Written by Steven Hansen
The U.S. new cases 7-day rolling average are 1.4 % HIGHER than the 7-day rolling average one week ago and U.S. deaths due to coronavirus are now 12.0 % LOWER than the rolling average one week ago. Today’s posts include:
- U.S. Coronavirus New Cases are 10,622
- U.S. Coronavirus deaths are at 311
- Supreme Court leaves CDC eviction moratorium intact
- CDC’s All-or-Nothing Approach to Teen COVID Vaccination Is All Wrong
- Here’s Why Experts Are Comfortable With Myocarditis Numbers
- Heart inflammation after COVID-19 shots higher than expected in study of U.S. military
- Kim berates North Korean officials for ‘crucial’ virus lapse
- Is the SARS-CoV-2 delta variant threatening vaccine efficacy?
- Adjuvant developed with NIH funding enhances efficacy of India’s COVID-19 vaccine
- US Consumer Confidence Approaching Pre-Pandemic Level
- Europe wants to stop the Covid delta variant. But experts say it may be too late
- GM Mosquito Progeny Not Dying in Brazil: Study
- Plus many more headlines …
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Hospitalizations Are The Only Accurate Gauge
Hospitalizations historically appear to be little affected by weekends or holidays. The hospitalization growth rate trend continues to improve.
source: https://gis.cdc.gov/grasp/covidnet/COVID19_3.html
Historically, hospitalization growth follows new case growth by one to two weeks.
As an analyst, I use the rate of growth to determine the trend. But, the size of the pandemic is growing in terms of real numbers – and if the rate of growth does not become negative – the pandemic will overwhelm all resources.
The graph below shows the rate of growth relative to the growth a week earlier updated through today [note that negative numbers mean the rolling averages are LOWER than the rolling averages one week ago]. As one can see, the rate of growth for new cases peaked in early December 2020 for Thanksgiving, and early January 2021 for end-of-year holidays – and it now shows that the coronavirus effect is improving.
In the scheme of things, new cases decline first, followed by hospitalizations, and then deaths. The potential fourth wave did not materialize likely due to immunizations.
Coronavirus and Recovery News You May Have Missed
US Consumer Confidence Approaching Pre-Pandemic Level – The Conference Board
The Conference Board Consumer Confidence Index® (CCI) improved further in June, following gains in each of the previous four months. The Index now stands at 127.3 (1985=100), up from its trough of 85.7 in April 2020 and just below its pre-pandemic reading of 132.6 in Feb 2020. The steady rise in confidence bodes well for the US economic recovery.
The improvement in the headline CCI in June was driven by upticks in both of its two components – The Present Situation Index and The Expectations Index. Consumers’ assessment of current conditions improved again, suggesting economic growth has strengthened further in Q2. Additionally, consumers’ short-term optimism rebounded, buoyed by expectations that business conditions and their own financial prospects will continue improving in the months ahead. While short-term inflation expectations increased, this had little impact on consumers’ confidence or purchasing intentions. In fact, the proportion of consumers planning to purchase homes, automobiles, and major appliances all rose—a sign that consumer spending will continue to support economic growth in the short-term. Vacation intentions also rose, reflecting a continued increase in spending on services.
Kim berates North Korean officials for ‘crucial’ virus lapse – AP
North Korean leader Kim Jong Un berated top officials for failures in coronavirus prevention that caused a “great crisis,” using strong language that raised the specter of a mass outbreak in a country that would be scarcely able to handle it.
The state media report Wednesday did not specify what “crucial” lapse had prompted Kim to call the Politburo meeting of the ruling Workers’ Party, but experts said North Korea could be wrestling with a significant setback in its pandemic fight.
So far, North Korea has claimed to have had no coronavirus infections, despite testing thousands of people and sharing a porous border with China. Experts widely doubt the claim and are concerned about any potential outbreak, given the country’s poor health infrastructure.
At the Politburo meeting, Kim criticized the senior officials for supposed incompetence, irresponsibility and passiveness in planning and executing anti-virus measures amid the lengthening pandemic, the North’s official Korean Central News Agency said.
[editor’s note: WHO ‘Not Aware’ of North Korea COVID-19 ‘Great Crisis]
Heart inflammation after COVID-19 shots higher than expected in study of U.S. military – Reuters
Members of the U.S. military who were vaccinated against COVID-19 showed higher-than-expected rates of heart inflammation, although the condition was still extremely rare, according to a study released on Tuesday.
The study found that 23 previously healthy males with an average age of 25 complained of chest pain within four days of receiving a COVID-19 shot. The incident rate was higher than some previous estimates would have anticipated, it said.
All the patients, who at the time of the study’s publication had recovered or were recovering from myocarditis – an inflammation of the heart muscle – had received shots made by either Pfizer Inc and BioNTech SE or Moderna.
U.S. health regulators last week added a warning to the literature that accompanies those mRNA vaccines to flag the rare risk of heart inflammation seen primarily in young males. But they said the benefit of the shots in preventing COVID-19 clearly continues to outweigh the risk.
The study, which was published in the JAMA Cardiology medical journal, said 19 of the patients were current military members who had received their second vaccine dose. The others had either received one dose or were retired from the military.
General population estimates would have predicted eight or fewer cases of myocarditis from the 436,000 male military members who received two COVID-19 shots, the study said.
[editor’s note: this was posted on 19May2021 but I missed it. Does this mean our data collection on new cases is accurate if the antibody test is that inaccurate?>
“The FDA is reminding the public of the limitations of COVID-19 antibody, or serology, testing and providing additional recommendations about the use of antibody tests in people who received a COVID-19 vaccination.
Antibody tests can play an important role in identifying individuals who may have been exposed to the SARS-CoV-2 virus and may have developed an adaptive immune response. However, antibody tests should not be used at this time to determine immunity or protection against COVID-19 at any time, and especially after a person has received a COVID-19 vaccination.
The FDA will continue to monitor the use of authorized SARS-CoV-2 antibody tests for purposes other than identifying people with an adaptive immune response to SARS-CoV-2 from a recent or prior infection.”
Additional Information
- Today, the U.S. Food and Drug Administration issued a safety communication informing the public that results from SARS-CoV-2 antibody tests should not be used to evaluate immunity or protection from COVID-19 at any time, and especially after the person received a COVID-19 vaccination.
- The authorized vaccines for prevention of COVID-19 induce antibodies to specific viral protein targets; post-vaccination antibody test results will be negative in individuals without a history of previous natural infection if the test used does not detect the type of antibodies induced by the vaccine.
- Currently authorized SARS-CoV-2 antibody tests are not validated to evaluate immunity or protection from COVID-19 infection. SARS-CoV-2 antibody tests should be ordered only by health care providers who are familiar with the use and limitations of the test.
CDC’s All-or-Nothing Approach to Teen COVID Vaccination Is All Wrong – MedPage
Last week, the CDC’s Advisory Committee on Immunization Practices (ACIP) met to discuss the safety signal of myocarditis among young people who receive mRNA vaccination against COVID-19. This dialogue has been months in the making. Ultimately, the panel continued to endorse a two-dose mRNA strategy for all ages. We are concerned with this recommendation and offer five alternative considerations. But first, let’s review how we got to this moment in order to make sense of vaccine-induced myocarditis.
The potential risk for vaccine-induced myocarditis was first raised on February 1 in the Jerusalem Post, which reported the hospitalization and intensive-care admission of a healthy 19-year old male 5 days after receiving his second dose of the Pfizer vaccine. This was followed by a nationwide report in the Times of Israel on April 23, later picked up by Reuters on April 25. These news reports suggested that Israel had seen elevated rates of this event after young men were vaccinated with the Pfizer vaccine, almost always after the second dose (56 out of 62 cases or 90%).
… These events raise several points of concern:
[editor’s note: this post deserves a full read]
- VAERS is a suboptimal system.
- If you change even one assumption, the CDC’s model tips.
- The CDC did not consider alternative strategies.
- The CDC is not accounting for COVID-19 risk factors.
- The CDC is not factoring in natural immunity.
GM Mosquito Progeny Not Dying in Brazil: Study – The Scientist
Afield experiment in Brazil that deployed genetically modified mosquitoes to control wild populations of the pest may be having unintended consequences. According to a genetic analysis of mosquitoes in the area, it appears the engineered stock has bred with wild mosquitoes and created viable, hybrid insects, scientists reported in Scientific Reports last week (September 10).
“The claim was that genes from the release strain would not get into the general population because offspring would die,” coauthor Jeffrey Powell, a professor of ecology and evolutionary biology at Yale University, says in a press release. “That obviously was not what happened.”
The biotech company Oxitec began releasing hundreds of thousands of genetically engineered mosquitoes in the city of Jacobina between 2013 and 2015. The idea is that genetically modified (GM) males would mate with wildtype females and pass on a gene that kills their offspring before they themselves can breed, ultimately knocking down Jacobina’s mosquito populations.
The study’s authors, who are not affiliated with Oxitec, began sampling mosquitoes in Jacobina before, during, and after the deployment of the GM insects. They created a genetic panel that distinguished the wildtype mosquitoes from the introduced ones and found that insects analyzed more than two years after the releases stopped were progeny of both wildtype and mutant, or OX513A, lineages. “The degree of introgression is not trivial,” the authors write in their report. “Depending on sample and criterion used to define unambiguous introgression, from about 10% to 60% of all individuals have some OX513A genome.”
Oxitec takes issue with Powell’s study. The company tells Gizmodo it is “currently in the process of working with the Nature Research publishers to remove or substantially correct this article, which was found to contain numerous false, speculative and unsubstantiated claims and statements about Oxitec’s mosquito technology.”
[editor’s note: this is important as the GM mosquitos were released in the Florida Keys]
The Delta deception: New COVID variant might be less deadly – Blaze
… The implication from these headlines is that somehow this variant is truly more transmissible and deadly (as the previous variants were falsely portrayed to be), they escape natural immunity and possibly the vaccine — and therefore, paradoxically, you must get vaccinated and continue doing all the things that failed to work for the other variants!
After each city and country began getting ascribed its own “variant,” I think the panic merchants realized that the masses would catch on to the variant scam, so they decided to rename them Alpha (British), Beta (South African), Gamma (Brazilian), and Delta (Indian), which sounds more like a hierarchy of progression and severity rather than each region simply getting hit when it’s in season until the area reaches herd immunity.
However, if people would actually look at the data, they’d realize that the Delta variant is actually less deadly. These headlines are able to gain momentum only because of the absurd public perception that somehow India got hit worse than the rest of the world. In reality, India has one-seventh the death rate per capita of the U.S.; it’s just that India got the major winter wave later, when the Western countries were largely done with it, thereby giving the illusion that India somehow suffered worse. Now, the public health Nazis are transferring their first big lie about what happened in India back to the Western world.
Fortunately, the U.K. government has already exposed these headlines as a lie, for those willing to take notice. On June 18, Public Health England published its 16th report on “SARS-CoV-2 variants of concern and variants under investigation in England,” this time grouping the variants by Greek letters.
As you can see, the Delta variant has a 0.1% case fatality rate (CFR) out of 31,132 Delta sequence infections confirmed by investigators. That is the same rate as the flu and is much lower than the CFR for the ancestral strain or any of the other variants. And as we know, the CFR is always higher than the infection fatality rate (IFR), because many of the mildest and asymptomatic infections go undocumented, while the confirmed cases tend to have a bias toward those who are more evidently symptomatic.
In other words, Delta is literally the flu with a CFR identical to it. This is exactly what every respiratory pandemic has done through history: morphed into more transmissible and less virulent form that forces the other mutations out since you get that one. Nothing about masks, lockdowns, or experimental shots did this. To the extent this really is more transmissible, it’s going to be less deadly, as is the case with the common cold. To the extent that there are areas below the herd immunity threshold (for example, in Scotland and the northwestern parts of the U.K.) they will likely get the Delta variant (until something else supplants it), but fatalities will continue to go down.
According to the above-mentioned report, the Delta variant represented more than 75% of all cases in the U.K. since mid-May. If it really was that deadly, it should have been wreaking havoc over the past few weeks.
You can see almost a perfect inverse relationship between hospitalization rates throughout April and May plummeting as the Delta variant became the dominant strain of the virus in England. Some areas might see a slight oscillation from time to time as herd immunity fills in, regardless of which variant is floating around. However, the death burden is well below that of a flu season and is no longer an epidemic.
As for vaccines, there is no evidence that somehow they provide better protection than prior infection from any other strain of the virus, nor does the Delta variant justify further use of these experimental shots. If anything, the U.K. data show that, to the extent there were deaths due to the Delta variant, there were more fatalities among those already vaccinated relative to the number of confirmed cases by vaccination status.
Again, the numbers are low across the board and there is no evidence the Delta variant is anything but less deadly for anyone. But there is certainly no evidence that somehow the vaccine is a greater imperative because of this variant. India itself appears to have achieved herd immunity – with the WHO estimating infection rates between 60% and 75% in most places – with one-seventh the death rate of England, but with one-fourth the percentage of people who have receive one dose of the vaccine.
Thus, the good news is that now that most countries have reached a large degree of herd immunity, there is zero threat of hospitals being overrun by any seasonal increase in various areas, no matter the variant. The bad news is that after Delta, there are Epsilon and 19 other letters of the Greek alphabet, which will enable the circuitous cycle of misinformation, fear, panic, and control to continue. And remember, as there is already a “Delta+,” the options are endless until our society finally achieves immunity to COVID panic porn.
[editor’s note: also read Covid delta variant unlikely to cause another U.S. ‘raging epidemic’]
Supreme Court leaves CDC eviction moratorium intact – The Hill
The Supreme Court on Tuesday left intact a nationwide pause on evictions put in place amid the coronavirus pandemic.
The 5-4 vote rejected an emergency request from a group of landlords asking the court to effectively end the Centers for Disease Control and Prevention’s (CDC) eviction moratorium, which is set to run through July.
The landlord group had asked the justices to lift the stay on a ruling by a federal judge in Washington, D.C., that the moratorium amounted to an unlawful government overreach.
But Chief Justice John Roberts and Justice Brett Kavanaugh joined with the court’s three liberals to keep the stay in place.
“Because the CDC plans to end the moratorium in only a few weeks, on July 31, and because those few weeks will allow for additional and more orderly distribution of the congressionally appropriated rental assistance funds, I vote at this time to deny the application to vacate the District Court’s stay of its order,” Kavanaugh wrote in brief concurrence.
Yet Kavanaugh also said he agreed with the federal judge’s determination that the CDC had exceeded its authority in enacting the moratorium.
Adjuvant developed with NIH funding enhances efficacy of India’s COVID-19 vaccine – NIH
An adjuvant developed with funding from the National Institutes of Health has contributed to the success of the highly efficacious COVAXIN COVID-19 vaccine, which roughly 25 million people have received to date in India and elsewhere. Adjuvants are substances formulated as part of a vaccine to boost immune responses and enhance a vaccine’s effectiveness. COVAXIN was developed and is manufactured in India, which is currently suffering a devastating health crisis due to COVID-19.
“Ending a global pandemic requires a global response,” said Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), part of NIH. “I am pleased that a novel vaccine adjuvant developed in the United States with NIAID support is part of an efficacious COVID-19 vaccine available to people in India.”
The adjuvant used in COVAXIN, Alhydroxiquim-II, was discovered and tested in the laboratory by the biotech company ViroVax LLC of Lawrence, Kansas with support exclusively from the NIAID Adjuvant Development Program. The adjuvant comprises a small molecule attached in a unique way to Alhydrogel, a substance frequently called alum that is the most commonly used adjuvant in vaccines for people. Alhydroxiquim-II travels to lymph nodes, where the small molecule detaches from alum and activates two cellular receptors. These receptors, TLR7 and TLR8, play a vital role in the immune response to viruses. Alhydroxiquim-II is the first adjuvant in an authorized vaccine against an infectious disease to activate TLR7 and TLR8. In addition, the alum in Alhydroxiquim-II stimulates the immune system to search for an invading pathogen.
Here’s Why Experts Are Comfortable With Myocarditis Numbers – MedPage
The CDC’s vaccine advisors concluded on Wednesday that while the risk of myocarditis is real for young people following an mRNA COVID-19 vaccine — particularly after the second dose — the benefits far outweigh the risks.
The U.S. isn’t the only country to make that call. Not long after Israel announced that 275 myocarditis cases among 5 million vaccinated people were likely tied to Pfizer’s shot (mostly in men ages 16 to 30, and especially after the second dose), the country approved vaccinating kids 12 and up.
Here’s why experts are reassured by the numbers so far, particularly when it comes to children.
How often is myocarditis occurring after vaccination in young people?
During Wednesday’s Advisory Committee on Immunization Practices (ACIP) meeting, Tom Shimabukuro, MD, MPH, of the CDC’s Vaccine Safety Team, provided an updated analysis of data from the Vaccine Adverse Event Reporting System (VAERS).
Among people age 29 and under, there were 484 preliminary reports of myocarditis or pericarditis through June 11. Of these, 323 met the CDC’s working case definition of the condition, and 148 were still under review.
Of the 323 cases, 309 went to the hospital and the vast majority (295) were discharged; 79% had fully recovered, while nine remained hospitalized and two were in the ICU.
In a larger dataset involving all reported cases, myocarditis cases were indeed higher than expected, especially for males after dose 2, up to 21 days after injection:
- Ages 12-17: 132 observed vs 1-12 expected
- Ages 18-24: 233 observed vs 2-25 expected
- Ages 25-29: 69 observed vs 2-21 expected
- Ages 30-39: 71 observed vs 5-48 expected
Is the SARS-CoV-2 delta variant threatening vaccine efficacy? – News-Medical
A new study in the UK, by researchers at Imperial College London, The Francis Crick Institute and the University of Glasgow, explores the loss of coronavirus disease 2019 (COVID-19) vaccine efficacy against the virus behind the current pandemic caused by the emergence of newer variants that have undergone mutational escape.
The paper, available on the medRxiv* preprint server, shows that the delta and beta variants, in particular, are associated with lower neutralizing efficacy compared to the alpha variant or the original Wuhan strain.
… The current study compared the BNT162b2 and ChAdOx1 vaccines (from Pfizer and AstraZeneca, respectively) for their neutralization of the original Wuhan lineage against the delta and the beta variants. The latter VOCs have been shown to be more resistant to neutralization and breakthrough infection in clinical trials.
Using the HIV (SARS-CoV-2) pseudovirus system, the neutralizing efficacy was 4 to 6-fold lower against the B.1.617.1, B.1.617.2 and B.1.351 variants compared to the Wuhan variant.
Two doses were associated with higher neutralizing efficacy against both the Wuhan and beta variants, and to a lesser extent, against the delta variant too.
Comparing the two vaccines, the AstraZeneca vaccine produced between 0.7 to 4-fold lower neutralizing activity against the B.1.351, B.1.617.1 and B.1.617.2 compared to the Wuhan strain. The Pfizer variant produced higher neutralizing titers after two doses compared to one dose, as well as compared to two doses of the AstraZeneca vaccine.
The latter also produced a lower mean antibody titer compared to the Pfizer vaccine. However, the Pfizer vaccine still showed 8 to 11-fold lower neutralizing titers against B.1.351, B.1.617.1 and B.1.617.2 VOCs, respectively.
Europe wants to stop the Covid delta variant. But experts say it may be too late – CNBC
The EU is certainly worried about the spread of the highly infectious delta variant which evidence suggests is around 60% more transmissible than the alpha variant first found in England, causes more hospitalizations and slightly reduces the efficacy of vaccines.
A number of European countries have introduced further restrictions on visitors from the U.K., but experts believe it’s only a matter of time before it takes off in mainland Europe — and there are strong signals it already has.
The following are foreign headlines with hyperlinks to the posts
Amazon and Walmart haven’t learnt their place in India
Sweltering heat wave linked to sudden deaths in Vancouver
Health Canada now recommends that people with a history of capillary leak syndrome do not get AstraZeneca’s COVID shot.
Scotland Says Nearly 2K COVID Cases Linked to European Championship
Spread of COVID Delta Variant Puts Bangladesh In New National Lockdown
The following additional national and state headlines with hyperlinks to the posts
Walmart is selling its own private-label insulin analog for $73 a vial.
Tuskegee relatives promote COVID-19 vaccines in ad campaign
Los Angeles County has urged vaccinated people to wear masks indoors. The C.D.C. says the vaccinated are protected from serious illness and don’t need masks in most situations.
The Supreme Court, in a 5-to-4 vote, kept a federal moratorium on evictions in place.
Who Are the COVID Vaccine ‘Holdouts’?
What Doctors Should Know About Delta
Amazon is using algorithms with little human intervention to fire Flex workers
Inflation Eats at Surging U.S. Wages With Biden Agenda at Stake
Los Angeles urges everyone to mask up because of delta variant — even the vaccinated
Test ballots mistakenly counted in New York mayoral race, prompting city to withdraw early tally
Two more case series describing myocarditis identified after COVID mRNA vaccination — one of male U.S. military members, the other from Duke University — were published in JAMA Cardiology.
COVID cases may be dropping in much of the country, but a hospital in Springfield, Missouri is overwhelmed and turning patients away as the Delta variant gains momentum there.
U.S. lawmakers have announced an investigation into FDA’s approval of aducanumab (Aduhelm), the controversial new drug for Alzheimer’s disease.
Delta-8 THC is legal in many states, but some want to ban it
Is mild COVID-19 in children due to stronger antiviral innate immunity in the upper airway? A new preprint on the medRxiv* server adds fuel to this train of thought, showing that the required cell program is already active in children – namely, a higher expression of specific pattern recognition receptors (PRRs), which mediate an interferon (IFN) response.
Computational analyses reveal 200 drugs that could be repurposed to treat COVID-19
Fauci warns of ‘two Americas’ due to widening gap between vaccinated and unvaccinated
Four Californians Found Guilty for Defrauding Millions From PPP Program
Unvaccinated Passengers on Royal Caribbean Required to Provide Insurance
Bill Cosby released from prison after conviction was overturned
COVID-19: Multisystem inflammatory syndrome affects Black, Latino children most
Today’s Posts On Econintersect Showing Impact Of The Pandemic and Recovery With Hyperlinks
May 2021 Headline Pending Home Sales Rise
June 2021 Chicago Purchasing Managers Barometer Falls To A Four Month Low
June 2021 ADP Employment Grew 692,000
Japan Trails In Vaccination Race As The Olympics Loom
Warning to Readers
The amount of politically biased articles on the internet continues. And studies and opinions of the experts continue to contradict other studies and expert opinions. Honestly, it is difficult to believe anything anymore.
I assemble this update daily – sifting through the posts on the internet. I try to avoid politically slanted posts. This daily blog is not an echo chamber for any party line – and will publish controversial topics unless there are clear reasons why the topic is false. And I usually publish conflicting topics. It is my job to provide information so that you have the facts necessary – and then it is up to readers to draw conclusions. It is not my job to sell any point of view.
Analyst Opinion of Coronavirus Data
There are several takeaways that need to be understood when viewing coronavirus statistical data:
- The global counts are suspect for a variety of reasons including political. Even the U.S. count has issues as it is possible that as much as half the population has had coronavirus and was asymptomatic. It would be a far better metric using a random sampling of the population weekly. In short, we do not understand the size of the error in the tracking numbers.
- Just because some of the methodology used in aggregating the data in the U.S. is flawed – as long as the flaw is uniformly applied – you establish a baseline. This is why it is dangerous to compare two countries as they likely use different methodologies to determine who has (and who died) from coronavirus.
- Older population countries will have a significantly higher death rate as there is relatively few hospitalizations and deaths in younger age groups..
What we do or do not know about the coronavirus [actually there is little scientifically proven information]. Most of our knowledge is anecdotal, from studies with limited subjects, or from studies without peer review.
- How many people have been infected as many do not show symptoms?
- Masks do work. Unfortunately, early in the pandemic, many health experts — in the U.S. and around the world — decided that the public could not be trusted to hear the truth about masks. Instead, the experts spread a misleading message, discouraging the use of masks.
- Current thinking is that we develop at least 12 months of immunity from further COVID infection.
- The Moderna and Pfizer vaccines have an effectiveness rate of about 95 percent after two doses. That is on par with the vaccines for chickenpox and measles. The 95 percent number understates the effectiveness as it counts anyone who came down with a mild case of Covid-19 as a failure.
- To what degree do people who never develop symptoms contribute to transmission? Research early in the pandemic suggested that the rate of asymptomatic infections could be as high as 81%. But a meta-analysis, which included 13 studies involving 21,708 people, calculated the rate of asymptomatic presentation to be 17%.
- The accuracy of rapid testing is questioned – and the more accurate test results are not being given in a timely manner.
- Can children widely spread coronavirus? [current thinking remains that they are a minor source of the pandemic spread]
- Why have some places avoided big coronavirus outbreaks – and others hit hard?
- Air conditioning contributes to the pandemic spread.
- It appears that there is increased risk of infection and mortality for those living in larger occupancy households.
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