The Mask Slackers of 1918

As the influenza pandemic swept across the United States in 1918 and 1919, masks took a role in political and cultural wars.

The masks were called muzzles, germ shields and dirt traps. They gave people a “pig-like snout.” Some people snipped holes in their masks to smoke cigars. Others fastened them to dogs in mockery. Bandits used them to rob banks.

More than a century ago, as the 1918 influenza pandemic raged in the United States, masks of gauze and cheesecloth became the facial front lines in the battle against the virus. But as they have now, the masks also stoked political division. Then, as now, medical authorities urged the wearing of masks to help slow the spread of disease. And then, as now, some people resisted.

In 1918 and 1919, as bars, saloons, restaurants, theaters and schools were closed, masks became a scapegoat, a symbol of government overreach, inspiring protests, petitions and defiant bare-face gatherings. All the while, thousands of Americans were dying in a deadly pandemic.

The first infections were identified in March, at an Army base in Kansas, where 100 soldiers were infected. Within a week, the number of flu cases grew fivefold, and soon the disease was taking hold across the country, prompting some cities to impose quarantines and mask orders to contain it.

By the fall of 1918, seven cities — San Francisco, Seattle, Oakland, Sacramento, Denver, Indianapolis and Pasadena, Calif. — had put in effect mandatory face mask laws, said Dr. Howard Markel, a historian of epidemics and the author of “Quarantine!

Organized resistance to mask wearing was not common, Dr. Markel said, but it was present. “There were flare-ups, there were scuffles and there were occasional groups, like the Anti-Mask League,” he said, “but that is the exception rather than the rule.”

At the forefront of the safety measures was San Francisco, where a man returning from a trip to Chicago apparently carried the virus home, according to archives about the pandemic at the University of Michigan.

By the end of October, there were more than 60,000 cases statewide, with 7,000 of them in San Francisco. It soon became known as the “masked city.”

“The Mask Ordinance,” signed by Mayor James Rolph on Oct. 22, made San Francisco the first American city to require face coverings, which had to be four layers thick.

Resisters complained about appearance, comfort and freedom, even after the flu killed an estimated 195,000 Americans in October alone.

Alma Whitaker, writing in The Los Angeles Times on Oct. 22, 1918, reviewed masks’ impact on society and celebrity, saying famous people shunned them because it was “so horrid” to go unrecognized.

“The big restaurants are the funniest sights, with all the waiters and diners masked, the latter just raising their screen to pop in a mouthful of food,” she wrote.

When Ms. Whitaker herself declined to wear one, she was “forcibly taken” to the Red Cross as a “slacker,” and ordered to make one and put it on.

The San Francisco Chronicle said the simplest type of mask was of folded gauze affixed with elastic or tape. The police went for gauze masks, which resembled an unflattering “nine ordinary slabs of ravioli arranged in a square.”

There was room for creativity. Some of the coverings were “fearsome looking machines” that lent a “pig-like aspect” to the wearer’s face.

The penalty for violators was $5 to $10, or 10 days’ imprisonment.

On Nov. 9, 1,000 people were arrested, The San Francisco Chronicle reported. City prisons swelled to standing room only; police shifts and court sessions were added to help manage.

“Where is your mask?” Judge Mathew Brady asked offenders at the Hall of Justice, where sessions dragged into night. Some gave fake names, said they just wanted to light a cigar or that they hated following laws.

Jail terms of 8 hours to 10 days were given out. Those who could not pay $5 were jailed for 48 hours.

On Oct. 28, a blacksmith named James Wisser stood on Powell and Market streets in front of a drugstore, urging a crowd to dispose of their masks, which he described as “bunk.”

A health inspector, Henry D. Miller, led him to the drugstore to buy a mask.

At the door, Mr. Wisser struck Mr. Miller with a sack of silver dollars and knocked him to the ground, The San Francisco Chronicle reported. While being “pummeled,” Mr. Miller, 62, fired four times with a revolver. Passers-by “scurried for cover,” The Associated Press said.

Mr. Wisser was injured, as were two bystanders. He was charged with disturbing the peace, resisting an officer and assault. The inspector was charged with assault with a deadly weapon.

That was the headline for a report published in The Los Angeles Times when city officials met in November to decide whether to require residents to wear “germ scarers” or “flu-scarers.”

Public feedback was invited. Some supported masks so theaters, churches and schools could operate. Opponents said masks were “mere dirt and dust traps and do more harm than good.”

“I have seen some persons wearing their masks for a while hanging about their necks, and then apply them to their faces, forgetting that they might have picked up germs while dangling about their clothes,” Dr. E.W. Fleming said in a Los Angeles Times report.

An ear, nose and throat specialist, Dr. John J. Kyle, said: “I saw a woman in a restaurant today with a mask on. She was in ordinary street clothes, and every now and then she raised her hand to her face and fussed with the mask.”

Suffragists fighting for the right to vote made a gesture that rejected covering their mouths at a time when their voices were crucial.

At the annual convention of the Illinois Equal Suffrage Association, in October 1918, they set chairs four feet apart, closed doors to the public and limited attendance to 100 delegates, the Chicago Daily Tribune reported.

But the women “showed their scorn” for masks, it said. It’s unclear why.

Allison K. Lange, an associate history professor at Wentworth Institute of Technology, said one reason could have been that they wanted to keep a highly visible profile.

“Suffragists wanted to make sure their leaders were familiar political figures,” Dr. Lange said.

San Francisco’s mask ordinance expired after four weeks at noon on Nov. 21. The city celebrated, and church bells tolled.

A “delinquent” bent on blowing his nose tore his mask off so quickly that it “nearly ruptured his ear,” The San Francisco Chronicle reported. He and others stomped on their masks in the street. As a police officer watched, it dawned on him that “his vigil over the masks was done.”

Waiters, barkeeps and others bared their faces. Drinks were on the house. Ice cream shops handed out treats. The sidewalks were strewn with gauze, the “relics of a torturous month,” The Chronicle said.

The spread had been halted. But a second wave was on the horizon.

By December, the San Francisco Board of Supervisors was again proposing a mask requirement, meeting with testy opposition.

Around the end of the year, a bomb was defused outside the office of San Francisco’s chief health officer, Dr. William C. Hassler. “Things were violent and aggressive, but it was because people were losing money,” said Brian Dolan, a medical historian at the University of California, San Francisco. “It wasn’t about a constitutional issue; it was a money issue.”

By the end of 1918, the death toll from influenza had reached at least 244,681, mostly in the last four months, according to government statistics.

In January, Pasadena’s city commission passed a mask ordinance. The police grudgingly enforced it, cracking down on cigar smokers and passengers in cars. Sixty people were arrested on the first day, The Los Angeles Times reported on Jan. 22, in an article titled “Pasadena Snorts Under Masks.”

“It is the most unpopular law ever placed on the Pasadena records,” W.S. McIntyre, the chief of police, told the paper. “We are cursed from all sides.”

Some mocked the rule by stretching gauze across car vents or dog snouts. Cigar vendors said they lost customers, though enterprising aficionados cut a hole in the cloth. (They were still arrested.) Barbers lost shaving business. Merchants complained traffic dropped as more people stayed home.

Petitions were circulated at cigar stands. Arrests rose, even of the powerful. Ernest May, the president of Security National Bank of Pasadena, and five “prominent” guests were rounded up at the Maryland Hotel one Sunday.

They had masks on, but not covering their faces.

As the contagion moved into its second year, so did the skepticism.

On Dec. 17, 1918, the San Francisco Board of Supervisors reinstituted the mask ordinance after deaths started to climb, a trend that spilled over into the new year with 1,800 flu cases and 101 deaths reported there in the first five days of January.

That board’s decision led to the creation of the Anti-Mask League, a sign that resistance to masks was resurfacing as cities tried to reimpose orders to wear them when infections returned.

The league was led by a woman, E.J. Harrington, a lawyer, social activist and political opponent of the mayor. About a half-dozen other women filled its top ranks. Eight men also joined, some of them representing unions, along with two members of the board of supervisors who had voted against masks.

“The masks turned into a political symbol,” Dr. Dolan said.

On Jan. 25, the league held its first organizational meeting, open to the public at the Dreamland Rink, where they united behind demands for the repeal of the mask ordinance and for the resignations of the mayor and health officials.

Their objections included lack of scientific evidence that masks worked and the idea that forcing people to wear the coverings was unconstitutional.

On Jan. 27, the league protested at a Board of Supervisors meeting, but the mayor held his ground. There were hisses and cries of “freedom and liberty,” Dr. Dolan wrote in his paper on the epidemic.

Repeal came a few days later on Feb. 1, when Mayor Rolph cited a downturn in infections.

But a third wave of flu rolled in late that year. The final death toll reached an estimated 675,000 nationwide, or 30 for every 1,000 people in San Francisco, making it one of the worst-hit cities in America.

Dr. Dolan said the story of the Anti-Mask League, which has drawn renewed interest now in 2020, demonstrates the disconnect between individual choice and universal compliance.

That sentiment echoes through the century from the voice of a San Francisco railway worker named Frank Cocciniglia.

Arrested on Kearny Street in January, Mr. Cocciniglia told the judge that he “was not disposed to do anything not in harmony with his feelings,” according to a Los Angeles Times report.

He was sentenced to five days in jail.

“That suits me,” Mr. Cocciniglia said as he left the stand. “I won’t have to wear a mask there.”

 

 

 

 

Graph of the Day: Daily Confirmed Covid-19 Cases (Rolling 3-day average)

Daily confirmed COVID-19 cases, rolling 3-day average - Our World ...

US weekly jobless claims hit 1.4 million, post second straight weekly increase

https://www.businessinsider.com/us-jobless-claims-unemployment-insurance-labor-market-filings-recession-coronavirus-2020-7

  • US jobless claims for the week that ended Saturday totaled 1.43 million, the Labor Department said Thursday. That came in slightly below the consensus economist estimate of 1.45 million.
  • It marked a second consecutive weekly increase after the prior week’s report ended a 15-week streak of declines. This week’s report brought total filings over a 19-week period to more than 54 million.
  • Continuing claims, the aggregate total of people receiving unemployment benefits, totaled 17 million for the week that ended July 18.

More than a million Americans filed for unemployment benefits last week, reflecting the continued high level of pandemic-induced layoffs as the US rolls back its economic-reopening efforts.

New US weekly jobless claims totaled 1.43 million in the week that ended Saturday, the Labor Department reported Thursday. That was slightly below the consensus economist estimate of 1.45 million compiled by Bloomberg. It also was a minor increase over the prior week’s 1.3 million filings, a reading that marked the first gain in 15 weeks.

In just a few months, the more than 54 million unemployment claims filed during the coronavirus pandemic have far surpassed the 37 million during the 18-month Great Recession. The latest figure is more than double the 665,000 filed during the Great Recession’s worst week.

“A combination of uncertainty from rising virus cases to the withdrawal of financial support is concerning for an already fragile recovery,” said Daniel Zhao, senior economist at Glassdoor. “The economy is still in deep risk of falling sideways – where conditions improve so sluggishly that the effects of the crisis become increasingly permanent.”

Continuing claims, which represent the aggregate total of people receiving unemployment benefits, came in at 17 million for the week that ended July 18, a decline from the prior period’s revised number.

Stubbornly high weekly claims for unemployment insurance add to growing concerns that the economic recovery from the pandemic-induced recession is stagnating as coronavirus cases increase. A number of states have had to pause or roll back their reopening plans to deal with COVID-19 spikes, harming the economic recovery.

Going forward, industry watchers will be waiting to see what the July jobs report shows. The report, due August 7, reflects a reference period that includes last week, when initial jobless claims ticked up for the first time in 15 weeks. That could foreshadow a negative headline jobs number in July, although the nonfarm payroll report has become increasingly difficult to predict.

Last week, the additional $600 unemployment benefit from the CARES Act expired, meaning that soon millions of Americans will see a significant decrease in weekly income. The GOP this week introduced its proposal, the HEALS Act, that would cut the weekly benefit to $200 until states could implement a program that’d replace 70% of wages for most filers.

In the week ending July 25, there were 829,697 initial claims from 50 states reporting for Pandemic Unemployment Assistance, the program that extended benefits to gig workers and independent contracts. The total applications for all state programs for the week ending July 11 was 30.2 million. 

 

 

 

 

‘I’m fighting a war against COVID-19 and a war against stupidity,’ says CMO of Houston hospital

https://www.beckershospitalreview.com/hospital-physician-relationships/i-m-fighting-a-war-against-covid-19-and-a-war-against-stupidity-says-cmo-of-houston-hospital.html?utm_medium=email

 

After two hours of sleep a night for four months and seeing a member of his team contract the virus, Joseph Varon, MD, is growing exasperated.

“I’m pretty much fighting two wars: A war against COVID and a war against stupidity,” Dr. Varon, MD, CMO and chief of critical care at United Memorial Medical Center in Houston, told NBC News. “And the problem is the first one, I have some hope about winning. But the second one is becoming more and more difficult.”

Dr. Varon noted that whether it’s information backed by science or common sense, people throughout the U.S. are not listening. “The thing that annoys me the most is that we keep on doing our best to save all these people, and then you get another batch of people that are doing exactly the opposite of what you’re telling them to do.”

In an interview with NPR, Dr. Varon said he has woken up at dawn every day for the past four months and has headed to the hospital. There, he spends six to 12 hours on rounds before seeing new admissions. He then returns home to sleep two hours, at most.

He said his staff is physically and emotionally drained. 

UMMC nurse Christina Mathers spoke with NBC News from a hospital bed in the segment, noting that she had recently tested positive for COVID-19 after not feeling well during one of her shifts. “All the fighting, all the screaming, all the finger pointing — enough is enough,” Ms. Mathers told NBC. “People just need to listen to us. We’re not going to lie. Why would we lie?” 

Ms. Mathers has worked every other day since April 29, according to The Atlantic, which created a photo essay of Dr. Varon and the UMMC team at work.

 

 

Nope, Kids Not ‘Almost Immune’ to COVID-19 at Georgia Camp

https://www.medpagetoday.com/infectiousdisease/covid19/87849?xid=fb_o&trw=no&fbclid=IwAR2HZ0s8huLi4I5pgLbA-21a4g65bl1kH6j1r_cWfJpyOwvkJrfHJMFCKEU

Nope, Kids Not 'Almost Immune' to COVID-19 at Georgia Camp ...

Even with mitigation measures, attack rates outpaced the Diamond Princess cruise ship.

President Trump’s repeated statements that children are “almost immune” to COVID-19 got a fact check from state and federal public health investigators examining an outbreak at a Georgia summer camp.

Among 597 Georgia residents, including campers, staff members, and trainees, the attack rate was 44%, reported Christine M. Szablewski, DVM, of the Georgia Department of Public Health, and colleagues.

The attack rate was highest among staff members (56%). Younger children ages 6-10 had a rate of 51%, those ages 11-17 had a rate of 44%, and those ages 18-21 had a rate of 33%, the authors wrote in an early edition of the Morbidity and Mortality Weekly Report.

By contrast, 19% of Diamond Princess cruise ship passengers tested positive for COVID-19 in February and March.

Among 136 cases with symptom information available, 26% reported no symptoms, with the authors specifically characterizing asymptomatic transmission as “common.” The flip side of that figure, however, is that a minimum of 100 children did develop symptoms. The report did not address symptom severity, outcomes, or transmission after leaving camp, as the investigation is still continuing, the authors indicated.

“This investigation adds to the body of evidence demonstrating that children of all ages are susceptible to SARS-CoV-2 infection and, contrary to early reports, might play an important role in transmission,” Szablewski and colleagues wrote.

Until recently, data on U.S. children contracting COVID-19, a key point in the argument to reopen schools, were scarce and conflicting. But recent evidence chipped away at the claim that kids are unaffected, with new research emerging this week about the association between school closures and declines in number of cases and deaths. Researchers also found children under age 5 may have far more SARS-CoV-2 viral nucleic acid in their noses than adults, which raises questions about their ability to transmit the virus.

While sleepover camps are not schools, and staff members are not teachers, the authors said the camps adopted CDC guidelines for youth and summer programs. All trainees, staff members, and campers provided documentation of a negative test for SARS-CoV-2. Cloth masks were required for staff members, though not campers, and the camp did not open doors and windows for increased ventilation, as recommended. Campers engaged in “a variety of indoor and outdoor activities,” including “daily vigorous singing and cheering,” they said.

The session was scheduled for June 21-27, and on June 23, a teenage staff member left after developing chills one day prior. The staff member tested positive for SARS-CoV-2. On June 24, campers were sent home, and on June 27, the camp was closed.

However, the damage was done. After excluding out-of-state attendees, researchers examined data from 597 Georgia residents at the camp. Campers were a median age of 12, and 53% were girls, while staff members were a median age of 17, and 59% were girls.

Of the 344 available testing results, 76% were positive for SARS-CoV-2. Not surprisingly, they found attack rates increased with increased time spent at the camp. Average occupancy was 15 per cabin, with a median attack rate of 50% among 28 cabins with one or more positive cases.

Among 100 patients reporting symptom data, two-thirds had fever, about 60% had headache, and 46% had a sore throat.

While the researchers said “consistent and correct” use of cloth masks, as well as physical distancing measures, should be emphasized to mitigate transmission in “congregate settings,” they acknowledged that “the multiple measures adopted by the camp were not sufficient to prevent an outbreak in the context of substantial community transmission.”

“An ongoing investigation will further characterize specific exposures associated with infection, illness course, and any secondary transmission to household members,” the group added.

 

 

 

 

Coronavirus threat rises across U.S.: ‘We just have to assume the monster is everywhere’

https://www.washingtonpost.com/health/coronavirus-threat-rises-across-us-we-just-have-to-assume-the-monster-is-everywhere/2020/08/01/cdb505e0-d1d8-11ea-8c55-61e7fa5e82ab_story.html?utm_campaign=wp_post_most&utm_medium=email&utm_source=newsletter&wpisrc=nl_most

The coronavirus is spreading at dangerous levels across much of the United States, and public health experts are demanding a dramatic reset in the national response, one that recognizes that the crisis is intensifying and that current piecemeal strategies aren’t working.

This is a new phase of the pandemic, one no longer built around local or regional clusters and hot spots. It comes at an unnerving moment in which the economy suffered its worst collapse since the Great Depression, schools are rapidly canceling plans for in-person instruction and Congress has failed to pass a new emergency relief package. President Trump continues to promote fringe science, the daily death toll keeps climbing and the human cost of the virus in America has just passed 150,000 lives.

“Unlike many countries in the world, the United States is not currently on course to get control of this epidemic. It’s time to reset,” declared a report released this week by Johns Hopkins University.

Another report from the Association of American Medical Colleges offered a similarly blunt message: “If the nation does not change its course — and soon — deaths in the United States could be well into the multiple hundreds of thousands.”

The country is exhausted, but the virus is not. It has shown a consistent pattern: It spreads opportunistically wherever people let down their guard and return to more familiar patterns of mobility and socializing. When communities tighten up, by closing bars or requiring masks in public, transmission drops.

That has happened in some Sun Belt states, including Arizona, Florida and Texas, which are still dealing with a surge of hospitalizations and deaths but are finally turning around the rate of new infections.

There are signs, however, that the virus is spreading freely in much of the country. Experts are focused on upticks in the percentage of positive coronavirus tests in the upper South and Midwest. It is a sign that the virus could soon surge anew in the heartland. Infectious-disease experts also see warning signs in East Coast cities hammered in the spring.

“There are fewer and fewer places where anybody can assume the virus is not there,” Gov. Mike DeWine (R) of Ohio said Wednesday. “It’s in our most rural counties. It’s in our smallest communities. And we just have to assume the monster is everywhere. It’s everywhere.”

Dire data

An internal Trump administration briefing document prepared by the Federal Emergency Management Agency and obtained Friday by The Washington Post counted 453,659 new infections in the past week.

Alaska is in trouble. And Hawaii, Missouri, Montana and Oklahoma. Those are the five states, as of Friday, with the highest percentage increase in the seven-day average of new cases, according to a Post analysis of nationwide health data.

“The dominoes are falling now,” said David Rubin, director of the PolicyLab at Children’s Hospital of Philadelphia, which has produced a model showing where the virus is likely to spread over the next four weeks.

His team sees ominous trends in big cities, including Baltimore, Chicago, Detroit, Indianapolis, Kansas City, Louisville, Philadelphia, St. Louis and Washington, with Boston and New York not far behind. And Rubin warns that the expected influx of students into college towns at the end of this month will be another epidemiological shock.

“I suspect we’re going to see big outbreaks in college towns,” he said.

Young people are less likely to have a severe outcome from the coronavirus, but they are adept at propelling the virus through the broader population, including among people at elevated risk. Numbers of coronavirus-related hospitalizations in the United States went from 36,158 on July 1 to 52,767 on July 31, according to The Post’s data. FEMA reports a sharp increase in the number of patients on ventilators.

The crisis has highlighted the deep disparities in health outcomes among racial and ethnic groups, and data from the Centers for Disease Control and Prevention this week showed that hospitalization rates due to the coronavirus are roughly five times higher among Black, Hispanic and Native Americans than Whites.

Thirty-seven states and Puerto Rico will probably see rising daily death tolls during the next two weeks compared with the previous two weeks, according to the latest ensemble forecast from the University of Massachusetts at Amherst that combines more than 30 coronavirus models.

There are glimmers of progress. The FEMA report showed 237 U.S. counties with at least two weeks of steady declines in numbers of new coronavirus cases.

But there are more than 3,100 counties in America.

“This is not a natural disaster that happens to one or two or three communities and then you rebuild,” said Beth Cameron, vice president for global biological policy and programs at the Nuclear Threat Initiative and a former White House National Security Council staffer focused on pandemics. “This is a spreading disaster that moves from one place to another, and until it’s suppressed and until we ultimately have a safe and effective and distributed vaccine, every community is at risk.”

A national strategy, whether advanced by the federal government or by the states working in tandem, will more effectively control viral spread than the current patchwork of state and local policies, according to a study from researchers at the Massachusetts Institute of Technology published Thursday in the Proceedings of the National Academy of Sciences.

The coordination is necessary because one state’s policies affect other states. Sometimes, that influence is at a distance, because states that are geographically far apart can have cultural and social ties, as is the case with the “peer states” of New York and Florida, the report found.

“The cost of our uncoordinated national response to covid-19, it’s dramatic,” said MIT economist Sinan Aral, senior author of the paper.

Some experts argue for a full six-to-eight-week national shutdown, something even more sweeping than what was instituted in the spring. There appears to be no political support for such a move.

Neil Bradley, executive vice president of the U.S. Chamber of Commerce, said fresh federal intervention is necessary in this second wave of closures. Enhanced federal unemployment benefits expired at the end of July, with no agreement on a new stimulus package in sight.

“Congress, on a bipartisan basis, was trying to create a bridge to help individuals and businesses navigate the period of a shutdown,” Bradley said. “Absent an extension of that bridge, in light of a second shutdown, that bridge becomes a pier. And then that’s a real problem.”

With the economy in shambles, hospitals filling up and the public frustrated, anxious and angry, the challenge for national leadership is finding a plausible sea-to-sea strategy that can win widespread support and simultaneously limit sickness and death from the virus.

Many Americans may simply feel discouraged and overtaxed, unable to maintain precautions such as social distancing and mask-wearing. Others remain resistant, for cultural or ideological reasons, to public health guidance and buy into conspiracy theories and pseudoscience.

DeWine is struggling to get Ohio citizens to take seriously the need to wear masks. A sheriff in rural western Ohio told the governor Wednesday that people didn’t think the virus was a big problem. DeWine informed the sheriff that the numbers in his county were higher per capita than in Toledo.

“The way I’ve explained to people, if we want to have Friday night football in the fall, if we want our kids back in school, what we do in the next two weeks will determine if that happens,” DeWine said.

The crucial metric

The coronavirus has always been several steps ahead of the U.S. government, the scientific community, the news media and the general public. By the time a community notices a surge in patients to hospital emergency rooms, the virus has seeded itself widely.

The virus officially known as SARS-CoV-2 can be transmitted by people who are infectious but not symptomatic. The incubation period is typically about six days, according to the CDC. When symptoms flare, they can be ambiguous. A person may not seek a test right away. Then, the test results may not come back for days, a week, even longer.

That delay makes contact tracing nearly futile. It also means government data on virus transmission is invariably out of date to some degree — it’s a snapshot of what was happening a week or two weeks before. And different jurisdictions use different metrics to track the virus, further fogging the picture.

The top doctors on the White House coronavirus task force, Deborah Birx and Anthony S. Fauci, are newly focused on the early warning signs of a virus outbreak. This week, they warned that the kind of runaway outbreaks seen in the Sun Belt could potentially happen elsewhere. Among the states of greatest concern: Indiana, Kentucky, Ohio and Tennessee.

Fauci and Birx have pointed to a critical metric: the percentage of positive test results. When that figure starts to tick upward, it is a sign of increasing community spread of the virus.

“That is kind of the predictor that if you don’t do something — namely, do something different — if you’re opening up at a certain pace, slow down, maybe even backtrack a little,” Fauci said in an interview Wednesday.

Without a vaccine, the primary tools for combating the spread of the virus remain the common-sense “non-pharmaceutical interventions,” including mask-wearing, hand-washing, staying out of bars and other confined spaces, maintaining social distancing of at least six feet and avoiding crowds, Fauci said.

“Seemingly simple maneuvers have been very effective in preventing or even turning around the kind of surges we’ve seen,” he said.

Thirty-three U.S. states have positivity rates above 5 percent. The World Health Organization has cited that percentage as a crucial benchmark for governments deciding whether to reopen their economy. Above 5 percent, stay closed. Below, open with caution.

Of states with positivity rates below 5 percent, nine have seen those rates rise during the last two weeks.

“You may not fully realize that when you think things are okay, you actually are seeing a subtle, insidious increase that is usually reflected in the percent of your tests that are positive,” Fauci said.

The shutdown blues

Some governors immediately took the White House warnings to heart. On Monday, Kentucky Gov. Andy Beshear (D) said at a news conference that he had met with Birx the previous day and was told he was getting the same warning Texas and Florida received “weeks before the worst of the worst happened.”

To prevent that outcome in his state, Beshear said, he was closing bars for two weeks and cutting seating in restaurants.

But as Beshear pleaded that “we all need to be singing from the same sheet of music,” discord and confusion prevailed.

Iowa Gov. Kim Reynolds (R) said Thursday she wasn’t convinced a mask mandate is effective: “No one knows particularly the best strategy.”

Earlier in the week, Tennessee Gov. Bill Lee (R) demurred on masks and bar closures even as he stood next to Birx and spoke to reporters.

“That’s not a plan for us now,” he said. He added emphatically, “We are not going to close the economy back down.”

The virus is spreading throughout his state, and not just in the big cities. Vacationers took the virus home from the honky-tonks of Nashville and blues clubs of Memphis to where they live in more rural areas, said John Graves, a professor at Vanderbilt University studying the pandemic.

“The geographical footprint of the virus has reached all corners of the state at this point,” Graves said.

In Missouri, Gov. Michael L. Parson (R) was dismissive of New York’s imposition of a quarantine on residents from his state as a sign of a worsening pandemic. “I’m not going to put much stock in what New York says — they’re a disaster,” he said at a news conference Monday.

Missouri has no mask mandate, leaving it to local officials to act — often in the face of hostility and threats. In the town of Branson, angry opponents testified Tuesday that there was no reason for a mask order when deaths in the county have been few and far between.

“It hasn’t hit us here yet, that’s what I’m scared of,” Branson Alderman Bill Skains said before voting with a majority in favor of the mandate. “It is coming, and it’s coming like a freight train.”

Democratic mayors in Missouri’s two biggest cities, Kansas City and St. Louis, said that with so many people needing jobs, they are reluctant to follow Birx’s recommendation to close bars.

“The whole-blanket approach to shut everybody down feels a little harsh for the people who are doing it right,” said Jacob Long, spokesman for St. Louis Mayor Lyda Krewson. “We’re trying to take care of some bad actors first.”

Minneapolis Mayor Jacob Frey also got a warning from Birx. On Wednesday, he said all bar drinking must move outside.

“We don’t want to be heading in the direction of everybody else,” said Kristen Ehresmann, director of the infectious-disease epidemiology division at the Minnesota Department of Health. She acknowledged that some options “are really pretty draconian.”

The problem is that less-painful measures have proven insufficient.

“The disease transmission we’re seeing is more than what would have been expected if people were following the guidance as it is laid out. It’s a reflection of the fact that they’re not,” she said.

‘A tremendous disappointment’

Wisconsin Gov. Tony Evers (D) tried to implement broad statewide measures early in the pandemic, only to have his “Safer at Home” order struck down by the state’s Supreme Court.

With cases in his state rising anew, he tried again Thursday, declaring a public health emergency and issuing a statewide mask mandate.

“While our local health departments have been doing a heck of a job responding to this pandemic in our communities, the fact of the matter is, this virus doesn’t care about any town, city or county boundary, and we need a statewide approach to get Wisconsin back on track,” Evers said.

Ryan Westergaard, Wisconsin’s chief medical officer, said he is dismayed by the failures of the national pandemic response.

“I really thought we had a chance to keep this suppressed,” Westergaard said. “The model is a good one: testing, tracing, isolation, supportive quarantine. Those things work. We saw this coming. We knew we had to build robust, flexible systems to do this in all of our communities. It feels like a tremendous disappointment that we weren’t able to build a system in time that could handle this.”

There is one benefit to the way the virus has spread so broadly, he noted: “We no longer have to keep track of people traveling to a hot spot if hot spots are everywhere.”

 

 

 

 

Cartoon – Our Coronavirus Strategic Imperative

Strategy Meetings Cartoons and Comics - funny pictures from ...

Cartoon – Lack of Strategy

Lack Of Strategy - Dilbert Comic Strip on 2019-10-11 : dilbert

Cartoon – Our National Coronavirus Strategy

Cartoon – What do you get when you combine cognitive bias with ...

July ends on an uncertain note in the pandemic battle

https://mailchi.mp/0fa09872586c/the-weekly-gist-july-31-2020?e=d1e747d2d8

Fighting a losing battle - post - Imgur

After a week that brought the most disastrous economic data in modern history, the death of a former Presidential candidate from COVID, and signs of an alarming surge in virus cases in the Midwest, Congress left Washington for the weekend without reaching a deal on a new recovery bill. That left millions of unemployed Americans without supplemental benefit payments, business owners wondering whether more financial assistance would be forthcoming, and hospitals facing the requirement to begin repaying billions of dollars of advance payments from Medicare.

Also remaining on the table was funding to bolster coronavirus testing, with the top health official in charge of the testing effort testifying on Friday that the system is not currently able to deliver COVID test results to patients in a timely manner. While the surge in cases appears to be shifting to the Midwest, there were early indications of positive news across the Sun Belt, as the daily new case count in Florida, Louisiana, Texas, Arizona and California continued to decline, while daily death counts (a lagging indicator) continued to hit new records.

Nationally, the daily case count appears to have reached a new plateau of around 65,000, with daily deaths rising to a 7-day average above 1,150, matching a level last seen in May.

Meanwhile, new clinical findings continued to refine our understanding of how the virus attacks its victims. Reporting in JAMA Cardiology, researchers used cardiac MRI to examine heart function among 100 coronavirus patients, 67 of whom recovered at home without hospitalization, finding that 78 percent demonstrated cardiac involvement and 60 percent had evidence of active heart muscle inflammation—concerning signs pointing to possible long-term complications, even in patients with relatively mild courses of COVID infection.

And yesterday in JAMA, investigators reported that while young children are typically less affected by COVID-19 than adults, children under 5 may harbor 100 times as much active virus in their nose and throat as infected adults. While the study does not confirm that kids spread the virus to adults, it is sure to raise concerns about reopening schools, which has generally been considered relatively safer for younger children.

US coronavirus update: 4.8M cases; 151K deaths; 52.9M tests conducted.