COVID-19 spreads even before people show symptoms, study says

Washington, Jun 9: When epidemiologists talked about "flattening the curve," they probably didn't mean it this way: the US hit its peak coronavirus caseload in April, but since that time the graph has been on a seemingly unending plateau.

That's unlike several other hard-hit countries which have successfully pushed down their numbers of new cases, including Spain and Italy, which now have bell-shaped curves.

Experts say the prolonged nature of the US epidemic is the result of the cumulative impact of regional outbreaks, as the virus that started out primarily on the coasts and in major cities moves inward.

Layered on top of that are the effects of lifting lockdowns in parts of the country that are experiencing rising cases, as well as a lapse in compliance with social distancing guidelines because of economic hardship, and in some cases a belief that the threat is overstated.

"The US is a large country both in geography and population, and the virus is at very different stages in different parts of the country," Tom Frieden, a former director of the Centers for Disease Control and Prevention told AFP.

The US saw more than 35,000 new cases for several days in April. While that figure has declined, it has still been exceeding 20,000 regularly in recent days.

By contrast, Italy was regularly hitting more than 5,000 cases per day in March but is currently experiencing figures in the low hundreds.

"We did not act quickly and robustly enough to stop the virus spreading initially, and data indicate that it travelled from initial hotspots along major transport routes into other urban and rural areas," added Frieden, now CEO of the non-profit Resolve to Save Lives.

To wit: the East Coast states of New York, New Jersey and Massachusetts accounted for about 50 percent of all cases until about a month or so ago -- but now the geographic footprint of the US epidemic has shifted to the Midwest and southeast, including Florida.

Another key problem, said Jennifer Nuzzo, an epidemiologist at Johns Hopkins, is that the United States is still not doing enough testing, contact tracing and isolation.

After coming late to the testing party -- for reasons ranging from technical issues to regulatory hurdles -- the US has now conducted more COVID-19 tests than any other country.

It even has one of the highest per capita rates per country of 62 per 1,000 people, according to the website ourworldindata.org -- better than Germany (52 per 1,000) and South Korea (20 per 1,000).

But according to Nuzzo, these numbers are misleading, because "the amount of testing that a country should do should be scaled to the size of its epidemic.

"The United States has the largest epidemic in the world so obviously we need to do a lot more testing than any other country."

For Johns Hopkins, the more important metric is the positivity rate -- that is, out of all tests conducted, how many came back positive for COVID-19.

As of June 7, the United States had an average daily positivity rate of 14 percent, well above the World Health Organization guideline of 5 percent over two weeks before social distancing guidelines should be relaxed.

By contrast, Germany, which has tested far fewer people in relation to its population, has a positivity rate of 5 percent.

Even if testing were scaled up, carrying out tests in of itself does very little good without the next steps -- finding out who was exposed and then asking them to isolate.

Here also, too many US states are lagging woefully behind.

Texas, which is experiencing a surge in cases after relaxing its lockdown, is a case in point. The state targeted hiring a modest 4,000 tracers by June, but according to local reports is still more than a thousand shy of even that goal.

Opt-in app based efforts have also been slow to get off the ground.

Then there is the fact that some people are growing tired of lockdowns, while others don't have the economic luxury of being able to stay home for prolonged periods.

The government sent some 160 million Americans a single stimulus check of up to $1,200 back in April but it's not clear whether more will be forthcoming.

Still others, particularly in so-called red states under Republican leadership, have chafed under restrictions and mask-wearing guidelines that they see as an affront to their personal freedom.

"The US is kind of on the extreme of the individual liberty side," Sten Vermund, dean of the Yale School of Public Health, told AFP.

Part of this has to do with mixed messaging from Republican leaders, including President Donald Trump, said Nuzzo.

"We have had at the highest political level an assertion that this is a situation that's been overblown, and that maybe certain protective behaviors are not necessary," she said.

More recently, tens of thousands of people across the country have taken to the streets to protest the killing on an unarmed black man by police, risking coronavirus infection to demonstrate against the public health threat of racialized state violence.

London, Apr 12: British Prime Minister Boris Johnson has thanked the medics and staff of the state-funded National Health Service (NHS) for saving his life after he tested positive for the coronavirus, saying he owed them his life.

In his first public statement since being moved out of the intensive care at St. Thomas’ Hospital in London on Saturday, the 55-year-old Johnson said, “I can't thank them enough, I owe them my life.”

Downing Street has said that Johnson, who completes a week in hospital on Sunday after being shifted there with persistent COVID-19 symptoms, continues to make “very good progress” while on the ward.

Coronavirus India update: State-wise total number of confirmed cases, deaths on April 12

He has been able to take short walks as his doctors monitor his recovery after being moved out of the intensive care and has been watching films and doing puzzles in his hospital bed.

Johnson's fiancee Carrie Symonds, who is pregnant with their first child, is said to have sent him letters and baby scans to lift his spirits during his time in the hospital.

Thousands of get-well-soon cards have also poured in for the prime minister since he went into self-isolation after testing positive for coronavirus over two weeks ago.

Asked about plans for his return to work, UK Home Secretary Priti Patel said on Saturday that the UK PM needed "time and space to rest, recuperate and recover".

The Indian-origin Cabinet minister, who led the daily Downing Street update on the pandemic on Saturday, revealed that the UK had recorded 917 new coronavirus deaths, taking the total deaths in the country to 9,875.

According to the Johns Hopkins University data, the country has nearly 80,000 coronavirus cases.

Patel urged people to stay at home over the Easter weekend to curb the spread of the virus, despite warm and sunny weather across parts of the UK.

“We have given the police powers to enforce the necessary measures we have put in place, including through enforcement fines," said Patel.

"If you don't play your part... our selfless police will be unafraid to act. You will be endangering the lives of your own family, friends and loved ones," she said.

Meanwhile, an Easter message posted on the official 10 Downing Street Twitter account on behalf of the prime minister also urged people to stay at home to save lives.

It read: “Wishing everyone a very happy Easter from Downing Street.

“This year across the country churches will remain closed, and families will spend the day apart. But by staying home, remember, you are protecting the NHS and saving lives.” 

Washington, May 23: President Donald Trump has labeled churches and other houses of worship as “essential" and called on governors nationwide to let them reopen this weekend even though some areas remain under coronavirus lockdown.

The president threatened Friday to “override” governors who defy him, but it was unclear what authority he has to do so.

“Governors need to do the right thing and allow these very important essential places of faith to open right now — for this weekend," Trump said at a hastily arranged press conference at the White House. Asked what authority Trump might have to supersede governors, White House press secretary Kayleigh McEnany said she wouldn't answer a theoretical question.

Trump has been pushing for the country to reopen as he tries to reverse an economic free fall playing out months before he faces reelection. White evangelical Christians have been among the president's most loyal supporters, and the White House has been careful to attend to their concerns throughout the crisis.

Following Trump's announcement, the Centers for Disease Control and Prevention released new guidelines for communities of faith on how to safely reopen, including recommendations to limit the size of gatherings and consider holding services outdoors or in large, well-ventilated areas.

Public health agencies have generally advised people to avoid gatherings of more than 10 people and encouraged Americans to remain 6 feet (1.8 meters) away from others when possible. Some parts of the country remain under some version of remain-at-home orders.

In-person religious services have been vectors for transmission of the virus. A person who attended a Mother's Day service at a church in Northern California that defied the governor's closure orders later tested positive, exposing more than 180 churchgoers. And a choir practice at a church in Washington state was labeled by the CDC as an early “superspreading" event.

But Trump on Friday stressed the importance of churches in many communities and said he was “identifying houses of worship — churches, synagogues and mosques — as essential places that provide essential services.”

“Some governors have deemed liquor stores and abortion clinics as essential” but not churches, he said. “It's not right. So I'm correcting this injustice and calling houses of worship essential." “These are places that hold our society together and keep our people united,” he added.

Dr. Deborah Birx, coordinator of the White House coronavirus task force, said faith leaders should be in touch with local health departments and can take steps to mitigate risks, including making sure those who are at high risk of severe complications remain protected.

“There's a way for us to work together to have social distancing and safety for people so we decrease the amount of exposure that anyone would have to an asymptomatic," she said.

A person familiar with the White House's thinking who spoke on condition of anonymity to discuss internal deliberations said Trump had called the news conference, which had not been on his public schedule, because he wanted to be the face of church reopenings, knowing how well it would play with his political base.

Churches around the country have filed legal challenges opposing virus closures.

In Minnesota, after Democratic Gov. Tim Walz this week declined to lift restrictions on churches, Roman Catholic and some Lutheran leaders said they would defy his ban and resume worship services. They called the restrictions unconstitutional and unfair since restaurants, malls and bars were allowed limited reopening.

Some hailed the president's move, including Kelly Shackelford, president of the conservative First Liberty Institute.

“The discrimination that has been occurring against churches and houses of worship has been shocking," he said in a statement. "Americans are going to malls and restaurants. They need to be able to go to their houses of worship.” But Rabbi Jack Moline, president of Interfaith Alliance, said it was “completely irresponsible” for Trump to call for a mass reopening of houses of worship.

“Faith is essential and community is necessary; however, neither requires endangering the people who seek to participate in them,” he said.

“The virus does not discriminate between types of gatherings, and neither should the president." Rhode Island Gov. Gina Raimondo, a Democrat, made clear that churches and other houses of worship will not resume in-person services in her state until at least next weekend and said she was skeptical Trump had the authority to impose such a requirement.

“It's reckless to force them to reopen this weekend. They're not ready,” she said. “We've got a good plan. I'm going to stick with it.” New Hampshire Gov. Chris Sununu, a Republican, said he would review the federal guidance, while maintaining a decision rests with him.

"Obviously we'd love to get to the point where we can get those open, but we'll look at the guidance documents and try to make some decisions rather quickly, depending on what it might say,” he said. “It's the governor's decision, of course.”

The CDC more than a month ago sent the Trump administration documents the agency had drafted outlining specific steps various kinds of organizations, including houses of worship, could follow as they worked to reopen safely.

But the White House dragged its feet, concerned that the recommendations were too specific and could give the impression the administration was interfering in church operations.

The guidance posted Friday contains most of the same advice as the draft guidance. It calls for the use of face coverings and recommends keeping worshippers 6 feet from one another and cutting down on singing, which can spread aerosolized drops that carry the virus.