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Saturday, July 11, 2020

Cal. doctor urges young to double down after demographic sees spike in COVID-19

People between the ages of 18 and 34 in Orange County are being urged to double down as numbers continue to prove the demographic is catching COVID-19 more than any other group.
“Those numbers have gone up dramatically faster in the last several weeks than they have in the months leading up to where we are today,” said County CEO Frank Kim during a press briefing this week.
From June 1 to June 26, data from the Orange County Health Care Agency shows people between the ages of 25 and 34 have seen the largest average of new cases than any other group at 151 per day.
In that same time period, 18 to 24-year-olds had the largest percentage increase of positive cases than any other age group at 436%.
“Recently with things opening, protests, there’s been a lot more contact between people, which of course we know can cause a more rapid spread of the virus,” said Dr. Michael Katz, who practices pulmonary and critical care medicine at St. Jude Medical Center in Fullerton.
He thinks young people have reached a breaking point.
“We understand that people are tired from maintaining such a high level of anxiety for so long, the social distancing, not feeling free to get together and enjoy life normally,” Katz said.
While most will be able to recover at home, he added the main concern is their contact with others.
“They’re less likely to become critically ill or need hospitalization, but of course it’s very important to monitor the infection in those age groups because they could easily spread the infection to older people and people with medical conditions that are more likely to become severely ill from the virus,” Katz said.
This is why he urging people 18 to 34 to think about the big picture.
“Especially for this time, which is not gonna last forever, maybe the next four to six weeks especially while we’re seeing this rapid rise again in the number of cases, there is still great value in young healthy people doubling down in order to protect people that have chronic medical conditions, people who are more at risk to become severely ill,” he said.
“The real message that we have for our younger members of our Orange County Community is to be safe and practice good hygiene and if you’re not feeling well, please, stay at home and limit your contact,” said Kim.

With Quick, Questionable Covid Test, NY Rooftop Pandemic Pool Parties Rage

When the Ravel Hotel in Long Island City reopened its rooftop Profundo pool lounge on June 25th, they promised that a series of festive pool parties would be safe for guests, thanks to the hotel’s mandatory on-site rapid coronavirus testing. Seth Levine, a co-owner of the hotel, told Gothamist he wanted to make it “a safe haven” to allow people who had been cooped up inside for months to enjoy a night out while maintaining social distancing. They were one of the first NYC venues, if not the first, to try to encourage people to go out again amidst the pandemic.
But instead of a safe haven, critics say the pool parties have begun to resemble the infamous Memorial Day weekend videos of partiers crowded together at the Lake Of The Ozarks. Based on first person accounts of events at Profundo last weekend, as well as the videos below, there was a distinct lack of social distancing or mask-wearing happening in and around the pool. Instead of cautious mingling among small groups of friends, the crowded gatherings looked more like Vaccine Victory parties—sans the vaccine.
“I was not there, because I think it’s too dangerous, but I know people who were there, and I saw all the videos online, and there’s a lot of group chats, so everybody was posting videos,” said Kristina Alaniesse, who reposted the videos above of the scene at Profundo on July 4th. Alaniesse, who is active in the nightlife scene in NYC, said she was shocked at what she saw and heard from attendees, including an employee who asked to remain anonymous: “There were no masks. No social distancing whatsoever. People were dancing on tables and the protocol is to usually stay at your table with a mask.”
“All the staff were wearing masks. But not the clients—no one was wearing masks, no one was social distancing, 100%,” said D.L., 38, who was at Profundo until about 11:30 p.m. for the evening session on the 4th. He said that people were congregating and drinking together by the DJ booth: “That’s where the action was. Everyone was dancing there.”
“To be honest, for me personally, I basically went there to have some drinks and hang out with my friends who I haven’t seen in months,” he added. “So I didn’t mingle with anybody. We were far away from everyone else, I legitimately spoke to maybe two people.”
Several partiers Gothamist spoke to said they had fun at the events, and that things were far more under control during the day session. “I didn’t see masks being worn, but I feel like everyone stayed within their own parties, unless they were walking around or going to the pool or restroom,” said 31-year-old makeup artist Mariela Sciandra, who was there until the day session ended in the late afternoon. “But besides that, we were staying within our own groups of eight. I didn’t really experience mingling between other parties. There were a few people dancing in front of DJ booth, but it wasn’t crowded, just a few people.”
Ashley Torres, a 25-year-old nanny who was also there for the day session, said she saw employees cleaning, spraying and wiping things down as the day progressed. She said people took their masks off often because of how hot it was outside, but overall she felt safe during the day session and thinks things were not as bad as they appeared in the videos: “There are tables next to where dance floor is, it could be misconstrued as a large gathering of groups. Each table is eight people, it might look congested, but in person it’s not.”
According to their website, all day beds and tables were installed six feet apart; staff and guests are expected to be diligent about remaining six feet apart in common areas like the restrooms and bar area, and all guests are required to wear a mask when entering and moving throughout the space. Their capacity has been reduced to 50%, though that still means they can still fit around 300 people at a time, despite the fact the state doesn’t allow gatherings of over 25 people in Phase 3 (these videos were taken while the city was still in Phase 2).
Establishments in NYC are only allowed to do socially distant outdoor dining right now, which doesn’t appear to be happening in the videos. An official with the mayor’s office confirmed that the city is currently following up with the owners “to make sure they’re compliant when they reopen this weekend.”
Complaints have also been made to the city’s Office of Nightlife: “We’re aware of the situation and are actively in contact with the venue and the patrons who’ve shared their concerns,” said the Senior Executive Director of the Office of Nightlife, Ariel Palitz. “As a non-enforcement office, our role is to ensure operators and patrons are getting the information they need so that venues are following guidelines, and everyone is socializing responsibly. That’s what we’re doing here.”
In response to questions about the lack of masks and social distancing, a spokesperson for Ravel said that “they’ve immediately implemented new protocols with increased security measures and social distancing practices. Any patrons who defy these policies will be given a warning, and on the second offense will be asked to leave the premises. Guests need to respect the state’s mandates, as well as Ravel’s.”
While health experts have said that there’s no evidence the virus can be spread in bodies of water including lakes, oceans and pools, that doesn’t mean pool parties are safe: “We know [coronavirus] is very effectively transmitted through aerosol droplets,” Robert Quigley, the regional medical director for travel risk mitigation company International SOS, who holds a PhD in immunology, told the Washington Post. “Just because you’re in the water doesn’t give you authorization to violate the six-foot rule.” Another expert added that it is intrinsic that facilities make sure “you’re not going to have the large congregations of people like you might have in prior years.”
Then there’s the testing: Ravel’s ballroom has been converted into an on-site testing facility run by a New Jersey company using Abbott Laboratories’ quick result tests.
All patrons must submit proof of insurance and agree to be tested there before they can enter the premises (it costs $50 without insurance, $35 with insurance), and the process is, at the very least, quite layered and complicated. People are taken to multiple rooms to get their temperature taken, then get a mandatory nasal swab test or finger prick test for active COVID-19 (they can also get an optional antibody test). Then they have to wait for the results. If anyone from your group tests positive, the entire group isn’t allowed in. Overall, it took some people as much as an hour and a half before they got their results and were allowed to enter.
The tests are administered by their medical partner Vestibular Diagnostics of Rochelle Park, New Jersey. Vestibular Diagnostics does not have a functioning website; they also were criticized in May after being contracted to perform testing in Paterson, New Jersey. Local officials complained to the Paterson Times that the company overcharged lab fees “by 75 percent higher than what is set by the federal Centers for Medicare & Medicaid Services (CMS).”
Levine previously told Gothamist that the Abbott ID NOW tests were very reliable, “99.5 percent accurate”—but Abbott themselves have said it is about 95% accurate in terms of identifying positive cases, and some experts say the accuracy rate is far, far lower than that.
In May, the FDA issued a rare public warning about the tests being unreliable after 15 “adverse event reports.” A month later, the FDA had reportedly received a total of 106 reports of adverse events for the Abbott test. A preliminary report by researchers at NYU found that Abbott’s test missed between a third to one-half of infections caught by a rival test in patients screened for the virus.
“There’s no way I would be comfortable missing 2 out of 10 patients,” Susan Whittier, director of clinical microbiology at NewYork-Presbyterian/Columbia University Medical Center, told KHN. There have been at least three other preliminary reports from researchers out of Stanford University, Loyola University and the Cleveland Clinic that have also flagged inaccuracy problems with the tests. The FDA is requiring Abbott to conduct follow-up studies in several different patient groups as a result.
Some experts have argued that the FDA rushed these rapid tests to the market under pressure from the White House, and it will take months before we really know how reliable they are. (Donald Trump enthusiastically touted the test back in May, calling them a “game changer.”) In a statement, Abbott vice president Hackett has admitted that “our normal process takes years” to properly test these technologies.
Dr. Colin West of the Mayo Clinic told the AP that both doctors and patients have put too much faith into these new tests popping up that have not been thoroughly vetted, and said that there are people with COVID-19 who are likely receiving false negative results. “The negative test does not mean that I’m off the hook,” West said. “We just need to maintain that level of vigilance until we have a better sense of how good these tests really can be.”
All of this casts significant doubts not only on the accuracy of the tests overall, but also about the ethics of using them outside of hospital or medical facilities at this time. Despite all the questions about the effectiveness and reliability of rapid testing, Ravel has made it the cornerstone of their publicity campaign—and it’s the number one thing attendees cited to Gothamist as to why they attended the parties and why they felt safe there.
“I was very curious, because I was very surprised at how fast they got the results,” said D.L., who had coronavirus a few months ago (he noted that it took him days to get his results). “Is it accurate? I don’t think so. But I saw some people get kicked out while I was in the waiting area.”
“I’m happy to have been in a environment where everyone with us tested negative, I felt safe being in that environment,” said Sciandra.
“I would go back again, absolutely, as long as they’re offering testing,” added Torres.
In one Instagram photo, in which you can see at least 10 people not wearing masks, the person wrote, “FYI: we had to be tested for covid on-site to go into this party so that’s why we aren’t wearing masks – thank you Profundo NYC for keeping us all safe and happy!”
“Like anyone else in nightlife community, I want to see people get their jobs back, I want to see nightlife come back, but there’s a right way to do it and a wrong way to do it,” said Susana Pereyra, 26, who is currently furloughed from her job within the hospitality business. “I’m seeing lots of people taking time to workshop precautions. So when I see something like Profundo, that is misleading people just so they can circumvent the social distancing rules to throw a Vegas-style pool party, it’s ruining it for everyone else who is trying to give it their best shot to go about this the right way. If we get put on second shutdown, that’s going to affect all the other bars and nightlife places trying to make honest efforts to be social and safe.”
Pereyra is particularly worried that there are people who have been misled by them “preaching the benefits of rapid testing. They’re calling it the gold standard, but obviously it is not the gold standard. Otherwise every single business worldwide would be doing it.”
Regarding the testing, a spokesperson for Ravel told Gothamist that their team “was provided these numbers by doctors who have verified these numbers with the testing machines, as well as with the FDA.” They claimed that they were informed that “negative results have a high percentage of accuracy,” which is not necessarily what the various preliminary studies found.
In a phone interview, Ravel co-owner Levine stressed that Ravel has “never guaranteed that what we’re doing is a 100% effective thing.” He said they have received “hundreds, if not thousands” of emails from other hospitality and catering companies “congratulating us on our forward thinking…who are begging us for our services of what we did. Las Vegas, Miami, LA, multiple giant organizations who have come to us and said, ‘Wow, what you’re doing is helping our industry not fail.'”
Levine also criticized what he said was Gothamist’s previous “negative” story about Profundo. “We found a safer way to do business, so if you’re going to call me with negative questions, call me with positive questions, because we’re not guaranteeing anything, we’re just adding one level more of safety than the next guy is doing,” he said. “Report that we’re the first in our country trying to be safer than the next guy.”


Seattle Area: COVID-19 Infection Rate High In Young Adults

King County has seen a surge in new coronavirus cases since it entered Phase 2 of the governor’s Safe Start plan and began reopening many nonessential businesses, jumping from an average of 40 cases a day to more than 130.
Friday, health officials confirmed the new cases have been overwhelmingly in young adults and shared a warning: take this virus seriously before the situation spirals out of control.
According to Public Health – Seattle & King County, the latest batch of coronavirus cases can be broken down as:
  • 1/3 were in patients aged 20-29
  • 1/2 were in patients aged 20-39
  • 3/4 of all cases are in patients under 40
That so many cases are in younger residents is a double-edged sword: younger adults are less likely to be hospitalized or die from the virus, but they’re also more mobile and could spread the virus to vulnerable populations.
“As the infections spread into older adults or others who have high risk conditions, we may see that change,” said Dr. Jeff Duchin, Public Health Officer for Seattle – King County. “This virus doesn’t stay in one group, it won’t stay in one group.”
As the infection rate has grown, hospitalizations have seen a slight rise in King County. The county is reporting that, over the past two weeks, 1.3 out of every 100,000 residents have been hospitalized, up from .8 patients the two weeks before. Health officials admit that’s not a huge jump but say it’s still a warning sign that residents need to take this virus more seriously.

“No one wanted this COVID-19 Pandemic, but we are stuck with it,” said Duchin.
Duchin says there are essentially three situations where the coronavirus can spread: at work, in social or public gatherings, and in the home. Two of those, the county has a handle on. There are protocols in place that have helped to stop workplace outbreaks and contract tracers have been able to prevent infections from spreading through households, but infections in public spaces remain a problem.
“We need to fundamentally change the way we interact with each other,” said Duchin.
Perhaps surprisingly, health officials say the spike in infections is likely unrelated to the recent mass protests. According to public health, Seattle tested over 4,000 protesters for the coronavirus, and found that only .2 percent of protesters tested positive for the virus, well under the normal positivity rate. To put that in perspective, normally about 5.9 percent of coronavirus tests come back positive across Washington. Part of the reason the infection rate at those gatherings is so low can be attributed to their setting: the virus spreads much easier indoors where it can settle on high-touch surfaces. That said, Duchin says protesters still should consider how to express themselves safely when choosing to gather.
“We are concerned any time large groups gather,” said Duchin.
He and other public health officials are urging everyone to reconsider if they really need to meet up with others before choosing to do so. They’re also working to expand education and enforcement of safety policies in public spaces, workplaces and restaurants. That effort includes a new program performing spot checks at restaurants to better enforce compliance, and a ‘safety checklist’ that health officials hope will better explain the ways workplaces can keep their employees safe.
But more than enforcement or punishment, health officials are hoping that people will make the right choice and follow safety guidelines, wearing masks in public, washing their hands and practicing better hygiene to protect against the virus.
“If we don’t deal with it, it will deal with us,” said Duchin.

Doctors note new COVID-19 symptoms in young adults

Statistics in multiple states show an increase in COVID-19 cases predominantly from people in their 20s and 30s, and now doctors say they are also seeing different symptoms among their younger patients.
“Around the country, we’re seeing more young people come to medical care and often having to be admitted to the hospital,” said Dr. William Schaffner, an Infectious Disease professor at Vanderbilt University.
The jump in such cases is reflected in cities like Nashville, where younger adults ages 25 to 34 are largely making up the spike.
“Over the past few days, they’re starting to develop, they’re describing some new symptoms,” explained Dr. Alex Jahangir with Metro Nashville’s Coronavirus Task Force.
While fever was originally the first telltale sign of the novel coronavirus, now many don’t ever get one.
“The spectrum of symptoms continues to expand and so younger people often do come in now somewhat to our surprise without fever, and this abdominal pain seems to affect them a little bit more,” said Schaffner.
Other symptoms include nausea, diarrhea, loss of taste and smell, and severe headaches.
Clinics in Nashville say their phones are ringing off the hook with younger COVID-19 patients suffering from debilitating migraines, something they haven’t found a medication that works for yet.
“We recognized this virus can do a variety of damage to you, from no symptoms, mild symptoms, a larger collection of symptoms … obviously it can make you very sick and (you) come into the hospital and (it disrupts) the way many of your organs function,” explained Schaffner.
Vigilance is key. Pay attention to any of these symptoms, self-isolate, and wait a few days before getting tested. Often tests are showing up negative if taken too early.
Doctors suggest getting tested about four days after starting to feel symptoms, that way the virus will show up on the swab.
If you do contract COVID-19, doctors advise staying hydrated and taking Tylenol.

If Covid is really airborne, we might be fighting it the wrong way

This was the week airborne transmission became a big deal in the public discussion about covid-19. Over 200 scientists from around the world cosigned a letter to the World Health Organization urging it to take seriously the growing evidence that the coronavirus can be transmitted through the air. WHO stopped short of redefining SARS-CoV-2 (the virus that causes covid-19) as airborne but did acknowledge that more research is “urgently needed to investigate such instances and assess their significance for transmission of COVID-19.”
“I honestly don’t know what people are waiting for,” says microbiologist Chad Roy of Tulane University in the US. “It doesn’t take WHO coming out to make a proclamation that it’s airborne for us to appreciate this is an airborne disease. I don’t know how much clearer it needs to be in terms of scientific evidence.”
So what does “airborne” really mean in this context? It’s basically an issue of size. We’re pretty sure that SARS-CoV-2 is spread through tiny droplets that contain viral particles capable of leading to an infection. For a virus to be airborne, however, means a few different things, depending on the expert you’re talking to. Typically it means it can spread via inhalation over long distances, perhaps even through different rooms, of small particles known as aerosols.


“That’s why when you ask some of the professionals if the virus is airborne, they’ll say it’s not, because we’re not seeing transmission over those sorts of distances,” says Lisa Brosseau, a retired professor of public health who still consults for businesses and organizations.
There is also some debate on what we mean by “aerosol.” The droplets that carry viral particles through the air can come in all sorts of sizes, but while the larger ones will drop quickly to the ground or other surfaces, the smaller ones (just a few microns across) can linger in the air for a while, giving them a chance to be inhaled. The word is mostly used to describe these smaller particles, although Brosseau would prefer the term “aerosol transmission” to cover the entire gamut of inhalable viral particles being expelled into the air—large and small alike.
If SARS-CoV-2 is airborne, it’s far from the only disease. Measles is notorious for being able to last in the air for up to two hours. Tuberculosis, though a bacterium, can be airborne for six hours, and Brosseau suggests that coronavirus superspreaders (people who seem to eject a larger amount of the virus than others) disseminate the virus in patterns that recall the infectiousness of tuberculosis.



The evidence that this type of transmission is happening with SARS-CoV-2  arguably already exists. Several big studies point to airborne transmission of the virus as a major route for the spread of covid-19. Other studies have suggested the virus can remain in aerosolized droplets for hours. One new study led by Roy and his team at Tulane shows that infectious aerosolized particles of SARS-CoV-2 could actually linger in the air for up to 16 hours, and maintain infectivity much longer than MERS and SARS-CoV-1 (the other big coronaviruses to emerge this century).
We still don’t know what gives SARS-CoV-2 this airborne edge. “But it may be one reason this is a pandemic, and not simply a small outbreak like any other coronavirus,” says Roy.

How to stay safe

Whether the virus is airborne isn’t simply a scientific question. If it is, it could mean that in places where the virus has not been properly contained (e.g., the US), the economy needs to be reopened more slowly, under tighter regulations that reinforce current health practices as well as introducing improved ones. Our current tactics for stopping the spread won’t be enough.
Roy would like to see aggressive mandates on strict mask use for anyone leaving home. “This virus sheds like crazy,” he says. “Masking can do an incredible amount in breaking transmission. I think anything that can promote the use of masking, to stop the production of aerosols in the environment, would be helpful.”
Brosseau, however, says that though masks can limit the spread of larger particles, they are less helpful for smaller ones, especially if they fit only loosely. “I wish we would stop relying on the idea that face coverings are going to solve everything and help flatten the curve,” she says. “It’s magical thinking—it’s not going to happen.” For masks to really make a difference, they would need to be worn all the time, even around family.
Brosseau does believe the evidence is trending toward the conclusion that airborne transmission is “the primary and possibly most important mode of transmission for SARS-CoV-2.” She says, “I think the amount of time and effort devoted to sanitizing every single surface over and over and over again has been a huge waste of time. We don’t need to worry so much about cleaning every single surface we touch.” Instead, the focus should be on other factors, like where we spend our time.

Crowded spaces

One of the biggest questions we still have about covid-19 is how much of a viral load is needed to cause infection. The answer changes if we think it is aerosols that we need to worry about. Smaller particles won’t carry as large a viral load as bigger ones, but because they can linger in the air for much longer, it may not matter—they’ll build up in larger concentrations and get distributed more widely the longer an infected person is around to expel aerosolized virus.
The more people you have coming in and out of an indoor space, the more likely it is that someone who is infected will show up. The longer those infected individuals spend in that space, the higher the concentration of virus in the air over time. This is particularly bad news for spaces where people congregate for hours on end, like restaurants, bars, offices, classrooms, and churches.
Airborne transmission doesn’t necessarily mean these places must stay closed (although that would be ideal). But wiping down surfaces with disinfectant, and having everyone wear masks, won’t be enough. To safely reopen, these spots will not just need to reduce the number of people allowed inside at any given moment; they will also need to reduce the amount of time those people spend there. Increasing social distancing beyond six feet would also help keep people safer.
Ventilation needs to be a higher priority too. This is going to be a big problem for older buildings that usually have worse ventilation systems, and areas with a lot of those might need to remain closed for much longer. The impact of asymptomatic spread (transmission by people who don’t feel ill) and superspreaders only compounds the problem even further. But research conducted by the US Department of Homeland Security has shown that in the presence of UV light, aerosolized particles of the size the Tulane researchers studied would disappear in less than a minute. A number of businesses have begun deploying UV-armed robots to disinfect hospital rooms, shopping malls, stores, public transit stations, and more.
For many places, considerable delays in economic reopening might ultimately be the price of getting the virus under control. Otherwise the kind of thing that happened when a single open bar in Michigan led to an outbreak of more than 170 new cases could become commonplace.
For Brosseau, the best strategy is simply to behave as we did in the early days of lockdown—stay home, and avoid coming into contact with anyone you don’t live with. And if you have to leave home, she says, “all I can say is spend as little time as possible in an enclosed space, in an area that’s well ventilated, with as few people as possible.”