Coronavirus COVID-19 - Global Health Pandemic #60

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Coronavirus in Scotland - Downward trend in deaths - BBC News

Summary
  1. After two days of no new deaths, the first minister confirms that seven fatalities were registered, through a lab test, as having had coronavirus
  2. Although each death is a tragedy for the families affected, Nicola Sturgeon says the trend in the number of fatalities was continuing downward
  3. Interim Chief Medical Officer Dr Gregor Smith says the virus was likely in Scotland and spreading in the general community before the first cases emerged
  4. Although there is "no real certainty", Dr Smith says the virus could have been infecting people in Scotland in February, many weeks before lockdown
  5. The Police Federation say people who commit "Covid-19 assaults" should be automatically held in custody
  6. MSPs are to investigate the disruption to Holyrood’s budgeting as a result of the coronavirus crisis
  7. Further plans to help communities through the pandemic are to be outlined by Scottish government
 
I think W.H.O. is being very clumsy about the messaging, but the research they're trying to explain is complicated.

There were no standards for what was considered "asymptomatic." Now there's this term "paucisymptomatic" that's in use (it's not brand new, but it's very uncommon). It means "few symptoms."

That's because as contact tracing and other research into the past of CV patients and their networks is showing that many people previously classified as asymptomatic were actually paucisymptomatic. IOW, when interviewed during contact tracing or as part of retrospective research, they did have symptoms - just very mild ones. A headache and malaise, maybe some GI symptoms, but no fever, no cold symptoms. Or a cough and a headache.

ANYWAY, W.H.O. is having to walk back its statement because NO ONE KNOWS. So sorry for yelling, but srsly. After W.H.O. said that yesterday, I got all excited (it would be such good news) and of course, started reading. There was no such evidence - the evidence is all over the place. The best studies look at households where the entry of CV into the household is known, and what happens next is also known. The data are only barely coming in, really sparse. The data are all over the place. It's just like a crime - no two are exactly alike, but there are trends and patterns.

WHO walks back comments on asymptomatic coronavirus spread, says much is still unknown

SO, the paucisymptomatic can definitely transmit. Remember when they were saying that 40-50% of cases were asymptomatic? Well, I think the research is starting to show that only 20% were completely asymptomatic, but we may never know, since people's memories are imperfect.

The 20% figure is coming from those who are in antibody studies, usually as part of a random study. They have antibodies to CV, so they've been infected, but they swear they can't recall any symptoms at all. (They must be super healthy people - most people if asked about any symptoms over the last 3 months would have had at least a minor GI upset or perhaps a day or two of a bit of a snuffy nose). Some symptoms (affects on breathing) are very hard to notice.

So now for some researchers, it's 20% asympto, 20% pauci, 20% mild and 10% severe to critical. 30% moderate to serious (with long convalescence and perhaps lifelong issues).

What do we make of this? Put into the the mix that some of these studies are also finding the children living in households with CV19 patients get infected at only half the rate of adults (maybe only 40%). BUT, once they do get it, they transmit it at the levels that adults do (apparently). This would partly account for the low rate of issues with people under the age of 20. It could be mistaken (as it was in Switzerland, IMO) for "children don't transmit."

The W.H.O. is trying to mutter "18--19% are asymptomatic" as well as "the asymptomatic don't transmit the disease very much." IF it turns out to be true that the asymptomatic can barely transmit this disease (and that may be true), what does it even mean? It's of virtually no use clinically and out in real life.

"Some" children with CoVid are very poor transmitters; many children with CoVid transmit the same way as adults. mmkay

"Some" adults with CoVid have no symptoms and may be poor transmitters.

So...we're back to looking around ourselves, slightly more confident if the person in front of is appears to have no symptoms (but what if they're pauci???)

We can quarantine ourselves if we have the slightest symptom, but we should be doing that anyway.

It does make the herd immunity issue a bit easier (if it is true that the asymptomatic don't transmit well at all and that's 20% of us).
So a vaccine that is 80% effective should be a winner then IMO.
 
I think W.H.O. is being very clumsy about the messaging, but the research they're trying to explain is complicated.

There were no standards for what was considered "asymptomatic." Now there's this term "paucisymptomatic" that's in use (it's not brand new, but it's very uncommon). It means "few symptoms."

That's because as contact tracing and other research into the past of CV patients and their networks is showing that many people previously classified as asymptomatic were actually paucisymptomatic. IOW, when interviewed during contact tracing or as part of retrospective research, they did have symptoms - just very mild ones. A headache and malaise, maybe some GI symptoms, but no fever, no cold symptoms. Or a cough and a headache.

ANYWAY, W.H.O. is having to walk back its statement because NO ONE KNOWS. So sorry for yelling, but srsly. After W.H.O. said that yesterday, I got all excited (it would be such good news) and of course, started reading. There was no such evidence - the evidence is all over the place. The best studies look at households where the entry of CV into the household is known, and what happens next is also known. The data are only barely coming in, really sparse. The data are all over the place. It's just like a crime - no two are exactly alike, but there are trends and patterns.

WHO walks back comments on asymptomatic coronavirus spread, says much is still unknown

SO, the paucisymptomatic can definitely transmit. Remember when they were saying that 40-50% of cases were asymptomatic? Well, I think the research is starting to show that only 20% were completely asymptomatic, but we may never know, since people's memories are imperfect.

The 20% figure is coming from those who are in antibody studies, usually as part of a random study. They have antibodies to CV, so they've been infected, but they swear they can't recall any symptoms at all. (They must be super healthy people - most people if asked about any symptoms over the last 3 months would have had at least a minor GI upset or perhaps a day or two of a bit of a snuffy nose). Some symptoms (affects on breathing) are very hard to notice.

So now for some researchers, it's 20% asympto, 20% pauci, 20% mild and 10% severe to critical. 30% moderate to serious (with long convalescence and perhaps lifelong issues).

What do we make of this? Put into the the mix that some of these studies are also finding the children living in households with CV19 patients get infected at only half the rate of adults (maybe only 40%). BUT, once they do get it, they transmit it at the levels that adults do (apparently). This would partly account for the low rate of issues with people under the age of 20. It could be mistaken (as it was in Switzerland, IMO) for "children don't transmit."

The W.H.O. is trying to mutter "18--19% are asymptomatic" as well as "the asymptomatic don't transmit the disease very much." IF it turns out to be true that the asymptomatic can barely transmit this disease (and that may be true), what does it even mean? It's of virtually no use clinically and out in real life.

"Some" children with CoVid are very poor transmitters; many children with CoVid transmit the same way as adults. mmkay

"Some" adults with CoVid have no symptoms and may be poor transmitters.

So...we're back to looking around ourselves, slightly more confident if the person in front of is appears to have no symptoms (but what if they're pauci???)

We can quarantine ourselves if we have the slightest symptom, but we should be doing that anyway.

It does make the herd immunity issue a bit easier (if it is true that the asymptomatic don't transmit well at all and that's 20% of us).
This explains things a bit more for me, and now I'm inclined to think I was infected (from DH). ER said those of us living with him and caring for him while he was sick should consider ourselves as positive as well.

I did experience very mild symptoms - slight cough, chest tightness and maybe a slight fever - though my temp runs low anyway, so 98.6 is above normal for me. We used a head-swipe thermometer as well - never know for sure the accuracy of them. The tightness in my chest was the most obvious symptom, fever (if that) only one day, and cough was once or twice a day. Interestingly enough, DH never had a cough and only had a low fever the first few days. He was mostly afflicted with extreme fatigue, body aches and chills.
 
I'm feeling so sad and conflicted today. Some friends of mine celebrated their daughter's birthday this week. What did the birthday girl get to do? She had a party with 9 other friends her age and then got to go clothes shopping at multiple stores that just re-opened in their area. No masks and no social distancing in any of the festivities. The party was outside and they had cupcakes but the pictures showed the kids sitting right next to each other in the grass, knees touching while eating their cupcakes. And the birthday girl tried on tons of clothes at a busy store with no masks seen in any of the photos. And I know these friends of mine have masks to wear because I've seen photos of their masks and masks for their children too. They were so careful in the beginning. Why are they suddenly acting as if the virus is gone? I wanted to celebrate that they got to have a "normal" party but I just couldn't bring myself to feel any joy for them. I only feel foreboding and sadness. They have been unemployed throughout this-- how will they pay their hospital bills if they or their children get sick? Or worse, how will they feel if they get it and pass it on to their elderly parents/grandparents and someone they love dies? I wanted to shout "What are you thinking, we're in the middle of a pandemic!?!" I restrained myself and simply gave a half-hearted, "How sweet she had a fun day, tell *advertiser censored* happy birthday from us..." And that was the end of the conversation. Maybe I'm the crazy one to still social distance and wear a mask to the store? I dread every grocery trip because of people like my friends who are acting irresponsibly in public. I've been convinced by the data so far that this virus is a death sentence for me if I get it. I'm no spring chicken, but I'm too young to die. I have a lot I still want to accomplish in this life. I have a lot to live for. Also I don't want to lose my parents, my in-laws, my many vulnerable friends and family members to this horrible virus all in one year. They all still have a lot to live for too. I'm sitting here crying now. Maybe I'm the crazy one though... Maybe the predictions of a second wave with higher death tolls are wrong? It seems like we never even got out of the first wave before things opened back up. MOO.

:(:confused::eek::mad:o_O

You are definitely NOT the "crazy one"! IMO.

The desire to return to normal-ish life is strong, and I understand that. I feel that way too, but am aware that doing so brings very serious risks and will not take chances, especially as an old-ish, aka elderly, person with some pre-existing conditions (my husband in the same category).

Those of us on this thread have a much better grasp of the risks of the virus and what is needed to avoid spreading/getting it than most people do. A good group to hang out with. MOO
 
This explains things a bit more for me, and now I'm inclined to think I was infected (from DH). ER said those of us living with him and caring for him while he was sick should consider ourselves as positive as well.

I did experience very mild symptoms - slight cough, chest tightness and maybe a slight fever - though my temp runs low anyway, so 98.6 is above normal for me. We used a head-swipe thermometer as well - never know for sure the accuracy of them. The tightness in my chest was the most obvious symptom, fever (if that) only one day, and cough was once or twice a day. Interestingly enough, DH never had a cough and only had a low fever the first few days. He was mostly afflicted with extreme fatigue, body aches and chills.

Have you had an antibody test? Or maybe considering having one? If you did have it (which seems likely), you were fortunate to have minor symptoms.
MOO
 
Completely varies by patient. We're seeing some very long uses of ventilators in this pandemic. Somewhere, I read that there's a woman in her 30's that's starting day 71 or 72 today, on ventilator.

There are reports that people are coming off ventilators from CV19 very differently than in other uses of ventilators. Apparently, they first reduce the sedation and the patient starts to stir around - this is a good sign. Then, when the ventilator is removed and the sedation completely lifted, in non-CV patients, it's typical for the patient to open their eyes and maybe try to speak a few words or give a thumbs up.

CV patients are remaining semi-comatose. I think increasing research is showing that in a small number of CV19 patients, there is involvement of the brain. Small petechial hemorrhages throughout the brain are being reported in younger CV19 patients upon autopsy. Some have massive hemorrhages.

Still, many of the non-responsive CV19 are breathing on their own and eventually waking up. I can't imagine how hard this must be on the families. I read a doctor's account of how they're starting to expect CV19 patients to take 12-24 hours to fully wake up, and they seem to be okay eventually. No one knows exactly why. Perhaps it's the long intubation, perhaps it's entirely CV19, no one knows.

Some CV19 do wake up normally, of course. And those who remain comatose are given MRI's and the doctor mentioned above said that MRI's were mostly normal. So of course, they wait to see what's going to happen.

It was reported yesterday that Mr Cordero was awake and off ventilator throughout the weekend, and that his white blood cell counts are much lower - things seem to be looking up.

I googled Nick Cordero to try to find the latest news, and I don't see a report that he was awake and off ventilator thru this past weekend. Can you provide a link? Maybe it's on social media.
 
So much conflicting info. Schools in England were going back, now they are not, mainly because unions said they weren't safe. Scottish schools going back early in August. Irish pubs opening. Schools already back in Ireland. Cannot visit relatives yet if it goes across the Welsh, Scottish or Irish border. All we can do is watch and wonder and do the best we can to follow the confusing guidance and messages. Wales have just announced to wear 3 masks on public transport. I'll find links on all this conflicting info where I can.

Schools in Wales to reopen later this month

Plan dropped for all primary pupils back in school

Face coverings recommended for use in Wales

Serving ‘substantial’ meal will be required for pubs to reopen

https://www.bbc.co.uk/newsround/52393241
BBM
The reopening timeline has certainly been accelerated in Ireland, Tresir, but schools aren't back here yet. The current plan is for them to open on a phased basis from late Aug/early Sept.

Cleaning, social distancing in schools being discussed
 
I think you are right to be skeptical. @Sundog 's "The Atlantic" article/editorial has this information inside (BBM):



Another article on the so-called Open "Letter" from the "medical professionals", same source, says this:



So, that's "the narrative"...

But...

People are looking at friends and family members like they are nuts, if they say "Either coronavirus is a problem; or it isn't."

Well, I'm sure they will be convinced that we should believe the "medical professional" identified by/as...

"Black female who's tired, USAF vet"

???

Or maybe, the one kinda, sorta implausibly named "Art Therapist"?

Gee, it couldn't possibly be the case that these people are lying to us, and the "1,000 medical professionals" is actually... a random Google petition where anyone could sign their name, and in fact some did?

That's kind of... almost... evil, isn't it?

Represent a social justice position, feign to cast it as having the weight of a thousand verifiable "medical professionals" behind it as signatories, all but telling the entire world that they will be safe from coronavirus even if they don't shelter in place...

issue a press release, say "1,000 medical professionals agree"...

release it and count on people not bothering to look at the signatures to see if the people are really, in fact, medical professionals?

Like those old movies where the prop envelope of "cash", contains cut-up phone books the size and shape of dollar bills?

o_Oo_Oo_O. Look and see.

Open Letter.pdf

It looks to me like many of the signers are public health students rather than medical professionals, health officials, faculty, or "experts." MOO
 
I think W.H.O. is being very clumsy about the messaging, but the research they're trying to explain is complicated.

There were no standards for what was considered "asymptomatic." Now there's this term "paucisymptomatic" that's in use (it's not brand new, but it's very uncommon). It means "few symptoms."

That's because as contact tracing and other research into the past of CV patients and their networks is showing that many people previously classified as asymptomatic were actually paucisymptomatic. IOW, when interviewed during contact tracing or as part of retrospective research, they did have symptoms - just very mild ones. A headache and malaise, maybe some GI symptoms, but no fever, no cold symptoms. Or a cough and a headache.

ANYWAY, W.H.O. is having to walk back its statement because NO ONE KNOWS. So sorry for yelling, but srsly. After W.H.O. said that yesterday, I got all excited (it would be such good news) and of course, started reading. There was no such evidence - the evidence is all over the place. The best studies look at households where the entry of CV into the household is known, and what happens next is also known. The data are only barely coming in, really sparse. The data are all over the place. It's just like a crime - no two are exactly alike, but there are trends and patterns.

WHO walks back comments on asymptomatic coronavirus spread, says much is still unknown

SO, the paucisymptomatic can definitely transmit. Remember when they were saying that 40-50% of cases were asymptomatic? Well, I think the research is starting to show that only 20% were completely asymptomatic, but we may never know, since people's memories are imperfect.

The 20% figure is coming from those who are in antibody studies, usually as part of a random study. They have antibodies to CV, so they've been infected, but they swear they can't recall any symptoms at all. (They must be super healthy people - most people if asked about any symptoms over the last 3 months would have had at least a minor GI upset or perhaps a day or two of a bit of a snuffy nose). Some symptoms (affects on breathing) are very hard to notice.

So now for some researchers, it's 20% asympto, 20% pauci, 20% mild and 10% severe to critical. 30% moderate to serious (with long convalescence and perhaps lifelong issues).

What do we make of this? Put into the the mix that some of these studies are also finding the children living in households with CV19 patients get infected at only half the rate of adults (maybe only 40%). BUT, once they do get it, they transmit it at the levels that adults do (apparently). This would partly account for the low rate of issues with people under the age of 20. It could be mistaken (as it was in Switzerland, IMO) for "children don't transmit."

The W.H.O. is trying to mutter "18--19% are asymptomatic" as well as "the asymptomatic don't transmit the disease very much." IF it turns out to be true that the asymptomatic can barely transmit this disease (and that may be true), what does it even mean? It's of virtually no use clinically and out in real life.

"Some" children with CoVid are very poor transmitters; many children with CoVid transmit the same way as adults. mmkay

"Some" adults with CoVid have no symptoms and may be poor transmitters.

So...we're back to looking around ourselves, slightly more confident if the person in front of is appears to have no symptoms (but what if they're pauci???)

We can quarantine ourselves if we have the slightest symptom, but we should be doing that anyway.

It does make the herd immunity issue a bit easier (if it is true that the asymptomatic don't transmit well at all and that's 20% of us).

Thank you for this post! I really appreciate your informative, helpful posts sharing what you are learning from your research.

I do have a question: is "pauci" pronounced like "Fauci"? :) (So I checked, and it's not. More like pah-sigh.)
 
@Gardener1850

This!

Texas Reports Record-Breaking COVID-19 Hospitalizations As State Reopens

It's not over...those of us who understand science know that this virus did not magically disappear because folks got tired of it!

I want to see my possible future grandchild (or more) as my only son got married last year....nothing is more important to me right now than that. I will keep taking precautions, but I know what you mean. When we look all around us at folks throwing caution to the wind, we tend to think we are the wrong ones...have to keep reading and researching and on our toes with the latest news to understand that we are not~
 
It looks to me like many of the signers are public health students rather than medical professionals, health officials, faculty, or "experts." MOO

There are a lot of public health students and other students in health fields, but a lot of MDs, some nurses (RNs), and epidemiology professors, and other faculty also. Don't have time to go through the list in detail today and count as it is a busy work day for me, but I did notice faculty from Emory University, University of Chicago, University of Texas, University of Massachusetts Medical School, Yale School of Medicine, MDs from Mt Sinai, faculty from Columbia, Harvard Medical School and some pharmacists. These are some examples of MDs, RNs, and faculty, some faculty in departments of Public Health, some in Medical Schools, etc.

ETA ... and UCLA
 
I'm feeling so sad and conflicted today. Some friends of mine celebrated their daughter's birthday this week. What did the birthday girl get to do? She had a party with 9 other friends her age and then got to go clothes shopping at multiple stores that just re-opened in their area. No masks and no social distancing in any of the festivities. The party was outside and they had cupcakes but the pictures showed the kids sitting right next to each other in the grass, knees touching while eating their cupcakes. And the birthday girl tried on tons of clothes at a busy store with no masks seen in any of the photos. And I know these friends of mine have masks to wear because I've seen photos of their masks and masks for their children too. They were so careful in the beginning. Why are they suddenly acting as if the virus is gone? I wanted to celebrate that they got to have a "normal" party but I just couldn't bring myself to feel any joy for them. I only feel foreboding and sadness. They have been unemployed throughout this-- how will they pay their hospital bills if they or their children get sick? Or worse, how will they feel if they get it and pass it on to their elderly parents/grandparents and someone they love dies? I wanted to shout "What are you thinking, we're in the middle of a pandemic!?!" I restrained myself and simply gave a half-hearted, "How sweet she had a fun day, tell *advertiser censored* happy birthday from us..." And that was the end of the conversation. Maybe I'm the crazy one to still social distance and wear a mask to the store? I dread every grocery trip because of people like my friends who are acting irresponsibly in public. I've been convinced by the data so far that this virus is a death sentence for me if I get it. I'm no spring chicken, but I'm too young to die. I have a lot I still want to accomplish in this life. I have a lot to live for. Also I don't want to lose my parents, my in-laws, my many vulnerable friends and family members to this horrible virus all in one year. They all still have a lot to live for too. I'm sitting here crying now. Maybe I'm the crazy one though... Maybe the predictions of a second wave with higher death tolls are wrong? It seems like we never even got out of the first wave before things opened back up. MOO.

:(:confused::eek::mad:o_O

Thank you SO much for taking the time to post this. It made me cry, but that's a good thing right now. I'm going through something similar. It's the first time in this whole pandemic that I've felt really disheartened and anxious - this whole reopening thing (and kids) is just so hard.

It feels so sad when we see people doing this, because it means those of us who are vulnerable have to step back even further. My younger family members have to go on with their lives, and while they are being more cautious than your friends, I am reacting very emotionally.

There are selfish reasons (I want to be able to see and hug them), and then there's worry (a couple of these wonderful people are in their 40's, one of them seems to get nearly every virus that comes through the area, doctor has recommended a certain surgery that is now rescheduled - but how can he even think about that surgery if the people around him keep extending the "bubble")??

Deep inside, I really fear dying of this thing, too. I have a number of co-morbidities. TONS of people with the same profile have survived, but for most, it's been quite difficult. I'm sure that many, many people your age and with your profile have survived too but who wants to risk that? You are a vibrant, relatively healthy, independent person. You don't want to be transformed into a longterm patient of CoVid.

I was crying Sunday evening and all day yesterday. Do you have someone to talk to, at home?

I swing back and forth between feeling my own feelings (of worry for myself, but also for everyone in my family as they reopen - California is seeing an upswing in cases which the scientific side of my brain says, well, that's due to increased testing - the ICU rate is not climbing!)

This is the time to have a teleconference with your doctor. Ask them what they think preventative measures are (if they say "none," that's not good - they should be telling you to take Vitamin D, perhaps NAC, and a good doctor will tolerate you asking politely about other measures, such as nasal heparin). Ask if they know about early treatment for people at risk. How often should you be tested? While it would be uncomfortable to have a nasal swab once a week, I'd do it if I though I was getting exposed (I don't even go to the grocery store or pharmacy right now - my DH does those things). I do go for walks around our quiet neighborhood, and now, I'll see my two daughters and families, outdoors only, with masks, and not for a long period of time. Sigh. I do need to follow my own advice - I have to change doctors and I'm dragging my feet.

Have a plan. Don't be afraid to get tested. If you are found to have CV early, there's so much more they can do for you. Be insistent about your vulnerability. Define yourself as high risk, if you test positive, you want immediate intervention not "wait and see," and you want all the treatments that prevent going on a ventilator. There are lots of them. Find out what your doctor knows, you will not be seen as paranoid, trust me.

You're not paranoid. Now we're all worrying about our friends and families, and one of these days, someone in our broader circles will get something respiratory, and even if it is not SARS, the entire social network will feel it like an earthquake. The kids are going to be okay, we all know that (with rare exceptions) but...young adults are getting this and are in hospital, some for a long time. It can be life-changing at any age.

Anyway, I'm not particularly optimistic, myself, about surviving this - although I try to be and am generally an optimist. But this disease is too unpredictable and now, deaths in my area are back on the rise again, as are hospitalizations.

I have your same thought "Maybe I'm the crazy, paranoid one."

I can't tell if my kids agree or not, they're too polite. We had to remind them yesterday that...I have a gene that increases morbidity, just for starters. They knew that, but hadn't read the scientific research, so I sent it. Now they're sad.

But there's no way to put this back in the bottle. And people are going to go to what your friends do. While my family members are relatively cautious, each time they socialize with other people - no matter how cautious - just two or three degrees away are going to be some people like your friends. It's not an orderly reopening.

We need to know more. Do the asymptomatic transmit or not? What percentage of kids actually get CV when exposed? (Research strongly indicates that kids transmit the disease as easily as adults - but are not as susceptible to getting it in the first place). Do we even know how soon the disease is transmissible? Because scientists who are studying monkeys for the vaccine wear special PPE...because they don't want to come into contact with even a few virions in a monkey's nose...

I too worry about your parents and other family members - but I don't see how young people with kids to raise can stop allowing them to socialize a bit (although what you describe is simply horrifying to me - you are not over-reacting one little bit, IMO). {{{hugs}}}
 
Have you had an antibody test? Or maybe considering having one? If you did have it (which seems likely), you were fortunate to have minor symptoms.
MOO
I have not. And I would like to, but with all the misinformation out there about their accuracy, I'm waiting for a legitimate update. I will probably call my PP as they have a lab on the premises.

Agreed - I hope I did have it.
 
So a vaccine that is 80% effective should be a winner then IMO.

Yes - I agree. It's hard for me to explain it to my DH or others, as it sounds slightly ineffective - so I'm very glad to have a compatriot. 80% (if that means complete immunity for 80%) is great. But I think it's even better than that. I think the remaining 20% will have partial immunity - and that means avoiding the cytokine storm and death.

There are always risks to vaccines. I will get it when it becomes available, because I know my health and chances are better that way.
 
Article in today's Sacramento Bee on increase of COVID-19 hospitalizations due to family gatherings that are multigenerational (mentions Sacramento, Fresno, Los Angeles County, and other regions of the state)

Sacramento coronavirus cases are spiking — and family home gatherings are a key cause

Sorry, paywall.
 
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