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Who are you?
Supplies:

1. 3 Sheets of Paper

2. Pen/Pencil/3 Color Markers

3.  Scissors

4. Knowledge of your name

5. Name of a mountain, river, ocean, valley, rain, wind, rainbow, mist, cloud, cliff, bluff, island etc. (choose 3)

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I ka wā ma mua, ka wā ma hope. The future is found in the past.

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I ka wā ma mua, ka wā ma hope. The future is found in the past.

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July 17, 2020, 3-5 pm HST
Click here to join ZOOM meeting

Open image below in new window to enlarge
Click here to see full agenda.

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Visit Session 3 Padlet for Questions and Activities

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Visit Session 3 Padlet for Questions and Activities

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Please visit the Session 3 Padlet

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Here are some of the main questions youʻll find there:

Question 1 | What new learning from the 1835 Nūpepa resource did you find interesting?
⁽NŪPEPA ʻEKAHI: Population Decline 1835)

Question 2 | What was Princess Lili`uokalani’s response to the 1861 smallpox epidemic? How does it parallel with COVID-19 decisions and actions made by leaders today?

Question 3 | How can we use what is happening in the world today to build the leaders of tomorrow?

Question 4 | How can we respond to the pandemic in a way that meets Hawaiiʻs specific needs?

Question 5 | How are kanaka polarizing the essence of  "ALOHA" through scrupulous acts of caring in the middle of a pandemic?

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Click the thumbnail below to visit the Additional Resources Padlet.

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Welcome to our Main Padlet! Look for its thumbnail on other Padlet pages to come back to it.

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Please respond to Session 4 discussion questions below.

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Please respond to Session 4 discussion questions below.

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Leave a comment on the following posts, or post your own questions to start a conversation! There are no Google Doc links for responses.

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The questions posed in Session 2 will form the basis for our inquiry.  

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The questions posed in Session 2 will form the basis for our inquiry.  

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We will go through some of the elements in the 5 E Lesson Design Process during this session to arrive at our own personal explanations and responses to the questions.   Please do not respond to them yet.  For now, they are purely food for thought.  I would like for everyone that participates in this session not to feel that they need to have any perfectly formulated responses.  What I love about the inquiry process, is that it is a journey towards understanding.  By examining the information presented, it will be interesting to see where your understanding takes you.  I am also hoping that you will consider how you can iterate and ideate on the information and activities shared to make it relevant to the spaces in which each of you hold.  Thus, the questions are for you to think about and consider.  If you already have responses, great, please record them in a journal.  (With my own students, we keep track of our thinking and where it goes in our interactive notebooks.  These are great spaces for us to track our personal journeys and reflect upon them.  And remember, feel free to journal in ways that make the most sense to you--maps, models, illustrations, writings...  I challenge you to try a method of recording your ideas that you may have not tried before.)  Mahalo for honoring, and allowing all participants the opportunity to consider where they are at individually at this point in time. Finally, we will also be looking at the science phenomena behind the proactive measures we have all been asked to take to keep our families and communities safe.

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Question 1 | What do we do in our communities when the virus begins to mutate?  Do you believe that viruses can mutate?
Please comment below.

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Papahana | Building Essential Questions Together

Find Google Doc here

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New strain of coronavirus appears to be more virulent (contagious)

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New strain of coronavirus appears to be more virulent (contagious)

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It's not known if this variant may be in Hawaii, but the recent high number of cases after the initial decline after lock down (see DOH COVID-19 Dashboard) in Hawaii and elsewhere may be partially due to this new, mutated strain.

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July 2
When the first coronavirus cases in Chicago appeared in January, they bore the same genetic signatures as a germ that emerged in China weeks before.

But as Egon Ozer, an infectious-disease specialist at the Northwestern University Feinberg School of Medicine, examined the genetic structure of virus samples from local patients, he noticed something different.

A change in the virus was appearing again and again. This mutation, associated with outbreaks in Europe and New York, eventually took over the city. By May, it was found in 95 percent of all the genomes Ozer sequenced.

At a glance, the mutation seemed trivial. About 1,300 amino acids serve as building blocks for a protein on the surface of the virus. In the mutant virus, the genetic instructions for just one of those amino acids - number 614 - switched in the new variant from a "D" (shorthand for aspartic acid) to a "G" (short for glycine).

But the location was significant, because the switch occurred in the part of the genome that codes for the all-important "spike protein" - the protruding structure that gives the coronavirus its crownlike profile and allows it to enter human cells the way a burglar picks a lock.
[Stay safe and informed with our free Coronavirus Updates newsletter]
And its ubiquity is undeniable. Of the approximately 50,000 genomes of the new virus that researchers worldwide have uploaded to a shared database, about 70 percent carry the mutation, officially designated D614G but known more familiarly to scientists as "G."

"G" hasn't just dominated the outbreak in Chicago - it has taken over the world. Now scientists are racing to figure out what it means.

At least five laboratory experiments suggest that the mutation makes the virus more infectious, although only one of those studies has been peer-reviewed. That study, led by scientists at Los Alamos National Laboratory and published Thursday in the journal Cell, also asserts that patients with the G variant actually have more virus in their bodies, making them more likely to spread it to others.

The mutation doesn't appear to make people sicker, but a growing number of scientists worry that it has made the virus more contagious.

"The epidemiological study and our data together really explain why the [G variant's] spread in Europe and the U.S. was really fast," said Hyeryun Choe, a virologist at Scripps Research and lead author of an unpublished study on the G variant's enhanced infectiousness in laboratory cell cultures. "This is not just accidental."

But there may be other explanations for the G variant's dominance: biases in where genetic data are being collected, quirks of timing that gave the mutated virus an early foothold in susceptible populations.

"The bottom line is, we haven't seen anything definitive yet," said Jeremy Luban, a virologist at the University of Massachusetts Medical School.
[Coronavirus pandemic exposes layers of government failure]
The scramble to unravel this mutation mystery embodies the challenges of science during the coronavirus pandemic. With millions of people infected and thousands dying every day around the world, researchers must strike a high-stakes balance between getting information out quickly and making sure that it's right.

A better lock pick

SARS-CoV-2, the novel coronavirus that causes the disease covid-19, can be thought of as an extremely destructive burglar. Unable to live or reproduce on its own, it breaks into human cells and co-opts their biological machinery to make thousands of copies of itself. That leaves a trail of damaged tissue and triggers an immune system response that for some people can be disastrous.
[How the virus kills]
This replication process is messy. Even though it has a "proofreading" mechanism for copying its genome, the coronavirus frequently makes mistakes, or mutations. The vast majority of mutations have no effect on the behavior of the virus.

But since the virus's genome was first sequenced in January, scientists have been on the lookout for changes that are meaningful. And few genetic mutations could be more significant than ones that affect the spike protein - the virus's most powerful tool.

This protein attaches to a receptor on respiratory cells called ACE2, which opens the cell and lets the virus slip inside. The more effective the spike protein, the more easily the virus can break into the bodies of its hosts. Even when the original variant of the virus emerged in Wuhan, China, it was obvious that the spike protein on SARS-CoV-2 was already quite effective.

But it could have been even better, said Choe, who has studied spike proteins and the way they bind to the ACE2 receptor since the severe acute respiratory syndrome outbreak in 2003.

The spike protein for SARS-CoV-2 has two parts that don't always hold together well. In the version of the virus that arose in China, Choe said, the outer part - which the virus needs to attach to a human receptor - frequently broke off. Equipped with this faulty lock pick, the virus had a harder time invading host cells.

"I think this mutation happened to compensate," Choe said.

Studying both versions of the gene using a proxy virus in a petri dish of human cells, Choe and her colleagues found that viruses with the G variant had more spike proteins, and the outer parts of those proteins were less likely to break off. This made the virus approximately 10 times more infectious in the lab experiment.

The mutation does not seem to lead to worse outcomes in patients. Nor did it alter the virus's response to antibodies from patients who had the D variant, Choe said, suggesting that vaccines being developed based on the original version of the virus will be effective against the new strain.

Choe has uploaded a manuscript describing this study to the website bioRxiv, where scientists can post "preprint" research that has not yet been peer reviewed. She has also submitted the paper to an academic journal, which has not yet published it.

The distinctive infectiousness of the G strain is so strong that scientists have been drawn to the mutation even when they weren't looking for it.

Neville Sanjana, a geneticist at the New York Genome Center and New York University, was trying to figure out which genes enable SARS-CoV-2 to infiltrate human cells. But in experiments based on a gene sequence taken from an early case of the virus in Wuhan, he struggled to get that form of the virus to infect cells. Then the team switched to a model virus based on the G variant.

"We were shocked," Sanjana said. "Voilà! It was just this huge increase in viral transduction." They repeated the experiment in many types of cells, and every time the variant was many times more infectious.

Their findings, published as a preprint on bioRxiv, generally matched what Choe and other laboratory scientists were seeing.

But the New York team offers a different explanation as to why the variant is so infectious. Whereas Choe's study proposes that the mutation made the spike protein more stable, Sanjana said experiments in the past two weeks, not yet made public, suggest that the improvement is actually in the infection process. He hypothesized that the G variant is more efficient at beginning the process of invading the human cell and taking over its reproductive machinery.

Luban, who has also been experimenting with the D614G mutation, has been drawn to a third possibility: His experiments suggest that the mutation allows the spike protein to change shape as it attaches to the ACE2 receptor, improving its ability to fuse to the host cell.

Different approaches to making their model virus might explain these discrepancies, Luban said. "But it's quite clear that something is going on."

Unanswered questions

Although these experiments are compelling, they're not conclusive, said Kristian Andersen, a Scripps virologist not involved in any of the studies. The scientists need to figure out why they've identified different mechanisms for the same effect. All the studies still have to pass peer review, and they have to be reproduced using the real version of the virus.

Even then, Andersen said, it will be too soon to say that the G variant transmits faster among people.

Cell culture experiments have been wrong before, noted Anderson Brito, a computational biologist at Yale University. Early experiments with hydroxychloroquine, a malaria drug, hinted that it was effective at fighting the coronavirus in a petri dish. The drug was touted by President Trump, and the Food and Drug Administration authorized it for emergency use in hospitalized covid-19 patients. But that authorization was withdrawn this month after evidence showed that the drug was "unlikely to be effective" against the virus and posed potential safety risks.

So far, the biggest study of transmission has come from Bette Korber, a computational biologist at Los Alamos National Laboratory who helped build one of the world's biggest viral genome databases for tracking HIV. In their paper published this week, Korber's team argues that the G variant "may have a fitness advantage" that explains its overwhelming dominance.

Using two statistical approaches, the researchers analyzed some 30,000 sequences from across the world; they found that most places where the original virus was dominant before March were eventually taken over by the mutated version. This switch often took place in a matter of weeks. This was especially apparent in the United States: Ninety-six percent of early sequences here belonged to the D variant, but by the end of March, more than two thirds of sequences carried the G amino acid instead.

Korber's collaborators in the U.K. also found evidence that people with the G variant had more viral particles in their bodies. Although this higher viral load didn't seem to make people sicker, it might explain the G variant's rapid spread, the scientists wrote. People with more virus to shed are more likely to infect others.

Meanwhile, the paper describes two laboratory experiments confirming what Sanjana, Choe and others have found: the G variant was 3 to 6 times more infectious.

A preliminary version of the Los Alamos paper, which did not include these laboratory findings, drew intense scrutiny when it was released as a pre-print in the spring. Though the additional data and the credibility of peer review make the case for increased transmissibility even stronger, many scientists -- including Korber -- say more research is needed.

"There are so many biases in the data set here that you can't control for and you might not know exist," Andersen said. In a time when as many as 90 percent of U.S. infections are still undetected and countries with limited public health infrastructure are struggling to keep up with surging cases, a shortage of data means "we can't answer all the questions we want to answer."

Pardis Sabeti, a computational biologist at Harvard University and the Broad Institute, noted that the vast majority of sequenced genomes come from Europe, where the G variant first emerged, and the United States, where infections thought to have been introduced by travelers from Europe spread undetected for weeks before the country shut down. This could at least partly explain why it appears so dominant.

The mutation's success might also be a "founder effect," she said. Arriving in a place like Northern Italy - where the vast majority of sequenced infections are caused by the G variant - it found easy purchase in an older and largely unprepared population, which then unwittingly spread it far and wide.

Scientists may be able to rule out these alternative explanations with more rigorous statistical analyses or a controlled experiment in an animal population. And as studies on the D614G mutation accumulate, researchers are starting to be convinced of its significance.

"I think that slowly we're beginning to come to a consensus," said Judd Hultquist, a virologist at Northwestern University.

Solving the mystery of the D614G mutation won't make much of a difference in the short term, Andersen said. "We were unable to deal with D," he said. "If G transmits even better, we're going to be unable to deal with that one."

But it's still essential to understand how the genome influences the behavior of the virus, scientists say. Identifying emerging mutations allows researchers to track their spread. Knowing what genes affect how the virus transmits enables public health officials to tailor their efforts to contain it. Once therapeutics and vaccines are distributed on a large scale, having a baseline understanding of the genome will help pinpoint when drug resistance starts to evolve.

"Understanding how transmissions are happening won't be a magic bullet, but it will help us respond better," Sabeti said. "This is a race against time."
Correction: An initial version of this article gave an incorrect affiliation for Jeremy Luban. He is a virologist at the University of Massachusetts Medical School.

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This coronavirus mutation has taken over the world. Scientists are trying to understand why.

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July 2 When the first coronavirus cases in Chicago appeared in January, they bore the same genetic signatures as a germ that emerged in China weeks before. But as Egon Ozer, an infectious-disease specialist at the Northwestern University Feinberg School of Medicine, examined the genetic structure of virus samples from local patients, he noticed something different.

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Food for thought: How can these seemingly simple, proactive measures - washing our hands, physical distancing, wearing masks - be so powerful in constraining COVID-19?
No responses are needed at this time.

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Population Decline 1835

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Please respond to these discussion questions before or during Session 1.

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Please respond to these discussion questions before or during Session 1.

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Clicking on one of the links below will open a Google Doc dedicated to one of four questions. If you leave a comment there before or during the workshop, we can address your thoughts together.

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Question 1 | Click here to respond
In many cultures, text literacy, schooling, and deep cultural knowledge are reserved for the elite. What do you think motivated the aliʻi to mandate a school in every ahupuaʻa, to call for all to write down and share their knowledge?

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We are all in this together: He wa`a he moku, he moku he wa`a.

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We are all in this together: He wa`a he moku, he moku he wa`a.

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July 15, 2020, 3-5 pm HST

Click here to join ZOOM meeting

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Population change of Kona, Kaua`i and Ni`ihau 1835

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KONA, KAUAI, AND NIIHAU.
Aloha to you, O Tinker [Tineka]. This is a chart showing the number of people from Nualolo to Hanapepe. From 1831 to 1835, there was a great decrease of 1,992. This is the reasons for their decrease. Death is perhaps the biggest cause, but that is not all. In 1831, the alii were living here and their retinue; here as well were the teachers at that time. However, during this census in 1835, the alii were living on Oahu along with their ohua. And some people went from Waimea to Waioli to live with the new teacher there. So too some people from Koloa. For these reasons, the people here in Kona [Kauai] have sharply decreased. By Whitney [Wini].

(Kumu Hawaii, 12/23/1835, p. 204)

This entry was posted in Alii, Population and tagged Reuben Tinker, Samuel Whitney, Tineka, Wini by nupepa. Bookmark the permalink.

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Population change of Kona, Kauai and Niihau, 1835.

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POPULATION. KONA, KAUAI, AND NIIHAU. Adults Children All together Entire population in 1831 Nuololo 49 9 58 53 Miloli 39 3 42 55 Haeleele 10 5 15 11 Olapa 7 1 8 15 Kolo 66 23 89 85 Ohaiula 6 3 9 9 ...

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Food for thought: As we reopen our state and the economy, why is it still important/more important than ever to maintain these practices?
No responses are needed at this time.

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Make Ma `Ewa - 1853

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DEATHS IN EWA. The Census Taker of those who died from "mai puupuu liilii" [smallpox] in Ewa and in Waianae announced thus: The number of deaths here in Ewa are 1,214. in Waianae, 170. Of the portions of deaths in Ewa, the greatest is in Waianae.

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Food for thought: How can understanding the science phenomena behind washing our hands, physical distancing, and wearing a mask drive us to make the right decisions in constraining COVID-19 to stop the spread?
No responses are needed at this time.

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What can we learn from the past to drive our decisions today?

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Participants will be able to explain how their mo`okuauhau would be affected if they were living during the epidemic of 1835 - 1861.

Task:
Participants will introduce themselves and post a snap shot of a rough outline/draft of a family tree with  grandparents, parents, children, etc. linking the mo`okuauhau (family genealogy) to the discussion.

Comment Below:
1. What new learning from the 1835 Nūpepa resource did you extract?

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Smallpox 1881

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Smallpox in Honolulu nei.

O Hawaiian Nation, the steamship "Meifoo" from China, entered into Honolulu Harbor, and within its passengers, there are six Chinese who are suffering from that frightful annihilating disease of 1853-4, that illness that took ten-thousand of our beloved people. There are two of them with the disease that are very bad, and four will perhaps live.

We understand the the Board of Health has decided to quarantine the sick at the hospital at Kahakaaulana, and for those that are not sick, to quarantine them at Kakaako, while detaining the agents of the ship to pay all expenses should the disease spread here after.

We call out to our beloved nation, let us watch out for ourselves, and let us not associate much with these foreigners, for the time for concern has come upon our nation, because this disease was brought here and it is at our own door. Should we be saved, it is only through the love of the Almighty.

Do recall, O Leaders of our Nation, as well as the members of the Board of Health, that the cabinet of Gerrit P. Judd [Kauka] was ended because of this, and we fear that maybe there will be one that follows the first one in the very near future. Only time will tell.

As we were returning to print the paper for today, it was heard that Smallpox appeared in the body of a haole boy of this town. Here is a query, a question: what of this?

(Ko Hawaii Pae Aina, 2/5/1881, p. 2)

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Smallpox in Honolulu nei. O Hawaiian Nation, the steamship "Meifoo" from China, entered into Honolulu Harbor, and within its passengers, there are six Chinese who are suffering from that frightful annihilating disease of 1853-4, that illness that took ten-thousand of our beloved people. There are two of them with the disease that are very bad,...

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Food for thought: What part does data, and metrics play during a pandemic? How can we make use of the information gathered across space and time to help us make the best, data-driven decisions?
No responses are needed at this time.

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READING #4             Hawai`i's Story By Hawai`i's Queen        

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READING #4             Hawai`i's Story By Hawai`i's Queen        

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Princess Lili`uokalani Closes the Port of Honolulu in 1881

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The Hawaiian Kingdom, Nūpepa, and Public Health Past, Present, and Future

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The Hawaiian Kingdom, Nūpepa, and Public Health Past, Present, and Future

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July 13, 2020, 3-5 pm HST
Click here to join ZOOM meeting
The ZOOM opens at 2:30 - talk story with us!

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What are the factors that drive people, and leaders to make decisions when faced with the challenges of this novel coronavirus?  

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What are the factors that drive people, and leaders to make decisions when faced with the challenges of this novel coronavirus?  

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The island of Kauai boasts more beaches than any other Hawaiian Island, something officials kept in mind when making decisions to keep the "Garden Isle" free of the coronavirus.

"We had to do some pretty unique out-of-the box creative solutions to address our challenges and problems," said Mayor Derek Kawakami.

Unique, like a beach park user fee.

"I initially proposed it to be $5,000," he revealed. "Then our attorneys came back and said: 'Mayor, you absolutely cannot charge $5,000.'"

Kawakami explained, "We're really trying to discourage visitors from sight-seeing and being on the beach. Here I am telling all of our people that live here: 'Hey stay home. If you're essential, go work and go home, you cannot hang on the beach.' We're trying to avoid conflict as well. What would our people feel if they're seeing visitors on the beach and they're not allowed to?"

He ended up agreeing to a more reasonable fee: $5 to access the beach, limited to 100 permits.

Kawakami also implemented an island-wide curfew. Residents could not leave their homes from 9 p.m. to 5 a.m. The curfew was lifted in May.

He says the emergency measures resulted in fewer 911 calls and less visits to the emergency room.

For 10 weeks, there were no new cases of coronavirus on the Garden Isle- until recently.

The state Department of Health confirmed a household cluster of cases, bringing the statewide total to 29.

By comparison, Hawaii island had 85 cases since the pandemic began. Maui County (including the islands of Moloka'i and Lana'i) reported 122. Oahu, the most densely populated island, has had 568 cases.

Health experts think the recent spike in cases is because residents are relaxing safe practices, such as social distancing or frequent hand-washing.

Meanwhile, Kawakami says he and his team are constantly making choices to keep Kauai's 72,000 residents safe.

"A lot of our decision making was based on instinct. There was so much information we didn't have. We tried to look at other countries where the pandemic hit, we observed what those leaders were saying. We followed that, took that model and put it all together."

But with restrictions loosening across the islands, the lifting of the state's mandatory 14-day inter island quarantine has some Kauai folks worried.

"We were so protected and had no new cases for 2 months. I am dreading opening the island up to inter island travel," said resident J Robertson.

"I know there are other incidents (of COVID-19) on other islands. If people visit us, they may bring it with them. We have no sure guarantee it won't happen. But it is good to see us open up, we have to face reality. I would love to have family visit from mainland. We have to take a first step. Doesn't mean I'm in love with it, but let's try it, and see how we do."
THE LATEST ON KHON2

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Kauai Mayor on pandemic: "We had to do some unique, out-of-the-box creative solutions to address our challenges"

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The island of Kauai boasts more beaches than any other Hawaiian Island, something officials kept in mind when making decisions to keep the "Garden Isle" free of the coronavirus. "We had to do some pretty unique out-of-the box creative solutions to address our challenges and problems," said Mayor Derek Kawakami.

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Question 2 | Click here to respond What do Hawaiian newspapers in Hawaiian and English reveal about infectious disease and the role of Hawaiian and western knowledge and values in public health policies and outcomes?

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Question 3 | Click here to respond What can we do as community members to address concerns about COVID-19 in Hawaiʻi?

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Question 4 | Click here to respond
In a pandemic, public health relies on community knowledge, values, and actions. If it is important for our COVID-19 lessons to move from the classroom into the community, what are ways to do this and assess the transfer?

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Ask questions/wonders, make comments, or start discussions for Session 2 by clicking the "+" sign below!

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Ask questions, make comments, or start discussions for Session 1 by clicking the "+" sign below!

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Nūpepa Preview | Hawaiʻi health timeline and major events.

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Video: What mindset, intent, and perspectives drove the Ali`i to make these decisive decisions?  

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Video: What mindset, intent, and perspectives drove the Ali`i to make these decisive decisions?  

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American Samoa Dodged a Pandemic in 1918. Here’s What We Learned.

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Spanish Flu 1920

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Video: How do the decisions of our Kanaka `Ōiwi, our Ali`i from the past compare to the decisions that are being made today?

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Video: How do the decisions of our Kanaka `Ōiwi, our Ali`i from the past compare to the decisions that are being made today?

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Video: How are kanaka polarizing the essence of  "ALOHA" through scrupulous acts of caring in the middle of a pandemic? 

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Video: How are kanaka polarizing the essence of  "ALOHA" through scrupulous acts of caring in the middle of a pandemic? 

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Ask questions, make comments, or start discussions for Session 3 by clicking the "+" sign below, or on the Session 3 Padlet!

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Ask questions, make comments, or start discussions for Session 4 by clicking the "+" sign below!

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Nūpepa Preview | Article with commentary on 1881 Smallpox quarantine regulations.

English translation provided:
Ko Hawaii Pae Aina, Buke IV, Helu 1, Aoao 2. Ianuari 1, 1881.

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Nūpepa Preview | Princess Lili'uokalani sets an example by following strict quarantine rules.

Hawaiian Gazette, Volume XVII, Number 30, Page 2. July 27, 1881.

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From Knowledge to Practice: Teaching for Resilience in the Face of Change

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From Knowledge to Practice: Teaching for Resilience in the Face of Change

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July 20, 2020, 3-5pm HST
Click here to join ZOOM meeting

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See Kaleoʻs full presentation here:

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COVID - 19 The Latest Hawaiian Epidemic - I ka wā ma mua, ka wā ma hope - Kaleo Hanohano

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See How-To: Embedding Audio in a Google Slides Presentation here:

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COVID-19: PD Session 3 | Hoʻopaʻa Leo no ka Heluhelu Nūpepa

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Workshop outline and a list of discussed resources found here:
Session 3 | Outline and Syllabus

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Please look over the Preview resources below. This information will help to set the stage for discussion during Session 4.

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Social distancing is one of the main practices recommended to mitigate the spread of the novel coronavirus.

However, as the number of cases rises and more people are staying home, social distancing could be a problem for people living in multigenerational homes, especially those who live with grandparents in the most at-risk age group.

Business Insider ranked the states with the largest share of multigenerational households using data from the US Census Bureau.

Hawaii was at the top of the list, where 7.72% of households are multigenerational.

Visit Business Insider's homepage for more stories.

The CDC recommends people social distance from one another to reduce the spread of the novel coronavirus. However, this may be more difficult for people living in homes with multiple family members, particularly elderly parents.

With more family members working from home, children taking online courses during this time, or grandparents taking care of children, it may be harder to social distance or self-isolate in multigenerational households.

"While grandparents are being advised to isolate themselves physically from grandchildren, it is nearly impossible for older caregivers to distance themselves from the children they are raising. You are on the front line for your family every day," Generations United, a nonprofit that supports improving the lives of all generations through public policy, intergenerational programs, and workshops on intergenerational issues, wrote in a coronavirus fact sheet.

Having larger families under one roof during the pandemic might put more members at risk if someone in the household has coronavirus. A recent Gothamist analysis found a positive relationship between the average number of people living in a home together and the number of coronavirus cases in ZIP codes around New York City. That is, the larger the typical household size in a neighborhood, the larger the number of confirmed coronavirus cases.

While COVID-19, the disease caused by the novel virus, can affect people of any age, it's especially dangerous for older adults. A recent Business Insider article looked at the large elderly population in Florida who could be infected by younger asymptomatic carriers of coronavirus.

That article looked at conclusions from a research paper from the University of Oxford that found one reason Italy was so vulnerable to the virus was because young people commute to work from multigenerational homes that could put the older population more at-risk.

Although not as common as other living situations, the number of multigenerational homes has been on the rise in the recent years in the United States.

According to a Pew Research Center analysis using individual-level data from the 2016 American Community Survey on Minnesota Population Center's Integrated Public Use Microdata Series program, 20% of Americans, or 64 million, lived in multigenerational households.

Pew defines multigenerational households as households that include "two or more adult generations, or including grandparents and grandchildren younger than 25." That is, these households could include people part of the most vulnerable age group to becoming severely ill from the coronavirus - adults over 65.

There's been a big rise in multigenerational households in the US over the last few decades. In 1990, 14% of Americans, or 34.4 million, lived in multigenerational households. The number of these kinds of households particularly rose during and after the Great Recession, according to Generations United, due to financial reasons like family members losing their jobs.

Pew notes that multigenerational housing is more common in some racial and ethnic groups, although it has been on the rise across all groups. The ethnic and racial groups with the largest share are Asians at 29% and Hispanics at 27%.

We took a look at Census data at the household, rather than population level, to get a sense of where in the US multigenerational households are more common. More than 4.6 million households were multigenerational in 2018. The Census Bureau defines multigenerational household as having three or more generations in a household.

Using 2018 data from US Census Bureau's 1-year American Community Survey estimates, we calculated the share of multigenerational households in each state. Hawaii had the largest share, where 7.72% of households were multigenerational. Florida has the 13th highest share at 4.02%.

Read on to find out the 14 states with the largest share of multigenerational households in the US:

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Social distancing may be harder for families who live with elderly relatives. Here are the 15 states with the largest share of multigenerational households.

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Social distancing is one of the main practices recommended to mitigate the spread of the novel coronavirus. However, as the number of cases rises and more people are staying home, social distancing could be a problem for people living in multigenerational homes, especially those who live with grandparents in the most at-risk age group.

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COVID-19 Preview | Video about the spread of infectious diseases.

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Nūpepa Preview | Announcement by the Board of Health regarding Smallpox Vaccination

English translation provided:

Ko Hawaii Pae Aina, Buke IV, Helu 4, Aoao 2. Ianuari 22, 1881.

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COVID-19 Preview | Interactive article containing information about SARS-CoV-2 contagion.

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It seems simple: Stop travel, stop the virus from spreading around the world.

Here's why that didn't work.

The true size of the outbreak was much larger even then - an invisible network of nearly 1,000 cases, or perhaps several times more.

Estimates from Trevor Bedford, Hutchinson Center and University of Washington, and Lauren Gardner, Johns Hopkins University

With each patient infecting two or three others on average, even a perfect response may not have contained the spread.

But Chinese officials did not alert the public to the risks in December. It wasn't until Dec. 31 that they alerted the World Health Organization and released a statement - and a reassurance.

"The disease is preventable and controllable," the government said.

The timing of the outbreak could not have been worse. Hundreds of millions of people were about to travel back to their hometowns for the Lunar New Year.

Here's how people moved around on Jan. 1, according to a Times analysis of data published by Baidu and major telecoms, which tracked the movements of millions of cell phones.

Travel volume on Jan. 1.Minor routes not shown.

At least 175,000 people left Wuhan just on that day, we found.

The departures from Wuhan accelerated over the next three weeks. About7 million people left in January, before travel was restricted.

Thousands of travelers were infected.

Red dots show proportion of infected travelers, based on estimates from Jeffrey Shaman, Columbia University.

By the time Chinese officials acknowledged the risk of human-to-human transmission on Jan. 21, local outbreaks were already seeded in Beijing, Shanghai and other major cities.

Two days later, the authorities locked down Wuhan, and many cities followed in the next few weeks. Travel across China nearly stopped.

But local outbreaks were already growing quickly.

As the outbreak moved across China in early January, international travel continued as normal.

Recent air travel, based on first quarter 2019 data from O.A.G.

About 85 percent of infected travelers went undetected, researchers believe. But they were still contagious.

Infected people, based on estimates by Jeffrey Shaman

It was too late. Outbreaks were already growing in over 30 cities across 26 countries, most seeded by travelers from Wuhan.

The virus started spreading locally, moving easily in confined spaces like churches and restaurants, and infecting people who had not traveled to China - the start of a pandemic.

In fact, as China started systematically testing, tracing and isolating patients, new cases there declined dramatically, showing that it was possible to slow the virus. Similar measures slowed the spread in Singapore, Hong Kong and South Korea.

Notes:
The cases shown in each world city include those in the broader metropolitan area or region and include patients who were transferred and treated there.

Data sources:
Travel patterns across China are based on data published by Baidu, and data from two Chinese telecoms published by Cao et al., " Incorporating Human Movement Data to Improve Epidemiological Estimates for 2019-nCoV." Both sources tracked the movements of cell phones.

Estimates of the size of the early outbreak in Wuhan are from Trevor Bedford, associate professor, Fred Hutchinson Cancer Research Center and the University of Washington; Bedford, "Phylodynamic estimation of incidence and prevalence of novel coronavirus infections through time"; and Lauren Gardner, associate professor and co-director of the Johns Hopkins Center for Systems Science and Engineering; Gardner et al., "Update January 31: Modeling the Spreading Risk of 2019-nCoV."

Estimates of the number of infected people who left Wuhan are from Jeffrey Shaman, professor of environmental health sciences at Columbia; and Li et al., "Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus."

Normal air travel patterns from Wuhan are from 2019 data from OAG. Travel patterns in 2020 are from Cirium.

Case data from Times reporting; local governments and health officials; The Center for Systems Science and Engineering at Johns Hopkins University; National Health Commission of the People's Republic of China; and the World Health Organization.

Additional sources:
* Elizabeth Halloran, professor of biostatistics at the University of Washington and researcher at the Hutchinson Center
* Alessandro Vespignani, professor and director of the Network Science Institute at Northeastern University
* Chinazzi et al., "The effect of travel restrictions on the spread of the 2019 novel coronavirus outbreak"
* Arthur L. Reingold, professor and division head of epidemiology and biostatistics at the University of California at Berkeley
* Benjamin F. Maier and Dirk Brockmann, "Effective containment explains sub-exponential growth in confirmed cases of recent COVID-19 outbreak in Mainland China"

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It seems simple: Stop travel, stop the virus from spreading around the world. Here's why that didn't work. The true size of the outbreak was much larger even then - an invisible network of nearly 1,000 cases, or perhaps several times more.

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COVID-19 Preview | The Color of Coronavirus - Deaths by Race and Ethnicity in the United States.

Reflect: Why might R naught (R ₀), the average number of people infected by a sick/asymptomatic person, differ by race or place?

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You value and rely on the work of the APM Research Lab. And we rely on you, especially
during this difficult time. If you can, please support our work with a donation today.

Our ongoing Color of Coronavirus project monitors how and where COVID-19 mortality is inequitably impacting certain communities-to guide policy and community responses to these disproportionate deaths. The coronavirus has claimed more than 240,000 American lives through Nov. 10, 2020-nearly 25,000 more than our last update four weeks ago. We have documented the race and ethnicity for 96% of the cumulative deaths in the United States.

Our latest update reveals that Black and Indigenous Americans continue to suffer the greatest loss of life-with both groups now experiencing a COVID-19 death toll exceeding 1 in 1,000 nationally.

We also adjust these mortality rates for differences in the age distribution of populations, a common and important tool that health researchers use to compare diseases that affect age groups differently. At the national level, this results in even larger documented mortality disparities- Black, Indigenous and Latino Americans all have a COVID-19 death rate of triple or more White Americans, who experience the lowest age-adjusted rates.

The APM Research Lab has independently compiled these death statistics. ( Learn more about how.) The result is the most robust and up-to-date portrait of COVID-19 mortality by race available anywhere, with a lens on inequitable deaths. We are now presenting mortality data over time for all states -not just cumulatively-to help us monitor the virus' changing impacts throughout fall and winter. We have been tracking these deaths for seven months now, revealing COVID-19's growing toll on all Americans, but with the heaviest losses among Black, Indigenous and Latino Americans.

KEY FINDINGS (from data through Nov. 10):

Of the more than 240,000 U.S. deaths catalogued in this Color of Coronavirus update, this is the number of deaths documented by group through Nov. 10, 2020: Asian (8,687), Black (46,211), Indigenous (2,251), Latino (46,912), Pacific Islander (334) and White (123,429). Additionally, 5,373 deaths are recorded only as "other" race (and likely include more Indigenous people and Pacific Islanders), while another 8,510 had an unknown race.

In the past four weeks, the death rate among Indigenous people has accelerated the fastest (shown by a steeper slope in the graph above).

These are the documented, nationwide actual mortality impacts from COVID-19 data (aggregated from all U.S. states and the District of Columbia) for all race groups:

1 in 875 Black Americans has died (or 114.3 deaths per 100,000)

1 in 925 Indigenous Americans has died (or 108.3 deaths per 100,000)

1 in 1,275 Latino Americans has died (or 78.5 deaths per 100,000)

1 in 1,325 Pacific Islander Americans has died (or 75.5 deaths per 100,000)

1 in 1,625 White Americans has died (or 61.7 deaths per 100,000)

1 in 2,100 Asian Americans has died (or 47.6 deaths per 100,000)

Black Americans continue to experience the highest actual COVID-19 mortality rates nationwide-about two or more times as high as the rate for Whites and Asians, who have the lowest actual rates. Indigenous Americans' death rate is just slightly lower than Blacks.

If they had died of COVID-19 at the same actual
rate as White Americans, about 21,200 Black,
10,000 Latino, 1,000 Indigenous and 70 Pacific Islander Americans would still be alive.

Adjusting the data for age differences in race groups widens the gap in the overall mortality rates between all other groups and Whites, who have the lowest rate. It also reveals that Indigenous people have suffered the greatest losses, accounting for age differences, followed closely by Blacks and Latinos. Compared to Whites, the latest U.S. age-adjusted COVID-19 mortality rate for:

Indigenous people is 3.2 times as high

Blacks is 3.0 times as high

Latinos is 3.0 times as high

Pacific Islanders is 2.3 times as high, and

Asians is 1.1 times as high.

(A fuller discussion of our indirectly age-adjusted rates follows.)

HOW TO EXAMINE THE DATA:

1. EXPLORE CUMULATIVE MORTALITY RATES BY GEOGRAPHY, COMPARING GROUPS

We've presented the data we've collected for the nation overall and each state as:

2. EXPLORE NUMBER OF DEATHS OR RATES OVER TIME, COMPARING GROUPS

Explore actual mortality rates and total deaths by race and ethnicity for any state or Washington, D.C., beginning in early June 2020.

3. EXPLORE CUMULATIVE FINDINGS BY GROUP, COMPARING GEOGRAPHIES

Examine the differences for one group at a time across all states with available data. For each group, we provide contextual data and a visual comparison against White Americans' rates using the age-adjusted data, to examine where disparities relative to Whites are the greatest.
For more context about the shortcomings of some of the data, please read our note about Indigenous, Pacific Islander, Multiracial and Other Race Americans. If you'd like to examine the percentage of deaths compared to the percentage of population by racial group for each state (which previously appeared on this site), you can find this data in our complete data file.

&plus; Understanding Age-Adjusted Mortality Rates

Click to read more

While there are many features of the novel coronavirus that are still unclear, this we know with certainty: The risk of dying from COVID-19 rises sharply with advanced age. Fewer than 4 in 100,000 Americans under age 45 have died from the virus, according to data submitted to the CDC through Oct. 31. The COVID-19 death rate for Americans age 45-54 rises to 28 per 100,000; more than doubles for those age 55-64 (65 per 100,000); and more than doubles again among those age 65-74 (154 per 100,000). Among Americans age 75 and older, the death toll is exceedingly high: 571 people per 100,000, as shown below.

Due to this steep age gradient to COVID-19 mortality, it is important to consider the varying age distributions of America's racial and ethnic groups. A higher share of White Americans are in the older age brackets than any other group. To illustrate this, consider that the median age of non-Hispanic White Americans is 44 years, according to the latest Census Bureau data. The comparable figure for all populations of color is considerably lower-for Asians (37), Blacks (34), Pacific Islanders (33), Indigenous (32) and especially Latinos (30), half of whom have not yet reached their 30th birthday.

Even within the same race groups, the age distribution varies-with retirement destination states such as Florida having a much higher share of older adults within their White population, for example.

Black, Indigenous and Latino Americans all have a COVID-19 death rate of triple or more the rate of White Americans (age-adjusted).

So, to remove the role of age differences from COVID-19 mortality rates, we have also produced age-adjusted rates. Because mortality data is not available for all states by race and age jointly (which is preferred), we have used indirect standardization to calculate these rates. See our NOTES section for details and cautions about our method.

Adjusting the racial data we've collected for age differences increases the COVID-19 mortality rate for all racial and ethnic groups except for Whites, who experience a decrease, as shown below. Latinos' rate rises the most following age-adjustment, revealing that the virus is impacting Latinos far more than would be expected based on their youhtful age profile.

After age-adjusting, the gap between Black and White mortality widens-from 1.9 to 3.0 times as high. Relative to Whites, mortality rates for Indigenous people also rise to 3.2 times as high (the highest rate) and Latinos to 3.0 times as high. Rates for Pacific Islanders also grow, to 2.3 times as high as Whites. Finally, the Asian mortality rate-which was slightly below the White rate-rises slightly above the White death rate (1.1 times as high), when age is taken into account. Put another way, Indigenous, Black and Latino Americans all have COVID-19 death rates of triple or more the rate of White Americans (age-adjusted).

What does this mean? It indicates that many younger Americans who are Black, Latino, Indigenous or Pacific Islanders are dying of COVID-19-driving their mortality rates far above White Americans'. Despite their relative youthfulness (a protective factor against COVID), their death rates are elevated. As Brookings Institution has reported, "In every age category, Black people are dying from COVID at roughly the same rate as White people more than a decade older."

It is important to note that, while age-adjusted mortality rates help us remove the influence of age differences in racial groups to examine disparities in outcomes, they are not the actual mortality rates experienced by these groups.

CUMULATIVE MORTALITY RATES

Review cumulative mortality rates-both actual and age-adjusted-for the District of Columbia or any state by changing the dropdown menu below. Rates were not calculated when there were fewer than 15 deaths for a particular group (resulting in a "0" value in the graph below). Rates for Indigenous and Pacific Islander residents could only be calculated for some states. Additionally, rates were not calculated for multiracial people, nor those identified as "Other" race.

ACTUAL MORTALITY RATES OVER TIME

REPORTED DEATHS BY RACE & ETHNICITY OVER TIME

Explore how the distribution of American lives lost varies by race and ethnicity for all states, beginning with totals in early June. Select a state to see the cumulative trend graphed similarly.

Users can examine the cumulative death totals, grouped by racial and ethnic group, for their state(s) of interest below. Depending on the geography, the "Other" group in this graph may include Indigenous people, Native Hawaiian or other Pacific Islanders, Multiracial people, those identified as "Other" race, and in a few cases, Asians. (This is due to uneven reporting by states.) Please see the notes below the graph, or request our complete data file for additional information.

Search by state

(Use Shift + Ctrl to select more than one state)

COVID-19 deaths by race and ethnicity, through Nov. 10, 2020

FOCUS ON BLACK AMERICANS

Lives lost to date

Actual mortality rate

Age-adjusted mortality rate

NOTE ABOUT INDIGENOUS, PACIFIC ISLANDER, MULTIRACIAL & OTHER RACE AMERICANS

COVID-19 mortality data for Americans who are Indigenous, Native Hawaiian or Other Pacific Islanders, Some Other race, or Multiracial is inconsistently reported by many states. Users may request our complete data file to better understand the loss of life in these groups as well. Users are cautioned that Indigenous and Pacific Islander people appear in the "Other" group in many states, along with Multiracial Americans and in a few cases, Asian Americans. We continue to advocate for complete, consistent reporting for all racial and ethnic groups.

HOW DID THE APM RESEARCH LAB OBTAIN THE DATA?

The APM Research Lab has independently compiled and analyzed these mortality data for Washington, D.C. and all states. At the time of this writing, only North Dakota and West Virginia did not yet publicly release COVID-19 mortality data by race and ethnicity on their state health department websites. For these two states, we have supplemented our data file using data reported to the National Center for Health Statistics, a division of the CDC. Note that these data have some time lag and often suppress data (i.e., hide for privacy's sake), especially for groups other than Whites. Nonetheless, their inclusion improves the picture of COVID-19 mortality for the entire United States.

In the case where a state is publicly releasing its mortality data, but the CDC data was found to be more robust, we have also opted to use the CDC data. This is the case for the following states: Florida, Indiana, Iowa, Kansas, Kentucky, Missouri, Montana, Nevada, Oklahoma, Pennsylvania, South Carolina and Texas, as well as the balance of New York outside of New York City (which is reported separately). The result is the most comprehensive and up-to-date portrait of COVID-19 mortality by race and ethnicity for the U.S.

Racial detail on Americans who have died of COVID-19 was available for 96% of all deaths to date-a vast improvement from the 38% that were known when our Color of Coronavirus project began tracking these data in early April.

As of Tuesday, Nov. 10, more than 240,000 Americans had died of COVID-19. Data about race and ethnicity is available for 96% of these deaths.

However, it should be noted that even among states releasing COVID-19 data by the race of the deceased, the data is often incomplete or nonuniform. Numerous states release only percentages, not counts of deaths, requiring us to estimate the data rather than know precisely how communities have been affected. Many states also fail to report smaller populations uniquely, obscuring the picture for Indigenous Americans, Pacific Islanders and other groups. All of these reporting shortcomings render our picture of the virus' toll incomplete and make it more difficult to assess the disproportionate impacts on communities.
We call on state and local health departments to release timely data about COVID-19 deaths with as complete racial and ethnic detail as is possible. As the data reporting improves, so too will our understanding of the devastating impact of this disease. This will inform states and communities about how to direct resources more equitably as well.

SOURCES

State and local health department or other governmental reporting bodies, and the National Center for Health Statistics. In a few cases, we have upwardly revised total counts of deaths (not by race) to conform with the New York Times' latest database. Estimates from the U.S. Census Bureau's 2018 American Community Survey were used for calculations regarding population by race/ethnicity and age. Importantly, we have aligned population data with each geography's method of collecting and reporting data (i.e., if Latino ethnicity is overlapping with race groups or discrete, and whether race groups are reported "alone" or "alone or in combination"). All calculations and subsequent analysis by APM Research Lab.

NOTES

Deaths of unknown race are excluded prior to calculating percentages and rates. Presumed or probable deaths due to COVID-19 are included here in our death counts. Many of the data sources have labeled their data preliminary. In some cases, percentages will differ from those given by health departments due to our method of excluding deaths with an unknown race from the denominator before calculating percentages. Additionally states employ varying collection methods regarding ethnicity data, which results in percentages summing to more than 100%. Where states have reported only percentages, we have estimated deaths by racial subgroups; these deaths may differ by small amounts from actual due to rounding errors. States can improve this reporting by releasing complete data.
Data for Indigenous, Native Hawaiian and Other Pacific Islanders, and other races are tallied separately in some states, but exist in "other" in other states, due to inconsistent reporting among states.

Mortality rates are presented in two ways on this page: 1) As "crude" rates, meaning no adjustment has been made to standardize varying age distributions in the populations. These are labeled "actual mortality rates," as they reflect the actual death rates experienced in the population groups. 2) As indirectly age-adjusted mortality rates. Because the White population is older on balance in nearly all locations, age-adjusting generally widens disparities between Whites and other populations.
To create our age-adjusted death rates by race and ethnicity, we first calculated an "expected" death rate for each race group by state and the nation overall. We did so by multiplying the latest national age-specific death rates from COVID-19 by age-specific population shares for each race group within each of the geographies (sourced from the 2018 American Community Survey). We then divided the crude death rates for each race and geography by the expected race-based death rate we calculated (resulting in Standard Mortality Ratios), and finally multiplied by the nationwide overall crude death rate. The result is an Indirect Adjusted Death Rate (IADR) of COVID-19 by race.

We indirectly adjusted these data for age because direct age-adjustment was not possible; timely and complete COVID-19 mortality data by race and age group is not being released for all or even most states. However, users are cautioned that indirect standardization is done to approximate the impact resulting from varying age distributions in cases because age-specific death rates are not available. Indirect standardization may deviate more from directly age-adjusted rates when comparing two populations that differ significantly in their age distribution, as race groups may. For this reason, data from individual states that are directly age-adjusted should be considered superior. For more on direct and indirect methods of standardization see this CDC publication.

Thoughts? Questions?

We want to hear from you! Leave us a message below.

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COVID-19 deaths analyzed by race and ethnicity - APM Research Lab

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COVID-19 has claimed more than 240,000 lives in the U.S. This page documents and analyzes all racial and ethnic background data for COVID-19 deaths by state and the nation-especially to track the disproportionate mortality impacts of the coronavirus for Black, Latino, Indigenous and other Americans

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COVID-19 Preview | Video about inter-species viral transmission.
(Transcript of audio available)

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Transcript of "How do viruses jump from animals to humans?"

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TED Talk Subtitles and Transcript: At a Maryland country fair in 2017, farmers reported feverish hogs with inflamed eyes and running snouts. While farmers worried about the pigs, the department of health was concerned about a group of sick fairgoers. Soon, 40 of these attendees would be diagnosed with swine flu.

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COVID-19 Preview | CDC article. How Vaccines Work - Making the Vaccine Decision & Addressing Common Concerns

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Centers for Disease Control and Prevention

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Parents often have questions about the vaccines recommended for their children. Your child's doctor can answer any questions you might have. Most families decide to follow the recommended vaccination schedule.

Vaccines protect against diseases

Different vaccines work in different ways, but every vaccine helps the body's immune system learn how to fight germs. It typically takes a few weeks for protection to develop after vaccination, but that protection can last a lifetime. A few vaccines, such as those for tetanus or seasonal flu, require occasional booster doses to maintain the body's defenses.

Strengthening your baby's immune system

Immunity is the body's way of preventing disease. Because a baby's immune system is not fully developed at birth, babies face a greater risk of becoming infected and getting seriously ill. Vaccines help teach the immune system learn how to defend against germs. Vaccination protects your baby by helping build up their natural defenses.

Children are exposed to thousands of germs every day. This happens through the food they eat, the air they breathe, and the things they put in their mouth.

Babies are born with immune systems that can fight most germs, but some germs cause serious or even deadly diseases a baby can't handle. For those, babies need the help of vaccines.

Vaccines use very small amounts of antigens to help your child's immune system recognize and learn to fight serious diseases. Antigens are the parts of a germ that cause the body's immune system to go to work.

Vaccine ingredients

Today's vaccines use only the ingredients they need to be as safe and effective as possible. A vaccine could include any of these kinds of ingredients:

Adjuvants such as aluminum salts help boost the body's response to a vaccination. (Also found in antacids, antiperspirants, etc.)

Stabilizers such as sugars or gelatin help keep a vaccine effective after it is manufactured. (Naturally present in the body and found in foods such as Jell-O®.)

Formaldehyde helps prevent bacterial contamination during manufacturing. Formaldehyde is naturally present in the body at levels higher than vaccines. (Also found in the environment, preservatives, and household products.)

Thimerosal is a preservative used in the vaccine manufacturing process. It is no longer used to make any vaccine except multi-dose vials of the flu vaccine. Single dose vials of the flu vaccine are available as an alternative.

Vaccines are safe

Before a new vaccine is ever given to people, extensive lab testing is done. Once testing in people begins, it can still take years before clinical studies are complete and the vaccine is licensed.

After a vaccine is licensed, the Food and Drug Administration (FDA), CDC, National Institutes of Health (NIH), and other federal agencies continue routine monitoring and investigate any potential safety concerns.

CDC and the FDA take great care to make sure that a vaccine is safe both before it is licensed and after the public begins using it. Making sure that all vaccines are safe is a top priority for CDC.

Mild side effects are expected

Vaccines, like medicine, can have some side effects. But most people who get vaccinated have only mild side effects or none at all. The most common side effects include fever, tiredness, body aches, and redness, swelling, and tenderness where the shot was given. Mild reactions usually go away on their own within a few days. Serious, long-lasting side effects are extremely rare. We know they are rare because CDC tracks and investigates reports of serious side effects.

If you have questions or concerns about a vaccine, talk with your child's doctor. Learn about the safety of each recommended vaccine.

Why your child should get vaccinated

Vaccines can prevent common diseases that used to seriously harm or even kill infants, children, and adults. Without vaccines, your child is at risk of becoming seriously ill or even dying from childhood diseases such as measles and whooping cough.

MEASLES: The United States had more than 1,200 cases of measles in 2019. This was the greatest number of cases reported in the U.S. since 1992 and since measles was declared eliminated in 2000.

It is always better to prevent a disease than to treat one after it occurs.

Vaccination is a safe, highly effective, and easy way to help keep your family healthy.

The recommended vaccination schedule balances when a child is likely to be exposed to a disease and when a vaccine will be most effective.

Vaccines are tested to ensure they can be given safely and effectively at the recommended ages.

CDC vaccine information statements (VISs) explain both the benefits and risks of a vaccine. Your health care provider can give you the VIS for any vaccine.

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Learning the facts can help you address concerns about vaccinating your child. Here's information to help you make the vaccine decision.

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COVID-19 Preview | A graphical guide briefly explaining immunity, viral infection, and development of a vaccine against SARS-CoV-2.

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COVID-19 Preview | An article written to tell a cautionary tale.

Follow the science, not the politics.

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Arizona Teacher Dies of COVID-19 After Sharing Classroom with Colleagues Who Also Tested Positive - People

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Meanwhile, Education Secretary Betsy Devos said on Sunday that it should be "the rule" for students to return to schools in the fall

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COVID-19 Resource | The Johns Hopkins University & Medicine Coronavirus Resource Center

Reflect: 188 countries/regions are represented in this data. How does the U.S. compare to others in terms of case rate and deaths? How can politics and values affect decision-making, public health, behavior, and deaths?

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Johns Hopkins Coronavirus Resource Center

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COVID-19 Map - Johns Hopkins Coronavirus Resource Center

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Coronavirus COVID-19 Global Cases by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU)

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An interactive map of Hawaiʻi with current data and critical trends can be found in link below:
COVID-19 Resource | Explore the Hawaiʻi COVID-19 Dashboard

Reflect: What patterns appear by island, age, source, race?  What may be the reasons for patterns?

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Preview Resilience | Cooperation vs. Competition: 6 Tongan boys survive 15 months on kapu island

Reflect: What message does this true story have for us today? What knowledge, actions and values supported their health and survival?  How did they develop a sustainable and resilient mini-society?  Will we be able to?

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The real Lord of the Flies: what happened when six boys were shipwrecked for 15 months

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(For equity and access to masks)
Materials to prep if you would like to actively participate:

Old or outgrown t-shirt and/or

Outgrown, or single tube sock

Scissors

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Kaleo | ulalenagirl@gmail.com

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COVID-19 Resource | Current values for Rt, a key measure of how fast the virus is growing. It’s the average number of people who become infected by an infectious person.

The more Rt is above 1.0, the more rapidly the virus will spread. When Rt is below 1.0, the virus will stop spreading.

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Up-to-date values for Rt - the number to watch to measure COVID spread.

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We want to address your questions and concerns.

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We want to address your questions and concerns.

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You may also consider joining Alika and Ruben in public health research. Ask questions, make comments, or start discussions by clicking the "+" sign below!

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Preview | Video with brief explanations of immunity, vaccines, and viral strains in the COVID-19 case.

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Coronavirus immunity: Did Sweden's model fail? | COVID-19 Special

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Preview | Short video describing Swedenʻs strategy to mitigate coronavirus spread.

Related Article | Click here to read about Swedenʻs Public Health Experiment.

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You can enable subtitles (captions) in the video player

It is not business as usual, not in Sweden, not anywhere.

Sweden's approach to dealing with the coronavirus pandemic has drawn global attention totally disproportionate to the relatively small size that this Scandinavian country of 10m people. That's because Sweden was the only EU country not to lock down, keeping its schools, restaurants, and borders open. But whereas its Nordic neighbours have had low death tolls due to coronavirus, Sweden has had one of the highest per capita death rates in the world.

I'm driving into Sweden now. On this side of the bridge, in Norway, there was a lockdown. And after three months of coronavirus they've had about 240 deaths. On the other side of the bridge, in Sweden, however, in the same period, they've had about 4,700 deaths. That's 10 times higher than Norway per capita.

Of course, we're suffering. Everybody in the world is suffering right now in different ways. But Swedish healthcare, which I guess is very difficult to understand. It's taking care of this in a very, very good manner. It's a lot of work. It's a lot of stress on the personnel. And it's really a fight for them every day. But it's working.

Swedish authorities have tried to defend their strategy, insisting that people were largely working from home, keeping their distance, and washing their hands, as well as arguing that even if worse than Norway or Denmark, Sweden had fared better than Belgium, the UK, or Spain.

Here in Sweden's second city of Gothenburg, the public mood is mixed. Most people support the approach. But there are worries about the high number of deaths in care homes, such as this one, in Northeastern Gothenburg, where more than a quarter of residents have died in the past three months.

They thought the strategy would work. But I don't think that they saw how big the problems were with elderly homes and how the disease will spread so widely. The problem is that I think if we could have made it, as we should have done it, keeping distances, not sitting around in coffee shops or bars so closely, I don't think the infection would have spread that much. That's just my opinion.

Sweden's strategy was always based on the idea that their measures could last a very long time, unlike lockdowns. If a second wave hits other countries hard in the autumn and winter that approach could seem prescient. Otherwise, though, the high death toll relative to its Nordic neighbours could come back to haunt Sweden.

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Has Sweden's coronavirus strategy failed?

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You can enable subtitles (captions) in the video player It is not business as usual, not in Sweden, not anywhere. Sweden's approach to dealing with the coronavirus pandemic has drawn global attention totally disproportionate to the relatively small size that this Scandinavian country of 10m people.

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Preview | Video with a brief introduction to COVID-19 testing, provided by the FDA.

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You've probably heard a lot about coronavirus testing recently. If you think you have coronavirus disease 2019 (COVID-19) and need a test, contact your health care provider, local pharmacy, or local health department immediately. The FDA has been working around the clock to increase the availability of critical medical products, including tests for the coronavirus, to fight the COVID-19 pandemic. Learn more about the different types of tests and the steps involved.

Types of Tests

There are two different types of tests - diagnostic tests and antibody tests.

1. A diagnostic test can show if you have an active coronavirus infection and should take steps to quarantine or isolate yourself from others. Currently there are two types of diagnostic tests which detect the virus - molecular tests, such as RT-PCR tests, that detect the virus's genetic material, and antigen tests that detect specific proteins on the surface of the virus.

2. An antibody test looks for antibodies that are made by your immune system in response to a threat, such as a specific virus. Antibodies can help fight infections. Antibodies can take several days or weeks to develop after you have an infection and may stay in your blood for several weeks or more after recovery. Because of this, antibody tests should not be used to diagnose an active coronavirus infection. At this time researchers do not know if the presence of antibodies means that you are immune to the coronavirus in the future.

Different Types of Coronavirus Tests

Also known as...

Diagnostic test, viral test, molecular test, nucleic acid amplification test (NAAT), RT-PCR test, LAMP test

Rapid diagnostic test

(Some molecular tests are also rapid tests.)

Serological test, serology, blood test, serology test

How the sample is taken...

Nasal or throat swab (most tests)

Saliva (a few tests)

Nasal or throat swab

Finger stick or blood draw

Is another test needed...

This test is typically highly accurate and usually does not need to be repeated.

Positive results are usually highly accurate but negative results may need to be confirmed with a molecular test.

Sometimes a second antibody test is needed for accurate results.

What it shows...

Diagnoses active coronavirus infection

Diagnoses active coronavirus infection

Shows if you've been infected by coronavirus in the past

What it can't do...

Show if you ever had COVID-19 or were infected with the coronavirus in the past

Definitively rule out active coronavirus infection. Antigen tests are more likely to miss an active coronavirus infection compared to molecular tests. Your health care provider may order a molecular test if your antigen test shows a negative result but you have symptoms of COVID-19.

Diagnose active coronavirus infection at the time of the test or show that you do not have COVID-19

There are some new diagnostic tests available with alternative methods and benefits.

Rapid, point-of-care diagnostic tests use a mucus sample from the nose or throat but can be analyzed at the doctor's office or clinic where the sample is collected and results may be available in minutes. These may be molecular or antigen tests.

At-home collection tests, available only by prescription from a doctor, allow the patient to collect the sample at home and send it directly to the lab for analysis.

Saliva tests allow a patient to spit into a tube rather than get their nose or throat swabbed. Saliva tests may be more comfortable for some people and may be safer for health care workers who can be farther away during the sample collection.

Molecular Tests

Many companies and labs have developed tests to diagnose COVID-19 based on detection of the virus's genetic material in a sample from the patient's nose or throat. These steps may change as new technology becomes available, but currently the typical steps in molecular testing are:

1. A doctor, pharmacist, or other health professional orders a COVID-19 test. All COVID-19 tests, including those used with a home collection kit, require a prescription or order from a health professional.

2. You or a health care professional use a specialized swab to collect mucus from your nose or throat.

3. You or a health care professional put the swab in a sterile container and seal it for transport to a lab.

4. During the shipping process, most molecular test swabs must be kept within a certain temperature range so that the test will be accurate. The sample must arrive at the lab within 72 hours.

5. A lab technician mixes chemicals with the swab to extract the genetic material of any virus that may be on the swab.

6. The lab technician uses special chemicals, called primers and probes, and a high-tech machine to conduct several controlled heating and cooling cycles to convert the virus's RNA into DNA, and then make millions of copies of the DNA. Some tests use only one warming cycle to make copies of the DNA.

7. When DNA binds to specific probes, a special type of light is produced that can be seen by the machine and the test shows a "positive" result for infection with SARS-CoV-2, the virus that causes COVID-19.

The FDA continues to work with test developers to make more coronavirus tests available to more people in the future.

Molecular diagnostic tests that detect the genetic material of the virus are commonly used for diagnosing COVID-19 or active coronavirus infection. But no test is 100% accurate all of the time. Some things that may affect the test's accuracy include:

You may have the virus, but the swab might not collect it from your nose or throat.

The swab or mucus sample may be accidentally contaminated by the virus during collection or analysis.

The nasal or throat swab may not be kept at the correct temperature before it can be analyzed.

The chemicals used to extract the virus genetic material and make copies of the virus DNA may not work correctly.

Antigen Tests

Antigen tests usually provide results diagnosing an active coronavirus infection faster than molecular tests, but antigen tests have a higher chance of missing an active infection. If an antigen test shows a negative result indicating that you do not have an active coronavirus infection, your health care provider may order a molecular test to confirm the result.

Antibody (Serology) Tests

Antibody tests may provide quick results, but should not be used to diagnose an active infection. Antibody tests only detect antibodies the immune system develops in response to the virus, not the virus itself. It can take days to several weeks to develop enough antibodies to be detected in a test.

How Coronavirus Tests May Be Used

Americans rely on the FDA to provide an independent review of medical products, such as drugs, diagnostic tests, and other medical devices. During a public health emergency like the COVID-19 pandemic there is an urgent need for products to diagnose, treat or prevent a medical threat. There are two ways a coronavirus test might be used for this emergency:

1. Emergency Use Authorization (EUA)

In certain types of emergencies, the FDA can issue an Emergency Use Authorization, or EUA, to provide more timely access to critical medical products that may help during the emergency when there are no adequate, approved, and available options. The EUA process is different than full approval or clearance because in some emergency situations we cannot wait for all of the evidence needed for full FDA approval or clearance. Instead, the FDA evaluates the options very quickly using the evidence that is available, carefully balancing the risks and benefits of the product as we know them, in addition to evaluating other criteria. FDA has issued many EUAs for diagnostic tests and antibody tests.

To expand the nation's COVID-19 testing capacity, the FDA also issued a policy guidance offering regulatory flexibility in certain circumstances. The policies in this guidance apply to commercial manufacturers and to laboratories certified under the Clinical Laboratory Improvement Amendments (CLIA) to perform high-complexity testing and who create laboratory-developed tests (LDTs) for coronavirus. In the guidance, the FDA outlines policies for test developers that offer certain types of COVID-19 tests before they receive an EUA for that test, under the circumstances described in the guidance. Under certain policies in the guidance, the test developers validate their test, give notice to FDA, and submit an EUA request within a specified timeframe.

2. State Authorization of LDTs

The FDA is providing flexibility to states that want to authorize labs certified to conduct high-complexity testings in that state to develop and perform coronavirus testing. Under this policy, the state or territory takes responsibility for the safety and accuracy of COVID-19 testing by laboratories in its state/territory and the lab does not submit an EUA request to the FDA.

Coronavirus Testing In Your Community

The best way to get a coronavirus test is to contact your health care provider. You may also visit your state or local health department's website to look for the latest local information on testing.

Report Adverse Events

The FDA encourages health care professionals and patients to report adverse events or side effects related to the use of coronavirus tests to the FDA's MedWatch Safety Information and Adverse Event Reporting Program:

Complete and submit the report online through the FDA's MedWatch website.

Download the form or call 1-800-332-1088 to request a form, then complete and return to the address on the form or submit by fax to 1-800-FDA-0178.

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You've probably heard a lot about coronavirus testing recently. If you think you have coronavirus disease 2019 (COVID-19) and need a test, contact your health care provider, local pharmacy, or local health department immediately. The FDA has been working around the clock to increase the availability of critical medical products, including tests for the coronavirus, to fight the COVID-19 pandemic.

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Alika | amaunake@hawaii.edu

Ruben | rubenj@hawaii.edu

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COVID-19 8 Lessons Lawe nui ka make a ka haole

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(Basic phenomena building)

Perfume or cologne

A member of your family to help you:)

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(Demo-only Activity)

I will demo (time permitting) an additional activity

The items needed can be ordered online (if you end up wanting to try this activity out.)

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(Why it's important)
If you would like to participate in real time, please prep the following materials

One used clear, see-through water bottle (remove labels)

Fill half-way with water.  Close to prevent spills.

¼ cup oil (make sure it won’t spill and make a mess in your learning space.)

One liquid soap dispenser.  (Soap that can be pumped out)

Paper towels...have some nearby just in case

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No Ka ʻElele: hoʻopaʻa leo, helu 1
(click image below to play audio)

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COVID-19 | Contagion, Spread, Inter-species transfer, and the Search for Vaccines
By Pauline, Alika, and Ruben

All Session 1: COVID-19 ... presentation resources can be found in the outline linked below:
COVID-19 | Presentation Outline

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Session 1 Presentation | Contagion, Spread of COVID-19, Inter-species transfer, the search for vaccines

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Nūpepa as Anchoring Phenomena in Place-based STEM Education; COVID-19
Video by Kolomona Nakatsuka

Nūpepa, Disease, and Public Health in Hawaiʻi | Past, Present, and Future Perspectives
Presented by Kauʻi Wells

All Session 1: Nūpepa ... presentation resources can be found in the outline linked below: Nūpepa | Presentation Outline

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COVID-19: The Latest Hawaiian Epidemic, Session 1 |  Nūpepa, Disease, and Public Health in Hawaiʻi

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No Ka ʻElele: hoʻopaʻa leo, helu 2
(click image below to play audio)

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Kumu Kalikoaloha - Hui hou nā kāhuna lapaʻau...

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Alika | amaunake@hawaii.edu  Kauʻi | rkwells@hawaii.edu
Ruben | rubenj@hawaii.edu
Pauline | chinn@hawaii.edu
Kolomona | kylean@hawaii.edu

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Hawaii State Department of Health traces 44 COVID-19 cases to a single person

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The Hawai'i State Department of Health has traced 44 cases of COVID-19 here to a single person.

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Kaʻōlinokaimana
Ali | ayasuoka@voyagerpcs.com

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I wonder how schools and communities responded to pandemics historically. Were they effective? What is similar/different in how Hawaiʻi responded to pandemics of the past to our present-day responses.

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I wonder how schools and communities responded to pandemics historically. Were they effective? What is similar/different in how Hawaiʻi responded to pandemics of the past to our present-day responses.

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No Ka ʻElele: hoʻopaʻa leo, helu 3
(click image below to play audio)

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American Samoa has a history of avoiding pandemics through coordinated chiefly and US governmental action starting from the 1918 Swine flu pandemic where a total quarantine led to 0 cases and deaths.  Last year, in Samoa the rate of vaccination against measles was 31% due anti-vax sentiment.  Children died from respiratory problems, field hospitals were set up and without realizing it, health personnel were prepared for the upcoming COVID-19, (See Retro Report American Samoa Dodfed a Pandemic and article below.)  American Samoa had a higher rate of vaccination but still locked down for measles as they did for COVID-19.  So far, 0 cases in American Samoa.

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'A state of emergency on March 21 effectively closed the island nation's borders to the world and dramatically limited the movement of the population'

After only one suspected case (now confirmed to have for COVID-19, along with at least twenty other suspected cases since) Samoan Prime Minister Tuilaepa Sailele Malielegaoi declared a on March 21, effectively closing the independent island nation's borders to the world and dramatically limiting the movement of the population. An escalation of previously implemented measures to reduce travel into and out of Samoa that have been in place since late February, the new state of emergency basically shuts the country down, closing the borders to international travelers (with the exception of returning residents who must provide medical clearance prior to traveling), limiting flights into and out of the country to only four per week, banning public transportation by bus or taxi, closing schools, and calling for church services to be halted-an unprecedented action in a nation whose predominantly Christian faith is central to its identity. With multiple epidemiological models now showing the potential benefit of such measures , the hope is that the country's case count will remain at zero.

'On lists of places to visit before they become famous, Samoa is known to most as a tiny tropical paradise'

in 2019, Samoa as a nation can ill afford another catastrophe. Starting in September 2019 the measles outbreak affected more than 5,700 people, mostly children, with 83 lives lost (coincidentally, a measles death rate among confirmed cases of 1.46 percent, which mirrors some of the recent global estimates for COVID-19

Starting in Sept. 2019 the Samoan measles outbreak affected more than 5,700 people, mostly children, with 83 lives lost

At the time, some in the global anti-vaccine community like Taylor Winterstein, whose husband is a famous Australian rugby star, likened Samoa's actions to those of Nazi Germany and cited them as being in opposition of the population's basic human rights . There were calls in the country for the leaders of the ministry of health to resign . Now, similar top-down measures have become commonplace worldwide, and it is reassuring to know that the Samoan health leadership-still in place-has weathered one storm and can hopefully help the nation weather another.

'The tireless and dedicated members are likely still physically and emotionally exhausted from their 24/7 responsibilities during the measles outbreak'

'Samoan health authorities are wasting no time reapplying the lessons learned in the measles epidemic: that early and significant action pays off'

'In some circles Samoan health leaders have almost as many fans as their national rugby team on the sidelines watching and cheering them on'

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Coronavirus in Samoa | Think Global Health

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'A state of emergency on March 21 effectively closed the island nation's borders to the world and dramatically limited the movement of the population' After only one suspected case (now confirmed to have for COVID-19, along with at least twenty other suspected cases since) Samoan Prime Minister Tuilaepa Sailele Malielegaoi declared a on March 21, effectively closing the independent island nation's borders to the world and dramatically limiting the movement of the population.

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Video: American Samoa--escaping the pandemic 

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Video: American Samoa--escaping the pandemic 

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This video connects the 1918 Swine flu pandemic to COVID-19.  It contrasts the 25% death rate in Western Samoa, controlled by NZ and American Samoa, where no one died due to strict quarantine by Gov. Poyer.  American Samoa is the only US state or territory with 0 COVID-19 cases. Compare this to the history of Western Samoa, now Samoa, an independent state that after a century, decided to realign itself with NZ with time change and driving British style with American built cars.  Pretty tricky!

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American Samoa Dodged a Pandemic in 1918. Here’s What We Learned. | Retro Report

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Reading: Samoa, Covid-19 response-learning from measles 

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Reading: Samoa, Covid-19 response-learning from measles 

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'A state of emergency on March 21 effectively closed the island nation's borders to the world and dramatically limited the movement of the population'

After only one suspected case (now confirmed to have for COVID-19, along with at least twenty other suspected cases since) Samoan Prime Minister Tuilaepa Sailele Malielegaoi declared a on March 21, effectively closing the independent island nation's borders to the world and dramatically limiting the movement of the population. An escalation of previously implemented measures to reduce travel into and out of Samoa that have been in place since late February, the new state of emergency basically shuts the country down, closing the borders to international travelers (with the exception of returning residents who must provide medical clearance prior to traveling), limiting flights into and out of the country to only four per week, banning public transportation by bus or taxi, closing schools, and calling for church services to be halted-an unprecedented action in a nation whose predominantly Christian faith is central to its identity. With multiple epidemiological models now showing the potential benefit of such measures , the hope is that the country's case count will remain at zero.

'On lists of places to visit before they become famous, Samoa is known to most as a tiny tropical paradise'

in 2019, Samoa as a nation can ill afford another catastrophe. Starting in September 2019 the measles outbreak affected more than 5,700 people, mostly children, with 83 lives lost (coincidentally, a measles death rate among confirmed cases of 1.46 percent, which mirrors some of the recent global estimates for COVID-19

Starting in Sept. 2019 the Samoan measles outbreak affected more than 5,700 people, mostly children, with 83 lives lost

At the time, some in the global anti-vaccine community like Taylor Winterstein, whose husband is a famous Australian rugby star, likened Samoa's actions to those of Nazi Germany and cited them as being in opposition of the population's basic human rights . There were calls in the country for the leaders of the ministry of health to resign . Now, similar top-down measures have become commonplace worldwide, and it is reassuring to know that the Samoan health leadership-still in place-has weathered one storm and can hopefully help the nation weather another.

'The tireless and dedicated members are likely still physically and emotionally exhausted from their 24/7 responsibilities during the measles outbreak'

'Samoan health authorities are wasting no time reapplying the lessons learned in the measles epidemic: that early and significant action pays off'

'In some circles Samoan health leaders have almost as many fans as their national rugby team on the sidelines watching and cheering them on'

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Coronavirus in Samoa | Think Global Health

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'A state of emergency on March 21 effectively closed the island nation's borders to the world and dramatically limited the movement of the population' After only one suspected case (now confirmed to have for COVID-19, along with at least twenty other suspected cases since) Samoan Prime Minister Tuilaepa Sailele Malielegaoi declared a on March 21, effectively closing the independent island nation's borders to the world and dramatically limiting the movement of the population.

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Recommendations for safely returning to extra-curricular activities?

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Recommendations for safely returning to extra-curricular activities?

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The Hawaiʻi DOE announced that Fall sports will return starting Aug. 19, two weeks after the Aug. 4 return to school date.  What precautionary measures can athletes (and their families) take since physical distancing is not possible in most contact sports like football?

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Is there any data available in regards to infants/toddlers and how they are being affected by COVID19? Are they considered a risk group?

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Is there any data available in regards to infants/toddlers and how they are being affected by COVID19? Are they considered a risk group?

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Are they considered a high risk group?

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How to Teach for Greater Impact and for Better Protective Measures and Cognition in the Next Crises and in the Next Generation?

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How to Teach for Greater Impact and for Better Protective Measures and Cognition in the Next Crises and in the Next Generation?

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Across the disciplines and in inter-disciplinary ways, how can we discuss (among the adults as well as when teaching each grade level in our classrooms) the ethics and morals of government and systemic policies and choices as well as causes and effects, statistics, kuleana to community/nation/world, and Nā Hopena A`o values and traits from K-12 so that we raise up a wiser generation who value each individual life as well as kuleana mālama ʻāina and deeper aloha pono -- and value them more than economic engines when we must make a choice and think more innovatively and creatively to "make a living" so more can live? What are some effective ways to teach a more pono way to ʻike and ʻimi with greater aʻo mānoa for clearer mana`o and perspectives and insights, along with greater impact and effectiveness and community power?

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Slideshow | Liliʻuokalani and the protection of her people in the face of an epidemic.

Presentation with additional slides, appended information, and resources linked below

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Session 4 | Lili'uokalani i ka wā o nā maʻi ahulau (with additional slides)

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From Cheryl Corbiell 05:10 PM

The delay and now rush to bring students back to school has not allowed for procedures to be practiced before students come on campus. Proper filters in the air conditioning. UV lights etc. in ducts. etc. The elementary to HS has not done anything physical in the schools. The colleges have worked on physical systems to help keep working spaces safe on top of human behavior.

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July 20 NYT article on kids and COVID-19

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July 20 NYT article on kids and COVID-19

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Not really understood why but several hypotheses about lower risk.

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Young children have consistently been slow to catch and spread Covid-19. Experts have a few hunches why.

Credit... Emmanuelle Walker

On the way home from a jog one afternoon in early July, Dr. Silvia Chiang noticed her husband and 2½-year-old daughter playing outdoors with a handful of neighborhood kids and their moms in face masks. As someone who specializes in pediatric infectious diseases and has helped care for dozens of children with Covid-19, Chiang said she felt uneasy at one point.

"I think at the height of the epidemic here, I would have asked them not to do that, to come inside," said Dr. Chiang, M.D., an assistant professor at the Warren Alpert Medical School of Brown University. "But at that time, Rhode Island had pretty good control of the virus. Case counts continued to drop. So, I felt a lot more comfortable."

Not that she thought the risk was zero, just that it was fairly low. Plus, Dr. Chiang knew the parents of two of the kids, both doctors, and they, too, were conscientious in their protection measures.

Dr. Chiang's post-jog decision reflects how many parents are thinking about the coronavirus and their children. Just weeks away from what some hope will be a return to school in the fall, many Americans are looking to new research findings and guidance - some of which suggest kids are less likely to get, spread or suffer from Covid-19 - and recalibrating the precautions they take.

So, how strict should parents be? Are babies and children in their toddler through primary school years somehow more able to fight off coronavirus infections, compared with adults? Is it OK if they don't wear masks or social distance?

Experts still say if families live in a hot spot or a family member is vulnerable to a severe case of Covid-19, children should remain as dedicated as ever to disinfection routines, distancing from people outside the home, wearing a mask and washing their hands even more than they did before the pandemic.

Outside of those situations, parents can relax at least one of the most stringent and challenging measures they took earlier this year - without raising risk significantly: they no longer need to completely isolate their young children, Dr. Chiang said. Similar guidance is implicit in the reopening guidelines for schools released in late June by the American Academy of Pediatrics, or A.A.P., which advocates for "having students physically present in school."

There are many hints and even some data showing that children fare better against the virus on a few levels than adults do. First, only 17 children under the age of 5 nationwide have died of Covid-19, according to data reported to the U.S. Centers for Disease Control as of July 11. That's a little under a third the number in that age range who have died of the flu this year. And while a multi-system inflammatory syndrome, called MIS-C, affects some children infected with the coronavirus, it is rare and most recover from it.

Experts who study and treat children with the coronavirus remain cautious but say they've seen positive signals amid limited data on how children catch and spread the novel coronavirus.

"The findings currently are pointing to a likelihood that young children have a lower risk of becoming infected and maybe even a lower risk of transmitting," Dr. Chiang said. "I think it's an evolving situation, but I wouldn't be surprised if those are the conclusions that we end up drawing."

The American Academy of Pediatrics' guidelines for reopening schools stated that children "may be less likely to become infected" with the coronavirus and to spread that infection.

While this is welcome news for parents, governmental and news media reports have raised concerns about the accuracy of data on adult infections and deaths, and for children. Undercounts are likely because tests can be difficult to obtain, results reportedly lag, and states' data collection and reporting practices differ. Without widespread testing and large, random targeted samples of children, researchers and doctors are not confident of the true number of children who catch the coronavirus, said Mark Schleiss, M.D., a pediatric infectious diseases expert at the University of Minnesota Medical School.

In Iceland, a team of researchers tested 6 percent of the country's population for the coronavirus. Out of more than 848 children who responded to an invitation to participate in one part of the study, the team found no coronavirus infections in kids under 10 years old, even with elementary schools and day cares open at the time. The children were either less vulnerable to the virus or never exposed to it, the authors wrote.

Another way researchers have gauged whether children were less likely to catch the coronavirus was to track infections within households where at least one person had tested positive. Two studies in China found that children were less likely than adults to catch the virus from an infected person living with them. A third study showed no difference.

Some researchers hypothesize that the virus cannot make its way into the cells of younger children as well as it can into those of adults because children make fewer receptors, called ACE2, which is where the virus docks.

As children grow into adolescence and adulthood, they make more ACE2 receptors. Their risk for infection and sickness from the coronavirus would, theoretically, likely increase. The evidence for this hypothesis is limited. To establish a link, experts would have to demonstrate it in lab mice and then in large studies of people over time.

It remains unclear whether young children spread the coronavirus to other children and to adults, according to a handful of studies. (A recent study from South Korea found that unlike the case for children under 10, older children transmit the virus as well as adults do.)

"It certainly doesn't seem like young kids play a huge role in transmission, but it's early days in this pandemic. It's not conclusive yet that they don't," Dr. Chiang said.

One theory suggests that because children's smaller lungs do not push out as many droplets as adults' do, they also push out fewer droplets potentially containing the coronavirus, said Jeffrey Starke, M.D., a professor of pediatrics at Baylor College of Medicine in Houston who sees patients at Texas Children's Hospital.

Whether it's small lungs, less-welcoming cells or other factors, the reason for why kids may be more resilient to catching and spreading the virus is elusive. Even under the best of circumstances, it can take decades for researchers to understand how an infectious disease behaves in adults, let alone its nuances in children.

"With many health issues, children can get the short end of the stick and don't get studied until we figure out what's going on in adults," Dr. Schleiss said.

Yet, just like Chiang when she saw the kids together in the street, some public-health experts are shifting and even loosening their thinking about isolating children and adopting a risk-benefit perspective.

"Any additional contact increases risk but we are facing a trade-off of what's best for our children," said Helen Jenkins, Ph.D., an assistant professor of biostatistics at Boston University.

For starters, rather than prohibiting children from playing together and eliminating all social risk, Dr. Chiang and the A.A.P. schools-reopening guidelines focus on reducing risk and state that outdoor play is safer than indoor play. Jenkins said her family now socializes with another cautious family. Their summer plans include outdoor playground and beach visits, but not museums.

Some families who initially tried going without sitters and nannies have relented, and public-health experts acknowledge that the strain was significant. Parents and nannies should have honest discussions about their expectations for mask-wearing and distancing. "But there is no way for a nanny to socially distance from a young kid she's taking care of," Dr. Chiang said. And there is no evidence that risk of transmission is lower for a younger nanny, she added.

Ultimately, parents have to weigh their threshold for risk when it comes to children's interactions with others. And that same advice applies to day care, summer camp or school in the fall. Parents should consider the demands of their work, whether any household member is at high risk for severe Covid-19, the status of the outbreak in their community and administrators' plans for keeping children and staffers at least in fixed and distanced groups. Also, look for policies requiring children and staffers to be screened for symptoms.

In other words, Dr. Chiang said, if the spread of coronavirus in your community is low, if administrators seem to be taking risk reduction seriously and if parents have to work from home or are essential workers, sending young kids to day care or school may make sense.

"The logistics of keeping kids out of school, but still trying to educate them, go far beyond just infectious diseases," Dr. Starke. "They go into economics, they go into social structure, and they go into families."

Dr. Chiang has the same decisions to make. When her daughter's day care reopened, she spoke with the facility's director about distancing, disinfection and other coronavirus-related policies. Statistics, family composition, and the age of her daughter also must be considered.

"With her being 2 1/2, the risk that she's going to have severe disease from Covid-19 or develop MIS-C is tiny," Dr. Chiang said. "We don't have any older family members living with us or in town, so we don't have to consider her getting infected at day care and infecting grandma and grandpa. And the benefits she gets from day care are amazing."

Dr. Starke's take is a little different. If he had young children now, given the current runaway outbreak in Texas, he would not let them stray far from home. "The virus doesn't make allowances for our coronavirus fatigue nor for our need for fellowship," he said. "The virus is looking for a place to jump from one person to another. That's it. And that's why distancing, masking, and hygiene work. If we do those three things, the virus literally has no place to go."

Robin Lloyd is a contributing editor at Scientific American magazine.

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What Is It That Keeps Most Little Kids From Getting Covid-19?

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Young children have consistently been slow to catch and spread Covid-19. Experts have a few hunches why. On the way home from a jog one afternoon in early July, Dr. Silvia Chiang noticed her husband and 2½-year-old daughter playing outdoors with a handful of neighborhood kids and their moms in face masks.