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New Report on 138 Coronavirus Cases Reveals Disturbing Details New Report on 138 Coronavirus Cases Reveals Disturbing Details
(32 minutes 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.
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.
Updated May 28, 2020 Updated June 1, 2020
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
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.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.
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.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.
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 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.)
More than 40 million people — the equivalent of 1 in 4 U.S. workers — have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.More than 40 million people — the equivalent of 1 in 4 U.S. workers — have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.
There is an uptick in people reporting symptoms of chilblains, which are painful red or purple lesions that typically appear in the winter on fingers or toes. The lesions are emerging as yet another symptom of infection with the new coronavirus. Chilblains are caused by inflammation in small blood vessels in reaction to cold or damp conditions, but they are usually common in the coldest winter months. Federal health officials do not include toe lesions in the list of coronavirus symptoms, but some dermatologists are pushing for a change, saying so-called Covid toe should be sufficient grounds for testing.
Yes, but make sure you keep six feet of distance between you and people who don’t live in your home. Even if you just hang out in a park, rather than go for a jog or a walk, getting some fresh air, and hopefully sunshine, is a good idea.Yes, but make sure you keep six feet of distance between you and people who don’t live in your home. Even if you just hang out in a park, rather than go for a jog or a walk, getting some fresh air, and hopefully sunshine, is a good idea.
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
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.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.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities.Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities.
“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.”