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Center for Devices and Radiological Health

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Expiration dates and more about authorized at-home OTC COVID-19 diagnostic tests information.

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From the California Department of Public Health. You can download your COVID-19 vaccination record. This can be added to you digital wallet.

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Get a digital copy of your vaccination record

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Masks, Scientific American, September 2021

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Masks, Scientific American, September 2021

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A wealth of evidence has shown that wearing a face mask helps prevent people from spreading the virus that causes COVID, SARS-CoV-2, to others and from becoming sick themselves. But there has been less guidance from public health officials on what kind of masks provide the best protection.

Early on in the pandemic, the U.S. Centers for Disease Control and Prevention and the World Health Organization told the public not to wear N95 respirators, a type of mask that is made from high-tech synthetic fibers and provides a high level of protection against virus-laden airborne particles called aerosols. That was because there was then a shortage of such masks-and health care workers desperately needed them. At the same time, both agencies said there was little risk of aerosol transmission of SARS-CoV-2. They recommended cloth masks or other homemade face coverings that can stop some relatively large virus-carrying droplets even as it became clear that SARS-CoV-2 commonly spreads through aerosols-and as the supply of better-quality masks increased.

There is now a cornucopia of high-filtration respirator-style masks on the market, including N95s, Chinese-made KN95s and South Korean-made KF94s. They have been widely available and relatively affordable for months and provide better protection than cloth or surgical masks. Yet it was not until September 10 that the CDC finally updated its guidance to say the general public could wear N95s and other medical-grade masks now that they are in sufficient supply.

Still, however, the "CDC continues to recommend that N95 respirators should be prioritized for protection against COVID-19 in healthcare settings," wrote CDC spokesperson Jade Fulce inan e-mail to Scientific American last week. "Essential workers and workers who routinely wore respirators before the pandemic should continue wearing N95 respirators," she continued. "As N95s become more available they can be worn in non-healthcare settings, however, cloth masks are an acceptable and recommended option for masking."

The agency announced in May that supplies of approved respirator masks had "increasedsignificantly." When asked why it only updated it guidance on N95 use by the public in September, Fulce replied that the "CDC regularly reviews and updates its guidance as more information becomes available."

Scientific American spoke with several experts on aerosol transmission-some of whom have tested various masks available on the market-and they agree that health authorities should strongly recommend people wear well-fitted, high-filtration masks.

"A year ago we could say that we were concerned about shortages for health care workers, so we were telling people to make your cloth mask, and any mask is better than no mask," says Linsey Marr, an environmental engineer and aerosol science expert at Virginia Tech. But given what scientists know now-especially with the virus's highly transmissible Delta variant spreading and people spending more time indoors in schools, for example-"I think the CDC should be recommending high-performance masks for everyone when they're in these risky indoor situations," she says.

What Makes a Good Mask?

When it comes to mask effectiveness, the most important parameters are filtration, fit and comfort. Filtration generally refers to the percentage of particles the mask material blocks. For example, an N95 filters at least 95 percent of airborne particles. But that does little good if gaps around the mask let air in freely. A well-fitted mask should sit snugly against the face and over the chin, with no gaps around the nose or mouth. Comfort is also an extremely important metric: a mask does no good if people simply find it intolerable to wear.

A good mask is "the most important defense we have" against COVID, says aerosol expert Kimberly Prather, an atmospheric chemist at the University of California, San Diego.

There are a number of national standards for respirator quality. The U.S. gold standard, N95s, are certified by the CDC's National Institute for Occupational Safety and Health (NIOSH). And the Occupational Safety and Health Administration (OSHA) sets standards for how they have to fit people in work settings (such as in hospitals). But there is no official standard for N95 use by the general public. The European equivalent of the N95 is the FFP2 respirator, which filters at least 94 percent of particles. China has the KN95, and South Korea has the KF94. All provide excellent filtration, so it really comes down to which fits an individual best and is most comfortable.

Which Masks are Best?

In the absence of more specific guidance from health authorities such as the CDC as to which brands of respirators and other masks provide the best protection, some skilled amateurs have stepped in to fill the gap. Aaron Collins, aka "Mask Nerd," is a mechanical engineer at Seagate Technology with a background in aerosol science. In his free time, he makes YouTube videos in which he tests and reviews high-filtration masks made by various manufacturers. Collins says he does not earn any money from mask manufacturers or his videos themselves-he considers them a service and wants them to be objective.

Collins has a mask-testing setup in his bathroom, where he assesses masks' filtration efficiency by generating aerosols of sodium chloride (salt). He then uses a condensation particle counter-a device that measures the concentration of particles inside and outside a mask he is wearing-to determine the total inward leakage through and around the mask. (For comparison, NIOSH's N95 standard requires manufacturers to measure leakage through the respirator material itself. And OSHA measures how a respirator fits on someone's face, which often involves wearing an N95 in an enclosed space with saccharin or another distinctly flavored test aerosol sprayed in: if the wearer reports tasting the substance, the mask fails the fit test.)

Collins also tests "pressure drop," which is basically how easy it is to breathe while wearing a mask. If doing so is too difficult, a wearer might not only find the mask less comfortable but also suck in air around its sides, negating its filtration. Some cloth masks-including those outfitted with coffee filters-have this problem. "There's a reason N95s aren't made from cloth," Collins says.

The Mask Nerd's top picks can be found in this video. In general, he recommends KN95s made by Chinese company Powecom and others, a variety of KF94s such as the Bluna FaceFit and N95s made by reputable brands such as 3M, Moldex or Honeywell. All of these masks had close to 99 percent filtration efficiencies and fairly low pressure drops in Collins's setup. (For comparison, he found that a surgical mask alone had between about 50 and 75 percent filtration efficiency, depending on the fit, and a good cloth mask had about 70 percent.) But when choosing the best mask, comfort should be a deciding factor, he says. Not everyone needs to wear an N95.

"To me, the minimum I want to see people wear is a KN95 or KF94 with the Delta variant," Collins says. "I don't think surgical masks are good enough anymore, and we should've gotten rid of cloth masks last summer-they're not even in the spectrum" of good filtration. (To be clear, some studies have found that surgical and cloth masks can provide at least some protection against COVID. A recent large, randomized study in Bangladesh found that surgical masks significantly lowered the risk of infection; cloth masks did not have a measurable benefit, although other studies suggest they provide some protection.)

The Best Masks for Kids

With children starting school in-person, many parents are understandably worried about their kids, especially those who are too young to be eligible for vaccination-and particularly in states where politicians have tried to ban mask mandates in schools. These parents might find Collins's recommendations for high-filtration kids' masks particularly helpful. There is no N95 standard for children, but plenty of manufacturers make KF94 or KN95 masks for them. Such masks are designed for small faces and are easy to put on. Collins sees no reason why kids could not tolerate them. "I have my own son," Collins says. "He's five years old. He wore them all summer."

Where to Find Legitimate Masks

An issue with commercially available high-filtration masks is that they may not come from reputable suppliers. The CDC's Web site warns that about 60 percent of KN95 respirators available in the U.S. are counterfeit. To find ones that are legitimate, Prather recommends the Web site Project N95. Masks can also be ordered directly from suppliers such as Bona Fide Masks, which sells KN95s made by Powecom. "That's the one people swear by," Prather says. They cost around $1 each. DemeTECH sells N95s for around $4 apiece, as well as other types of masks.

Reusing Masks

One reason people may be reluctant to use KN95s and similar masks is because they are usually considered disposable. But several experts say they can in fact be worn multiple times. "You can probably reuse it until it becomes visibly damaged or soiled," Marr says. Collins's amateur testing suggests mask can be used for up 40 hours with no decrease in their filtration efficacy (he recommends using them within six months of opening a package). The virus likely does not survive long on these masks, but it is not a bad idea to have a few in rotation, reusing one every three days or so, Collins says.

Double Masking

One popular way to increase effectiveness is to wear a cloth mask on top of a surgical mask. This strategy, which the CDC has recommended, combines the filtration efficiency of the surgical mask material with the fit of a cloth mask. But how well does it actually work?

According to Collins, pretty well. He measured a filtration efficiency of upward of 90 percent for a cloth mask (with nose wire) over a surgical mask. But the pressure drop was almost twice as high as that of an N95. One reason the CDC and others have recommended against the use of N95s by the general public, apart from their previous scarcity, is that they can be difficult to breathe through-so Collins finds it "baffling" that the CDC would recommend double masking. "So does double masking work? Yes, but ... I think there are better solutions," he said in one of his videos.

Another way to get a better fit is to use masks with straps that go around the back of the head or to use a mask brace if one only has access to a surgical mask.

Not all experts agree that high-filtration masks are necessary for everyone. "What I usually say is 'The best mask is the one you wear properly,'" says Judith Flores, a pediatrician and a fellow of the American Academy of Pediatrics and of the New York Academy of Medicine. Flores believes surgical masks are the most convenient and cleanest option if they are discarded after each use. Cloth masks are okay, too, she adds, as long as they have three layers. "Unless you are a health care worker or home care worker tending to a person who is COVID-positive," Flores says, "you don't need an N95."

Facial Hair

What about the bewhiskered among us? How does facial hair influence the effectiveness of various masks? While there are not a great deal of data on this, some research suggests that the longer a person's beard or mustache is, the less effective a mask will be because it makes an inferior seal with the face. The CDC has released a somewhat amusing graphic demonstrating styles of facial hair that are appropriate to wear with a respirator.

At this point in the pandemic, with supplies of high-quality masks readily available in many areas, perhaps it is time to ditch loose-fitting cloth or surgical masks for something that provides better protection. "The most important layer of protection," Prather says, "is to never let the virus get out in the air in the first place."

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Why We Need to Upgrade Our Face Masks-and Where to Get Them

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A wealth of evidence has shown that wearing a face mask helps prevent people from spreading the virus that causes COVID, SARS-CoV-2, to others and from becoming sick themselves. But there has been less guidance from public health officials on what kind of masks provide the best protection.

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Feb. 26, 2021

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We can learn from our failures.

Contributing writer at The Atlantic

Alex Wong / Chet Strange/ Sarah Silbiger / Bloomberg / Getty / The Atlantic

When the polio vaccine was declared safe and effective, the news was met with jubilant celebration. Church bells rang across the nation, and factories blew their whistles. "Polio routed!" newspaper headlines exclaimed. "An historic victory," "monumental," "sensational," newscasters declared. People erupted with joy across the United States. Some danced in the streets; others wept. Kids were sent home from school to celebrate.

One might have expected the initial approval of the coronavirus vaccines to spark similar jubilation-especially after a brutal pandemic year. But that didn't happen. Instead, the steady drumbeat of good news about the vaccines has been met with a chorus of relentless pessimism.

The problem is not that the good news isn't being reported, or that we should throw caution to the wind just yet. It's that neither the reporting nor the public-health messaging has reflected the truly amazing reality of these vaccines. There is nothing wrong with realism and caution, but effective communication requires a sense of proportion-distinguishing between due alarm and alarmism; warranted, measured caution and doombait; worst-case scenarios and claims of impending catastrophe. We need to be able to celebrate profoundly positive news while noting the work that still lies ahead. However, instead of balanced optimism since the launch of the vaccines, the public has been offered a lot of misguided fretting over new virus variants, subjected to misleading debates about the inferiority of certain vaccines, and presented with long lists of things vaccinated people still cannot do, while media outlets wonder whether the pandemic will ever end.

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Conor Friedersdorf: The public-health value of speaking plainly

This pessimism is sapping people of energy to get through the winter, and the rest of this pandemic. Anti-vaccination groups and those opposing the current public-health measures have been vigorously amplifying the pessimistic messages-especially the idea that getting vaccinated doesn't mean being able to do more-telling their audiences that there is no point in compliance, or in eventual vaccination, because it will not lead to any positive changes. They are using the moment and the messaging to deepen mistrust of public-health authorities, accusing them of moving the goalposts and implying that we're being conned. Either the vaccines aren't as good as claimed, they suggest, or the real goal of pandemic-safety measures is to control the public, not the virus.

Five key fallacies and pitfalls have affected public-health messaging, as well as media coverage, and have played an outsize role in derailing an effective pandemic response. These problems were deepened by the ways that we-the public-developed to cope with a dreadful situation under great uncertainty. And now, even as vaccines offer brilliant hope, and even though, at least in the United States, we no longer have to deal with the problem of a misinformer in chief, some officials and media outlets are repeating many of the same mistakes in handling the vaccine rollout.

The pandemic has given us an unwelcome societal stress test, revealing the cracks and weaknesses in our institutions and our systems. Some of these are common to many contemporary problems, including political dysfunction and the way our public sphere operates. Others are more particular, though not exclusive, to the current challenge-including a gap between how academic research operates and how the public understands that research, and the ways in which the psychology of coping with the pandemic have distorted our response to it.

Recognizing all these dynamics is important, not only for seeing us through this pandemic-yes, it is going to end-but also to understand how our society functions, and how it fails. We need to start shoring up our defenses, not just against future pandemics but against all the myriad challenges we face-political, environmental, societal, and technological. None of these problems is impossible to remedy, but first we have to acknowledge them and start working to fix them-and we're running out of time.

The past 12 months were incredibly challenging for almost everyone. Public-health officials were fighting a devastating pandemic and, at least in this country, an administration hell-bent on undermining them. The World Health Organization was not structured or funded for independence or agility, but still worked hard to contain the disease. Many researchers and experts noted the absence of timely and trustworthy guidelines from authorities, and tried to fill the void by communicating their findings directly to the public on social media. Reporters tried to keep the public informed under time and knowledge constraints, which were made more severe by the worsening media landscape. And the rest of us were trying to survive as best we could, looking for guidance where we could, and sharing information when we could, but always under difficult, murky conditions.

Despite all these good intentions, much of the public-health messaging has been profoundly counterproductive. In five specific ways, the assumptions made by public officials, the choices made by traditional media, the way our digital public sphere operates, and communication patterns between academic communities and the public proved flawed.

Risk Compensation

One of the most important problems undermining the pandemic response has been the mistrust and paternalism that some public-health agencies and experts have exhibited toward the public. A key reason for this stance seems to be that some experts feared that people would respond to something that increased their safety-such as masks, rapid tests, or vaccines- by behaving recklessly. They worried that a heightened sense of safety would lead members of the public to take risks that would not just undermine any gains, but reverse them.
Julia Marcus: The danger of assuming that family time is dispensable
The theory that things that improve our safety might provide a false sense of security and lead to reckless behavior is attractive-it's contrarian and clever, and fits the "here's something surprising we smart folks thought about" mold that appeals to, well, people who think of themselves as smart. Unsurprisingly, such fears have greeted efforts to persuade the public to adopt almost every advance in safety, including seat belts, helmets, and condoms.

But time and again, the numbers tell a different story: Even if safety improvements cause a few people to behave recklessly, the benefits overwhelm the ill effects. In any case, most people are already interested in staying safe from a dangerous pathogen. Further, even at the beginning of the pandemic, sociological theory predicted that wearing masks would be associated with increased adherence to other precautionary measures-people interested in staying safe are interested in staying safe-and empirical research quickly confirmed exactly that. Unfortunately, though, the theory of risk compensation-and its implicit assumptions-continue to haunt our approach, in part because there hasn't been a reckoning with the initial missteps.

Rules in Place of Mechanisms and Intuitions

Much of the public messaging focused on offering a series of clear rules to ordinary people, instead of explaining in detail the mechanisms of viral transmission for this pathogen. A focus on explaining transmission mechanisms, and updating our understanding over time, would have helped empower people to make informed calculations about risk in different settings. Instead, both the CDC and the WHO chose to offer fixed guidelines that lent a false sense of precision.

In the United States, the public was initially told that "close contact" meant coming within six feet of an infected individual, for 15 minutes or more. This messaging led to ridiculous gaming of the rules; some establishments moved people around at the 14th minute to avoid passing the threshold. It also led to situations in which people working indoors with others, but just outside the cutoff of six feet, felt that they could take their mask off. None of this made any practical sense. What happened at minute 16? Was seven feet okay? Faux precision isn't more informative; it's misleading.

All of this was complicated by the fact that key public-health agencies like the CDC and the WHO were late to acknowledge the importance of some key infection mechanisms, such as aerosol transmission. Even when they did so, the shift happened without a proportional change in the guidelines or the messaging-it was easy for the general public to miss its significance.

Frustrated by the lack of public communication from health authorities, I wrote an article last July on what we then knew about the transmission of this pathogen-including how it could be spread via aerosols that can float and accumulate, especially in poorly ventilated indoor spaces. To this day, I'm contacted by people who describe workplaces that are following the formal guidelines, but in ways that defy reason: They've installed plexiglass, but barred workers from opening their windows; they've mandated masks, but only when workers are within six feet of one another, while permitting them to be taken off indoors during breaks.

Perhaps worst of all, our messaging and guidelines elided the difference between outdoor and indoor spaces, where, given the importance of aerosol transmission, the same precautions should not apply. This is especially important because this pathogen is overdispersed: Much of the spread is driven by a few people infecting many others at once, while most people do not transmit the virus at all.

After I wrote an article explaining how overdispersion and super-spreading were driving the pandemic, I discovered that this mechanism had also been poorly explained. I was inundated by messages from people, including elected officials around the world, saying they had no idea that this was the case. None of it was secret-numerous academic papers and articles had been written about it-but it had not been integrated into our messaging or our guidelines despite its great importance.

Crucially, super-spreading isn't equally distributed; poorly ventilated indoor spaces can facilitate the spread of the virus over longer distances, and in shorter periods of time, than the guidelines suggested, and help fuel the pandemic.

Outdoors? It's the opposite.

There is a solid scientific reason for the fact that there are relatively few documented cases of transmission outdoors, even after a year of epidemiological work: The open air dilutes the virus very quickly, and the sun helps deactivate it, providing further protection. And super-spreading-the biggest driver of the pandemic- appears to be an exclusively indoor phenomenon. I've been tracking every report I can find for the past year, and have yet to find a confirmed super-spreading event that occurred solely outdoors. Such events might well have taken place, but if the risk were great enough to justify altering our lives, I would expect at least a few to have been documented by now.

And yet our guidelines do not reflect these differences, and our messaging has not helped people understand these facts so that they can make better choices. I published my first article pleading for parks to be kept open on April 7, 2020-but outdoor activities are still banned by some authorities today, a full year after this dreaded virus began to spread globally.

We'd have been much better off if we gave people a realistic intuition about this virus's transmission mechanisms. Our public guidelines should have been more like Japan's, which emphasize avoiding the three C's -closed spaces, crowded places, and close contact-that are driving the pandemic.

Scolding and Shaming

Throughout the past year, traditional and social media have been caught up in a cycle of shaming-made worse by being so unscientific and misguided. How dare you go to the beach? newspapers have scolded us for months, despite lacking evidence that this posed any significant threat to public health. It wasn't just talk: Many cities closed parks and outdoor recreational spaces, even as they kept open indoor dining and gyms. Just this month, UC Berkeley and the University of Massachusetts at Amherst both banned students from taking even solitary walks outdoors.
Read: America is trapped in a pandemic spiral
Even when authorities relax the rules a bit, they do not always follow through in a sensible manner. In the United Kingdom, after some locales finally started allowing children to play on playgrounds-something that was already way overdue-they quickly ruled that parents must not socialize while their kids have a normal moment. Why not? Who knows?

On social media, meanwhile, pictures of people outdoors without masks draw reprimands, insults, and confident predictions of super-spreading -and yet few note when super-spreading fails to follow.

While visible but low-risk activities attract the scolds, other actual risks-in workplaces and crowded households, exacerbated by the lack of testing or paid sick leave-are not as easily accessible to photographers. Stefan Baral, an associate epidemiology professor at the Johns Hopkins Bloomberg School of Public Health, says that it's almost as if we've "designed a public-health response most suitable for higher-income" groups and the "Twitter generation"-stay home; have your groceries delivered; focus on the behaviors you can photograph and shame online-rather than provide the support and conditions necessary for more people to keep themselves safe.

And the viral videos shaming people for failing to take sensible precautions, such as wearing masks indoors, do not necessarily help. For one thing, fretting over the occasional person throwing a tantrum while going unmasked in a supermarket distorts the reality: Most of the public has been complying with mask wearing. Worse, shaming is often an ineffective way of getting people to change their behavior, and it entrenches polarization and discourages disclosure, making it harder to fight the virus. Instead, we should be emphasizing safer behavior and stressing how many people are doing their part, while encouraging others to do the same.

Harm Reduction

Amidst all the mistrust and the scolding, a crucial public-health concept fell by the wayside. Harm reduction is the recognition that if there is an unmet and yet crucial human need, we cannot simply wish it away; we need to advise people on how to do what they seek to do more safely. Risk can never be completely eliminated; life requires more than futile attempts to bring risk down to zero. Pretending we can will away complexities and trade-offs with absolutism is counterproductive. Consider abstinence-only education: Not letting teenagers know about ways to have safer sex results in more of them having sex with no protections.

As Julia Marcus, an epidemiologist and associate professor at Harvard Medical School, told me, "When officials assume that risks can be easily eliminated, they might neglect the other things that matter to people: staying fed and housed, being close to loved ones, or just enjoying their lives. Public health works best when it helps people find safer ways to get what they need and want."

Another problem with absolutism is the "abstinence violation" effect, Joshua Barocas, an assistant professor at the Boston University School of Medicine and Infectious Diseases, told me. When we set perfection as the only option, it can cause people who fall short of that standard in one small, particular way to decide that they've already failed, and might as well give up entirely. Most people who have attempted a diet or a new exercise regimen are familiar with this psychological state. The better approach is encouraging risk reduction and layered mitigation-emphasizing that every little bit helps-while also recognizing that a risk-free life is neither possible nor desirable.

Socializing is not a luxury-kids need to play with one another, and adults need to interact. Your kids can play together outdoors, and outdoor time is the best chance to catch up with your neighbors is not just a sensible message; it's a way to decrease transmission risks. Some kids will play and some adults will socialize no matter what the scolds say or public-health officials decree, and they'll do it indoors, out of sight of the scolding.

And if they don't? Then kids will be deprived of an essential activity, and adults will be deprived of human companionship. Socializing is perhaps the most important predictor of health and longevity, after not smoking and perhaps exercise and a healthy diet. We need to help people socialize more safely, not encourage them to stop socializing entirely.

The Balance Between Knowledge And Action

Last but not least, the pandemic response has been distorted by a poor balance between knowledge, risk, certainty, and action.

Sometimes, public-health authorities insisted that we did not know enough to act, when the preponderance of evidence already justified precautionary action. Wearing masks, for example, posed few downsides, and held the prospect of mitigating the exponential threat we faced. The wait for certainty hampered our response to airborne transmission, even though there was almost no evidence for-and increasing evidence against-the importance of fomites, or objects that can carry infection. And yet, we emphasized the risk of surface transmission while refusing to properly address the risk of airborne transmission, despite increasing evidence. The difference lay not in the level of evidence and scientific support for either theory-which, if anything, quickly tilted in favor of airborne transmission, and not fomites, being crucial-but in the fact that fomite transmission had been a key part of the medical canon, and airborne transmission had not.

Renee DiResta: Virus experts aren't getting the message out

Sometimes, experts and the public discussion failed to emphasize that we were balancing risks, as in the recurring cycles of debate over lockdowns or school openings. We should have done more to acknowledge that there were no good options, only trade-offs between different downsides. As a result, instead of recognizing the difficulty of the situation, too many people accused those on the other side of being callous and uncaring.

And sometimes, the way that academics communicate clashed with how the public constructs knowledge. In academia, publishing is the coin of the realm, and it is often done through rejecting the null hypothesis-meaning that many papers do not seek to prove something conclusively, but instead, to reject the possibility that a variable has no relationship with the effect they are measuring (beyond chance). If that sounds convoluted, it is-there are historical reasons for this methodology and big arguments within academia about its merits, but for the moment, this remains standard practice.

At crucial points during the pandemic, though, this resulted in mistranslations and fueled misunderstandings, which were further muddled by differing stances toward prior scientific knowledge and theory. Yes, we faced a novel coronavirus, but we should have started by assuming that we could make some reasonable projections from prior knowledge, while looking out for anything that might prove different. That prior experience should have made us mindful of seasonality, the key role of overdispersion, and aerosol transmission. A keen eye for what was different from the past would have alerted us earlier to the importance of presymptomatic transmission.

Thus, on January 14, 2020, the WHO stated that there was "no clear evidence of human-to-human transmission." It should have said, "There is increasing likelihood that human-to-human transmission is taking place, but we haven't yet proven this, because we have no access to Wuhan, China." (Cases were already popping up around the world at that point.) Acting as if there was human-to-human transmission during the early weeks of the pandemic would have been wise and preventive.

Later that spring, WHO officials stated that there was "currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection," producing many articles laden with panic and despair. Instead, it should have said: "We expect the immune system to function against this virus, and to provide some immunity for some period of time, but it is still hard to know specifics because it is so early."

Similarly, since the vaccines were announced, too many statements have emphasized that we don't yet know if vaccines prevent transmission. Instead, public-health authorities should have said that we have many reasons to expect, and increasing amounts of data to suggest, that vaccines will blunt infectiousness, but that we're waiting for additional data to be more precise about it. That's been unfortunate, because while many, many things have gone wrong during this pandemic, the vaccines are one thing that has gone very, very right.

As late as April 2020, Anthony Fauci was slammed for being too optimistic for suggesting we might plausibly have vaccines in a year to 18 months. We had vaccines much, much sooner than that: The first two vaccine trials concluded a mere eight months after the WHO declared a pandemic in March 2020.

Moreover, they have delivered spectacular results. In June 2020, the FDA said a vaccine that was merely 50 percent efficacious in preventing symptomatic COVID-19 would receive emergency approval-that such a benefit would be sufficient to justify shipping it out immediately. Just a few months after that, the trials of the Moderna and Pfizer vaccines concluded by reporting not just a stunning 95 percent efficacy, but also a complete elimination of hospitalization or death among the vaccinated. Even severe disease was practically gone: The lone case classified as "severe" among 30,000 vaccinated individuals in the trials was so mild that the patient needed no medical care, and her case would not have been considered severe if her oxygen saturation had been a single percent higher.

These are exhilarating developments, because global, widespread, and rapid vaccination is our way out of this pandemic. Vaccines that drastically reduce hospitalizations and deaths, and that diminish even severe disease to a rare event, are the closest things we have had in this pandemic to a miracle-though of course they are the product of scientific research, creativity, and hard work. They are going to be the panacea and the endgame.

And yet, two months into an accelerating vaccination campaign in the United States, it would be hard to blame people if they missed the news that things are getting better.

Yes, there are new variants of the virus, which may eventually require booster shots, but at least so far, the existing vaccines are standing up to them well-very, very well. Manufacturers are already working on new vaccines or variant-focused booster versions, in case they prove necessary, and the authorizing agencies are ready for a quick turnaround if and when updates are needed. Reports from places that have vaccinated large numbers of individuals, and even trials in places where variants are widespread, are exceedingly encouraging, with dramatic reductions in cases and, crucially, hospitalizations and deaths among the vaccinated. Global equity and access to vaccines remain crucial concerns, but the supply is increasing.

Here in the United States, despite the rocky rollout and the need to smooth access and ensure equity, it's become clear that toward the end of spring 2021, supply will be more than sufficient. It may sound hard to believe today, as many who are desperate for vaccinations await their turn, but in the near future, we may have to discuss what to do with excess doses.

So why isn't this story more widely appreciated?

Part of the problem with the vaccines was the timing-the trials concluded immediately after the U.S. election, and their results got overshadowed in the weeks of political turmoil. The first, modest headline announcing the Pfizer-BioNTech results in The New York Times was a single column, "Vaccine Is Over 90% Effective, Pfizer's Early Data Says," below a banner headline spanning the page: "BIDEN CALLS FOR UNITED FRONT AS VIRUS RAGES." That was both understandable-the nation was weary-and a loss for the public.
Read: A quite possibly wonderful summer
Just a few days later, Moderna reported a similar 94.5 percent efficacy. If anything, that provided even more cause for celebration, because it confirmed that the stunning numbers coming out of Pfizer weren't a fluke. But, still amid the political turmoil, the Moderna report got a mere two columns on The New York Times ' front page with an equally modest headline: "Another Vaccine Appears to Work Against the Virus."

So we didn't get our initial vaccine jubilation.

But as soon as we began vaccinating people, articles started warning the newly vaccinated about all they could not do. "COVID-19 Vaccine Doesn't Mean You Can Party Like It's 1999," one headline admonished. And the buzzkill has continued right up to the present. "You're fully vaccinated against the coronavirus-now what? Don't expect to shed your mask and get back to normal activities right away," began a recent Associated Press story.

People might well want to party after being vaccinated. Those shots will expand what we can do, first in our private lives and among other vaccinated people, and then, gradually, in our public lives as well. But once again, the authorities and the media seem more worried about potentially reckless behavior among the vaccinated, and about telling them what not to do, than with providing nuanced guidance reflecting trade-offs, uncertainty, and a recognition that vaccination can change behavior. No guideline can cover every situation, but careful, accurate, and updated information can empower everyone.

Take the messaging and public conversation around transmission risks from vaccinated people. It is, of course, important to be alert to such considerations: Many vaccines are "leaky" in that they prevent disease or severe disease, but not infection and transmission. In fact, completely blocking all infection-what's often called "sterilizing immunity"-is a difficult goal, and something even many highly effective vaccines don't attain, but that doesn't stop them from being extremely useful.

As Paul Sax, an infectious-disease doctor at Boston's Brigham & Women's Hospital, put it in early December, it would be enormously surprising "if these highly effective vaccines didn't also make people less likely to transmit." From multiple studies, we already knew that asymptomatic individuals-those who never developed COVID-19 despite being infected-were much less likely to transmit the virus. The vaccine trials were reporting 95 percent reductions in any form of symptomatic disease. In December, we learned that Moderna had swabbed some portion of trial participants to detect asymptomatic, silent infections, and found an almost two-thirds reduction even in such cases. The good news kept pouring in. Multiple studies found that, even in those few cases where breakthrough disease occurred in vaccinated people, their viral loads were lower-which correlates with lower rates of transmission. Data from vaccinated populations further confirmed what many experts expected all along: Of course these vaccines reduce transmission.

And yet, from the beginning, a good chunk of the public-facing messaging and news articles implied or claimed that vaccines won't protect you against infecting other people or that we didn't know if they would, when both were false. I found myself trying to convince people in my own social network that vaccines weren't useless against transmission, and being bombarded on social media with claims that they were.

What went wrong? The same thing that's going wrong right now with the reporting on whether vaccines will protect recipients against the new viral variants. Some outlets emphasize the worst or misinterpret the research. Some public-health officials are wary of encouraging the relaxation of any precautions. Some prominent experts on social media-even those with seemingly solid credentials-tend to respond to everything with alarm and sirens. So the message that got heard was that vaccines will not prevent transmission, or that they won't work against new variants, or that we don't know if they will. What the public needs to hear, though, is that based on existing data, we expect them to work fairly well-but we'll learn more about precisely how effective they'll be over time, and that tweaks may make them even better.

A year into the pandemic, we're still repeating the same mistakes.

The top-down messaging is not the only problem. The scolding, the strictness, the inability to discuss trade-offs, and the accusations of not caring about people dying not only have an enthusiastic audience, but portions of the public engage in these behaviors themselves. Maybe that's partly because proclaiming the importance of individual actions makes us feel as if we are in the driver's seat, despite all the uncertainty.

Psychologists talk about the "locus of control"-the strength of belief in control over your own destiny. They distinguish between people with more of an internal-control orientation-who believe that they are the primary actors-and those with an external one, who believe that society, fate, and other factors beyond their control greatly influence what happens to us. This focus on individual control goes along with something called the " fundamental attribution error "-when bad things happen to other people, we're more likely to believe that they are personally at fault, but when they happen to us, we are more likely to blame the situation and circumstances beyond our control.

An individualistic locus of control is forged in the U.S. mythos-that we are a nation of strivers and people who pull ourselves up by our bootstraps. An internal-control orientation isn't necessarily negative; it can facilitate resilience, rather than fatalism, by shifting the focus to what we can do as individuals even as things fall apart around us. This orientation seems to be common among children who not only survive but sometimes thrive in terrible situations-they take charge and have a go at it, and with some luck, pull through. It is probably even more attractive to educated, well-off people who feel that they have succeeded through their own actions.

You can see the attraction of an individualized, internal locus of control in a pandemic, as a pathogen without a cure spreads globally, interrupts our lives, makes us sick, and could prove fatal.

There have been very few things we could do at an individual level to reduce our risk beyond wearing masks, distancing, and disinfecting. The desire to exercise personal control against an invisible, pervasive enemy is likely why we've continued to emphasize scrubbing and cleaning surfaces, in what's appropriately called " hygiene theater," long after it became clear that fomites were not a key driver of the pandemic. Obsessive cleaning gave us something to do, and we weren't about to give it up, even if it turned out to be useless. No wonder there was so much focus on telling others to stay home-even though it's not a choice available to those who cannot work remotely-and so much scolding of those who dared to socialize or enjoy a moment outdoors.

And perhaps it was too much to expect a nation unwilling to release its tight grip on the bottle of bleach to greet the arrival of vaccines-however spectacular-by imagining the day we might start to let go of our masks.

The focus on individual actions has had its upsides, but it has also led to a sizable portion of pandemic victims being erased from public conversation. If our own actions drive everything, then some other individuals must be to blame when things go wrong for them. And throughout this pandemic, the mantra many of us kept repeating-"Wear a mask, stay home; wear a mask, stay home"-hid many of the real victims.
Read: The good news of COVID-19 is sticking, for now
Study after study, in country after country, confirms that this disease has disproportionately hit the poor and minority groups, along with the elderly, who are particularly vulnerable to severe disease. Even among the elderly, though, those who are wealthier and enjoy greater access to health care have fared better.

The poor and minority groups are dying in disproportionately large numbers for the same reasons that they suffer from many other diseases: a lifetime of disadvantages, lack of access to health care, inferior working conditions, unsafe housing, and limited financial resources.

Many lacked the option of staying home precisely because they were working hard to enable others to do what they could not, by packing boxes, delivering groceries, producing food. And even those who could stay home faced other problems born of inequality: Crowded housing is associated with higher rates of COVID-19 infection and worse outcomes, likely because many of the essential workers who live in such housing bring the virus home to elderly relatives.

Individual responsibility certainly had a large role to play in fighting the pandemic, but many victims had little choice in what happened to them. By disproportionately focusing on individual choices, not only did we hide the real problem, but we failed to do more to provide safe working and living conditions for everyone.

For example, there has been a lot of consternation about indoor dining, an activity I certainly wouldn't recommend. But even takeout and delivery can impose a terrible cost: One study of California found that line cooks are the highest-risk occupation for dying of COVID-19. Unless we provide restaurants with funds so they can stay closed, or provide restaurant workers with high-filtration masks, better ventilation, paid sick leave, frequent rapid testing, and other protections so that they can safely work, getting food to go can simply shift the risk to the most vulnerable. Unsafe workplaces may be low on our agenda, but they do pose a real danger. Bill Hanage, associate professor of epidemiology at Harvard, pointed me to a paper he co-authored: Workplace-safety complaints to OSHA-which oversees occupational-safety regulations-during the pandemic were predictive of increases in deaths 16 days later.

New data highlight the terrible toll of inequality: Life expectancy has decreased dramatically over the past year, with Black people losing the most from this disease, followed by members of the Hispanic community. Minorities are also more likely to die of COVID-19 at a younger age. But when the new CDC director, Rochelle Walensky, noted this terrible statistic, she immediately followed up by urging people to "continue to use proven prevention steps to slow the spread-wear a well-fitting mask, stay 6 ft away from those you do not live with, avoid crowds and poorly ventilated places, and wash hands often."

Those recommendations aren't wrong, but they are incomplete. None of these individual acts do enough to protect those to whom such choices aren't available-and the CDC has yet to issue sufficient guidelines for workplace ventilation or to make higher-filtration masks mandatory, or even available, for essential workers. Nor are these proscriptions paired frequently enough with prescriptions: Socialize outdoors, keep parks open, and let children play with one another outdoors.

Vaccines are the tool that will end the pandemic. The story of their rollout combines some of our strengths and our weaknesses, revealing the limitations of the way we think and evaluate evidence, provide guidelines, and absorb and react to an uncertain and difficult situation.

But also, after a weary year, maybe it's hard for everyone-including scientists, journalists, and public-health officials-to imagine the end, to have hope. We adjust to new conditions fairly quickly, even terrible new conditions. During this pandemic, we've adjusted to things many of us never thought were possible. Billions of people have led dramatically smaller, circumscribed lives, and dealt with closed schools, the inability to see loved ones, the loss of jobs, the absence of communal activities, and the threat and reality of illness and death.

Hope nourishes us during the worst times, but it is also dangerous. It upsets the delicate balance of survival-where we stop hoping and focus on getting by-and opens us up to crushing disappointment if things don't pan out. After a terrible year, many things are understandably making it harder for us to dare to hope. But, especially in the United States, everything looks better by the day. Tragically, at least 28 million Americans have been confirmed to have been infected, but the real number is certainly much higher. By one estimate, as many as 80 million have already been infected with COVID-19, and many of those people now have some level of immunity. Another 46 million people have already received at least one dose of a vaccine, and we're vaccinating millions more each day as the supply constraints ease. The vaccines are poised to reduce or nearly eliminate the things we worry most about-severe disease, hospitalization, and death.

Not all our problems are solved. We need to get through the next few months, as we race to vaccinate against more transmissible variants. We need to do more to address equity in the United States-because it is the right thing to do, and because failing to vaccinate the highest-risk people will slow the population impact. We need to make sure that vaccines don't remain inaccessible to poorer countries. We need to keep up our epidemiological surveillance so that if we do notice something that looks like it may threaten our progress, we can respond swiftly.

And the public behavior of the vaccinated cannot change overnight-even if they are at much lower risk, it's not reasonable to expect a grocery store to try to verify who's vaccinated, or to have two classes of people with different rules. For now, it's courteous and prudent for everyone to obey the same guidelines in many public places. Still, vaccinated people can feel more confident in doing things they may have avoided, just in case-getting a haircut, taking a trip to see a loved one, browsing for nonessential purchases in a store.

But it is time to imagine a better future, not just because it's drawing nearer but because that's how we get through what remains and keep our guard up as necessary. It's also realistic-reflecting the genuine increased safety for the vaccinated.

Public-health agencies should immediately start providing expanded information to vaccinated people so they can make informed decisions about private behavior. This is justified by the encouraging data, and a great way to get the word out on how wonderful these vaccines really are. The delay itself has great human costs, especially for those among the elderly who have been isolated for so long.

Public-health authorities should also be louder and more explicit about the next steps, giving us guidelines for when we can expect easing in rules for public behavior as well. We need the exit strategy spelled out-but with graduated, targeted measures rather than a one-size-fits-all message. We need to let people know that getting a vaccine will almost immediately change their lives for the better, and why, and also when and how increased vaccination will change more than their individual risks and opportunities, and see us out of this pandemic.

We should encourage people to dream about the end of this pandemic by talking about it more, and more concretely: the numbers, hows, and whys. Offering clear guidance on how this will end can help strengthen people's resolve to endure whatever is necessary for the moment-even if they are still unvaccinated-by building warranted and realistic anticipation of the pandemic's end.

Hope will get us through this. And one day soon, you'll be able to hop off the subway on your way to a concert, pick up a newspaper, and find the triumphant headline: "COVID Routed!"

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initial approval of the coronavirus vaccines

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We can learn from our failures. Contributing writer at The Atlantic When the polio vaccine was declared safe and effective, the news was met with jubilant celebration. Church bells rang across the nation, and factories blew their whistles. "Polio routed!" newspaper headlines exclaimed. "An historic victory," "monumental," "sensational," newscasters declared.

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The risk of contagion in each scenario.

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The coronavirus is spread through the air, especially in indoor spaces. While it is not as infectious as measles, scientists now openly acknowledge the role played by the transmission of aerosols - tiny contagious particles exhaled by an infected person that remain suspended in the air of an indoor environment. How does the transmission work? And, more importantly, how can we stop it?

At present, health authorities recognize three vehicles of coronavirus transmission: the small droplets from speaking or coughing, which can end up in the eyes, mouth or nose of people standing nearby; contaminated surfaces (fomites), although the US Centers for Disease Control and Prevention (CDC) indicates that this is the least likely way to catch the virus, a conclusion backed by the European Center for Disease Control and Prevention's (ECDC) observation that not a single case of fomite-caused Covid-19 has been observed; then finally, there is transmission by aerosols - the inhalation of invisible infectious particles exhaled by an infected person that, once leaving the mouth, behave in a similar way to smoke. Without ventilation, aerosols remain suspended in the air and become increasingly dense as time passes.

Without ventilation, aerosols remain suspended in the air, becoming increasingly concentrated as time goes by.

Breathing, speaking and shouting

At the beginning of the pandemic, it was believed that the large droplets we expel when we cough or sneeze were the main vehicle of transmission. But we now know that shouting and singing in indoor, poorly ventilated spaces over a prolonged period of time also increases the risk of contagion. This is because speaking in a loud voice releases 50 times more virus-laden particles than when we don't speak at all. These aerosols, if not diffused through ventilation, become increasingly concentrated, which increases the risk of infection. Scientists have shown that these particles - which we also release into the atmosphere when simply breathing and which can escape from improperly worn face masks - can infect people who spend more than a few minutes within a five-meter radius of an infected person, depending on the length of time and the nature of the interaction. In the following example, we outlined what conditions increase the risk of contagion in this situation.

In the spring, health authorities failed to focus on aerosol transmission, but recent scientific publications have forced the World Health Organization (WHO) and the CDC to acknowledge it. An article in the prestigious Science magazine found that there is " overwhelming evidence" that airborne transmission is a "major transmission route" for the coronavirus, and the CDC now notes that, "under certain conditions, they seem to have infected others who were more than six feet [two meters] away. These transmissions occurred within enclosed spaces that had inadequate ventilation. Sometimes the infected person was breathing heavily, for example, while singing or exercising."

A bar or restaurant

Coronavirus outbreaks at events, and in establishments such as bars and restaurants, account for an important number of contagions in social settings. What's more, they are the most explosive: each outbreak in a nightclub infects an average of 27 people, compared to only six during family gatherings - as explained in the first graphic. One of these superspreading outbreaks took place at a club in the Spanish southern city of Córdoba, where 73 people tested positive after a night out. Scientists have also recently analyzed an outbreak in a bar in Vietnam, where 12 patrons contracted the virus.

School

Schools only account for 6% of coronavirus outbreaks recorded by Spanish health authorities. The dynamics of transmission via aerosols in the classroom change completely depending on whether the infected person - or patient zero - is a student or a teacher. Teachers talk far more than students and raise their voices to be heard, which multiplies the expulsion of potentially contagious particles. In comparison, an infected student will only speak occasionally. According to the Spanish National Research Council (CSIC) guidelines, the Spanish government has recommended that classrooms be ventilated - even though this may cause discomfort in the colder months - or for ventilation units to be used.

To calculate the likelihood of transmission between people in "at-risk" situations, we used the Covid Airborne Transmission Estimator developed by a group of scientists led by Professor José Luis Jiménez from the University of Colorado. This tool is aimed at highlighting the importance of measures that hinder aerosol transmission. The calculation is not exhaustive nor does it cover all the innumerable variables that can affect transmission, but it serves to illustrate how the risk of contagion can be lowered by changing conditions we do have control over.

During the simulations, the subjects maintain the recommended safe distance, eliminating the risk of transmission via droplets. But they can still become infected if all possible preventive measures are not simultaneously applied: correct ventilation, shortening the encounters, reducing the number of participants and wearing face masks. The ideal scenario, whatever the context, would be outdoors, where infectious particles are rapidly diffused. If a safe distance from the infected person is not maintained, the probability of transmission is multiplied because there would also be the risk of contagion from droplets - not just aerosols. Making matters worse, even if there is ventilation, it would not be enough to diffuse the aerosols if the two people were close together.

The calculations shown in the three different scenarios are based on studies of how aerosol transmission occurs, using real outbreaks that have been analyzed in detail. A very pertinent case with regard to understanding the dynamics of indoor transmission was a choir rehearsal in Washington State, in the United States, in March. Only 61 of the 120 members of the choir attended the rehearsal, and efforts were made to maintain a safe distance and hygiene measures. But unknown to them, they were in a maximum risk scenario: no masks, no ventilation, singing and sharing space over a prolonged period. Just one infected person passed the virus on to 53 people in the space of two-and-a-half hours. Some of those infected were 14 meters away, so only aerosols would explain the transmission. Two of those who caught the virus died.

After studying this outbreak carefully, scientists were able to calculate the extent to which the risk could have been mitigated if they had taken measures against airborne transmission. For example, if masks had been worn, the risk would have been halved and only around 44% of those present would have been affected as opposed to 87%. If the rehearsal had been held over a shorter period of time in a space with more ventilation, only two singers would have become infected. These super-spreading scenarios increasingly appear to be critical to the development and spread of the pandemic, meaning that having tools to prevent mass transmission at such events is key to controlling it.
Methodology For any queries about this article, please contact its co-author Javier Salas at javier@esmateria.com. : we calculated the risk of infection from Covid-19 using a tool developed by José Luis Jiménez, an atmospheric chemist at the University of Colorado and an expert in the chemistry and dynamics of air particles. Scientists around the world have reviewed this Estimator, which is based on published methods and data to estimate the importance of different measurable factors involved in an infection scenario. However, the Estimator's accuracy is limited as it relies on numbers that are still uncertain - numbers that describe, for example, how many infectious viruses are emitted by one infected person. The Estimator assumes that people practice the two-meter social distancing rule and that no one is immune. Our calculation is based on a default value for the general population, which includes a wide range of masks (surgical and cloth), and a loud voice, which increases the amount of aerosols expelled.

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A room, a bar and a classroom: how the coronavirus is spread through the air

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The risk of contagion is highest in indoor spaces but can be reduced by applying all available measures to combat infection via aerosols. Here is an overview of the likelihood of infection in three everyday scenarios, based on the safety measures used and the length of exposure

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CA List of County Public Health COVID-19 websites

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CA List of County Public Health COVID-19 websites

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The state has ordered that certain businesses and activities be restricted in order to slow the spread of COVID-19. See what can be open or must be closed in your county.

Your local health department may have more restrictions. Find your county's COVID-19 website for more details.

While each county may have different restrictions, it is important to stay home as much as possible. If you do go out, stay 6 feet away from others who are not in your household and wear a mask or face covering. Your actions save lives.

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The state has ordered that certain businesses and activities be restricted in order to slow the spread of COVID-19. See what can be open or must be closed in your county. Your local health department may have more restrictions. Find your county's COVID-19 website for more details.

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COVID-19 info

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Children May Carry Coronavirus at High Levels

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Children May Carry Coronavirus at High Levels

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The research does not prove that infected children are contagious, but it should influence the debate about reopening schools, some experts said.

Coronavirus testing at a mobile clinic at the Walker Temple A.M.E. Church in south Los Angeles earlier this month. Credit... Mario Tama/Getty Images

It has been a comforting refrain in the national conversation about reopening schools: Young children are mostly spared by the coronavirus and don't seem to spread it to others, at least not very often.

But on Thursday, a study introduced an unwelcome wrinkle into this smooth narrative.

Infected children have at least as much of the coronavirus in their noses and throats as infected adults, according to the research. Indeed, children younger than age 5 may host up to 100 times as much of the virus in the upper respiratory tract as adults, the authors found.

That measurement does not necessarily prove children are passing the virus to others. Still, the findings should influence the debate over reopening schools, several experts said.

"The school situation is so complicated - there are many nuances beyond just the scientific one," said Dr. Taylor Heald-Sargent, a pediatric infectious diseases expert at the Ann and Robert H. Lurie Children's Hospital of Chicago, who led the study, published in JAMA Pediatrics.

"But one takeaway from this is that we can't assume that just because kids aren't getting sick, or very sick, that they don't have the virus."

The study is not without caveats: It was small, and did not specify the participants' race or sex, or whether they had underlying conditions. The tests looked for viral RNA, genetic pieces of the coronavirus, rather than the live virus itself. (Its genetic material is RNA, not DNA.)

Still, experts were alarmed to learn that young children may carry significant amounts of the coronavirus.

"I've heard lots of people saying, 'Well, kids aren't susceptible, kids don't get infected.' And this clearly shows that's not true," said Stacey Schultz-Cherry, a virologist at St. Jude Children's Research Hospital.

"I think this is an important, really important, first step in understanding the role that kids are playing in transmission."

Jason Kindrachuk, a virologist at the University of Manitoba, said: "Now that we're rolling into the end of July and looking at trying to open up schools the next month, this really needs to be considered."

The standard diagnostic test amplifies the virus's genetic material in cycles, with the signal growing brighter each round. The more virus present in the swab initially, the fewer cycles needed for a clear result.

Dr. Heald-Sargent, who has a research interest in coronaviruses, began noticing that children's tests were coming back with low "cycle thresholds," or C.T.s, suggesting that their samples were teeming with the virus.

Intrigued, she called the hospital lab on a Sunday and asked to look back at test results for the past several weeks. "It wasn't even something we had set out to look for," she said.

She and her colleagues analyzed samples collected with nasopharyngeal swabs between March 23 and April 27 at drive-through testing sites in Chicago and from people who came to the hospital for any reason, including symptoms of Covid-19.

They looked at swabs taken from 145 people: 46 children younger than age 5; 51 children aged 5 to 17; and 48 adults aged 18 to 65. To forestall criticisms that really ill children would be expected to have a lot of the virus, the team excluded children who needed oxygen support. Most of the children in the study reported only a fever or cough, Dr. Heald-Sargent said.

To compare the groups fairly, the team included only children and adults who had mild to moderate symptoms and for whom they had information about when symptoms began. Dr. Heald-Sargent left out people who didn't have symptoms and who did not remember when they had started to feel ill, as well as those who had symptoms for more than a week before the testing.

The results confirmed Dr. Heald-Sargent's hunch: Older children and adults had similar C.T.s, with a median of about 11 and ranging up to 17. But children younger than age 5 had significantly lower C.T.s of about 6.5. The upper limit of the range in these children was a C.T. of 12, however - still comparable to those of older children and adults.

"It definitely shows that kids do have levels of virus similar to and maybe even higher than adults," Dr. Heald-Sargent said. "It wouldn't be surprising if they were able to shed" the virus and spread it to others.

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"One takeaway from this is that we can't assume that just because kids aren't getting sick, or very sick, that they don't have the virus," said one infectious disease expert. Credit... Tom Brenner/Reuters

The results are consistent with those from a German study of 47 infected children between the ages 1 and 11, which showed that children who did not have symptoms had viral loads as high as adults', or higher. And a recent study from France found that asymptomatic children had C.T. values similar to those of children with symptoms.

C.T. values are a reasonable proxy for the amount of coronavirus present, said Dr. Kindrachuk, who relied on this metric during the Ebola outbreaks in West Africa.

The Coronavirus Outbreak ›

Frequently Asked Questions

Updated July 27, 2020

Should I refinance my mortgage?

It could be a good idea, because mortgage rates have never been lower. Refinancing requests have pushed mortgage applications to some of the highest levels since 2008, so be prepared to get in line. But defaults are also up, so if you're thinking about buying a home, be aware that some lenders have tightened their standards.

What is school going to look like in September?

It is unlikely that many schools will return to a normal schedule this fall, requiring the grind of online learning, makeshift child care and stunted workdays to continue. California's two largest public school districts - Los Angeles and San Diego - said on July 13, that instruction will be remote-only in the fall, citing concerns that surging coronavirus infections in their areas pose too dire a risk for students and teachers. Together, the two districts enroll some 825,000 students. They are the largest in the country so far to abandon plans for even a partial physical return to classrooms when they reopen in August. For other districts, the solution won't be an all-or-nothing approach. Many systems, including the nation's largest, New York City, are devising hybrid plans that involve spending some days in classrooms and other days online. There's no national policy on this yet, so check with your municipal school system regularly to see what is happening in your community.

Is the coronavirus airborne?

The coronavirus can stay aloft for hours in tiny droplets in stagnant air, infecting people as they inhale, mounting scientific evidence suggests. This risk is highest in crowded indoor spaces with poor ventilation, and may help explain super-spreading events reported in meatpacking plants, churches and restaurants. It's unclear how often the virus is spread via these tiny droplets, or aerosols, compared with larger droplets that are expelled when a sick person coughs or sneezes, or transmitted through contact with contaminated surfaces, said Linsey Marr, an aerosol expert at Virginia Tech. Aerosols are released even when a person without symptoms exhales, talks or sings, according to Dr. Marr and more than 200 other experts, who have outlined the evidence in an open letter to the World Health Organization.

What are the symptoms of coronavirus?

Does asymptomatic transmission of Covid-19 happen?

So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was "very rare," but she later walked back that statement.

Still, he and others said that ideally researchers would grow infectious virus from samples, rather than test only for the virus's RNA.

"I suspect that it probably will translate into meaning that there is more actual virus there as well, but we can't say that without seeing the data," said Juliet Morrison, a virologist at the University of California, Riverside.

Some RNA viruses multiply quickly and are prone to genetic errors that render the virus incapable of infecting cells. Some RNA detected in children may represent these "defective" viruses: "We need to understand how much of that is actually infectious virus," Dr. Schultz-Cherry said.

(The researchers said they did not have access to the type of high-security lab required to grow infectious coronavirus, but other teams have cultivated virus from children's samples.)

The experts all emphasized that the findings at least indicate that children can be infected. Those who harbor a lot of virus may spread it to others in their households, or to teachers and other school staff members when schools reopen.

Many school districts are planning to protect students and staff members by implementing physical distancing, cloth face coverings and hand hygiene. But it's unclear how well staff members and teachers can keep young children from getting too close to others, Dr. Kindrachuk said.

"Frankly, I just haven't seen a lot of discussion about how that aspect is going to be controlled," he said.
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Observations from schools in several countries have suggested that, at least in places with mild outbreaks and preventive measures in place, children do not seem to spread the coronavirus to others efficiently.

Strong immune responses in children could limit both how much virus they can spread to others and for how long. The children's overall health, underlying conditions such as obesity or diabetes, and sex may also influence the ability to transmit the virus.

Some experts have suggested that children may transmit less virus because of their smaller lung capacity, height or other physical aspects.

Dr. Morrison dismissed those suggestions. The virus is shed from the upper respiratory tract, not the lungs, she noted.

"We are going to be reopening day care and elementary schools," she said. If these results hold up, "then yeah, I'd be worried."

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Children May Carry Coronavirus at High Levels, Study Finds

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The research does not prove that infected children are contagious, but it should influence the debate about reopening schools, some experts said. It has been a comforting refrain in the national conversation about reopening schools: Young children are mostly spared by the coronavirus and don't seem to spread it to others, at least not very often.

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UCSF Presentation on How the Virus Gets in and How to Block It: Aerosols, Droplets, Masks, Face Shields, & More

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UCSF Presentation on How the Virus Gets in and How to Block It: Aerosols, Droplets, Masks, Face Shields, & More

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July 16, 2020

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Covid-19: How the Virus Gets in and How to Block It: Aerosols, Droplets, Masks, Face Shields, & More

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Find a testing location

Types of tests

Two kinds of tests are available for COVID-19: Tests for current COVID-19 infection (also known as viral PCR tests) and tests for past infection (also known as antibody or serology tests).

California's community-based testing sites by Verily's Project Baseline and OptumServe provide viral tests to determine if individuals have COVID-19.

Antibody tests detect past infections (but not current infections). They are used to detect past COVID-19 infections in an individual and can be used to determine if you are a good candidate to donate blood plasma. It can take 1-3 weeks after infection for your body to make antibodies.

You can find locations for both viral and antibody tests on California's testing map.

Cost for testing

There are no out-of-pocket costs for necessary testing. If you have medical insurance, Verily or OptumServe will bill your insurance company. If you're uninsured, your viral test is paid for by the government.

Who can get tested

Testing is prioritized for individuals who are at high risk, including hospitalized patients, healthcare workers, first responders and essential workers, people with symptoms, residents and employees in group living facilities and people who may have been exposed in high-risk situations. As testing capacity continues to increase statewide, local health officers can expand testing within their communities. See current public health testing guidance.

How you can get tested

California has partnered with Verily and OptumServe to provide free, confidential testing statewide. The state's testing program ensures that every county has enough testing capacity, and that tests are available for underserved communities and individuals who are at high risk of contracting COVID-19 or becoming seriously ill from the virus.

Find a Verily testing location near you and make an appointment:

You will need a Google account.

Drive-through testing sites are now open in the following areas:

Alturas (Modoc County)

American Canyon (Napa County)

Bear Valley (Alpine County)

Bieber (Lassen County)

Bishop (Inyo County)

Calpine (Sierra County)

Cedarville (Modoc County)

Clearlake (Lake County)

Coleville (Mono County)

Crescent City (Del Norte County)

Daly City (San Mateo County)

Downieville (Sierra County)

Doyle (Lassen County)

East Palo Alto (San Mateo County)

French Camp (San Joaquin County)

Half Moon Bay (San Mateo County)

Hayfork (Trinity County)

Herlong (Lassen County)

Jackson (Amador County)

Lakeport (Lake County)

Lone Pine (Inyo County)

Loyalton (Sierra County)

Mammoth Lakes (Mono County)

Markleeville (Alpine County)

Middletown (Lake County)

Napa (Napa County)

North San Juan (Nevada County)

Oakland (Alameda County)

Placerville (El Dorado County)

Redwood City (San Mateo County)

Sacramento (Sacramento County)

Salida (Stanislaus County)

San Bruno (San Mateo County)

San Francisco (San Francisco)

San Jose (Santa Clara County)

San Mateo (San Mateo County)

St. Helena (Napa County)

Susanville (Lassen County)

Upper Lake (Lake County)

Weaverville (Trinity County)

Westwood (Lassen County)

Willow Creek (Humboldt County)

Yosemite Valley (Mariposa County)

Bell (Los Angeles County)

Bakersfield (Kern County)

Lake Elsinore (Riverside County)

Los Angeles (Los Angeles County)

Frequently asked questions (Verily's Project Baseline)

There are two steps to this process: screening and testing. First, you will create an account and take the online screener. If your answers from the screener determine you are eligible at this time, you will receive details on how and where to get tested. Once tested, you'll be informed via email or phone when your COVID-19 test results are available.

For the Baseline COVID-19 Program to work, Verily needs a way to authenticate users to appropriately protect their information. Verily turned to Google for this service because Google Account provides best-in-class authentication. We ask that you link to an existing Google Account or create a new Google Account (which can be done with any email address). This lets Verily authenticate your account, and securely and privately contact you during the screening and testing process. All the data provided by Baseline COVID-19 Program users for screening is stored separately and not directly linked to a user's Google Account.

OptumServe testing sites

Tests are by appointment only. Find a location near you and make an appointment at:

Register to be tested for COVID-19

If you do not have internet access, call 1-888-634-1123.

OptumServe community testing sites serve all individuals who qualify for a test, including uninsured, underinsured, undocumented and homeless individuals. OptumServe will generate a unique identification number for individuals who do not have a driver's license.

Treatment questions and answers

If you develop any of these warning signs for COVID-19, get emergency medical attention immediately:

Trouble breathing

Persistent pain or pressure in the chest

New confusion

Inability to awake or stay awake

Bluish lips or face

There are other, less-common symptoms. Please call your medical provider if you have any symptoms that are severe or concerning to you.

If you need to go to the hospital, call ahead so they can prepare for your arrival. If you call 911, tell the operator you have coronavirus symptoms so ambulance workers can be ready to treat you safely.

If you're not sure if this applies to you, you can check your symptoms using the Symptom Screener or by contacting your doctor through telehealth.

You can be with others after:

3 days with no fever and

Respiratory symptoms have improved (e.g. cough, shortness of breath) and

10 days since symptoms first appeared

CDPH and CDC have detailed recommendations for quarantine/isolation, if you are sick with COVID-19 or tested positive for coronavirus.

California's Testing Task Force

California's COVID-19 Testing Task Force works to ensure that Californians who need a COVID-19 test have access to tests and that there's enough laboratory capacity to meet demand.

Stay informed

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How can I find a coronavirus testing location near me? Find a testing location See the map Types of tests Two kinds of tests are available for COVID-19: Tests for current COVID-19 infection (also known as viral PCR tests) and tests for past infection (also known as antibody or serology tests).

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What’s the Risk of Catching Coronavirus From a Surface?

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What’s the Risk of Catching Coronavirus From a Surface?

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Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen.

Credit... Getty Images

Fears about catching the coronavirus from contaminated surfaces have prompted many of us to spend the past few months wiping down groceries, leaving packages unopened and stressing about touching elevator buttons.

But what's the real risk of catching Covid-19 from a germy surface or object?

The question has been on people's minds lately, and there was some confusion after the Centers for Disease Control and Prevention made some edits to its website last week. Social media sites and some news outlets suggested the agency had downgraded its warnings and that surface transmission was no longer a worry.

The C.D.C. subsequently issued a news release to clarify that indirect contact from a contaminated surface - what scientists call fomite transmission - remains a potential risk for catching Covid-19.

"Based on data from lab studies on Covid-19 and what we know about similar respiratory diseases, it may be possible that a person can get Covid-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose or possibly their eyes," the agency wrote. "But this isn't thought to be the main way the virus spreads."

So does this mean we can catch coronavirus from touching a doorknob? Catching a Frisbee? Sharing a casserole dish?

The answer, in theory, is yes, which is why you need to wash your hands often and avoid touching your face. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals.

"What they're saying is that high touch surfaces like railings and doorknobs, elevator buttons are not the primary driver of the infection in the United States," said Erin Bromage, a comparative immunologist and biology professor at the University of Massachusetts, Dartmouth. "But it's still a bad idea to touch your face. If someone who is infectious coughs on their hand and shakes your hand and you rub your eyes - yes, you're infected. Someone's drinking from a glass, and you pick it up near the rim and later rub your eyes or mouth, you're infected."

Here's how fomite transmission works. An infected person coughs or sneezes on their hands. Some of the droplets may splash onto a nearby surface, or the person spreads the germs by touching a faucet or countertop before washing his hands. Studies show that coronavirus can last up to three days on plastic and steel, but once it lands on a surface, the amount of viable virus begins to disintegrate in a matter of hours. That means a droplet on a surface is far more infectious right after the sneeze - not so much a few days later.

Next, you have to come along and touch the contaminated surface, pick up enough viable virus on your hands, and then touch your eyes, nose or mouth. If all goes well for the virus, you will get sick.

"There's a long chain of events that would need to happen for someone to become infected through contact with groceries, mail, takeout containers or other surfaces," said Julia Marcus, an infectious disease epidemiologist and assistant professor in the department of population medicine at Harvard Medical School. "The last step in that causal chain is touching your eyes, nose or mouth with your contaminated hand, so the best way to make sure the chain is broken is washing your hands."

An outbreak associated with a shopping mall in Wenzhou, China, may have been fueled by fomite transmission. In January, seven workers who shared an office in a shopping mall became ill when one of their co-workers returned from Wuhan. The mall was closed, and public health officials tracked two dozen more sick people, including several women who had shopped at the mall, as well as their friends. None of them had come into contact with the original sick office workers. The researchers speculated that a women's restroom or the mall elevators had been the source of transmission.

Other studies have used invisible fluorescent tracers - fake germs that glow under black light - to track how germs are spread from surfaces. The findings are unnerving. In one series of experiments, 86 percent of workers were contaminated when spray or powder tracers were put on commonly touched objects in an office. When tracer powder was put on a bathroom faucet and exit doorknob, the glowing residue was found on employees' hands, faces, phones and hair. From a shared phone, the tracer spread to desktop surfaces, drinking cups, keyboards, pens and doorknobs. A contaminated copy machine button added a trail of fluorescent finger prints transferred to documents and computer equipment. And just 20 minutes after arriving home from the office, the fake germs were found on backpacks, keys and purses, and on home doorknobs, light switches, countertops and kitchen appliances.

A video making rounds on the internet shows how the black light experiment works. The glow germs are put on the hands of just one diner at a buffet, but by the end of the meal, everyone at the table has come into contact with the glowing germs. The video explains why scientists discourage the sharing of food during a viral outbreak.

But while those experiments show how germs can spread on surfaces, the microbe still has to survive long enough and in a large enough dose to make you sick. Eugene M. Chudnovsky, a professor at the City University of New York, notes that surfaces are not a particularly effective means of viral transmission. With the flu, for instance, it takes millions of copies of the influenza virus to infect a person through surface-to-hand-to-nose contact, but it may take only a few thousand copies to infect a person when the flu virus goes from the air directly into the lungs.

Dr. Chudnovsky, a theoretical physicist whose research has focused on the spread of the airborne infection, said a similar pattern is likely to be true for the new coronavirus, but the exact numbers are not known.

"I believe the C.D.C. is right when it says that surface transmission is not a dominant one," said Dr. Chudnovsky. "Surfaces frequently touched by a large number of people, like door handles, elevator buttons, etc., may play a more significant role in spreading the infection than objects touched incidentally, like food packages delivered to homes."

The bottom line is that the best way to protect ourselves from coronavirus - whether it's surface transmission or close human contact - is still social distancing, washing our hands, not touching our faces and wearing masks.

"Hand washing is important not only for fomite transmission, but also for person-to-person transmission," said Dr. Daniel Winetsky, a postdoctoral fellow in the division of infectious diseases at Columbia University. "The respiratory droplets we produce when speaking, coughing and sneezing fall mostly onto our hands, and can fall onto other people's hands if they are within six feet from us."

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What's the Risk of Catching Coronavirus From a Surface?

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Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. Fears about catching the coronavirus from contaminated surfaces have prompted many of us to spend the past few months wiping down groceries, leaving packages unopened and stressing about touching elevator buttons.

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What We Know About Your Chances of Catching the Virus Outdoors

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What We Know About Your Chances of Catching the Virus Outdoors

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A stir-crazy nation wonders: Is it safe to stroll on the beach in a deadly pandemic? How about a picnic in the park? Or coffee with a friend at an outdoor table? The risk is in the details.

New Yorkers ventured outside in Washington Square Park in Manhattan this month. Keep your distance, experts say, and wear a mask if you get closer than six feet to others. Credit... Jeenah Moon for The New York Times

The warmer weather across the country calls to mind carefree summers - picnics in the park, swimming at the beach, fireworks on the Fourth. But nothing feels carefree now.

As states move to relax restrictions intended to fight the coronavirus pandemic, even the simplest outdoor activities seem fraught with a thousand questions and calculations.

Is it safe to meet friends in the park, as long as they stay six feet away, on the other side of a blanket? What about a burger and beer at an outdoor restaurant? How risky is a trip to the beach or swimming pool with the kids?

The good news: Interviews show a growing consensus among experts that, if Americans are going to leave their homes, it's safer to be outside than in the office or the mall. With fresh air and more space between people, the risk goes down.

But experts also expressed particular caution about outdoor dining, using locker rooms at pools and crowds in places like beaches. While going outside can help people cope with quarantine fatigue, there is a risk they will lower their guard or meet people who are not being safe.

"I think going outside is important for health," said Julia L. Marcus, an epidemiologist and assistant professor at Harvard Medical School. "We know that being outdoors is lower risk for coronavirus transmission than being indoors. On a sunny, beautiful weekend, I think going outside is indicated, but I also think there are things to do to reduce our risk."

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When exercising outside, experts say, stay at least six feet apart, and wear a face covering if distancing is not possible. Credit... Jeenah Moon for The New York Times

While many treasured outdoor rites of the season have been closed or canceled, including Disney's amusement parks, the Coachella festival in California and Free Shakespeare in the Park in New York, governors across the country have been opening golf courses, trails and beaches, hoping to restore some semblance of a normal summer for restless Americans.

Some parks, including small urban ones like Ellis Island and vast ones like Joshua Tree National Park, remain closed. But Yellowstone will reopen on a limited basis on Monday, and the Grand Canyon reopened its South Rim entrance on Friday. In Los Angeles County, beaches reopened on Wednesday, but not for sunbathing. Only active pursuits like jogging, swimming and surfing are allowed.

Even in the hard-hit New York region, some restrictions will be eased. Connecticut plans to allow outdoor seating at restaurants and outdoor exhibits at zoos on May 20. New Jersey, New York, Delaware and Connecticut will open state beaches on Memorial Day weekend, restricting them to 50 percent capacity. But New York City's beaches and pools will remain closed.

The different approaches have left many Americans bewildered about what is safe behavior outside. Experts have a simple answer: Practice social distancing and wear a mask when that is not possible.

Ideally, people should socialize only with people who live in their homes, they say. If you decide to meet friends, you're increasing your risk, but you can take precautions. It's important to keep gatherings small. Don't share food, utensils or beverages; keep your hands clean; and keep at least six feet from people who don't live in your home.

"I think outdoors is so much better than indoors in almost all cases," said Linsey Marr, an engineering professor and aerosol scientist at Virginia Tech. "There's so much dilution that happens outdoors. As long as you're staying at least six feet apart, I think the risk is very low."

Pandemic life is safer outdoors, in part, because even a light wind will quickly dilute the virus. If a person nearby is sick, the wind will scatter the virus, potentially exposing nearby people but in far smaller quantities, which are less likely to be harmful.

"The virus load is important," said Eugene Chudnovsky, a physicist at Lehman College and the City University of New York's Graduate Center. "A single virus will not make anyone sick; it will be immediately destroyed by the immune system. The belief is that one needs a few hundred to a few thousand of SARS-CoV-2 viruses to overwhelm the immune response."

While the risk of outdoor transmission is low, it can happen. In one study of more than 7,300 cases in China, just one was connected to outdoor transmission. In that case, a 27-year-old man had a conversation outdoors with a traveler who had just returned from Wuhan. Seven days later, he had his first symptoms of Covid-19.

"The risk is lower outdoors, but it's not zero," said Shan Soe-Lin, a lecturer at the Yale Jackson Institute for Global Affairs. "And I think the risk is higher if you have two people who are stationary next to each other for a long time, like on a beach blanket, rather than people who are walking and passing each other."

One recent study found that just talking can launch thousands of droplets that can remain suspended in the air for eight to 14 minutes. But the risk of inhaling those droplets is lower outdoors.

For many Americans who have spent anxious months at home, wide-open parks and trails feel like the safest options these days.

Kate Wathall, a Los Angeles television producer and reporter, went for her first hike in weeks last Sunday, one day after local trails reopened. She drove an hour to Trail Canyon Falls in Tujunga, avoiding more popular trails in the city.

"It was like being back to normal life," she said. "Obviously, it's not. But it's a day where I forgot what was going on."

In Memorial Park in Maplewood, N.J., on Thursday, Gabriella Gabriel, 22, was exercising with her friend Candace Brodie, also 22, on mats a few feet apart on the grass.

"People are spread out and there's no way for someone to be right on top of me," Ms. Gabriel said. "But in a pool or beach, everyone is so condensed - too close for comfort."

Experts agreed that the risk of swimming in pools, lakes or the ocean is not from the water, but from exposure to people in and near the water.

Although scientists don't have data on the novel coronavirus specifically, other coronaviruses are not stable in water and are very sensitive to chlorine, said Angela Rasmussen, a virologist at the Columbia University Mailman School of Public Health.

"In my opinion, pool water, fresh water in a lake or river, or seawater exposure would be extremely low transmission risk even without dilution (which would reduce risk further)," Dr. Rasmussen said in an email. "Probably the biggest risk for summer water recreation is crowds - a crowded pool locker room, dock or beach, especially if coupled with limited physical distancing or prolonged proximity to others. The most concentrated sources of virus in such an environment will be the people hanging out at the pool, not the pool itself."

Experts say that a person walking, jogging or cycling too close for a few seconds is not a big worry. But they recommend joggers wear a mask or some other form of face covering if they're going to come close to other people. If someone sets up a picnic blanket within your six-foot perimeter and plans to stay a while, that's a bigger concern. Try to avoid a confrontation. That only increases your risk of exposure. Such conflicts could spike as more people head outside.

"If someone is too close to you and not wearing a mask and you don't feel safe, instead of yelling at them, just say, 'I need some space, please,'" Dr. Marcus said.

For families with small children, navigating the outdoors can produce a special anxiety.

Ms. Gabriel said her brother, who is 6, had wanted to go to the playground, but her mother wouldn't allow it. She worries about the virus lingering on slides and swings and about a mysterious inflammatory syndrome linked to the virus that has been sickening and killing some children.

"It's hard for a child to understand," Ms. Gabriel said. "At least we can stay six feet apart. You can't tell a little kid that."

One challenge in dense cities is finding six feet to call your own on a running path or in a bicycle lane. An open-air cafe may seem safe, until people start walking by on the sidewalk without masks.

Some cities, including New York, Boston, Minneapolis and Oakland, have closed streets to traffic, giving people room to spread out. Others have extended sidewalks to make more space for pedestrians and outdoor seating.

Even outside, there is a risk of contracting the virus by touching a contaminated surface - a restaurant menu, park bench or lawn chair - and then touching your face. Studies have shown the virus can last three days on hard surfaces like steel and plastic and about 24 hours on cardboard under laboratory conditions. The virus is also more stable in heat and humidity than many other viruses are.

According to Dr. Chudnovsky, a sunny day is better than a cloudy day, because there's more sunlight to kill the virus and more wind to dilute it. If you want to take extreme precautions, position yourself upwind from other people. "This may be especially important at the beach, where people tend to spend a long time at one localized place," he said.

Experts said that although outdoor restaurant patrons can't wear masks while eating, servers should. The main risk of exposure is if the guests within a few feet at the table aren't from your household. Sitting and talking for extended periods of time as well as sharing food and common serving utensils are also potential sources of exposure if one of the guests is infected and doesn't know it.

Another worry: Because it can take two weeks for symptoms to appear after a person is infected, there is no way to know if you're going to the beach or the park in the midst of an invisible local outbreak, experts said. It's yet another reason to take precautions.

"If we now go back to the old normal and don't follow the social distancing strategy anymore, it's like a ticking time bomb," said Peter Jüni, an epidemiologist at the University of Toronto and St. Michael's Hospital. "You never know where it blows up and when."

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What We Know About Your Chances of Catching the Virus Outdoors

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A stir-crazy nation wonders: Is it safe to stroll on the beach in a deadly pandemic? How about a picnic in the park? Or coffee with a friend at an outdoor table? The risk is in the details. The warmer weather across the country calls to mind carefree summers - picnics in the park, swimming at the beach, fireworks on the Fourth.

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There's no playbook for living through a pandemic, so we decided to create one. With some basic rules to guide you, everyone can lower risk and live a full life while we wait for the virus to get under control.

Abby Fisher, a hostess, prepares a table at Lindey's restaurant in Columbus, Ohio on June 5. Credit... Maddie McGarvey for The New York Times

While it might feel as if the coronavirus crisis is over, it's not. The virus is still out there.

But some things have changed. To start, lockdowns are ending because cases are low or falling in some areas or because state leaders have decided to move ahead despite the risk. Testing has increased, giving us more indicators of community health. Plus we know a lot more about how the virus behaves and what activities pose the highest risk.

And because life on permanent lockdown isn't sustainable, public health experts are beginning to embrace a "harm reduction" approach, giving people alternatives to strict quarantine. These options - like forming a "bubble" with another household or moving social activities outdoors - don't eliminate risk, but they minimize it as people try to return to daily life.

Nobody knows exactly what will happen as communities open up. The most likely scenario is that virus cases will continue to surge and fall around the globe for the foreseeable future.

"It's hard to imagine how we will avoid another surge in infections, which is why these harm reduction approaches that keep people away from much higher risk situations are so important," said Julia Marcus, an infectious disease epidemiologist and assistant professor in the department of population medicine at Harvard Medical School. "If someone expanding their bubble keeps them from having crowded dinner parties or going to bars, then that is a success."

While we've learned to live with masks and social distancing, as well as new rituals of hand-washing after handling packages and touching surfaces, we need some basic rules to minimize risk and still have a life going forward. We've consulted with several public health experts and scientists to give you the tools you need to make your own decisions, whether it's dining at a restaurant, going to church or simply getting a haircut.

To gauge your risk of coming into contact with an infected person, pay attention to two important indicators of Covid-19 in your area: the percentage of tests that are positive, and the trend in overall case rates.

Start by learning the percentage of positive Covid-19 tests in your state, which tells you if testing and contact tracing are finding mild and asymptomatic cases. When positive test rates stay at 5 percent or lower for two weeks, that suggests there's adequate testing in your state to get virus transmission under control, and you're less likely to cross paths with the virus. The closer the number is to 2 percent, the better.

"It doesn't mean you have total freedom," warns Erin Bromage, a comparative immunologist and biology professor at the University of Massachusetts, Dartmouth. "It means there's enough testing going on there that you can feel confident that your interactions in society are going to be of much lower risk."

If the percentage of positive tests starts to rise, you should take more precautions.

To find out whether your state is meeting the testing criteria, go to your state health department website. Or you can use this chart from Johns Hopkins University The website Covid Act Now allows you to see positive test rates by county.

Next, use our maps and case count pages to stay informed of the Covid-19 trends in your area. When the number of overall cases is low or falling, you should feel safer, but you still need to be vigilant. Be more cautious when case counts start rising.

You're safest with members of your household, but if you want to widen your circle to extended family or friends, keep the number of close contacts as low and as consistent as possible. One way to do this is to form a "corona bubble," which happens when two households form an exclusive social circle, agreeing on safety guidelines and to see only each other. The arrangement allows people to visit each other's homes and lead a somewhat normal, if limited, social life. It may be particularly helpful for families with similar structures - such as those with young children longing for playmates or teenagers seeking in-person contact.

The arrangement requires a high level of trust. How does each family define reasonable precautions? Count the number of potential "leaks" for each member of the bubble - such as trips to the store or office, play dates, children and teens who see friends, or housekeepers and nannies who may visit multiple homes.

Keep communication open and without judgment, so people feel comfortable disclosing new exposure risks and potential "leaks" in the bubble.

"People's activities are going to change every day - schools may reopen, someone may decide to go to protest," said Dr. Marcus. "This is not just a one-time agreement. The communication about risk needs to be ongoing and open."

Risk is cumulative. Going forward, you'll need to make trade-offs, choosing activities that are most important to you (like seeing an aging parent) and skipping things that might matter less (an office going-away party). Think about managing virus risk just as you might manage a diet: If you want dessert, eat a little less for dinner.

During a pandemic, every member of the household should manage their own exposure budget. (Think Weight Watchers points for virus risk.) You spend very few budget points for low-risk choices like a once-a-week grocery trip or exercising outdoors. You spend more budget points when you attend an indoor dinner party, get a haircut or go to the office. You blow your budget completely if you spend time in a crowd.

"Moving into a long-term management phase, we have to start thinking like this," says Johannes Eichstaedt, a computational social scientist and psychology professor at Stanford University. "Don't take risks where it's not needed, and make trade-offs that are congruent with your larger health needs and priorities. If seeing my grandchild in the park means, to balance this, I can only go to the supermarket every other week, maybe that's a trade-off I'm willing to make for my mental health and well-being."

Unfortunately, there's no magic number to determine your personal exposure budget and the exposure "costs" of different actions. But think about your overall exposure budget when you make decisions to spend time with other people, particularly older people and those with high-risk conditions.

Every time you make plans, ask yourself, "If an infected person happens to be nearby, how much time could I be spending with them?" It takes an extended period of close contact with an infected person, or extended time in a poorly ventilated room with an infected person, to have a substantial risk of catching the virus through the air, said Linsey Marr, an aerosol scientist at Virginia Tech.

When making decisions, keep indoor events brief and move social events outdoors. Wear a mask and practice social distancing. Here's some guidance about time of exposure.

Brief exposure:Brief encounters, particularly those outside - like passing someone on the sidewalk or a runner who huffs and puffs past your picnic - are unlikely to make you sick.

Face-to-face contact: Wear a mask, and keep close conversations short. We don't know the level of exposure required to make you sick, but estimates range from a few hundred to 1,000 copies of the virus. In theory, you might reach the higher estimate after just five minutes of close conversation, given that a person might expel 200 viral particles a minute through speech. When health officials perform contact tracing, they typically look for people with whom you've spent at least 15 minutes in close contact.

Indoor exposure:In an enclosed space, like an office, at a birthday party, in a restaurant or in a church, you can still become infected from a person across the room if you share the same air for an extended period of time. There's no proven time limit that is safest, but based on contact tracing guidelines and the average rate at which we expel viral particles - through breathing, speaking and coughing - it's best to keep indoor activities, like shopping or haircuts, to less than an hour. Even shorter is better.

As you make decisions, Dr. Bromage suggests you consider the volume of air space (open space is safer than a small meeting room), the number of people in the space (fewer is better) and how much time everyone is together (keep it brief). To learn more about timing and risk, read Dr. Bromage's blog post on the topic, which has been viewed more than 18 million times.

Already some people in many communities have stopped wearing masks, suspended social distancing and returned to their pre-pandemic socializing. Time will tell if case counts start to rise as a result, but in the coming months you would be wise to adopt the following habits.

Keep a mask handy. Wear a mask in enclosed spaces, when you shop or go to the office and anytime you are in close contact with people outside your household.

Practice social distancing - staying six feet apart - when you are with people who live outside your household. Keep social activities outdoors.

Wash hands frequently, and be mindful about touching public surfaces (elevator buttons, hand rails, subway poles, and other high-touch areas)

Adopt stricter quarantine practices if you or someone in your circle is at higher risk.

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There's no playbook for living through a pandemic, so we decided to create one. With some basic rules to guide you, everyone can lower risk and live a full life while we wait for the virus to get under control.

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The vast majority of the country is under lockdown right now. But stay-at-home orders come with a few exceptions - like grocery shopping.

Many of us are still venturing out to stock up on food and toiletries. But what's the safest way to shop during this pandemic? And what should you do once you've brought your haul home?

We asked infectious disease, virology and food safety experts to share their tips about safe grocery shopping - and what you can stop worrying about.
Know the dangers - focus on the people, not the food
Many people worry about the possibility of picking upthe coronavirusfrom things like grocery store conveyor belts or cereal boxes. But every expert NPR spoke with agrees that the biggest risk when it comes to groceries is being inside the store itself with other people who may be infected.

"While it is possible to contract the virus [from contaminated surfaces], the majority of transmission is probably going to be from respiratory droplets, which you're exposed to when you're around other people," says Angela Rasmussen, a virologist at the Center for Infection and Immunity at Columbia University's Mailman School of Public Health.
Avoid crowds and shop quickly
Donald Schaffner, a food microbiologist and distinguished professor at Rutgers University, advises that you look for a grocery store that limits the number of shoppers who are allowed to go in at one time. While that might lead to a long line outside, it's also likely to make it easier to practice social distancing inside the store - staying at least 6 feet away from other people. And once you are in there, he says, focus on getting in and out as fast as possible to minimize your risk.

"Be as efficient as possible in the store," Schaffner says. "Have a list. Move through the store quickly and efficiently. Get out of the way. Be respectful of other people. Maintain social distance while you're in the store."
Wear a face covering
Given the growing evidence that people can shed the virus before they are showing symptoms, they might not know they're infected either. That's why the Centers for Disease Control and Prevention now recommends that people wear cloth face coverings out in public, and some stores now require shoppers to wear them - not so much to protect you as to protect other people from you in case you are infected.
Go alone
Dr. David Aronoff, director of the Division of Infectious Diseases at Vanderbilt University Medical Center, says to go to the store alone if you can, because bringing the whole family shopping is just going to add to crowding in the aisles - and could potentially raise your household's risk of infection too.

"If you have three people living together and all three people go to the store, even if all three people have a low risk of getting infected at an individual level, as a group they've tripled their risk, essentially," says Aronoff, who recently wrote about safe food practices during this pandemic in the medical journal JAMA.
Sanitize carts and hands
Once you are in the store, make sure to sanitize the handles of your cart or basket. Many stores do this for customers now, but it doesn't hurt to bring your own hand sanitizer or disinfecting wipes if you have them. Be sure to avoid touching your face while you are there, until you can sanitize your hands again.

One other tip, from Rasmussen: Don't use your cellphone while you're in the store, because a "phone is a great way to get your hands right up next to your face."
Skip the gloves
"Gloves are not magic," Schaffner says. "Gloves don't make you invulnerable. As soon as you touch something with your gloved hand, that contamination is on the gloves."

Rasmussen agrees. "I've seen a lot of people wearing gloves out in public, and they just kind of wear them all day and do a lot of normal activities, like talk on their phone, potentially eat, potentially handle food that they're going to eat later with those gloves on," she says. "And that's not great practice."

She leaves the gloves at home and sanitizes or washes her hands instead - before entering the store, after leaving and again once she gets home.

Rachel Graham, a virologist who studies coronaviruses at the University of North Carolina's Gillings School of Global Public Health, also skips the gloves. But if you do choose to wear them, she says be sure to remove them properly: "The best way to remove gloves that might be contaminated is to basically grab them from the inside on your palm side and pull them out like you're pulling off a sock, so you end up turning them inside out."
Give the cashier some space
While grocery shopping may stress you out, it's the workers at the grocery store who are more at risk, because they interact with many customers daily. Protect them by making sure you stand 6 feet away, or as far as you can, while checking out.

As for whether to use self-checkout or a cashier, look for the option that allows you the most room to maintain social distance. It all depends on how the store is set up. Some checkout counters now have plexiglass between the cashier and the paying customer. In that situation, says Aronoff, going to a cashier is fine, especially if one or both of you is wearing a mask or face covering.
Choose no-touch payment when you can
If you've got a no-touch option like Apple Pay or Google Pay, use it. If that's not an option, a credit card machine with a chip reader can be no-touch, notes Graham. She's personally avoiding cash at the moment, because earlier research has found that cash currency can harbor lots of microorganisms.

However, Rasmussen notes that we don't know how long this coronavirus survives on cash. And she says that if your credit card transaction requires you to touch a keypad, that's a "high-touch surface" that could potentially harbor other pathogens, if not the coronavirus. That said, "I don't want to encourage people to be extreme germophobes," Rasmussen says.

Cash or credit, she says, just make sure to sanitize your hands (and your credit card) after the transaction.
Don't drive yourself crazy disinfecting your groceries
Many shoppers are now following elaborate routines to disinfect their groceries, thanks to a viral video put out by a Michigan family doctor. But all of the experts we spoke with say that disinfecting and hand-washing every last item in your grocery haul is really not necessary. You might find it comforting to know that none of these experts are doing this themselves.

Rasmussen explains that the probability of getting infected from a contaminated surface is not zero, but it is fairly low. That's because respiratory droplets would have to have landed on the exact spot on, say, a box of cereal that you are touching. And even then, you'd have to get enough residual virus on your hand to start an infection - and you'd have to transfer that virus to your face. Bottom line: If you follow good hand-hygiene practices - washing your hands after unpacking your groceries, before cooking and before eating - then, she says, your risk is probably "very, very low."

As Aronoff notes, "Time is really on your side here." That's because as soon as the virus lands on a surface, it starts to lose infectiousness. "After 24 hours, the vast majority of virus is no longer infectious," he says. And after 72 hours, he notes that research has found the virus is trace or undetectable on most surfaces.So if you know that you're not going to use a can of soup for two or three days, he says, just put it away, wash your hands and go about your day. And one more thing: Make sure to wipe down your countertops after you unpack, using a household disinfectant registered with the Environmental Protection Agency.

If you're still worried and it's a food that doesn't need to be refrigerated, Graham says just leave it out for 24 hours.
If you really want to wash your groceries, don't use disinfecting spray or wipes Rinse fresh produce in plain water - and eat your veggies!
If it somehow lessens your anxiety to wipe down every last jar of jelly, there's no harm in that, experts agree. But Graham warns that if you feel compelled to wipe, it might be wise to stick to soap and water. "A lot of the packaging that groceries come in is really not meant to be sprayed with disinfectant, and you [could] actually end up contaminating your food," she says.

Schaffner adds that disinfecting sprays and wipes are meant to be used on hard surfaces, which would not include many of the kinds of plastics or cardboard used for food packaging.
Should you shower or change clothes after shopping? It depends
Some people are advocating washing produce in soap and water. But Schaffner says that's a bad idea because it's possible that if you ingest soap residue, it could lead to diarrhea or vomiting. He says the best thing is just to rinse your produce in cold water. If it's an item with a tough skin, you can use a vegetable brush.

And Schaffner says, please don't reduce your consumption of fresh fruit or vegetables. "There's just no evidence that these foods can transmit the virus or can cause COVID-19," he says. Plus, he says, produce offers valuable nutrients that are especially important in these stressful times.

"I personally don't like to do a full de-con [de-contamination] when I get home from the store," Rasmussen says. "I wash my hands. I'm not routinely putting my face and mouth all over my clothing."
Still anxious? Order online
But, she adds, "people with small children might consider otherwise, since kids - especially little kids - are maybe not so concerned about where they put their mouths or their hands." She says it comes back to personal comfort. "If you feel more comfortable changing clothes and taking a shower after you come back from an essential errand, then by all means do so," she says.
A word about frozen food
Graham adds that if you live with someone who is at high risk for severe disease with COVID-19, showering and changing might be a reasonable precaution to take.

One simple way to stop worrying about grocery shopping and to practice social distancing is online delivery.You can pay ahead of time online and have the groceries delivered outside your door with no face-to-face contact. Just remember, while you're staying home safe, workers are putting themselves at risk to collect and deliver your food. So be sure to tip generously. As for what to do with unpacking those groceries, experts say the advice is the same as if you'd gone to the store yourself.

Some of you have asked if freezing food kills the virus. The answer is no. Refrigerating or freezing would actually help the virus survive longer - that's why research labs freeze virus samples to preserve them, as Graham notes. But if you're worried about handling a frozen dinner, just throw away the packaging and remember to wash your hands after you've removed the food, Rasmussen says.

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No, You Don't Need To Disinfect Your Groceries. But Here's How To Shop Safely

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The vast majority of the country is under lockdown right now. But stay-at-home orders come with a few exceptions - like grocery shopping. Many of us are still venturing out to stock up on food and toiletries. But what's the safest way to shop during this pandemic?

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Support Nonprofits

Nonprofits of all types - especially those serving vulnerable communities - need your help. Donate to nonprofits you love, that you see helping people in need, that your friends recommend to you, and that are addressing systemic inequities and disparities. You can also consider giving to regional funds that will disburse grants to nonprofits: https://www.philanthropyca.org/covid-19-response.

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Support Nonprofits Nonprofits of all types - especially those serving vulnerable communities - need your help. Donate to nonprofits you love, that you see helping people in need, that your friends recommend to you, and that are addressing systemic inequities and disparities. You can also consider giving to regional funds that will disburse grants to nonprofits: https://www.philanthropyca.org/covid-19-response.

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Coronavirus symptoms: 10 key indicators and what to do

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Coronavirus symptoms: 10 key indicators and what to do

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April 7, 2020

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coronavirus symptoms: 10 key indicators and what to do - cnn

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Coronavirus symptoms: 10 key indicators and what to do

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We are learning more about coronavirus symptoms every day. Here are 10 of the most common symptoms and what to do to keep you and your family safe.

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Centers for Disease Control and Prevention

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Resources and information on the COVID-19 pandemic from the Centers for Disease Control and Prevention (CDC) and other government agencies

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Explore concepts and publications in a visual Knowledge Map that enables you to see how ideas are connected. Complements traditional search engines and databases to extend your discovery toolkit.

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Advice About COVID-19 For People Over 60 With Chronic Conditions

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Advice About COVID-19 For People Over 60 With Chronic Conditions

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Advice About COVID-19 For People Over 60 With Chronic Conditions

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Message to New Haven Area About COVID and People Over 60 and With Chronic Conditions

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Questions about COVID-19 or the County Health Officer's Shelter in Place Order should be directed to the County's 2-1-1 Call Center. For questions about City Services, please call the City's main line at (650) 522-7000.

Staff in non-essential functions will be working remotely to the extent possible and checking email, but please expect some delay in responses. The public should be prepared for further changes, included extended closures of services and businesses, as more information becomes available from public health officials and as directed by state and federal leadership.

Library Services:

Libraries Closed: Public libraries are closed and services suspended. All programs, events and meeting room reservations have been cancelled.

Keep Your Library Items: Checked out library items should be kept by patrons and not returned during the closure. We will automatically extend checkout times for borrowed items and no one will be fined during this closure.

Parks & Recreation Services:

Recreation Programs Suspended: All registered and drop-in recreation programs, special events and activities are suspended until further notice. Staff can be reached on a limited basis at (650) 522-7400 or parksandrecreation@cityofsanmateo.org

All Recreation Centers Closed: The Senior Center and community centers at Beresford, Martin Luther King Jr., Shoreview and Lakeshore are closed. Poplar Creek Golf Course and the Japanese Garden at Central Park are also closed. Private facility rentals have been cancelled.

Senior Lunches Available for Pick-Up: Senior Lunches will be available for pick up at King and the Senior Centers between the hours of 12:15 pm and 1:15 pm on their normal day of operations, T-TH at King Center and M-W-F at the Senior Center however pre-registration is required. Please call (650) 522-7490 to reserve your lunch.

Senior Transportation Program Uninterrupted: The Senior Get Around Transportation Program provided through Serra Cabs will continue uninterrupted.

Mobile Rec and PAL Activities Suspended: The Mobile Rec Van and Police Activities League (PAL) activities are suspended.

Youth Sports Suspended: Youth sports leagues, including San Mateo Little League National, San Mateo Little League American, San Mateo Youth Softball Association and AYSO are suspended.

All Picnic Area and Field Reservations Cancelled: All outdoor picnic reservations and miscellaneous field reservations are cancelled.

Please read our Frequently Asked Questions for additional information.

Police Services:

Increased Patrols: The Police Department will be increasing patrols and the number of officers on the street to help maintain order and public safety.

Police Department Closed to Public: The Police Department will be closed to public access. Walk-up needs will be assessed on a case-by-case basis via the vestibule phone at the front of the police department building.

Non-Emergency Call Number: The non-emergency phone number is (650) 522-7700.

Call 9-1-1 for All Emergencies: For emergencies, continue to call 9-1-1.

File Police Reports Online: We encourage the public to reduce non-critical calls to police, and remember you can file many police reports online.

City Hall Services:

City Hall Closed: City Hall will be closed to the public. Staff will be available to answer questions from the public by phone or email. For general information, please call (650) 522-7000 or email webmaster@cityofsanmateo.org.

Finance Department: Business Tax - applications are available online and staff will respond to voicemails left on the main line.

Public Works Department: The Public Works Department will continue to provide road construction, wastewater collection/treatment services, and limited public infrastructure maintenance. Staff will be available for general and project-specific questions over the phone (650) 522-7300 and via email publicworks@cityofsanmateo.org.

Street Cleaning Paused: Street cleaning services will pause temporarily.

Pending Encroachment Permits: Pending Encroachment Permit applications will proceed in a limited capacity via email, however, no new permits or in-person applications will be processed until further notice pwencroachment@cityofsanmateo.org.

Maintenance Concerns Outside of Office Hours: For any maintenance concerns outside of office hours, residents should call (650) 522-7350.

Community Development Department: Planning, Building, Code Enforcement and Housing Services staff will be available for telephone and email inquiries. Contact information for each service is available online.

Building inspections only for critical life/safety situations, as determined by the Building Official - scheduled by telephone only (650) 522-7172

Planning Division - there will be limited internal plan processing of pending planning and building permit applications - no in-person activities. No new Planning applications will accepted during this period. (650) 522-7212 or planning@cityofsanmateo.org

Code Enforcement Division - will only handle critical life/safety situations as determined by the CDD director. (650) 522-7150 or codeenforcement@cityofsanmateo.org

Housing and Neighborhood Improvement Division (650) 522-7220 or housing@cityofsanmateo.org

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Staff in non-essential functions will be working remotely to the extent possible and checking email, but please expect some delay in responses. The public should be prepared for further changes, included extended closures of services and businesses, as more information becomes available from public health officials and as directed by state and federal leadership.

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Group games and solo games.

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Coronavirus Disease (COVID-19) – Statistics and Research

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Coronavirus Disease (COVID-19) – Statistics and Research

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Explore the global situation

Coronavirus Country Profiles

We built 207 country profiles which allow you to explore the statistics on the coronavirus pandemic for every country in the world.

In a fast-evolving pandemic it is not a simple matter to identify the countries that are most successful in making progress against it. For a comprehensive assessment, we track the impact of the pandemic across our publication and we built country profiles for 207 countries to study in depth the statistics on the coronavirus pandemic for every country in the world.

Each profile includes interactive visualizations, explanations of the presented metrics, and the details on the sources of the data.

Every country profile is updated daily.

Every profile includes five sections:

1. Cases: How many new cases are being confirmed each day? How many cases have been confirmed since the pandemic started? How is the number of cases changing?

2. Deaths: How many deaths from COVID-19 have been reported? Is the number of deaths rising or falling? How does the death rate compare to other countries?

3. Vaccinations: How many vaccine doses are being administered each day? How many doses have been administered in total? What share of the population has been vaccinated?

4. Testing: How much testing for coronavirus do countries conduct? How many tests did a country do to find one COVID-19 case?

5. Government responses: What measures did countries take in response to the pandemic?

Acknowledgements

We would like to acknowledge and thank a number of people in the development of this work: Carl Bergstrom, Bernadeta Dadonaite, Natalie Dean, Joel Hellewell, Jason Hendry, Adam Kucharski, Moritz Kraemer and Eric Topol for their very helpful and detailed comments and suggestions on earlier versions of this work. We thank Tom Chivers for his editorial review and feedback.

And we would like to thank the many hundreds of readers who give us feedback on this work. Your feedback is what allows us to continuously clarify and improve it. We very much appreciate you taking the time to write. We cannot respond to every message we receive, but we do read all feedback and aim to take the many helpful ideas into account.

Reuse our work freely

All visualizations, data, and code produced by Our World in Data are completely open access under the Creative Commons BY license. You have the permission to use, distribute, and reproduce these in any medium, provided the source and authors are credited.

The data produced by third parties and made available by Our World in Data is subject to the license terms from the original third-party authors. We will always indicate the original source of the data in our documentation, so you should always check the license of any such third-party data before use and redistribution.

All of our charts can be embedded in any site.

Citation

Our articles and data visualizations rely on work from many different people and organizations. When citing this entry, please also cite the underlying data sources. This entry can be cited as:

Hannah Ritchie, Edouard Mathieu, Lucas Rodés-Guirao, Cameron Appel, Charlie Giattino, Esteban Ortiz-Ospina, Joe Hasell, Bobbie Macdonald, Diana Beltekian and Max Roser (2020) - "Coronavirus Pandemic (COVID-19)". Published online at OurWorldInData.org. Retrieved from: 'https://ourworldindata.org/coronavirus' [Online Resource]

BibTeX citation

@article{owidcoronavirus,
    author = {Hannah Ritchie, Edouard Mathieu, Lucas Rodés-Guirao, Cameron Appel, Charlie Giattino, Esteban Ortiz-Ospina, Joe Hasell, Bobbie Macdonald, Diana Beltekian and Max Roser},
    title = {Coronavirus Pandemic (COVID-19)},
    journal = {Our World in Data},
    year = {2020},
    note = {https://ourworldindata.org/coronavirus}
}

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Country-by-country data and research on the pandemic. Updated daily.

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The Coronavirus Explained & What You Should Do

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The Coronavirus Explained & What You Should Do

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From my dad, a physician, who highly recommends it.

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The Coronavirus Explained & What You Should Do

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How Long Will Coronavirus Live on Surfaces or in the Air Around You?

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How Long Will Coronavirus Live on Surfaces or in the Air Around You?

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A new study could have implications for how the general public and health care workers try to avoid transmission of the virus.

A passenger wiped down her surroundings before a flight from Detroit to Washington earlier this month. Credit... Alyssa Schukar for The New York Times

The coronavirus can live for three days on some surfaces, like plastic and steel, new research suggests. Experts say the risk of consumers getting infected from touching those materials is still low, although they offered additional warnings about how long the virus survives in air, which may have important implications for medical workers.

The new study, published Tuesday in the New England Journal of Medicine, also suggests that the virus disintegrates over the course of a day on cardboard, lessening the worry among consumers that deliveries will spread the virus during this period of staying and working from home.

When the virus becomes suspended in droplets smaller than 5 micrometers - known as aerosols - it can stay suspended for about a half-hour, researchers said, before drifting down and settling on surfaces where it can linger for hours. The finding on aerosol in particular is inconsistent with the World Health Organization's position that the virus is not transported by air.

The virus lives longest on plastic and steel, surviving for up to 72 hours. But the amount of viable virus decreases sharply over this time. It also does poorly on copper, surviving four hours. On cardboard, it survives up to 24 hours, which suggests packages that arrivein the mail should have only low levels of the virus- unless the delivery person has coughed or sneezed on it or has handled it with contaminated hands.

That's true in general. Unless the people who handle any of these materials are sick, the actual risk of getting infected from any of these materials is low, experts said.

"Everything at the grocery store and restaurant takeout containers and bags could in theory have infectious virus on them," said Dr. Linsey Marr, who was not a member of the research team but is an expert in the transmission of viruses by aerosol at Virginia Tech in Blacksburg. "We could go crazy discussing these 'what-ifs' because everyone is a potential source, so we have to focus on the biggest risks."

If people are concerned about the risk, they could wipe down packages with disinfectant wipes and wash their hands, she said.

It is unclear why cardboard should be a less hospitable environment for the virus than plastic or steel, but it may be explained by the absorbency or fibrous quality of the packaging compared with the other surfaces.

That the virus can survive and stay infectious in aerosols is also important for health care workers.

For weeks experts have maintained that the virus is not airborne. But in fact, it can travel through the air and stay suspended for that period of about a half-hour.

The virus does not linger in the air at high enough levels to be a risk to most people who are not physically near an infected person. But the procedures health care workers use to care for infected patients are likely to generate aerosols.

"Once you get a patient in with severe pneumonia, the patients need to be intubated," said Dr. Vincent Munster, a virologist at the National Institute of Allergy and Infectious Diseases who led the study. "All these handlings might generate aerosols and droplets."

Health care workers might also collect those tiny droplets and larger ones on their protective gear when working with infected patients. They might resuspend these big and small droplets into the air when they take off this protective gear and become exposed to the virus then, Dr. Marr cautioned.

A study that is being reviewed by experts bears out this fear. And another study, published March 4 in JAMA, also indicates that the virus is transported by air. That study, based in Singapore, found the virus on a ventilator in the hospital room of an infected patient, where it could only have reached via the air.

Dr. Marr said the World Health Organization has so far referred to the virus as not airborne, but that health care workers should wear gear, including respirator masks, assuming that it is.

"Based on aerosol science and recent findings on flu virus," she said, "surgical masks are probably insufficient."

Dr. Marr said based on physics, an aerosol released at a height of about six feet would fall to the ground after 34 minutes. The findings should not cause the general public to panic, however, because the virus disperses quickly in the air.

"It sounds scary," she said, "but unless you're close to someone, the amount you've been exposed to is very low."

Dr. Marr compared this to cigarette smoke or a foggy breath on a frosty day. The closer and sooner another person is to the exhaled smoke or breath, the more of a whiff they might catch; for anyone farther than a few feet away, there is too little of the virus in the air to be any danger.

To assess the ability of the virus to survive in the air, the researchers created what Dr. Munster described as "bizarre experiments done under very ideal controllable experimental conditions." They used a rotating drum to suspend the aerosols, and provided temperature and humidity levels that closely mimic hospital conditions.

In this setup, the virus survived and stayed infectious for up to three hours, but its ability to infect drops sharply over this time, he said.

He said the aerosols might only stay aloft for about 10 minutes, but Dr. Marr disagreed with that assessment, and said they could stay in the air for three times longer. She also said that the experimental setup might be less comfortable for the virus than a real-life setting.

For example, she said, the researchers used a relative humidity of 65 percent. "Many, but not all viruses, have shown that they survive worst at this level of humidity," she said. They do best at lower or much higher humidity. The humidity in a heated house is less than 40 percent, "at which the virus might survive even longer," she said.

Mucus and respiratory fluids might also allow the virus to survive longer than the laboratory fluids the researchers used for their experiments.

Other experts said the paper's findings illustrate the urgent need for more information about the virus' ability to survive in aerosols, and under different conditions.

"We need more experiments like this, in particular, extending the experimental sampling time for aerosolized virus beyond three hours and testing survival under different temperature and humidity conditions," said Dr. Jeffrey Shaman, an environmental health sciences expert at Columbia University.

Dr. Munster noted that, overall, the new coronavirus seems no more capable of surviving for long periods than its close cousins SARS and MERS, which caused previous epidemics. That suggests there are other reasons, such as transmission by people who don't have symptoms, for its ability to cause a pandemic.

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How Long Will Coronavirus Live on Surfaces or in the Air Around You?

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A new study could have implications for how the general public and health care workers try to avoid transmission of the virus. The coronavirus can live for three days on some surfaces, like plastic and steel, new research suggests.

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How Long Does the Coronavirus Live on Surfaces

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How Long Does the Coronavirus Live on Surfaces

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How long can the new coronavirus live on a surface, like say, a door handle, after someone infected touches it with dirty fingers? A study out this week finds that the virus can survive on hard surfaces such as plastic and stainless steel for up to 72 hours and on cardboard for up to 24 hours.

"This virus has the capability for remaining viable for days," says study author, James Lloyd-Smith, an assistant professor of ecology and evolutionary biology at the University of California, Los Angeles, who researches how pathogens emerge.

Although the World Health Organization had previously estimated the survival time on surfaces to be a "few hours to a few days" based on research on other coronaviruses, this is the first study by scientists at a federal laboratory to test the actual virus causing the current pandemic, SARS-CoV-2.

The study is out in preprint form and expected to be published.

Interestingly, some surfaces are less hospitable to SARS-CoV-2. For instance, the virus remained viable on copper for only about four hours.

It's useful to know how long it can stay alive of course, because the virus can contaminate surfaces when an infected person sneezes or coughs. Virus-laden respiratory droplets can land on doorknobs, elevator buttons, handrails or countertops - and spread the virus to anyone who then touches these surfaces.

To test the survival time of the virus, scientists at the Rocky Mountain Laboratories in Montana, part of the National Institutes of Health, conducted a series of experiments comparing the novel coronavirus with the SARS virus (a similar coronavirus that led to an outbreak back in 2003).

In the lab, "they'd pick up the virus from the surfaces that had been contaminated and then put [the virus] into cell cultures," he explains. Then the researchers documented whether the virus could infect those cells in the dish. They did this multiple times, for both the viruses, at various time points.

"Big picture, the [two viruses] look very similar to each other in terms of their stability in these environments," Lloyd-Smith says.

Lloyd-Smith says these findings establish a good ballpark estimate for the survivability of the virus on these surfaces. "In a laboratory experiment, the conditions are pretty carefully controlled and constant," he says. By comparison, "in the real world, conditions fluctuate" - conditions like temperature, humidity and light. So the survivability may vary, too.

For instance, if the virus contaminates a sunny windowsill or countertop, it may not last as long.

"Ultraviolet light can be a really powerful disinfectant and we get a lot of UVA light from the sun," says Daniel Kuritzkes an infectious disease expert at Brigham and Women's Hospital. "Direct sunlight can help rapidly diminish infectivity of viruses on surfaces," he says. He was not involved in the new research.

Much is still unknown about the virus's survivability on other types of surfaces like clothing, or carpeting. Kuritzkes says that based on prior research, it seems that "flat surfaces and hard surfaces are more friendly to viruses than cloth or rough surfaces."

And how about food? "Food is probably not a major risk factor here," Kuritzkes says. That's because most infection from the new coronavirus starts with the respiratory system, not the digestive tract. So infection comes from getting the virus on your hands and then touching your own eyes, nose and mouth. "Of more concern would be utensils, and plates and cups that might be handled by a large number of people in a cafeteria setting, for example," he says.

So, what can you do to protect yourself? Well, you've likely already heard this. Wash your hands. And wipe down shared surfaces.

Follow these tips for cleaning surfaces - your own and public ones.
Wipe right: Use ammonia or alcohol-based products. Skip the baby wipes
"The good thing about COVID-19 is that it does not require any unique cleaning chemicals to disinfect hands and surfaces," says Andrew Janowski, an infectious disease expert at Washington University School of Medicine and St. Louis Children's Hospital. COVID-19 is the disease caused by the current coronavirus,

Good old-fashioned soap and water does the trick.

You can also use a wipe, but make sure you use an alcohol-based wipe, not baby wipes, which may not be effective, Janowski says.

And given that wipes are hard to come by at many stores at the moment, you can instead buy an EPA-registered disinfecting spray, such as one on this list from the Center for Biocide Chemistries, recommended by the Centers for Disease Control and Prevention and by Dr. David Warren, an infectious disease specialist at Washington University School of Medicine in St. Louis.

Or make a bleach-based spray yourself. You can make a DIY cleaning spray by mixing 4 teaspoons bleach per quart of water, according to the CDC.
Wash. Your. Hands. (Seriously!)
Yes, you've heard it a hundred times. So do it, already! Especially after you've been out in public, touching a lot of surfaces. Lather up with soap and scrub for 20 seconds. (Two times the "Happy Birthday" song, or sing "Baby Shark" - you'll get midway through Daddy Shark).

And be thorough. Spend some time rubbing the backs of your hands as well as the front, interlace your fingers and pull them through, soap up each thumb with the opposite hand and, finally, to keep your fingernails virus-free, lightly scratch them against your palm. (For more detail, listen to NPR Short Wave's Maddie Sofia give a lesson here.)

Hand-washing is so important that if everyone followed good hand-washing hygiene, it could prevent an estimated 1 in 5 respiratory infections, according to the CDC - that's the equivalent of about 6 million cases of the flu this year.
Hand sanitizer: DIY in a pinch?
Hand sanitizer is effective at killing viruses, too, although hand-washing is preferred, according to the CDC. If you can't get to a sink, hand sanitizer is a good backup plan - just make sure it's at least 60% alcohol.

Given the shortage of hand sanitizers in some stores and reports of price-gouging online, there's lots of interest in DIY hand sanitizer. We've seen lots of recipes calling for a combination of rubbing alcohol and aloe vera gel, like this one from Wired.

"On paper, if a recipe can maintain the alcohol concentration above 60%, it should be effective against SARS-COV-2," says Andrew Janowski, but he says getting it just right might be trickier than you think. If in doubt when making these homemade sanitizers, soap and water are still effective against the virus.

Your smartphone is like a third hand. Wipe it down

So you've just washed your hands and you're feeling squeaky clean. Then you pick up your cellphone, and guess what? It's covered with potential pathogens.

"Studies have shown that smartphones surfaces are covered in bacteria, including bacteria that can cause serious infections like Staphylococcus species," says Judy Guzman-Cottrill, an infectious disease expert at Oregon Health & Science University.

And phones are often held close to the eyes, nose and mouth, where germs can enter the body. So wipe it down often.

And you don't have to rub down your phone for long if you're using an alcohol-based sanitizer. "Just a few seconds should be sufficient to disinfect," says Janowski.
Try this stinky trick to stop touching your face
Your face offers multiple entry points for the virus. So every time you touch your eyes, nose and mouth with grubby hands, you risk infection.

"If you have touched a table or a doorknob or some surface contaminated [with the virus] and then touch your eyes, nose or mouth, you have a chance of inoculating yourself with the virus," Kuritzkes says.

But, as a matter of habit, most of us touch our faces multiple times an hour without even realizing it.

So, here's an idea. "After you wash your hands really well, touch a piece of raw onion," says Catherine Belling of Northwestern University Feinberg School of Medicine. With this strong smell on your fingers, "you'll notice when you touch your face," she says. Sure, it may make you a tad antisocial, but it could be a good way to train yourself to touch less.

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The New Coronavirus Can Live On Surfaces For 2-3 Days - Here's How To Clean Them

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How long can the new coronavirus live on a surface, like say, a door handle, after someone infected touches it with dirty fingers? A study out this week finds that the virus can survive on hard surfaces such as plastic and stainless steel for up to 72 hours and on cardboard for up to 24 hours.

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Covid-19 info for our county.

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¿Qué es el "novel coronavirus" (COVID-19)?

El "novel coronavirus" es un nuevo virus respiratorio identificado originalmente en la cuidad de Wuhan, Provincia de Hubei, China, en Diciembre del 2019. El virus se ha propagado a muchos países, incluyendo los Estados Unidos. Técnicamente, el nombre del virus es SARS-COv-2 y la enfermedad que causa se llama COVID-19 (enfermedad del coronavirus 2019 por sus siglas en Inglés.) Para más información acerca del "novel coronavirus" (COVID-19) consulte el sitio en Internet de los Centros para el Control y la Prevención de Enfermedades (CDC por sus siglas en Inglés.)

¿Qué medidas está tomando el Departamento de Saludo del condado de San Mateo?

Oficiales del Departamento de Salud del condado de San Mateo están trabajando en colaboración con el Departamento de Salud Pública de California (CDPH -siglas en Inglés) y con los Centros para el Control y la Prevención de Enfermedades (CDC -siglas en Inglés) para coordinar la respuesta al brote de COVID-19. Estamos proveyendo información a los proveedores de salud de nuestro condado sobre cómo evaluar de manera efectiva y segura a personas enfermas. Continuamos supervisando la situación de cerca, coordinando con nuestros colaboradores para identificar posibles casos de infección, proveyendo información y servicios de consulta para asegurar que los casos que se presenten sean diagnosticados y manejados de modo seguro, e implementando las recomendaciones provenientes de los CDC. Asimismo, realizamos investigaciones completas, y proveemos apoyo logístico desde transporte a hospedaje para todos los casos que resulten positivos.

¿Cuál es la capacidad de hacer tests para detectar COVID-19 en el condado de San Mateo?

Es posible que usted haya recibido información incorrecta el 4 de Marzo del 2020 por parte del gobierno federal y del estatal. El condado de San Mateo actualmente no cuenta con la capacidad de realizar tests independientemente del testeo al que se puede acceder a través del Estado y de los CDC. La cantidad de tests disponible es tremendamente limitada. En caso de que aumente nuestra capacidad de realizar tests, deberá priorizarse el uso de los mismos teniendo en cuenta la infraestructura de salud, al riesgo de exposición, y/o en personas internadas. Los tests no estarán disponibles ni serán administrados u ofrecidos automáticamente como respuesta a una prescripción médica formal. Esto también puede cambiar si hubieran más tests disponibles en los próximos meses.

¿Deberia hacer un test para saber si tengo el "novel coronavirus"?

El 4 de Marzo del 2020, los CDC actualizaron sus pautas para evaluar y reportar Personas Bajo Investigación (PUI, por sus siglas en Inglés) por COVID-19 a los efectos de expandir testeo a un grupo más amplio de pacientes sintomáticos. Estas nuevas pautas deben interpretarse cuidadosamente para evitar agobiar a nuestros sistemas de salud locales. Estamos trabajando en colaboración con los CDC y con el Departmento de Salud Pública del estado de California (CDPH, por sus siglas en Inglés,) para determinar cómo implementar estos cambios. Tan pronto como lleguemos a esa determinación, diseminaremos recomendaciones adicionales a los proveedores de salud en el condado de San Mateo a través de los canales regulares. Las pautas actualizadas de los CDC expanden el testeo a un grupo más amplio de pacientes sintomáticos. Los proveedores de salud deben utilizar su juicio profesional para determinar si un paciente presenta signos y síntomas compatibles con COVID-19, y si el paciente debe ser chequeado para detectar la presencia del "novel coronavirus." Las decisiones acerca de qué pacientes someter a análisis deben basarse en la epidemiología local de COVID-19 y en el curso clínico de la enfermedad.

La mayoría de los pacientes con un diagnóstico confirmado de COVID-19 han tenido fiebre y/o síntomas de enfermedad respiratoria aguda (por ejemplo: tos, dificultad al respirar.) Instamos encarecidamente a los proveedores de salud que chequeen por otras causas de enfermedad respiratoria, incluyendo infecciones como la influenza.

Factores epidemiológicos que pueden ser de ayuda para decidir cuándo testear: toda persona, incluyendo trabajadores de salud, que hayan estado en contacto cercano dentro de los 14 días de la aparición de los síntomas con un paciente con diagnóstico de COVID-19 confirmado por un laboratorio, o con historial de viajes en áreas geográficas afectadas (ver abajo) también dentro de un período de 14 días desde la aparición de los síntomas.

¿Qué medidas pueden tomar los residentes del condado, y los visitantes, para prevenir COVID-19?

Cada individuo puede prevenir enfermedades:

Lávese las manos con jabón y agua por lo menos por 20 segundos, y hágalo frecuentemente.

Siempre cubra su boca cuando tosa o estornude.

Permanezca en su casa si está enfermo/a/x.

Si usted ha regresado recientemente de un país en el que la enfermedad COVID-19 está presente, monitoree su salud y siga las instrucciones de los oficiales de salud pública.

Cada individuo debe prepararse para la posible disrupción que un brote puede causar:

Asegúrese de tener un suministro suficiente de todos los medicamentos esenciales que su familia necesita;

Haga un plan alternativo de cuidados para menores de edad, para personas de la tercera edad y/o para personas adultas con discapacidades en caso de que usted o quienes proveen cuidados normalmente seas afectados por la enfermedad;

Haga un plan de acción para su familia en caso de que las escuelas cierren; y

También haga un plan de acción sobre cómo cuidar de miembros de su familia que se enfermen al mismo tiempo evitando contraer la enfermedad usted mismo/a/x.

¿De dónde proviene COVID-19?

Los virus llamados "coronavirus" son un numeroso grupo de virus que comúnmente afectan a distintos tipos de animales, tales como camellos, ganado, gatos y murciélagos. En raros casos, esos virus en animales pueden infectar a personas, y luego transmitirse de persona en persona. Actualmente no se sabe de qué animal proviene la enfermedad llamada COVID-19.

¿Cuáles son los síntomas del "novel coronavirus"?

En los casos confirmados de la "enfermedad del coronavirus 2019" (COVID-19 por sus siglas en Inglés,) la gravedad de las enfermedad ha variado de ligera a severa, e incluso fallecimiento. Los síntomas más comunes incluyen fiebre, tos, y falta de aire. Hasta la fecha los CDC creen que los síntomas de COVID-19 pueden presentarse entre 2 y 14 días luego de que alguien haya sido expuesto al virus.

¿Cómo se transmite el "novel coronavirus"?

El consenso actual es que el virus se transmite de persona a persona, entre personas que están en contacto cercano (unos 6 pies de distancia,) y a través de gotas muy pequeñas que emiten las personas infectadas cuando tosen o estornudan. Esas pequeñas gotas pueden depositarse en la boca o la nariz de personas que se encuentren próximas, e incluso pueden ser inhaladas y así llegar a los pulmones.

Esta es la época del año en la que el resfrío y la gripe son muy comunes, y muchas personas tienen síntomas de enfermedades que no tienen ninguna relación con COVID-19. Si usted tiene fiebre, tos, o falta de aire, llame a su proveedor de salud de inmediato y hágale saber sus síntomas y si ha realizado algún viaje recientemente. Por favor, asegúrese de llamar a su proveedor de su salud antes de presentarse en persona en su oficina, clínica, u hospital, para que el proveedor de salud se prepare por anticipado para su visita.

¿Puedo acceder a algún examen para determinar si tengo el "novel coronavirus"?

No es posible encargar un examen para determinar la presencia del "novel coronavirus." Si su proveedor de salud lo estima médicamente necesario, él/ella ordenará los exámenes correspondientes.

¿Deberia hacer un test para saber si tengo el "novel coronavirus"?

El 4 de Marzo del 2020, los CDC actualizaron sus pautas para evaluar y reportar Personas Bajo Investigación (PUI, por sus siglas en Inglés) por COVID-19 a los efectos de expandir testeo a un grupo más amplio de pacientes sintomáticos. Estas nuevas pautas deben interpretarse cuidadosamente para evitar agobiar a nuestros sistemas de salud locales. Estamos trabajando en colaboración con los CDC y con el Departmento de Salud Pública del estado de California (CDPH, por sus siglas en Inglés,) para determinar cómo implementar estos cambios. Tan pronto como lleguemos a esa determinación, diseminaremos recomendaciones adicionales a los proveedores de salud en el condado de San Mateo a través de los canales regulares. Las pautas actualizadas de los CDC expanden el testeo a un grupo más amplio de pacientes sintomáticos. Los proveedores de salud deben utilizar su juicio profesional para determinar si un paciente presenta signos y síntomas compatibles con COVID-19, y si el paciente debe ser chequeado para detectar la presencia del "novel coronavirus." Las decisiones acerca de qué pacientes someter a análisis deben basarse en la epidemiología local de COVID-19 y en el curso clínico de la enfermedad.

La mayoría de los pacientes con un diagnóstico confirmado de COVID-19 han tenido fiebre y/o síntomas de enfermedad respiratoria aguda (por ejemplo: tos, dificultad al respirar.) Instamos encarecidamente a los proveedores de salud que chequeen por otras causas de enfermedad respiratoria, incluyendo infecciones como la influenza.

Factores epidemiológicos que pueden ser de ayuda para decidir cuándo testear: toda persona, incluyendo trabajadores de salud, que hayan estado en contacto cercano dentro de los 14 días de la aparición de los síntomas con un paciente con diagnóstico de COVID-19 confirmado por un laboratorio, o con historial de viajes en áreas geográficas afectadas (ver abajo) también dentro de un período de 14 días desde la aparición de los síntomas.

¿Debo usar una máscara para evitar contraer el "novel coronavirus"?

Observar una buena práctica de lavado de manos es la manera más eficaz de prevenir la enfermedad. "Buena práctica" implica lavarse las manos con jabón y agua, y frotarlas durante no menos de 20 segundos. En este momento no recomendamos el uso de máscaras. No obstante, si usted decide utilizar una máscara, es importante que comprenda que la máscara no es un substituto para el lavado de manos. Lavarse las manos es la mejor estrategia. Si usted tiene fiebre o tos, se recomienda utilizar una máscara para prevenir que los gérmenes se propaguen.

¿Es seguro viajar?

La recomendación de los CDC es evitar todo viaje no-esencial a China y Corea del Sur. Los CDC mencionan a Italia, Irán y Japón como países en los que actualmente hay transmisión comunitaria sostenida de COVID-19, y recomiendan que personas de la tercera edad, así como personas con enfermedades crónicas, consideren posponer viajes no-esenciales. La situación mundial en relación con COVID-19 está evolucionando rápidamente, y es posible que más países se agreguen a la lista. Manténgase informado/a/x a través de las noticias de salud para viajeros de los CDC.

¿Existe una vacuna para el "novel coronavirus"?

No. Si bien actualmente existen varios esfuerzos para crear una vacuna en distintos lugares del mundo, actualmente no hay ninguna vacuna para protegernos contra el "novel coronavirus."

¿Cuál es el tratamiento indicado para alguien que contraiga el "novel coronavirus"?

El tratamiento actual consiste en tratar los síntomas. No existe ningún tratamiento específico para el "novel coronavirus."

Siento un alto nivel de estrés y agobio. ¿Qué puedo hacer al respecto?

Si busca información para acceder a servicios de salud mental y de adicción a substancias, contacte a su seguro médico. Si usted reside en San Mateo y su seguro médico es Medi-Cal, llame al (800) 686-0101 (Centro de Acceso a Servicios de Salud Mental y Recuperación de las Adicciones.)

Para recibir asistencia confidencial durante las 24 horas por parte de organizaciones locales y/o nacionales que proveen apoyo en caso de crisis, llame al (650) 579-0350 o al (800)273-8255. Para chatear online: envíe la palabra "START" al número de texto 741741.

Soy un proveedor de servicios de salud. ¿Dónde puedo conseguir más información?

Para información y alertas acerca del "novel coronavirus" para proveedores de servicios de salud, haga click aquí.

¿Dónde puedo conseguir más información?

Visite el sitio en Internet del COVID-19 del Departamento de Salud del Condado o visite el sitio en Internet de los CDC. Asimismo, puede acceder a más información a través de los enlaces listados a continuación.

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Novel Coronavirus (COVID-19) - San Mateo County Health

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¿Qué es el "novel coronavirus" (COVID-19) ? El "novel coronavirus" es un nuevo virus respiratorio identificado originalmente en la cuidad de Wuhan, Provincia de Hubei, China, en Diciembre del 2019. El virus se ha propagado a muchos países, incluyendo los Estados Unidos.

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Podcast from The Daily, interview with Donald McNeil. EXCELLENT.

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transcript

clare toeniskoetter

Test test, test. OK. Just got to Donald's.

Is it OK to lock my bike here?

donald g. mcneil jr.

Yeah, sure. You want to bring it inside?

clare toeniskoetter

If you don't think it's exposed.

donald g. mcneil jr.

OK. Hello.

clare toeniskoetter

Hi.

donald g. mcneil jr.

There.

clare toeniskoetter

We just, rather than shaking hands, bumped elbows.

donald g. mcneil jr.

Yes, the W.H.O. elbow bump. You want to sit down?

clare toeniskoetter

Should I wash my hands?

donald g. mcneil jr.

Yeah. You probably should, as much for your protection as for mine. It depends on what you put your hands on.

clare toeniskoetter

I wanted to ask you. We heard you, yesterday, sanitizing the studio. What do you do when you come home?

donald g. mcneil jr.

I wash my hands. I know the inside of my house is clean, because the only people in here are my girlfriend and myself, and we're both still healthy. But people who live upstairs - and this is a two-apartment building - we have agreed that we will tell each other if any of us has a fever or a cough, and we keep some alcohol wipes in the front hall to wipe down the doorknob, light switch, and other surfaces we might both touch, just to make sure that there's no possibility of us passing it back and forth to each other. I know it sounds kooky, but this is actually the way the disease gets transmitted. You don't have to be a crazy germaphobe. Or actually, at a time like this, it helps to be a crazy germaphobe just by instinct. And here. I'll wash my hands in front of you so that you know that my hands are clean. But the danger with somebody else is, of course, that they're coughing. But I'm not. I'm fine.

clare toeniskoetter

I've never been in someone's home in these circumstances.

[music]

michael barbaro

From The New York Times, I'm Michael Barbaro. This is "The Daily."

Today, now that the coronavirus has gone from an epidemic to a pandemic, and both infections and deaths from the disease are surging across the world and the United States, we return to Times science reporter, Donald G. McNeil, Jr., who has covered the story from the start, to understand how to navigate this new reality.

It's Friday, March 13.

michael barbaro

Hey, Donald.

donald g. mcneil jr.

Hey. How are you?

michael barbaro

Good. Welcome back, and thank you for letting us into your home. I know we've been hearing a lot from you lately, so let us know if we're beginning to exhaust your generosity.

donald g. mcneil jr.

OK. So far, so good.

michael barbaro

So far. Key word. Donald, when we first started talking to you about the coronavirus about two weeks ago, you gave us an overview of what it was, where it was headed. Since then, a lot has changed. Given the evolution of the situation, we have questions related to this new phase of the epidemic, now that it's very much in our lives. I'm working from home. You're working from home. So let's start with questions about precautions for people who don't have the virus - which, presumably, is the vast majority of us at the moment - and how we can protect ourselves from getting the virus. What kind of activities should be avoided right now?

donald g. mcneil jr.

You have to be aware not only of people around you who are coughing, but you also have to be aware that every - basically every hard surface you touch might potentially have virus on it, unless you know it's been cleaned since the last person that you don't know was there might have been on it.

michael barbaro

Let me tick through a couple of what we imagine, from conversations with everybody on "The Daily" team at The Times, to be the kinds of scenarios I think people want to better understand how to approach. A bit of a lightning round here. Is it dangerous, at this moment, to keep going to work?

donald g. mcneil jr.

Look, some people are going to have to go to work. Doctors have to go to work. But it's not so much the danger. The reason the government's asking people not to go to work is because it creates what they call social distancing. The less interactions there are between people, the less exchange of virus there is. If you slow down the virus, you change what is sometimes called R-naught. And if you get people to be more distant from each other, the virus is transmitted less.

michael barbaro

Can you translate that phrase, R-naught?

donald g. mcneil jr.

Yeah. It's called the reproductive number of the virus. It's, "If I'm sick, how many people am I going to infect?" You never know the real R-naught, or the real fatality rate, or anything about a disease, until it's completely gone through the world. So we're never going to know the real answers to these things for at least a year or two, because they're going to be different in Africa than they are in New York. They're going to be different anywhere. But if you create more distance between people so that I infect, hopefully, no people, you've substantially slowed my part of transmitting the virus. And if you do that across the entire population, you really slow down the movement of that virus in the population. When a lot of people are infected, and a lot of people have pneumonia, a lot of people all need to get to the hospital at the same time. A lot of those people need to get on oxygen or on ventilators, and eventually you run out of ventilators. Then you're making the triage decisions that they're now making in northern Italy, which is to say, OK, this is Donald McNeil, 66 years old. I've got a choice between saving him or a 25-year-old mother of two. Goodbye, Mr. McNeil. Sorry there isn't any time for your family to say goodbye to you, because we can't have visitors, but that's it. See you later.

michael barbaro

Sheesh.

donald g. mcneil jr.

Which is the right thing to do. That's the right decision for a doctor to make. But those are really tough decisions for doctors.

michael barbaro

Let me return to our lightning round that has not yet turned into a lightning round.

donald g. mcneil jr.

Sorry.

michael barbaro

Based on some of what you just said, I'm intuiting where this may be headed, but - take the bus or the subway at this moment. Is that wise?

donald g. mcneil jr.

I don't think it's terribly wise. I did it yesterday to get home. I ride the subway standing up with my face close to the vent. I have one glove on my hand, one gardening glove, and I use that if I have to hold onto a rail. The other hand, I make sure, never touches a surface, and I use that for my phone. Mostly, I keep it in my pocket. And I won't get into a crowded car. I'll let the train go by.

michael barbaro

But if you don't have to take the subway.

donald g. mcneil jr.

If you don't have to take the subway, don't.

michael barbaro

Staying on this theme - lots of people are curious about plane travel.

donald g. mcneil jr.

I would avoid plane travel if I could help it. I have friends who were about to fly to Kentucky to visit their son, and I said, you know what? Why don't you drive? You know where all the surfaces inside your car have been. You don't know where all the surfaces inside that plane or that airport have been. I know it's going to be 11 hours instead of two hours, but I'd say, do it. And that's what they're doing.

michael barbaro

How about trips to familiar retail establishments - a grocery store, a restaurant?

donald g. mcneil jr.

Well, you have to have food, so go to the grocery store. Be super careful about the handle of the cart, and remember that every box you touch has been placed on that shelf by somebody who might have coughed into their hand. Now, restaurants - I did eat in a restaurant a couple of nights ago. We looked for one that was, really, pretty empty, and we sat at the bar which had just been wiped down. But as this pandemic progresses, I'll worry more, and I'll probably avoid going into restaurants.

michael barbaro

The gym.

donald g. mcneil jr.

Yeah, the gym. I go to a gym. I play squash, which means all I have to touch in common with the other player is the ball, and I know my partner. I would be real reluctant to start grabbing a bunch of weights, not knowing who else had touched them, grabbing a bunch of handles on machines, not knowing who had touched them. I would be reluctant to play basketball with a dozen other guys, because you can't have 10 guys handling the same ball. If one of them is spewing virus, a virus is going to get on the ball, and then everybody's got it on their hands.

michael barbaro

How about movies, concerts - things that might be open-air, but where people are sitting quite close to each other?

donald g. mcneil jr.

Open-air is safer than enclosed, but even in open-air venues, if you're sitting on a seat, the handles of the seat might have virus on them. The railings when you walk down to your seat might have virus on them. The ticket taker, as he takes your ticket and hands it back to you - I know it's paranoid-sounding, but these are all the ways that virus can be transmitted in large gatherings. It's not just the coughing. It's the many surfaces that get touched.

michael barbaro

In general, I'm hearing you say that going out and interacting with other people poses risks. So I wonder if you can help us understand the calculations behind your thinking in these particular categories. Does it have to do with the lifespan of the virus? Does it have to do with recommendations around social distancing? What is the underlying logic?

donald g. mcneil jr.

Yes. They're related to all these things. But I think people get way too obsessive about numbers, about exactly how many hours or days does the virus live on a surface? Exactly how many feet do you have to stand away from somebody else? I mean, you can't run around through life with a tape measure, trying to figure out, is 3 feet safe enough? Is 6 feet safe enough? But stay away from people who are coughing. Stay away from people who look feverish. And if you have to communicate with somebody, keep your distance. That's what I'd say. Just generally keep your distance.

michael barbaro

You've talked about social distancing. How do you socially distance yourself from your family, from your children, from your partner, your spouse, your boyfriend, your girlfriend? Does that really work?

donald g. mcneil jr.

You can't. My girlfriend and I still kiss each other. We just trust each other enough to believe we're not infected. It's impossible to socially distance yourself from your children. They're going to come up and hug you. That's why the whole idea of home quarantine - home isolation, rather - is virtually impossible.

michael barbaro

Donald, there's a strong sense that very young people and people in their teens, 20s, early 30s, are at a much lower risk level for the coronavirus. And I think that's been borne out. Correct me if I'm wrong. So do all the recommendations that we keep hearing apply as stringently to the young?

donald g. mcneil jr.

Yes, unless you're totally selfish.

michael barbaro

What you mean?

donald g. mcneil jr.

Do you have a parent? Do you have a grandparent? Do you want to be the vector that carries that disease to them? Do you know anybody and love anybody who's older and might be frail? You don't want your last memory of that person -

being that you gave them the virus that killed them. You'll kick yourself for the rest of your life if you did that. People who were hospitalized in China started at age 30 and went up to 70s and 80s. Yes, on average, the outcomes are better. But if you want something to worry about, you might be the person who doesn't have a good outcome. You're spreading a disease to your friends, your social circle. That's something you ought to feel guilty about. It's not something you ought to feel indifferent about. People have to take this seriously.

michael barbaro

We'll be right back.

michael barbaro

We've been talking about precautions for people who don't have the virus and want to keep it that way. I want to turn, now, to what happens if you think you might have the virus. Based on your reporting, and based on the publicly available information, what are the first signs of illness that have been reported and that people, therefore, could be looking out for?

donald g. mcneil jr.

What the Chinese found in the large study of the first 45,000 cases is that it's not like a cold. Fever is the number-one sign. High fever, a dry cough, and then, after that, fatigue. Runny nose was only 4% of cases, and those people might have had flu or a cold at the same time. But there's something I wanted to say that was important. I described, in our first interview, that 80% of all cases were mild, and the other 20% were either severe or critical. And that stuck in too many people's minds as if, oh, 80% of cases are practically nothing. You don't even have it. Maybe it's asymptomatic. No. That's wrong. The Chinese study that was based on - everything was either mild, severe, or critical. Mild included everything from "barely any symptoms" to pneumonia, but pneumonia not needing hospitalization or oxygen. Once you stepped over into needing oxygen, then you were severe. Once you were in organ failure, you were critical. So if people think this is a mild disease, get over that idea. I'm sorry if I contributed to the spread of that idea. I should have been much more careful in describing the whole range of symptoms that came under the term "mild."

michael barbaro

Right. In other words, "mild" doesn't necessarily mean mild.

donald g. mcneil jr.

Nothing like what we mean by a mild cold.

michael barbaro

When is it recommended that, no matter how mild or severe the symptoms are, a person be tested? Is there a threshold?

donald g. mcneil jr.

I don't know if the authorities have set a threshold yet. I know what happens in pandemics is that, ultimately, you have to assume that a lot of people have the disease. And that really when you reach the point where almost everybody has it, you end up stopping even bothering to test them. You ultimately are going to assume that everybody has it, because it's the most popular virus going around. If you have no trouble breathing, if you have got a fever that you can handle at home, then stay home and take care of it. Although that's not the way the Chinese handled it. The Chinese said, if you think you have symptoms - and I hope we get to this point. The Chinese said, if you think you have symptoms, if you think you're getting sick, get directed to a fever clinic, where somebody who is in protective gear can see you, and they will see you and sort out whether you have bacterial pneumonia, or flu, or whether you have coronavirus. And if you have coronavirus, you're going to go into isolation with a lot of other people who have coronavirus. Even if you have a very mild case, you're going to go in with all the other mild cases, because they know cases can crash. It's a pretty common phenomenon that people are going along OK with some breathing difficulty, and then in the second week, they crash. Their oxygen saturation drops, and they need oxygen. And in those cases, in the isolation centers in China, when you might be in a gymnasium with 1,000 other people, when you crashed, they recognized it right there. There was no wait, and they would move you to a hospital.

michael barbaro

This is a bit of an ethics question, but let's say you get into a cab, and you're on your way to get tested for the coronavirus, or you hitch a ride with a friend. Should it be disclosed that you think you might have the virus? Should basically anyone you come in contact with be aware of your status?

donald g. mcneil jr.

Yes. You're carrying a potentially lethal disease, so you've got to warn other people. There's no ethical question about this. Unfortunately, this has been the story of I don't know how many pandemics. How many people have lied about having a sexually transmitted disease, especially in the five minutes right before they thought they were going to get lucky, and if they disclosed what they had, they were going to ruin the moment? Unfortunately, that's how a whole lot of sexually transmitted diseases, including H.I.V., get passed on. It takes a lot of courage to be that ethical, and I hope during this epidemic, people will.

michael barbaro

And the test itself, it remains somewhat scarce, but to the degree you know it, can you describe the test? Is it a saliva swab?

donald g. mcneil jr.

The point is to get a sample of where the virus is, so there are different ways of getting that swab. Typically, for a while, they were doing nasopharyngeal swabs, which is, basically, pushing a Q-tip so far up your nose that it feels like it's going into your brain. But I've seen swabs that were just taken from the back of the throat. And I know that there are some times, when people are coughing hard, they try to get them to cough up sputum so they can test that. You want to get a sample that's got virus from where the cells are infected. Originally, it attaches deep in the lungs, so you're trying to get a sample from there. But once it moves up into your nose and throat, maybe you can get a sample from there. So it's very dangerous for the person who's trying to get the Q-tip in, or the sputum sample out, to be standing right in front of them as they do that. They have to be really protected in order to do that safely.

michael barbaro

How long do the results generally seem to be taking for these tests?

donald g. mcneil jr.

I was told that, in China, when they had the on-the-spot labs and the fever clinics, they could give you an answer in as little as four hours, but that's ideal. There were others of seven hours. Other times, they had to send it off someplace overnight. Until recently, we've been having to send every sample to Atlanta. So that's several days.

michael barbaro

Right. To the C.D.C.

donald g. mcneil jr.

Yes, to the C.D.C.

michael barbaro

Which is the least efficient version of this, it would seem.

donald g. mcneil jr.

It's the least efficient version, but for a while, it was the only accurate version, and a positive wasn't considered a positive until the C.D.C. had confirmed it. We've got to solve this testing problem. We've got to have it so that tests are literally right there, because you've got to diagnose people and then isolate them so they don't go home and give the virus to the family, and they don't go back to work and give the virus to their coworkers.

michael barbaro

And we are not at that phase just yet, are we?

donald g. mcneil jr.

Right now, we're not even talking about that phase. That's how they did it in China. Right now, we're still talking about home isolation, and the W.H.O., the Chinese, and the South Koreans would say, that doesn't work. That's too dangerous. There's no way you can isolate at home without infecting your family.

michael barbaro

The final phase of questions, Donald, are, what happens when a person has been diagnosed with the virus? You've told us that there really is no cure for the coronavirus. It's going to run its course. Are there useful over-the-counter medicines that would help somebody get through this virus?

donald g. mcneil jr.

This is kind of crazy, because I don't think it's safe to think of it as something you can happily stay home with and treat like, oh, I've got the flu. You've got to be aware that there is the possibility of crashing. You've got to have a number you can call. The state should be aware that you're a patient, that you're in home quarantine, and there should be somebody checking in on you each day, or you should be checking in with somebody so that they say, how high is your fever? How fast are you breathing?

michael barbaro

How long can a person expect to be sick, once diagnosed?

donald g. mcneil jr.

Mild cases typically resolved themselves in two weeks. People who were on ventilators and in severe situations were usually three to six weeks.

michael barbaro

That's a long time.

donald g. mcneil jr.

Yeah. That's a long time. It's a long time for one of your ventilators to be in use. Even the severe and the critical cases - most of the time, they ended in good outcomes. But for some people, death took several weeks, too. People didn't just immediately crash and die. It would be a somewhat slow process.

michael barbaro

Donald, once you have this virus, does it confer immunity on getting the coronavirus again in the next couple weeks, next couple of years, forever?

donald g. mcneil jr.

Nobody knows about forever. Virtually all doctors assume that having recovered from this confers immunity, because that's the norm. When you recover from a disease, you normally have immunity at least for a while.

michael barbaro

Once a person recovers from the virus, is there permanent damage? Do we know?

donald g. mcneil jr.

Some people who have gone into severe pneumonia or A.R.D.S., adult respiratory distress syndrome, yes, will have permanent damage. They'll live, but they'll have permanently damaged lungs. That can definitely happen.

michael barbaro

And what do we know about how the virus, long-term, affects people who I think would be, justifiably, quite anxious at this moment - pregnant women?

donald g. mcneil jr.

The small numbers of women that have been studied in China who were pregnant during this relatively short time period - there was a study that came out just a couple of days ago. Nine women all delivered healthy babies. Something like six of the women were delivered by cesarean, which doctors may have chosen to do just for the extra safety of knowing that the baby wasn't going to be infected in the birth canal. But some of the babies were born naturally, too, and all the babies were healthy.

michael barbaro

That's reassuring.

donald g. mcneil jr.

That's good news it's a very small sample, but it's good news from what we know from the small sample. It's really different from some other diseases.

michael barbaro

Finally, Donald, we want to tackle a few questions that we've observed from friends, family and from the internet that may be in the territory of rumor or half-baked theories, but that are gaining some currency. So basically, a true-or-false section here. First off, are there multiple strains of the coronavirus, and are some more dangerous than others?

donald g. mcneil jr.

No. There are slightly different variants of the coronavirus - really, variances by a couple of nucleotides. There is no evidence that one is more infectious than the other, or one is more lethal than the other. Not so far, anyway.

michael barbaro

Next. This is a seasonal virus, and it will more or less be gone in a few months.

donald g. mcneil jr.

That would be lovely, but we don't know that. This is a new virus. We've never seen it in summertime, so we don't know how it's going to behave in summertime. Respiratory viruses like influenza tend to disappear in the summer. We don't know what this virus is going to do in the summer, so it's not a good idea to make predictions. That's just wishful thinking on the part of people who say, oh, it's all going to disappear in the summertime.

michael barbaro

And the last of these true-of-false questions, Donald. Are the media - we hear this a lot - blowing the scale of this out of proportion, given the relatively small number of infections compared with the overall populations in any given country?

donald g. mcneil jr.

Look. I ask myself this question every day, because I'm the media in this case. Normally, I get to blame the other jackals of the press for blowing things out of proportion, but this time -

michael barbaro

Not this time.

donald g. mcneil jr.

- it's on my shoulders. I'd like to think there's nothing to worry about. I never worried about Ebola coming to New York. I never worried much about SARS spreading in New York. I worried, in the beginning, about H1N1 flu in 2009, but then, as the mortality data got clearer, I stopped worrying. I knew we'd mostly get it, but I knew it would be, mostly, not a problem. This one, same as I said two-plus weeks ago, really flips me out. This one reminds me of 1918 - a dangerous virus that transmits easily between people. Yes, 80% of the cases are mild, but as I described, "mild" is a term that the Chinese use describing all the way up to pneumonia. That's not mild. We don't know what the fatality rate is. It got as high, in some weeks in Wuhan, as 5%. That was during the chaos period in Wuhan. We don't know what it is in Italy now, and we won't know, until it's all over, what the total fatality rate is going to be. I'd love to be told I was wrong, I was an alarmist, I should eat my hat. But we'll see. So far, I've been right about every scary thing I said about this disease. I've been worried, ever since I looked at the numbers, about how fast the epidemic was doubling in China, and how fast people were going to hospitals. I sat down and wrote down on a piece of paper about how fast this could double, and I came into work the next day and said, this is going to go pandemic. Originally, nobody believed me, and I had to call 12 different experts and count which ones believed me and which ones didn't believe me. It came out, basically, eight to two to two. Eight thought it -

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- had the potential to go pandemic, two thought it was overblown, and two didn't want to comment, didn't want to take a guess.

michael barbaro

It sounds like you're saying, so far, we haven't blown it out of proportion, and you have been a relatively successful prognosticator of this virus. So that's why we're going to keep talking to you about it. I want to tell you how much I appreciate you giving us your time and your wisdom. Thank you.

donald g. mcneil jr.

Thank you for inviting me.

michael barbaro

Over the coming weeks, we'll be answering your questions about the coronavirus and how to navigate the pandemic. You can send us your questions by voicemail at 646-598-6012. Be sure to tell us your name and where you're calling from.

We'll be right back.

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Here's what else you need to know today. Wall Street experienced its worst day since the crash of 1987 as investors responded to President Trump's plan to severely limit travel between Europe and the United States, and general confidence faded that Western economies will quickly recover from the pandemic. In Washington, the Senate canceled a scheduled week-long recess so it could negotiate a major economic relief package to address the financial fallout. Meanwhile, closures and cancellations cascaded across the country. The N.C.A.A. called off its annual basketball tournaments following a decision by the N.B.A. to suspend its operations. Both the N.H.L. and Major League Soccer said that they, too, would pause their seasons. In New York, all 41 Broadway theaters began shutting down on Thursday night under instructions from the state's governor and will not reopen until April 12 at the earliest, while New York restaurants and bars have been ordered to operate at 50% capacity. And in California, Disneyland will close its doors until the end of the month, its first closure since the September 11 terror attacks in 2001. "The Daily" is made by Theo Balcomb, Andy Mills, Lisa Tobin, Rachel Quester, Lynsea Garrison, Annie Brown, Clare Toeniskoetter, Paige Cowett, Michael Simon Johnson, Brad Fisher, Larissa Anderson, Wendy Dorr, Chris Wood, Jessica Cheung, Alexandra Leigh Young, Jonathan Wolfe, Lisa Chow, Eric Krupke, Marc Georges, Luke Vander Ploeg, Adizah Eghan, Kelly Prime, Julia Longoria, Sindhu Gnanasambandan, Jazmin Aguilera, M.J. Davis Lin, Austin Mitchell, Sayre Quevedo, Neena Pathak, Dan Powell, Dave Shaw, Sydney Harper, Daniel Guillemette, Hans Buetow, Robert Jimison and Mike Benoist. Our theme music is by Jim Brunberg and Ben Landsverk of Wonderly. Special thanks to Sam Dolnick, Mikayla Bouchard, Stella Tan, Lauren Jackson, Julia Simon, Mahima Chablani and Nora Keller. That's it for "The Daily." I'm Michael Barbaro. See you on Monday.

Our science reporter answers your questions about how to protect yourself and your loved ones from the pandemic.

Hosted by Michael Barbaro, produced by Clare Toeniskoetter and Michael Simon Johnson, and edited by Wendy Dorr

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Now that the coronavirus is a pandemic, and both infections and deaths are surging in many places across the world, we return to a reporter who has covered the story from the start and ask him how best to navigate this new reality.

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Fear, Humor, Defiance: How the World Is Reacting to Coronavirus

The coronavirus has touched a diverse collection of countries and cultures, but a number of shared experiences have emerged - from grieving the dead to writing songs.

[Bagpipe music] There are moments that seem bizarre, moments of fear ... ... preparation and moments of emptiness. These are scenes from the world living with coronavirus. It has spread across cultures, languages and even out to sea. And despite these global differences, a number of shared experiences have emerged. There is grief over the dead. In Iran, hospital staff mourn a doctor's death from the virus. In China, a quarantined building collapses, and a firefighter breaks down after pulling bodies from the rubble. In Italy, a man mourns the death of his sister. To try and save lives, authorities take precautions. They disinfect public areas and screen populations. "This is just crazy. Around the world, people are afraid and on edge. "Unbelievable." In Northern Ireland, routine construction work at an Apple Store is mistaken for virus-related activity. In Japan, tempers flare when a man sneezes on a train. One Italian takes the fear and adds humor. This is a circle to keep people at a safe distance. In fact, lots of people use humor to cope with the uncertainty or the stigma of being sick. In Australia, a run on toilet paper leads to lessons in self-defense. "He's going to show you how to deal with people stealing your toilet paper." There is also defiance, a conviction that life must go on despite the virus. Across rooftops in China, quarantined neighbors socialize. From a rooftop in Italy, a theater group performs poetry for an area where movement is restricted. On a quarantined cruise ship, there's songwriting to pass the time. In an apartment in China, too. But perhaps some of the most striking moments from the pandemic are those where little happens: the empty streets. "Unbelievable. No traffic." The quiet airports. The places of worship without worshippers. Stores without goods. This is how it is across the globe as we prepare, grieve and wait for the next chapter of the coronavirus.

The coronavirus has touched a diverse collection of countries and cultures, but a number of shared experiences have emerged - from grieving the dead to writing songs. Credit Credit... Carlos Lemos/EPA, via Shutterstock

Background reading:

The World Health Organization now describes the coronavirus as a pandemic, and the number of cases continues to rise worldwide. These basic steps can help you reduce your risk of getting sick or infecting others.

The global pandemic is affecting many aspects of daily life. Here are the latest updates on school closures, social distancing measures and event cancellations.

Tune in, and tell us what you think. Email us at thedaily@nytimes.com. Follow Michael Barbaro on Twitter: @mikiebarb. And if you're interested in advertising with "The Daily," write to us at thedaily-ads@nytimes.com.

Donald G. McNeil Jr. contributed reporting.

"The Daily" is made by Theo Balcomb, Andy Mills, Lisa Tobin, Rachel Quester, Lynsea Garrison, Annie Brown, Clare Toeniskoetter, Paige Cowett, Michael Simon Johnson, Brad Fisher, Larissa Anderson, Wendy Dorr, Chris Wood, Jessica Cheung, Alexandra Leigh Young, Jonathan Wolfe, Lisa Chow, Eric Krupke, Marc Georges, Luke Vander Ploeg, Adizah Eghan, Kelly Prime, Julia Longoria, Sindhu Gnanasambandan, Jazmín Aguilera, M.J. Davis Lin, Austin Mitchell, Sayre Quevedo, Neena Pathak, Dan Powell, Dave Shaw, Sydney Harper, Daniel Guillemette, Hans Buetow, Robert Jimison and Mike Benoist. Our theme music is by Jim Brunberg and Ben Landsverk of Wonderly. Special thanks to Sam Dolnick, Mikayla Bouchard, Stella Tan, Lauren Jackson, Julia Simon, Mahima Chablani and Nora Keller.

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