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Germany’s ‘R-Naught’: Are Three Days Over 1.0 Cause for Worry? Germany’s ‘R-Naught’: Are Three Days Over 1.0 Cause for Worry?
(31 minutes later)
BERLIN — When Chancellor Angela Merkel explained “R-naught,” or the reproduction variable, for the coronavirus during a news conference last month, she identified 1.0 as a key threshold.BERLIN — When Chancellor Angela Merkel explained “R-naught,” or the reproduction variable, for the coronavirus during a news conference last month, she identified 1.0 as a key threshold.
If the R-naught in Germany remained below 1.0, she said, it would suggest that active cases were in decline. A number above 1.0 would indicate that cases were on the rise.If the R-naught in Germany remained below 1.0, she said, it would suggest that active cases were in decline. A number above 1.0 would indicate that cases were on the rise.
So when Germany’s R-naught, or R0, number rose above 1.0 on Saturday and remained there for three days before dipping back down to 0.9 on Tuesday, many wondered about the implications. Was the virus surging again, given that the R0 number seemed to climb just as Germany began its second major phase of reopening?So when Germany’s R-naught, or R0, number rose above 1.0 on Saturday and remained there for three days before dipping back down to 0.9 on Tuesday, many wondered about the implications. Was the virus surging again, given that the R0 number seemed to climb just as Germany began its second major phase of reopening?
Health officials in the country are trying to assuage those fears. Officials from the Robert Koch Institute, Germany’s primary disease control agency, said the reproduction number is an estimate that will vary from day to day, and is only cause for concern if it remains elevated for an extended period of time.Health officials in the country are trying to assuage those fears. Officials from the Robert Koch Institute, Germany’s primary disease control agency, said the reproduction number is an estimate that will vary from day to day, and is only cause for concern if it remains elevated for an extended period of time.
The reproduction number is subject to natural fluctuations, Lars Schaade, vice president of the Robert Koch Institute, said at a news conference on Tuesday. The institute calculates R0 using case numbers reported by local health authorities across the country.The reproduction number is subject to natural fluctuations, Lars Schaade, vice president of the Robert Koch Institute, said at a news conference on Tuesday. The institute calculates R0 using case numbers reported by local health authorities across the country.
The local numbers are subject to delays of a week to 10 days, and they may include localized outbreaks, making the nationwide R0 likely to shift on any given day.The local numbers are subject to delays of a week to 10 days, and they may include localized outbreaks, making the nationwide R0 likely to shift on any given day.
“The number will always fluctuate, and as long as it remains around 1.0, that is considered a stagnation and not an increase,” Dr. Schaade said. A reproduction factor of 1.0 means that, on average, one infected person is spreading the virus to another person.“The number will always fluctuate, and as long as it remains around 1.0, that is considered a stagnation and not an increase,” Dr. Schaade said. A reproduction factor of 1.0 means that, on average, one infected person is spreading the virus to another person.
The variation seen this week was attributed to a series of local outbreaks in nursing homes, hospitals and meatpacking plants. But those outbreaks can easily be contained through contact tracing, health officials said. Anyone in contact with those infected can be found and isolated, preventing the virus from spreading, which would bring the reproduction number back down.The variation seen this week was attributed to a series of local outbreaks in nursing homes, hospitals and meatpacking plants. But those outbreaks can easily be contained through contact tracing, health officials said. Anyone in contact with those infected can be found and isolated, preventing the virus from spreading, which would bring the reproduction number back down.
Five regions have seen the number of active infections rise above 50 per 100,000 inhabitants within the past week, a threshold set by Ms. Merkel as triggering the need for a local lockdown. In some cases, the affected regions have reinstated restrictions; in other instances, they have taken targeted isolation measures.Five regions have seen the number of active infections rise above 50 per 100,000 inhabitants within the past week, a threshold set by Ms. Merkel as triggering the need for a local lockdown. In some cases, the affected regions have reinstated restrictions; in other instances, they have taken targeted isolation measures.
The idea is to isolate the virus where it is, while allowing the rest of the country to continue on with a more normal life, which is possible when the overall number of new infections remains low.The idea is to isolate the virus where it is, while allowing the rest of the country to continue on with a more normal life, which is possible when the overall number of new infections remains low.
“If the numbers are very low, even with a reproduction number of two, not all is lost. We still have so much capacity that we will be able to cope,” said Thomas Hotz, a professor of statistics at Ilmenau University of Technology.“If the numbers are very low, even with a reproduction number of two, not all is lost. We still have so much capacity that we will be able to cope,” said Thomas Hotz, a professor of statistics at Ilmenau University of Technology.
Recommendations on whether to lock down or reopen the economy are not only based on the R0 number, officials at the Koch Institute said. Other numbers are also taken into consideration.Recommendations on whether to lock down or reopen the economy are not only based on the R0 number, officials at the Koch Institute said. Other numbers are also taken into consideration.
In determining whether an epidemic is manageable, officials also consider the daily number of new cases, the number of intensive care beds available and the number of tests being carried out every day.In determining whether an epidemic is manageable, officials also consider the daily number of new cases, the number of intensive care beds available and the number of tests being carried out every day.
Overall, the number of new cases has been going down in Germany. On Tuesday, the institute recorded 933 new cases — for a total of 170,508 — as compared with the 2,486 new infections recorded on April 15.Overall, the number of new cases has been going down in Germany. On Tuesday, the institute recorded 933 new cases — for a total of 170,508 — as compared with the 2,486 new infections recorded on April 15.
Updated June 16, 2020Updated June 16, 2020
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
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.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.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. 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. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. 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. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
“The R0 looks different when there are fewer cases overall,” said Hanno Kautz, a spokesman for Germany’s health ministry. “Of course we take it seriously that the reproduction number has increased again, but one cannot conclude from this that we are now again dealing with an uncontrolled outbreak.”“The R0 looks different when there are fewer cases overall,” said Hanno Kautz, a spokesman for Germany’s health ministry. “Of course we take it seriously that the reproduction number has increased again, but one cannot conclude from this that we are now again dealing with an uncontrolled outbreak.”
In fact, when there are fewer new cases, “individual outbreaks have a stronger influence on the reproduction number,” said Dr. Schaade.In fact, when there are fewer new cases, “individual outbreaks have a stronger influence on the reproduction number,” said Dr. Schaade.
Dr. Schaade said new cases in Germany appear to be reaching a plateau, a hopeful sign that could indicate the country still has its arms around the epidemic, even when the reproduction number nudges above the 1.0 mark.Dr. Schaade said new cases in Germany appear to be reaching a plateau, a hopeful sign that could indicate the country still has its arms around the epidemic, even when the reproduction number nudges above the 1.0 mark.
During her April remarks, Ms. Merkel stressed that the entire effort “rests on having a number of infections that we can keep track of and trace.”During her April remarks, Ms. Merkel stressed that the entire effort “rests on having a number of infections that we can keep track of and trace.”
Since mid-April, Germany has more than tripled the number of tests it can carry out daily, making it easier for health authorities to trace people who have been in contact with an infected individual and order them to remain at home.Since mid-April, Germany has more than tripled the number of tests it can carry out daily, making it easier for health authorities to trace people who have been in contact with an infected individual and order them to remain at home.
“It is always debatable how strong the restriction measures should be,” said Dr. Hotz. “But right now I think that the authorities have it under control. We’ll see for how long.”“It is always debatable how strong the restriction measures should be,” said Dr. Hotz. “But right now I think that the authorities have it under control. We’ll see for how long.”