April 22 coronavirus news
As several states make plans for reopening their communities during the coronavirus pandemic, a group of top public health experts cautioned Tuesday against reopening society before testing capacity expands significantly.
Different parts of the country are in different stages of the epidemic, with New York well into the first wave and other places just beginning to see the impact of the disease. This matters, said Dr. Caroline Buckee, Harvard associate professor of epidemiology and the associate director of the university’s Center for Communicable Disease Dynamics.
Knowing the location of the virus is key to relaxing social distancing and returning to normalcy, Buckee told a symposium sponsored by Harvard’s T.H. Chan School of Public Health and the New England Journal of Medicine.
The lack of testing capacity is a big problem because the disease has “a very broad clinical spread,” Buckee said. So even when people show up at the hospital and get tested there are many more cases in the community, including mild and asymptomatic cases. “And those are the people that are spreading the disease,” she said.
It’s important to learn whether people who have recovered can still spread the disease, noted NEJM editor Dr. Eric Rubin.
“What we really need is some epidemiological data to tell us, 'Are people who have left the hospital going on to transmit the disease?'” Rubin said. “That’s kind of the shoe leather epidemiology, contact tracing, following what happens to the context of those patients, which takes some manpower.
Buckee added that without knowing the answers, the nation could reopen too soon and risk a deadly second pandemic wave.
“Right now, we don’t have good estimates for where we are on the epidemic curve in different places. So, discussions of relaxation of physical distance, which do seem to be having an effect, curbing some of the worst impacts of the outbreak, need to be based on the capacity to test people so we know where we are,” she said.
The novel coronavirus lingers for as long as three weeks in the bodies of patients with severe disease, Chinese researchers reported Tuesday.
The virus can be found deep in the lungs and in the stool of patients, and the sicker they are, the longer it stays, the team at a hospital in China’s Zhejiang province reported. But the virus was found in the urine of patients less than half the time, and rarely in the blood at first.
Their report provides another piece of evidence about the pattern of disease in Covid-19 patients. It was published in the BMJ. Unlike many recently released studies about the coronavirus, this one has gone through peer review, which means other experts have reviewed the findings.
The team tested 96 patients treated in their hospital for Covid-19 between January and March. They tested samples from the nose and throat, from deeper in the respiratory system, in the blood, stool and urine. They wanted to see how long people had virus in their systems and whether it was likely to spread in various ways. The findings support other studies showing that the virus could spread in stool from infected people.
In general, the sicker people were, the longer the virus could be detected. That could be important for doctors to know, so they can predict which patients will fare better, and, perhaps, how long they may remain infectious to others.
“The median duration of virus in respiratory samples was 18 days,” they wrote.
More on this: An earlier Chinese study showed that people without symptoms had just as much virus in their noses as people who had Covid-19 symptoms -- something that indicated people who are not sick could be just as likely to spread virus as people who are.
The team in Zhejiang found that sicker people had more virus deeper in their respiratory tracts, however.
They also found differences between men and women with Covid-19. “In this study, we found that the duration of virus was significantly longer in men than in women,” they wrote.
“Our results shed light on the causes of disease severity in men in terms of the duration of the virus. In addition to differences in immune status between men and women, it has also been reported to be related to differences in hormone levels,” the team wrote.
Italian Prime Minister Giuseppe Conte outlined a five-point plan for managing the coronavirus epidemic on Tuesday.
Addressing Italy's house of representatives, Conte said that the plan will focus on:
- Continued social distancing with use of masks and gloves until a vaccine or a therapy is available.
- Reinforcing the health care system, and paying special attention to care homes to "avoid another out-of-control explosion of contagion."
- Creating special Covid-19 hospitals designated to cater exclusively to coronavirus patients.
- Conducting antibody testing in a large study to determine the spread of the virus among the population. Conte said 300,000 serological tests have been requested.
- Contact tracing. Last week the government officially chose a contract tracing app, called Immuni, which is in the testing phase, but the choice to download it will be voluntary, Conte said.
The number of patients admitted to intensive care in France has declined for the 13th consecutive day, Jerome Salomon, the director of France's health agency, announced on Tuesday.
Salomon, speaking at his daily news conference in Paris, gave an overview of where things stand now:
- There have so far been at least 117,324 confirmed coronavirus cases in France, including deaths and recoveries.
- At least 30,106 patients are currently hospitalized.
- At least 5,433 patients are in intensive care units.
The Netherlands will extend its lockdown for most businesses until May 20 and ban large events until September 1, Dutch Prime Minister Mark Rutte said during a news conference on Tuesday.
“As much as I understand that impatience is creeping in, we know that a rapid easing could lead to the virus immediately getting the chance to peak again,” Rutte said.
The uncertainty is still “too large” for businesses that require close contact, like barbers and nail salons, he said.
Primary students will begin attending school in a staggered fashion starting May 11.
“Children in primary education will, to start with, go to school half of the time,” he said. “For example, one half of the students will go one day and the other half will go the other day.”
He said that social distancing for these students is “not realistic,” but that all evidence indicates that their Covid-19 risk is much lower.
Some other primary education institutions like nurseries and special education will be able to open to students full time.