Before ‘Tidal Wave’ Of Illness, Nursing Home Thought It Had COVID-19 Contained

More than 20 patients have died. Dozens more are still hospitalized. And residents who had already been sent back to a nursing home in Gallatin, Tennessee, have turned up with new cases of COVID-19.

An investigation finds that the facility downplayed the outbreak to first responders on 911 calls in late March. But the nursing home administrator told WPLN News that the coronavirus was unstoppable in Tennessee’s largest outbreak yet.

Dawn Cochran, the administrator of the Gallatin Center for Rehabilitation and Healing, said department heads were summoned to a Saturday night meeting within 20 minutes of learning a staff member had tested positive for the coronavirus. And all employees were notified on March 21, a full week before a mass evacuation began.

But COVID-19 was not a concern expressed in multiple 911 calls made on behalf of patients being sent to the hospital with trouble breathing in the days following that staffer’s positive test, WPLN News learned through recordings obtained from an open-records request.

Nursing homes are quickly becoming the deadliest battleground in this pandemic, with more than 3,600 deaths, according to the Associated Press. Nearly every resident is in poor health already, and, even under normal circumstances, infection control is difficult with so many older adults living in tight quarters. Most states are tracking only overall death counts at nursing homes, not individual outbreaks, according to the AP, which is relying on state health departments and press accounts to keep tabs on the scope of the problem.

First Responders Not Informed Of Cases

As the Gallatin Center found residents needing more care than it could provide to help with breathing, it began to call 911 to transport patients to the hospital, recorded calls show.

“Do you know if she’s been in contact with someone who tested positive for the coronavirus?” the dispatcher asked on March 25.

“No,” the nurse responded, after a pause.

Staffers did not warn 911 dispatchers, who asked specific screening questions so first responders could take precautions and wear protective gear.

Another patient needed to go to the hospital the next day, March 26, after several employees had already tested positive and multiple patients were being tested.

“Do you know if she’s been around anybody who has traveled to the airport or on an airplane or been confirmed with coronavirus?”

“No,” the caller said, cutting off the question.

And on March 27, just hours before a mass evacuation would begin, another patient was short of breath and unconscious.

“Do you know if he’s been in contact with someone who tested positive for the coronavirus?” the dispatcher asked.

“We don’t know. We have no clue,” the caller said.

That weekend, every patient and staff member would be tested. Nearly 100 residents had positive tests along with 33 staff members, most of whom had no symptoms. As of Friday, the Gallatin Center outbreak remained the largest in Tennessee, with at least 20 of the state’s 142 deaths.

A Deadly Front In The War On Coronavirus

The guidance from federal regulators changes by the week, but the nursing home with the country’s first deadly outbreak, in Washington state, was faulted by regulators for not moving rapidly enough to identify and manage ill residents.

In Gallatin, federal surveyors told WPLN News they have completed their review but won’t release their list of deficiencies until later this month. Patient families expect flaws to be identified.

“I think a lot of it could have been prevented,” said Tammy Howell. Her mother lives at the Gallatin nursing home and spent three weeks at the nearby Sumner Regional Medical Center, which took nearly all the COVID-19-positive patients. She had to test negative twice before returning to the nursing home.

Howell and other family members said the nursing home dismissed ailments that turned out to be COVID-19.

“Don’t tell me that you’ve got a couple of cases and tell me my mom doesn’t, and she has some of the symptoms, just because you want to cover your butt,” she said.

Howell said the hospital gave her more information than the nursing home ever did.

The home has already been put on notice that some families intend to file lawsuits. They accuse the facility of making nurses work even though they weren’t feeling well and failing to make everyone wear masks and gloves.

Local officials have been displeased with the response, as well.

“We were being told at first that basically they had this situation under control,” Sumner County Mayor Anthony Holt said. “And it wasn’t under control. It was completely out of control.”

Holt said the nursing home continued to ignore the advice of local officials who wanted patients to stay in area hospitals longer. Those who tested negative had been transported to neighboring counties so Sumner Regional hospital could focus on the patients who tested positive for COVID-19.

After everyone was moved out of the nursing home and it was deep-cleaned, the nursing home started moving people back immediately — which was the plan, endorsed by state regulators, all along. But Sumner County emergency management chief Greg Miller doubted the Gallatin Center had enough nurses who hadn’t been exposed.

“We thought they were rushing the decision to move them back in,” he said. “We just weren’t getting many answers.”

In the following days, after supposedly negative residents were moved back to Gallatin Center, at least three more residents fell ill and were moved to the hospital. On those 911 calls, though, staffers were more direct with dispatchers.

“Have you obviously been in contact with anyone who has tested positive for the coronavirus?” one asked a caller from the nursing home on April 6.

“Oh yeah, everybody here has,” she said with a laugh. “I’m sorry. I just have to say that and laugh because that’s all I can do.”

‘You Cannot Stop It’

The nursing home’s administrator has also become more open about the experience. In an interview with WPLN News, Dawn Cochran acknowledged she was overrun, even though she didn’t think so at first.

“Once you get one sick patient, it’s a tidal wave. You cannot stop it,” she said in an April 7 interview.

Cochran said she was doing everything the Centers for Medicare & Medicaid Services recommended, often ahead of schedule, like screening employees for symptoms.

In recent years, though, CMS has cited the 200-bed Gallatin nursing home for deficiencies in infection control. They’re minor lapses — people sticking their hands in the community ice machine or poor management of bed linens. But they’ve resulted in below-average ratings.

New Jersey-based Care Rite Centers purchased the nursing home in 2016 and owns nine facilities in the Nashville area.

Cochran has a long career as a nursing home administrator but has been in the Gallatin facility only since early March. She said she could speak only for the time since she took over. As for the 911 calls without disclosing COVID-19 concerns, she said nurses were genuinely confused.

“What appears to be COVID-like symptoms wasn’t in two residents we had tested,” she said. “So we just don’t always know.”

Cochran said she has cooperated with state health officials from the beginning and saw them as a partner in planning the evacuation. Even as they await the federal findings, state officials have said they find the nursing home’s response to be “perfectly adequate.”

“I’m hoping everybody can learn from it,” Cochran said. “But at the same time, I don’t know what we could have done better at the time —  I don’t.”

At least 16 other Tennessee nursing homes also have multiple confirmed cases. Whether those get out of hand will shed light on whether an outbreak is truly inevitable.

This story is part of a partnership that includes WPLN, NPR and Kaiser Health News.

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Coronavirus Briefing: Leadership emerges, cancer care struggles, bobbleheads prevail

Top stories

 

  • 22 million Americans — about one in seven workers — have filed for unemployment benefits over the past four weeks. Some economists predict unemployment could reach Depression-era levels of 20% or more.
  • President Trump’s latest plan for reopening the economy would allow areas with “limited transmission, ample public health and health system capacity” to begin easing social distancing in May, but “hot spots” would have to wait until at least June. The White House plan is a suggested framework for phasing back to normal activity; specific action steps will continue to come from state governors.
  • Other countries are already venturing onto that tightrope. Like many of her European counterparts, German Chancellor Angela Merkel is easing some restrictions. Small shops would open in the next week and school would resume in May, but large public gatherings would be shut down until the end of August.
  • Around the world, countries will open and close on their own schedules. Japan just expanded its state of emergency to cover the entire nation. The measures, designed to reduce contact with others by 80%, is effective through May 6, the end of the Golden Week holidays.
  • More and better testing is needed before we can come out of the burrow. A positive step in that direction was approval of the first saliva test to detect coronavirus infection, put to use this week at a drive-through testing facility in New Jersey. Thousands of tests can be done each day, results take 24 to 48 hours, and the method does not require the personal protective equipment that’s needed to perform throat swabs.

The Takeaway:

We are headed for a thaw in the world of social distancing, but the timing is still iffy — dependent on the course of the virus itself, the availability of testing, and what we can hope are the well-informed judgments of government leaders.


Businesswoman on laptop at window in morning sun
Source: Getty

Taking the lead

Natural leadership has a way of emerging during a crisis of epic proportions.

  • Andrew Reid, strategy director at the London-based creative agency Shelton Fleming Associates summarizes “8 Rules for Being a Great Leader During a Lockdown” in Conference & Incentive Travel (C&IT).  1. People first. 2. Be honest. 3. Talk often. 4. Engage everyone in the future. 5. Stay sane. 6. Act fast. 7. Remain positive. 8. Keep in touch with any staff that may need to be furloughed.
  • In Medical Marketing & Media, John Cahill, Global CEO of the McCann Health, lists three abiding principles that can guide healthcare and pharma marketers in times of turmoil as well as normal times: responsibility, adaptability, and authenticity. Cahill notes that marketers have a unique opportunity to serve as a “beacon of information” at a time when customers are anxious and uncertain about the public health crisis.
  • More than 80 live events companies in the U.S. have come together in a coalition, called Live for Life, that is lending construction capabilities, logistics expertise, raw material inventories, and labor to build temporary hospital rooms, testing centers, and emergency treatment rooms. “We are highly organized, very familiar with operating at scale, and we know how to build the impossible quickly,” says Chris Meyer, CEO of George Johnson, one of the coalition’s founding members. “Most importantly, we want to help,” he tells C&IT.
  • According to People Management, CEOs at one in four of the biggest companies in the U.K. have taken a pay cut during the pandemic. Typical reduction in compensation was 20%, with one CEO taking a 35% cut and donating the other 65% to an employee fund.

The Takeaway:

No time like the crisis of a lifetime for leaders in all sectors to step up. Opportunities abound in a time for optimism rather than optics.


Old woman with Ventilator mask on Hospital bed
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Cancer in the time of coronavirus

Cancer patients are in double jeopardy these days. They are among the most vulnerable to COVID-19 infection. The pandemic is also posing obstacles to their getting the cancer treatments they need.

  • A powerful perspective in PR Week U.K. from a Stage 4 cancer patient describes the even more daunting survival odds he and others now face: “Scans and treatment are canceled for the foreseeable future. Relative risks are too high. .. I’m playing Health Russian Roulette… The stark reality is that should I fall seriously ill, I may not qualify for a ventilator.”
  • Guidelines to help mitigate the transmission of COVID-19 among cancer patients and the health professionals who care for them have been developed by the National Comprehensive Cancer network. As noted in Cancer Therapy Advisor, strategies for oncology practices include prescreening for COVID-19 symptoms and exposure history using telemedicine platforms, and having patients who come to the office seen in a separate unit by a separately dedicated staff.
  • Can patients who need surgery for thoracic cancers (such as cancers of the lung or esophagus) have the operation right away, or do they need to wait? Cancer Therapy Advisor also reports that a panel of experts has agreed on a plan for triaging these patients into three categories depending on the individual’s clinical condition and the intensity of COVID-19 activity in the area: 1. surgery as soon as possible, 2. surgery delayed for three months, and 3. use of alternate therapies.
  • The pandemic is also causing delays in treatment and surgery for blood-related cancers, according to Hematology Advisor.

The Takeaway:

Getting back to normal must include not only allowing workers to return to work and schoolkids to school and shoppers to shops, it also has to open up the health system once again so that people who have had to delay their care can get the attention they need.


Governor Cuomo And Mayor De Blasio Argue Over New York School Closures Until Fall
Source: Getty

Odds and ends

  • Is your car sitting a lot these days? U.K.’s Autocar offers a comprehensive checklist for auto maintenance through the lockdown, so that it won’t be rusting while it’s resting.
  • As of this week, about half of the 51 million kids in U.S. public schools will be staying home for the rest of the school year, affecting students in 26 of the 50 states. Seniors will be graduating with much less pomp and much more circumstance.
  • Bobblehead dolls of Drs. Anthony Fauci and Deborah Birx, medical mainstays on the White House coronavirus task force, are on presale at the National Bobblehead Hall of Fame and Museum (yes, there is such a place, in Milwaukee). Five dollars from each sale will be donated to the American Hospital Association’s Protect the Heroes Campaign. Delivery — delayed like so many other things these days — won’t take place until July.

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‘It’s Not Over Until It’s Over’: 5 Things To Know About Hitting The COVID-19 Peak

As New York, California and other states begin to see their numbers of new COVID-19 cases level off or even slip, it might appear as if we’re nearing the end of the pandemic.

President Donald Trump and some governors have pointed to the slowdown as an indication that the day has come for reopening the country. “Our experts say the curve has flattened and the peak in new cases is behind us,” Trump said Thursday in announcing the administration’s guidance to states about how to begin easing social distancing measures and stay-at-home orders.

But with the national toll of coronavirus deaths climbing each day and an ongoing scarcity of testing, health experts warn that the country is nowhere near “that day.” Indeed, a study released this week by Harvard scientists suggests that without an effective treatment or vaccine, social distancing measures may have to stay in place into 2022.

Kaiser Health News spoke to several disease detectives about what reaching the peak level of cases means and under what conditions people can go back to work and school without fear of getting infected. Here’s what they said.

It’s Hard To See The Peak

Health experts say not to expect a single peak day — when new cases reach their highest level — to determine when the tide has turned. As with any disease, the numbers need to decline for at least a week to discern any real trend. Some health experts say two weeks because that would give a better view of how widely the disease is still spreading. It typically takes people that long to show signs of infection after being exposed to the virus.

But getting a true reading of the number of cases of COVID-19, the disease caused by the coronavirus, is tricky because of the lack of testing in many places, particularly among people under age 65 and those without symptoms.

Another factor is that states and counties will hit peaks at different times based on how quickly they instituted stay-at-home orders or other social distancing rules.

“We are a story of multiple epidemics, and the experience in the Northeast is quite different than on the West Coast,” said Esther Chernak, director of the Center for Public Health Readiness and Communication at Drexel University in Philadelphia.

Also making it hard to determine the peak is the success in some areas of “flattening the curve” of new cases. The widespread efforts at social distancing were designed to help avoid a dramatic spike in the number of people contracting the virus. But that can result instead in a flat rate that may remain high for weeks.

“The flatter the curve, the harder to identify the peak,” said William Miller, a professor of epidemiology at Ohio State University.

The Peak Does Not Mean The Pandemic Is Nearly Over

Lowering the number of new cases is important, but it doesn’t mean the virus is disappearing. It suggests instead that social distancing has slowed the spread of the disease and elongated the course of the pandemic, said Pia MacDonald, an infectious disease expert at RTI International, a nonprofit research institute in North Carolina. The “flatten the curve” strategy was designed to help lessen the surge of patients so the health care system would have more time to build capacity, discover better treatments and eventually come up with a vaccine.

Getting past peak is important, Chernak said, but only if it leads to a relatively low number of new cases.

“This absolutely does not mean the pandemic is nearing an end,” MacDonald said. “Once you get past the peak, it’s not over until it’s over. It’s just the starting time for the rest of the response.”

What Comes Next Depends On Readiness

Although Trump said the nation has passed the peak of new cases, health experts cautioned that from a scientific perspective that won’t be clear until there is a consistent decline in the number of new cases — which is not true now nationally or in many large states.

“We are at the plateau of the curve in many states,” said Dr. Ricardo Izurieta, an infectious disease specialist at the University of South Florida. “We have to make sure we see a decline in cases before we can see a light at the end of the tunnel.”

Even after the peak, many people are susceptible.

“The only way to stop the spread of the disease is to reduce human contact,” Chernak said. “The good news is having people stay home is working, but it’s been brutal on people and on society and on the economy.”

Before allowing people to gather in groups, more testing needs to be done, people who are infected need to be quarantined, and their contacts must be tracked down and isolated for two weeks, she said, but added: “We don’t seem to have a national strategy to achieve this.”

“Before any public health interventions are relaxed, we better be ready to test every single person for COVID,” MacDonald said.

In addition, she said, city and county health departments lack staffing to contact people who have been near those who are infected to get them to isolate. The tools “needed to lift up the social distancing we do not have ready to go,” MacDonald said.

You’re Going To Need Masks A Long Time

Whether people can go back out to resume daily activities will depend on their individual risk of infection.

While some states say they will work together to determine how and when to ease social distancing standards to restart the economy, Chernak said a more national plan will be needed, especially given Americans’ desire to travel within the country.

“Without aggressive testing and contact tracing, people will still be at risk when going out,” she said. Social gatherings will be limited to a few people, and wearing masks in public will likely remain necessary.

She said major changes will be necessary in nursing home operations to reduce the spread of disease because the elderly are at the highest risk of complications from COVID-19.

Miller said it’s likely another surge of COVID-19 cases could occur after social distancing measures are loosened.

“How big that will be depends on how long you wait from a public health perspective [to relax preventative measures]. The longer you wait is better, but the economy is worse off.”

The experts pointed to the 1918 pandemic of flu, which infected a quarter of the world’s population and killed 50 million people. Months after the first surge, there were several spikes in cases, with the second surge being the deadliest.

“If we pull off the public health measures too early, the virus is still circulating and can infect more people,” said Dr. Howard Markel, professor of the history of medicine at the University of Michigan. “We want that circulation to be among as few people as possible. So when new cases do erupt, the public health departments can test and isolate people.”

The Harvard researchers, in their article this week in the journal Science, said their model suggested that a resurgence of the virus “could occur as late as 2025 even after a prolonged period of apparent elimination.”

Will School Bells Ring In The Fall?

Experts say there is no one-size-fits-all approach to when office buildings can reopen, schools can restart and large public gatherings can resume.

The decision on whether to send youngsters back to school is key. While children have been hospitalized or killed by the virus much less frequently than adults, they are not immune. They may be carriers who can infect their parents. There are also questions of whether older teachers will be at increased risk being around dozens of students each day, MacDonald said.

Another factor: The virus is likely to re-erupt next winter, similar to what happens with the flu, said Jerne Shapiro, a lecturer in the University of Florida Department of Epidemiology.

Without a vaccine, people’s risk doesn’t change, she said.

“Someone who is susceptible now is susceptible in the future,” Shapiro said.

Experts doubt large festivals, concerts and baseball games will happen in the months ahead. California Gov. Gavin Newsom endorsed that view Tuesday, telling reporters that large-scale events are “not in the cards.”

“It’s safe to say it will be a long time until we see mass gatherings,” MacDonald said.
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A Colorado Ski Community Planned To Test Everyone For COVID-19. Here’s What Happened.

In late March, residents of the Colorado town of Telluride and surrounding San Miguel County stood in line, along marked spots spaced 6 feet apart, to have their blood drawn by medical technicians wearing Tyvek suits, face shields and gloves for a new COVID-19 test.

While the Centers for Disease Control and Prevention’s tests for the virus that causes the respiratory illness have been in short supply since the outbreak began, this was a new type of test. It wasn’t to see who was sick right now. It was an antibody test that would assess who had been exposed and how widespread the virus was in the community to inform decisions about managing the outbreak.

When part-time Telluride residents and United Biomedical Inc. co-CEOs Mei Mei Hu and Lou Reese had offered to provide their company’s newly developed COVID-19 antibody tests for free to not just Telluride, but all of San Miguel County too, more than 6,000 of the county’s estimated 8,000 residents jumped at the chance.

“People really want to be part of it,” said Donna Fernald, a home health nurse who was tested the first day.

The widespread testing was an experiment in this community best known for its tony ski resort and summer music festivals. But it also served as a model for what, perhaps, could be possible everywhere to guard against the spread of the disease.

“This was a gift and an opportunity,” said San Miguel County spokesperson Susan Lilly.

That was the original plan, anyway. But on Tuesday, the grand experiment with bold aspirations appeared to fall apart. Lilly put out a statement announcing that testing was being “delayed indefinitely due to United Biomedical Inc.’s reduced ability to process the tests due to the COVID-19 pandemic.” Lilly declined to comment on the decision.

The test that Hu and Reese’s company had promoted as “fast — results in two hours” had slowed to a virtual halt. The company had initially told the county to expect results within 48 to 72 hours after the samples arrived at the company’s New York lab. Results from tests conducted March 26 and 27 were announced April 1, but results from subsequent tests have still not come in.

A San Miguel County Department of Public Health and Environment press release quoted a company statement that blamed the delay on operations and the majority of staff being located in New York, where the pandemic has hit especially hard. The press release issued Tuesday said the company is aiming to resume processing the estimated 4,000 outstanding tests from the first round of testing.

But with only a fraction of the results in so far, and additional testing in question, the COVAXX testing appears to be yet another example of the chaotic response to the coronavirus crisis gone wrong.

A Different Kind Of Test

The test that Hu and Reese donated to the Telluride community is an antibody test developed by COVAXX, a newly formed subsidiary of their New York-based United Biomedical. It’s one of more than 30 commercially available tests without Food and Drug Administration approval under flexible rules adopted to address the COVID-19 pandemic. So far only one antibody test has received official FDA approval — a test made by Cellex, which uses just a pinprick of blood and produces results in about 15 minutes.

Antibody tests are fundamentally different than the CDC swab tests currently used to make official diagnoses. Where the swab test looks for the virus’s genetic material to determine active infections, an antibody test looks for antibodies in a person’s blood that show an immune response to the virus that causes COVID-19. Robert Garry, a virologist at Tulane University School of Medicine, said the test can’t tell whether the person is currently sick or infectious.

The plan in Telluride was for participants to be tested twice, two weeks apart, with the COVAXX test because it can take a while for someone infected to show up as positive when measuring antibodies.

The COVAXX website claims its test has 100% sensitivity (that’s the test’s ability to find antibodies to the virus) and 100% specificity (a measure of how good the test is at differentiating this novel coronavirus’ antibodies from other antibodies).

But, Garry said, no test is perfect. And creating an antibody test for the virus being called SARS-CoV-2 is “tricky,” he said, because it needs to distinguish among several seasonal coronaviruses. Furthermore, he added, the COVAXX test is a peptide assay, which he said typically is not very sensitive.

“We know 100% is an almost impossible bar to reach,” Garry said. “It kind of raises some red flags.”

In an interview with KHN before the Telluride program stopped, Hu said that “I always hesitate when I say 100%,” but she said that the company validated the test against 900 samples collected before the COVID-19 outbreak, with no false positives. She added the test also correctly produced positive results from blood samples that have been verified as positive through other tests.

Theoretically, having antibodies to SARS-CoV-2 could make a person immune to the virus, but how robust this immunity is and how long it might last remain open questions. The big promise behind testing a whole community is that if one can identify people who have been infected and recovered (or never gotten sick in the first place), one can safely send them back to work or out in the community, Reese said.

“It’s absolutely my goal to make this standard for how we get the country back to a new normal,” Reese had said before the test was suspended. “If we tested everyone in the whole country and were prepared to do it twice, you would know exactly when you would be back at functioning — everybody back at work.”

Reese isn’t alone in his excitement. Hedge fund billionaire Bill Ackman invested an undisclosed amount of capital into COVAXX through his Pershing Square Foundation, and bestselling author and XPrize founder Dr. Peter Diamandis is listed as part of the COVAXX leadership team on the company’s website. Diamandis presents a fawning interview with Hu and Reese in a widely shared YouTube video, which does not disclose his relationship with the company. Neither responded to requests for comment.

Testing Results

In all, about 6,000 of San Miguel residents were tested at three locations across the county, which covers about 1,300 square miles. As of Monday, only 1,631 of the tests had been processed, with eight (0.5%) of them deemed positive, 25 (1.5%) “borderline” and 1,598 (98%) negative. Borderline results indicate the person may be in the early stages of producing antibodies, Lilly said.

Yet the single tests alone can’t provide a clear picture of how many people have been exposed.

As of Thursday, a total of 11 cases in San Miguel County had been identified with standard swab tests. Officials continue to recommend that all residents practice social distancing and that those experiencing symptoms practice further isolation to prevent the potential spread of COVID-19.

One way to look at this attempt at large-scale testing is that “everybody’s getting together and trying to do something cooperative and innovative,” said George Annas, director of the center for health law, ethics and human rights at Boston University School of Public Health.

“If you wanted to be cruel, you could say this is a publicity stunt,” Annas said.

The program certainly won COVAXX a lot of good publicity, along with gratitude from local residents — at least initially.

And a resort town in Wyoming is following suit. John Goettler, president of St. John’s Health Foundation in Jackson, said his organization is spending “less than $20,000” on COVAXX tests for about 500 health professionals and first responders. Goettler said Jackson resident Dakin Sloss, a hedge fund owner listed as another member of COVAXX’s leadership team, helped secure the tests. Testing is set to begin next week, and the test will be processed at a local lab, rather than in New York.

But in Ouray County, adjacent to San Miguel County, officials decided against such testing even before the Telluride suspension.

The cost “would shoot a hole in my budget for at least the next two years,” said Ouray County public health director Tanner Kingery.

But that wasn’t the only concern, Kingery said. It would have required a large supply of precious masks and other personal protective equipment, he said, while potentially exposing health care workers and community members to the virus.

Dr. Andrew Yeowell, an emergency room physician and Ouray County EMS medical director, also was concerned that negative tests might give people a false sense of security. If people with negative tests felt emboldened to go out in the community and interact with others, he said, it could undermine the county’s advisory to stay home.

“If you’re having symptoms or feel sick, stay home,” Kingery added. “That guidance doesn’t really change if you have a positive test.”
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Millennial Zeitgeist: Attitudes About COVID-19 Shift As Cases Among Young Adults Rise

When Laura Mae, 27, first heard about the coronavirus, it didn’t seem like a big deal.

“I’m in college, and school was still going on. It didn’t really sink in,” she said. “And once it did start spreading, I thought, if I did get it, I’m young and healthy, I’ll be fine. I don’t need to worry.”

It was Saturday, March 14, and concerns about the coronavirus were amping up around the nation, said Laura Mae, who lives in Milwaukee. (Kaiser Health News is using Laura Mae’s first and middle names to grant her request for partial anonymity due to concern about online harassment.)

She realized it might be the last weekend to go out before everything shut down. Plus, her spring break had just started. So she and a friend decided to party that night.

And she wasn’t the only one.

As college and university spring breaks across the country converged that weekend, news coverage showed young people frolicking on Miami beaches, walking down Bourbon Street in New Orleans and crowding music clubs in Nashville, Tennessee. And to celebrate St. Patrick’s Day, many cities, such as New York, Washington, Chicago and Austin, Texas, saw throngs of people dressed in green and lining up for beer. There wasn’t a lot of social distance to be seen.

Part of the reason these young adults might have felt comfortable going to spots with large crowds was that media reports, buttressed by data from China’s outbreak, indicated younger people were not as susceptible to the coronavirus as older age groups or people with underlying conditions. But, that hasn’t held true. Now, in several major American cities, young adults between 18 and 40 account for some of the largest shares among groups testing positive.

As of Thursday, in New York City, 39% of cases were among those ages 18 to 44. Out of Los Angeles County’s 7,194 confirmed cases, 2,409, or 33%, were in the 18-40 age range. Nearly half of those testing positive in Travis County, Texas, which encompasses much of the Austin metro area, were between 20 and 39. Washington, D.C., the nation’s capital, released numbers Wednesday showing that 40% of the district’s cases were ages 19-40.

Dissecting The Numbers

Epidemiologists say that these high percentages of young adults testing positive for the coronavirus don’t necessarily mean that a disproportionate number of young people are becoming infected. What the numbers show is that people in this demographic are just as susceptible to COVID-19 as other age groups.

“Young people are equally at risk of becoming infected and spreading [the coronavirus] to others who then become infected,” said Denis Nash, a professor of epidemiology at The City University of New York School of Public Health.

The percentages of coronavirus cases appear high partly because health departments are reporting based on age groups that cover wide spans of years, he added.

New York City, for example, has 3.5 million people in the 18-44 age range, Nash said, and 700,000 people in the 65-74 age range. Since the “young” age group constitutes a large segment of the city’s population, it is logical that the numbers of those testing positive for COVID-19 are high. In other words, the numbers make sense once a calibration for population size is done.

“This just means everybody in every age group has the same rate of infection,” said Adolfo García-Sastre, director of Mount Sinai’s Global Health and Emerging Pathogens Institute in New York.

But fewer 20- and 30-somethings are likely being diagnosed, García-Sastre said, since most of them have milder symptoms compared with older patients and can often recover at home. New York health care providers have been limiting coronavirus testing to individuals who are experiencing the most severe symptoms and need hospitalization.

The more important statistics to consider, Nash said, are whether young people are being hospitalized or dying from COVID-19. And those numbers are much less stark.

He calculated the case fatality rate (with data up to March 23) in New York City by dividing the number of COVID-19 deaths by the hospital admission numbers. He found that 1.8% of deaths were among people 18-44. By comparison, 3.9% of deaths were among people 45-64, 9.5% were 65-74, and 16.3% were 75 and older.

A March 18 CDC report showed a similar trend. While 29% of coronavirus cases were among those ages 20-44, the percentages of ICU admissions were lowest in this age category. In addition, the percentages of people who died from COVID-19 increased with age.

‘It Was A Complete Shock’

Young adults are now coming to terms with that new reality — driven in part by statistics that show they are not safe from the coronavirus. News reports, such as that of a 25-year-old dying from COVID-19 or the announcement by Texas public health officials that 44 college students tested positive for the illness after returning from a group spring break trip to Mexico, drove home the point that they, too, were at risk.

A couple of days after her Saturday night out, Laura Mae started to feel sick. First, she had a sore throat. Then she developed a fever and chills and was short of breath and constantly tired ― all reported symptoms of COVID-19. She called a local coronavirus hotline and a nurse told her she was presumptive positive, which meant it would be assumed she had the coronavirus but wouldn’t be tested for it.

“It was a complete shock,” said Laura Mae. “I didn’t realize that someone like me, a healthy 27-year-old who has no immune issues, could get so sick.”

While she’s now mostly back to normal, she said her experience changed her perspective — especially when she thinks about the people she might have unknowingly exposed in the days before her symptoms appeared.

“You might be young and healthy and be able to fight this off on your own, but there are people who could end up hospitalized, and it’s not a joke,” she said. “I was laughing at all the memes and the jokes [about the coronavirus], and now I’m not. It’s real.”

Ishaan Shah, a political science major and 22-year-old senior at Washington University in St. Louis, said some of his classmates had similar reactions, staying relatively carefree despite the public health warnings. Then, the university shut down in the middle of its spring break ― giving students only a few days to gather their belongings from the dorms before the campus was shuttered.

Once that happened, Shah said, “we knew what was up. That made it immediately serious.”

And as he hears more about the coronavirus, his concerns amplify. “Every day that goes by, I personally have become more scared of this virus,” he said.

This change in perspective seemed to happen fast in hot spots like New York City, where the virus exploded with a shockingly high daily death rate and case counts. People there now say that almost everyone — whether crossing paths on the street or in line at the grocery ― is presumed positive.

Indeed, a tracking poll released last week found that most of the nation has adjusted its behavior to slow the spread of the coronavirus. Eighty-two percent of respondents reported they are sheltering in place and nearly everyone (92%) now reports some kind of social distancing — up from 59% two weeks ago, according to the poll from the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)

But there are those who had factored this new reality into their daily habits almost from the beginning.

Take Megan Bohley, a 30-year-old behavioral health nurse who works in an outpatient facility in Flint, Michigan, interacting with patients all day.

When she gets home from work, she drops everything by the door, washes her hands, changes out of her work clothes and then dons a pair of rubber gloves and Clorox wipes to clean off her belongings. She also has talked to her husband about offering to help at a nearby hospital if Flint’s circumstances worsen.

But she’s scared, knowing that nurses and doctors are getting exposed and falling ill. “Some are dying,” Bohley said. “It does make me more nervous about what I do.”
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Government, researchers and big tech team up for digital COVID-19 tools

Remember all those times Facebook asked to know your location? Or when you searched for “flu symptoms” and filled out an online symptom checker? These same tech tools are now being used to inform, track and even predict the coronavirus pandemic.

All of the large tech companies are working on some kind of COVID-19 effort. Some companies have partnered with government agencies and some with university researchers. Each project has a slightly different goal, with some hoping to track and predict where the virus will be and others meant to educate and keep people informed.

Apple

The Centers for Disease Control and Prevention (CDC) teamed up with Apple to create a COVID-19 symptom checker app. The app, available on the App Store or online, screens people online who are concerned about symptoms.

It asks about current symptoms, pre-existing conditions, contact with people who have been exposed and more to give users information about what steps to take. If, for instance, you answer the questions saying that you have no symptoms or exposure, but live in an area where the virus is widespread, the app suggests you practice social distancing and provides tips like what symptoms to watch for. Each result also states plainly whether a user needs a test for COVID-19.

For people who may have been exposed or are experiencing symptoms like COVID-19, the app directs them to self-isolate and monitor for symptoms or contact their doctor if they have pre-existing conditions.

The app is meant to keep people informed about the virus and help them decide what steps to take depending on their health or exposure.

Facebook

This week, Facebook began surveying users about COVID-19 symptoms for a research project with Carnegie Mellon University. Researchers will compile the survey data along with Facebook location data to create heat maps of self-reported symptoms.

The research may also help health systems prepare for outbreaks and potentially forecast where outbreaks may happen next. The research group at Carnegie Mellon working on this project, the Delphi Research Center, focuses on epidemiology forecasting and conducts flu forecasting every year.

Facebook is also sharing location data with partners in 40 countries to track how the virus is spreading and whether stay-home orders are working.

Verily

Alphabet’s health company Verily received a durge of attention in late March for its COVID-19 online screening tool. The tool is similar to Apple’s symptom checker app, but goes further to connect users directly with testing centers.

In late March, President Donald Trump called out Verily’s project, which was still in its early launch phase and only available to residents of two California counties. The surge of interest crashed the screening tool.

But the tool has since expanded. It is now available in more locations (still only in California) and has implemented automated scheduling for users to set up drive-thru COVID-19 tests.

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