What the rest of the world can learn from South Korea's COVID-19 response

by Meghan Azralon, University of Colorado Denver

This chart demonstrates how South Korea was able to limit the number of coronavirus deaths compared to other major countries around the world. Credit: Johns Hopkins

As the world continues to closely monitor the newest coronavirus outbreak, the government of South Korea has been able to keep the disease under control without paralyzing the national health and economic systems. In a new research article published in the American Review of Public Administration, University of Colorado Denver researcher Jongeun You reviewed South Korea's public health policy to learn how the country managed coronavirus from January through April 2020.

Testing Timeline

In January, the Korea Centers for Disease Control and Prevention, in partnership with the Korean Society for Laboratory Medicine and the Korean Association of External Quality Assessment Service, developed and evaluated the real-time reverse transcription polymerase chain reaction (rRT-PCR) diagnostic method for coronavirus.

By February, the diagnostic kit was authorized, and as of March 9, 15,971 kits were produced, capable of testing 522,700 people.

As of April 15, South Korea has tested 534,552 people for coronavirus, which is 10.4 people per one thousand population. South Korea also operated 600 screening centers (including 71 drive-through centers), and more than 90 medical institutions assessed specimens with an rRT-PCR test.

According to You's research, the critical factors in South Korea's public health administration and management that led to success include national infectious disease plans, collaboration with the private sector, stringent contact tracing, an adaptive health care system, and government-driven communication. The South Korean government proactively found patients who contracted coronavirus, disclosed epidemiologic findings of confirmed patients to the public, and provided differentiated treatments based on the severity of symptoms. Unlike other major nations, South Korea has a mostly homogenous cultural and institutional structure, which enabled the policies put in place by the government to become effective.

The Three Major Keys to South Korea's Success

South Korea conducted rigorous and extensive epidemiologic field investigations for coronavirus cases. This process included interviews with patients and triangulation of multiple sources of information (e.g., medical records, credit card and GPS data). The Institute for Future Government's survey in 2020 found that 84% of South Koreans accept the loss of privacy as a necessary tradeoff for public health security.

South Korea is a democratic unitary political system. The local governments have limited autonomy and its public health governance is centralized, enabling South Korean agencies to act quickly to implement policy decisions at the local level. After the MERS outbreak in 2015, the South Korean government expanded legal and administrative boundaries regarding pandemic responses, enabling public administration to acknowledge the different procedures. For example, the Infectious Disease Control and Prevention Act was amended significantly to prevent infectious disease and secure the public's right to know through surveillance and tracing techniques.


Lastly, the public health budget and flexible fiscal management systems allowed the South Korean government to provide adequate resources. The South Korean government and national health insurance program shouldered the full cost of coronavirus testing, quarantine, and treatment for Korean citizens and noncitizens. Furthermore, on March 17, 2020, the South Korean Legislature passed the supplementary budget of 11.7 trillion KRW ($10.1 billion) in 12 days. The Korean Ministry of Health and Welfare's (KMHW) supplementary budget passed in March 2020 is 3.7 trillion KRW ($3.2 billion), which enabled the KMHW to increase COVID-19 prevention and treatment facilities and to support medical institutions and workers.

United States Viability

"There are many variables to consider when emulating policies from other countries," said Jongeun You. "South Korea's extensive surveillance and contact tracing using ICT (information and communications technology) may not be applicable at the federal level in the U.S. due to different cultural norms."

According to You, what the United States could have adopted from South Korea was its ability to quickly ramp up its testing capacity. As mentioned above, South Korea had testing capabilities by end of January after a fast review from the Korean FDA. In the United States, on February 12, 2020, when public and private labs had not yet received FDA approval for their own tests, the CDC revealed that a CDC-designed test kit contained a faulty reagent.

Public Administrator Implications

You suggests the public administrators need to meticulously document everything—and in a timely manner. Using this information, administrators must go one step further and update policy regarding key lessons learned.

"Though many solutions are emerging, I believe one essential solution for public administrators is to collect documentation about their successes and struggles, and what they hear from citizens and residents about policy implementation and communication."


Explore further Follow the latest news on the coronavirus (COVID-19) outbreak

More information: Jongeun You. Lessons From South Korea's Covid-19 Policy Response, The American Review of Public Administration (2020). DOI: 10.1177/0275074020943708

Provided by University of Colorado Denver

Young men are more likely to believe COVID-19 myths: Here is how to actually reach them

by Carissa Bonner, Brooke Nickel, Kristen Pickles, The Conversation

Credit: Shutterstock

If the media is anything to go by, you'd think people who believe coronavirus myths are white, middle-aged women called Karen.

But our new study shows a different picture. We found men and people aged 18-25 are more likely to believe COVID-19 myths. We also found an increase among people from a non-English speaking background.

While we've heard recently about the importance of public health messages reaching people whose first language isn't English, we've heard less about reaching young men.

What did we find?

Sydney Health Literacy Lab has been running a national COVID-19 survey of more than 1,000 social media users each month since Australia's first lockdown.

A few weeks in, our initial survey showed younger people and men were more likely to think the benefit of herd immunity was covered up, and the threat of COVID-19 was exaggerated.

People who agreed with such statements were less likely to want to receive a future COVID-19 vaccine.

In June, after restrictions eased, we asked social media users about more specific myths. We found:
men and younger people were more likely to believe prevention myths, such as hot temperatures or UV light being able to kill the virus that causes COVID-19
people with lower education and more social disadvantage were more likely to believe causation myths, such as 5G being used to spread the virus
younger people were more likely to believe cure myths, such as vitamin C and hydroxychloroquine being effective treatments.

We need more targeted research with young Australians, and men in particular, about why some of them believe these myths and what might change their mind.

Although our research has yet to be formally peer-reviewed, it reflects what other researchers have found, both in Australia and internationally.


An Australian poll in May found similar patterns, in which men and younger people believed a range of myths more than other groups.

In the UK, younger people are more likely to hold conspiracy beliefs about COVID-19. American men are also more likely to agree with COVID-19 conspiracy theories than women.

Why is it important to reach this demographic?

We need to reach young people with health messaging for several reasons. In Australia, young people:
are less likely to have symptoms, so they are less likely to meet testing criteria such as having a sore throat, fever or cough
when they do present for testing, are more likely to test positive
are likely to have more social contacts through seeing friends more often or having service jobs. So the potential for spreading COVID-19 is greater, putting extra pressure on contact tracing
can potentially be hospitalized with COVID-19, some with severe complications despite their age.
Telstra is using comedian Mark Humphries to dispel 5G coronavirus myths.

The Victorian and New South Wales premiers have appealed to young people to limit socializing.

But is this enough when young people are losing interest in COVID-19 news? How many 20-year-old men follow Daniel Andrews on Twitter, or watch Gladys Berejiklian on television?

How can we reach young people?

We need to involve young people in the design of COVID-19 messages to get the delivery right, if we are to convince them to socialize less and follow prevention advice. We need to include them rather than blame them.

We can do this by testing our communications on young people or running consumer focus groups before releasing them to the public. We can include young people on public health communications teams.

We can also borrow strategies from marketing. For example, we know how tobacco companies use social media to effectively target young people. Paying popular influencers on platforms such as TikTok to promote reliable information is one option.

We can target specific communities to reach young men who might not access mainstream media, for instance, gamers who have many followers on YouTube.

We also know humor can be more effective than serious messages to counteract science myths.

Some great examples

There are social media campaigns happening right now to address COVID-19, which might reach more young men than traditional public health methods.

NSW Health has recently started a campaign #Itest4NSW encouraging young people to upload videos to social media in support of COVID-19 testing.

The United Nations is running the global Verified campaign involving an army of volunteers to help spread more reliable information on social media. This may be a way to reach private groups on WhatsApp and Facebook Messenger, where misinformation spreads under the radar.

Telstra is using Australian comedian Mark Humphries to address 5G myths in a satirical way (although this would probably have more credibility if it didn't come from a vested interest).

Finally, tech companies like Facebook are partnering with health organizations to flag misleading content and prioritize more reliable information. But this is just a start to address the huge problem of misinformation in health.

But we need more

We can't expect young men to access reliable COVID-19 messages from people they don't know, through media they don't use. To reach them, we need to build new partnerships with the influencers they trust and the social media companies that control their information.

It's time to change our approach to public health communication, to counteract misinformation and ensure all communities can access, understand and act on reliable COVID-19 prevention advice.

Explore further Follow the latest news on the coronavirus (COVID-19) outbreak

Provided by  The Conversation

This article is republished from The Conversation under a Creative Commons license. Read the original article.

A scientist's plea on coronavirus: Now is not the time to relax

by Lena Ciric, The Conversation

Credit: Our World in Data, CC BY

Living under lockdown and the uncertainty that COVID-19 has brought to our lives has been difficult for everyone. We have all welcomed the opportunity to return to a more normal way of life. But a resurgence in cases after the easing of lockdown in many countries shows us that this pandemic is by no means over. We need to remember that now is not the time to relax and take risks.


Governments around the world have taken different approaches to responding to the pandemic, but social distancing measures have been a common factor for all. That's because it's one of the most powerful tools we have in preventing the transmission of this disease. The fewer people we interact with, the lower the chances that the virus will spread. This has been a successful strategy to lower numbers of cases.

In June and July it was evident that the numbers of new cases were down significantly in Europe, so governments started to relax some of the lockdown measures that had been put in place.

However it is worth keeping in mind that on July 4, when most shops, pubs and restaurants reopened in the UK, the daily number of reported new cases globally was still 205,610 and this number continues to rise—it is 266,864 on the day of publication, more than three times what it was in April when the UK new daily cases were at their peak.

While there are new cases emerging, there is still a risk of transmission. People taking more risks in August and September will mean that case numbers will be higher than if we had maintained stricter measures.

Preparing for a second wave

There is now broad agreement in the scientific community that a second wave will come. This will coincide with colder weather and the seasonal onslaught of respiratory infections such as colds and flu.

But the severity with which a second wave will hit is not beyond our control. If we are all more careful about our actions now, we will reduce the numbers of cases and deaths that will occur in the coming months and ease the burden on the health services.

I am a microbiologist—my expertise is in how dangerous microbes including viruses live in indoor spaces. I have been working on COVID-19 since March and I understand the risks.

I am also a human being. I miss seeing my friends and family. I worry that my son's development will suffer because he is not interacting with his friends and has missed a lot of school. I miss traveling and eating out. But I know that if I relax, I may expose myself and others to the virus. I am not willing to take my chances with COVID-19.

Yes, for most people the illness is mild, but it can be severe, and it is impossible to know which route it will take until it is too late. It might be that I am fine, but that my husband is not. Or that I give it to our neighbor who is at high risk of severe COVID-19.

Our knowledge about how this virus behaves and spreads is growing each day and, as a result, the government advice has evolved over the past few months. We know that infected people can spread the virus before showing symptoms and that many people who carry the virus but do not show any symptoms at all but can give it to others. This increases the chances of the virus spreading among the population.

We also know that the majority of transmission events take place indoors, so it is best to meet outdoors. At the start of the pandemic there was little evidence that the virus could be transmitted by tiny airborne droplets, but this now a distinct possibility which means that wearing a face covering will protect you and others. There is also now evidence that the cells in your nasal passages are the ones most prone to infection by the virus, so make sure you cover your nose.

It is quite clear that COVID-19 is not going away, however much we might want it to. The more care and restraint we show now, the lower the likelihood of another devastating wave of cases that will cripple health services and result in yet more thousands of lives lost.

Before you head to the office, the shops or the pub, think whether you need to take the risk. Is it really worth it?


Explore further Follow the latest news on the coronavirus (COVID-19) outbreak

Provided by The Conversation

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Mouthwashes could reduce the risk of coronavirus transmission

by Ruhr-Universitaet-Bochum

Mouthwashes have an effect on the novel coronavirus. Credit: RUB, Marquard

Sars-Cov-2 viruses can be inactivated using certain commercially available mouthwashes. This was demonstrated in cell culture experiments by virologists from Ruhr-Universität Bochum together with colleagues from Jena, Ulm, Duisburg-Essen, Nuremberg and Bremen. High viral loads can be detected in the oral cavity and throat of some Covid-19 patients. The use of mouthwashes that are effective against Sars-Cov-2 could thus help to reduce the viral load and possibly the risk of coronavirus transmission over the short term. This could be useful, for example, prior to dental treatments. However, mouth rinses are not suitable for treating Covid-19 infections or protecting yourself against catching the virus.


The results of the study are described by the team headed by Toni Meister, Professor Stephanie Pfänder and Professor Eike Steinmann from the Bochum-based Molecular and Medical Virology research group in the Journal of Infectious Diseases, published online on 29 July 2020. A review of laboratory results in clinical trials is pending.

Eight mouthwashes in a cell culture test

The researchers tested eight mouthwashes with different ingredients that are available in pharmacies or drugstores in Germany. They mixed each mouthwash with virus particles and an interfering substance, which was intended to recreate the effect of saliva in the mouth. The mixture was then shaken for 30 seconds to simulate the effect of gargling. They then used Vero E6 cells, which are particularly receptive to Sars-Cov-2, to determine the virus titer. In order to assess the efficacy of the mouthwashes, the researchers also treated the virus suspensions with cell culture medium instead of the mouthwash before adding them to the cell culture.

All of the tested preparations reduced the initial virus titer. Three mouthwashes reduced it to such an extent that no virus could be detected after an exposure time of 30 seconds. Whether this effect is confirmed in clinical practice and how long it lasts must be investigated in further studies.

The authors point out that mouthwashes are not suitable for treating Covid-19. "Gargling with a mouthwash cannot inhibit the production of viruses in the cells," explains Toni Meister, "but could reduce the viral load in the short term where the greatest potential for infection comes from, namely in the oral cavity and throat—and this could be useful in certain situations, such as at the dentist or during the medical care of Covid-19 patients."

Clinical studies in progress

The Bochum group is examining the possibilities of a clinical study on the efficacy of mouthwashes on Sars-Cov-2 viruses, during which the scientists want to test whether the effect can also be detected in patients and how long it lasts. Similar studies are already underway in San Francisco; the Bochum team is in contact with the American researchers.


Explore further

Researchers urge immediate study of oral rinses as the COVID-19 pandemic continues to spread

More information: Toni Luise Meister et al, Virucidal efficacy of different oral rinses against SARS-CoV-2, The Journal of Infectious Diseases (2020). DOI: 10.1093/infdis/jiaa471
Journal information: Journal of Infectious Diseases

Provided by Ruhr-Universitaet-Bochum

Quality of care at rural hospitals may not differ as much as reported, study suggests

by Laura Kallio Joyce, Brown University

Critical access hospitals are important health care access points in rural communities across the U.S. Credit: Brown University

Critical access hospitals (CAHs) provide care to Americans living in remote rural areas. As important health care access points, these hospitals serve a population that is disproportionately older, impoverished and burdened by chronic disease. In 1997, with small rural hospitals under increasing financial strain and closing in large numbers, the federal CAH designation was established to increase their viability and to ensure that rural communities have adequate access to health care.

Prior research studies comparing the quality of care provided by CAHs and non-CAHs have found that risk-adjusted mortality rates at CAHs were higher, and the hospitals' quality of care, therefore, lower. But a new study led by investigators at the Center for Gerontology and Healthcare Research in Brown's School of Public Health suggests that standard risk-adjustment methodologies have been unfairly penalizing CAHs.

According to the study, for Medicare beneficiaries in rural areas who were hospitalized during the period of 2007 to 2017, CAHs submitted significantly fewer hospital diagnosis codes than did non-CAHs. The primary reason for the relative under-reporting of diagnoses at CAHs has to do with differences in Medicare reimbursements—while non-CAHs are incentivized by Medicare to complete diagnosis coding, CAHs, which receive cost-based reimbursements, are not.

"When payments for episodes of care are tied to the acuity of patients, health care providers have the incentive to fully report or even overstate acuity," said study senior author Momotazur Rahman, an associate professor of health services, policy and practice at Brown. "Since payments for non-CAHs are dependent on reported acuity while payments for CAHs are not, non-CAH patients will appear comparatively sicker than they actually are."

Because mortality rates are adjusted per severity of illness—acuity, in Rahman's words—the result is that CAHs appear to have higher mortality rates for patients with similar conditions, when in reality their patients may in fact be sicker than those in non-CAHs, from the standpoint of risk adjustment.

The study was published in the Journal of the American Medical Association on Tuesday, Aug. 4.

How did the researchers determine that CAHs tend to overreport diagnoses? In 2010, Medicare increased the allowable number of billing codes for hospitalizations from 10 to 25.

"We observed a large jump in reported acuity among non-CAH patients in 2010," Rahman said, "but we saw a much smaller jump for CAH patients. We found that due to this difference in acuity reporting, when compared to non-CAHs, the risk-adjusted performance of CAHs on short-term mortality measures looks much worse than it actually is."

The CAH program, created to prevent rural hospitals from closing, has repeatedly come under threat. Given that in many parts of the U.S., CAHs serve as sole health care providers, Rahman said that examining differences in quality of care is important for understanding the value of the CAH program and informing decisions about the allocation of funding for rural health care.

The finding that short-term mortality outcomes at rural CAHs may not differ from those of non-CAHs after accounting for different coding practices, he added, is essential knowledge for ensuring timely access to acute care for vulnerable rural communities.


Explore further Critical access hospitals have higher transfer rates after surgery

More information: Cyrus M. Kosar et al, Association of Diagnosis Coding With Differences in Risk-Adjusted Short-term Mortality Between Critical Access and Non–Critical Access Hospitals, JAMA (2020). DOI: 10.1001/jama.2020.9935

Journal information: Journal of the American Medical Association

Provided by Brown University

US COVID-19 Cases in Children Increased by 100,000 in Two Weeks

AUG 10, 2020 | KEVIN KUNZMANN

The rate of coronavirus 2019 (COVID-19) cases among children in the US raised by 40% in the last 2 weeks of July, according to a new data report.

In a joint report from the American Academy of Pediatrics (AAP) and the Children’s Hospital Association (CHA), a collection of state-level reports from the best publicly available data from 49 states, New York City, Washington DC, Puerto Rico, and Guam, showed 97,078 new child cases of COVID-19 were reported from July 16-30.

The jump in new pediatric cases brings the US total to nearly 339,000, or an overall rate of 447 per 100,000 children, according to the report. State-level populations for children were estimated with data from the US Census Bureau.

California, Florida, and Arizona currently contribute more than 85,000, or 25%, of all pediatric cases, according to the report.

The lone abstention of statewide pediatric COVID-19 data was New York, which only offers reported age distribution of cases in New York City. Despite being the best publicly available data for pediatric COVID-19 cases, state-level data comes with limitations, including that the definition of a child varies anywhere from ages 0-14 to 0-24 years.

That said, the newest data showed children currently represent 8.8% of all US cases, and that 6 states have already surpassed 15,000 total pediatric cases.

Pediatric COVID-19 hospitalizations—per 20 states and New York City, which offer such data—were just 0.6% to 3.7% of total reported cases, and between 0.6% and 8.9% of all cases in children alone. Mortality, among 44 reporting states and New York City, remained low: the greatest rate was 0.8% of infected children, and 20 states reported no child deaths at the time of the report.

The AAP-CHA joint report has been ongoing since mid-April of this year, when it first collected pediatric-level data from 46 states, New York City, and Washington, DC. In that time, cumulative COVID-19 child cases have increased by 35-fold.

Cases per 100,000 children have also risen from 13.3 on April 16, to 446.5 on July 30. In the difference of just the last month—from June 25 to July 30—the rate of COVID-19 cases in children has risen 2.5-fold.

Just last week, data published in the journal Pediatrics showed pediatric COVID-19 incidence was spiked among American black and Hispanic children compared to white children: about 30% and 46% versus just 7% positive rates, respectively. The findings align with similar inequities in COVID-19 positivity and severity observed among US adults.

The alarming AAP-CHP data also comes in the same week as reports from most major US cities stating they will begin the 2020-21 school year in a remote, virtual capacity.

Some regions—most notably, New York City—have expressed intention to reopen schools to start the year. According to report, the city had more than 6600 pediatric COVID-19 cases as of July 30.

As schools reopen, report shows 97,000 U.S. kids infected with COVID in late July

by Robin Foster and E.j. Mundell, Healthday Reporters


(HealthDay)—With millions of American children soon returning to school, a new study shows that at least 97,000 kids were infected with COVID-19 during the last two weeks of July.

According to the new report from the American Academy of Pediatrics and the Children's Hospital Association, at least 338,000 U.S. children had tested positive through July 30, The New York Times reported. That means that more than a quarter of those cases had come up positive in the second half of July alone.

Already, some schools have tried to reopen and then had to order quarantines or close after COVID-19 cases were reported among students and staff, the Times reported. North Paulding High School in Georgia, which gained national attention last week after videos of crowded hallways made their way onto social media, announced Sunday it would switch to online instruction for Monday and Tuesday after at least nine coronavirus cases were reported there.

In the new report, states in the South and West accounted for more than 7 of 10 infections. The count could be higher because the report did not include complete data from Texas and parts of New York State outside of New York City.

Missouri, Oklahoma, Alaska, Nevada, Idaho and Montana were among the states with the highest percentage increase of child infections during that period, the report found.

There were differences in how states classified children: Most places cited in the report considered children to be no older than 17 or 19. But in Alabama, the age limit was 24, while it was only 14 in Florida and Utah, the Times reported.

Though public health officials say that most children do not get severe illness, a new report from the U.S. Centers for Disease Control and Prevention found that a new, more dangerous COVID-19 condition known as Multisystem Inflammatory Syndrome in Children has struck children of color far more often than whites. From early March through late July, the CDC received reports of 570 young people—ranging from infants to age 20 with the condition, the Times reported. Of those, 40 percent were Hispanic or Latino, 33 percent were Black and 13 percent were white. Ten died and nearly two-thirds were admitted to intensive care units, the report found.


New model shows 300,000 dead

Meanwhile, a new model predicted that nearly 300,000 Americans could die of COVID-19 by December if more people don't wear masks or practice better social distancing.

Researchers from the University of Washington's Institute for Health Metrics and Evaluation (IHME) have issued a forecast of 295,011 deaths from coronavirus by Dec. 1.

However, if 95 percent of people were to wear a face mask in public, some 66,000 lives could be saved, they added.

"We're seeing a rollercoaster in the United States," institute director Christopher Murray said in a statement. "It appears that people are wearing masks and socially distancing more frequently as infections increase, then after a while as infections drop, people let their guard down and stop taking these measures to protect themselves and others which, of course, leads to more infections. And the potentially deadly cycle starts over again."

His team's model also identifies which states will need to re-impose mask mandates between now and the winter to slow the spread of transmission.

In other pandemic news, the U.S. State Department has lifted its 5-month-old blanket warning against international travel for Americans. Instead, the department will now issue travel recommendations by country.

Why the change? "Health and safety conditions improving in some countries and potentially deteriorating in others" influenced its decision, the state department said in a statement released Thursday. The change will allow travelers to make "informed decisions" based on the situation in specific countries, officials said.

"We continue to recommend U.S. citizens exercise caution when traveling abroad due to the unpredictable nature of the pandemic," the agency's statement said.

Despite the lifting of the travel warning, many other countries are currently restricting American citizens from entry because the United States has far more coronavirus cases than any other nation in the world, the Washington Post reported.

Scientists call for faster tests

To try to better track and stem the spread of coronavirus, scientists have called for widespread adoption of simpler, less accurate tests, as long as they're given often and quickly.

"Even if you miss somebody on Day 1," Omai Garner, director of clinical microbiology in the UCLA Health System, told the Times. "If you test them repeatedly, the argument is, you'll catch them the next time around."

The strategy hinges on having an enormous supply of testing kits. But many experts believe more rapid, frequent testing would spot people who need immediate medical care while also identifying those most likely to spread COVID-19, the Times reported.

Of the dozens of coronavirus tests that have been granted emergency use authorization by the U.S. Food and Drug Administration, most rely on complex laboratory procedures, such as PCR, the Times reported.

Only a few tests are quick and simple enough to be run in a doctor's office or urgent care clinic, without the need for lab equipment. And these tests are still relatively scarce nationwide, though government officials say they plan to ramp up production of such tests by the fall, the newspaper said.

"If you had asked me this a couple months ago, I would have said we just need to be doing the PCR tests," Susan Butler-Wu, a clinical microbiologist at the University of Southern California, told the Times. "But we are so far gone in this country. It is a catastrophe. It's kitchen sink time, even if the tests are imperfect."

By Monday, the U.S. coronavirus case count surpassed 5 million as the death toll exceeded 162,400, according to a Times tally.

According to the same tally, the top five states in coronavirus cases as of Monday were: California with over 563,000; Florida with nearly 533,000; Texas with over 508,000; New York with over 425,500; and New Jersey with more than 186,600.

Nations grapple with pandemic

Elsewhere in the world, the situation remains challenging.

Australia logged a record daily death toll on Monday, following weeks of rising case numbers there, the Post reported.

In the Australian state of Victoria, authorities confirmed more than 300 new infections and 19 deaths over the last 24 hours, the Post reported. But there were hopeful signs that the peak of the outbreak might be over. The number of new daily cases in Victoria has been falling significantly since the middle of last week, the newspaper said. A strict lockdown imposed on the state's capital, Melbourne, more than a week ago may start affecting case numbers soon.

Things continue to worsen in India.

On Monday, the country passed 2.2 million infections and over 44,300 deaths, a Johns Hopkins tally showed. The surge comes weeks after a national lockdown was lifted, and it's prompted some parts of the country to revert back to stricter social distancing measures.

Brazil is also a hotspot in the coronavirus pandemic, with over 3 million confirmed infections by Monday, according to the Hopkins tally. It has the second-highest number of cases, behind only the United States.

Cases are also spiking wildly in Russia: As of Monday, that country reported the world's fourth-highest number of COVID-19 cases, at over 890,700, the Hopkins tally showed.

Worldwide, the number of reported infections passed 19.8 million on Monday, with over 73,500 deaths, according to the Hopkins tally.


Explore further

Model shows 300,000 american deaths by december if more don't wear face masks
More information: The U.S. Centers for Disease Control and Prevention has more on the new coronavirus.

Copyright © 2020 HealthDay. All rights reserved.

Five million cases: What next for America's COVID-19 epidemic?

Credit: Unsplash/CC0 Public Domain

It took the United States just 17 days to move from four million to five million coronavirus cases—even as the country is finally starting to bend its curve downward.


Here is the state of play of America's COVID-19 epidemic, and what may happen in the coming months.

The good

First some positive trends: the national daily new case rate has been falling for more than two weeks.

The US is still recording more than 50,000 cases a day, a huge figure, but that's down substantially from 70,000 at the peak around July 23-24.

The drop-off in cases is so far more pronounced than in April when the country headed into a long springtime plateau, which lulled many states into a false sense of security that paved the way for the spike that began mid-June.

Experts attribute the decline to policy and behavior changes in the populous states behind the summer surge—namely California, Texas, Florida and Arizona.

Widespread adoption of masks, physical distancing and closing down bars all helped, while some scientists believe that increasing population immunity may have also played a role.

According to COVID19-projections.com, up to 20 percent of Florida may by now have been infected—and infection is thought to confer immunity to some extent.

"I believe the substantial epidemics in Arizona, Florida and Texas will leave enough immunity to assist in keeping COVID-19 controlled," Trevor Bedford, a scientist studying viruses at Fred Hutch wrote on Twitter.

"However, this level of immunity is not compatible with a full return to societal behavior as existed before the pandemic," he added.

The bad

Even if the trend is downward the daily case rate is still extremely high, and much more work needs to be done to bring the national curve back to baseline.

Unless the curve is pushed down much further, hospitals will continue to be stretched and people will continue to die needlessly. The current daily average is more than 1,000 deaths a day.

More than 163,000 have died so far —22 percent of the world's total, though the US has just four percent of the world's population.

Models predict 200,000 deaths by the middle of September.

And experts can already see the next area of failure emerging: cheered on by the administration of President Donald Trump, some states are rushing headlong to reopen schools in virus hotspots.



"We've seen the failure of federal leadership in the early days around PPE, we're seeing it over and over again around testing, and now we're seeing it around education policy," Thomas Tsai, a Harvard health expert told AFP.

A Georgia high school that suspended students for posting pictures of crowded hallways full of unmasked teens reported nine cases over the weekend, forcing the school to close down.

While children aren't at as great a risk as adults to getting severe COVID-19, cases are climbing.

A new report from the American Academy of Pediatrics and the Children's Hospital Association found that nearly 100,000 children were infected in the final two weeks of July, of a total of some 340,000 pediatric cases.

A recent study found children have higher viral load in their noses than adults, meaning they could be major spreaders once infected.

What comes next?

The reasons for the summer surge are clear and have been repeatedly articulated by experts: states that weren't initially hard hit got complacent and relaxed their lockdowns too soon.

They were supported by President Trump, whose administration also crucially failed to develop a national testing strategy unlike other developed countries.

It isn't rocket science: California, Texas, Arizona and Florida brought down their caseloads largely by implementing basic public health measures.

The key question to watch out for is whether other states will be proactive or simply wait until they experience their own surges before acting.

"When you have something that needs everybody pulling at the same time, if you have one weak link in there that doesn't do it, it doesn't allow you to get to the end game," Anthony Fauci, the country's top infectious disease official said Friday.

For his part, Trump seems to be betting everything on the emergence of an effective vaccine to end the crisis and win him re-election in November. The US has spent at least $9 billion so far on this goal.


Explore furtherFollow the latest news on the coronavirus (COVID-19) outbreak

© 2020 AFP

Masks could save the lives of 66,000 Americans by Dec. 1—if more people wear them

by Kasra Zarei, The Philadelphia Inquirer

Credit: Pixabay/CC0 Public Domain

By Dec. 1, there will be an estimated 295,011 coronavirus deaths in the United States since the start of the pandemic. But nearly 66,000 of these deaths—about one in four—could have been prevented if all Americans would wear a mask in public, according to the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

While the estimates are based on projections, the institute's previous models have been accurate for several months.

"The accuracy (of IHME's model) is within 5% of the true estimate for projections up to four weeks later," said Ali Mokdad, professor and chief strategy officer of population health at IHME.

Despite the bleak numbers of coronavirus cases and deaths six months into the pandemic, public mask wearing continues to be a contentious topic. Experts have said repeatedly that the pandemic can be controlled if everyone wore masks properly while in public. But over the summer, the number of new cases has risen considerably, mostly in states that do not require masks in public or have been slow to adopt such mandates.

Currently 32 states—including Pennsylvania and New Jersey—and the District of Columbia require wearing masks in public, according to AARP. Texas and Montana also have mandates, but allow counties with low case totals to opt out. In the remaining states, including Florida, Georgia, Arizona, and Iowa, masks are not required.

The evidence supporting masks is clear. One study found that earlier in the pandemic, at least 200,000 U.S. coronavirus cases were avoided by mask-wearing mandates. Another preliminary study of almost 200 countries has found that government policies requiring public mask wearing are associated with lower per-capita mortality from the coronavirus, even after controlling for other factors, including population density, lockdown policies, and international travel restrictions.

"You look at the countries that got large segments of the population to wear masks early— countries like Hong Kong, Taiwan, and Slovakia—they have seen way less mortality from the coronavirus compared to other countries," said the preliminary study's lead author, Christopher T. Leffler, an associate professor of ophthalmology at Virginia Commonwealth University.


Mandating proper mask-wearing in public can help increase compliance, as IHME's latest report states. But Mokdad noted that one doesn't always lead to the other. For instance, in no-mandate states, more people started wearing masks and staying home after they saw that cases were soaring. On the other hand, some states with public mask mandates, like Illinois and Indiana, have relatively low self-reported compliance rates. According to IHME, about 55% of people in the U.S. say they wear a mask when they go out in public, up from 30% in the middle of April.

The importance of mask wearing has grown with increasing evidence that the coronavirus is airborne, meaning you're more likely to get it from another person's exhalations than from touching a surface. One study showed that the coronavirus was present in air samples collected from the hospital rooms of coronavirus patients, demonstrating the need for better ventilation.

"Even the whole idea that breathing and talking can create transmission is sort of an admission that airborne transmission is a factor," said Joshua L. Santarpia, associate professor of pathology and microbiology at the University of Nebraska Medical Center and lead author of the study.

But this is not like the fictional movie Outbreak, where a virus quickly becomes airborne and infects a crowded theater.

"That's not a realistic assessment of what airborne means for this disease," Santarpia said. "It is apparent that mask wearing of any kind and social distancing are having an impact."

Another study sought to visualize the effects of a cough or sneeze, and found that droplets from an uncovered cough can spread out to eight feet on average and a maximum of 12 feet—both estimates are farther than the six feet recommended for social distancing.

"To see all of this with my own eyes was surprising. One of the good surprises was how well homemade masks could work," said Siddhartha Verma, an assistant professor of engineering at Florida Atlantic University and lead author of the study.

Different types of masks vary in effectiveness. Verma's study showed that a stitched mask made from quilting cotton limited the spread of droplets to two to three inches, which is just as effective, if not better, than a commercial mask.

Using a mask doesn't eliminate the risk of contracting the virus. That's why it's important to also practice social distancing.

"No one is saying masks are 100% effective, but they will in fact reduce transmission if not prevent it," Santarpia said.

Another measure that could help, experts say, is a national policy on masks, like other countries have implemented.

"It's very confusing to the public. A national mandate will help instead of leaving it up to the states," Mokdad said.


©2020 The Philadelphia Inquirer
Distributed by Tribune Content Agency, LLC.

POSTMODERN ALCHEMY
From cedar trees and grapefruit rinds comes a new bug repellent

by Robin Foster, Healthday Reporter


(HealthDay)—Bugs beware: There's a powerful new insect repellent in town.

Just approved by the U.S. Environmental Protection Agency and known as nootkatone, the citrus-scented ingredient repels mosquitoes, ticks, bedbugs and fleas.

In high concentrations, it can kill these pesky insects and slow the spread of the diseases they can carry, according to the U.S. Centers for Disease Control and Prevention, which developed nootkatone. In addition, it may work against lice, sandflies, midges and other pests.

Nootkatone, which is found in Alaska yellow cedar trees and grapefruit skin, can also kill bugs that are resistant to DDT, pyrethroids and other common insecticides, the CDC said in an agency news release.

One proposed use is in soaps that people in tick-infested areas could shower with, repelling and possibly killing ticks that try to attach to them.

"Its use as an insecticidal soap has great potential," Duane Gubler, a former CDC chief of vector-borne diseases, told The New York Times.

It repels ticks better than DEET or other synthetic chemicals do, and it is equally good at repelling mosquitoes, Dr. Joel Coats, an insect toxicologist from Iowa State University, told the Times.

And unlike natural bug repellents like citronella, peppermint oil and lemongrass oil, nootkatone does not lose its potency after an hour or so, Coats added.

How does it work? It appears to activate receptors in insects that send electrical impulses from one nerve cell to the next, Ben Beard, deputy director of the CDC's division of vector-borne diseases, told the Times. Unable to turn off the signal, the bugs literally twitch to death.

Nootkatone can now be used to develop new bug repellents and insecticides for both people and pets. The CDC's licensed partner, a Swiss company called Evolva, is in discussions with leading pest control companies for possible commercial partnerships, the agency said.
"This new active ingredient has the potential to be used in future insect repellents and pesticides that will protect people from disease," Alexandra Dapolito Dunn, the EPA's assistant administrator for the Office of Chemical Safety and Pollution Prevention, said in the CDC news release.

"In many areas of the United States, mosquitoes have become resistant to currently available pesticides. A new active ingredient in our toolbox will help vector-control programs," she added.

Mosquito- and tick-borne diseases are a growing threat in the United States. The number of reported cases of such diseases doubled from 2004 to 2018, according to the CDC. Tick-borne diseases represent almost eight in 10 of all reported vector-borne disease cases in the United States, the agency added.

Dr. Jay Butler is deputy director for infectious diseases at the agency. He said, "CDC is proud to have led the research and development of nootkatone. Providing new alternatives to existing bite-prevention methods paves the way to solving one of biggest challenges in preventing vector-borne diseases—preventing bites."

Explore further

Substance that gives grapefruit its flavor and aroma could give insect pests the boot

More information: Visit the National Pesticide Information Center at Oregon State University for more on insect repellents.

Copyright © 2020 HealthDay. All rights reserved.

Schooling is critical for cognitive health throughout life, study says

by Association for Psychological Science

Credit: CC0 Public Domain

Investing time in education in childhood and early adulthood expands career opportunities and provides progressively higher salaries. It also conveys certain benefits to health and longevity.

A new analysis published in the journal Psychological Science in the Public Interest (PSPI), however, reveals that even though a more extensive formal education forestalls the more obvious signs of age-related cognitive deficits, it does not lessen the rate of aging-related cognitive declines. Instead, people who have gone further in school attain, on average, a higher level of cognitive function in early and middle adult adulthood, so the initial effects of cognitive aging are initially less obvious and the most severe impairments manifest later than they otherwise would have.

"The total amount of formal education that people receive is related to their average levels of cognitive functioning throughout adulthood," said Elliot M. Tucker-Drob, a researcher with the University of Texas, Austin, and coauthor on the paper. "However, it is not appreciably related to their rates of aging-related cognitive declines."

This conclusion refutes the long-standing hypothesis that formal education in childhood through early adulthood meaningfully protects against cognitive aging. Instead, the authors conclude that individuals who have gone further in school tend to decline from a higher peak level of cognitive function. They therefore can experience a longer period of cognitive impairment before dropping below what the authors refer to as a "functional threshold," the point where cognitive decline becomes so obvious that it interferes with daily activities.
"Individuals vary in their rates of aging-related cognitive declines, but these individual differences are not appreciably related to educational attainment," notes lead author Martin Lövdén, formerly with the Karolinska Institute and Stockholm University in Sweden and now with the University of Gothenburg.

For their study, the researchers examined data from dozens of prior meta-analyses and cohort studies conducted over the past two decades. The new PSPI report evaluates the conclusions from these past studies to better understand how educational attainment affects both the levels of and changes in cognitive function in aging and dementia.

Although some uncertainties remain after their analysis, the authors note, a broader picture of how education relates to cognitive aging is emerging quite clearly. Throughout adulthood, cognitive function in individuals with more years of schooling is, on average, higher than cognitive function in those with fewer years of schooling.

This review highlights the importance of formal education for cognitive development over the course of childhood, adolescence, and early adulthood. According to the researchers, childhood education has important implications for the well-being of individuals and societies not just during the years of employment, but throughout life, including old age. "This message may be particularly relevant as governments decide if, when, and how to reopen schools during the COVID-19 pandemic. Such decisions could have consequences for many decades to come," said Tucker-Drob.

The authors conclude that improving the conditions that shape development during the first decades of life carries great potential for improving cognitive ability in early adulthood and for reducing public-health burdens related to cognitive aging and dementia.

Explore further

Childhood exposure to parental smoking linked to poorer cognitive function in midlife

More information: Martin Lövdén et al, Education and Cognitive Functioning Across the Life Span, Psychological Science in the Public Interest (2020). 

DOI: 10.1177/1529100620920576

Journal information: Psychological Science in the Public Interest

Provided by Association for Psychological Science