Day: October 27, 2020

health

Covid-positive health workers asked to keep working as crisis worsens

Health workers in some hospitals in Liege, Belgium’s third largest city and a coronavirus hotspot, have been asked to continue working even if they test positive for Covid-19 — as long as they are not showing any symptoms of the disease.



a woman sitting at a table using a laptop computer: A medical worker wearing a protective equipment tends to a patient at the intensive care unit for patients infected with Covid-19 (novel coronavirus) at The University Hospital Centre in Liege, Belgium on October 22, 2020. Belgium, is experiencing one of the worst second waves of the epidemic in the world, and with 10,539 deaths in a country of 11.5 million people, one of the deadliest outbreaks per capita.


© Kenzo Tribouillard/AFP/Getty Images
A medical worker wearing a protective equipment tends to a patient at the intensive care unit for patients infected with Covid-19 (novel coronavirus) at The University Hospital Centre in Liege, Belgium on October 22, 2020. Belgium, is experiencing one of the worst second waves of the epidemic in the world, and with 10,539 deaths in a country of 11.5 million people, one of the deadliest outbreaks per capita.

Top health official have warned that Belgium could run out of intensive care beds in as little as two weeks and some hospitals are facing staff shortages. The country of 11.5 million people has reported on average more than 13,000 cases a day in the past week, according to the national public health institute Sciensano. The Covid-19 outbreak in Belgium is the second worst in Europe in terms of new cases per capita, after only the Czech Republic.

Yves Van Laethem, Belgium’s spokesperson for the fight against the coronavirus, warned that unless Belgians change their behavior, intensive care units will reach their capacity of 2,000 patients in 15 days.

Liege, the largest city in the French-speaking Wallonia region, has the highest incidence rate in Belgium. Tje communications director of Liege University Hospital, Louis Maraite, told CNN on Tuesday that because of staff shortages, the hospital had “no choice” but to make doctors and nurses who tested positive but have no symptoms come to work.

“This is not a problem as they are working in coronavirus units with patients who also tested positive,” he added. Maraite said that health workers with Covid-19 accounted for 5% to 10% of the total hospital workforce.

Health workers who show symptoms, such as fever, have been asked not to come to work, and Maraite said the hospital could not force asymptomatic health workers to show up.

Another Liège hospital, CHC MontLégia, also confirmed to CNN that positive asymptomatic health workers have been asked to continue working on a voluntary basis and in the “strict observance of sanitary measures” that include limiting contact with their colleagues.

The spokesperson for the private hospital’s communication department told CNN that positive asymptomatic staff are working mainly in Covid-19 units but can work across all units including those with non-covid patients, except the geriatric, neonatology and oncology departments, where patients are “particularly vulnerable”.

A spokeswoman for the Belgian Health Ministry told CNN allowing asymptomatic health workers to continue working is allowed in “very strict conditions” because there are not enough health care workers. “We try to ensure the security of all patients,” she added.

At a news conference Monday, Van Laethem said that 1,000 of the country’s intensive beds are already being used, with total of 1,250 set to be occupied by the end of the

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health

Lilly Stops Antibody Trial in Hospitalized COVID-19 Patients

Editor’s note: Find the latest COVID-19 news and guidance in Medscape’s Coronavirus Resource Center.

Eli Lilly announced it will halt its ACTIV-3 trial evaluating the antibody bamlanivimab in combination with remdesivir for people hospitalized with COVID-19, after new evidence regarding efficacy emerged.

The new data from the National Institutes of Health suggest that the experimental neutralizing antibody therapy does not offer significant clinical benefit for people with more advanced COVID-19 illness, according to a company statement.

Eli Lilly also announced it plans to continue its other trials evaluating the antibody, including those assessing a potential role in treating people in the earlier stages of COVID-19.

“While there was insufficient evidence that bamlanivimab improved clinical outcomes when added to other treatments in hospitalized patients with COVID-19, we remain confident based on data from Lilly’s BLAZE-1 study that bamlanivimab monotherapy may prevent progression of disease for those earlier in the course of COVID-19,” the statement reads.

The ACTIV-3 trial was paused on October 13 after a data and safety monitoring board cited safety concerns.

The most recent data update that triggered an end to the trial did not reveal any significant differences in safety, though.  

Damian McNamara is a staff journalist based in Miami. He covers a wide range of medical specialties, including infectious diseases, gastroenterology, and rheumatology. Follow Damian on Twitter:  @MedReporter.

For more news, follow Medscape on Facebook, Twitter, Instagram, and YouTube.

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health

Wisconsin facing ‘urgent crisis’ as cases rise

Wisconsin’s governor on Tuesday warned of an impending crisis as the state continues to see coronavirus cases rise and its hospitals overwhelmed.



a boy wearing a hat: Nyasia Camara, medical assistant, checks in a person for a COVID-19 test at the drive-thru testing site at Mercy Health Anderson Hospital, Thursday, Oct. 22, 2020. You must have an ID. They're open from 8am - 1pm and do about 70 tests each day. Over 5,000 deaths in Ohio have been reported during the pandemic, according to Ohio Department of Health.  Testing Political Signs Scenes For Wwlt


© Liz Dufour/The Enquirer/Imagn/USA Today
Nyasia Camara, medical assistant, checks in a person for a COVID-19 test at the drive-thru testing site at Mercy Health Anderson Hospital, Thursday, Oct. 22, 2020. You must have an ID. They’re open from 8am – 1pm and do about 70 tests each day. Over 5,000 deaths in Ohio have been reported during the pandemic, according to Ohio Department of Health. Testing Political Signs Scenes For Wwlt

“There is no way to sugarcoat it, we are facing an urgent crisis and there is an imminent risk to you and your family,” Gov. Tony Evers said.

Hospital beds in the state are 84% full, as well as 87% of intensive care unit beds, according to state data, as hospitalizations continue to escalate.

The state opened a hospital facility at the state fair grounds October 14, and five patients have been cared for there as of Tuesday.

More than 5,000 confirmed cases were reported in Wisconsin as of Tuesday, bringing the total number there to more than 200,000 — a “tragic” and “concerning” milestone, Evers said. The state’s death toll rose by 64 Tuesday, bringing the total to 1,852.

“The increasing cases, and our increase in deaths today are the largest single day increases we’ve seen throughout the course of this pandemic,” said Andrea Palm, Secretary-designee of Wisconsin’s Department of Health Services. “We must take significant and collective action.”

The state’s seven-day average of new cases has increased by more than 400%, Palm said. It took seven months for cases to reach 100,000 there, and only 36 days to hit 200,000 Evers said.

Evers’ warning comes as nearly half a million Americans tested positive for Covid-19 in just the last week as a fall surge of the contagious virus claws its way into every region of the country.

More than 8.7 million in US infected since pandemic began

The past seven days have been marked by daunting coronavirus records and upticks, with 489,769 new cases reported since October 20.

In the US, more than 8.7 million people have now been infected since the pandemic began, according to Johns Hopkins University.

The fall resurgence has led some local and state officials to rein in their reopening plans, as hospitalization numbers increase and states report case records. Still, public fatigue and political unwillingness to require masks and restrict gatherings — exemplified by the White House chief of staff’s frank admission that “we are not going to control the pandemic” — suggest worse days to come.

Dr. Scott Gottlieb, former commissioner of the US Food and Drug Administration, said on CNBC’s “Squawk Box” on Monday that the US was at a tipping point, where aggressive action could stem the worst of the pandemic.

“But we’re not going to do that and I understand why. There’s a lot of fatigue set in and a lot of policy resistance

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health

Virus pushes twin cities El Paso and Juarez to the brink

A record surge in coronavirus cases is pushing hospitals to the brink in the border cities of El Paso and Ciudad Juarez, confronting health officials in Texas and Mexico with twin disasters in the tightly knit metropolitan area of 3 million people.

Health officials are blaming the spike on family gatherings, multiple generations living in the same household and younger people going out to shop or conduct business.

The crisis — part of a deadly comeback by the virus across nearly the entire U.S. — has created one of the most desperate hot spots in North America and underscored how intricately connected the two cities are economically, geographically and culturally, with lots of people routinely going back and forth across the border to shop or visit with family.

“We are like Siamese cities,” said Juarez resident Roberto Melgoza Ramos, whose son recovered from a bout of COVID-19 after taking a cocktail of homemade remedies and prescription drugs. “You can’t cut El Paso without cutting Juarez, and you can’t cut Juarez without cutting El Paso.”


In other developments Tuesday, Illinois Gov. J.B. Pritzker, a Democrat, banned indoor dining and drinking in Chicago in one of the biggest retreats yet in the face of the latest surge. And Wisconsin’s governor pleaded with residents to voluntarily stay home as the state shattered records for daily cases and deaths. Democratic Gov. Tony Evers issued a stay-at-home order in March, but the conservative-leaning state Supreme Court struck it down two months later.

In El Paso, authorities have instructed residents to stay home for two weeks and imposed a 10 p.m. curfew, and they are setting up dozens of hospital beds at a convention center.

Also, the University Medical Center of El Paso erected heated isolation tents to treat coronavirus patients. As of Tuesday, Ryan Mielke, director of public affairs, said the hospital had 195 COVID-19 patients, compared with fewer than three dozen less than a month ago, and “it continues to grow by the day, by the hour.”

In Juarez, the Mexican government is sending mobile hospitals, ventilators and doctors, nurses and respiratory specialists. A hospital is being set up inside the gymnasium of the local university to help with the overflow.

Juarez has reported more than 12,000 infections and over 1,100 deaths, but the real numbers are believed to be far higher, because COVID-19 testing is extremely limited. El Paso County recorded about 1,400 new cases Tuesday, just short of the previous day’s record of 1,443. The county had 853 patients hospitalized for the virus on Monday, up from 786 a day earlier.

Even the mayor of Juarez hasn’t been spared. Armando Cabada was first diagnosed in May and appeared to have recovered, but then landed in the hospital last week with inflamed lungs.

Last week, Chihuahua, which includes Juarez, became the only state in Mexico to return to its highest level health alert, or red, under which most nonessential services are shut down and people are encouraged to stay home.

A curfew is

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health

Alabama adds another 1,000-plus coronavirus cases; When is mask order set to end?

Alabama added another 1,000-plus coronavirus cases overnight.

The Alabama Department of Public Health’s Oct. 27 10 a.m. numbers show the state has had 186,437 cases since March, adding 1,115 since yesterday.  Of those cases, 159,439 are confirmed and 26,998 are probable. The state added 26 deaths to its total, bring the death toll to 2,892.

Hospitalizations also increased, rising by 32 to 967.

Alabama’s mask order

Alabama remains under a mandatory face mask covering order until Nov. 8.

Alabama Gov. Kay Ivey and State Health Officer Dr. Scott Harris first issued the mask order on July 16.

The mask order requires people to wear coverings over their nostrils and mouth when within 6 feet of people from another household in indoor spaces open to the public, a vehicle operated by a transportation service, or an outdoor space where 10 or more people are gathered. Masks are not required for children 6 and younger, people with a medical disability that prevents wearing a mask, people voting, or those “actively providing or obtaining access to religious worship.”

At the time of the most recent extension, Ivey cited the importance of protecting people from coronavirus on election day. She has not indicated if she will extend the order past next week.

Here are the latest county-by-county numbers from the Alabama Department of Public Health. The numbers include both confirmed and probable cases with the overnight increases shown in parenthesis:

Autauga – 2082 (+6)

Baldwin – 6712 (+18)

Barbour – 1042 (+9)

Bibb – 850 (+7)

Blount – 1972 (+30)

Bullock – 650 (+1)

Butler – 1012

Calhoun – 4647 (+26)

Chambers – 1368 (+16)

Cherokee – 756 (+11)

Chilton – 1904 (+11)

Choctaw – 393 (+1)

Clarke – 1366 (+13)

Clay – 753 (+4)

Cleburne – 573

Coffee – 1807 (+12)

Colbert – 2060 (+19)

Conecuh – 565 (+4)

Coosa – 209 (+4)

Covington – 1759 (+4)

Crenshaw – 609

Cullman – 2557 (+49)

Dale – 1789 (+17)

Dallas – 1881 (+9)

DeKalb – 3492 (+31)

Elmore – 3246 (+19)

Escambia – 1749 (+19)

Etowah – 4341 (+19)

Fayette – 589 (+5)

Franklin – 2064 (+3)

Geneva – 921 (+5)

Greene – 346

Hale – 777

Henry – 723 (+4)

Houston – 4193 (+13)

Jackson – 2194 (+19)

Jefferson – 23,573 (+130)

Lamar – 508 (+2)

Lauderdale – 2338 (+25)

Lawrence – 869 (+8)

Lee – 6571 (+21)

Limestone – 2936 (+43)

Lowndes – 716 (+2)

Macon – 539 (+2)

Madison – 9422 (+28)

Marengo – 1026 (+1)

Marion – 1103 (+6)

Marshall – 4426 (+15)

Mobile – 16,994 (+60)

Monroe – 655 (+7)

Montgomery – 10,352 (+54)

Morgan – 4223 (+31)

Perry – 595 (+2)

Pickens – 869 (+9)

Pike – 1345 (+1)

Randolph – 835 (+6)

Russell – 1960 (+7)

St. Clair – 3040 (+41)

Shelby – 7504 (+68)

Sumter – 474 (+2)

Talladega – 2714 (+40)

Tallapoosa – 1339 (+9)

Tuscaloosa – 10,462 (+48)

Walker – 2837 (+14)

Washington – 751 (+2)

Wilcox – 570

Winston – 940 (+3)

S

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health

Governor bans indoor dining in Chicago as virus cases surge

SPRINGFIELD, Ill. (AP) — Surging COVID-19 cases in Chicago prompted Gov. J.B. Pritzker on Tuesday to ban indoor dining and bar services and limit the number of people gathering in one place.

The rules taking effect Friday will force diners and bar patrons outdoors and shut down service at 11 p.m. No more than 25 people may gather at one time, or fewer if that number would exceed 25% of room capacity.

“We can’t ignore what is happening around us, because without action, this could look worse than anything we saw in the spring,” Pritzker said, referring to the start of the pandemic, when health care resources were pushed to the limit because of the overwhelming number of COVID-19 cases.


Chicago, which comprises Region 11 of the state’s 11 COVID-19 monitoring regions, joins six other regions subject to what the Pritzker administration calls “resurgence mitigations.” A day earlier, Pritzker imposed the restrictions on Region 10, Cook County outside of Chicago and Lake County to the north.

After a summer of declining case numbers — Illinois fared better than many other states, particularly in the South and West — they began climbing again in August and jumped precipitously this month. There were 4,000 new infections and 46 additional deaths Tuesday, bringing total cases to 382,985 with 9,568 deaths.

There were 2,758 hospitalized, an 86% increase from a month ago, and both intensive care patients at 595 and the 241 on ventilators represented increases in the 70% range.

Other regions which hit the mitigation bar did so when positive rates of COVD-19 test results topped 8% for three consecutive days. Dr. Ngozi Ezike, the state public health director, said the latest additions, Cook County on Monday and Chicago on Tuesday, have seen the troubling rise in numbers of sick people requiring inpatient treatment as well as a jump in positive test results.

“Based on current trends, we soon could face reduced hospital bed availability and overwhelming our health care systems,” Ezike said.

Earlier Tuesday, Dr. Allison Arwady, commissioner of the Chicago Department of Public Health, predicted the action taken by the governor, pointing out that while COVID-19 is not as prevalent in Chicago as during the pandemic’s early days in March, the number of confirmed cases is doubling every nine days.

“COVID is widespread here in Chicago, and we need you to double down on the things that you know work,” Arwady said. “Please as much as you can, if there are interactions you’re having that are not essential, back off on those.”

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Associated Press writer Kathleen Foody contributed from Chicago.

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Follow Political Writer John O’Connor at https://twitter.com/apoconnor

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health

Novavax delays U.S. trial of COVID-19 vaccine to November

FILE PHOTO: A woman holds a small bottle labeled with a “Vaccine COVID-19” sticker and a medical syringe in this illustration taken April 10, 2020. REUTERS/Dado Ruvic

(Reuters) – Novavax Inc on Tuesday delayed the start of a late-stage U.S. trial of its experimental coronavirus vaccine by roughly a month to the end of November, citing delays in scaling up the manufacturing process.

The U.S.-based drug developer said data from a separate Phase III trial being conducted in Britain was expected by the first quarter of 2021 and could be the basis for global regulatory approvals although it did not elaborate. Shares of the company rose nearly 3%.

It is not immediately clear whether that could apply in the United States. Novavax did not respond to a request for clarification.

“I think the FDA has generally been loathe to approve vaccines for Americans that haven’t been tested in Americans, historically,” Dr. Paul Offit, an infectious disease expert at the University of Pennsylvania and a member of the U.S. Food and Drug Administration’s vaccine advisory panel, said on in an interview with the editor of JAMA medical journal on Tuesday.

Data from an early-to-mid stage trial of the vaccine is expected on Friday, the company said. Earlier data had showed the vaccine produced high levels of antibodies against the novel coronavirus.

A handful of companies, including larger rivals Pfizer Inc and AstraZeneca Plc, are conducting late-stage trials of their experimental COVID-19 vaccines, though none have reported pivotal data that would be used to seek emergency authorization or approval.

The companies, including Novavax, have already made distribution deals with several countries for the vaccines, once approved.

Novavax in August said it will supply 60 million doses of its coronavirus vaccine to the UK from as early as the first quarter of 2021.

The company is also preparing to deliver 100 million doses to the United States by January after it was awarded $1.6 billion for its potential vaccine, and has also signed supply agreements with Canada and Japan.

Reporting by Manas Mishra in Bengaluru and Julie Steenhuysen in Chicago; Editing by Arun Koyyur and Bill Berkrot

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fitness

Federal judge rules against gym owner who sued CA governor

The front entrance at Fitness System’s health club in Sacramento, with a copy of the Bill of Rights taped to the door. A federal judge dismissed a lawsuit Tuesday, Oct. 27, 2020, that the owner had filed against California Gov. Gavin Newsom and other officials because of COVID-19 shutdowns. 

The front entrance at Fitness System’s health club in Sacramento, with a copy of the Bill of Rights taped to the door. A federal judge dismissed a lawsuit Tuesday, Oct. 27, 2020, that the owner had filed against California Gov. Gavin Newsom and other officials because of COVID-19 shutdowns. 

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A federal judge on Tuesday dismissed a lawsuit against Gov. Gavin Newsom and San Joaquin County and Lodi officials that had been filed by the owner of three Sacramento-area gyms after officials ordered the shutdown of fitness centers last spring because of COVID-19.

After a Zoom hearing in Sacramento federal court, U.S. District Judge John A. Mendez agreed to requests by the defendants that the lawsuit be dismissed and found that the coronavirus pandemic was so dangerous that officials were within their authority when they first ordered the closures.

The orders were “a constitutional response to an unprecedented pandemic,” Mendez said.

Attorney John Killeen argued for the state that since Newsom’s original stay-at-home orders the state has loosened restrictions on fitness centers, including allowing some outdoor exercising and indoor workouts in San Joaquin County at 10% of capacity.

“A number of restrictions have been lifted,” Mendez said.

“I just don’t see any basis for allowing this lawsuit to go forward in the district court,” he added.

The suit was brought by Sean Covell, owner of Fitness System gyms in Land Park, West Sacramento and Lodi, and argued that the shutdown orders violated the Constitution and were costing his operations huge amounts of revenues and lost memberships.

The lawsuit was one of numerous complaints filed by fitness centers, churches and businesses against orders Newsom and health officials issued to combat the spread of COVID-19.

The lawsuits have largely been unsuccessful, although some are pending and yet another involving gyms in Dixon and Sacramento was filed in federal court in Sacramento on Monday.

Sam Stanton has worked for The Bee since 1991 and has covered a variety of issues, including politics, criminal justice and breaking news.

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health

End of the Road for High-Dose Biotin in MS?

High-dose biotin, a B vitamin used at lower doses as a food supplement, does not significantly improve disability or walking speed in patients with progressive multiple sclerosis, new research shows.

For this reason, and because of the possibility of false lab reports as a result of high biotin serum concentrations, investigators of the randomized, double-blind, placebo-controlled study conclude that high dose biotin is not recommended for treatment of progressive MS.

For investigators involved in the study, the findings are a blow.

“I’m very disappointed,” lead investigator Bruce A. C. Cree, MD, PhD, professor of clinical neurology at the University of California San Francisco, told Medscape Medical News.



Dr Bruce Cree

“I’ve spent years working on this study and was very excited about the opportunity to develop a product, a non-inflammatory drug that might improve disability in patients with MS.”

The study was published online October 23 in Lancet Neurology.

Targeting Myelin

Most studies of disease modifying therapies in MS use agents designed to modulate or suppress immune function. In contrast, the biotin approach targets myelin.

Biotin is essential for breaking down proteins, carbohydrates, and fats. It’s especially important for healthy skin, hair, eyes, liver, and nervous system functioning.

At low doses, biotin, which is also known as vitamin B7 or vitamin H, is found in some foods and is used as a supplement to treat biotin deficiency, experienced by some pregnant women

MD1003 (MedDay Pharmaceuticals), the agent used in the study, is a highly concentrated oral preparation of biotin. High-dose biotin, explained Cree, potentially addresses two mechanisms — mitochondrial energy failure that seems to occur in MS, and enhancement of myelin metabolism.

Taking high doses of biotin may affect certain blood tests, such as thyroid function tests, some pregnancy blood tests, and cardiac tests.

An earlier pilot study demonstrated safety and efficacy of high-dose biotin in progressive MS, which prompted the design of a phase 2 randomized double blind placebo-controlled trial (MS-SPI).

Results of the MS-SPI study showed that compared with placebo, MD1003 improved disability outcomes over 12 months in patients with progressive MS.  

“We were very excited about the results of the first clinical trial. It seemed to work and I was excited of course to see a bigger study replicate it,” said Cree.

The new study, known as MS-SPI2, was designed to extend the observations of the first study in a larger, more diverse patient population.

It included 642 adult patients with primary or secondary progressive MS without relapse in the past 2 years. It was conducted at 90 centers in 13 countries. The mean age of study subjects was 52.7 years, 54% were women, and 65% were diagnosed with secondary progressive MS.

Study Details

In this patient population, the mean expanded disability status scale (EDSS) score was 5.4, and the mean timed 25-foot walk (TW25) was 11.7 seconds. About 58% of subjects required a walking aid (EDSS 6.0 or 6.5), 46% were receiving concomitant disease-­modifying therapies, and 5% had at least one gadolinium­-enhancing lesion on MRI.

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health

Alabama statewide school COVID tracker to debut Oct. 30; Here’s how it works

Alabamians anxious to get a look at the prevalence of COVID-19 among students, teachers, and staff in schools statewide will get their chance on Friday.

The dashboard, in the works since late August, will be published on the Alabama Department of Public Health website and will include the number of self-reported positive COVID-19 cases in each school system, but will not be broken down by school.

After discussion between Alabama State Department of Education officials during a Monday afternoon training session for school nurses about whether to report only laboratory-confirmed COVID-19 cases or whether to report all known self-reported positives among students and faculty, Alabama State Superintendent Eric Mackey told AL.com the school tracker will follow the same reporting protocol school nurses follow now on the ADPH report card.

“The (Alabama Department of Public Health) school dashboard will use the same protocols for reporting as the ADPH report card,” Mackey wrote to AL.com.

Currently, the ADPH report card—the mechanism through which school nurses report positive cases to ADPH for contact tracing—does not require laboratory confirmation of positive cases.

Schools currently rely on parents and staff to report positive cases of COVID-19, but schools are not required to collect laboratory results before reporting a positive case.

K-12 schools have not appeared to be the source of community spread of coronavirus, something many feared prior to the opening of schools in August. The school tracker, Mackey said earlier this month, is important for two reasons, Mackey said: “So people take it seriously, and so they don’t overreact.”

“We want to be fully transparent so that people know that there are cases in the community,” Mackey said. Knowing the level of spread, he added, helps people to continue to do the things needed to mitigate that spread.

The school tracker will include positive cases for the week ending each Tuesday evening, officials said. State department of education nurses will review the data, and it will be published online by 10 a.m. each Friday morning.

A school district’s lead nurse is the only school official who can complete the school tracker report for the district, and while student and faculty cases will be reported separately, only a total will be reported to the public. Five cases or fewer will not be reported by number for privacy reasons, officials said.

While there is no national template or standard for reporting cases in schools, some states provide a more detailed breakdown than Alabama is planning to report.

Florida reports positive cases by school and whether the person is a student, teacher, or other staff member. Their report also includes whether persons were showing symptoms. Louisiana reports cases weekly but only by parish, or county. Utah breaks case data down into three age groups, 5 to 10 years old, 11 to 13 years old and 14 to 18 years old.

For its school reporting dashboard, New York’s public health department not only relies on self-reporting, but also uses official lab results, matching the lab results to the

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