci-covid-19-testing-capabilities/\" target=\"_blank\" rel=\"noopener noreferrer\">we are not there yet\u003c/a>” with the number of tests and the capacity to perform them. “No, I think we’re doing a great job in testing,” the president said.\u003c/p>\n\u003cp>But the new state-by-state review reveals a far more fragmented picture: 31 states and the District of Columbia were doing too little testing last week to identify most infected people in a timely manner. Ten states would need to increase their daily testing totals by at least 10,000 to do so by May 1. New York, for instance, would have to perform more than 100,000 more tests a day, and New Jersey 68,000 more. Nineteen states — all but two in the South or the western half of the country — are already doing enough testing.\u003c/p>\n\u003cp>Most assessments of the amount of testing that will be needed over the next few months are national. But while those are a good starting point, they do not give individual states, let alone cities, much guidance. “You can’t just take the national number and scale it to states by their population,” said Ashish Jha, director of the Harvard Global Health Institute. “You have to base it on the size of the outbreak in a state.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>At STAT’s request, Jha and his colleagues at the institute calculated the number of tests that each state would need to be doing as of May 1. STAT then compared those numbers to each state’s daily testing totals in an average week in mid-April, using data collected by the \u003ca href=\"https://covidtracking.com/data\" target=\"_blank\" rel=\"noopener noreferrer\">Covid Tracking Project\u003c/a>.\u003c/p>\n\u003cp>The results show that states with few COVID-19 cases and deaths so far will need to perform relatively few tests: between 68 and 145 per day in Alaska and between 31 and 156 in Montana, for instance. States harder hit by the pandemic face a much heavier lift: New York would have to do 130,000 to 155,000 tests every day, New Jersey 75,000 to 90,000, and both Massachusetts and Illinois about 30,000 to 35,000.\u003c/p>\n\u003cp>Many hard-hit states are not even close to their goals. New York, for instance, has been averaging barely more than 20,000 tests per day since mid-April. New Jersey has been doing about 7,000, on average. Neither has announced reopening plans or dates, giving them time to ramp up testing. Massachusetts and Illinois are in no better shape, conducting just under 7,000 a day. Michigan, Connecticut, and Colorado are all about 15,000 tests a day below their May 1 targets. Texas, with more than 9,000 tests a day, and Washington state, with more than 3,000, are already doing enough.\u003c/p>\n\u003cp>The more worrisome gap involves states that, despite having thousands of COVID-19 cases, are easing mitigation strategies by, for instance, allowing more businesses and public spaces such as beaches to reopen. To catch hot spots before they turn into wildfires of disease, Georgia must do 9,600 to 10,000 tests per day; it has been averaging around 4,000. Florida will need 16,000; in the last week it has been hitting just above 10,000. South Carolina is a rare bright spot: It will need 1,200 to 1,600 tests per day and has been averaging close to the low end of that, with at least 1,500 tests on several recent days.\u003c/p>\n\u003cp>In the last week, the U.S. as a whole conducted 1.6 million tests, according to the \u003ca href=\"https://covidtracking.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Covid Tracking Project\u003c/a>. The Harvard team says twice that many tests will be needed — at minimum.\u003c/p>\n\u003cp>Performing enough tests is only one of the essential steps before states can reopen, experts say. Test results also have to be returned more quickly, public health workers must identify and contact potentially exposed people, and hospitals and nursing homes require adequate amounts of personal protective equipment and other supplies in case a new wave of seriously ill patients crashes over them.\u003c/p>\n\u003cp>The Harvard institute based its calculations on best-case scenarios. If the goal were not to miss a single new infection, “you would need more than 300 million tests a day,” said Jha — testing nearly every resident of every state every day (or every few days). “That’s an interesting theoretical exercise but since it’s not going to happen, it’s policy-irrelevant. If you say that, people stop listening.”\u003c/p>\n\u003cp>Instead, he said, “we tried to come up with numbers that wouldn’t make governors gag.”\u003c/p>\n\u003cp>Jha and the institute’s Ben Jacobson crunched the numbers two ways for each state. Both start with the number of deaths projected for May 15 by Los Alamos National Laboratory, whose COVID-19 model the Centers for Disease Control and Prevention \u003ca href=\"https://www.cdc.gov/coronavirus/2019-ncov/covid-data/forecasting-us.html\" target=\"_blank\" rel=\"noopener noreferrer\">consults\u003c/a>. Los Alamos projects that, nationally, the death toll on that day will be 545 — but more if states keep easing up on social distancing. For comparison, on April 25, the U.S. reported just over 2,065\u003cb> \u003c/b>new COVID-19 deaths.\u003c/p>\n\u003cp>The researchers then assume that deaths on May 15 will reflect the number of cases on May 1, since two weeks is the average time between infection and death. If 1 out of every 100 people diagnosed with COVID-19 dies (for a “case fatality rate” of 1%), then on May 1 there would be 100 times as many new cases as there would be deaths on May 15; call it 54,500 (545 times 100) cases on May 1 for the country as a whole. The case fatality rate for COVID-19 remains unknown, so if it is lower, perhaps 0.5%, then the number of cases would be greater: 109,000. Jha’s choice of 1% reflects his decision to make recommendations that are within reach of realistic testing capacity, and 1% is the rough consensus of experts now.\u003c/p>\n\u003cp>To control the epidemic, public health workers would need to identify those 54,500 new cases on or around May 1 in order to trace and test their contacts, quarantining those who also test positive. (The “around” is because cases don’t have to be identified right away; probably within two or three days of infection is OK.) The chances of picking precisely the right 54,500 people to test are nil.\u003c/p>\n\u003cp>It’s therefore necessary to test many times more than 54,500 people to find that number of cases. How many more?\u003c/p>\n\u003cp>Jacobson and Jha calculated that using two different methods, which serve as a check on each other.\u003c/p>\n\u003cp>One method is based on the fact that people most likely to be infected with the new coronavirus are also the most likely to be tested. But because of inadequate testing capacity, and because many people don’t even show symptoms, tens of thousands of cases have been missed.\u003c/p>\n\u003cp>Roughly 20% of U.S. tests are positive for the virus. Epidemiologists estimate that for infectious diseases such as influenza and tuberculosis, if more than 3% of people test positive, then the net is not being cast wide enough. South Korea has a 3% positive rate for its coronavirus testing. To achieve that, the U.S. would have to increase its number of daily tests to 2 million by May 1. (It should be 5 million now, but that ship has sailed.) Even 2 million seems beyond reach.\u003c/p>\n\u003cp>But the World Health Organization says a positive rate below 10% “reflects adequate testing,” Jha said. Using that rate, the U.S. would have to be testing 545,000 people per day by May 1 and every day thereafter, until projected deaths two weeks ahead fall.\u003c/p>\n\u003cp>At STAT’s request, Jacobson and Jha then applied the 10% positive rate to each state individually. That yielded an enormous range, from 155,000 a day in New York to just 18 a day in Wyoming. Is it feasible? That will vary by state, but last week California \u003ca href=\"https://www.latimes.com/science/story/2020-04-21/california-first-state-coronavirus-tests-without-symptoms\" target=\"_blank\" rel=\"noopener noreferrer\">said\u003c/a> it aims to conduct 25,000 tests a day by the end of April, up from an average of about 14,000 in recent days. The Harvard team calculated the Golden State needs about 26,000, suggesting that if California hits its goal it could well be on track to safely reopen.\u003c/p>\n\u003cp>As a check on their work, the researchers did the calculation a second way.\u003c/p>\n\u003cp>They again started with Los Alamos’ 545 projected deaths on May 15 and inferred that there were 100 times as many new cases, 54,500, on May 1. That’s a starting point for tracing contacts, which offers the best shot at containing both the current outbreak and any that threaten to erupt after shutdown orders are lifted: “Reopened” cities and states must catch and quarantine cases, then identify and test their contacts before they infect more people.\u003c/p>\n\u003cp>Without social distancing, each case has an estimated 19 close contacts, Jha said. With social distancing, each might have 10, again suggesting roughly half a million tests per day.\u003c/p>\n\u003cp>A lot of assumptions — case fatality rate, test positivity rate, and more — went into these calculations. But other researchers have come up with approximately the same number via different reasoning.\u003c/p>\n\u003cp>Last week, an \u003ca href=\"https://www.rockefellerfoundation.org/national-covid-19-testing-action-plan/\" target=\"_blank\" rel=\"noopener noreferrer\">analysis\u003c/a> by the Rockefeller Foundation concluded that the U.S. should test 3 million people a week. Vital Strategies, the nonprofit headed by former CDC Director \u003ca href=\"https://www.statnews.com/2020/04/13/video-chat-conversation-on-the-coronavirus-with-tom-frieden/\" target=\"_blank\" rel=\"noopener noreferrer\">Tom Frieden\u003c/a>, recommended a minimum of 450,000 tests per day. Researchers arrived at that figure by counting the number of people who have the highest priority for testing: people who are sick and their contacts, of course, but also nursing home and shelter residents, prison inmates, and vital workers in health care and public transit and other infrastructure, said epidemiologist Cyrus Shahpar of Vital Strategies.\u003c/p>\n\u003cp>As in the Harvard calculation, the national testing goal of 450,000 would not be evenly distributed according to state (or city) population, he said.\u003c/p>\n\u003cp>The White House has said that individual states and cities need to do roughly 30 tests per 1,000 people per month, as Deborah Birx, the White House’s COVID-19 response coordinator, \u003ca href=\"https://www.whitehouse.gov/briefings-statements/remarks-president-trump-vice-president-pence-members-coronavirus-task-force-press-briefing-april-17-2020/\" target=\"_blank\" rel=\"noopener noreferrer\">explained\u003c/a> at a recent briefing, citing New Orleans’ 27 tests per 1,000. Birx said that all but three states — Oregon, Maine, and Montana — had the ability to do that many tests and that the administration is working with states to ensure all the potential for testing is “brought to bear.”\u003c/p>\n\u003cp>Both Shahpar’s and Jha’s calculations, however, say the number of needed tests is closer to 45 per 1,000 people per month, but with significant regional variation.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>https://www.youtube.com/watch?v=i0khDiSoqBw&feature=emb_logo\u003c/p>\n\u003cp>\u003cspan class=\"style-scope yt-formatted-string\" dir=\"auto\">Misinformation about the coronavirus is so widespread, researchers are beginning to \u003ca href=\"https://abcnews.go.com/US/coronavirus-misinformation-widespread-report-calls-infodemic/story?id=70249400\" target=\"_blank\" rel=\"noopener noreferrer\">call\u003c/a> it an “infodemic.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan class=\"style-scope yt-formatted-string\" dir=\"auto\">False claims and rumors about everything from treatments and remedies to how the virus is spread are popping up everywhere; it’s hard to keep track of what’s accurate and what’s not.\u003c/span>\u003c/p>\n\u003cp>“\u003cspan class=\"style-scope yt-formatted-string\" dir=\"auto\">\u003ca href=\"https://www.kqed.org/education/collection/above-the-noise\" target=\"_blank\" rel=\"noopener noreferrer\">Above the Noise \u003c/a>” is a Youtube show for teens that investigates the research behind controversial and trending topics in the news.\u003c/span>\u003c/p>\n\u003cp>In this episode, host Myles Bess speaks with John Swartzberg, a professor of infectious disease at UC Berkeley’s School of Public Health, to set the record straight and provide tips for vetting information you might find online.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\u003cp>\u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutube'>\n \u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutubeInside'>\n \u003ciframe\n loading='lazy'\n class='utils-parseShortcode-shortcodes-__youtubeShortcode__youtubePlayer'\n type='text/html'\n src='//www.youtube.com/embed/i0khDiSoqBw'\n title='//www.youtube.com/embed/i0khDiSoqBw'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003cp>\u003cspan class=\"style-scope yt-formatted-string\" dir=\"auto\">Misinformation about the coronavirus is so widespread, researchers are beginning to \u003ca href=\"https://abcnews.go.com/US/coronavirus-misinformation-widespread-report-calls-infodemic/story?id=70249400\" target=\"_blank\" rel=\"noopener noreferrer\">call\u003c/a> it an “infodemic.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan class=\"style-scope yt-formatted-string\" dir=\"auto\">False claims and rumors about everything from treatments and remedies to how the virus is spread are popping up everywhere; it’s hard to keep track of what’s accurate and what’s not.\u003c/span>\u003c/p>\n\u003cp>“\u003cspan class=\"style-scope yt-formatted-string\" dir=\"auto\">\u003ca href=\"https://www.kqed.org/education/collection/above-the-noise\" target=\"_blank\" rel=\"noopener noreferrer\">Above the Noise \u003c/a>” is a Youtube show for teens that investigates the research behind controversial and trending topics in the news.\u003c/span>\u003c/p>\n\u003cp>In this episode, host Myles Bess speaks with John Swartzberg, a professor of infectious disease at UC Berkeley’s School of Public Health, to set the record straight and provide tips for vetting information you might find online.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"tagline": "The flip side of gentrification, told through one town",
"info": "Gentrification is changing cities across America, forcing people from neighborhoods they have long called home. Call them the displaced. Now those priced out of the Bay Area are looking for a better life in an unlikely place. American Suburb follows this migration to one California town along the Delta, 45 miles from San Francisco. But is this once sleepy suburb ready for them?",
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},
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"tagline": "Exploring the Bay Area, one question at a time",
"info": "KQED’s new podcast, Bay Curious, gets to the bottom of the mysteries — both profound and peculiar — that give the Bay Area its unique identity. And we’ll do it with your help! You ask the questions. You decide what Bay Curious investigates. And you join us on the journey to find the answers.",
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},
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"info": "KQED’s statewide radio news program providing daily coverage of issues, trends and public policy decisions.",
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"order": 8
},
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},
"link": "https://www.cityarts.net",
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"order": 1
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"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
"airtime": "THU 10pm, FRI 1am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg",
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"source": "Commonwealth Club of California"
},
"link": "/radio/program/commonwealth-club",
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}
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"tagline": "The conversation starts here",
"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
"airtime": "MON-FRI 9am-11am, 10pm-11pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Forum with Mina Kim and Alexis Madrigal",
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"source": "kqed",
"order": 9
},
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"id": "fresh-air",
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"hidden-brain": {
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"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
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"airtime": "SUN 7pm-8pm",
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"source": "NPR"
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"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
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"airtime": "SUN 7:30pm-8pm",
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"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"jerrybrown": {
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"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
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"order": 18
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},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
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},
"link": "/radio/program/latino-usa",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
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},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
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"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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"rss": "https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"
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},
"masters-of-scale": {
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"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
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"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
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"source": "WaitWhat"
},
"link": "/radio/program/masters-of-scale",
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"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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