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New Report on 138 Coronavirus Cases Reveals Disturbing Details New Report on 138 Coronavirus Cases Reveals Disturbing Details
(1 day later)
One patient, admitted to a hospital in Wuhan, China, infected at least 10 health care workers and four other patients with the coronavirus that has sickened more than 34,000 people, killed 700 and reached two dozen other countries.One patient, admitted to a hospital in Wuhan, China, infected at least 10 health care workers and four other patients with the coronavirus that has sickened more than 34,000 people, killed 700 and reached two dozen other countries.
The case was just one disturbing detail in a new report on 138 patients in Wuhan that helps explain how the illness progresses and how it spreads.The case was just one disturbing detail in a new report on 138 patients in Wuhan that helps explain how the illness progresses and how it spreads.
The report, one of two published on Friday by JAMA, is among the most comprehensive articles to date about people infected with the newly identified virus.The report, one of two published on Friday by JAMA, is among the most comprehensive articles to date about people infected with the newly identified virus.
The patients ranged in age from 22 to 92, with a median of 56 years, and were admitted to Zhongnan Hospital of Wuhan University from Jan. 1 to Jan 28. Many of them — 41 percent — were presumed to have caught the virus in the hospital, including 17 people who had been admitted for other illnesses, and 40 health care workers.The patients ranged in age from 22 to 92, with a median of 56 years, and were admitted to Zhongnan Hospital of Wuhan University from Jan. 1 to Jan 28. Many of them — 41 percent — were presumed to have caught the virus in the hospital, including 17 people who had been admitted for other illnesses, and 40 health care workers.
The patient who infected so many health workers had been placed in a surgical ward because of abdominal symptoms, and the coronavirus was not initially suspected. Four other patients in that ward also contracted the disease, presumably from the first patient.The patient who infected so many health workers had been placed in a surgical ward because of abdominal symptoms, and the coronavirus was not initially suspected. Four other patients in that ward also contracted the disease, presumably from the first patient.
The incident was a chilling reminder of the “super-spreaders” in outbreaks of other coronavirus diseases, SARS and MERS — patients who infected huge numbers of other people, sometimes dozens. The phenomenon is poorly understood and unpredictable, an epidemiologist’s nightmare. Super-spreaders led to considerable transmission of MERS and SARS inside hospitals.The incident was a chilling reminder of the “super-spreaders” in outbreaks of other coronavirus diseases, SARS and MERS — patients who infected huge numbers of other people, sometimes dozens. The phenomenon is poorly understood and unpredictable, an epidemiologist’s nightmare. Super-spreaders led to considerable transmission of MERS and SARS inside hospitals.
Reporting on Friday in JAMA, the authors said their data suggested that rapid person-to-person spread of the virus had occurred among their cases. That was in part because of patients like the one admitted to the surgical department, whose symptoms misled doctors into suspecting other illnesses and failing to take precautions to prevent spread of the virus until it was too late.Reporting on Friday in JAMA, the authors said their data suggested that rapid person-to-person spread of the virus had occurred among their cases. That was in part because of patients like the one admitted to the surgical department, whose symptoms misled doctors into suspecting other illnesses and failing to take precautions to prevent spread of the virus until it was too late.
About 10 percent of the patients did not initially have the usual symptoms, cough and fever, but instead had diarrhea and nausea first. Other uncommon symptoms included headache, dizziness and abdominal pain.About 10 percent of the patients did not initially have the usual symptoms, cough and fever, but instead had diarrhea and nausea first. Other uncommon symptoms included headache, dizziness and abdominal pain.
Another cause for concern was that some patients who at first appeared mildly or moderately ill then took a turn for the worse several days or even a week into their illness. The median time from their first symptoms to when they became short of breath was five days; to hospitalization, seven days; and to severe breathing trouble, eight days. Experts say that pattern means patients must be carefully monitored, and it is not safe to assume that someone who seems to be doing well early on is out of the woods.Another cause for concern was that some patients who at first appeared mildly or moderately ill then took a turn for the worse several days or even a week into their illness. The median time from their first symptoms to when they became short of breath was five days; to hospitalization, seven days; and to severe breathing trouble, eight days. Experts say that pattern means patients must be carefully monitored, and it is not safe to assume that someone who seems to be doing well early on is out of the woods.
The finding is a “heads up” to doctors to keep an eye on these patients, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said in a recorded interview posted by JAMA.The finding is a “heads up” to doctors to keep an eye on these patients, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said in a recorded interview posted by JAMA.
Like previous reports on coronavirus patients, this one found that older people and those with underlying health problems like diabetes, heart disease or cancer tended to become more severely ill than younger, healthier patients.Like previous reports on coronavirus patients, this one found that older people and those with underlying health problems like diabetes, heart disease or cancer tended to become more severely ill than younger, healthier patients.
Over all, about 26 percent of the 138 patients needed intensive care; their median age was 66, compared with a median of 51 years for those who did not require intensive care.Over all, about 26 percent of the 138 patients needed intensive care; their median age was 66, compared with a median of 51 years for those who did not require intensive care.
For this series of patients, the death rate was 4.3 percent, which is higher than the estimates coming from other parts of China. The reason is not known, and the figures may change as more information is gathered.For this series of patients, the death rate was 4.3 percent, which is higher than the estimates coming from other parts of China. The reason is not known, and the figures may change as more information is gathered.
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Unlike some earlier reports, the new one did not find many more men than women to be infected: 54 percent of the patients were male.Unlike some earlier reports, the new one did not find many more men than women to be infected: 54 percent of the patients were male.
Updated June 30, 2020
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles.
A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
The data on the patients shows that the illness caused pneumonia and a systemic viral infection that set off a powerful inflammatory response in the body, Dr. William Schaffner, an infectious disease expert at Vanderbilt University, said in an interview.The data on the patients shows that the illness caused pneumonia and a systemic viral infection that set off a powerful inflammatory response in the body, Dr. William Schaffner, an infectious disease expert at Vanderbilt University, said in an interview.
“There are biochemical indicators that a number of the body’s organ systems are likely affected and you have an inflammatory response that is disrupting their function to some extent,” Dr. Schaffner said.“There are biochemical indicators that a number of the body’s organ systems are likely affected and you have an inflammatory response that is disrupting their function to some extent,” Dr. Schaffner said.
The lungs, heart, liver, kidneys and the systems that control blood clotting are all affected, Dr. Schaffner said, though it is not clear that the virus itself infects organs other than the lungs.The lungs, heart, liver, kidneys and the systems that control blood clotting are all affected, Dr. Schaffner said, though it is not clear that the virus itself infects organs other than the lungs.
The inflammatory response is a hallmark of a serious viral disease, he said, adding that in recent years it has become apparent that heightened inflammation from diseases like the flu can persist for a month or so after the acute illness is gone, and can increase the risk of heart attacks and strokes in older people.The inflammatory response is a hallmark of a serious viral disease, he said, adding that in recent years it has become apparent that heightened inflammation from diseases like the flu can persist for a month or so after the acute illness is gone, and can increase the risk of heart attacks and strokes in older people.
The second JAMA report concerns 13 patients treated in three hospitals in Beijing from Jan. 16 to Jan. 29. They were younger than the Wuhan group, with a median age of 34, and no underlying diseases. Only one was over 50. The youngest was a 2-year-old. They did not become as ill as the Wuhan patients, and none died.The second JAMA report concerns 13 patients treated in three hospitals in Beijing from Jan. 16 to Jan. 29. They were younger than the Wuhan group, with a median age of 34, and no underlying diseases. Only one was over 50. The youngest was a 2-year-old. They did not become as ill as the Wuhan patients, and none died.
The cases, mostly in healthy, young adults, should dispel the notion that only older people contract the illness.The cases, mostly in healthy, young adults, should dispel the notion that only older people contract the illness.
“It can take a young, healthy person and make them sick,” Dr. Schaffner said. “That’s clear from the health care workers and the young people in this paper.”“It can take a young, healthy person and make them sick,” Dr. Schaffner said. “That’s clear from the health care workers and the young people in this paper.”