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And more importantly, will they help?

As the US passes its 13 millionth COVID-19 case, curfews are being put in place across the country, in hopes of reducing the spread of the virus. In California, Governor Gavin Newsom imposed a curfew on all indoor social gatherings and non-essential activities outside the home across most of the state, meaning “nonessential work and gatherings” are banned from 10 p.m. to 5 a.m. A similar curfew was issued by Governor Mike DeWine of Ohio. And in New York, Governor Andrew M. Cuomo directed bars, restaurants, and gyms to close by 10 p.m.

Cue a lot of unhappy people, some of whom have taken part in protests against their local curfews. On Nov. 28, about 80 people gathered at the Santa Monica Pier to protest Newsom’s limited stay at home order, a week after a couple of hundred did the same at Huntington Beach Pier. Similar demonstrations have been held in upstate New York and Minnestota.

Some cities have taken a targeted approach, setting a curfew for residents in ZIP codes with surges in COVID-19 cases. But this has created different rules for different places, resulting in confusion—as well as disappointment, especially as the holiday season gets underway. So what’s the thinking behind these curfews—and is there actually any science to back them up?

The hope behind COVID-19 curfews is simple: To reduce infection rates

Curfews are in place to reduce opportunities for people to gather. “The hope is that it will discourage and decrease mobility among populations with the highest infection rates who are also most likely to be out late at night,” Anne Rimoin, PhD, MPH, professor of epidemiology at UCLA Fielding School of Public Health, tells Health. “The thinking behind this is that people who are out past 10 p.m. and before 5 a.m., doing things other than grocery shopping or other essential tasks, may be out at bars or restaurants or at events where they are likely to let their guard down and be less likely to wear a mask or social distance. The biggest impact of a curfew is likely that it is a signal about the seriousness of the situation—and how we all need to limit contact with others.”

Obviously, the best way to get infection rates as low as possible is to go into another lockdown. But that has serious financial implications, not to mention the widespread mental health impact of stay-at-home orders. Dan Tierney, DeWine’s press secretary, said a complete closure of Ohio bars, restaurants, and gyms had been considered, but the Governor believed the economic impact would have been too damaging. So the curfew, together with the statewide mask mandate and social distancing, is something of a plan B. “We think we can make a dent in these numbers by doing what we’re doing,” Tierney told The New York Times, referring to Ohio’s surge in COVID-19 infections. As of Wednesday, state health records showed that confirmed cases in Ohio were up to 351,304, along with 6,118 total deaths and 25,069 hospitalizations.

In a statement published on his website, Newsom explained the reasoning behind the curfews in California as well, where the rate of COVID-19 cases increased by approximately 50% during the first week of November. “The virus is spreading at a pace we haven’t seen since the start of this pandemic and the next several days and weeks will be critical to stop the surge,” Newsom wrote. “We are sounding the alarm. It is crucial that we act to decrease transmission and slow hospitalizations before the death count surges. We’ve done it before and we must do it again.”

While having different curfews in place in different parts of the country, and in adjacent cities and counties, is potentially confusing (particularly when people can still cross county lines, as Dr. Adalja points out), some experts believe it’s sensible for each jurisdiction to have its own rules.

“I think it’s preferable for each jurisdiction to consider the extent of the pandemic in their local communities and take appropriate steps to intervene, rather than trying to impose a ‘one size fits all’ approach,” Dr. Seidman says. However he adds that it would perhaps reduce the confusion if the guidance was clearer. “It would be very helpful if the CDC and/or State Departments of Public Health established guidelines that could be followed at the state and local level.”

The science and data behind COVID-19 curfews, however, are less straightforward

There is some evidence that bars and restaurants are COVID-19 hotspots. In September, a study by the Centers for Disease Control and Prevention (CDC) found that adults who tested positive for COVID-19 were around twice as likely to have reported dining at a restaurant in the 14 days before becoming ill than those who tested negative.

“Contact tracing efforts have shown that the most common sources of the spread of COVID-19 include gatherings at places such as restaurants and bars,” Richard Seidman, MD, chief medical officer of L.A. Care Health Plan, the largest publicly-operated health plan in the US, tells Health. “The goal of limiting late night and early morning operating hours of these types of businesses is to reduce the extent to which people are at increased risk of close contact and, therefore, becoming infected.”

A recent report from the CDC analyzed trends in percent positivity by age group in COVID-19 “hotspot” counties and found that the highest percent positivity was among the 18–24 years (14%) age group. According to the authors, “addressing transmission among young adults is an urgent public health priority.”

But of course, the 10 p.m. closing time put in place by many COVID-19 curfews is confusing to many—especially since the virus isn’t limited by time. “There is no time of day or night that the virus is more likely to spread than any other,” infectious disease expert Amesh A. Adalja, MD, senior scholar at the Johns Hopkins Center for Health Security in Maryland, tells Health.

However, Dr. Seidman points out that while it’s true that the virus behaves the same, day or night, people do often behave differently as the night wears on, particularly when alcohol is involved. In other words, people are more likely to interact closely with others, and be less vigilant in terms of mask-wearing and social distancing, if they’ve been drinking for a few hours. But that argument doesn’t support curfews on gyms and movie theaters, where alcohol isn’t involved.

Dr. Adalja says there’s no hard data to support the use of curfews to reduce COVID-19 spread, and warns that they might, in fact, have the opposite effect. “Social interaction is what drives spread and curfews might paradoxically drive people to private gatherings—where spread may be more likely,” Dr. Adalja warns. While there are rules against at-home gatherings, it’s extremely difficult to prevent them. And there’s always the risk of the curfews backfiring, if people try to pack into establishments that aren’t enforcing COVID-19 safety guidelines (such as social distancing and mask wearing) before the curfew.

Some people are also arguing that it’s more important to keep schools open right now and forget about curfews and close bars and restaurants altogether—a view Rimoin can understand. “Personally, I think we should be focusing on finding ways to reduce spread of the virus so we can keep our schools open,” she says. “Placing heavier restrictions on activities that present higher risk transmission than schools would be helpful in reducing spread. With the virus spreading so rampantly, we are going to have to make choices—do we want to keep bars and restaurants open or do we want our schools open?”

However, Rimoin points out that there’s no “one size fits all” scenario. “High schools can be a source of community spread than elementary schools because the older kids tend to get—and spread—the virus more readily.”

Right now we don’t have a lot of data on how curfews work as a single measure. There is no one measure that will make a difference, we have to use a layered approach. Curfews can help by reducing opportunities for people to be gathering, but they won’t work on their own.

If rates of COVID-19 infections decrease, that’s a pretty clear indication that curfews are working, Rimoin says. She points out that curfews—along with other restrictions—have been effective in reducing spread in Europe. But she also notes that a “layered approach” is the best solution. “Curfews won’t work on their own, although targeted curfews in places like college towns where you see significant gatherings late at night are potentially helpful,” she says. “A national strategy for masks and social distancing is the best option.”

Source: https://www.health.com/condition/infectious-diseases/coronavirus/covid-19-curfews-science

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As doctors observe a growing number of coronavirus patients, they have identified a few patterns in how typical symptoms progress.

As many as 40 percent of coronavirus cases are asymptomatic, according to the Centres for Disease Control and Prevention. And 20 percent of symptomatic cases become severe or critical.

Among patients who develop symptoms, a fever and cough are usually the first to arrive. They’re often followed by a sore throat, headache, muscle aches and pains, nausea, or diarrhoea (though in severe cases, gastrointestinal issues can appear earlier in the course of an infection).

Patients with severe infections tend to develop difficulty breathing – one of the virus‘ hallmark symptoms – around five days after symptoms start.

But symptoms generally don’t appear right after a person has been infected. The virus’ median incubation period is about four to five days, according to the Centres for Disease Control and Prevention.

During that time, an infected person likely won’t yet know they’re sick, but evidence shows they could transmit the virus during the presymptomatic phase.

A day-by-day breakdown

After observing thousands of patients during China’s outbreak earlier this year, hospitals there identified a pattern of symptoms among COVID-19 patients:

  • Day 1: Symptoms start off mild. Patients usually experience a fever, followed by a cough. A minority may have had diarrhoea or nausea one or two days before this, which could be a sign of a more severe infection.
  • Day 3: This is how long it took, on average, before patients in Wenzhou were admitted to the hospital after their symptoms started. A study of more than 550 hospitals across China also found that hospitalized patients developed pneumonia on the third day of their illness.
  • Day 5: In severe cases, symptoms could start to worsen. Patients may have difficulty breathing, especially if they are older or have a preexisting health condition.
  • Day 7: This is how long it took, on average, for some patients in Wuhan to be admitted to the hospital after their symptoms started. Other Wuhan patients developed shortness of breath on this day.
  • Day 8: By this point, patients with severe cases will have most likely developed shortness of breath, pneumonia, or acute respiratory distress syndrome (ARDS), an illness that may require intubation. ARDS is often fatal.
  • Day 9: Some Wuhan patients developed sepsis, an infection caused by an aggressive immune response, on this day.
  • Days 10-11: If patients have worsening symptoms, this is the time in the disease’s progression when they’re likely to be admitted to the ICU. These patients probably have more abdominal pain and appetite loss than patients with milder cases.
  • Day 12: In some cases, patients don’t develop ARDS until nearly two weeks after their illness started. One Wuhan study found that it took 12 days, on average, before patients were admitted to the ICU. Recovered patients may see their fevers resolve after 12 days.
  • Day 16: Patients may see their coughs resolve on this day, according to a Wuhan study.
  • Day 17-21: On average, people in Wuhan either recovered from the virus and were discharged from the hospital or passed away after 2.5 to 3 weeks.
  • Day 19: Patients may see their shortness of breath resolve on this day, according to a Wuhan study.
  • Day 27: Some patients stay in the hospital for longer. The average stay for Wenzhou patients was 27 days.

5f7dee2b94fce90018f7ba8d(Shayanne Gal/Insider)

Just because patients leave the hospital, though, doesn’t mean their symptoms are fully gone. Some coronavirus patients report having symptoms for months, including chest pain, shortness of breath, nausea, heart palpitations, and loss of taste and smell.

People who got sick and were never hospitalized can have lingering symptoms, too.

July report from CDC researchers found that among nearly 300 symptomatic patients, 35 percent had not returned to their usual state of health two to three weeks after testing positive.

Patients who felt better after a few weeks said their symptoms typically resolved four to eight days after getting tested. Loss of taste and smell usually took the longest to get back to normal, they said: around eight days, on average.

COVID-19 may be a vascular disease more than a respiratory one

Though the coronavirus attacks the lungs first, it can infect the heart, kidneys, liver, brain, and intestines as well. Some research has suggested that COVID-19 is a vascular disease instead of a respiratory one, meaning it can travel through the blood vessels. This is the reason for additional complications like heart damage or stroke.

Scientists have a few theories about why some coronavirus patients take a rapid turn for the worse. One is that immune systems overreact by producing a “cytokine storm” – a release of chemical signals that instruct the body to attack its own cells.

Dr. Panagis Galiatsatos, a pulmonary physician at Johns Hopkins Bayview Medical Centre, compared that process to an earthquake – generally, it’s the falling buildings that kill someone, not the quake itself.

“Your infection is a rattling of your immune system,” he said. “If your immune system is just not well structured, it’s just going to collapse.”

The most concerning symptom: shortness of breath

Once symptoms appear, some early signs should be treated with more caution than others.

“I would of course always ask about shortness of breath before anything, because that’s somebody who has to be immediately helped,” Megan Coffee, an infectious-disease clinician who analysed the Wenzhou data, told Business Insider.

Patients who develop ARDS may need to be put on a ventilator in ICU. Coffee estimated that one in four hospitalized COVID-19 patients wind up on the ICU track. Those who are ultimately discharged, she added, should expect another month of rest, rehabilitation, and recovery.

But viewing coronavirus infections based on averages can hide the fact that the disease often doesn’t progress in a linear fashion.

“Courses can step by step worsen progressively. They can wax and wane, doing well one day, worse the next,” Coffee said.

“An 80-year-old man with medical issues can do quite well. Sometimes a 40-year-old woman with no medical issues doesn’t.”

This story was originally published February 21, 2020. It has been updated over time with additional research findings.

This article was originally published by Business Insider.

Source: https://www.sciencealert.com/here-s-a-day-by-day-breakdown-of-coronavirus-symptoms?fbclid=IwAR2BOXsv6Jkg7PmYKGgXFujl9vr8w1IkUHouzMHKCnN7RwU0UxDYdCryCJ0

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Masks are a critical tool in preventing COVID-19, the CDC said, because symptoms do not appear for several days and people can unknowingly spread the virus.


People who aren’t showing COVID-19 symptoms but have the virus are causing most of the spread, the Centers for Disease Control said in a new guidance.

In most COVID-19 cases, people do not begin to show symptoms, such as coughing, fever and shortness of breath, for about six days after they are infected. During that time span, people are highly infectious and typically unaware that they have the virus, leading to unintended spread. People can also be asymptomatic and have the virus but never show symptoms.

“Most SARS-CoV-2 infections are spread by people without symptoms,” the CDC said. “CDC and others estimate that more than 50% of all infections are transmitted from people who are not exhibiting symptoms. This means at least half of new infections come from people likely unaware they are infectious to others.”

This period when people are pre-symptomatic but infectious is why masks are a critically important tool in slowing the spread of COVID-19, the CDC said. Masks — even non-medical cloth versions — benefit other people, as they stop infectious people from spreading the virus, and protect the wearer from taking in others’ respiratory droplets.

“The prevention benefit of masking is derived from the combination of source control and personal protection for the mask wearer,” the CDC said. “Cloth masks not only effectively block most large droplets, but they can also block the exhalation of fine droplets and particles (also often referred to as aerosols) smaller than 10 microns.”

“Upwards of 80% blockage has been achieved in human experiments,” they continued, “… with cloth masks in some studies performing on par with surgical masks as barriers for source control.”

Currently, about half of the U.S. requires people to wear masks in public spaces and enforces some kind mask mandate. President Donald Trump has resisted instituting a nationwide mask mandate and often mocked people who wear masks, including President-elect Joe Biden, despite research showing that a mandate could save 130,000 American lives through the winter season. As Biden prepares for his presidency, he urged all Americans to wear masks.

“Please, I implore you, wear a mask, do it for yourself, do it for your neighbor,” he said on Nov. 9. “A mask is not a political statement, but it is a good way to start pulling the country together.”

Currently, the U.S. is struggling to contain a massive increase in COVID-19 cases. Nearly every state is seeing some of their highest daily case totals of the entire pandemic, and U.S. cases have increased by 2.5 million in November. As of Nov. 23, more than 12,418,700 Americans have tested positive for COVID-19, and at least 257,117 people have died from the virus, according to The New York Times.

The CDC said that “Adopting universal masking policies can help avert future lockdowns, especially if combined with other non-pharmaceutical interventions such as social distancing, hand hygiene, and adequate ventilation.”

Source: https://www.health.com/syndication/infected-people-arent-showing-covid-symptoms-causing-most-spread-cdc

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