Coronavirus UPDATE: Recap 6/19/20

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Coronavirus UPDATE: Recap 6/10/20

(WellnessPursuits.com) – As cases spike in 10 states across the south and west, the United States Food and Drug Administration (FDA) revoked the Emergency Use Authorization (EUA) for hydroxychloroquine and chloroquine, anti-malarial drugs tested in multiple trials. A silver lining appeared in the form of a steroid, dexamethasone, which research has found to be extremely effective in treating COVID patients who are ventilated or receiving supplemental oxygen. We have more on these and other highlights from the week:

COVID-19: Snapshot of the Week

Last week, as of 1:00 PM EDT (17:00 GMT), June 10, 2020, the reported worldwide numbers were 7,389,237 cases and 415,812 deaths in 213 countries and territories. There were 3,643,462 recoveries reported worldwide.

The US had 2,053,738 reported cases and 114,414 deaths. New York accounted for 400,660 of those cases and 30,603 of those deaths. New Jersey, California, Illinois, Massachusetts, Pennsylvania, Texas, Florida and Michigan were the states with the next highest numbers of reported cases (all above 65,000).

The US Military reported 10,822 cases and 36 deaths while the Veterans Affairs reported 16,347 cases and 1,408 deaths. The Navajo Nation reported 6,150 cases and 285 deaths. Federal Prisons reported 6,822 cases and 79 deaths.

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This week, as of 1:00 PM EDT (17:00 GMT), June 18, 2020, the reported worldwide numbers were 8,326,680 cases and 448,075 deaths in 213 countries and territories. There were 4,357,262 recoveries reported worldwide.

The US had 2,219,691 reported cases and 119,453 deaths. New York accounted for 406,280 of those cases and 31,033 of those deaths. New Jersey, California, Illinois, Massachusetts, Texas, Pennsylvania and Florida were the states with the next highest numbers of reported cases (all above 82,000).

The US Military reported 12,152 cases and 36 deaths while the Veterans Affairs reported 17,517 cases and 1,485 deaths. The Navajo Nation reported 6,672 cases and 319 deaths. Federal Prisons reported 6,905 cases and 86 deaths.

National and State Reopenings

As of this week, all 52 states, districts and territories have reopened to varying degrees. States that have reopened include:

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  • Alabama Open amenities include parks, beaches, gyms, retail stores, restaurant -dining, bars, breweries, salons and entertainment venues, including theaters.
  • Alaska — Open amenities include restaurant dining, bars, retail stores, hair salons, barbershops, nail salons, gyms, pools, libraries, theaters, bowling alleys and museums.
  • Arizona — Open amenities include retail stores, barbershops, salons, restaurant dining, pools, gyms, spas and casinos.
  • Arkansas — Open amenities include campgrounds, gyms, pools, hair salons, barbershops, nail salons, restaurant dining, bars, theaters, stadiums, museums, bowling alleys, large venues and casinos.
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  • California  — Open amenities include manufacturing, warehouses, offices, movie, TV and music production, pet groomers, hair salons and barbershops in some counties, restaurant dining in some counties, bars in some counties, houses of worship, retail , casinos in some counties; museums in some counties, galleries, zoos, aquariums in some counties, bowling alleys, arcades, mini golf, gyms in some counties — opening soon: nail salons, cosmetology services, tattoo parlors and piercing shops in some counties.
  • Colorado — Open amenities include salons and personal services, retail stores, offices, manufacturing, campgrounds, pools, playgrounds, gyms and restaurant dining.
  • Connecticut — Open amenities include restaurant dining, retail stores, malls, museums, zoos, offices, beaches, hair salons, nail salons, barbershops, tattoo parlors, spas, museums, zoos, casinos, movie theaters, libraries, amusement parks, bowling alleys, offices, beaches and gyms.
  • Delaware — These amenities have reopened: barbershops, hair salons, tanning salons, nail salons, tattoo parlors, massage therapy, farmers markets, retail stores, malls, beaches, pools, gyms, restaurants, bars, breweries, museums, libraries, galleries, live performances and casinos.
  • District of Columbia — These amenities have reopened: retail shops for curbside pickup, restaurants are open for outdoor dining, libraries open to curbside pickup, dog parks, golf courses, tennis courts, parks, barbershops and hair salons.
  • Florida — Open amenities include restaurant dining, bars in most counties, retail stores, beaches, trails, gyms, houses of worship and sporting venues without spectators, movie theaters, concert halls, bowling alleys in most counties, tattoo parlors, massage therapy, tanning salons and acupuncture in most counties.
  • Georgia — Open amenities include gyms, bowling alleys, theaters, private social clubs, hair salons, barbershops, restaurant dining, large venues, bars and nightclubs.
  • Hawaii — Open amenities include beaches, piers, docks, etc., state parks, pools and waterparks in some areas, campgrounds in some areas, gyms in some areas, retail stores, pet groomers, salons and barbershops, nail salons in some areas and tattoo parlors in some areas, construction in some areas, offices in some areas, houses of worship and restaurant dining in some areas — opening soon: gyms.
  • Idaho — Open amenities include houses of worship, gyms, pools, waterparks, restaurant dining, bars, hair salons, movie theaters, nightclubs and large venues.
  •  Illinois — These amenities have reopened: state parks, limited fishing, boating, golf courses, gyms, retail stores, pet grooming, hair salons, barbershops, nail salons, spas, waxing centers, tattoo parlors, restaurants open for outdoor dining, manufacturing and offices.
  • Indiana — Open amenities include libraries, museums, zoos and aquariums, movie theaters, large venues, manufacturing, offices, houses of worship, restaurant dining, bars and nightclubs, spas, salons, barbershops, tattoo parlors, retail stores, gyms in most counties, pools, bowling alleys, tennis and basketball courts, campgrounds, amusement parks and water parks.
  • Iowa — Open amenities include houses of worship, libraries, movie theaters, museums, zoos, aquariums, campgrounds, gyms, pools, playgrounds, skating rinks, skate parks, medical spas, tanning salons, salons, barbershops, tattoo parlors, etc, restaurant dining, bars, retail stores and malls.
  • Kansas — Open amenities include restaurant dining, bars, retail stores, houses of worship, offices, salons, barbershops, tattoo parlors, gyms, community centers, sports facilities, pools, theaters, nightclubs, museums and bowling alleys.
  • Kentucky — Open amenities include houses of worship, manufacturing, construction, offices, pet grooming and boarding, salons, barbershops, tattoo parlors, etc., retail stores and restaurant dining, distilleries, movie theaters bowling alleys, aquatic centers, gyms, campgrounds, museums, aquariums, libraries and outdoor attractions.
  • Louisiana — Open amenities include restaurant dining, bars, gyms, state parks, pools, malls, movie theaters, certain museums, zoos and aquariums, casinos, event centers, salons and barbershops, houses of worship, spas, tattoo parlors, pools, bowling alleys and skating rinks.
  • Maine — Open amenities include hair salons, barbershops, pet groomers, state parks, boating, golf courses, remote campgrounds, hunting and fishing, private campgrounds, RV parks, houses of worship, retail stores and restaurants, bars for outdoor service, gyms, nail salons and tattoo parlors.
  • Maryland — Open amenities include golf courses, outdoor shooting ranges, marinas, campgrounds, beaches, outdoor pools, day camps, retail stores, manufacturing, construction, offices, hotels, lodging, houses of worship, hair salons and barbershops, massage parlors, tanning salons, tattoo parlors, restaurants open for outdoor dining, outdoor service at breweries, wineries, and distilleries — opening soon: gyms, casinos, and malls.
  • Massachusetts — Open amenities include golf courses, beaches, parks, fishing, hunting and boating, houses of worship, construction, manufacturing, offices, hotels, lodging, retail for curbside pickup, retail, hair salons, barbershops, pet grooming, and outdoor dining at restaurants.
  • Michigan — Open amenities include golf courses, marinas, pools, gyms in some regions, construction, real estate, manufacturing, including auto companies, offices, retail, restaurants, bars, veterinary services, Pet groomers, hair salons, barbershops, nail salons, tattoo parlors, arcades, bowling alleys, theaters, night clubs and convention centers. Opening soon: Hair salons, barbershops, nail salons, tattoo parlors and convention centers in some regions.
  • Minnesota — Open amenities include manufacturing, offices, retail stores and malls, houses of worship, restaurants and bars, salons and barbershops, tattoo parlors, campgrounds, gyms, theaters and concert halls, bowling alleys, arcades and museums.
  • Mississippi — Open amenities include retail stores, restaurant dining, bars, state parks, gyms, salons and barbershops, tattoo parlors, casinos, movie theaters, libraries and museums.
  • Missouri — Open amenities include restaurant dining, salons, barbershops, tattoo parlors, etc., retail stores, gyms, campgrounds, movie theaters and music venues.
  • Montana — Open amenities include houses of worship, retail stores, salons, barbershops, massage parlors, restaurant dining, bars, breweries and distilleries, gyms, museums and movie theaters, concert venues and bowling alleys.
  • Nebraska (never issued a stay-at-home order, but closed businesses; regional reopenings) — Open amenities include houses of worship, salons, barbershops, tattoo parlors, restaurant dining, bars in certain counties, zoos in certain counties, movie theaters in certain counties and pools in certain counties — opening soon: bars, zoos, movie theaters, libraries, venues, pools and gyms .
  • Nevada — Open amenities include golf courses, pickleball, tennis courts, state parks, pools, waterparks, retail stores, malls, restaurants, bars, barbershops, hair salons and nail salons, cosmetology and skin services, massage therapy, tattoo and piercing shops, museums, art galleries, zoos and aquariums, movie theaters, bowling alleys, outdoor attractions, houses of worship and gaming.
  • New Hampshire — Open amenities include retail stores, barbershops, hair salons, nail salons, tanning salons, tattoo shops, acupuncturists and massage therapists, golf courses, outdoor attractions beaches, personal and small group fitness training, restaurants open for outdoor dining, restaurant fining in some counties, houses of worship, libraries, museums, art galleries, bowling alleys and entertainment centers.
  • New Jersey — Open amenities include golf courses, outdoor recreational businesses, beaches, construction and retail stores, outdoor dining at restaurants, libraries for curbside pickup — opening soon: hair salons, barbershops, nail salons, tattoo parlors, spas, massage therapy, tanning salons, and pools.
  • New Mexico — Open amenities include state parks, golf courses, boating, gyms, pools, pet grooming and boarding, veterinary services, hair salons, barbershops, tattoo parlors, massage parlors, nail salons, retail stores at 25% capacity, malls, restaurant dining, breweries, offices at 25% capacity, houses of worship and restaurants.
  • New York — Open amenities include low-risk businesses, retail stores open to pick-up in some regions, retail for in-store shopping in some regions, houses of worship, beaches, fishing and hunting, public pools and playgrounds, offices in some regions, construction, manufacturing, agriculture, forestry, outdoor dining at restaurants in some regions, indoor dining in some regions, hair salons, barbershops, tattoo parlors, massage parlors, nail salons in some regions.
  • North Carolina — Open amenities include retail stores, restaurant dining, salons, barbershops, tattoo parlors and pools.
  • North Dakota (never issued a stay-at-home order, but closed businesses; allowed businesses to reopen May 1) — Open amenities include restaurant dining, bars, gyms, sports venues, salons, tattoo parlors, massage therapy, etc., movie theaters, music and entertainment venues.
  • Ohio — Open amenities include manufacturing, distribution, construction, offices, retail stores, salons, barbershops, etc., as well as dine-in restaurants and bars, campgrounds, gyms, pools, sports leagues, bowling alleys, miniature golf and batting cages, aquariums, zoos, skating rinks, playgrounds, country clubs, movie theaters, museums, art galleries — opening soon: casinos, racinos, amusement parks and water parks.
  • Oklahoma — Open amenities include salons, barbershops, spas, pet groomers, etc., tattoo parlors, state parks, gyms, restaurant dining, bars, movie theaters, sports venues, museums, nightclubs, houses of worship and offices.
  • Oregon (regional) — Open amenities include some state parks, outdoor recreation facilities, gyms in some counties, pools in most counties, restaurant dining in some counties, retail stores, salons and barbershops in some counties, movie theaters, bowling alleys in most counties and offices in most counties.
  • Pennsylvania — Open amenities include golf courses, marinas, guided fishing trips, privately-owned campgrounds, gyms in some counties, beaches, outdoor sports, state parks, public pools, retail stores, restaurants and bars in most counties, outdoor dining restaurants and bars, hair salons, barbershops, spas in some counties and casinos, theaters and shopping malls in most counties.
  • Puerto Rico — These amenities have reopened: restaurants, salons, barbershops, pet grooming, spas. retail stores, malls, outdoor malls and beaches, gyms, museums, cinemas, autocinemas, outdoor concerts and other open venues, and houses of worship.
  • Rhode Island — Open amenities include state parks, beaches, gyms, casinos, retail stores, malls, offices, hair salons, barbershops, nail salons, massage parlors, tattoo shops, restaurants dining and houses of worship.
  • South Carolina — Open amenities include retail stores, beaches, piers, docks, etc., gyms, pools, restaurant dining, salons, barbershops and tattoo parlors etc.
  • South Dakota (Did not have a statewide stay-at-home order).
  • Tennessee (regional) — Open amenities include state parks, gyms in most counties, theaters, museums, amusement parks, restaurant dining in most counties, retail stores in most counties, salons and barbershops, etc. in most counties.
  • Texas — Open amenities include state parks, pools, gyms, natural caverns, waterparks, zoos, retail stores, malls, restaurant dining, bars, movie theaters, museums, libraries, bowling alleys, bingo halls, skating rinks, rodeos, aquariums, salons, barbershops, etc., massage and personal care, offices and manufacturing — opening soon: amusement parks and carnivals.
  • Utah — Open amenities include restaurant dining, salons, personal care businesses, gyms and pools.
  • Vermont — Open amenities include manufacturing, construction, distribution, state parks, golf courses, trails etc., campgrounds, gyms, fitness centers, retail stores, hair salons and barbershops, nail salons, spas, tattoo parlors, museums, theaters, libraries and restaurant dining.
  • Virginia (State stay-at-home order set to expedite June 10, but regional reopenings authorized) — Open amenities include restaurants and bars, retail stores, salons, barbershops, etc., beaches, campgrounds, gyms, pools and houses of worship, gyms in most counties, pools in most counties, museums, zoos, aquariums and outdoor concerts in most counties.
  • Washington — Open amenities include state parks, fishing, hunting, golf courses, gyms in some counties, retail stores open to curbside pickup, in-store retail in some counties, restaurant dining in certain counties, construction, hair salons, barbershops, tattoo parlors, etc.in some counties, pet grooming and drive-in religious services, religious services in some counties and casinos.
  • West Virginia — Open amenities include salons, barbershops, pet groomers, tanning salons, spas, massage parlors, gyms, recreation centers, state parks, campgrounds, museums, zoos, pools, casinos, restaurant dining, bars, retail stores and malls, bowling alleys, pool halls, and roller rinks.
  • Wisconsin — Open amenities include golf courses, state parks, pet groomers for curbside dropoff and retail stores.
  • Wyoming (Never issued a stay-at-home order, but closed businesses; allowed businesses to reopen May 1) — Open amenities include gyms, state parks, hair salons, barbershops, tattoo parlors, massage therapy, etc., restaurant dining, movie theaters and entertainment venues.

All states except Montana and Wyoming had closed schools for extended periods of time before the summer break, with many shut down until the end of the academic school year or until further notice. Most schools and colleges conducted online learning. Most districts have now dismissed students for the summer break. Commencements have been delayed or postponed for most high schools, colleges and universities. Many institutions are making arrangements for graduates to walk with future graduating classes. Decisions about fall classes will be made at a later time as more information becomes available.

A total of 11 states have imposed self-quarantines upon individuals entering from specific “hot” infection zones in an attempt to keep citizens of their states safer. These states include Arkansas, Florida, Hawaii, Kansas, Maine, New Mexico, North Dakota, Oklahoma, Rhode Island, Utah and Vermont. Most of those states are requiring entrants to undergo a 14-day self-quarantine, although Utah is requesting entrants to fill out and file forms with the health department.

CDC Guideline Updates

No significant new public guidance was issued this last week by the Centers for Disease Control and Prevention (CDC). States are continuing to follow the comprehensive guidance issued for reopening and for contact tracing. Although guidelines on social distancing are no longer being maintained by the CDC, many states are continuing to follow past guidance. Other guidelines are in effect, including the hand hygiene guidelines. It is still advisable to:

  • Stay at least 6 feet (2 meters) away from other people.
  • Avoid groups and mass gatherings, as well as crowded spaces.
  • Use a cloth face covering to cover your mouth and nose when you’re in public places, such as the grocery store.
  • Work from home, if you’re able.
  • Avoid using any kind of public transportation, ride-sharing, or taxis, if possible. If you must use these modes of transport, be sure to wear a cloth face cover.
  • Wash your hands often with soap and water. When hand-washing isn’t an option, use a hand sanitizer containing at least 60% alcohol (but the higher the percent, the better).
  • Avoid touching your eyes, nose and mouth.
  • Clean and disinfect frequently touched surfaces using an EPA-registered household disinfectant. Spots to watch out for include doorknobs, light switches, toilets and other objects in shared spaces.

Financial Assistance Updates

Another 1.5 million people filed for unemployment claims last week, joining more than 43 million already unemployed in the US — suggesting a current unemployment rate of over 24.0% and an estimated total of nearly 45 million job losses. The 1.5 million figure was higher than anticipated and marks the 13th consecutive week that claim numbers have exceeded 1 million. Additional claims may continue to be filed.

While funding had been set aside by the federal government to assist state governments in meeting unemployment insurance payments, many state systems were overwhelmed by the sheer volume of claims and some are still struggling to catch up. Nine states are seeking $36 billion in federal advances from the Department of Labor to cover the astronomical unemployment claims. Illinois ($11B), California ($8B), Texas ($6.4B) and New York ($4.4B) top the list, but Connecticut, Hawaii, Massachusetts, Ohio and West Virginia have also signaled an intent to borrow to cover their claims between May and July.

Government and private businesses are striving to meet the unprecedented economic needs in several ways:

  • Unemployment benefits are available; the waiting period has been waived.
  • The U.S. Department of Housing and Urban Development has a foreclosure and eviction moratorium in place. Most states have also placed a moratorium on foreclosures and evictions.
  • An economic relief bill made paid sick leave and paid time off available to most employees impacted by the virus. Most states have also implemented additional emergency leave and benefits for first responders who may fall ill.
  • The U.S. Small Business Administration has pledged up to $2 million in low-interest loans. That funding has been completely used up, and Congress passed a $484 billion interim bill funding on Thursday, April 23, and the President signed it on Friday, April 24. The bill allocates $310 billion to replenish the SBA’s Paycheck Protection Program (PPP), $75 billion for hospitals and $25 billion for COVID-19 testing. The bill also includes additional funds for the Economic Injury Disaster Loan (EIDL) program.
  • The deadline for filing federal taxes has been pushed to July 15. Most states have also delayed their filing deadlines to July 15 without penalty.
  • The $2.2 trillion stimulus package passed on March 27 providing economic stimulus incentives to taxpayers, increased and expanded unemployment benefits for laid-off employees and limited payroll assistance for small businesses.
  • A phase 4 stimulus package (CARES2) has been proposed, which would further aid small businesses, as well as individuals, states and hospitals.
  • Although the House passed the $3 trillion HEROES Act on May 15 for coronavirus relief and stimulus, Senate majority leaders indicated they had no intention of passing the bill in its current form. Some aspects of the act may reappear in new legislation, as yet unwritten. That may not be good news in the face of questionable economic indicators.

Testing Capacity

As of June 18 at 1 pm Eastern time (1700 GMT), the US has officially run more than 25,928,175 tests for COVID-19. It has run approximately 3.50 million of those tests since last week (June 10). Some leading researchers have estimated that a capacity of 3-4 million tests per week is needed for the economy to fully reopen safely. Admiral Brett Giroir, the Health and Human Services (HHS) Testing Czar said that they were working to provide the ability to test up to 50 million people per month by September. That number may still be a bit low based on recommendations by the Rockefeller Foundation, which calls for testing capability to be ramped to 30 million tests per week by October.

10 States See a Surge in Cases

Some states are seeing record high numbers of cases this week. Texas reported 2,326 cases on Monday, a record for that state to date. Other states reporting record-high averages over the last week include Alabama, Arizona, California, Florida, Nevada, North Carolina, Oklahoma, Oregon, and South Carolina.

These cases can’t be attributed solely to increases in testing, according to Dr. Ezekial Emanuel, chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania. Small increases due to increased testing might be expected — “But when you see 50% or 150% increase in the number of cases you are seeing — which is what we are seeing across the South — that’s not testing. That’s new cases. That’s community spread,” explained Dr. Emanuel.

The spikes may be due to a number of factors, including the speed at which many states raced to fully reopen, the societal relaxation of social distancing, mask wearing, and minimizing contact with others, and the massive gatherings of people during Memorial Day celebrations and during protests during the last two weeks.

FDA Revokes EUAs

On Monday, June 15, the FDA revoked the Emergency Use Authorizations for hydroxychloroquine and chloroquine, malarial drugs that had been touted as treatments for COVID-19. Based on its ongoing analysis of the EUA and emerging scientific data, the FDA determined that chloroquine and hydroxychloroquine were unlikely to be effective in treating COVID-19. They based this opinion on a series of studies, including double-blind studies, which failed to prove the efficacy of the drugs in treating COVID-19.

Three recent trials specifically played into the FDA decision. The Recovery Trial enrolled over 11,000 patients, 1542 of whom were randomly assigned to hydroxychloroquine therapy. That study concluded there was no clinical benefit from use of hydroxychloroquine in hospitalised patients with COVID-19.

Two Post-exposure Prophylaxis (PeP) studies also played roles. The first, a randomized, double-blind, placebo-controlled trial performed cooperatively by the US and Canada enrolled 821 asymptomatic participants. Nearly 88% of those participants reported contact with a high-risk exposure with a confirmed COVID-19 contact.That study concluded that hydroxychloroquine did not prevent illness compatible with Covid-19 or confirmed infection when used as postexposure prophylaxis within 4 days after exposure.

A second, much larger PeP study was performed in Spain with 2250 participants. According to the lead researcher, Oriol Mitjà, of the Germans Trias i Pujol University Hospital, they saw no significant statistical difference between the number of participants who developed COVID-19 with or without hydroxychloroquine prophylaxis. Mitjà has submitted the full results for publication and peer review.

Steroid Reduces Mortality in COVID-19 Patients

Dexamethasone is a stronger, longer-acting steroid, which is comparatively inexpensive and well-understood. In this case, the Recovery Study has found that the use of a single 6 mg dose of dexamethasone per patient may have reduced mortality by as much as 20%. The drug was given to those COVID patients who were already intubated or who were already receiving another form of oxygen support. Because steroids suppress the immune system, it’s possible that dexamethasone also helped fend off the cytokine storm seen in many COVID-19 patients.

What to Do if You Get Sick

Call your healthcare provider or reach out to a telehealth provider if you believe you have COVID-19. Do not go to a medical facility without calling ahead. It may be possible to treat symptoms of the virus at home with over-the-counter medications. When you speak to your doctor or telehealth provider, they will be able to evaluate your symptoms and their severity and will direct you to go to a testing center or hospital, if necessary.

If you have a medical emergency, call 911; tell them if you or anyone else in the home might have COVID-19. If you have questions or aren’t sure what to do, call your local health department. Many states have hotlines set up for this purpose. Some states have 211 service lines that you can call for help and resources.

Medically, we’re finding out more about what works and what doesn’t against to prevent and treat COVID. Socially, it looks like we might need to adjust our regimens to reduce infection rates as we inch toward economic normalcy again. We face collective challenges, but perhaps our most important challenges are the ones we set for ourselves each day. Mask Up, Distance, Clean Hands, and Stay Safe as we prepare to ride another wave.

~Here’s to Your Healthy Pursuits!

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