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Nebraska health experts call herd immunity approach to defeating coronavirus 'reckless'

It sounds like a compelling idea at a time when everyone longs for life to get back to normal.

Instead of continuing with the strict social-distancing policies that have kept people in their homes, closed schools and businesses and blasted the economy, why not let less-vulnerable people become infected with the novel coronavirus? They could build up the antibodies needed to create what’s known as herd immunity and leave the virus with nowhere to go and no one to infect.

Two state senators recently proposed the idea. Nebraska Gov. Pete Ricketts, however, rejected the call, saying herd immunity isn’t really a plan.

He and Dr. Ali Khan, dean of the University of Nebraska Medical Center’s College of Public Health, dismissed the notion again during a call-in show Thursday night. They spoke after Ricketts participated in a conference call with President Donald Trump and other governors Thursday afternoon and after Trump released three-phase guidelines for reopening parts of the economy.

Ricketts said later in the day that the opening must be done in a way that doesn’t allow the virus to return.

“Herd immunity,” said Khan, a pandemic expert, “means 60 to 80% of people get infected. Herd immunity would have been devastation in terms of ... cases and deaths.”

Earlier in the week, Khan said that the social-distancing steps Nebraskans have taken have not only reduced the projected death toll here but also are likely to mean Nebraska can reopen more safely — and sooner — than many other parts of the country.

But State Sens. Steve Halloran of Hastings and Steve Erdman of Bayard argued in a letter published in the Hastings Tribune that the dangers of the virus have been overblown and that the best, fastest way to defeat the virus is to let people become infected and build up herd immunity.

“Our point is this: We are creating the best environment for COVID-19 to exist and flourish and stay with us for a long time,” Halloran said in an interview. “Because the virus thrives in an environment where you don’t allow people to interact and create antibodies to fight it.”

Erdman said in an interview that he and Halloran essentially were arguing the same thing Trump announced. Erdman called for precautions that include testing for health care and emergency workers, protecting vulnerable people such as those in nursing homes and then opening the economy and the schools.

“We weren’t saying open it up and go rampant,” Erdman said, “but go gradually.”

Both said they have received calls and emails from constituents concerned that their businesses, including farms, won’t recover. “I’m convinced it’s the right thing to do, opening the economy up with precautions,” Erdman said.

Both senators cited the experience of Sweden, which has allowed schools and gatherings of up to 50 to continue and focused instead on protecting the elderly.

That nation has, however, suffered a higher death toll than its Nordic neighbors, even adjusting for its much larger population. The World Health Organization also has questioned its approach.

In their letter, the senators also referred to two sources considered coronavirus contrarians, one of whom is a fiction writer.

Dr. Mark Rupp, chief of UNMC’s infectious diseases division, said the social distancing now in place is intended to buy time to develop a vaccine and create herd immunity. That’s the goal of vaccination. If done aggressively, it can eradicate diseases. Smallpox is one example.

The idea of simply letting nature take its course, however, “is a reckless and not advisable strategy,” he said. “I think we can do this in a lot smarter way that will prevent an awful lot of morbidity and mortality.”

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Many questions remain about how immunity works with the novel coronavirus, including how much it takes to keep the virus from spreading, how much immunity different individuals develop and how long it lasts.

One consideration, Rupp said, is a disease’s contagiousness. Measles, for example, is extremely contagious. To keep it from spreading, 90% or more of a population has to be vaccinated and made immune.

The novel coronavirus isn’t as contagious as measles or chickenpox, which is working in humanity’s favor. On the other hand, humans had no immunity to it. “That’s why it’s spreading so rapidly and so widely within a totally virgin population,” Rupp said.

How much immunity would be needed to create herd immunity for COVID-19 isn’t entirely clear. Rupp said he has seen estimates in the neighborhood of 40-60%.

Serological tests, which look for antibodies produced when someone has had a disease, are expected to begin to give researchers an idea how many people have been infected, particularly those who have had no symptoms or only mild ones.

“I’m going to guess you have some level of immunity and it lasts in the neighborhood of months to a year or two,” Rupp said. “But I don’t know that.”

With other coronaviruses, including the four types known to cause the common cold, people develop some immunity, he said, but it wanes in a short period of time.

Dr. Kelly Cawcutt, a Nebraska Medicine infectious diseases and critical care physician, said patients who became severely ill in the original SARS outbreak did develop antibodies.

But the novel coronavirus produces a wide range of disease, from asymptomatic to deadly. “We may not have the same level of production of antibodies across the spectrum,” she said.

In hard-hit Wuhan, China, the Wall Street Journal reported, the number of people with antibodies in recent testing fell short of what’s needed for herd immunity. One hospital found that 2.4% of employees and 2% to 3% of recent patients and other visitors had developed antibodies, doctors there told the newspaper. They cautioned, however, that the number of samples was small.

The chickenpox parties that parents held before a vaccine was available were based on the notion of herd immunity. Once everyone had it, it no longer could spread through a classroom or family.

But chickenpox produces a durable immune response. “If this isn’t a durable immune response, which it isn’t, those parties don’t work,” Cawcutt said. “It just makes people sick, but it doesn’t guarantee they don’t get it again.”

Quarantining only those most at risk — the elderly and those with underlying health conditions — still could result in a lot of people becoming seriously ill, she said. Predicting who that might be has been difficult. Even some young, healthy people have become seriously ill from the virus.

Khan said about 55% of those who are hospitalized with the virus are under 65. So are 20% of those who die.

Rupp said researchers have projected a second wave of the virus will come in the fall and winter.

But the hope is that more testing and contact tracing will be available by then, along with some treatments.

“Those are things we’re working toward as we buy time,” Rupp said, “and the thought of just ripping off the Band-Aid and getting this over with ... doesn’t have as much appeal to me.”

April photos: Nebraska faces coronavirus

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Trump pushes states to lift restrictions; most cautious

WASHINGTON (AP) — A day after laying out a roadmap for gradually reopening the economy, President Donald Trump urged his supporters Friday to "LIBERATE" three states led by Democratic governors.

The president took to Twitter with the kind of rhetoric some of his supporters have used in demanding the lifting of the restrictions that have thrown millions of Americans out of work.

"LIBERATE MINNESOTA!" "LIBERATE MICHIGAN!" "LIBERATE VIRGINIA," Trump tweeted.

Responding to pleas from governors for help from Washington in ramping up testing for the virus, Trump put the burden back on them, tweeting: "The States have to step up their TESTING!"

Trump has repeatedly expressed his desire to see businesses reopen quickly and claimed earlier this week that he possesses total authority over the matter, even though the lockdowns and other social-distancing measures have been imposed by state and local leaders.

On Thursday, the president detailed a three-step set of guidelines for easing restrictions over a span of several weeks in places that have robust testing and are seeing a decrease in COVID-19 cases, assuring the nation's governors: "You're going to call your own shots."

Governors of both parties Friday suggested they would be cautious in returning to normal, some of them warning that they can't do it without help from Washington to expand testing.

Michigan Gov. Gretchen Whitmer, a Democrat who has been critical of the federal government's response to the crisis, said she hopes to begin reopening parts of the state's economy May 1 but that it would be done in a "smart way" to avoid a second wave of infections.

West Virginia Gov. Jim Justice, a Republican ally of Trump's, endorsed the White House plan but made clear that he will listen to medical experts in deciding how to move forward. He said more testing is needed before any restrictions can be rolled back.

"I am not going to do something that I feel in my heart is the wrong thing that's going to endanger our people," he said.

Other states did take some of the nation's first, small steps toward loosening restrictions.

In Florida, GOP Gov. Ron DeSantis gave the green light for cities to reopen beaches and parks if they can do so safely. In Texas, Republican Gov. Greg Abbott said stores can begin selling curbside. He said nonessential surgery can resume and state parks can reopen.

New York Gov. Andrew Cuomo, whose state has the most COVID-19 deaths and is still seeing more than 600 deaths a day, accused the government of "passing the buck without passing the bucks."

"The federal government cannot wipe its hands of this and say, 'Oh, the states are responsible for testing.' We cannot do it. We cannot do it without federal help," he said.

Even in largely rural states with small populations, such as Wyoming, Maine and South Dakota, governors said they hesitated to quickly resume business as usual.

"Until we've got the testing up to speed — which has got to be part of the federal government stepping in and helping — we're just not going to be there," said Wyoming Gov. Mark Gordon, a Republican.

The University of Washington, whose computer models have frequently been cited by health officials at White House briefings, predicted Friday that Vermont, West Virginia, Montana and Hawaii could open as early as May 4 if they restrict large gatherings, test widely and quarantine the contacts of people who test positive.

Nebraska and Iowa are among states that would need to wait until mid-June or early July, the researchers said, along with North and South Dakota, Utah, Arkansas and Oklahoma. Every state, they said, should gauge the capacity of its public health system to handle outbreaks.

The official death toll in the U.S. neared 35,000, with about 685,000 confirmed infections.

The crisis has cost at least 22 millions Americans their jobs, pushing the unemployment rate toward levels not seen since the Great Depression.

Many Americans, especially in parts of the country that have not seen major outbreaks, have urged governors to reopen their economies. Protesters have taken to the streets in Ohio, Texas, North Carolina, Kentucky, Virginia and Michigan, where more than 3,000 turned out on Wednesday.

Protests continued Friday, including one outside the home of Gov. Tim Walz of Minnesota and another in Idaho, where the governor is a Republican.

Polls show the protesters' views are not widely held. An AP-NORC survey this month found large majorities of Americans support a long list of government restrictions, including closing schools, limiting gatherings and shuttering bars and restaurants. Three-quarters of Americans backed requiring people to stay in their homes. And majorities of both Democrats and Republicans gave high marks for the state and city governments.

Public health experts have warned that an easing of the shutdowns must be accompanied by wider testing and tracing of infected people to keep the virus from coming back with a vengeance.

But labs and public officials say critical supply shortages are making it impossible to increase testing to the levels experts say is necessary to keep the virus in check.

Trump's plan envisions setting up "sentinel surveillance sites" that would screen people without symptoms in locations that serve older people or minority populations. Experts say testing would have to increase as much as threefold to be effective.


Education
University of Nebraska will be tuition-free for residents who meet income guidelines

Offering free tuition to undergraduate Nebraska students whose families earn less than $60,000 a year will be “a game-changer” for the state, University of Nebraska President Ted Carter said Friday.

Carter said he won’t ask the Legislature for more money to pay for the program, tabbed Nebraska Promise.

The announcement of the program comes during the same week university officials forecast a shortfall of at least $50 million this fiscal year because of the coronavirus pandemic. Officials attributed the shortfall to housing refunds, event cancellations, medical costs and other factors.

“We’re going to do this within our existing budget lines,” he said.

But to make the numbers work, officials may have to make “some hard calls on some programs,” he said.

No private money is being used, he said.

Carter said the program is “the right thing to do.”

He said that families are struggling right now and that officials want to make sure no Nebraskan is denied a college education because of cost.

The program takes effect for fall 2020. It covers tuition at the university’s four four-year campuses: Lincoln, Kearney, Omaha and the medical center. At UNMC, it applies only to undergraduate nursing students.

The program is for new and returning students, attending physical classes or studying online.

To be eligible for full tuition coverage, students must take at least 12 credit hours per semester and maintain a 2.5 GPA. Nebraska Promise will cover up to 30 credit hours per academic year.

Room and board and fees will not be covered.

Gov. Pete Ricketts backs the program, according to a press release from the university. Ricketts said the program would help more of the state’s young people afford college, graduate on time and get “a great-paying job here in our state.”

“I’m pleased to see the university taking this important step to keep costs down for Nebraskans, especially at a time when all of us are tightening our belts,” he said.

The existing need-based financial aid program, Collegebound Nebraska, guarantees tuition-free education for qualifying Pell Grant-eligible Nebraska students. Almost 3,000 students currently attend NU tuition-free under the program.

Nebraska Promise would cover about 1,000 additional current and future NU students, officials said.

Though the program could benefit students financially undercut by the pandemic, the program is a long-term venture and not a response to the pandemic, Carter said.

At this time of year, a lot of high school students are deciding whether to attend college in state, he said. The program could tip their decision toward Nebraska, he said.

As for students whose family income exceeds the threshold, Carter said he will do everything he can to keep tuition rates flat and education affordable.

Carter announced the program at Friday’s Board of Regents meeting.

Carter said many people have worked hard to put this together, and he thanked the campus financial aid directors as well as members of a systemwide strategic planning committee whom he said have been discussing ideas about student access, success and well-being.

“The chancellors and I are exploring other steps related to affordability. … We don’t have further announcements just yet but will share any decisions as soon as we make them,” Carter said.

Regent Tim Clare said he favors the program.

In addition to helping students with financial need because of the pandemic, it will help families still recovering from last year’s flooding, he said. The students can graduate without debt, Clare said. And once COVID-19 is behind the state, it will still face workforce shortages that the university will play a role in solving, he said.

Clare said tuition shouldn’t be a barrier keeping young people out of the university.

“If we can provide this opportunity for young families, it’s transformational,” he said.

He said that he is comfortable with the 2.5 GPA requirement and that some students’ GPA may be lower because they’re working jobs that cut into study time.

Regent Robert Schafer said he supports the program and called it “awesome.”

“Ultimately what you’re trying to do is give someone the opportunity to live the American dream,” he said.

Regent Elizabeth O’Connor said some students have lost jobs because of the social gathering restrictions triggered by the pandemic. The program will prevent their education from being interrupted because they can’t pay tuition, she said.

That will alleviate stress for those students, she said.

“It’s definitely going to be a positive for Nebraska,” O’Connor said.

Higher education is too important to individual and economic prosperity to allow Nebraskans to be left behind, Carter said.

“We want to make sure we are accessible for all,” he said.

The university provided quotes from the system’s chancellors in a press release.

Ronnie Green, chancellor of the University of Nebraska-Lincoln, said, “This takes away the guessing game for many families and provides a clear path for a college degree at our Big Ten university.”

University of Nebraska at Kearney Chancellor Doug Kristensen said, “This promise to Nebraska will change lives by making a university degree more affordable. Investing in students benefits all Nebraskans, and this news comes at the critical enrollment decision time to remind families that an affordable, quality bachelor’s degree is attainable.”

Dr. Jeffrey Gold, chancellor of the University of Nebraska at Omaha and University of Nebraska Medical Center, said, “Access is at the heart of the missions of both UNO and UNMC. Cost should not be a limiting factor for any Nebraska student who wants to change their life with a degree from one of our campuses.”

April photos: Nebraska faces coronavirus

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MAN CAUGHT AFTER STANDOFF

Sarpy County sheriff's deputies look for a man after a standoff Friday near Papillion's Shadow Lake Towne Center. The 45-year-old man was driving a stolen pickup, authorities said. An in-vehicle security system disabled the truck, which skidded into a nearby ditch. The man refused to get out of the pickup and claimed to have weapons, authorities said. He fled through a drainage culvert but was taken into custody within an hour. He was in serious condition after being shot with pepper balls and bean bag rounds. STORY INMIDLANDS


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Omaha man warned his Bhutanese community about coronavirus. Now he's in the ICU

When it came to curbing the spread of the coronavirus, Karna Gurung seemed to be doing everything right.

He wore masks and gloves before federal and local officials started to recommend their use.

He closed the two grocery stores he partially owns to in-store shopping — customers had to call in their orders for produce and toilet paper and pick up bags from the curb — even though it meant the stores were losing thousands of dollars per day.

“$5,000 is nothing in terms of people’s lives,” he said on March 29. “Life is more important than money. Money we can recover.”

He took his role as a leader among Omaha’s Bhutanese-Nepalese population seriously, too, translating coronavirus news and announcements into Nepali on his Facebook page to keep his community informed.

Now, in a cruel twist, Gurung is on a ventilator in the intensive care unit at the Nebraska Medical Center with COVID-19, the disease caused by the coronavirus, his family said.

He is just 32 years old but is also a diabetic, one of the groups most at risk for serious coronavirus complications. The virus, which made him gasp for breath, also sent his blood sugar spiking.

“When it happens to my own family, my twin brother Karna, I felt it so closely,” Bhim Gurung said. “It’s heartbreaking.”

Karna Gurung tested positive for the coronavirus over a week ago, his brother said. His family is not sure where he was exposed, but suspect it may be related to a home health care business the entrepreneurial refugee family runs.

The coronavirus crisis shows why it’s critical to support local journalism

Nine Gurung siblings and their parents live in Omaha, after fleeing violence in Bhutan and life in a refugee camp in eastern Nepal. They own several businesses, including a wholesale distribution operation, the home health care agency and the iMart stores near 40th and Cuming and 90th and Fort Streets. The stores are closed through the end of the month.

Most people with COVID-19 will experience mild to moderate symptoms, if any at all. Others, including those who are older or have underlying health conditions, may require more medical care or breathing support.

Karna Gurung exhibited the telltale signs of COVID-19: coughing, shortness of breath. His wife tested positive, too.

Karna Gurung seemed to be handling the illness with medication at home, his brother said.

Then things took a turn for the worse on Monday. He was admitted to the Nebraska Medical Center and has been sedated on a ventilator, though his family hopes he will be able to be removed from it this weekend.

He is receiving an experimental antiviral drug called remdesivir through a clinical trial, and seemed to be responding well later this week, Bhim Gurung said.

No visitors are allowed at the hospital.

“That’s the saddest part,” Bhim Gurung said. “We can’t even see him.”

Prayers are pouring in from around the world — Karna Gurung was well-known for his work with groups and events like the Refugee Congress.

Bhim Gurung, who is quarantined in a separate part of the house from his wife and parents, is waiting to be tested for the coronavirus, too.

He is fearful for his brother, and the broader Bhutanese-Nepalese community — already he knows of five people who have tested positive.

Bhim Gurung is president of the Bhutanese Community of Nebraska, and has asked people to adhere to a strict three-week lockdown: no shopping, no work.

“We did a voluntary lockdown but it’s not working … because people still feel they have to go to work,” he said. “We’re not the government, we can’t force them.”

Before Karna Gurung became ill, he said in an interview that he thought Nebraska needed a full shutdown order to truly contain the virus and persuade everyone to stay home.

A number of refugees in Omaha, including the Bhutanese, work in and carpool to meatpacking plants. Outbreaks have emerged at beef and pork plants in Grand Island; Sioux Falls, South Dakota; and Columbus Junction, Iowa. Food production is considered an essential service during the pandemic.

Some plants are offering bonuses or increased pay for workers during the pandemic, which is tempting to those living paycheck to paycheck, Bhim Gurung said.

“It will be a big problem if it spreads in the refugee community,” he said.

So, following in the footsteps of his brother, who is too sick to talk, he is once again trying to get the word out.

Do not take this lightly. Take steps to protect yourself, your family, your community.

“My people need to know it’s not some kind of flu virus,” Bhim Gurung said. “It’s really the worst virus.”

April photos: Nebraska faces coronavirus