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Czech health care under pressure; hospitals hit virus record

PRAGUE (AP) — A record surge of new coronavirus infections in the Czech Republic in September has been followed by a record number of virus patients being hospitalized, putting the nation’s health care system under serious pressure for the first time in the pandemic.

After relaxing almost all virus restrictions in the summer, the Czech government has responded to the new spike by declaring a state of emergency on Wednesday. That has been accompanied by strict restrictions ranging from limiting public events to a ban on singing at churches and schools.

The Czech Republic faced a record surge of new COVID-19 cases two weeks ago with more than 3,000 testing positive in one day. On Wednesday, it hit almost 3,000 new cases again.


On Tuesday, 151 COVID-19 patients were admitted at hospitals across the country, bringing the total number of those hospitalized to 976. Of them, 202 needed intensive care. All three categories are records.

“(The outbreak) is not under control at this very moment,” Petr Smejkal, chief epidemiologist at the Institute of Clinical and Experimental Medicine in Prague, told The Associated Press.

September was by far the worst month for the country of nearly 10.7 million people. The number of all infected went up by more than 46,000 from 24,616 to 70,771, according to government figures released Thursday. A month ago, only 172 virus patients were being treated in hospitals and 35 were in intensive care wards.

“We have quite a robust health care system,” Smejkal said. “But the bottleneck of the system is not the ventilators and the machines. The bottleneck is the staff.”

Hospitals in the country have 6,000 beds assigned for COVID-19 patients and another 1,000 at intensive care wards.

“So, you can estimate that at the end of October, with only 1,000 ICU beds empty, they can easily fill up. (Then) all of the ICU capacity could be filled up and then you won’t have staff and you won’t be able to take care of other things besides COVID,” he said.

Some 1,700 Czech medical personnel have been infected, while others have been quarantined or remain home with their children.

Health care labor unions have urged hospitals to re-employ former staffers and to ask medical students for help. A major hospital in Uherske Hradiste county, the hardest hit area in the country with over 256 people infected per 100,000 inhabitants in the last seven days, has postponed all non-urgent operations for next week and was planning to send some coronavirus patients to nearby hospitals.

After health authorities acknowledged they could not properly trace the contacts of those infected in Prague, the capital, 250 police officers will be trained to help.

Smejkal said testing also needs to be increased because currently up to 12% of all those tested are positive.

“This should be down to 5%. If not, you’re still missing a lot of people who are positive and who can spread the disease,” he added.

Of the country’s 658 confirmed virus deaths, 217 of them

New York City Schools Hit Last Step for Reopening Thursday

Students in hundreds of New York City middle and high schools start in-person classes Thursday, as the system gears up for its first effort at random testing for the new coronavirus.

In the third—and if all goes well—final phase of school reopenings for the nation’s largest district, roughly 1,600 traditional public schools will be open Thursday. On Tuesday, about 870 schools welcomed children in elementary grades, including schools serving children in kindergarten through fifth grade and K-8. Preschool and some special-education students returned to school last week.

“A really extraordinary number of schools will be open and ready to serve, and they’re doing it the right way,” Mayor Bill de Blasio said at a press briefing Wednesday. He said virus testing in schools will start next week.

The mayor has pushed to be one of the few major districts nationwide to offer in-person classes, despite resistance from many teachers and parents concerned that gathering large numbers of people in aging buildings might spread the coronavirus.

An Edward R. Murrow High School student attended remotely from Brooklyn, N.Y., Sept. 21.



Photo:

caitlin ochs/Reuters

About half of the district’s one million students have chosen to study online full time, by city data. Many teachers have gotten permission to teach from home because they have medical conditions or live with someone who does.

The mayor has said schools will close if the share of people tested in New York City who are positive for Covid-19 hits 3% on a seven-day rolling average, and his administration was boosting testing and enforcement of mask wearing and other safety rules in areas seeing increases.

The daily share of people tested in New York City who were positive for Covid-19 hit 3.25% for the first time since June, Mr. de Blasio said Tuesday, just as most public schools began reopening. Despite the uptick, on Wednesday the mayor reported a positivity rate of 1.46% on a seven-day rolling average.

The in-school testing is a result of a deal the city negotiated in September with the teachers union to avert a strike vote. As part of a reopening deal with the union, City Hall promised random monthly testing of 10% to 20% of students and staff showing up in person at each school.

School staff members wore protective masks as they waited for students to arrive for in-person classes at Public School 188 Tuesday.



Photo:

John Minchillo/Associated Press

In correspondence with families, the city described its virus-surveillance program as free, quick and painless.

The city Department of Education asked parents this week to sign consent forms for testing. It said consent isn’t mandatory, but students who don’t have consent forms on file might be required to learn remotely if a school has too few permissions.

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City officials said the test isn’t a long swab, but a short, small one that only goes in the nostril. “We are

Elderly hit so hard by COVID-19 because of lower levels of certain immune cells

Elderly people who get COVID-19 have lower levels of important immune cells, which may explain why they are more likely than younger patients to have severe symptoms or die, new research suggests.

For the study, the researchers analyzed blood samples from 30 people with mild COVID-19, ranging in age from the mid-20s to late-90s. Compared with healthy people, all of the COVID-19 patients had lower numbers of T cells — which target virus-infected cells — in their blood.

But COVID-19 patients over 80 years of age had fewer T cells than those who were younger, and so-called “killer” T cells in older patients produced lower amounts of cytotoxic molecules that find and kill infected cells, the investigators found.

This age-related difference in immune response may partially explain why older COVID-19 patients have more severe illness, according to the authors of the study published this month in the journal mBio.

“Elderly people have more severe diseases compared to young people, and we found that the cytotoxic part of immune control is not as efficient to respond to the virus in older people,” said study leader Gennadiy Zelinskyy, a virologist at University Hospital Essen, in Germany.

The lower levels of T cells in COVID-19 patients is among the many unwelcome surprises of the pandemic, he noted in a news release from the American Society for Microbiology.

Once inside the body, most viruses trigger a boost in T cells, including cytotoxic-producing killer T cells that play a critical role in destroying virus-infected cells. If a person’s immune system produces fewer of these T cells, it has greater difficulty combating a viral infection.

The findings suggest that cytotoxic T cells play a key role in control of early infections, but Zelinskyy said it’s too soon to know if these cells can be used to create an immunotherapy against the new coronavirus.

More study is needed to understand the potential risks and benefits of interfering with T cells as a way to control the new coronavirus and other viruses, he concluded.

More information
The U.S. Centers for Disease Control and Prevention has more on COVID-19.

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Coronavirus cases hit multiweek lows in D.C. region, but experts fear cold weather could reverse trend

But health experts cautioned that there’s no guarantee the numbers will continue to fall, as chillier October weather begins to usher outdoor activities indoors.

Taison Bell, an assistant professor of medicine specializing in infectious diseases and critical care at the University of Virginia in Charlottesville, said the greater Washington region is “in a bit of a steady state” in its number of reported coronavirus cases. The region’s caseload had held steady for several weeks before starting to tick downward about 10 days ago.

He also cautioned that the arrival of cooler weather could increase the spread of the virus as people increasingly decide to congregate indoors.

Neil J. Sehgal, an assistant professor of health policy and management at the University of Maryland School of Public Health, urged residents to consider the pandemic as they make plans for the holidays. They should remember that this is “not the normal holiday season,” he said.

Sehgal said progress in some jurisdictions while battling the virus has started to slow, singling out Prince George’s County, where outbreaks have been reported at the University of Maryland. He said other college towns in the region, including Virginia’s Blacksburg and Charlottesville, also have seen caseloads rise as students go back to school.

“We haven’t controlled transmissions,” Sehgal said. “We’re still riding our first wave of the outbreak. We saw a summer dip, but we never stamped it out. There are still chains of transmission in the community.”

Short of a vaccine, Sehgal said, recent days are probably “as safe as it’s going to be” in terms of a lowered number of cases in the Washington region, also noting the likelihood of increased spread as the weather turns colder.

Still, D.C., Maryland and Virginia have made progress in battling the virus in recent days.

The seven-day rolling average of new cases in Washington’s Northern Virginia suburbs stood at 190 on Wednesday, with the region this week notching its lowest average caseloads since early August. Statewide, the number of new daily cases is the lowest since mid-July.

In D.C., the seven-day average dropped to 39 on Wednesday, the lowest in the city since early July.

Maryland’s seven-day average stood at 490 on Wednesday, up slightly in recent days but about half the number of daily cases as early August. Caseloads have held mostly steady in Montgomery and Prince George’s counties in recent weeks.

Montgomery County officials said Wednesday that they are continuing to accumulate supplies in preparation for a possible increase in coronavirus cases this fall or winter.

“We are in a lot better position than we were in the spring,” County Executive Marc Elrich (D) said at a news conference. “We made a decision in the beginning that we would accumulate enough supplies for a second surge.”

Among the supplies are 50 new ventilators that arrived this summer, officials said.

The seven-day rolling average of new cases in the county stood at 83 on Wednesday, with a test positivity rate of 2.6 percent. County health officer Travis Gayles