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A mother in Florida lost her 20-year-old son to COVID-19, and then 11 days later, her 22-year-old daughter also died from the disease.
“I hold up pretty much well at the daytime, but at night, it really hits me,” Monete Hicks, 48, of Lauderdale Lakes, told NBC 6 of South Florida. “I’m so used to them being in here.”
Planning their two funerals is difficult, she said.
Hicks did not immediately respond to a request for an interview Tuesday.
Mychaela and Byron Francis.Family photos / via FLA6
She told the South Florida station that her son and daughter both had underlying health conditions.
An official with the Broward County Medical Examiner’s Office confirmed to NBC News on Tuesday that the primary cause of death for Hicks’ son, Byron, and daughter, Mychaela Francis, was COVID-19, the disease caused by the coronavirus.
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Morbid obesity and asthma are listed as contributing causes of Byron’s death, the official said, while, for Mychaela, obesity, asthma and chronic obstructive pulmonary disease were contributing causes.
Hicks said her son Byron had trouble breathing on June 27.
“I came and checked on him. He was in the living room on the floor sitting up. He was sleeping, but he was breathing very poorly,” Hicks said.
She called 911, and Byron was taken to a hospital where he later died.
A week later, as the family grieved Byron’s death, Hicks said Mychaela went to the hospital after she began having headaches and a fever.
As the days went by, “everything just went to breaking down in her body,” Hicks told NBC 6.
Mychaela needed oxygen, her blood pressure fell, and she eventually lost a kidney.
She died July 8.
Hicks, who has four other children, said she had believed Mychaela was going to recover because, like Byron, she was a fighter.
She is now imploring people to take measures to keep themselves safe.
“Wear y’all masks,” Hicks said. “Be careful, be safe out there, take it seriously.”
Broward County in a statement on July 17 said the number of coronavirus cases was continuing to climb, more than 1,300 new cases each day over the previous week. “Our hospitals are either at or are exceeding their bed capacity,” the statement said.
The county had 42,121 confirmed cases of the coronavirus, with 517 deaths, as of Tuesday, according to the Florida Department of Health.
Janelle Griffith
Janelle Griffith is a breaking news reporter for NBC News.
President Donald Trump in Phoenix on June 23 and Anthony Fauci in D.C. on April 29. Saul Loeb, Mandel Ngan/AFP via Getty Images
By now, you probably know who Dr. Anthony Fauci is. And you probably know how you feel about him. More than half of Americans say they think Fauci, the director of the National Institute of Allergy and Infectious Diseases, is handling the coronavirus well. But President Donald Trump and a few of his closest advisers have begun murmuring about Fauci over the past few days, highlighting the ways they think the doctor has stumbled since this coronavirus began spreading. The White House has given reporters anti-Fauci Talking points, and a top adviser to the president challenged Fauci on the op-ed pages of USA Today. But Fauci has not been afraid to speak up in his own defense. So, for Tuesday’s episode of What Next, we called him to talk about the politics and science of this moment. Our conversation has been edited and condensed for clarity.
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Mary Harris: The New York Times ran a whole story saying that the chatter in Washington is “What’s happening to Dr. Fauci?” Do you get asked that question directly? Do you want to answer it?
Anthony Fauci: Well, you know, a lot of what you’ve heard about an editorial that was written, I think, to the displeasure of most people in the White House—
By Peter Navarro.
Yeah, I mean, that’s a whole bunch of nonsense that we need to just put aside to concentrate on this very important task on which we need to work together. So when I hear and see those things, you’ve got to trust me, I try to pay as little attention to it as I possibly can.
Your role in the coronavirus response has shifted over the course of the pandemic. Could you walk me through a day in your life right now?
For example, we’;re Monday. I’m actually been in my office working with my team in the development of vaccines and in therapies and diagnostics. This afternoon, soon after we finish this discussion, I will rush downtown to the White House, where I will spend time with the Coronavirus Task Force. We’ll be doing a governors’ call to help the governors as they work their way through this difficult situation. Down at the White House, very likely I’ll get time to chat considerably with the vice president and then come back and continue to do work here. So, it’s a packed day.
Given all the back-and-forth over the course of this past week, do you fear for your job at all?
No, no. It depends on what you mean by my “job.” I mean, my job is as director of the National Institute of Allergy and Infectious Diseases. I have no fear at all about my job of being a member of the Coronavirus Task Force. I have been ensured by the president and by everyone in the White House that we are fine. I think that’s all chatter that you hear. I don’t think there’s any reason for anybody to want to remove me from the Coronavirus Task Force. If they do, I would leave and go back to my day job, which is trying to develop a vaccine and therapies against COVID-19.
“I have no fear at all about my job of being a member of the Coronavirus TaskForce.”
— Anthony Fauci
It’s felt like this public affairs wrestling match, with various folks speaking out. Notably, Mitch McConnell came out and said his faith in you is “total,” which is a big thing. But then we saw these pictures of McConnell in the White House with the president, and no one is wearing a mask. I wonder, when you see pictures like that, if you just bang your head against a wall.
No, if I banged my head against the wall for everything I hate or that bothered me, I wouldn’t be speaking to you now. I’m very, very explicit about the fact that I feel masks are really important. And everyone should wear a mask when they’re outside in contact with people. Distance is probably as important as, or more important than, anything. I will take this opportunity to say we really must emphasize physical distancing and mask usage.
We’re talking on Monday, July 20. How would you describe the state of public health in the United States right now?
We’re being challenged right now. I mean, if you look at the numbers, they don’t lie. We have a situation, particularly in Southern states that over the past several weeks have had a substantial resurgence of cases to record numbers. Cases that ultimately will lead to an increase in hospitalizations, which ultimately will lead to an increase in deaths. That’s what we’re starting to see right now.
You sound alarmed.
it’s something we need to address. Some states, the ones that are most severely affected, certainly have to put a pause on the reopening and maybe take a step or two back and take a look at the things we have to do. And that is: no crowds, close the bars, masks, physical distancing. There’s no doubt, from the scientific data that we and other countries have accumulated over this trying period of several months, that if you do that, we can turn it around. We should not despair, throw our hands up and say, oh, my goodness, this is out of control. We can get it under control. We just need to do certain fundamental things.
I want to look back a little bit because a few months ago, you spoke to a reporter for the New York Times about how your focus was on opening up the right way. You were like, we know if we open up, we’re gonna see the cases go up, and so we need to be prepared for that. But I look at the wait times and the lines for testing in places like Florida and Texas, and I just think, did those preparations happen?
That’s a very good question. If you look at the result of what’s going on, we can say that something did not go right. When I think about things that I said back when we were doing the daily White House press conferences and we were talking about opening America again, when we first introduced the criteria, the phases, you can recall and look at the record of what I said. I said it is important that we all start moving toward reopening the country, getting the economy back, getting employment back. But I also said, it is critical we do it in a measured, prudent way. And even when we do it correctly, we have to get the cooperation of the citizens of the cities, of the states, and of the regions that we’re dealing with. You can’t have a situation where you’re trying to prudently open and then you see the pictures and the films and the clips of what we’ve seen, people congregating in crowds, at bars, no masks, no physical distancing. I mean, that’s just the recipe to get into the kind of trouble we’ve gotten into.
Isn’t it that the message they’re getting is also really confused and confusing, potentially?
It’s possible, yes. I think we can’t deny that there are some aspects of mixed messages you’re getting from different local leaders and national leaders. But we’ve got to overcome that. We’ve got to try as best as possible.
I wonder if youlook at what’s happening now and are thinking about the fall, because there’s been this idea that the virus could be seasonal, and if we’re keeping the infection rate high then we’re going to really get walloped when it gets colder.
That is certainly conceivable. One of the issues in this country that has been particularly problematic is if you look at our curve and compare it with the curve, let’s say, of the European Union, in general its cases went way up. But when it brought cases down, it brought them down to essentially a baseline, which means tens and maybe hundreds of cases, not thousands and tens of thousands of cases. If you look at us right now in the summer, our baseline never got down below 20,000 per day. And then over recent weeks, as you well know, we’ve gone up to even 70,000 cases.
Given all that, what should the fall look like? We’re talking so much about schools now because parents are looking at four to six weeks until they would typically be sending their kids to schools.
When you talk about schools, you have to put some general principles in place. And then you’ve got to fashion it to what the local on-the-ground situation is. I think it’s important that to the best of our ability, within the realm of safety and with attention to the health and the welfare of the children and the teachers, we should try as best as possible to try to get the children back to school, and the schools open. Having said that, we live in a very large country that is very heterogeneous, and there will be counties, regions, cities of our country in which there’s very little activity or viral spread. So you could, with impunity, open up the schools there with no problem. But there are going to be places with a lot of cases now being transmitted. When that occurs, you may need to take a second look and say: Now, wait a minute, if we are going to open, we’re either going to be in such bad shape that we can’t open, or if we are going to open, we’ve got to creatively figure out a way to mitigate the risk of transmission.
I hear what you’re saying. But doing it that way introduces so much room for error because you’re asking individual school districts and principals and superintendents to make this public health call. Is that fair?
No, actually you make a good point. And that’s the reason the CDC has guidelines for that. I’ve spoken to many school district superintendents and principals about the kinds of creative things they can do, and they can be helped by the CDC. One of the things is hybrid: You have part of the day for a class, the other part of the day not for the class. The alternate is physical separating in the class. I know it’s difficult logistically to do that sometimes, but to try to separate the desks, to get children to wear masks depending on their age, to have some of the children be online and do virtual learning and have others in the class. But above everything has to be the safety and the welfare of the children and the teachers.
There was some reporting in the New York Times looking at how we got here, how we got this surge in cases, how the White House made a decision to give more authority to the states and let them make their own choices. We can see now that, for many states, the consequences of that don’t look very pretty. But you’re discussed in that article, and it talked about the fact that every night you were going home and calling public health officials around the country to say what was happening where you are. You did this epidemiology on your own, and I’m wondering why you thought that was important.
The reason I felt it was important is that I am fundamentally a physician and a scientist. I have been in the trenches. I have been in emergency rooms treating patients. I have treated Ebola patients at the NIH. I spent decades in the early part of my career in the treating desperately ill, HIV-infected individuals. So I’m not just somebody sitting in a room in Washington opining about things. I know what it’s like. So I felt that, since that has been my life experience, let me go out, call up people I know in New York, New Orleans, Los Angeles, D.C., Seattle, San Francisco, and find out, is there any disconnect in what’s going on in the ground vs. what we perceive is going on as we sit in Washington? And I have found that sometimes the dots don’t get connected and you’ve got to put a little extra effort, because many of the people were telling me that even though there’s a lot of testing, what’s happening is that sometimes you have to wait several days to get results. And when you’re doing contact tracing that, if you have to wait several days, then you almost nullify the purpose of contact tracing. What I wanted to find out is, what is the real impact of that testing? That’s the reason I called people up. I’m still having those phone calls.
More good news on progress towards an escape route from this pandemic: On Monday, vaccine researchers from Oxford University and the pharmaceutical company AstraZeneca announced results from a “Phase 1/2 trial,” suggesting their product might be able to generate immunity without causing serious harm. Similar, but smaller-scale results, were posted just last week for another candidate vaccine produced by the biotech firm Moderna, in collaboration with the U.S. National Institutes of Health.
As both these groups and others push ahead into the final phase of testing, it’s vital that the public has a clear and balanced understanding of this work—one that cuts through all the marketing and hype. But we’re not off to a good start. The evidence so far suggests that we’re getting blinkered by these groups’ PR, and so seduced by stories of their amazing speed that we’re losing track of everything else. In particular, neither the mainstream media nor the medical press has given much attention to the two vaccines’ potential downsides—in particular, their risk of nasty adverse effects, even if they’re not life-threatening. This sort of puffery doesn’t only help to build a false impression; it may also dry the tinder for the future spread of vaccine fear-mongering.
Back in May, a CNN report described the Oxford group as being “the most aggressive in painting the rosiest picture” of its product, so let’s start with them. Just how rosy is the Oxford picture really? It’s certainly true that this week’s news shows the vaccine has the potential to provide protection from Covid-19. But there are flies in the ointment. After the first clinical trial for this vaccine began in April, for example, the researchers added new study arms in which people got acetaminophen every six hours for 24 hours after the injection. That’s not featured in their marketing, of course, and I saw no discussion of this unusual step in media coverage in early summer. Newspapers only said the vaccine had been proven “safe with rhesus monkeys,” and did not cause any adverse effects in those animal tests. It was a worrying signal though: How rough a ride were people having with this vaccine? Was the acetaminophen meant to keep down fever, headaches, malaise—or all of the above?
The Oxford group is also giving acetaminophen to participants in an advanced, phase 3 trial now underway in Brazil, too. In another major study of the vaccine, involving 10,000 people in the UK, you can’t participate if you have an allergy or condition that could be made worse with acetaminophen. No mention of the extra drug, though, in the same group’s trial in South Africa.
Journalists could have pressed them on this issue months ago. The first people to get vaccines are carefully picked to be the least likely to have a negative reaction. If the Oxford vaccine is knocking them around badly, it might not bode well for the rest of us. Don’t get me wrong: a day or two of pain or illness wouldn’t deter me from getting an effective Covid-19 vaccine. But I think we need to be prepared if that’s going to be the case.
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The press release for Monday’s publication of results from the Oxford vaccine trials described an increased frequency of “minor side effects” among participants. A look at the actual paper, though, reveals this to be a marketing spin that has since been parroted in media reports. (The phrases “minor side effects” or “only minor side effects” appeared in writeups from the New York Times, the Wall Street Journal and Reuters, among other outlets.) Yes, mild reactions were far more common than worse ones. But moderate or severe harms—defined as being bad enough to interfere with daily life or needing medical care—were common, too. Around one-third of people vaccinated with the Covid-19 vaccine without acetaminophen experienced moderate or severe chills, fatigue, headache, malaise, and/or feverishness. Close to 10 percent had a fever of at least 100.4 degrees and just over one-fourth developed moderate or severe muscle aches. That’s a lot, in a young and healthy group of people—and the acetaminophen didn’t help much for most of those problems. The paper’s authors designated the vaccine as “acceptable” and “tolerated,” but we don’t yet know how acceptable this will be to most people. If journalists don’t start asking tougher questions, this will become the perfect setup for anti-vaccine messaging: Here’s what they forgot to tell you about the risks…
There is another red flag. Clinical trials for other Covid-19 vaccines have placebo groups, where participants receive saline injections. Only one of the Oxford vaccine trials is taking this approach, however; the others instead compare the experimental treatment to an injected meningococcal vaccine. There can be good reasons to do this: Non-placebo injections may mimic telltale signs that you’ve received an active vaccine, such as a skin reaction, making the trial more truly “blind.” But their use also opens the door to doubt-sowing claims that any harms of the new vaccine are getting buried among the harms already caused by the control-group, “old” vaccines.
Coverage of the Moderna vaccine reflects a different kind of pharma spin: the drip-feeding of selective data via press release. On May 18, Moderna put out some patchy, positive findings on interim outcomes from their first-in-human trial. The company followed that up with a stock offering—and company executives sold off nearly $30 million in shares into the feeding frenzy their press release created.
With last week’s paper from Moderna, results from that same group of people finally had their formal publication. At the same time, the group registered a 30,000-person phase 3 clinical trial, specifying a pair of 100-microgram injections of the Covid-19 vaccine. According to the press release from May, there were no serious adverse events for the people in that particular dosage group. But last week’s paper shows the full results: By the time they’d had two doses, every single one was showing signs of headaches, chills or fatigue; and for at least 80 percent this could have been enough to interfere with their normal activities. A participant who had a severe reaction to a particularly high dose has talked in detail about how bad it was: If reactions even half as bad as this were to be common for some of these vaccines, they will be hard sells once they reach the community—and there could be a lot of people who are reluctant to get the second injection.
There is already a high level of misinformation and distrust about fast-tracked Covid-19 vaccines in the American community. This week, a new preprint from Kin On Kwok and colleagues found that even a sizable proportion of nurses in Hong Kong would be hesitant to take one. We may have a vaccine soon, say the authors of that paper, but “communities are not ready to accept it.” It won’t help to overcome this skepticism if notable evidence of harms keeps getting pushed off to the side. It’s much better to be straight up about what it’s really like to take one of these vaccines. Why would anyone trust the experts otherwise?
As health experts urge the public to wear masks to slow the spread of the coronavirus, they continue to get pushback. Among the arguments of skeptics: If masks can’t fully protect me against COVID-19, what is the point of wearing them?
Scientists’ counterargument is that masks can help reduce the severity of the disease caused by coronavirus even if you get infected.
There’s now mounting evidence that silent spreaders are responsible for the majority of transmission of the coronavirus — making universal masking essential to slow the spread of the highly contagious virus, experts say.
This makes the coronavirus different from the seasonal flu. With seasonal flu, peak infectiousness occurs about one day after the onset of symptoms. But with the coronavirus, even among people who do end up becoming visibly sick, peak infectiousness can occur before they show symptoms.
In fact, experts say, significant amounts of virus can start coming out of people’s noses and mouths even when they feel well.
This is a key reason, they say, why tactics to deal with the coronavirus must be markedly different than with the seasonal flu. And the universal wearing of masks is key. Here’s a Q&A based on research and interviews with medical experts.
What’s the point of wearing a cloth face covering if it doesn’t filter out everything?
Cloth face masks still provide a major protective benefit: They filter out a majority of viral particles.
As it turns out, that’s pretty important. Breathing in a small amount of virus may lead to no disease or a more mild infection. But inhaling a huge volume of virus particles can result in serious disease or death.
That’s the argument Dr. Monica Gandhi, UC San Francisco professor of medicine and medical director of the HIV Clinic at Zuckerberg San Francisco General Hospital, is making about why — if you do become infected with the virus — masking can still protect you from more severe disease.
“There is this theory that facial masking reduces the [amount of virus you get exposed to] and disease severity,” said Gandhi, who is also director for the Center for AIDS Research at UC San Francisco.
What evidence supports this theory?
The idea that a lower dose of virus means less severe illness is a well-worn idea in medicine.
Even going back to 1938, there was a study showing that by giving mice a higher dose of a deadly virus, the mice were more likely to get severe disease and die, Gandhi said.
The same principle applies to humans. A study published in 2015 gave healthy volunteers varying doses of a flu virus; those who got higher doses got sicker, with more coughing and shortness of breath, Gandhi said.
And another study suggested that the reason the second wave of the 1918-19 flu pandemic was the deadliest in the U.S. was because of the overcrowded conditions in Army camps as World War I wound down. “In 1918, the Army camps [were] characterized by a high number of contacts between people and by a high case-fatality rate, sometimes 5 to 8 times higher than the case-fatality rate among civilian communities,” the study said.
Finally, a study published in May found that surgical mask partitions significantly reduced the transmission of the coronavirus among hamsters. And even if the hamsters protected by the mask partitions acquired the coronavirus, “they were more likely to get very mild disease,” Gandhi said.
What happens if a city dramatically masks up in public?
If Gandhi is right, it may mean that even if there’s a rise in coronavirus infections in a city, the masks may limit the dose of virus people are getting and result in less severe symptoms of illness.
That’s what Gandhi says she suspects is happening in San Francisco, where mask wearing is relatively robust. Further observations are needed, she said.
There’s more evidence that masks can be protective — even when wearers do become infected. She cited an outbreak at a seafood plant in Oregon where employees were given masks, and 95% of those who were infected were asymptomatic.
Gandhi also cited the experience of those aboard a cruise ship that was traveling from Argentina to Antartica in March when the coronavirus infected people on board, as documented in a recent study. Passengers got surgical masks; the crew got N95 masks.
But instead of about 40% of those infected being asymptomatic — which is what would normally be expected — 81% of those testing positive were asymptomatic, and the masks may have helped reduce the severity of disease in people on board, Gandhi said.
What has happened in other countries where residents have masked up?
The protective effects are seen in countries where masks have been universally accepted for years, such as Taiwan, Thailand, South Korea and Singapore.
“They have all seen cases as they opened … but not deaths,” Gandhi said.
The Czech Republic moved early to require masks, issuing an order in mid-March, Gandhi said; that’s about three months before Gov. Gavin Newsom did so statewide in California.
But in the Czech Republic, “every time their cases would go up … their death rate was totally flat. So they didn’t get the severe illness with these cases going on.”
By May, the Czech Republic lifted its face mask rule. “And they’re doing great,” Gandhi said.
STOCKHOLM (Reuters) – Sweden’s top epidemiologist said on Tuesday a rapid decline in new critical COVID-19 cases alongside slowing death rates indicated that Sweden’s strategy for slowing the epidemic, which has been widely questioned abroad, was working.
Sweden has foregone a hard lockdown throughout the outbreak, a strategy that set it apart from most of Europe.
Chief epidemiologist Anders Tegnell of the public health agency said a rapid slowdown in the spread of the virus indicated very strongly that Sweden had reached relatively widespread immunity.
“The epidemic is now being slowed down, in a way that I think few of us would have believed a week or so ago,” he told a news conference.
Daily COVID-19 death rates as well as the number of infected in intensive care have been slowing gradually since April, with seven new deaths and no new ICU admissions reported by the health agency.
“It really is yet another sign that the Swedish strategy is working,” Tegnell said. It is possible to slow contagion fast with the measures we are taking in Sweden.”
The slowdown in Sweden matched that in several countries that have accredited it to lockdowns. “We have managed to do it with substantially less invasive measures,” he said.
Sweden’s death toll of 5,646, when compared relative to population size, has far outstripped those of its Nordic neighbours, although it remains lower than in some European countries that locked down, such as Britain and Spain.
Related video: Swedish man gets tattoo of Anders Tegnell
(Reporting by Anna Ringstrom; Editing by Angus MacSwan)
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Only a small proportion of people in many parts of the United States had antibodies to the novel coronavirus as of this spring, indicating most of the population remains highly susceptible to the pathogen, according to new data from the Centers for Disease Control and Prevention.
The agency also reported the number of actual coronavirus infections is likely far higher — by two to 13 times — than the reported cases. The higher estimate is based on the study on antibodies, which indicates who has had the virus. Currently, the number of reported cases in the United States now stands at 3.8 million.
The new data appeared Tuesday in JAMA Internal Medicine and on the CDC website. The information about antibodies was derived from blood samples drawn from 10 geographic regions, including New York, Utah, Washington state and South Florida. The samples were collected in discrete periods in two rounds — one in early spring and the other several weeks later, ending in early June. For two sites, only the earlier results were available.
The blood samples were collected during routine screenings such as cholesterol tests. Such serological surveys are being conducted throughout the country as public health experts, government officials and academics try to determine the virus’s course, how many people have been infected and how many have produced antibodies in response.
In New York City, almost 24 percent of the population had antibodies as of early May — the highest proportion by far of any of the locations but still far below the 60 to 70 percent threshold for herd immunity, the point at which enough people are immune to the virus, either through exposure or because they have been vaccinated. Herd immunity makes it far less likely the virus will be transmitted from person to person.
In the other areas, the percentages of people with antibodies were in the single digits in late May and early June. That included Missouri, at 2.8 percent; Philadelphia, at 3.6 percent; and Connecticut, at 5.2 percent.
The new data emerged as the nation struggles with a wily pathogen that can produce no symptoms at all, or sicken and kill — 138,000 Americans have died of the coronavirus to date. Large swaths of the nation are in turmoil as many communities debate how to reopen schools this fall, wrestle with rising virus-related hospitalizations and, in some cases, roll back restrictions to restart a flailing economy.
“Most of us are likely still very vulnerable to this virus and we have a long way to go to control it,” said Jennifer Nuzzo, an epidemiologist at the John Hopkins Center for Health Security. “This study should put to bed any further argument that we should allow this virus to rip through our communities in order to achieve herd immunity.”
With vaccines still months or years off, some people have suggested allowing large numbers of people to become infected to speed the process of herd immunity. Many call that idea dangerous.
“The study rebukes the idea that current population-wide levels of acquired immunity (so-called herd immunity) will pose any substantial impediment to the continued propagation” of the virus, at least for now, wrote Tyler S. Brown and Rochelle Walensky, infectious-disease specialists at Massachusetts General Hospital, in an accompanying editorial. “These data should also quickly dispel myths that dangerous practices like ‘COVID parties’ are either a sound or safe way to promote herd immunity.”
“Covid parties” refer to events where people get together in an attempt to infect themselves and develop immunity to the virus that causes covid-19. A 30-year-old man who believed the coronavirus was a hoax and attended a “Covid party” died recently after being infected with the virus, according to the chief medical officer at a Texas hospital, the New York Times reported. But the account, it said, has not been independently corroborated.
The new study gave details on the undercount: In Missouri, the estimated number of actual infections was 13 times greater than the confirmed cases. In Utah, it was at least twice as high.
“The findings may reflect the number of persons who had mild or no illness, or who did not seek medical care or undergo testing but who still may have contributed to ongoing virus transmission in the population,” the study’s authors wrote. Researchers say more than 40 percent of people who are infected don’t have symptoms.
Because people often don’t know they are infected, the public should continue to take steps to reduce the risk of transmitting the virus, including wearing face coverings outside the home, remaining six feet from other people, washing hands frequently and staying home when sick.
Separately, in a report in the CDC’s Morbidity and Mortality Weekly Report, a study by Indiana University and the Indiana State Department of Health found that 2.8 percent of state residents had been infected as of late April. It was the first randomized study to determine the prevalence of the coronavirus infection in the state. It also included members of minority communities who were not randomly selected. The study used nasal-swab tests to detect active infections and blood tests to find antibodies that indicated a past infection.
The 2.8 percent represented about 187,000 people, or 10 times more than the number of confirmed cases identified through conventional testing. About 44 percent of the infected people were asymptomatic, according to Nir Menachemi, the lead scientist on the study and a professor of public health at Indiana University. The percentage fell to a little over 2 in a second round of testing in early June, but in a change, more people had antibodies, indicating past infections, while fewer had active infections.
In a second report in MMWR, CDC researchers surveyed residents of two Georgia counties — DeKalb and Fulton — in late April and early May and found that 2.5 percent had antibodies to the coronavirus.
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It’s the middle of the summer, and the coronavirus has not gone away.
When the pandemic first began, some had hoped that there’d be a lull during the summer, with the heat knocking the virus into submission, but it has continued its march across America, with outbreaks flaring across the southern and southwestern states. Arguments have also become part of the daily discourse, with people debating over case counts and death tolls, how the trends should be interpreted and whether the reported numbers can even be trusted.
I’ve watched so many reporters, both at ProPublica and at other outlets, do their best to debunk myths, demystify confusing trends and answer the public’s questions. It is, frankly, exhausting, especially when the same arguments keep coming up again and again. I’m also concerned to see not just laypeople, but local and national leaders, using data out of context to justify their own narratives. At the same time, I see members of the public who are sincerely confused, trying to find a way through all the numbers and charts being thrown around, asking: “How concerned should I be right now? How bad are things, really?”
So I wanted to step back and, with my colleague Ash Ngu, walk you through some common coronavirus metrics and explain how to interpret them. I hope this will leave you better equipped to assess claims with appropriate skepticism, filter out the garbage and find the real signal amid the noise.
Case Counts Won’t Give You the Full Picture
The first thing I asked experts was: What metric would you recommend I track if I wanted to understand what was going on in my state?
Both Matthew Fox, professor of epidemiology and global health at Boston University, and Youyang Gu, a data scientist best known for his COVID-19 prediction models, advised looking at three measurements together: number of cases, case positivity rates and number of deaths.
“Cases going up or down tells you a fair bit about what’s going on at the moment in terms of transmission of the virus — but it’s only valid if we’re testing enough people,” Fox said.
When there aren’t enough tests available, as was the case in New York in March, the number of cases reported will be an undercount, perhaps by a lot. That’s where case positivity rates come in: that measures the percentage of total tests conducted that are coming back positive. It helps you get a sense of how much testing is being done overall in a region.
“WHO guidelines say we want that to be below 5%,” Fox noted. When a positivity rate is higher, epidemiologists start worrying that means only sicker people have access to tests and a city or region is missing mild or asymptomatic cases. When almost all of the tests come back negative, on the other hand, it’s a good indicator that a locality has enough tests available for everyone who wants one, and public health officials have an accurate picture of all the infections, Fox said.
He gave the example of Massachusetts, where he lives. Currently, daily positive case counts have been steadily falling for the past three months. “The positivity rate is now below 2%, so I feel confident in saying that we know what’s going on, and it’s not that we’re not doing enough testing and we’re missing a lot of positive cases.”
On the flip side, any state where the positivity rate is higher than 10% is “really going to worry me,” Fox said. “That tells me that we’re probably missing a fair number of cases, and you’re not doing enough testing to see what’s going on.”
Fox noted that some states in the Sun Belt, such as Arizona and Florida, have recently had very high positivity rates, even above 20%. “That means we don’t have full visibility.”
Deaths are also an important metric, because this is what most people care about when it comes to the virus’s ultimate impact, Gu said. “There are instances where you have clusters of infections but they’re mostly in young people, so you see a spike in cases, but not in deaths, because they’re all low-risk individuals — but if they were all to transmit it to their parents or older, high-risk individuals, or if the virus started going around long-term care homes, that’d be a high cause for concern.”
Computational epidemiologist Maimuna Majumder also recommends tracking deaths. Even though deaths lag behind new cases, typically by three weeks to a month, “it’s a good indicator for just how serious of a burden this pandemic is causing, not only on our health care system, but also on the general public’s mental health and well-being.”
Hospitalization data is another way to track the impact of the pandemic that has less of a lag than reported deaths. After the U.S. Department of Health and Human Services told hospitals this month to stop reporting data to the Centers for Disease Control and Prevention and report directly to HHS instead, some of these numbers have become more erratic, according to The Covid Tracking Project. Currently, all the states except for Hawaii and Kansas are reporting COVID-19 hospitalization data.
Don’t Want to Be Wrong? Wait a Beat.
One of the easiest ways to be wrong when looking at the numbers is to focus on too small of a time frame. Look at case numbers on any given Sunday, and you might think that cases are falling, but you’d be fooled. Since some local labs and county health departments don’t report data on weekends, there’s a dip in numbers every Sunday and Monday, and then a corresponding surge on Tuesdays.
To make sure you don’t get misled, it’s better to look at what’s called the rolling seven-day average, which takes each day’s number and averages it with the six days before it. Many trackers provide this figure to smooth out the data. Also, wait to see if the trend holds. It’s kind of like the stock market; it’s unhelpful to to obsess over daily swings. The experts I interviewed suggested waiting one, two or even three weeks to make sure that any trends you think you’ve spotted bear out.
Let’s look at a specific claim to see how watching and waiting can make a difference in getting the whole story.
Over the past few weeks, President Donald Trump has emphasized that even while coronavirus cases have been rising in the U.S., that’s not a cause for concern because he insists the mortality rate is low. On Sunday, when Fox News host Chris Wallace asked him to address the fact that the U.S. had reached 900 coronavirus deaths on a single day, Trump responded: “I heard we had the best mortality rate. Number, number one low mortality rate.” This is untrue: the U.S. was about in the middle of the pack of 20 countries analyzed by Johns Hopkins University on July 16.
Setting aside the hyperbole, it is true that the case fatality rate (i.e., the number of deaths divided by the number of confirmed positive cases) has been gradually falling even as the daily case counts have soared.
So what’s going on there? Does this mean that the coronavirus is becoming less deadly?
Let’s look a little closer. We’ve known from early in the pandemic — even from the data coming out of China — that this coronavirus is less deadly to younger people and more deadly to older people. We’ve also come to learn that many people, as many as 40%, infected with the coronavirus do not show any symptoms or have such mild symptoms that it would never have occurred to them that they could have COVID-19. So it shouldn’t be a surprise that if we have more testing capacity than early on in the pandemic and are now capturing younger people and more asymptomatic patients, that the case fatality rate would be lower than if the population that’s being tested is mainly older and sicker. That’s what’s been happening recently. Check out Florida: The median age of residents testing positive fell into the 30s in June from the 60s in March.
But the other critical thing to remember is that deaths lag behind cases. A patient may get tested once they have symptoms but take a while to get sick enough to need to go to the hospital. With COVID-19, many patients who unfortunately don’t survive are often in the ICU for many weeks before they die. Then there may be a few more days’ delay before the death certificate is recorded.
The delay between cases rising and deaths can be hard to see at a national level, because many states have different story arcs going on: Right now, New York is coming down from its big outbreak, while Texas’ big surge is still on the upswing. That muddles the national picture. But when we zoom in to one state, you can see the picture more clearly. Let’s take Florida as an example.
There are other factors at play to consider as well when tackling a broad claim like, “Is COVID less deadly now?” such as hospital capacity. Dr. Michael Peters, an associate professor of medicine and pulmonologist at the University of California, San Francisco, has treated patients both in San Francisco and in New York City. He flew to New York and worked at a hospital in Queens to help support the overwhelmed doctors during the peak of the city’s outbreak.
“It’s obviously the same disease, but we haven’t ever been overloaded at UCSF. There’s data that shows, and my personal experience suggests, that when systems are overloaded, patients do worse,” he said. “If you take the same 50-year-old man and put him in San Francisco in March versus New York in March, he’d do differently — it’s just that the capacity to take care of people was limited and impaired.”
Peters explained that a lot of this has to do with the hands-on nature of care needed for the sickest of patients in ICUs. “Ventilators need to be watched and monitored to make sure you’re not getting too much air or too little air, because if you have too much air, that can cause injury to your lungs, so the doctors and nurses are constantly evaluating you.”
With each passing month, researchers are learning more about how to best treat the sickest patients. While there still is no cure, there is now some evidence for how to use treatments such as remdesivir and dexamethasone, said Dr. Abraar Karan, an internal medicine doctor at Brigham and Women’s Hospital in Boston, so arguably, your chances of survival are better now than in February. “The longer you wait to be infected, the less chance you have of being part of an experiment, and the better chance you have to be receiving the outcome of a well-done experiment,” he said.
None of this means that the virus itself has become less deadly, noted Boston University’s Fox, so one has to be careful not to leap to the conclusion that just because the case fatality rate has been falling, that means that it’s safe for the elderly to mingle in crowds again.
There Are Some Things We Can’t Know for Certain
Another question that’s been on my mind is whether a layperson can see the effects of specific events on transmission. For example, have protests in my state driven an increase in COVID-19 cases or not?
I’ve already seen people on my social media feeds ardently declaring that protests either did or did not lead to more cases, and therefore this means that masks either do or do not work. Mayor Eric Garcetti of Los Angeles first said there was no “conclusive evidence” that the protests led to a rise in coronavirus cases, then a few days later he said that the county’s director of public health did think that some spread was due to the protesting without adequate physical distancing or wearing a mask. I wanted to know if it’s possible to definitively make these conclusions.
The epidemiologists I interviewed prescribed caution, for a number of reasons.
First, it’s hard to isolate an event in a vacuum. “It’s not like there were protests and nothing else happened — they happened shortly after states started reopening, and just after Memorial Day,” Fox said. How would you untangle if an increase in cases was due to reopening activities or protests, if you didn’t know the identities of people who got sick in ensuing weeks and the history of their movements? Contact tracing case studies might be able to answer these questions, but for a layperson, this would be impossible to discern by just looking at case counts and a timeline.
Furthermore, many states have had testing backlogs, meaning that the cases being reported today belong to people who were swabbed more than a week ago and who got infected even before that. “Are we even seeing it in the numbers yet? That could be contested,” Majumder said. “That’s a piece of this that has been very frustrating. For any analysis to be done, you’d need to know not the national backlog in testing, but what is the backlog for your locality.”
Majumder and her team of researchers are now trying to analyze whether protests in which people were doused with tear gas and pepper spray led to more transmission than protests in which such tactics weren’t deployed. That analysis is even more complicated and best left to the professionals.
When testing any hypothesis, Gu encouraged cultivating a neutral perspective. “Watch out for selection bias, which is when you gravitate towards data that matches your belief and you ignore data that goes against your belief,” he said.
Fox similarly cautioned to be on the watch for “extraordinary claims.”
“If you’re reading a blog post that sounds very scientific and credible, but everything lines up perfectly, then something’s wrong,” he said. “The world doesn’t work that way. The world never fits a perfect pattern. You should expect things to diverge.”
Take a Deep Breath and Try to Look at the Big Picture
I’ve noticed that some folks like to nitpick about specific numbers, with an argument along the lines of, “Well, here’s a problem with this statistic, and that’s why you can’t trust any of these numbers and this is all a vast conspiracy!”
For instance, more than one person has suggested to me that people who have tested positive may be getting retested multiple times, and thus are getting double- or even triple-counted, vastly inflating the number of coronavirus cases. There have also been multiple debates about death counts, with people proffering arguments for why they are either overcounted or undercounted.
To address the concern about double-counting coronavirus cases, I checked with some public health officials, who said that should not be happening, because health departments receive patients’ details, such as names and contact information (which is used for contact tracing work), and they do their best to weed out duplicates when reporting numbers.
“In some cases, could it happen? Sure, particularly if the data doesn’t get entered correctly and they misspell the name or reverse the first or last name,” said Dr. Rex Archer, director of the Kansas City Health Department. “But is it a huge percentage? No. It’s nowhere near the number of people who are positive and untested.”
The thing is, you can always make arguments for why the data isn’t perfect. But that doesn’t automatically mean that the numbers can’t be trusted. This is why I like to step back, wait and see how the trends are going and look for confirmation — then I don’t let myself get distracted by the people in my inbox arguing that a few cases of double counting mean all the numbers are fraudulent.
Taking this big picture approach can help us get above the fog of confusion when politicians come along and declare things like “cases are only going up because we’re testing more.”
If the virus was not spreading and, say, you tested twice as many people, then you shouldn’t find double the number of cases. In fact, if the virus was well under control and you tested twice as many people, you should find far less than double the number of cases, and the positivity rate should decrease over time.
But that is not what has happened. From the second week of June to the first full week of July, while the average number of tests per day went up by 41%, the average number of positive cases per day nearly tripled, and the average positivity rate went from 4.4% to 8.5% according to The Covid Tracking Project. That’s a clear sign that it’s not just testing that’s behind the increase in cases. At the same time, in many states where cases are soaring, hospitalizations have also surged, adding further confirmation that we’re not getting the wrong signal.
Find Trusted Sources
If you’ve been finding all the numbers and charts dizzying, that’s very understandable. It’s not really fair to ask people to research and fact check every single thing that they’re told (unless you’re a reporter like me, and that’s your job!).
“I don’t think we need to all know everything,” Majumder pointed out to me, after I asked her for tips for the public on how to read coronavirus statistics. “As a society, we should be able to rely on trusted sources to help us make better decisions.”
But how do you figure out who’s a trusted source? I liked the following advice from Andy Slavitt, former head of the Centers for Medicare and Medicaid Services during the Obama administration, which he shared on Twitter recently. He said to look for people who say “we don’t know” a lot, who give the source for their data and the type of study and who acknowledge their biases and experience.
“Even then they will be wrong on occasion & to keep your trust they should acknowledge it,” he added.
What the Numbers Show Us Today
One last thought: Let’s be clear about what the numbers reveal to us about the state of America today.
Even if the data is imperfect, when you zoom out enough, you can see the following trends pretty clearly. Since the middle of June, daily cases and hospitalizations have been rising in tandem. Since the beginning of July, daily deaths have also stopped falling (remember, they lag cases) and reversed course.
I fear that our eyes have glazed over with so many numbers being thrown around, that we’ve forgotten this: Every day, hundreds of Americans are dying from COVID-19. Some days, the number of recorded deaths has reached more than 1,000. Yes, the number recorded every day is not absolutely precise — that’s impossible — but the order of magnitude can’t be lost on us. It’s hundreds a day.
And there are nowtens of thousands of new infections every day. The last time fewer than 10,000 new cases were recorded on a single day was in March. The recorded number is now above 50,000 a day. This past week, it crossed 70,000 on Thursday and Friday.
The positivity rate nationwide fell steadily for months, as more testing became available. It went under 5% briefly in late May and early June, and it has since climbed back up into the high single digits. In many states, it’s now in the double digits. That means we are not testing enough, and in many states, we are blind to the true extent of who is sick and where the cases are.
The bottom line: We don’t have the pandemic under control. My hope is that this country’s leaders stop squabbling over specific numbers and using partial trends to tell their own narratives. Instead, let’s focus on the takeaway — there’s a lot of work to do.
President Donald Trump discussed a proposed round of federal stimulus aid with House Minority Leader Kevin McCarthy, R-Calif., (left) and Senate Majority Leader Mitch McConnell, R-Ky., (center) in the Oval Office on Monday.
Photo by Doug Mills/Getty Images
Enhanced unemployment benefits are likely ending sooner than many may realize. That could impose financial hardship on millions of families come month’s end.
The CARES Act, the federal coronavirus relief law enacted in March, gave an extra $600 a week in aid through July 31 to Americans receiving jobless benefits.
But, in all states, that subsidy will end this weekend — on July 25 or 26 — unless Congress passes legislation before then to extend the timeline, which looks increasingly unlikely.
“I think people don’t recognize they won’t get the benefit the last week in July,” according to Michele Evermore, a senior policy analyst at the National Employment Law Project, who said many are likely relying on those payments for rent, mortgages and other end-of-month bills.
“I think it’ll come as an unwelcome shock,” she said.
Payments are ending about a week earlier than the CARES Act allows due to the administrative calendar that states use to pay benefits.
States pay aid according to the timeline of a “benefit week.”
All states have benefit weeks ending on a Saturday or Sunday. But July 31 falls on a Friday.
That means states must stop paying the $600 after this weekend in order to comply with the CARES Act, which requires the subsidy to end on or before July 31.
Around 32 million Americans were collecting unemployment benefits as of June 27, according to most recent data from the U.S. Labor Department.
They would continue to get standard state benefits, which averaged $383 a week in the first quarter this year, according to the Department. That amount would be a roughly 61% decrease in aid.
‘Tough choices’
Meanwhile, federal lawmakers are debating the contours of another coronavirus relief package.
Democrats have called for an extension of the weekly $600 supplement for jobless workers. Republicans have signaled they want those payments to end.
It’s unclear what, if anything, would take their place if they disappear, but some Republicans have proposed a cash bonus for people who find new jobs or a reduced amount of aid.
Failure to pass legislation by this weekend would effectively mean the $600-a-week unemployment enhancement would lapse.
Every week they don’t get that payments after July 25 or 26 is a week where workers and their families will have to make tough choices.
Ernie Tedeschi
labor economist at Evercore ISI
House Minority Leader Kevin McCarthy, R-Calif., doesn’t expect legislation to pass until the first week of August, he told CNBC on Tuesday.
“Every week they don’t get that payments after July 25 or 26 is a week where workers and their families will have to make tough choices about what spending they’re going to cut, and that will have an effect on the economy and the recovery,” said Ernie Tedeschi, a labor economist at Evercore ISI.
Congress may make any federal unemployment aid included in the next bill retroactive, meaning recipients could receive back pay for weeks going back to the end of July or early August.
However, that could mean Americans must endure a few weeks of financial hardship before being made whole, Tedeschi said.
President Trump departs a July 2019 press conference on the census with U.S. Attorney General William Barr (center) and Commerce Secretary Wilbur Ross in the White House Rose Garden.
Alex Wong/Getty Images
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President Trump departs a July 2019 press conference on the census with U.S. Attorney General William Barr (center) and Commerce Secretary Wilbur Ross in the White House Rose Garden.
Alex Wong/Getty Images
President Trump is signing a memorandum Tuesday that calls for an unprecedented change to the constitutionally mandated count of every person living in the country — the exclusion of unauthorized immigrants from the numbers used to divide up seats in Congress among the states.
The White House has not provided any additional details and has not yet released the text of the memorandum, but in a written statement, a White House official who spoke on background said the “action will clarify that illegal aliens are not to be included for the purpose of apportionment of Representatives following the 2020 Census.”
But the move by the president, who does not have final authority over the census, is more likely to spur legal challenges and political spectacle in the last months before this year’s presidential election than a transformation of the once-a-decade head count.
Since the first U.S. census in 1790, both U.S. citizens and noncitizens — regardless of immigration status — have been included in the country’s official population counts.
The fifth sentence of the Constitution specifies that “persons” residing in the states should be counted every 10 years to determine each state’s share of seats in the House of Representatives. The 14th Amendment goes further to require the counting of the “whole number of persons in each state.”
It is Congress — not the president — that Article 1, Section 2 of the country’s founding document empowers to carry out the “actual enumeration” of the country’s population in “such manner as they shall by law direct.”
In Title 2 of the U.S. Code, Congress detailed its instructions for the president to report to lawmakers the tally of the “whole number of persons” living in each state for the reapportionment of House seats. In Title 13, Congress established additional key dates for the “tabulation of total population.”
The state of Alabama, however, is arguing in an ongoing federal lawsuit that the framers of the Constitution did not intend for the term “persons” to include immigrants living in the country without authorization. Alabama says it’s trying to avoid losing a seat in Congress after the 2020 census by seeking to leave out unauthorized immigrants from the results of the national count that are used to reapportion the U.S. House.
Trump’s announcement, first signaled in a Politico newsletter last week, comes just over a year after the administration backed down in its failed attempt to add the now-blocked citizenship question to the 2020 census.
In July 2019,the president issued an executive order to use government records, including from state departments of motor vehicles and federal agencies such as the Department of Homeland Security, to produce anonymized citizenship data that could be used to redraw voting districts in a way that, a GOP strategist concluded, would politically benefit Republicans and non-Hispanic white people.
With the national census self-response rate at just over 62%, the White House announcement threatens to derail the Census Bureau’s efforts to finish tallying up roughly four out of 10 households that have not filled out a census form on their own.
The agency’s operational plan for the 2020 census includes specially designed efforts, such as providing online forms and call centers in 13 languages, to try to make sure the census includes undocumented immigrants and other populations the bureau considers “hard-to-count.”
According to the Census Bureau’s residence criteria for determining how to count different groups of residents for the 2020 census, citizens of foreign countries who are living in the U.S. are supposed to be counted “at the U.S. residence where they live and sleep most of the time,” while international visitors should not be counted.
The bureau has been relying on ads and community groups to help ramp up its outreach to households with immigrants, people of color and other historically undercounted groups, many of whom remain distrustful of sharing their information with the government despite federal laws that require the Census Bureau to keep personally identifiable census information confidential until 72 years after it’s been collected and prohibit that information from being used against an individual.
The administration has also raised concerns in recent weeks by making two new political appointments at the bureau. The move has sparked an inquiry by the inspector general for the Commerce Department, which oversees the bureau. Democratic lawmakers and professional associations, including the American Statistical Association and the American Economic Association, are questioning whether the appointments of Nathaniel Cogley, a political science professor, and Adam Korzeniewski, a former political consultant to a YouTube personality known for racist pranks, are a partisan attempt to interfere with the census.
NPR White House correspondent Tamara Keith contributed to this report.
