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As coronavirus rules ease further, cases are falling, but Nebraska has 'not achieved containment'

Starting Monday, bars and restaurants in 89 of Nebraska’s 93 counties, including in the Omaha and Lincoln areas, will be allowed to open at 100% of capacity, up from 50%.

Patrons will be able to take a seat at the bar for the first time since March, when COVID-19 brought that and a host of other normal activities to a screeching halt. Child care centers can accept more kids. And nursing homes can reopen to visitors after clearing baseline testing for staff and residents.

By July 1, practices and games for contact sports such as football and soccer will be permitted.

Meanwhile, Nebraska Gov. Pete Ricketts has previewed a fourth phase of reopening at a yet-to-be-determined future date. And schools, colleges and universities are planning a fall return to the classroom.

Ricketts has said the easing of restrictions is supported by data indicating a declining number of cases of COVID-19 in the state. New daily case counts peaked at 677 on May 7 and generally have drifted downward since then.

Health officials caution, however, that while the decline in cases is good news, the virus is by no means gone.

Wednesday, the state had averaged 171 new cases a day over the preceding seven days. Not counting Washington, D.C., Nebraska still ranked No. 10 in the U.S. in total cases per 100,000 people since the pandemic began, according to data maintained by the New York Times. Cases in Douglas County, a remaining hot spot, were down last week but were still averaging nearly 100 a day.

The country as a whole also has seen a decrease in new cases, but for weeks, daily cases have remained on a plateau of 20,000 to 25,000. Concerns also have arisen recently with cases increasing in parts of the South and West, including Arizona, Texas and Florida.

“We have not achieved containment of this virus,” said Dr. Ali Khan, dean of the University of Nebraska Medical Center’s College of Public Health. He said, however, that “it is possible with good public health practices.”


Dr. Ali Khan of UNMC speaks at a Black Lives Matter rally on June 5.

But Khan said the question isn’t so much whether Nebraska should reopen but whether it reopens safely.

That, he said, will take a partnership. For Nebraskans, it means wearing face coverings in public, washing or disinfecting their hands frequently and maintaining social distancing. The government’s job, Khan said, is to provide testing, contact tracing and good public health information.

The good news is that other countries have contained the virus with variations on those approaches, said Khan, a former disease detective with the federal Centers for Disease Control and Prevention.

New Zealand, for instance, locked down fast and hard and followed up with aggressive contact tracing, which is the process of quickly finding and isolating sick people and tracking down and quarantining their close contacts. Germany and South Korea also have focused heavily on contact tracing.

Recently, New Zealand welcomed thousands of rugby fans to packed stadiums.

“The road to a bowl game for the Huskers,” Khan said, “is interrupting community transmission so we can have full stands of people rooting them on.”

Khan said he would consider the virus contained if the state had fewer than 10 to 20 new cases a day. Nebraska’s case count is nowhere near that low number.

The novel coronavirus poses a tricky balance. While most people won’t become seriously ill if they catch it and develop COVID-19, some 90% of people still are susceptible. And about a third of Americans have underlying health conditions that put them at more serious risk from the disease.

Researchers also have learned a few things about the virus in the past several months.

The CDC last month concluded that surface transmission, picking up the virus from a doorknob or tabletop, wasn’t the virus’s main transmission route.

And evidence that even cloth face coverings can reduce viral spread — initially considered an iffy prospect — has solidified in recent months, said Dr. Maureen Tierney, an infectious diseases physician and soon-to-be assistant dean at Creighton University.

Wearing masks, she said, prevents both asymptomatic and presymptomatic people from shedding and spreading the virus, literally holding in virus particles. While that largely protects other people, masks also can protect the wearer from droplets produced when others around them cough, laugh or sing.

In Springfield, Missouri, no cases of COVID-19 have been reported among 140-plus customers and co-workers after two hairstylists at the same salon tested positive for the virus. Both had worn masks.

“If we all wore masks, the transmission rate would go down very significantly,” said Tierney, who until recently was involved with the state health department’s COVID-19 response. “If we’re going to open back up, wearing those masks, keeping at least 6 feet from other people, is just crucial in making that opening up be successful.”

While none of those measures may be perfect on its own, she added, the more people combine the measures, the more they reduce their risk.

Another lesson: While early efforts to test for and trace the virus focused on the number of tests and the number of contact tracers in the field, attention now needs to shift to using both tests and tracing to their best advantage.

“It’s inadequate anymore just to say we have lots of tests,” Khan said. “Are you using the tests the way they ought to be used?”

Dr. Tom Frieden, a former CDC director, wrote recently in the Washington Post that tests need to be conducted soon after people feel sick and intensively in nursing homes and other places where people congregate.

Testing in Nebraska has increased significantly, with more than 148,000 Nebraskans tested through Friday. Access to testing also has improved since the early days of the pandemic, with more Nebraskans now able to get a test when they want it.

Recently, testing also has targeted those at greatest risk, including people with ties to food processing plants and those involved in protests and rallies.

Contact tracing, too, has been stepped up. More than 730 contact tracers are available in the state, taking into account additional staff hired by local health departments, repurposed state employees and those working for three companies contracted by the state to help.

But Khan said more data is needed to indicate how well the measures are working, such as how many people are in quarantine, how many others they have infected and how long it takes to find and isolate them.

Dr. Anne O’Keefe, senior epidemiologist at the Douglas County Health Department, said the county has hired a furloughed data analyst to help drill further into the information it’s collecting from its 120 contact tracers.

Among other steps, the department is working on database changes that would allow officials to track how long it takes to get contacts isolated. With so many new tracers, the Health Department also is using the data to see whether any tracers need additional training, with the aim of making the process as fast and efficient as possible. Officials also are discussing developing an indicator it can add to the county’s dashboard.

“What gets measured gets done,” she said.

And there is some good news.

Doctors have learned more about how to treat patients with COVID-19, including waiting longer to put patients on ventilators, using lower settings when they do and placing patients on their bellies to help get more oxygen into their blood.

Researchers in England last week announced that a cheap, widely available steroid called dexamethasone reduced deaths by up to one-third in severely ill patients.

And a major international study that enrolled its first patient at the Nebraska Medical Center indicated that an antiviral drug, called remdesivir, shortened by four days, on average, the time it takes for patients to recover.

Dr. William Lydiatt

“We’ve learned a huge amount in the last three to four months,” said Dr. William Lydiatt, vice president of medical affairs and chief medical officer for Methodist and Methodist Women’s Hospitals.

Hospitals, he said, also have learned they can shut things down rapidly if they need to in order to preserve hospital capacity, which Ricketts has called his “North Star.”

Although hospitals have reopened for elective surgery, they continue to choose patients carefully, Lydiatt said. They avoid operating on those who are likely to need a long stay or a referral to skilled nursing.

Hospitals also are in a better position when it comes to supplies of protective gear.

As for other steps Nebraskans can take, Tierney encouraged those who think they have been exposed and those experiencing symptoms to get tested. Those at high risk, and the people who live with them, should consider extra precautions.

“The way I would characterize it,” Tierney said, “is we’re in a hopeful position if we’re careful and mask and social distance.”

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special report
Q&A: What to expect as Nebraska eases coronavirus rules

With the coronavirus pandemic continuing, Nebraska takes its next step Monday to lift restrictions, restart activities and open to more business.

As of last week, Nebraska was still adding an average of about 170 new COVID-19 cases a day.

But citing progress and encouraging signs in fighting the virus, Gov. Pete Ricketts authorized a further loosening of his directed health measures.

Certain rule changes around sports and elective surgeries will apply statewide.

A total of 89 counties, including the Omaha metro area and Lincoln, will move to what’s considered Phase 3 of reopening, allowing further opening of large gatherings, bars, restaurants, child care centers and a number of other places.

In the remaining four counties — Dakota, Hall, Hamilton and Merrick — the public health restrictions will open up to Phase 2, where the other counties are now.

Here’s an explainer of how the new rules work and where Nebraska stands on the pandemic.

The coronavirus is still spreading. Why is the governor doing this now?

Ricketts wants to “get Nebraska growing” after the economic hit from the pandemic. The governor’s approach is to reopen step by step, letting each phase prove it can happen safely.

What are the rules on large gatherings?

Indoor gatherings can go up to 50% of their rated occupancy. Outdoor gatherings can go up to 75%. But in any case, they can’t exceed 10,000.

This applies to a whole list of places: Indoor or outdoor arenas, auditoriums, stadiums and tracks, indoor theaters, indoor or outdoor auctions, fairgrounds, festivals, zoos, event conference rooms and meeting halls, libraries, swimming pools or “any other confined indoor or outdoor space.”

But within that, individual groups can’t have more than eight people, and groups are suggested to be 6 feet apart.

For places that hold 500 or more people, reopening plans or plans to expand to higher capacity must be submitted to the local health department. In Douglas County, that applies to places that hold 1,000 or more.

Bars and restaurants could already reopen. What changes?

They can now hold up to 100% of their rated occupancy — up from 50%. Instead of six people in a group, an individual party can go up to eight people. Patrons can now eat food at bar seating. Bar games are allowed.

What’s opening up on sports?

The earlier rules allowed non-contact and limited-contact sports: Baseball, softball, volleyball, golf and tennis. That will expand to contact sports, including basketball, tackle football, soccer and wrestling. As for timing, that will expand July 1, not on Monday.

But on Monday, fans who aren’t household family of the players can attend games.

The sports changes apply statewide.

What about wedding and funeral receptions? Any changes?

Seated parties can be a little larger — eight people per table instead of six. Limited dancing is allowed.

Self-serve buffets remain prohibited.

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What else will have restrictions relaxed?

Several other things are changing.

Elective surgeries: Hospitals and other health centers can schedule surgeries as they see fit. Restrictions requiring them to meet a certain capacity first are being lifted.

Child care centers: The rules had put a maximum of 15 children per room. But that can expand to 20 children per room for 3-year-olds, 24 children for 4- and 5-year-olds, and 30 children for K-12 age kids.

Gyms: They can go up to 75% occupancy.

Salons, barbershops and various parlors: They can go to 75% occupancy, too. Customers and workers must still wear masks.

What else remains prohibited?

Parades, carnivals, midways, dances, street dances and beer gardens.

Should I wear a mask when I’m out?

Yes — masks are the clear recommendation from health experts. With the exception of salons and parlors, the rules don’t require masks. But they’re a quick and easy way to make a difference against the coronavirus.

Where does Nebraska stand in the pandemic?

Nebraska’s COVID-19 figures reflect improvement from the pandemic’s peak. But the coronavirus is far from gone.

Back on May 7, when the coronavirus was hitting Grand Island, Nebraska recorded a single-day high of 677 new COVID-19 cases, according to figures from the Nebraska Department of Health and Human Services. A week before that, the state had single-day gains of 544 and 525 cases.

On Tuesday, Wednesday and Thursday last week, the state recorded 180, 195 and 189 new cases each day.

Those numbers are even down from a couple of weeks ago. Still, people remain susceptible to catching the virus in the community.

Ricketts calls hospitalization data his benchmark. What does that show?

As of late last week, hospitals around the state had 42% of their beds open and 45% of their intensive care beds available, according to state figures. Plus, 80% of all ventilators were available.

In the Omaha area, hospitalizations are trending down. Friday, the Douglas County Health Department reported 104 patients with a confirmed case of COVID-19 in Omaha area hospitals — the lowest total since May 10.

Statewide, about 150 people were hospitalized as of late last week. With about 100 people in Omaha area hospitals and 25 in Lincoln hospitals, that means a couple dozen are hospitalized around the rest of the state.

What’s next?

We have to see how coronavirus cases respond to more people being out and about. Some other parts of the country are seeing a resurgence as they open more.

But Ricketts is already looking ahead to the next phase of reopening, although he says he has not decided when that might happen.

What are the biggest changes in the next reopening phase?

Public gatherings — including indoor arena events or games at outdoor stadiums — can potentially have 10,000 people.

Bars and restaurants can reach 100% of their capacity.

Plus, contact sports — basketball (yes, basketball is considered a contact sport), football and soccer — are allowed.

Photos: Omaha zoo's first weekend open since closing amid coronavirus

Chemicals used at businesses create health worries of their own

Businesses across the U.S. have begun intensive COVID-19 disinfection regimens, exposing returning workers and consumers to some chemicals that are largely untested for human health, a development that's alarming health and environmental safety experts.

The rush to disinfect is well-intentioned. Executives want to protect employees while abiding by U.S. Centers for Disease Control & Prevention guidelines (and to avoid liability). Pre-pandemic, corporate cleaning staffs typically "freshened" lobbies every three hours, sanitized restrooms every four hours and cleaned other areas at night, said Rich Feczko, national director of systems, standards and innovation at Crothall Healthcare, which cleans hundreds of hospitals, as well as offices and universities.

That pace has now accelerated. "Our frequencies have ramped up in public places like lobbies and elevators to six to eight times per day," Feczko said. Restrooms are cleaned every two hours. "Before the pandemic, clients were happy if their trash was emptied and vacuum marks were in the plush carpet," said Jill Frey, owner of Ohio-based Cummins Facility Services. Now, customers ask for sanitization (reducing pathogens on a surface) and disinfection (killing all pathogens).

"This is a hazardous proposition," said Dr. Claudia Miller, an immunologist, allergist and co-author of Chemical Exposures: Low Levels and High Stakes. "Cleaners tend to go in with hugely toxic chemicals. We're creating another problem for a whole group of people, and I'm not sure we're actually controlling infections."

Cleaning companies are selecting disinfectants from hundreds on List N, the month-old compendium of products approved by the Environmental Protection Agency to kill the novel coronavirus. Those chemicals have passed tests to show they're effective against the pathogen, but "this doesn't mean that they have been approved because they're considered safe with regard to human health," said exposure scientist Lesliam Quiros-Alcala, an assistant professor at Johns Hopkins Bloomberg School of Public Health.

Limited studies, including on rodents, have raised concerns that some might increase risk of neurological and dermatological problems, as well as respiratory ailments like asthma, or have notable reproductive effects. And while those studies don't necessarily mean the disinfectants are harmful to humans, environmental health experts contend that risks are rising sharply with the increase in exposure. They also note that there are alternative ways to kill off the virus that carry less potential risk.

"I don't know that I would be using potent disinfectants in an elevator, rather than something like 70% rubbing alcohol," Quiros-Alcala said. (The rubbing alcohol option is approved by the CDC.)

The disinfection methods themselves may also prove concerning to employees. Cleaning companies sometimes use electrostatic sprayers - machines that positively charge and aerosolize small droplets of cleaning solution. Spraying is fast, allowing cleaners to cover 14,000 square feet of office space per hour, and the positive charge allows the solution to stick to surfaces.

"The risks of aerosolizing many of the disinfectants on List N hasn't been studied," said Ian Cull, president of Indoor Sciences, an environmental consultancy. "And there are very few that are approved for aerosolizing or misting or fogging." The EPA is still researching whether sprayers and foggers are effective against COVID-19.

A spokesperson for the EPA didn't immediately comment on List N or concerns raised by health experts.

Meanwhile, enclosed areas with poor ventilation — particularly common to high-rises that often recirculate air — greatly increase exposure to cleaning agents, Cull said. "Many are hampered by their equipment and unable to ventilate more."

For a small percentage of workers, disinfectants pose an immediate risk, Claudia Miller said. Up to 10% of people, including asthmatics, migraine sufferers and those with allergies or immune disorders or suppressed immune systems, may experience symptoms such as memory loss, trouble concentrating, mood swings, irritability, headaches, seizures, nausea and vomiting, she said.

Repeated or extended exposures can lead to neuro-immune sensitization and intolerances to common chemicals, foods and drugs. "That becomes a nightmare for us to deal with as physicians," Miller said.

The cleaning industry has been actively applying new technologies to combat the coronavirus. Merrick Group, a Pennsylvania-based industrial cleaning company now pivoting to disinfecting schools, businesses and hospitals, uses a proprietary process that propels a combination of isopropyl alcohol and quaternary ammonium onto surfaces using a CO2 gun. The no-wipe chemical dries within a minute, and the EPA has pronounced it safe for some food grade and hospital surfaces.

"If we can spray it in a Hershey's food plant or at a hospital, we can certainly spray it on a school bus," said Merrick Group President Bob Gorski. The health care sector, however, is proceeding with caution.

"We're letting the science guide us," said Geoff Price, co-founder of Oak Street Health, which treats 85,000 patients in 56 clinics. "There's a lot of new stuff out there, and I think companies are just grasping at different things to throw at the problem, and it's not always fact-based. Existing technologies do the work if they're applied correctly." Oak Street, for example, cleans its patient transport vans with wipes.

WHO reports largest single-day jump in new coronavirus cases

GENEVA (AP) — The World Health Organization on Sunday reported the largest single-day increase in coronavirus cases by its count, at more than 183,000 new cases in the previous 24 hours.

The U.N. health agency said Brazil led the way with 54,771 cases tallied, and the U.S. was next at 36,617. More than 15,400 came in India.

Experts said rising case counts can reflect multiple factors, including more widespread testing as well as broader infection.

Overall in the pandemic, WHO reported 8,708,008 cases— 183,020 in the past 24 hours—with 461,715 deaths worldwide, a daily increase of 4,743.

More than two-thirds of those new deaths were reported in the Americas.

In Spain, officials ended a national state of emergency after three months of lockdown, allowing its 47 million residents to freely travel around the country for the first time since March 14. The country also dropped a 14-day quarantine for visitors from Britain and the 26 European countries that allow visa-free travel.

But there was only a trickle of travelers at Madrid-Barajas Airport, which on a normal June day would be bustling.

"This freedom that we now have, not having to justify our journey to see our family and friends, this was something that we were really looking forward to," Pedro Delgado, 23, said after arriving from Spain's Canary Islands.

Spanish Prime Minister Pedro Sánchez urged people to take maximum precautions: "The virus can return and it can hit us again in a second wave, and we have to do whatever we can to avoid that at all cost."

At a campaign rally in Tulsa, Oklahoma, Trump said Saturday that the U.S. has tested 25 million people, but the "bad part" is that it found more cases.

"So I said to my people, slow the testing down, please."

White House trade adviser Peter Navarro said on CNN that Trump made the comment in a "light mood."

Democratic rival Joe Biden's campaign accused Trump of "putting politics ahead of the safety and economic well-being of the American people."

The U.S. has the world's highest number of reported infections, more than 2.2 million, and the highest death toll, at about 120,000, according to Johns Hopkins University. Health officials say robust testing is vital for tracking outbreaks and keeping the virus in check.

In England, lockdown restrictions prevented druids, pagans and partygoers on Sunday from watching the sun rise at the ancient circle of Stonehenge to mark the summer solstice, the longest day of the year in the Northern Hemisphere. English Heritage, which runs the site, livestreamed it instead. A few people gathered outside the fence.

"You can't cancel the sunrise," druid Arthur Pendragon told the BBC.

The number of confirmed virus cases is still growing rapidly, not only in the U.S. but in Brazil, South Africa and other countries, especially in Latin America.

Brazil's Health Ministry said the total number of cases had risen by more than 50,000 in a day. President Jair Bolsonaro has been downplaying the risks even as his country has seen nearly 50,000 fatalities, the second-highest death toll in the world.

South Africa reported a one-day high of almost 5,000 new cases on Saturday and 46 deaths. Despite the increase, President Cyril Ramaphosa announced a further loosening of one of the world's strictest lockdowns. Casinos, beauty salons and sit-down restaurant service will reopen.

In the United States, the virus appears to be spreading across the West and South. Arizona reported more than 3,100 new infections, just short of Friday's record, and 26 deaths. Nevada also reported a new high of 445 cases.

In Europe, a single meatpacking plant in Germany has had more than 1,000 cases, so the regional government issued a quarantine for all 6,500 workers, managers and family members.

In Asia, China and South Korea reported new coronavirus cases Sunday in outbreaks that threatened to set back their recoveries.

Chinese authorities recorded 25 new confirmed cases — 22 in Beijing. In the past week, Beijing tightened travel controls by requiring anyone who wants to leave the Chinese capital, a city of 20 million people, to show proof that they tested negative for the virus.

In South Korea, nearly 200 infections have been traced to employees at a door-to-door sales company in Seoul, and at least 70 other infections are tied to a table tennis club there. But South Korean officials are reluctant to enforce stronger social distancing to avoid hurting the economy.