Coronavirus roundup: Experts say peak coming soon; general public should wear face coverings; Marin testing capacity increases

April 8, 2020

APRIL 6 — The number of Marin residents infected with the coronavirus climbed past 100 last week, just days before the global count surpassed 1 million and as the U.S. saw more than 1,000 deaths in a single day — the most for any nation since the pandemic began and a daily figure that may triple by late next week.

 

With new evidence suggesting as many as a quarter to half of all those infected with COVID-19, the disease caused by coronavirus SARS-CoV-2, have no symptoms of the illness, the Marin Department of Health and Human Services and the U.S. Centers for Disease Control on April 3 issued new guidelines recommending everyone — not just health workers and the sick — wear face coverings when leaving home for essential travel.

 

But public-health experts warn the worst is yet to come, with new models showing as many as a quarter million Americans may die, with a peak of more than 3,000 in a day coming potentially coming late next week.

 

“The next two weeks are extraordinarily important,” White House Coronavirus Task Force coordinator Dr. Deborah Birx said at an April 4 press conference. “This is the moment to not be going to the grocery store, not going to the pharmacy, but doing everything you can to keep your family and your friends safe.”

 

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  • Marin: 141 confirmed cases, seven deaths, per the Marin Department of Health and Human Services as of 4:30 p.m. April 5. Up from 93 cases, 1 death the previous week.

  • California: 14,336 confirmed cases, 343 deaths, per the California Department of Public Health as of 2 p.m. April 5. Up from 5,763 cases, 135 deaths the previous week.

  • U.S.: 330,891 cases, 8,910 deaths, per the U.S. Centers for Disease Control and Prevention as of 4 p.m. April 6. Up from 140,904 cases and 2,405 deaths the previous week.

  • World: 1,210,956 cases and 67,594 deaths, per the World Health Organization as of 1 a.m. April 6. Up from 693,224 cases and 33,106 deaths the previous week.

 

Public health officials: Wear a mask

 

Public-health officials are now recommending the use of face coverings when leaving home for essential travel to stem the spread of the coronavirus. The announcement by Marin early April 3 aligned with new guidance issued by the California Department of Public Health and anticipated the updated recommendations issued by the CDC later that day.

 

Public-health officials say masks should cover the nose and mouth to help filter droplets from coughs and sneezes. Home-sewn fabric masks, bandanas and neck gaiters are among the recommended solutions as they can be washed and worn again. Officials explicitly advise against purchasing medical-grade surgical masks and N95 respirators, as they remain in short supply globally for health-care workers.

 

Those who already own surgical masks and N95 respirators — which are intended to be disposed of after limited use — should wear cloth face coverings over those masks and respirators to extend their life.

 

State experts still assert the “best community and individual defense against COVID-19 is washing our hands frequently, avoiding touching our eyes, nose and mouth with unwashed hands, avoiding being around sick people and physical distancing, especially by staying at home.”

 

CDC Director Dr. Robert Redfield said last week that research shows the virus is about three times as infectious as the flu and that as many as 25 percent of those infected are asymptomatic or pre-symptomatic yet highly contagious. In Iceland, DeCODE, a subsidiary of U.S.-based biotech Amgen, found that roughly 50 percent of 9,000 people who tested positive in their lab tests there were asymptomatic at the time they were surveyed.

 

Further, Dr. Harvey Fineberg, chair of the National Academy of Sciences’ infectious-diseases committee, told the White House last week current research supports the possibility that the coronavirus can be aerosolized in exhalation — meaning the virus could be spread through simple talking and breathing and not just in droplets from coughs and sneezes.

 

As potential evidence, health officials point to a super-spreading event in Washington state — a 2½-hour choir practice March 10 in which hand sanitizer was set out and no one showed symptoms, hugged, shook hands or shared sheet music — that left 45 of the 60 participants infected, with two later dying. A small study published in the New England Journal of Medicine on March 17 suggested the virus can linger suspended in the air for up to three hours, though concentrations rapidly dissipate, particularly in outdoor environments.

 

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Coverings, therefore, should supplement and not replace physical-distancing practices and proper hygiene, as cloth face coverings and surgical masks can help protect against droplets but have limited effect on aerosolized virus that can penetrate fabric and gauze. 

 

A peer-reviewed 2008 study has shown homemade masks are about half as effective for aerosol protection as surgical masks and up to 50 times less effective than N95 respirators, which are designed to filter the virus, while a 2013 study showed homemade masks were about half as effective as surgical masks for blocking droplets in a cough test and a third as effective for bacterial filtration.

 

In addition to physical distancing of at least 6 feet, the importance of hand-washing increases with mask wear due to the possibility of cross contamination and contact transmission, as all masks — cloth, surgical and N95s — should be considered contaminated with every use. 

 

Residents should wash their hands before applying the covering, not touch it for the duration of wear, then wash hands again before and after removal. Used coverings should ideally be washed after each use or at least daily — stored in a bag or bin until they can be laundered with detergent in hot water on a hot dry cycle.

 

The CDC and World Health Organization have not previously recommended mask-wearing for healthy individuals, in part due to supply shortages for commercial masks and respirators, the potential for cross-contamination, the likelihood of improper fitment and the potential false sense of security that could lead wearers to relax distancing and hygiene measures — or, more simply, that distancing and hygiene are more effective than masks alone, which still aligns with the new local, state and federal face-covering guidelines. 

 

WHO continues to recommend masks only for health-care professionals, those who are sick and those who care for or share a household with the sick.

 

To see a video of U.S. Surgeon General Dr. Jerome Adams making easy do-it-yourself face coverings, visit arkn.ws/CDCeasycovering.

 

Marin officials encourage increased testing

 

The county reported a numerical spike in the number of residents tested between April 1 and 2 — to 1,250 from 774 — with officials emphasizing the sudden increase was due to commercial lab data being entered into regional systems. 

 

The updated figure represented cumulative data for local test sites, hospitals and outside labs since testing began rather than a single-day increase. As of April 4, 1,435 Marin patients had been tested.

 

“We’re excited by the increase because it … confirms an increasing capacity for testing,” officials said in a press release.

 

Local officials say the increase was the direct result of a unified demand by Bay Area counties of labs to provide more comprehensive testing data, however a massive backlog in test processing statewide was being cleared at the same time. 

 

On March 31, the state’s Department of Public Health reported that of more than 86,000 tests performed, the results of 57,400 were still pending, meaning that two of every three people tested — since testing began in California — didn’t have their results back. But by April 3, of 126,700 tests conducted, just 13,000 were still pending.

 

Dr. Lisa Santora, the county’s deputy public-health official, has said the county is working under the notion that as many as 1 percent of residents, or nearly 3,000 people, are already infected but undiagnosed, as only those with moderate and severe symptoms had been approved for tests due to limited capacity. Those with mild or no symptoms remain undiagnosed but highly contagious.

 

“With more testing available, we are encouraging residents with mild symptoms of respiratory illness to consult their health-care provider and determine if they should be tested for COVID-19,” she said last week in a video statement. “Research is showing that people with mild cases may be fueling this epidemic. People may be most infections during the first days of developing symptoms.”

 

Child-care program helps essential workers

 

Marin officials announced April 1 the creation of the Marin County Emergency PopUp Childcare program to support health-care workers, first responders and other essential workers while classroom instruction is suspended.

 

The county is working with the Marin Office of Education, Marin Free Library, city of San Rafael, North Bay Children’s Center, Community Action Marin, North Bay Community Services and Marin YMCA.

 

Fees for infants, toddlers and preschool programs are $1,554 per month. Fees for transitional kindergarten through grade 5 are $24 per day with a minimum of three days per week. Parents are only charged for hours outside the school day, 7-8 a.m. or 3-7 p.m. Tuition assistance is available.

 

There are no fees for grades 6-12.

 

For more information, see the Google document via arkn.ws/popupchildcare.

 

Separately, Gov. Gavin Newsom on April 4 signed an executive order that waives certain eligibility requirements for state-subsidized child care and for children’s meal programs, an effort to further assist front-line health-care workers and first-responders.  

 

County launches rent-assistance program

 

On March 31, Marin launched the Emergency Rental Assistance Program for those who are at risk of homelessness and need rental assistance to prevent eviction due to loss of income. 

 

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While the state and county have a moratorium on evictions through May 31, residents who cannot currently pay their rent are still required to eventually repay it.

 

The program, in which the county has partnered with Community Action Marin, the St. Vincent de Paul Society of Marin, Ritter Center, Adopt a Family of Marin and North Marin Community Services, will issue checks to eligible families.

Priority is given to residents who earn less than 30 percent the area median income, and residents apply with proof of income, proof of loss of income due to the coronavirus pandemic and proof that savings or investments cannot sustain housing requirements.

 

For more information on the county program, visit housingfirst.marinhhs.org.

 

Other developments

  • Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said March 31 that models used by the White House Coronavirus Task Force indicate 100,000-240,000 Americans will die from COVID-19, even with physical-distancing protocols in place. That figure compares with the model’s estimate that up to 2.2 million people would die without social interventions like shelter-in-place orders, closing schools, banning large gatherings and limiting travel. It was the first time Fauci and Birx, the response coordinator and an immunologist who served as the global AIDS coordinator at the U.S. Department of State, elected to publicly speculate on a potential death toll. A separate Institute for Health Metrics and Evaluation model referenced by Fauci and Birx indicates the daily U.S. death toll is expected to peak by April 16 at more than 3,100 people in a single day. President Donald Trump said the data influenced his decision to extend the national guidelines through April 30, when he previously had sought to end the guidelines to restart the economy by Easter, April 12. Fauci has said that while he doesn’t want to delve into the politics of states’ rights, he believes the entire nation should be on a shelter-in-place order — and that relaxing social distancing shouldn’t occur until “it goes down to essentially no new cases, no deaths.” That could be more than a year away, as “the ultimate game changer in this will be a vaccine,” he said.

  • Media outlets reported widely that global infections had surpassed 1 million people and that the U.S. had suffered 1,000 deaths in a day on April 1, numbers provided by Johns Hopkins University’s Coronavirus Resource Center, which draws from multiple agencies including the WHO, CDC, European and Chinese government health organizations — as well as other aggregation sites, including online forums and local media reports. WHO’s official daily situation report, however, didn’t indicate both milestones were reached until April 3. 

  • The U.S. Food and Drug Administration on April 2 approved the first test for coronavirus antibodies, which can show whether a patient has ever been exposed to the virus. Tests used to date could only detect fragments of the virus’s DNA to indicate an ongoing infection. Knowing whether a person has been exposed and recovered — and therefore likely developed an immunity to re-infection — can help scientists determine how widespread the virus is in a community and can better pinpoint true mortality rates. While immunity isn’t guaranteed, and scientists still aren’t certain how long it lasts, antibody detection can also help determine who can more safely return to the workforce. While the test, made by Cellex, is the first approved by the FDA, it’s not the only one on the market. Last month the FDA relaxed its regulations to make it easier for companies to sell such antibody tests, even without federal review, validation or approval. The CEO of the Association of Public Health Laboratories said last week the U.S. market is being flooded with “crappy” tests that can produce false results and dangerously provide a false sense of security that someone is immune.

  • California has partnered with Google to provide Chromebooks and 100,000 donated mobile hotspots to provide free, unlimited high-speed Internet for the rest of the school year.

  • The state has launched a hotline, at 833-544-2374, to connect older residents with essential services like food and medication.

  • The state has launched the website covid19supplies.ca.gov to allow individuals and companies to donate, sell or offer to manufacture 13 essential medical supplies, including ventilators, disposable N95 respirators surgical masks, face shields, goggles, gloves, hand sanitizer and wipes.

  • All small businesses filing a return for less than $1 million in taxes will get a 90-day extension — through the end of July — to file their first-quarter tax returns and payments.

  • The California Health Corps has been created to recruit health-care workers, from students to retirees, to help staff at least 50,000 additional hospital beds. The state is seeking “medical doctors, nurses, respiratory therapists, behavioral-health scientists, pharmacists, EMTs, medical and administrative assistants, as well as certified nursing assistants” to sign up at healthcorps.ca.gov.

 

Kevin Hessel is The Ark’s executive editor. Reach him at 415-435-2652, on Twitter at @thearknewspaper and on Facebook at fb.me/thearknewspaper.

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