Covid 19 Cases In States Since Reopening

 

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There are now over 5 million confirmed cases of the coronavirus and more than 325,000 known deaths around the world. Over 2 million people around the world have recovered from the virus. Despite the US having less than 5% of the world’s population, there are almost 1.5 million confirmed cases with over 100,000 deaths, representing over one-quarter of all fatalities and almost one-third of the confirmed cases. Over 450,000 people have recovered from Covid 19 but there are now cases in the US of people that have been re-infected, meaning they did not develop antibodies to build immunity with their first infection.
Forty-eight states will be at least partially reopened this week as health experts continue to warn of the danger of a hasty end to lockdowns. Each state has their own guidelines on what businesses have reopened and a timeline on further openings. There are 17 states that have seen an uptick in new cases since reopening. Officials from the World Health Organization say those who ignore measures such as social distancing are at risk of seeing a resurgence of the coronavirus. They also advise people to wear face masks when they are in groups. While coronavirus generally doesn’t spread outdoors as easily as it does indoors, there’s still a risk with any cramped crowd — especially because the virus can spread by just talking.
A cluster of new cases emerged after a swim party in Arkansas. In Atlanta, several recent prep school graduates also tested positive for the coronavirus, including one who had friends over for a graduation party. NY Governor Andrew Cuomo confirmed new COVID-19 cases are predominantly coming from people leaving their homes to shop, exercise or socialize. Meanwhile, in California, Orange County’s coronavirus cases continue to mount, with over 4,000 cases reported. COVID-19 cases are on the rise in Texas, with 1,800 new infections reported last Saturday — the highest single-day increase in Texas so far. South Dakota has also seen a spike in cases since reopening.
Some states are now seeing drops in the number of confirmed cases. New Jersey, one of few states that had one of the strictest and longest stay at home orders, has seen a decrease in cases. This appears to be relatively bright news for hard-hit New Jersey, second in the country only to New York for the number of total reported cases with over 143,600 confirmed and over 10,000 deaths.
Missouri also saw a drop in cases when they began allowing all businesses to reopen May 4, but then an increase during the second week of reopening. Businesses were allowed to reopen provided they could abide by certain social distancing guidelines. Indoor retail businesses must limit their number of customers to no more than 25% of normal capacity, and local communities can choose stricter rules if they choose. Missouri has over 11,000 cases and over 600 deaths. Idaho, which only has around 2,500 cases, also saw a decrease in reported cases.
As each state opened, many leaders stressed the importance of following the social distancing guidelines but left responsibility up to it’s’ citizens. The CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies) especially in areas of significant community-based transmission. They say that maintaining 6-feet social distancing remains important to slowing the spread of the virus. CDC is additionally advising the use of simple cloth face coverings to slow the spread of the virus and help people who may have the virus and do not know it from transmitting it to others. Cloth face coverings fashioned from household items or made at home from common materials at low cost can be used as an additional, voluntary public health measure.

Two Men Arrested In Killing of Ahmaud Arbery

 

 

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Two months after the February shooting death of 25 year old Ahmaud Arbery, and just two days after video of the shooting was released to the public, the two men who gunned him down while he was jogging were arrested and charged for murder. The men, Gregory McMichael, 64, and his son Travis McMichael, 34, were each charged with murder and aggravated assault and booked into a jail in coastal Glynn County, Ga., where the killing took place. The Georgia Bureau of Investigation, in a news release, stated that it was Travis McMichael who shot and killed Mr. Arbery on Feb. 23.
The details of Mr. Arbery’s killing — and the fact that no one had been arrested in the months since it happened — led to a wave of outrage nationwide. Public pressure for an arrest intensified with the release of the video. The video of the shooting, taken from inside a vehicle, shows Mr. Arbery running along a shaded two-lane residential road when he comes upon a white truck, with a man, Travis McMichael, standing beside its open driver’s-side door with a rifle in his hand. Gregory McMichael is standing in the bed of the pickup. Mr. Arbery runs around the other side of the truck to avoid Travis McMichael. As Travis approaches the front of his truck, muffled shouting can be heard before Arbery emerges, tussling with the man outside the truck as three shotgun blasts echo.
It’s during this struggle that Arbery was shot a point blank range by Travis McMichael. Arbery then attempts to run away but collapses face down in the street. Gregory, a retired Glynn County police officer, and his son Travis both claim they were trying to make a citizen’s arrest when they followed Arbery after seeing him enter a home under construction 2 doors down from their home. They said he fit the description of a suspect in break-ins and burglaries in the area despite no reports of any in the neighborhood.
The owner of the home said nothing has ever been taken from the property but people have entered before. He released dozens of surveillance videos of people entering the property including one of Arbery from minutes before he was shot. Arbery was inside the home for less than 3 minutes looking around before he exits to continue his run. The additional videos show many other people entering the property to look around, including neighborhood kids and a couple who entered the same day Arbery was killed but no other trespassers were confronted.
The Georgia Attorney General Christopher M. Carr formally requested the intervention of the FBI in the case to investigate the killing after there were reports that Brunswick Judicial Circuit District Attorney Jackie Johnson said that no arrests should be made in the case and recused herself from further involvement in the case because Gregory McMichael had previously worked as an investigator in her office. The GBI found probable cause to charge Gregory and Travis McMichael within 36 hours of taking the case, and, on May 7, arrested the pair on charges of felony murder and aggravated assault. The McMichaels were booked into the Glynn County Jail and were denied bond the following day.
Georgia Attorney General Chris Carr announced he asked the Georgia Bureau of Investigation and federal authorities to look into how local prosecutors possibly held crucial evidence of Arbery’s killing and refused to make arrests, as more than two months passed before the attackers were arrested. The Brunswick police reportedly had a copy of the shocking video but no arrests were made until 2 days after it was released to the public by a lawyer the McMichaels consulted with but did not retain.

FDA Issues EUA of Remdesivir For Severe Covid 19 Cases

 

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The Food and Drug Administration (FDA) announced the emergency use authorization for the antiviral drug remdesivir, after preliminary results from a federal trial showed the drug could speed recovery in patients infected with the coronavirus. The finding, which has not yet been peer reviewed, came after another study found no benefit for the drug in severely ill patients in China. The new results suggest a moderate improvement in the death rate of patients taking remdesivir, whose hospital stays were shortened, on average, from 15 days to 11.

The issuance of an EUA is different than FDA approval. In determining whether to issue an EUA, the FDA evaluates the available evidence and carefully balances any known or potential risks of any unproven products with any known or potential benefits of making them available during the emergency.  Based on evaluation of the emergency use authorization criteria and the scientific evidence available, it was determined that it is reasonable to believe that remdesivir may be effective in treating COVID-19, and that, given there are no adequate, approved, or available alternative treatments, the known and potential benefits to treat this serious or life-threatening virus currently outweigh the known and potential risks of the drug’s use.

The emergency use authorization (EUA) allows for remdesivir to be distributed in the U.S. and administered intravenously by health care providers, as appropriate, to treat suspected or laboratory-confirmed COVID-19 in adults and children hospitalized with severe disease. Severe disease is defined as patients with low blood oxygen levels or needing oxygen therapy or more intensive breathing support such as a mechanical ventilator.

The EUA requires that fact sheets that provide important information about using remdesivir in treating COVID-19 be made available to health care providers and patients, including dosing instructions, potential side effects and drug interactions.  The EUA is temporary and will be effective until the declaration that circumstances exist justifying the authorization of the emergency use of drugs and biologics for prevention and treatment of COVID-19 is terminated.  It may be revised or revoked if it is determined the EUA no longer meets the statutory criteria for issuance.

Possible side effects of remdesivir include increased levels of liver enzymes, which may be a sign of inflammation or damage to cells in the liver; and infusion-related reactions, which may include low blood pressure, nausea, vomiting, sweating, and shivering.

The top coronavirus task force scientist Dr. Anthony Fauci welcomed news of the first potential treatment for COVID-19.  The U.S. government will coordinate the donation and distribution of remdesivir to hospitals in cities most heavily impacted by COVID-19. Given the severity of illness of patients appropriate for remdesivir treatment and the limited availability of drug supply, hospitals with intensive care units and other hospitals that the government deems most in need will receive priority in the distribution of remdesivir.

France Extends Stay At Home Order to May 11

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France extended its coronavirus lockdown another four weeks until May 11. President Emmanuel Macron announced the extension in a televised address.  France has reported over 140,000 cases and over 17,000 coronavirus deaths.  From May 11 onward, he said, quarantine will be “gradually” lifted, starting with nurseries, K-12 schools, and some shops.

Macron’s address was his third since March 17, when the government ordered 67 million French people to stay home, allowing them out just once a day to exercise, buy food or medicine, or seek medical care.  In the sobering televised address, Macron was apologetic, admitting he thought they were ready for the crisis but they clearly were not.  He acknowledged state failures in rolling out testing and supporting healthcare workers, and admitted that he didn’t have all the answers.  Macron said they have faced up to that and have had to make very difficult decisions that required them to adapt constantly as fragmentary information continued to change.  “This moment, let’s be honest, has revealed cracks, shortages. Like every country in the world, we have lacked gloves, hand gel, we haven’t been able to give out as many masks as we wanted to our health professionals.”

France has seen progress with slowing the spread but Macron urged that that is no reason to lift the order.  “I fully understand the effort I’m asking from you,” Macron told the nation, adding that the current rules were working.  “When will we be able to return to a normal life? I would love to be able to answer you. But to be frank, I have to humbly tell you we don’t have definitive answers,” he said.

“Over the next four weeks, the rules must be respected,” he explained.  Macron said the four-week extension will give France the ability to test anyone presenting COVID-19 symptoms, which will allow for better containment of the virus.  He said that by May 11, France would be able to test every citizen presenting COVID-19 symptoms which is why the orders have to be extended.

He offered a rough timeline for how the country may reopen, starting with schools and shops in May and ending with restaurants, hotels, cafés and cinemas in July.  International arrivals from non-European countries will remain prohibited until further notice.  “We’ll end up winning,” Macron said. “But we’ll need to live with the virus for a few months.”

After a steady increase in cases until the first week of April, the number of patients in French hospitals’ intensive care units has started to decline, prompting health authorities to call a plateau in the epidemic.  French hospitals are just about coping, while nursing homes are still overwhelmed.  Some of that pressure has been eased by a massive effort to transfer patients by plane, helicopter or even high-speed train from hospitals in the east and Paris to the west.

 

 

New York Covid 19 Hospitalizations Declining

 

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While the US has become the global epicenter for the Covid-19 pandemic, New York State is the US’s epicenter, far leading in confirmed cases and deaths.  Over 200,000 of the confirmed cases in the US are in New York and over 10,000 people in the state have died.  Almost 110,000 of those cases are concentrated in New York City.  About 25% of New York State’s COVID19 deaths are residents of nursing homes and adult care facilities. There are about 96,000 residents at 613 licensed nursing homes in New York State. More than 5,500 residents at 338 nursing homes have tested positive for the coronavirus.

For the first time since the coronavirus crisis struck New York, there were fewer admissions to the intensive care unit on Thursday, April 9th than the day before. It’s one of a number of encouraging signs that the worst may have passed.  The governor said that he is “cautiously optimistic” that we are slowing the infection rate. He cited a dramatic decline in hospitalizations and even a negative statistic for the first time in the ICU.

Governor Cuomo said that social distancing policies and compliance by the public greatly flattened the curve after the death toll stabilized but he warned the situation is still dire and New Yorkers would need to maintain strict measures to continue the trend.  Gov. Andrew Cuomo: “If we are plateauing, we are plateauing at a very high level, and there’s tremendous stress on the healthcare system. And to say to this healthcare system — which is at maximum capacity today, right? This is a hospital system where we have our foot to the floor and the engine is at red line and you can’t go any faster. And by the way, you can’t stay at red line for any period of time, because the system will blow.”

Cuomo said schools and nonessential businesses will now remain closed and he announced fines for violating social distancing rules would increase from a maximum of $500 to $1,000. As of today, New York State has nearly 5,000 recorded deaths from COVID-19, with over 131,000 confirmed cases and over 16,000 hospitalizations.  While the total number of statewide cases of Covid 19 hospitalizations is plateauing, confirmed cases are rising in some areas as they fall in others.

Cuomo announced that the state would issue a number of additional guidelines, including requiring that cloth masks be provided, cost-free to essential workers, by businesses, and the expansion of who is eligible to receive an antibody test.  Cuomo again said testing would be the key to restarting the economy.  It’s been almost a month since stores around the state have been shut, its employees home and out of work, and trying to apply for unemployment benefits. This week 347,000 New Yorkers filed for unemployment, bringing the number of jobless claims since March 14 to over 800,000.

When asked when he thought things would return to normal for the hard hit state, Cuomo said “As far as when things could go back to normal, well, when will we return to normal? I don’t think we return to normal. I don’t think we return to yesterday, where we were. I think if we are smart, we achieve a new normal.”

Stay At Home Orders in the US

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Millions of U.S. residents are now under some sort of stay-at-home order in response to the Covid 19 pandemic.  There are now over 500,000 confirmed COVID-19 cases in the U.S. — more than one-quarter of the reported total cases worldwide, though the actual numbers both in the U.S. and around the world are likely much higher due to limited testing.  Governors that were originally against stay-at-home orders finally succumbed last week after COVID-19 cases in their states increased rapidly.

There are still a few states that have not issued stay at home orders.  Arkansas, Iowa, Nebraska, North Dakota, South Dakota, Utah and Wyoming have yet to issue any state-wide orders but they have a number of local directives suggesting residents stay indoors or have stay at home orders in place only in their harder hit counties.

For the other 95% of Americans, the states they call home slowly joined the majority to issue stay at home orders for all non-essential activities.  Just as governors issued stay-at-home orders on a rolling, piecemeal basis, they have done the same on the backend, with each governor setting his or her own time frame for lifting the order. Consequently, we have end dates spanning two months, from April 15 to June 10.  More than half of the states have already extended the end date of their original order and the new end date could be pushed back again as the pandemic unfolds.

Three Pacific coast states — California, Oregon and Washington — have formed an alliance called the “Western States Pact” that will reopen at the same time. They announced that they “have agreed to work together on a shared approach for reopening our economies – one that identifies clear indicators for communities to restart public life and business.”  California was the first to issue its order but within 3 days, Oregon and Washington followed suit.  All three states orders were issued with no set end date so their orders stay in place until further notice.

On the east coast, seven states — Connecticut, Delaware, Massachusetts, New Jersey, New York, Pennsylvania and Rhode Island — have formed the “Multi-State Council” that will also reopen at the same time. New York Governor Andrew Cuomo said the council “will come up with a framework based on science and data to gradually ease the stay at home restrictions and get our economy back up and running.”  Many of these states with an end date on their original order issued extensions with new dates in May.

Two states have stay-at-home orders that are set to expire soon; Idaho (April 15) and Kansas (April 19). Both Idaho Governor Brad Little and Kansas Governor Laura Kelly have indicated that they will extend the orders.  Eight states’ orders are due to expire between April 20 and April 26. Indiana, Mississippi, Alaska, District of Columbia, Missouri, Montana, Wisconsin and Colorado are fast approaching their end dates.  Four governors — half of this group — have already issued one extension and several have stated they are planning another.

For the last week of April, 19 states are due to lift their stay-at-home mandates.  South Carolina, New York, North Carolina, Alabama, Arizona, Florida, Georgia, Hawaii, Illinois, Louisiana, Maine, Michigan, Nevada, New Mexico, Pennsylvania, Tennessee and Texas have end dates at the end of April but again, more than half of the governors in this group have already extended the end dates for their orders once.

Nine states have stay-at-home orders that end May 4 or later. Notably, seven of them have already bumped back their end dates once, from April to May. If the trend continues, we can expect more states to be extending their mandates into May.

 

Supplies Depleting Fast For New York Healthcare Systems

 

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In New York City, the epicenter of the US crisis, the death toll from COVID-19 is over 4,500 and continuing to climb.  There have been more than 140,000 confirmed cases of the coronavirus discovered in New York, including more than 76,876 in New York City.  Thirty-five percent of the confirmed cases in the US are in the state of New York.  Governor Andrew Cuomo warned state residents to expect a high death rate through July.

The Federal Emergency Management Agency is dispatching more than 250 ambulances and 85 refrigerated trucks to New York to serve as temporary morgues.  In Central Park, an emergency field hospital began operations to treat spillover patients from nearby Mount Sinai Hospital.  Mayor Bill de Blasio has repeatedly warned city hospitals are in dire need of millions of masks, hundreds of thousands of gowns and hundreds of ventilators, and are on the brink of running out of supplies.

Following complaints by health care workers about their inability to get tested for the coronavirus despite a colleague recently dying from COVID-19, the Mount Sinai hospital system in New York City will begin providing tests on Tuesday for any employee who shows symptoms of the disease. Mount Sinai will use PCR tests for anyone showing symptoms.  They will also administer a serum antibody test to anyone who was symptomatic.

The Justice Department and Department of Health and Human Services announced that hundreds of thousands of masks and other pieces of medical equipment seized from a Brooklyn man have been distributed to medical workers on the front lines treating novel coronavirus patients in New York and New Jersey.  According to the DOJ, the equipment seized and distributed includes roughly 192,000 N95 respirator masks, nearly 600,000 medical gloves, 130,000 surgical masks, procedure masks, N100 masks, surgical gowns, disinfectant towels, particulate filters, bottles of hand sanitizer and disinfectant spray.  Prosecutors say 43-year-old Baruch Feldheim hoarded the supplies in order to take advantage of the COVID-19 crisis and was selling them to doctors and nurses at prices as much as 700% above market value.

Governor Cuomo said it’s unclear what will happen after New York hits its peak. Cases could begin dropping off or there could be more of a plateau effect, in which new cases and death rates remain flat.  Cuomo said the falling rate of infection will not be met with a slackening of social-distancing measures. Schools and nonessential business will remain closed at least until April 29 and there will be higher fines for people violating social-distancing rules. The maximum fine is now $1,000.