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The Pronk Pops Show 1402, February 25, 2020, Story 1: Progressive Panic Pandering Propaganda — Chinese Communist Party (CCP) Coronavirus Goes Global — What Doesn’t Kill You Makes You Stronger — Are You In Fear of Your Life — Videos — Story 2: Stock Market Correction Linked To Impact of COVID -19 on China Supply Chains — Create More Money — Just Stay Home — Consumer Confidence Crashes — Stagflation Recession 2021 –Panic Propaganda — Do Not Believe It — Videos — Story 3: Neither Government Dependency Nor Country Dependency Are Reliable When A Real Crisis Hits — United States Gets Most of Its Drugs From Communist China and India — Cheap But Risky and Maybe Deadly — Videos

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The Pronk Pops Show Podcasts

Pronk Pops Show 1402 February 25, 2020

Pronk Pops Show 1401 February 24, 2020

Pronk Pops Show 1400 February 21, 2020

Pronk Pops Show 1399 February 14, 2020

Pronk Pops Show 1398 February 13, 2020

Pronk Pops Show 1397 February 12, 2020

Pronk Pops Show 1396 February 11, 2020

Pronk Pops Show 1395 February 10, 2020

Pronk Pops Show 1394 February 7, 2020

Pronk Pops Show 1393 February 6, 2020

Pronk Pops Show 1392 February 5, 2020

Pronk Pops Show 1391 February 4, 2020

Pronk Pops Show 1390 February 3, 2020

Pronk Pops Show 1389 January 31, 2020

Pronk Pops Show 1388 January 30, 2020

Pronk Pops Show 1387 January 29, 2020

Pronk Pops Show 1386 January 28, 2020

Pronk Pops Show 1385 January 27, 2020

Pronk Pops Show 1384 January 24, 2020

Pronk Pops Show 1383 January 23, 2020

Pronk Pops Show 1382 January 22, 2020

Pronk Pops Show 1381 January 21, 2020

Pronk Pops Show 1380 January 17, 2020

Pronk Pops Show 1379 January 16, 2020

Pronk Pops Show 1378 January 15, 2020

Pronk Pops Show 1377 January 14, 2020

Pronk Pops Show 1376 January 13, 2020

Pronk Pops Show 1375 December 13, 2019

Pronk Pops Show 1374 December 12, 2019

Pronk Pops Show 1373 December 11, 2019

Pronk Pops Show 1372 December 10, 2019

Pronk Pops Show 1371 December 9, 2019

Pronk Pops Show 1370 December 6, 2019

Pronk Pops Show 1369 December 5, 2019

Pronk Pops Show 1368 December 4, 2019 

Pronk Pops Show 1367 December 3, 2019

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Pronk Pops Show 1365 November 22, 2019

Pronk Pops Show 1364 November 21, 2019

Pronk Pops Show 1363 November 20, 2019

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Pronk Pops Show 1361 November 18, 2019

Pronk Pops Show 1360 November 15, 2019

Pronk Pops Show 1359 November 14, 2019

Pronk Pops Show 1358 November 13, 2019

Pronk Pops Show 1357 November 12, 2019

Pronk Pops Show 1356 November 11, 2019

Pronk Pops Show 1355 November 8, 2019

Pronk Pops Show 1354 November 7, 2019

Pronk Pops Show 1353 November 6, 2019

Pronk Pops Show 1352 November 5, 2019

Pronk Pops Show 1351 November 4, 2019

Pronk Pops Show 1350 November 1, 2019

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If by Rudyard Kipling – Inspirational Poetry

If—

Launch Audio in a New Window

(‘Brother Square-Toes’—Rewards and Fairies)

If you can keep your head when all about you
    Are losing theirs and blaming it on you,
If you can trust yourself when all men doubt you,
    But make allowance for their doubting too;
If you can wait and not be tired by waiting,
    Or being lied about, don’t deal in lies,
Or being hated, don’t give way to hating,
    And yet don’t look too good, nor talk too wise:
If you can dream—and not make dreams your master;
    If you can think—and not make thoughts your aim;
If you can meet with Triumph and Disaster
    And treat those two impostors just the same;
If you can bear to hear the truth you’ve spoken
    Twisted by knaves to make a trap for fools,
Or watch the things you gave your life to, broken,
    And stoop and build ’em up with worn-out tools:
If you can make one heap of all your winnings
    And risk it on one turn of pitch-and-toss,
And lose, and start again at your beginnings
    And never breathe a word about your loss;
If you can force your heart and nerve and sinew
    To serve your turn long after they are gone,
And so hold on when there is nothing in you
    Except the Will which says to them: ‘Hold on!’
If you can talk with crowds and keep your virtue,
    Or walk with Kings—nor lose the common touch,
If neither foes nor loving friends can hurt you,
    If all men count with you, but none too much;
If you can fill the unforgiving minute
    With sixty seconds’ worth of distance run,
Yours is the Earth and everything that’s in it,
    And—which is more—you’ll be a Man, my son!

If – Rudyard Kipling (by John Hurt) with lyrics

{youtube=https://www.youtube.com/watch?v=Ow5xbBnOU2A]

Story 1: Progressive Panic Pandering Propaganda — Chinese Communist Coronavirus SARS CoV-2 or (COVID-19) Goes Global — What Doesn’t Kill You Makes You Stronger — Are You In Fear of Your Life — If — Videos

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The 2020 Flu Season So Far

Update: Public Health Response to the Coronavirus Disease 2019 Outbreak — United States, February 24, 2020

Daniel B. Jernigan, MD1; CDC COVID-19 Response Team (View author affiliations)

View suggested citation

Summary

What is already known about this topic?

An outbreak of coronavirus disease 2019 (COVID-19) has spread throughout China and to 31 other countries and territories, including the United States.

What is added by this report?

Fourteen cases have been diagnosed in the United States, in addition to 39 cases among repatriated persons from high-risk settings, for a current total of 53 cases within the United States. The U.S. government and public health partners are implementing aggressive measures to slow and contain transmission of COVID-19 in the United States.

What are the implications for public health practice?

Interim guidance is available at https://www.cdc.gov/coronavirus/index.html. As more is learned about this virus and the outbreak, CDC will rapidly incorporate new knowledge into guidance for action.

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An outbreak of coronavirus disease 2019 (COVID-19) caused by the 2019 novel coronavirus (SARS-CoV-2) began in Wuhan, Hubei Province, China in December 2019, and has spread throughout China and to 31 other countries and territories, including the United States (1). As of February 23, 2020, there were 76,936 reported cases in mainland China and 1,875 cases in locations outside mainland China (1). There have been 2,462 associated deaths worldwide; no deaths have been reported in the United States. Fourteen cases have been diagnosed in the United States, and an additional 39 cases have occurred among repatriated persons from high-risk settings, for a current total of 53 cases within the United States. This report summarizes the aggressive measures (2,3) that CDC, state and local health departments, multiple other federal agencies, and other partners are implementing to slow and try to contain transmission of COVID-19 in the United States. These measures require the identification of cases and contacts of persons with COVID-19 in the United States and the recommended assessment, monitoring, and care of travelers arriving from areas with substantial COVID-19 transmission. Although these measures might not prevent widespread transmission of the virus in the United States, they are being implemented to 1) slow the spread of illness; 2) provide time to better prepare state and local health departments, health care systems, businesses, educational organizations, and the general public in the event that widespread transmission occurs; and 3) better characterize COVID-19 to guide public health recommendations and the development and deployment of medical countermeasures, including diagnostics, therapeutics, and vaccines. U.S. public health authorities are monitoring the situation closely, and CDC is coordinating efforts with the World Health Organization (WHO) and other global partners. Interim guidance is available at https://www.cdc.gov/coronavirus/index.html. As more is learned about this novel virus and this outbreak, CDC will rapidly incorporate new knowledge into guidance for action by CDC, state and local health departments, health care providers, and communities.

Person-to-person spread of COVID-19 appears to occur mainly by respiratory transmission. How easily the virus is transmitted between persons is currently unclear. Signs and symptoms of COVID-19 include fever, cough, and shortness of breath (4). Based on the incubation period of illness for Middle East respiratory syndrome (MERS) and severe acute respiratory syndrome (SARS) coronaviruses, as well as observational data from reports of travel-related COVID-19, CDC estimates that symptoms of COVID-19 occur within 2–14 days after exposure. Preliminary data suggest that older adults and persons with underlying health conditions or compromised immune systems might be at greater risk for severe illness from this virus (5).

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COVID-19 Cases in the United States

As of February 23, 14 COVID-19 cases had been diagnosed in the following six states: Arizona (one case), California (eight), Illinois (two), Massachusetts (one), Washington (one), and Wisconsin (one). Twelve of these 14 cases were related to travel to China, and two cases occurred through person-to-person transmission to close household contacts of a person with confirmed COVID-19. An additional 39 cases were reported among repatriated U.S. citizens, residents, and their families returning from Hubei province, China (three), and from the Diamond Princess cruise ship that was docked in Yokohama, Japan (36). Thus, there have been 53 cases within the United States. No deaths have been reported in the United States.

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CDC Public Health Response

As of February 24, 2020, a total of 1,336 CDC staff members have been involved in the COVID-19 response, including clinicians (i.e., physicians, nurses, and pharmacists), epidemiologists, veterinarians, laboratorians, communicators, data scientists and modelers, and coordination staff members. Of these CDC staff members, 497 (37%) have been deployed to 39 locations in the United States and internationally, including CDC quarantine stations at U.S. ports of entry, state and local health departments, hospitals, and U.S. military bases that are housing quarantined persons, as well as WHO and ministries of health around the world. CDC staff members are working with state, local, tribal, and territorial health departments and other public health authorities to assist with case identification, contact tracing, evaluation of persons under investigation (PUI) for COVID-19,* and medical management of cases; and with academic partners to understand the virulence, risk for transmission, and other characteristics of this novel virus.

CDC teams are working with the Department of Homeland Security at 11 airports where all flights from China are being directed to screen travelers returning to the United States, and to refer them to U.S. health departments for oversight of self-monitoring. CDC is also working with other agencies of the U.S. government including the U.S. Department of Defense; multiple operational divisions with the U.S. Department of Health and Human Services, including the Assistant Secretary for Preparedness and Response and the Administration for Children and Families; and the U.S. Department of State to safely evacuate U.S. citizens, residents, and their families to the United States from international locations where there is substantial, sustained transmission of COVID-19, and to house them and monitor their health during a 14-day quarantine period.

Specific guidance has been developed and posted online for health care settings, including for patient management; infection control and prevention; laboratory testing; environmental cleaning; worker safety; and international travel. Guidance is updated as more is learned. To prepare for the possibility of community spread of COVID-19, CDC has developed tailored guidance and communications materials for communities, health care settings, public health, laboratories, schools, and businesses. Chinese and Spanish versions of certain documents are available.

Information for travelers. Several recent travel notices have been posted by CDC to inform travelers and clinicians about current health issues that could affect travelers’ health.§ A Level 3 travel notice (avoid all nonessential travel) for China has been in effect since January 27. On February 19, Level 1 travel notices (practice usual precautions) for travelers to Hong Kong and Japan were posted. On February 22, the Level 1 travel notice for Japan was raised to Level 2 (practice enhanced precautions). A Level 2 travel notice was posted for South Korea on February 22, which was updated to Level 3 on February 24. Level 1 travel notices were posted for Iran and Italy on February 23, and then updated to Level 2 on February 24. In addition, CDC has posted information for travelers regarding apparent community transmission in Singapore, Taiwan, Thailand, and Vietnam, and recommendations for persons to reconsider cruise ship voyages in Asia.

Airport screening. As of February 23, a total of 46,016 air travelers had been screened at the 11 U.S. airports to which all flights from China are being directed. Since February 2, travelers to the United States who have been in China in the preceding 14 days have been limited to U.S. citizens and lawful permanent residents and others as outlined in a presidential proclamation. Incoming passengers are screened for fever, cough, and shortness of breath. Any travelers with signs or symptoms of illness receive a more comprehensive public health assessment. As of February 23, 11 travelers were referred to a hospital and tested for infection; one tested positive and was isolated and managed medically. Seventeen travelers were quarantined for 14 days because of travel from Hubei Province, China, an area that was designated as high risk for exposure to COVID-19**; 13 of these 17 have completed their quarantine period.

Persons under investigation (PUIs). Recognizing persons at risk for COVID-19 is a critical component of identifying cases and preventing further transmission. CDC has responded to clinical inquiries from public health officials, health care providers, and repatriation teams to evaluate and test PUIs in the United States for COVID-19 following CDC guidance. As of February 23, 479 persons from 43 states and territories had been or are being tested for COVID-19; 14 (3%) had a positive test, 412 (86%) had a negative test, and 53 (11%) test results are pending.

Laboratory testing. As part of laboratory surge capacity for the response, CDC laboratories are testing for SARS-CoV-2 to assist with diagnosis of COVID-19. During January 18–February 23, CDC laboratories used real-time reverse transcription–polymerase chain reaction (RT-PCR) to test 2,620 specimens from 1,007 persons for SARS-CoV-2. Some additional testing is performed at selected state and other public health laboratories, with confirmatory testing at CDC. CDC is developing a serologic test to assist with surveillance for SARS-CoV-2 circulation in the U.S. population. The test detects antibodies (immunoglobulin [Ig]G, IgA, and IgM) indicating SARS-COV-2 virus exposure or past infection. In addition, CDC laboratories are developing assays to detect SARS-CoV-2 viral RNA and antigens in tissue specimens. Finally, following CDC’s establishment of SARS-CoV-2 in cell culture, CDC shared virus isolates with the Biodefense and Emerging Infections Research Resources Repository to securely distribute isolates to U.S. public health and academic institutions for additional research, including vaccine development.

Repatriation flights from areas with substantial COVID-19 transmission. During January 29–February 6, the U.S. government repatriated 808 U.S. citizens, residents, and their families from Hubei Province, China, on five chartered flights. At the time of departure, all travelers were free of symptoms for COVID-19 (fever or feverishness, cough, difficulty breathing). After arriving in the United States, the repatriated travelers were quarantined for 14 days at one of five U.S. military bases. CDC and U.S. government staff members monitored these travelers’ health. As of February 23, 28 (3%) of these persons developed COVID-19-related symptoms and were evaluated for infection; three were found to be positive for SARS-CoV-2 and were referred for medical care and isolation. As of February 24, the remaining 805 travelers had completed their 14-day quarantine.

On February 3, passengers and crew of the Diamond Princess cruise ship were quarantined off Yokohama, Japan; a passenger who had recently disembarked in Hong Kong was confirmed to have COVID-19, and ongoing transmission was identified on the ship. By February 16, a total of 355 cases of COVID-19 had been identified among passengers and crew,†† including 67 U.S. citizens or residents. As a result, during February 16–17, the U.S. government assisted in the repatriation of 329 U.S. citizens or residents from the ship. These travelers returned on two chartered flights. As of February 23, 36 (11%) of these repatriated persons had tested positive for SARS-CoV-2 and are under appropriate medical supervision. The remaining repatriated persons are in quarantine for 14 days. CDC is working with the U.S. embassy in Japan and the Japanese government to support U.S. passengers and crew who remained in Japan.

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Discussion

COVID-19 is a serious public health threat. Cases of COVID-19 have been diagnosed in the United States, primarily in travelers from China and quarantined repatriates, and also in two close contacts of COVID-19 patients. Currently, COVID-19 is not recognized to be spreading in U.S. communities. If sustained transmission in U.S. communities is identified, the U.S. response strategy will enhance implementation of actions to slow spread in communities (2,6). Implementation of basic precautions of infection control and prevention, including staying home when ill and practicing respiratory and hand hygiene will become increasingly important.

Community-level nonpharmaceutical intervention might include school dismissals and social distancing in other settings (e.g., postponement or cancellation of mass gatherings and telework and remote-meeting options in workplaces). These measures can be disruptive and might have societal and economic impact on individual persons and communities (6). However, studies have shown that early layered implementation of these interventions can reduce the community spread and impact of infectious pathogens such as pandemic influenza, even when specific pharmaceutical treatments and vaccines are not available (7,8). These measures might be critical to avert widespread COVID-19 transmission in U.S. communities (2,6). Mitigation measures implemented in China have included the closing of major transport hubs and preventing exit from certain cities with widespread transmission, cancellation of Chinese New Year celebrations, and prohibition of attendance at school and work (5). However, the impact of these measures in China has not yet been evaluated.

In the United States, the National Institutes of Health (NIH) and their collaborators are working on development of candidate vaccines and therapeutics for COVID-19. In China, multiple clinical trials of investigational therapeutics have been implemented, including two clinical trials of remdesivir, an investigational antiviral drug.§§ An NIH randomized controlled clinical trial of investigational therapeutics for hospitalized COVID-19 patients in the United States was approved by the Food and Drug Administration; the first investigational therapeutic to be studied is remdesivir.¶¶ In the absence of a vaccine or therapeutic, community mitigation measures are the primary method to respond to widespread transmission and supportive care is the current medical treatment.

COVID-19 symptoms are similar to those of influenza (e.g., fever, cough, and shortness of breath), and the current outbreak is occurring during a time of year when respiratory illnesses from influenza and other viruses, including other coronaviruses that cause the “common cold,” are highly prevalent. To prevent influenza and possible unnecessary evaluation for COVID-19, all persons aged ≥6 months should receive an annual influenza vaccine; vaccination is still available and effective in helping to prevent influenza (9). To decrease risk for respiratory disease, persons can practice recommended preventive measures.*** Persons ill with symptoms of COVID-19 who have had contact with a person with COVID-19 or recent travel to countries with apparent community spread††† should communicate with their health care provider. Before seeking medical care, they should consult with their provider to make arrangements to prevent possible transmission in the health care setting. In a medical emergency, they should inform emergency medical personnel about possible COVID-19 exposure.

Areas for additional COVID-19 investigation include 1) further clarifying the incubation period and duration of virus shedding, which have implications for duration of quarantine and other mitigation measures; 2) studying the relative importance of various modes of transmission, including the role of droplets, aerosols, and fomites; understanding these transmission modes has major implications for infection control and prevention, including the use of personal protective equipment; 3) determining the severity and case-fatality rate of COVD-19 among cases in the U.S. health care system, as well as more fully describing the spectrum of illness and risk factors for infection and severe disease; 4) determining the role of asymptomatic infection in ongoing transmission; and 5) assessing the immunologic response to infection to aid in the development of vaccines and therapeutics. Public health authorities are monitoring the situation closely. As more is learned about this novel virus and this outbreak, CDC will rapidly incorporate new knowledge into guidance for action.

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Corresponding author: Daniel B. Jernigan, eocevent294@cdc.gov, 770-488-7100.

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1CDC COVID-19 Response Team, CDC.

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The author has completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

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* Criteria to guide evaluation and testing of patients under investigation for SARS-CoV-2 include 1) fever or signs or symptoms of lower respiratory tract illness (e.g., cough or shortness of breath) in any person, including a health care worker, who has had close contact with a patient with laboratory-confirmed SARS-CoV-2 infection within 14 days of symptom onset; 2) fever and signs or symptoms of lower respiratory tract illness (e.g., cough or shortness of breath) in any person with a history of travel from Hubei Province, China, within 14 days of symptom onset; or 3) fever and signs or symptoms of lower respiratory tract illness (e.g., cough or shortness of breath) requiring hospitalization in any person with a history of travel from mainland China within 14 days of symptom onset. Additional information is available at https://emergency.cdc.gov/han/han00427.asp and https://emergency.cdc.gov/han/han00426.asp.

 https://www.cdc.gov/coronavirus/2019-ncov/index.html.

§ https://www.cdc.gov/coronavirus/2019-ncov/travelers/index.html.

 Office of the President. Proclamation on suspension of entry as immigrants and nonimmigrants of persons who pose a risk of transmitting 2019 novel coronavirus. Washington, DC: Office of the President; 2020. https://www.whitehouse.gov/presidential-actions/proclamation-suspension-entry-immigrants-nonimmigrants-persons-pose-risk-transmitting-2019-novel-coronavirus/external icon.

** https://www.cdc.gov/coronavirus/2019-ncov/travelers/from-china.html.

†† https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200216-sitrep-27-covid-19.pdf?sfvrsn = 78c0eb78_2pdf iconexternal icon.

§§ https://clinicaltrials.gov/ct2/show/NCT04257656?cond = remdesivir&draw = 2&rank = 1external iconhttps://clinicaltrials.gov/ct2/show/NCT04252664?cond = remdesivir&draw = 2&rank = 2external icon.

¶¶ https://clinicaltrials.gov/ct2/show/NCT04280705?cond = COVID-19&draw = 4&rank = 22external icon.

*** https://www.cdc.gov/coronavirus/2019-ncov/about/prevention-treatment.html.

††† https://www.cdc.gov/coronavirus/2019-ncov/locations-confirmed-cases.html.

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References

  1. World Health Organization. Coronavirus disease 2019 (COVID-19) situation report–34. Geneva, Switzerland: World Health Organization; 2020. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200223-sitrep-34-covid-19.pdf?sfvrsn=44ff8fd3_2pdf iconexternal icon
  2. Holloway R, Rasmussen SA, Zaza S, Cox NJ, Jernigan DB. Updated preparedness and response framework for influenza pandemics. MMWR Recomm Rep 2014;63(No. RR-6). PubMedexternal icon
  3. Reed C, Biggerstaff M, Finelli L, et al. Novel framework for assessing epidemiologic effects of influenza epidemics and pandemics. Emerg Infect Dis 2013;19:85–91. CrossRefexternal icon PubMedexternal icon
  4. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020;395:507–13. CrossRefexternal icon PubMedexternal icon
  5. The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19)—China, 2020. China CDC Weekly 2020. Epub February 17, 2020.
  6. Qualls N, Levitt A, Kanade N, et al.; CDC Community Mitigation Guidelines Work Group. Community mitigation guidelines to prevent pandemic influenza—United States, 2017. MMWR Recomm Rep 2017;66(No. RR-1). CrossRefexternal icon PubMedexternal icon
  7. Hatchett RJ, Mecher CE, Lipsitch M. Public health interventions and epidemic intensity during the 1918 influenza pandemic. Proc Natl Acad Sci U S A 2007;104:7582–7. CrossRefexternal icon PubMedexternal icon
  8. Markel H, Lipman HB, Navarro JA, et al. Nonpharmaceutical interventions implemented by US cities during the 1918–1919 influenza pandemic. JAMA 2007;298:644–54. CrossRefexternal icon PubMedexternal icon
  9. Dawood FS, Chung JR, Kim SS, et al. Interim estimates of 2019–20 seasonal influenza vaccine effectiveness—United States, February 2020. MMWR Morb Mortal Wkly Rep 2020;69:177–82. CrossRefexternal icon PubMedexternal icon

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Suggested citation for this article: Jernigan DB. Update: Public Health Response to the Coronavirus Disease 2019 Outbreak — United States, February 24, 2020. MMWR Morb Mortal Wkly Rep. ePub: 25 February 2020. DOI: http://dx.doi.org/10.15585/mmwr.mm6908e1external icon.

https://www.cdc.gov/mmwr/volumes/69/wr/mm6908e1.htm

 

SARS-CoV-2 Viral Load in Upper Respiratory Specimens of Infected Patients

TO THE EDITOR:

Figure 1.Viral Load Detected in Nasal and Throat Swabs Obtained from Patients Infected with SARS-CoV-2.

The 2019 novel coronavirus (SARS-CoV-2) epidemic, which was first reported in December 2019 in Wuhan, China, and has been declared a public health emergency of international concern by the World Health Organization, may progress to a pandemic associated with substantial morbidity and mortality. SARS-CoV-2 is genetically related to SARS-CoV, which caused a global epidemic with 8096 confirmed cases in more than 25 countries in 2002–2003.1 The epidemic of SARS-CoV was successfully contained through public health interventions, including case detection and isolation. Transmission of SARS-CoV occurred mainly after days of illness2 and was associated with modest viral loads in the respiratory tract early in the illness, with viral loads peaking approximately 10 days after symptom onset.3 We monitored SARS-CoV-2 viral loads in upper respiratory specimens obtained from 18 patients (9 men and 9 women; median age, 59 years; range, 26 to 76) in Zhuhai, Guangdong, China, including 4 patients with secondary infections (1 of whom never had symptoms) within two family clusters (Table S1 in the Supplementary Appendix, available with the full text of this letter at NEJM.org). The patient who never had symptoms was a close contact of a patient with a known case and was therefore monitored. A total of 72 nasal swabs (sampled from the mid-turbinate and nasopharynx) (Figure 1A) and 72 throat swabs (Figure 1B) were analyzed, with 1 to 9 sequential samples obtained from each patient. Polyester flock swabs were used for all the patients.

From January 7 through January 26, 2020, a total of 14 patients who had recently returned from Wuhan and had fever (≥37.3°C) received a diagnosis of Covid-19 (the illness caused by SARS-CoV-2) by means of reverse-transcriptase–polymerase-chain-reaction assay with primers and probes targeting the N and Orf1b genes of SARS-CoV-2; the assay was developed by the Chinese Center for Disease Control and Prevention. Samples were tested at the Guangdong Provincial Center for Disease Control and Prevention. Thirteen of 14 patients with imported cases had evidence of pneumonia on computed tomography (CT). None of them had visited the Huanan Seafood Wholesale Market in Wuhan within 14 days before symptom onset. Patients E, I, and P required admission to intensive care units, whereas the others had mild-to-moderate illness. Secondary infections were detected in close contacts of Patients E, I, and P. Patient E worked in Wuhan and visited his wife (Patient L), mother (Patient D), and a friend (Patient Z) in Zhuhai on January 17. Symptoms developed in Patients L and D on January 20 and January 22, respectively, with viral RNA detected in their nasal and throat swabs soon after symptom onset. Patient Z reported no clinical symptoms, but his nasal swabs (cycle threshold [Ct] values, 22 to 28) and throat swabs (Ct values, 30 to 32) tested positive on days 7, 10, and 11 after contact. A CT scan of Patient Z that was obtained on February 6 was unremarkable. Patients I and P lived in Wuhan and visited their daughter (Patient H) in Zhuhai on January 11 when their symptoms first developed. Fever developed in Patient H on January 17, with viral RNA detected in nasal and throat swabs on day 1 after symptom onset.

We analyzed the viral load in nasal and throat swabs obtained from the 17 symptomatic patients in relation to day of onset of any symptoms (Figure 1C). Higher viral loads (inversely related to Ct value) were detected soon after symptom onset, with higher viral loads detected in the nose than in the throat. Our analysis suggests that the viral nucleic acid shedding pattern of patients infected with SARS-CoV-2 resembles that of patients with influenza4 and appears different from that seen in patients infected with SARS-CoV.3 The viral load that was detected in the asymptomatic patient was similar to that in the symptomatic patients, which suggests the transmission potential of asymptomatic or minimally symptomatic patients. These findings are in concordance with reports that transmission may occur early in the course of infection5 and suggest that case detection and isolation may require strategies different from those required for the control of SARS-CoV. How SARS-CoV-2 viral load correlates with culturable virus needs to be determined. Identification of patients with few or no symptoms and with modest levels of detectable viral RNA in the oropharynx for at least 5 days suggests that we need better data to determine transmission dynamics and inform our screening practices.

Lirong Zou, M.Sc.
Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China

Feng Ruan, M.Med.
Zhuhai Center for Disease Control and Prevention, Zhuhai, China

Mingxing Huang, Ph.D.
Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China

Lijun Liang, Ph.D.
Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China

Huitao Huang, B.Sc.
Zhuhai Center for Disease Control and Prevention, Zhuhai, China

Zhongsi Hong, M.D.
Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China

Jianxiang Yu, B.Sc.
Min Kang, M.Sc.
Yingchao Song, B.Sc.
Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China

Jinyu Xia, M.D.
Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China

Qianfang Guo, M.Sc.
Tie Song, M.Sc.
Jianfeng He, B.Sc.
Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China

Hui-Ling Yen, Ph.D.
Malik Peiris, Ph.D.
University of Hong Kong, Hong Kong, China

Jie Wu, Ph.D.
Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China

Disclosure forms provided by the authors are available with the full text of this letter at NEJM.org.

This letter was published on February 19, 2020, and updated on February 20, 2020, at NEJM.org.

Ms. Zou, Mr. Ruan, and Dr. Huang contributed equally to this letter.

https://www.nejm.org/doi/full/10.1056/NEJMc2001737

Coronavirus illustration - CR: Maurizio De AngelisTo assist health workers and researchers working under challenging conditions to bring this outbreak to a close, The Lancet has created a Coronavirus Resource Centre. This resource brings together new 2019 novel coronavirus disease (COVID-19) content from across The Lancet journals as it is published. All content listed on this page is free to access.

Media queries

For media enquiries in relation to content published below, please contact pressoffice@lancet.com.

Focus

A modelling study published in The Lancet estimates that Egypt, Algeria and South Africa are at the highest risk of importing new coronavirus cases in Africa. The three countries are estimated to have the most prepared health systems in the continent and be least vulnerable. However, the authors call for increased resources, surveillance, and capacity building to be urgently prioritised in countries with a moderate risk which are more likely to be ill-prepared to detect cases and limit transmission.

Research

View more…

Case Report

Clinical Picture

Correspondence

Data sharing

The Lancet journals endorse the Wellcome Trust Statement on sharing research data and findings relevant to the 2019 novel coronavirus disease (COVID-19) outbreak.

Register to receive email updates:

Infographics

Explore our infographics on the first published information on COVID-19 cases in Wuhan.

 

Comment

News

Editorial

Obituary

Novel Coronavirus Information Center

Elsevier’s free health and medical research on novel coronavirus (2019-nCoV)

3D illustration of Coronavirus (© istock.com/Dr_Microbe)
3D illustration of Coronavirus (© istock.com/Dr_Microbe)

Welcome to Elsevier’s Novel Coronavirus Information Center. Here you will find expert, curated information for the research and health community on Novel Coronavirus (also referred to as COVID-19 and its temporary title 2019-nCoV). All resources are free to access and include guidelines for clinicians and patients. Under the ‘Research’ tab you will find the latest early stage and peer-reviewed research from journals including The Lancet and Cell Press, as well as a link to the Coronavirus hub on ScienceDirect, where you will find every article relevant article to Coronavirus, SARS, and MERS freely available. Under the Clinical Solutions tab you will find resources for nurses, clinicians and patients, including FAQs on symptoms.


Introduction

Margaret Trexler Hessen, MD, Director, Point of Care, Elsevier

Recent events have shown us (again) how rapidly a new disease can take root and spread. Such events are accompanied by an explosion of clinical and epidemiological information and research. The goal of this website is to open whatever resources we can to help public health authorities, researchers and clinicians contain and manage this disease. We will provide continually updated resources from Elsevier’s content and experts. Our resources span scientific and medical journals and textbookseducational products, and a variety of other resources, like travel precautions from the CDC and media posts of interest to our community. We have also created a  interactive global map of experts based on Scopus data.

Read more


Expert guidance and commentary

COVID-19: Seeking reliable information amid uncertainty

By Ian Chuang, MD, Chief Medical Officer, Elsevier

Medicine is continuously evolving in terms of refining, revising and discovering new knowledge. This is heightened in importance and compressed in timeframe during a crisis such as the current viral outbreak of the COVID-19.

The COVID-19 that originated in Wuhan, China, has exceeded more than 71,000 confirmed cases and over 1,700 deaths since the first case was detected in December 2019. As of February 18, the number of confirmed cases in Singapore has risen to 77. The World Health Organization (WHO) has termed this current epidemic as a global emergency, and it is a public health responsibility at a massive scale.

Read more

JAMA Medical News Podcast: Coronavirus and Beyond: Responding to Biological Threats

The 2019 novel coronavirus outbreak exemplifies ongoing biothreats to global security, as each new threat tests principles of preparation and response at national, regional, and clinical levels. Tom Inglesby, MD, director of the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health, discusses biosecurity with Angel Desai, MD, JAMA Fishbein fellow. Listen to the interview

6 of the most common coronavirus questions the media is asking

By Rodney E. Rohde, PhD, Professor and Chair, Clinical Laboratory Program, Texas State University | Feb 6, 2020

As an infectious disease and clinical microbiology expert, Prof. Rodney E. Rohde of the Texas State University College of Health Professions receives daily calls from the media, government and university officials, and public health and professional organizations asking him about the emerging novel coronavirus outbreak. In this article, he shares some of the most common questions and his responses.

Read more

Interactive map: global disease outbreak experts

The map represents the most active institutions researching disease outbreak and control. We ran a search in Scopus — a source-neutral abstract and citation database of over 75 million records — for publications researching the coronavirus and related diseases such as SARS from 1996 to the present (Feb 6, 2020). We then used the resulting ~22,000 publications to identify the researchers and institutions that are working in these areas. The map shows the 500 most prolific global institutions, along with the 200 most prolific Chinese institutions by publication count.

Click on a pin to see more about the institution, the numbers of researchers and their publications. Then link through to the researcher’s profiles in Scopus to learn more about their areas of expertise.

Explore the interactive map here


Video: Novel Coronavirus Update

Livestreamed on Feb 6, 2020

JAMA Editor-in-Chief Howard Baucher, MD, interviews Anthony Fauci, MD, Director of the NIH National Institute of Allergy and Infectious Diseases.


Key facts for clinicians

By Margaret Trexler Hessen, MD, Director, Point of Care, Elsevier | Updated Feb 21, 2020

Background: In December, China notified the World Health Organization of several cases of human respiratory illness, which appeared to be linked to an open seafood and livestock market in the city of Wuhan. The infecting agent has since been identified as a novel coronavirus, now called SARSCoV-2 (initially called 2019-nCoV). Although the virus is presumed zoonotic in origin, person-to-person spread is evident. Novel Coronavirus associated infection is now designated as COVID-19. Cases have now been reported in many parts of mainland China and in other countries in Asia, Europe, the eastern Mediterranean, Australia, Asia Pacific and North America. Travel within China has been restricted and travel to and from China markedly reduced. Screening of travelers is being implemented in other countries and quarantine measures have been enacted under some circumstances. Despite these precautions, it is anticipated that more cases will be seen both inside China and internationally.

Read more

Clinicians need reliable and current information to combat novel coronavirus

By Jonathan Temte, MD, PhD, Consultant, PracticeUpdate, Elsevier

Coronaviruses are incredibly diverse, found in many animal species, and are commonly encountered in clinical practice during the cold and flu season, yet many primary care clinicians are not familiar with these respiratory pathogens. We rarely test for them, and when we do it’s usually when we’re looking for something else. Moreover, we have no specific treatments for these viruses.

Read more


Elsevier Clinical Solutions

We’ve selected content from ClinicalKey, Clinical Solutions Nursing, Interprofessional Practice and Patient Education collections to share what we know to date about the novel coronavirus.

Clinical Overviews on ClinicalKey

Clinical Overviews are easy-to-scan clinically focused medical topic summaries designed to match the clinician workflow. Elsevier’s Point-of-Care Editorial team develops Clinical Overviews through a process that includes review and revision by a medical editor; peer reviews performed by subject matter experts; a production review to ensure consistency in style, grammar, and punctuation; and a final evaluation by the editor-in-chief.

Clinical Skills for Nursing

Clinical Skills for Nursing provides the highest quality evidence for nursing practice procedures for nurses to care for patients. Our Isolation Precautions and Personal Protective Equipment checklists align with CDC and OSHA guidelines:

Interprofessional Care Plans

These Interprofessional Care Plans provide an evidence-based and individualizable Interprofessional plan of care to manage fever and the possible development of pneumonia, which is consistent with the presentation of this virus. Using an interprofessional approach to patient care that aligns current evidence with the individual needs of the patient results in improved patient care outcomes.

Patient engagement resources

Patient engagement resources use plain language to support shared decision-making between patients and healthcare providers. The goal is to deliver the right message in the right way at the time the patient is most ready to learn. The following resources provide an overview of the novel coronavirus to help patients and their families understand their risk, identify signs and symptoms, and prevent it from spreading:


Video overview of Coronavirus from 3D4Medical – Watch now:

https://www.elsevier.com/connect/coronavirus-information-center

SARS (Severe Acute Respiratory Syndrome)

Cause

SARS coronavirus (SARS-CoV) – virus identified in 2003. SARS-CoV is thought to be an animal virus from an as-yet-uncertain animal reservoir, perhaps bats, that spread to other animals (civet cats) and first infected humans in the Guangdong province of southern China in 2002.

Transmission

An epidemic of SARS affected 26 countries and resulted in more than 8000 cases in 2003. Since then, a small number of cases have occurred as a result of laboratory accidents or, possibly, through animal-to-human transmission (Guangdong, China).

Transmission of SARS-CoV is primarily from person to person. It appears to have occurred mainly during the second week of illness, which corresponds to the peak of virus excretion in respiratory secretions and stool, and when cases with severe disease start to deteriorate clinically. Most cases of human-to-human transmission occurred in the health care setting, in the absence of adequate infection control precautions. Implementation of appropriate infection control practices brought the global outbreak to an end.

Nature of the disease

Symptoms are influenza-like and include fever, malaise, myalgia, headache, diarrhoea, and shivering (rigors). No individual symptom or cluster of symptoms has proved to be specific for a diagnosis of SARS. Although fever is the most frequently reported symptom, it is sometimes absent on initial measurement, especially in elderly and immunosuppressed patients.

Cough (initially dry), shortness of breath, and diarrhoea are present in the first and/or second week of illness. Severe cases often evolve rapidly, progressing to respiratory distress and requiring intensive care.

Geographical distribution

The distribution is based on the 2002–2003 epidemic. The disease appeared in November 2002 in the Guangdong province of southern China. This area is considered as a potential zone of re-emergence of SARS-CoV.

Other countries/areas in which chains of human-to-human transmission occurred after early importation of cases were Toronto in Canada, Hong Kong Special Administrative Region of China, Chinese Taipei, Singapore, and Hanoi in Viet Nam.

Risk for travellers

Currently, no areas of the world are reporting transmission of SARS. Since the end of the global epidemic in July 2003, SARS has reappeared four times – three times from laboratory accidents (Singapore and Chinese Taipei), and once in southern China where the source of infection remains undetermined although there is circumstantial evidence of animal-to-human transmission.

Should SARS re-emerge in epidemic form, WHO will provide guidance on the risk of travel to affected areas. Travellers should stay informed about current travel recommendations. However, even during the height of the 2003 epidemic, the overall risk of SARS-CoV transmission to travellers was low.

Prophylaxis

None. Experimental vaccines are under development.

Precautions

Follow any travel recommendations and health advice issued by WHO.

https://www.who.int/ith/diseases/sars/en/

 

China’s early warning system didn’t work on covid-19. Here’s the story.

Lies and coverups halted vital information.

Feb. 24, 2020 at 4:13 a.m. CST

Chinese authorities have placed an estimated 760 million people into lockdown as part of an epic campaign to contain the spread of covid-19, the disease caused by the novel coronavirus. As of Sunday, there were over 77,000 confirmed cases and more than 2,500 deaths in China, mostly in Hubei province. Wuhan, the provincial capital and the epicenter of the outbreak, has been hard hit.

Why did China’s CDC system, once touted as among the world’s best disease control programs, fail to help contain the virus early on? And what has the crisis exposed about China’s system of governance? Here’s what you need to know.

China built a system to prevent another SARS crisis

In the aftermath of the 2003 SARS crisis, China invested heavily to improve its system for infectious disease control and prevention. These measures included new laboratories and a nationwide Infectious Diseases Reporting System, as well as new laws on infectious diseases control and public health emergencies. The reporting system is extensive, covering all of China’s more than 2,800 county-level jurisdictions.

This sentinel system for infectious diseases helped China tackle various outbreaks — including H1N1avian flu and malaria. Successive China CDC directors have taken great pride in this system. In a March 2019 interview, Gao Fu, the China CDC director general, said he was “very confident that the SARS incident will not recur. This is due to our country’s well-built infectious disease surveillance network; we can block the virus when it appears.”

The system worked, according to local authorities

The Wuhan Health Commission (WHC) began to release information on its website on the atypical pneumonia cases on Dec. 31, 2019.

But local authorities didn’t tell the full story

The China CDC official line, however, suggests a different timeline. According to Feng Zijian, deputy director general of the China CDC, the direct reporting system was “not activated that expeditiously.” In fact, the award to Zhang for reporting on Dec. 29 reminds us that the pre-Dec. 29 cases were not reported, let alone filed into the disease reporting system in real time.

Two separate sources reveal that Gao himself was the real sentinel of the coronavirus outbreak. In the evening of Dec. 30, Gao Fu noticed from scanning group-chats that the WHC had just issued two internal notices on atypical pneumonia cases. Alarmed that such information had not been submitted to the national reporting system, he called the Wuhan CDC head and learned that the number of cases was well above the threshold for reporting. Troubled by what he heard — and didn’t hear — Gao immediately alerted the National Health Commission (NHC) leadership. The following day, Dec. 31, the NHC dispatched a national team of experts to Wuhan to investigate.

Local authorities also silenced whistleblowers

As the national team was on its way to Wuhan, the WHC issued its first public statement about the atypical pneumonia outbreak, reassuring the public that the health administrations and hospitals were managing the situation well. Of the 27 cases, “seven were critical, but the rest were stable and controllable, including two that … are expected to be discharged.” In fact, the latest retrospective study by China CDC reveals there were already 104 cases, including 15 deaths, in December.

In contrast, on Jan. 2, health authorities in Singapore and other countries began to screen passengers from Wuhan.

The case of Li Wenliang has captured global attention. Early on Dec. 31, the Chinese doctor was reprimanded by WHC and the Wuhan Central Hospital he worked at for spreading false rumors about SARS-like cases on Dec. 30. Police later forced him to sign a document promising not to spread “false rumors” again. Other doctors were also admonished for “irresponsible behavior that caused social panic and disrupted Wuhan’s development and stability.”

Systemic fissures contributed to further delays

Local officials, including Wuhan’s mayor, blamed their inadequate public disclosure on the need to secure approval from above. But the truth is more complicated. We now know that on Dec. 30, a joint Hubei-Wuhan CDC investigation team concluded that there were no clusters of cases but there were nonetheless a family of several members that became infected.

Had China CDC experts seen this report — or engaged with the infectious disease doctors at the major Wuhan hospitals — they would likely have recognized earlier that the virus was spreading from human to human. Three crucial weeks would elapse before a new national experts team, including Zhong Nanshan and Gao, finally concluded that the coronavirus was highly contagious.

The infectious diseases sentinel system only works if the hospitals and local health administrations actively engage with it and contribute to the information. In Wuhan, the system failed, monumentally. The failure has laid bare the inherent tensions of a reporting system that is also beholden to the political imperatives of provincial and municipal Communist Party bosses.

For now, President Xi Jinping has replaced the top leaders of Hubei and Wuhan. China remains in the midst of an unprecedented and enormously costly effort to contain covid-19. While the Chinese leadership can lay some of the blame for the crisis on local missteps, a more effective public health emergency response system will depend on encouraging information flows and realigning institutional interests.

Dali L. Yang is the William C. Reavis Professor of Political Science at the University of Chicago. His research has emphasized governance and regulation in China.

Read more:

https://www.washingtonpost.com/politics/2020/02/24/chinas-early-warning-system-didnt-work-covid-19-heres-story/

Updated COVID-19 (Coronavirus) statistics

Data update dates: World Health Organisation: 25 Feb | Hubei: 25 Feb | China: 25 Feb

COVID-19 (Coronavirus) is the number 1 issue facing investors at the moment. Given issues with data from China, we have put together these charts (updating throughout the day) to highlight the data from outside of China. Often the final data point will only include countries which have reported that day and so will change throughout the day. 

NOTE: China has re-classified statistics at least three times. There are also numerous revisions to prior numbers. We have made some adjustments to the charts below to normalise these statistics where possible, but treat China and Hubei data with scepticism. We now use both suspected and confirmed cases in Chinese ratios. 

COVID-19 cases caught outside of China

Whilst at first most cases of COVID-19 outside China were people who had flown from China to another country, we now seeing transmission of the virus outside of China taking off:

Source of new Covid-19 cases

Number of new Covid-19 cases

 

Total Covid-19 cases outside China

 

Given that a single cruise ship made up the bulk of cases outside China in early February, it is still useful to look at cases with and without that ship.

Total Covid-19 cases caught outside of China

New Covid-19 cases caught outside China each day

The average incubation period of COVID-19 probably less than a week (but could be as much as 24 days), and then an additional 3-4 days before diagnosis. So, you would expect measures like quarantines and travel restrictions to take around 10 days before showing up in statistics.

Time to doubling

This is an examination of how long it takes for cases or deaths to double.

Days taken for Covid-19 cases outside China to double to double

Number of days for Covid-19 cases and deaths in China to double

 

Winter is here

If we limit cases to only those caught in a particular country, exclude China, and then split countries into:

  • Winter countries: Northern Hemisphere Countries currently in winter (including Vietnam as the domestic transmission cases are in the north)
  • Summer/Equatorial countries: Southern Hemisphere countries currently in summer or Countries near the equator where temperatures are relatively high all year

Covid-19 cases by season

Covid-19 cases by season

Note: Countries near China are more likely to have contact with Chinese citizens and these countries are in winter which probably distorts this data.

New and total COVID-19 case numbers in Hubei, the rest of China

Our analysis (and the analysis of many others) suggests reporting of COVID-19 cases in Hubei province were under-reported.

Then, on the 7th of February, China changed its definition of how it is reporting new cases to exclude patients who test positive for the virus but have no symptoms will no longer be regarded as confirmed. This means up to 80% of cases might no longer be reported. On the 13th of February Hubei reclassified how it classifies cases. On 20th February Hubei reclassified again. All changes affect the quality of the data. Confirmed + suspected cases in China are our key measure.

We are tracking data from Hubei and the rest of China separately. We are sceptical of the China data, but there is some information in the series.

Total number of Covid-19 cases in China

On 7 Feb China made some adjustments to how they report data. Below we have made an estimate of what the case count might look like if China did not make this adjustment:

Extrapolated and suspected Covid-19 cases in Hubei province

Extrapolated, suspected and confirmed Covid-19 cases in China province

 

New confirmed Covid-19 cases in China

Daily change in confirmed & suspected Covid-19 cases

New and total Coronavirus death toll in Hubei, the rest of China, and the rest of the world

Total Covid-19 death toll in China

 

New daily Covid-19 deaths in China

 

Total Covid-19 deaths outside China & Iran

COVID-19 Mortality Rate using lag periods

The mortality rate is where we can see distinct differences in data. Dividing the number of deaths by the number of cases during the early stages of an outbreak is very misleading. People who were diagnosed today with the disease are still alive, but they still might die from the disease in the coming days.

A better way is to compare the current deaths to the number of cases from “x” days ago. We still don’t know how many days we should be looking back. The stats so far suggest that the median days from the first symptom to death is 14. But with a broad range from 6 to 41. And, we don’t know how long on average after the first symptom a person would take to become a case.

The below charts show the death rate if the right period to look back is 4, 8 or 12 days. Using data without Hubei, a mortality rate of somewhere between 0.5% and 3% is likely.

In recent days, data from Iran has skewed the results. There is likely a significantly larger outbreak in Iran than what is being reported. We have started showing our mortality rates for the rest of the world excluding Iran.

For more on what this means, see our article on understanding COVID-19 statistics

 

China Covid-19 mortality rate using different lag periods

 

Hubei province Covid-19 mortality rate using different lag periods

 

Worldwide Covid-19 mortality rate

More Analysis

See our latest investment view and here for our latest podcast. Keep in mind that the economic impact is not particularly related to the number of deaths, more important is the disruption to business which already looks to be significant.

Data sources

This is a list of some of the main data sources we use:

https://www.worldometers.info/coronavirus/  Probably the best one

https://ncov.dxy.cn/ncovh5/view/pneumonia  Faster than worldometers for Chinese data, but slower on rest of the world data

http://www.nhc.gov.cn/yjb/pqt/new_list.shtml Official source for Chinese Data. Explains data adjustments.

http://wjw.hubei.gov.cn/fbjd/tzgg/ Official source for Hubei Data. Usually comes out a few hours before the China data.  Doesn’t always explain adjustments.

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports The slowest to update, but the most authoritative in our view. More consistent with definitions than other sources.

https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6 The prettiest pictures, but one of the slower sites to update. I don’t find the charts that useful.

https://www.youtube.com/user/MEDCRAMvideos has a daily youtube wrap-up

https://www.youtube.com/user/ChrisMartensondotcom has a daily youtube wrap-up

Updated COVID-19 statistics and analysis

Story 2: Stock Market Correction Linked To Impact of COVID -19 on China Supply Chain — Create More Money — Just Stay Home — Consumer Confidence Crashes — Stagflation Recession 2021 –Panic Propaganda — Do Not Believe It — Videos —

Coronavirus outbreak could threaten a US recession: Michael Farr

A coronavirus outbreak in the US could be cause for global recession: Moody’s Mark Zandi

Wait to buy the dip until there’s bigger shift in risk aversion, strategist says

Kudlow: Not hearing Fed will make panic rate moves due to virus

Former Dallas Fed president Richard Fisher on the economic effects of coronavirus

Gottlieb on coronavirus spread: ‘We’re just seeing the tip of the iceberg’

[youube=https://www.youtube.com/watch?v=Rel6TDmAnbE]

Allianz’s El-Erian: Resist the inclination to buy the coronavirus-driven dip

The slowdown still isn’t fully baked in these stocks, Jim Cramer says

Jim Cramer: These are the five things investors must consider after a major sell-off

Bond market telegraphing more rate cuts this year

Markets rocked for second straight day, Dow down 1,900 points total

How Badly Will the Coronavirus Hurt China’s Economy?

The Economic Effects of Coronavirus Are Spreading Says El-Erian

Supply chains are going to have massive disruptions if outbreak continues to build: Strategists

Big Tech tumbles: Apple, Microsoft, Facebook are in correction territory

The David Knight Show – (HD) 02/17/2020 – China Corona-Effect: Destroying, Hoarding

Keiser Report 1506

Toilet Paper

Civil forfeiture in the United States

From Wikipedia, the free encyclopedia

Jump to navigationJump to search

Civil forfeiture in the United States, also called civil asset forfeiture or civil judicial forfeiture,[1] is a process in which law enforcement officers take assets from persons suspected of involvement with crime or illegal activity without necessarily charging the owners with wrongdoing. While civil procedure, as opposed to criminal procedure, generally involves a dispute between two private citizens, civil forfeiture involves a dispute between law enforcement and property such as a pile of cash or a house or a boat, such that the thing is suspected of being involved in a crime. To get back the seized property, owners must prove it was not involved in criminal activity. Sometimes it can mean a threat to seize property as well as the act of seizure itself.[2] Civil forfeiture is not considered to be an example of a criminal justice financial obligation.

Proponents see civil forfeiture as a powerful tool to thwart criminal organizations involved in the illegal drug trade, with $12 billion annual profits,[3] since it allows authorities to seize cash and other assets from suspected narcotics traffickers. They also argue that it is an efficient method since it allows law enforcement agencies to use these seized proceeds to further battle illegal activity, that is, directly converting value obtained for law enforcement purposes by harming suspected criminals economically while helping law enforcement financially.

Critics argue that innocent owners can become entangled in the process to the extent that their 4th Amendment and 5th Amendment rights are violated, in situations where they are presumed guilty instead of being presumed innocent. It has been described as unconstitutional by a judge in South Carolina[4][5]. Further, critics argue that the incentives lead to corruption and law enforcement misbehavior. There is consensus that abuses have happened but disagreement about their extent as well as whether the overall benefits to society are worth the cost of the instances of abuse.

Civil forfeitures are subject to the “excessive fines” clause of the U.S. Constitution‘s 8th amendment, both at a federal level and, as determined by the 2019 Supreme Court case, Timbs v. Indiana, at the state and local level.[6]

History

Legal origins

The idea of going at people through their property has a long history. The theories are quite old. The prevalence of the practice is comparatively recent.

— Daniel C. Richman, Fordham Law School, 1999[7]

Civil forfeiture has a history dating back several hundred years with roots in British maritime law to the British Navigation Acts around the middle 1600s. These laws required ships importing or exporting goods from British ports to fly the British flag; ships that failed to do this could be seized regardless of whether the ship’s owner was guilty of doing any wrongdoing.[8] It was easier to seize a vessel than try to apprehend an owner on the other side of the ocean,[9] as explained by Supreme Court justice Joseph Story:

… (A) vessel which commits the aggression is treated as the offender, as the guilty instrument or thing to which the forfeiture attaches, without any reference whatsoever to the character or conduct of the owner. (The seizure of the ship is justified by …) the necessity of the case, as the only adequate means of suppressing the offense or wrong, or insuring an indemnity to the injured party.

During the later Colonial years, forfeiture practices by the Crown officials using writs of assistance were one of the many activities that angered colonists, who saw the writs as “unreasonable searches and seizures” that deprived persons of “life, liberty, or property, without due process”.[9] The early Congress wrote forfeiture laws based on British maritime law to help federal tax collectors collect customs duties, which financed most of the expenses of the federal government in the early days of the republic.[8] Seizures allowed government to confiscate property from citizens who failed to pay taxes or customs duties.[7] The Supreme Court upheld these forfeiture statutes in situations where it was virtually impossible to get hold of guilty persons on the high seas while possible to get hold of their property.[8] During much of the 19th century there was not much attention paid to forfeiture laws.[8]

Prohibition era

During ProhibitionDetroit police inspect equipment suspected of being used to make alcohol; under civil forfeiture laws, police could seize the equipment without having to charge any owners with a crime.

Government used forfeiture during the Prohibition years 1920–1933.[8] Police seized vehicles and equipment and cash and other property from bootleggers.[7] When Prohibition ended in 1933, much of the forfeiture activity ended as well, and modern forfeiture was an “infrequent resort” until the last few decades.[9]

War on Drugs (1980–present)

Civil forfeiture activity increased substantially in the past thirty years.[10] It stepped up forfeiture during the War on Drugs during the early 1980s and onwards.[8] It became harder for criminal organizations to launder dirty money by means of the financial system, so drug cartels preferred bulk payments of cash.[11] Illegal drugs are a big business; one estimate was that the annual profit from selling illegal drugs was $12 billion, according to the United States Drug Enforcement Administration.[8] The initial intent, similar to methods used to try to fight alcohol trafficking and use during the Prohibition era, was to use civil forfeitures as a weapon against drug kingpins.[12]

According to journalist Sarah Stillman, a major turning point in forfeiture activity was the passage of the Comprehensive Crime Control Act of 1984.[13] This law permitted local and federal law enforcement agencies to share the seized assets and cash.[9] Civil forfeiture allowed federal and local governments to “extract swift penalties from white-collar criminals and offer restitution to victims of fraud”, according to Stillman.[9] From 1985 to 1993, authorities confiscated $3 billion of cash and other property based on the federal Asset Forfeiture Program, which included both civil and criminal forfeitures.[13] The methods were supported by the Reagan administration as a crime fighting strategy.

It’s now possible for a drug dealer to serve time in a forfeiture-financed prison after being arrested by agents driving a forfeiture-provided automobile while working in a forfeiture-funded sting operation.

— Reagan attorney general Richard Thornburgh in 1989.[9]

The politics of civil forfeiture were somewhat unusual. The federal forfeiture laws were introduced and pushed through by Republicans in the 1980s, with support from some Democrats; but efforts to reform forfeiture laws have also come from the right,[14] as libertarians in Congress have focused on the basic idea as offensive to property rights.[14] In many areas civil forfeiture adversely affects persons from minorities and low-income communities, in which the typical seizure is less than $500, and Democrats have also been critical of civil forfeiture programs.[14] The ACLU has also been a long time opponent.[14]

Forfeiture was used for purposes other than trying to discourage illegal drug activity, such as attempts in New York City to discourage drunk driving. Forfeiture rules were used to confiscate cars of intoxicated motorists.[7] In such instances, there are two types of cases: a criminal case against the drunk driver as a person, and a civil case against the property used to facilitate the drunk driving, specifically their car.[7] Critics contend that the punishment can be “deemed out of proportion with the offense”; for example, after a drunk driver is arrested and convicted and possibly imprisoned, is it proper to punish him or her additionally by civil forfeiture means by confiscating a $50,000 car?[7] Civil forfeiture has been used to discourage illegal activities such as cockfightingdrag racinggambling in basements, poaching of endangered fish, securities fraud, and other illegal activity.[9]

A chart showing that payouts are growing, according to the equitable sharing arrangement. Source: United States Justice and Treasury Departments.

Courts helped set up the legal framework to help law enforcement stem the drug tide while sometimes trying to rein in abuses. A 1984 law set up the equitable sharing arrangement in which state and local police can share the seizures with federal agents.[15] While the 1993 Supreme Court case Austin v. United States ruled that a forfeiture could be considered as an excessive fine,[16] the court upheld the principle of civil forfeiture generally.[8] A 1996 Supreme Court decision ruled that prosecuting a person for a crime and seizing his or her property via civil forfeiture did not constitute double jeopardy, and therefore did not violate the Constitution.[16] However, in 1999, the Supreme Court ruled that civil forfeiture was not permitted if the amount seized was “grossly disproportional” to the gravity of the offense.[7]

Legislatures played a role as well. Since the 1990s, the number of federal statutes permitting government forfeiture doubled from 200 to 400.[15] In 2000, lawmakers passed the Civil Asset Forfeiture Reform Act, or CAFRA, which stipulated protections for individuals and increased the level of proof required.[15] Critics said that the new guidelines did not require poor persons to have free access to legal services.[15] CAFRA guidelines suggest that if a claimant wins a civil-forfeiture case, that some of the legal fees paid to recover the property are partially payable by the government.[15] CAFRA was supposed to raise government’s burden of proof before seizing property.[17] CAFRA meant if government loses a forfeiture challenge, government must pay the victim’s attorney costs, but often victims are unaware of this fact, so they fail to hire lawyers thinking the cost will be prohibitive.[17]

Police forces heeded instruction from a law enforcement consultant named Joe David who had an “uncanny talent for finding cocaine and cash in cars and trucks”, according to one report.[18] Officers trained in David’s so-called Desert Snow stop-and-seizure techniques raked in $427 million from highway encounters during a five-year period.[18] A contract allowed David’s consulting firm to keep 25% of the seized cash.[18]

But when innocent owners were sometimes ensnarled in seizure proceedings, it spurred criticism. In the early 1990s, San Francisco-based defense attorney Brenda Grantland organized a group called Forfeiture Endangers American Rights (which spells the letters FEAR), with branches in New JerseyVirginiaCalifornia, and Massachusetts.[13] Debate about reforming civil forfeiture procedures happened in the late 1990s but after public scrutiny died down, lawmakers quietly relaxed the reforms at the behest of police groups and prosecutors without much public debate.[10]

Civil forfeiture was used successfully on many occasions. For example, it was used to seize assets by corrupt foreigners, such as against Teodoro Nguema Obiang Mangue, who stole money from the African nation of Equatorial Guinea and was convicted.[19] Overall, the pattern in recent decades has been a substantial increase in forfeiture activity. According to government records, Justice department seizures went from $27 million in 1985 to $556 million in 1993 and $4.2 billion in 2012.[9]

In 2015, Eric Holder ended the policy of “adoptive forfeiture”, which occurred “when a state or local law enforcement agency seizes property pursuant to state law and requests that a federal agency take the seized asset and forfeit it under federal law” due to abuse.[20] Although states proceeded to curtail the powers of police to seize assets, actions by the Justice Department in July 2017 have sought to reinstate police seizure powers that simultaneously raise funding for federal agencies and local law enforcement.[21]

Legal background

Civil versus criminal forfeiture

Civil
forfeiture
Criminal
forfeiture
Police against
thing
or in rem
Police against
person
or in personam
Legal test is
Preponderance of evidence
Legal test is
Beyond a reasonable doubt
Court can weigh
defendant’s taking
the 5th in their decision[22]
Court can not
do this[22]
Assets returned if owner proves innocence Assets returned if prosecution cannot prove guilt
Example:
United States v. Forty-Three Gallons of Whiskey
Example:
United States v. John Doe

Civil procedure cases generally involve disputes between two private citizens, often about money or property, while criminal procedure involves a dispute between a private citizen and the state, usually because a law has been broken. In legal systems based on British law such as that of the United States, civil and criminal law cases are handled differently, with different tests and standards and procedures, and this is true of forfeiture proceedings as well. Both civil and criminal forfeiture involve the taking of assets by police.

In civil forfeiture, assets are seized by police based on a suspicion of wrongdoing, and without having to charge a person with specific wrongdoing, with the case being between police and the thing itself, sometimes referred to by the Latin term in rem, meaning “against the property”; the property itself is the defendant and no criminal charge against the owner is needed.[1]

In contrast, criminal forfeiture is a legal action brought as “part of the criminal prosecution of a defendant”, described by the Latin term in personam, meaning “against the person”, and happens when government indicts or charges the property that is either used in connection with a crime, or derived from a crime, that is suspected of being committed by the defendant;[1] the seized assets are temporarily held and become government property officially after an accused person has been convicted by a court of law; if the person is found to be not guilty, the seized property must be returned.

The tests to establish the burden of proof are different;[15] in civil forfeiture, the test in most cases[23] is whether police feel there is a preponderance of the evidence suggesting wrongdoing; in criminal forfeiture, the test is whether police feel the evidence is beyond a reasonable doubt, which is a tougher test to meet.[3][15]

If property is seized in a civil forfeiture, it is “up to the owner to prove that his cash is clean”.[3] Normally both civil and criminal forfeiture require involvement by the judiciary; however, there is a variant of civil forfeiture called administrative forfeiture, which is essentially a civil forfeiture that does not require involvement by the judiciary, which derives its powers from the Tariff Act of 1930, and empowers police to seize banned imported merchandise, as well as things used to import or transport or store a controlled substance, money, or other property that is less than $500,000 value.[1]

Justification

The Supreme Court has generally upheld the principle of civil forfeiture.

According to the Justice Department, there are three main justifications for civil forfeitures:

  1. Punishment and deterrence. To punish and deter criminal activity by depriving criminals of property used or acquired through illegal activities.[22]
  2. Enhance police cooperation. To enhance cooperation among foreign, federal, state, and local law enforcement agencies, through the equitable sharing of assets recovered through this program.[22]
  3. Revenue for law enforcement. As a byproduct, to produce revenues to enhance forfeitures and strengthen law enforcement.[22]

Since a prosecutor can charge a person with a crime in a criminal case and charge his or her things in a civil case, issues such as double jeopardy have been raised. Further, there has been debate about whether seizures of property are considered as a fine or as a punishment in a legal sense. The distinction was clarified by the Supreme Court in United States v. Bajakajian, which decreed that a criminal forfeiture could be considered as both a type of fine and a punishment, while a civil forfeiture was not intended as a punishment of a person but rather a “legal fiction of punishing the property”.[24] As a result, the court decreed that civil forfeitures that served as remedial were not considered as a type of fine.[24][25]

The United States Supreme Court has upheld the principle of civil asset forfeiture at the federal level.[10][26] The Court ruled in Austin v. United States (1993) that such civil forfeiture, treated as punitive actions, are subject to the Excessive Fines clause of the Eighth Amendment. The Supreme Court ruled in Timbs v. Indiana (2019) that protection against excessive fees in civil forfeiture is also incorporated against state and local government.[27][28]

In addition, there are more than 400 federal statutes that empower police to take assets from convicted criminals, as well as from persons not charged with criminality.[15] Sometimes the seizures happen as a result of different government agencies working together, such as the Internal Revenue Service and the Department of Justice.[29] Police at national and state levels cooperate in many instances according to procedural laws known as equitable sharing. In addition, there are laws that make it difficult for criminals to get dirty money clean by methods of money laundering; for example, law requires that cash deposits greater than $10,000 to a bank account be reported by the bank to the federal government,[30] and there have been instances in which repeated cash deposits under this amount have looked suspicious to authorities even though they were done legitimately, leading to civil forfeiture seizures directly from a bank account. What has caused controversy is when the property of innocent persons is seized by police who believe that the seized items were involved in criminal activity.

A June 2019 study found that more equitable sharing funds do not translate into more crimes solved, not improving overall police effectiveness. Such funds also do not lead to less drug use. And forfeiture rates are linked to local economic performance, increasing when the local economy suffers, suggesting that such tactics are more geared towards raising revenue, not fighting crime.[31]

Prevalence

Although there are accessible statistics of seizures at the federal level, it often happens that the totals of forfeitures from both criminals and innocent owners are combined; for example, one report was that in 2010, government seized $2.5 billion in assets from criminals and innocent owners by forfeiture methods,[15] and the totals of assets seized incorrectly from innocent owners was not separated statistically. Further, since the United States is a federal republic with governments at both the national and state level, there are civil forfeiture seizures at the state level, which are not tracked and recorded in any central database,[11] which make it difficult to make assessments, since state laws and procedures vary widely. According to The Washington Post, federal asset forfeiture in 2014 accounted for over $5 billion going into Justice and Treasury Department coffers, while in comparison, official statistics show that the amount stolen from citizens by burglars during that same year was a mere $3.5 billion.[32]

Methods

Civil forfeiture begins when government suspects that a property is connected with illegal drug activity, and files a civil action:[22]

The government simply files a civil action in rem against the property itself, and then generally must prove, by a preponderance of the evidence, that the property is forfeitable under the applicable forfeiture statute. Civil forfeiture is independent of any criminal case, and because of this, the forfeiture action may be filed before indictment, after indictment, or even if there is no indictment. Likewise, civil forfeiture may be sought in cases in which the owner is criminally acquitted of the underlying crimes …

— Craig Gaumer, Assistant United States Attorney, 2007[22]

Properties that can be confiscated include real estate property such as a house or motel, cars, cash, jewelry, boats, and almost anything[15] suspected of being related to the manufacture and sale and transportation of illegal controlled substances, such as:

  1. controlled substances[22]
  2. raw materials needed to make them[22]
  3. containers to hold them[22]
  4. vehicles to transport them[22]
  5. information for manufacture and distribution, such as books, records, and formulas[22]
  6. money and other valuables “used or intended to be used” to buy or sell them[22]
  7. property facilitating illegal transactions[22]
  8. chemicals needed to make them[22]
  9. machines for making capsules and tablets[22]
  10. drug paraphernalia[22]
  11. firearms[22]

Traffic stops

A motorist stopped by police in Tennessee.

In a civil forfeiture case in the United States, the state is the plaintiff and a thing is the defendant—in this case, the thing is $25,180 cash that was seized by police under suspicion of being involved in illegal activity. In legal terms, it is an in rem case (against a thing) as opposed to an in personam case (against a person). Here is the docket for a real case that happened after police seized money.

From 2006 to 2008, currency deposits alone exceeded $1 billion for each year. Source: the Institute for Justice[33]

One method of intercepting funds is by highway interdictions, typically along highway routes suspected to be used regularly by drug smugglers, often between Mexico and the United States.

News media have reported many examples:

  • Mandrel Stuart was not charged with a crime and there was no evidence of illegal activity but police seized his money because they assumed it was drug-related:[34]

    Mandrel Stuart and his girlfriend were on a date driving on Interstate 66 … The traffic stop on that balmy afternoon in August 2012 was the beginning of a dizzying encounter that would leave Stuart shaken and wondering whether he had been singled out because he was black and had a police record. Over the next two hours, he would be detained without charges, handcuffed and taken to a nearby police station … stripped of $17,550 in cash … earned through … a small barbecue restaurant … he was going to use the money that night for supplies and equipment.

    — report in The Washington Post, 2014[34]
  • Javier Gonzalez was carrying $10,000 cash in a briefcase and got pulled over in Texas; deputies handed Gonzalez a waiver, that if he signed over the money and did not claim it later, he would not be arrested, but if he refused to sign the waiver, Gonzalez would be arrested for money-laundering.[17] Gonzalez signed the waiver wondering if the officers were real “officers of law” and wondering if he got robbed, but later sued the county, which lost, and returned his cash plus paid him $110,000 in damages plus attorney’s fees.[17]
  • Matt Lee of Clare, Michigan, was driving to California with $2,500 cash when pulled over by police in Nevada, who seized almost all of the cash under suspicion that it was a “drug run”; Lee hired an attorney who took half as his fee, leaving Lee with only $1130 remaining.[34]

    I just couldn’t believe that police could do that to anyone … It’s like they are at war with innocent people.

    — Matt Lee, interviewed in The Washington Post, 2013[34]
  • Tan Nguyen. In 2008, a federal judge ordered $50,000 returned to a man after police seized the money during a traffic stop in Nebraska, after reviewing a recording of the seizure in which a sheriff’s deputy suggested that we “take his money and, um, count it as a drug seizure”.[15] Tan Nguyen’s $50,000 was confiscated by police during a traffic stop, and the county agreed to return the funds after a legal challenge.[35]
  • In May 2010 a couple was driving from New York to Florida and they were stopped by police because of a cracked windshield.[34] During questioning, the officer decided that $32,000 cash in the van was “probably involved in criminal or drug-related activity”, seized it, shared it with federal authorities under equitable sharing.[34] The victim hired a lawyer to get back the seized money who urged settling for half of the seized amount, and after the lawyer’s fees, the victim got back only $7,000.[34]
  • A 2013 The New Yorker piece detailed abuses in Tenaha, Texas, where police would target out-of-state drivers using rental cars, often not issuing traffic tickets, and disproportionately pulling over African Americans and Latino-Americans.[9] Police sometimes ask stopped motorists to sign “roadside property waivers”, which, unless signed, threaten criminal charges unless valuables are handed over; the waivers say, in effect, that victims will not contest the seizure in exchange for not being arrested.[9]

If a passing motorist does not sign a waiver and it becomes recorded as a legal case, the case names are often unusual.[9] In a civil forfeiture case, the asset itself is listed as the “defendant”.[15] For example, one case was titled State of Texas v. One Gold Crucifix, based on a traffic stop in which a woman was pulled over, no charges were filed, but this item of jewelry was seized.[9] Another case name was United States v. $35,651.11 in U.S. Currency.[30]

The Washington Post analyzed 400 seizures in 17 states that were examples of equitable sharing arrangements.[34] Police stop motorists under the pretext of a minor traffic infraction, and “analyze” the intentions of motorists by assessing nervousness, and request permission to search the vehicle without a warrant; however, of the 400 seizures studied by The Washington Post, police did not make any arrests.[34]

Other cash seizures

Cash has been seized in peculiar circumstances. For example, New York businessman James Lieto’s $392,000 in cash was seized by federal authorities, since his legitimate funds mixed up with illegal funds in an armored car that was seized by an FBI probe.[15] Lieto had to wait until the government’s criminal case was finished before he could get his money back, which took considerable time, and caused considerable financial hardship and stress.[15]

Police have broken into homes. In March 2012, in the middle of the night, without a warrant, New York City police burst into the home of Gerald Bryan, ransacked his belongings, ripped out light fixtures, arrested him, and seized $4,800 of his cash, but after a year, the case against him was dropped.[10] When Bryan tried to get back his money, he was told it was “too late” since the money had already been put into the police pension fund.[10] Victims of forfeiture often find themselves faced with fighting in a “labyrinthine” procedure to get their money back.[10]

In May, 2013, IRS agents seized $32,821 from the account of a restaurant owner in Arnolds Park, Iowa, on suspicion of tax evasion,[36] but the seizure was contested by lawyers from the Institute for Justice.[37][38]

The IRS is increasingly taking money from legitimate businesspeople who … run an honest cash business and make frequent cash deposits … The government doesn’t allege that she evaded taxes. The government doesn’t allege that she was depositing money from an illicit source. She’s simply depositing her own lawfully-earned money … that she gets from customers in her restaurant …

— Institute for Justice attorney Larry Salzman, 2014[37]

The U.S. Drug Enforcement Administration has been seizing cash from passengers on domestic flights. Agents seized $209 million in cash from travelers at the 15 busiest airports from 2006 to 2016, according to an investigation by USA Today.[39] Agents seized $82,373 from a passenger, transporting her father’s life savings, while boarding a domestic flight, despite any indication of criminal activity or drug use or charges, leading to a lawsuit to get the funds returned.[39]

Seizures of real estate

Prosecutors threatened to seize a motel, similar to this one owned by the Caswell family, when there was illegal drug use on the premises in Chelmsford, Massachusetts.

Police can seize not only cash from cars but real estate such as a person’s home. For example, homes have been seized even if someone other than the homeowner on the premises committed drug crimes without the owner’s awareness.[10] If the IRS suspects that property is involved with crime, or has been produced as a result of crime, then it has a pretext with which to seize it.[30] From 2010 to 2013, two motel owners were under constant threat of their property being seized after there were incidents of drug selling on the motel premises.[2] A judge ruled in 2013 that the owners could keep their motel since the owners did not know about the illegal activity and took all reasonable steps to prevent it.[2]

I’d like to see this law done away with, or heavily modified … This law, where you are presumed guilty and have to prove yourself innocent, is completely backward from any other law I’ve ever heard of. It’s hard to believe the government has that kind of power. It’s ridiculous. Prosecutors abuse it, and the average person can’t afford to fight it.

— Russell Caswell, motel owner, 2013[2]

Police seized a house on the pretext that it was being used for selling drugs, after a couple’s son was arrested for selling $40 worth of illegal drugs.[12] In another case, homeowners Carl and Mary Shelden sold their house to a man who was later convicted of fraud, but because of the real estate transaction, the Sheldens got caught up in a 10-year legal battle that left them “virtually bankrupt”; after years, they finally got back their house but it was in badly damaged condition; the Sheldens had done nothing wrong.[13]

Seizures of vehicles

In Detroit, men suspected of hiring prostitutes had their automobiles seized.[10][13] An owner’s sailboat was taken after he was caught with a negligible amount of marijuana.[13] Members of the Bergen County Prosecutor’s Office were charged with fraud after knowingly selling counterfeit goods at an asset forfeiture auction.[40]

Seizures of firearms

Five states (CaliforniaConnecticutIndianaNew York, and Oregon) have statutes that allow law enforcement officials to seize a person’s firearms without a warrant or court order if there is probable cause the individual is mentally unstable or may use the weapons to commit a crime. The weapons are to be held in the custody of the law enforcement agency until the case against the individual is dispositioned in a court of law; or the weapons must be returned to the owner if no criminal charges are filed within the timeframe specified by law. In practice, some law enforcement agencies in these states have been known to either sell or destroy seized firearms without compensating the owner after the legal matter that led to the initial seizure has been settled.[citation needed]

Seizures of funds in a bank account

The government can seize money directly from a bank account. One way this happens is when there are large numbers of cash deposits that government investigators suspect are structured as a way to avoid deposits exceeding $10,000, since deposits greater than that amount must be reported to the federal government. But it can happen that legitimate businesses have regular large deposits of cash. In one instance, the Internal Revenue Service waited for large deposits to be placed into an owner’s bank account, and then forced the bank by legal means to surrender it to the agency by means of a secret warrant;[30] authorities took $135,000 from Michigan restaurant owners, named the Cheung family, who made cash deposits from their Chinese restaurant.[29] In another instance, a businessman in New Jersey made repeated cash deposits to save for purchasing a house; each payment was below the $10,000 threshold for reporting to the government, but there were 21 deposits over a period of four months, which caused government to suspect that criminal activity was involved; as a result, the IRS seized $157,000 and the businessman was forced to hire an attorney to get his funds returned.[15] Officials seized $35,000 from the bank account of a grocery store “without any warning or explanation” in 2013.[29]

Contested seizures

After police and authorities have possession of cash or other seized property, there are two ways in which the seized assets become permanently theirs: first, if a prosecutor can prove that seized assets were connected to criminal activity in a courtroom, or second, if nobody tries to claim the seized assets.[41] What happens in many instances is that the assets revert to police ownership by default. If a victim challenges the seizure, prosecutors sometimes offer to return half of the seized funds as part of a deal in exchange for not suing.[17] Sometimes police, challenged by lawyers or by victims, volunteer to return all of the money provided that the victim promises not to sue police or prosecutors; according to The Washington Post, many victims sign simply to get some or all of their money back.[34] Victims often have “long legal struggles to get their money back”.[34] One estimate was that only one percent of federally taken property is ever returned to their former owners.[42]

Statistics

Asset forfeitures selected years
Year Total forfeitures Notes
1986 $93.7 million DOJ’s Asset
Forfeiture Fund
[8]
2004 $567 million [3]
2005 $1.25 billion [15]
2007 $1.58 billion [11]
2008 $1.6 billion DOJ Asset Forfeiture
fund
 took in
$1 billion
[3][8]
2010 $2.50 billion [15][15]

Statistical evidence suggests a strong upward trend in recent years towards greater seizure activity. In 1986, the Department of Justice’s Asset Forfeiture Fund took in $93.7 million; in 2008, it took in $1 billion.[8] Much of this growth happened in the past decade; one analysis suggested that seizures had grown 600 percent from 2002 to 2012.[42] From 2005 to 2010, government seizures of assets from both criminals as well as innocent citizens went from $1.25 billion to $2.50 billion.[15] Federal authorities seized over $4 billion in 2013 through forfeiture, with some of the money being taken from innocent victims.[29] In 2010, there were 15,000 cases of forfeitures.[15] Over 12 years, agencies have taken $20 billion in cash, securities, other property from drug bosses and Wall Street tycoons as well as “ordinary Americans who have not committed crimes”.[42] One estimate was that in 85% of civil forfeiture instances, the property owner was never charged with a crime.[10] In 2010, there were 11,000 noncriminal forfeiture cases.[15] In 2010, claimants challenged 1,800 civil forfeiture seizures in federal court.[15]

States

Standards of proof in state forfeiture laws
Source: Institute for Justice[43]
Note: “9” means most protection for citizens
State Standard Rank
Alabama Prima facie/Probable cause 1
Alaska Prima facie/Probable cause 1
Delaware Prima facie/Probable cause 1
Massachusetts Prima facie/Probable cause 1
Missouri Prima facie/Probable cause 1
Rhode Island Prima facie/Probable cause 1
South Carolina Prima facie/Probable cause 1
Wyoming Prima facie/Probable cause 1
Georgia Probable cause/Preponderance 2
North Dakota Probable cause/Preponderance 2
South Dakota Probable cause/Preponderance 2
Washington Probable cause/Preponderance 2
Arizona Preponderance 3
Arkansas Preponderance 3
Hawaii Preponderance 3
Idaho Preponderance 3
Illinois Preponderance[44] 3
Indiana Preponderance 3
Iowa Preponderance 3
Kansas Preponderance 3
Louisiana Preponderance 3
Maine Preponderance 3
Maryland Preponderance 3
Michigan Preponderance 3
Mississippi Preponderance 3
New Hampshire Preponderance 3
New Jersey Preponderance 3
Oklahoma Preponderance 3
Pennsylvania Preponderance 3
Tennessee Preponderance 3
Texas Preponderance 3
Virginia Preponderance 3
West Virginia Preponderance 3
Kentucky Preponderance
Clear & convincing
4
New York Preponderance
Clear & convincing
4
Oregon Preponderance
Clear & convincing
4
Colorado Clear & convincing 5
Minnesota Clear & convincing 5
Nevada Clear & convincing 5
Ohio Clear & convincing 5
Utah Clear & convincing 5
Vermont Clear & convincing 5
California Clear & convincing
Beyond a reasonable doubt
6
Wisconsin Preponderance of the Evidence (greater weight of the credible evidence).
Florida Beyond a reasonable doubt[45] 7
Connecticut Criminal conviction
required before seizure[46]
8
North Carolina Criminal conviction
required before seizure[47]
8
Montana Criminal conviction
required before seizure[48]
8
Nebraska Criminal conviction required
before seizure[49]
9
New Mexico Abolished[48] 9

Civil forfeiture varies greatly state by state. An analysis by Sarah Stillman in The New Yorker suggested that states that place seized funds in neutral accounts, such as MaineMissouri (which puts seized funds in accounts for public education), North Dakota, and Vermont, have been much less likely to have major scandals involving forfeiture abuse.[9] States like Texas and Virginia and Georgia, which have few restrictions on how police use the seized funds have had more scandals, as have states that allow the Equitable sharing program. With Equitable Sharing, state police can “skirt state restrictions on the use of funds”, according to Stillman.[9] In Florida, using Equitable Sharing, the small village of Bal Harbour raked in at least $71.5 million in three years by its vice squad by carrying out an undercover money laundering sting operation, but in the end, made no arrests.[9] In 2019, Arkansas enacted a new law that requires felony conviction before forfeiture of related assets with few exceptions.[50]

Florida
Allows Equitable sharing between state and federal agencies.[9]
Georgia
There are few restrictions on how police use seized assets.[9] Georgia investigators found more than $700,000 in “questionable expenses” by Camden County’s sheriff between 2004 and 2008, including a $90,000 Dodge Viper and a $79,000 boat.[14]
Maine
Seized funds go into neutral accounts.[9]
Maryland
In Maryland, police forfeitures were $6 million in 2012 and $2.8 million in 2013.[41]
Minnesota
Minnesota passed a law in 2014 forbidding authorities from confiscating a suspect’s property unless they have been convicted of a crime or plead guilty to committing it.[51]
Missouri
Seized funds go into accounts earmarked for public education.[9]
Montana
In June 2015, governor Steve Bullock signed a law requiring authorities to first get a criminal conviction before seizing property through civil forfeiture.[48]
Nebraska
State civil forfeiture standard was beyond a reasonable doubt[8] but in 2016 it was changed to require a criminal conviction first before any assets could be seized.[49]
Nevada
There were allegations that Nevada police unlawfully took tens of thousands of dollars from motorists.[35]
New Mexico
Government took $800,000 from a used car dealer in Albuquerque, New Mexico, and held his money for many months before giving it back, but the seizure had an adverse effect on his business and on the owner’s health.[29] In 2015, New Mexico Governor Susana Martinez signed a bill into law making Civil Forfeiture illegal in New Mexico. The prohibition does not apply to property directly connected to the commission of a crime (e.g., money or property obtained through drug trafficking, or stolen property)[48][52]
New York
New York City ransacked a home, seized cash, but it was later returned.[10]
North Carolina
Abolished civil forfeiture almost entirely.[47]
North Dakota
Seized funds go into neutral accounts.[9]
Oklahoma
Seized funds or property are forfeited if any connection to any drug crime is proved by a preponderance of the evidence. Once forfeited, the seizing agency can keep and use the funds largely at its discretion. Due to the lack of any state reporting or centralized accounting, no accurate total of seizures is available, but estimates tend to run in the tens of millions each year, much from known drug trafficking corridors such as Interstate 40.[53] Notable abuses of forfeiture funds include prosecutors paying off student loans and living in seized houses rent free.[54]
Pennsylvania
In Philadelphia, it is often the homes of African-Americans and Hispanics who are targeted by civil forfeiture abuses; what happens in many instances is that a child or grandchild who doesn’t own the home is nabbed on a drug-related offense, and police use this as a pretext to seize the entire home.[9] In Philadelphia, authorities made thousands of “small-dollar seizures”; in 2010, the city filed 8,000 forfeiture cases, which amounted to $550 for the average take.[12] From 2002 to 2012, Philadelphia seized $64 million by means of its forfeiture program, a total that was more than that seized by Brooklyn and Los Angeles combined.[12]
Texas
In Texas, in Jim Wells County, authorities seized more than $1.5 million during a four-year period mostly off of U.S. Route 281, described as a “prime smuggling route for drugs going north and money coming south”.[17] Seized cash is a third of the budget of the sheriff’s department, allowing it to buy more equipment, high-powered rifles, and police vehicles.[17] There are few restrictions on how police use seized funds.[9] In some counties in Texas, 40% of police revenue comes from forfeitures.[9] Texas, with many smuggling corridors to Mexico, and police seized $125 million in 2007.[3]
Vermont
Seized funds go into neutral accounts.[9]
Virginia
Few restrictions on how police use seized assets.[9]
Washington, D.C.
Victims seeking to get their seized property back in Washington, D.C., may be charged up to $2500 for the right to challenge a police seizure in court, and it can take months or years for a decision to finally happen.[9]
Wisconsin
State civil forfeiture standard is preponderance of the evidence (Wis Stat sec. 961.555(3).

Controversy

Civil forfeiture has generated substantial controversy.

Proponents

FBI special agent Douglas Leff argues that civil forfeiture is a necessary tool for law enforcement to combat money laundering by criminal operatives.

Proponents argue that civil forfeiture tactics are necessary to help police fight serious crime.[42] It is seen as a vital and powerful weapon in the continuing battle against illegal drugs,[13][26] and effective at discouraging criminal activity.[15][30] It makes it easier for law enforcement to fight organized crime when they had trouble imprisoning offenders, since they could deprive them of their property and income when it is much harder to prove their guilt in a court of law.[10]

Prosecutors choose civil forfeiture not because of the standard of proof, but because it is often the only way to confiscate the instrumentalities of crime. The alternative, criminal forfeiture, requires a criminal trial and a conviction. Without civil forfeiture, we could not confiscate the assets of drug cartels whose leaders remain beyond the reach of United States extradition laws and who cannot be brought to trial. Moreover, criminal forfeiture reaches only a defendant’s own property. Without civil forfeiture, an airplane used to smuggle drugs could not be seized, even if the pilot was arrested, because the pilot invariably is not the owner of the plane. Nor could law enforcement agencies confiscate cash carried by a drug courier who doesn’t own it, or a building turned into a “crack house” by tenants with the knowing approval of the landlord.

— Gerald E. Mcdowell Chief, Asset Forfeiture & Money Laundering Section, Dept. of Justice, 1996, writing in The New York Times[26]

The head of the asset forfeiture section of the Department of Justice said that civil forfeiture of cash from innocents was insignificant compared to the “thousands of traffic stops” that bust major drug money couriers.[17]

What’s troubling to you? That a drug trafficker who’s bringing money from the U.S. to Mexico, who’s carrying hundreds of thousands of millions of dollars in cash in their pickup truck, who just sold dope and crack and cocaine to children in your playgrounds, and his money is being taken away? That troubles you?

— Richard Weber, US Justice Department, 2008[17]

Police used civil forfeiture laws to help return swindled funds to their owners. Photo: Convicted swindler Bernard Madoff.

Civil forfeiture has been used to restore money stolen by fraud and other schemes by corrupt politicians.[55] Civil forfeiture targets cybercrime, fraud, and scams in high finance at Wall Street, and money-laundering on a global scale.[42] It enables police to have sufficient power to “return money to crime victims” in instances of swindling or fraud.[15] Civil forfeiture laws were helpful in enabling authorities to seize and return swindled funds by the Bernard Madoff fraud.[15]

Proponents argue that government has sufficient safeguards in place so that individuals can challenge seizures if the need arises.[17] Justice William H. Rehnquist said in a Supreme Court decision that federal forfeiture in drug-related cases was not a punishment but served nonpunitive purposes such as encouraging people to be careful that their property was not used illegally.[16] A lobbyist for the Maryland State Police named Thomas Williams argued that bills to require police to keep better records of seized property would cost law enforcement more time and money, and that trying to track seizures by multi-agency task forces would not be easy.[41] Proponents say that when claimants contest the seizures, they rarely win back their money, suggesting that the “system is working properly”.[15] Proponents say the system is monitored to make sure seizures are properly done.[15] In addition, the funds enable police forces to equip themselves further for more effective crime prevention; for example, a $3.8 million drug bust let officers equip their cars with $1,700 video cameras and heat-sensing equipment for a seven-member force.[13]

Critics

Critics include citizens, defense attorneys, and advocates for civil rights.[13] They point to serious instances of abuse in which innocent owners have been victimized.[42] Critics are from both sides of the political spectrum, from left-leaning groups such as the American Civil Liberties Union and right-leaning groups such as The Heritage Foundation.[15] The main criticisms of civil forfeiture proceedings are as follows:

  • Flawed judicial process. Critics suggest that civil forfeitures are mostly “devoid of due process”.[30] Arguments have been made that the seizures violate the Due Process Clause of the Constitution since owners have few means to challenge the seizures.[51] They see some seizures as assaults against individual rights.[29] Critics argue that criminals are treated better in the courts than innocent owners who have property seized, since criminals are often told they have a right to an attorney, and that the beyond a reasonable doubt standard of proof is much higher in criminal trials than in civil trials.[30] Burden of proof is shifted to victims to prove innocence.[8] Victims of civil forfeiture are considered guilty until proven innocent, thereby turning the principle of innocent until proven guilty on its head.[12][29][30] Because it is part of the civil justice system, there are no attorneys provided for defendants as can happen in some criminal trials; people who can not afford an attorney have slim chances of recovering their property.[12] Most cases are never heard by a jury or judge since victims are unable to fight the seizures by hiring a lawyer.[29] In contrast to principles of open justice, seizures are often done through sealed documents with a lack of transparency.[42] Clinical law professor Louis Rulli of the University of Pennsylvania said that a piece of property does not have the same rights as a human: no right to an attorney, no presumption of innocence.[9]
  • Excessive punishment. Justice John Paul Stevens said in a single dissenting vote in 1996 that civil forfeiture of a house, in which marijuana had been illegally processed, was an example of an excessive fine, and a violation of the Eighth Amendment, although the majority of the court disagreed.[16]

Critics contend that the lure of cash tempts police towards subverting the rules for personal gain.

  • Motivates police misbehavior. Critics contend that the system is set up in a way as to incentivize “perverse behavior” by “predatory government agencies”.[30] It makes it possible for government officials to seize property such as cash, vehicles, houses, and jewelry from people without ever convicting them for wrongdoing in a court or even charging them with a crime.[29] The cash and assets are a major temptation for police to presume that activity is illegal. Critics say the huge amount of money involved have a distorting effect on police, such that they are more interested in seizing cash rather than illegal drugs.[3] Seized assets can be used for police office expenses, new equipment, vehicles.[3] The profit motive, in which police can keep 90% or more of profits, “forms the rotten core of forfeiture abuse”.[8] Prosecutors and police have a strong incentive to seize property since the funds can be used to pay expenses of the District Attorney’s office, including salaries. Over a ten-year period, the forfeiture money collected was $25 million in Philadelphia, with seized funds being used to pay salaries for people working in the District Attorney’s office.[12] When funds are returned to the victim, it can happen that the funds come out of taxpayer money, not out of police funds such as a pension fund.[10] Seized amounts of money have gone for new police equipment, parties, travel expenses, training seminars, sometimes held in distant locations such as Las Vegas or Hawaii.[10] A Texas prosecutor used $25,000 in seized cash to take his office staff including spouses and a judge on a vacation to Hawaii.[10] There are no penalties for wrongful seizures, particularly when taxpayers pay when ill-gotten gains from innocent citizens must be returned, so there is an incentive to “find” a drug-related issue when police come across cash.[10] The incentives work against police seizing drugs but push them to seize cash instead:

If a cop stops a car going north with a trunk full of cocaine, that makes great press coverage, makes a great photo. Then they destroy the cocaine … If they catch ’em going south with a suitcase full of cash, the police department just paid for its budget for the year.

— Jack Fishman, former IRS agent, criminal defense attorney, 2008[3]
  • Innocent owners ensnared. Critics argue that innocent owners suffer emotionally and financially.[34]
  • Difficult to challenge seizures. The process forces property owners with limited financial abilities to have to hire attorneys and take time and money simply to “prove their innocence”.[30] Victims must actively fight to recover their seized property; if they do nothing, or wait, then they will lose everything.[30] If victims do not seek help from sympathetic lawyers such as those of the Institute for Justice, they can sometimes be offered to have a fraction of their property returned as part of a deal; critics have described the IRS as “bullies” practicing “extortion” against innocent citizens.[30] Procedures to get money back are often fraught with difficulty.[10] Retrieving seized property can be a “bureaucratic nightmare” where victims meet not with a judge or jury but with a prosecutor.[12]
  • Arbitrary punishments. Critics suggest that civil forfeitures can be arbitrary, varying significantly from one case to another; for example, Alan Finder in The New York Times wondered whether it was “fair that one driver loses a car worth $45,000 and another loses one worth $700?”, if each situation resulted from drunk driving arrests.[7]
  • Unfairly targets poor and politically weak persons. Many victims of civil forfeiture are “poor and politically weak” and unable to mount a sustained battle in the courts to get their property returned.[51]
  • Subverts state law. Local and state police often cooperate with federal authorities in what has been called equitable sharing agreements.[14] Since many states have laws restricting or limiting civil forfeitures, as well as requiring higher standards of proof before property can be taken, local police can sidestep these rules by treating the suspected criminal activity as a federal crime, and bringing in federal authorities.[14] As a result, after the seizure, local and federal agencies share the proceeds with 10% to 20% of it going to the federal agency and the remainder to the local police force.[14] Accordingly, equitable sharing “effectively subverts the will and intent of the state legislatures” and has been criticized by prominent civil rights attorney and property rights advocate Scott Bullock as being a “complete violation” of the principle of federalism.[14]
  • Extent of abuse. Proponents and critics differ about the extent of cases in which innocent persons had their property seized. Proponents argue that the cases are few in number, while critics contend that many instances of abuse happen without awareness by the public as a result of the signing of waivers, victims not challenging seizures for lack of knowledge, and other reasons related to a general lack of judicial transparency. The Baltimore Sun made reports that in 2012, half of victims with seized assets were not convicted of a crime.[41]

Efforts at reform

Comedian and political commentator John Oliver did a sixteen-minute segment on his show Last Week Tonight in 2014 discussing civil forfeiture.

There have been numerous reports in the media about systemic abuse of civil forfeiture. USA Today described it as “an increasingly common—and utterly outrageous—practice that can amount to legalized theft by police”.[56] Reporter Sarah Stillman writing in The New Yorker interviewed numerous police officers, lawyers, prosecutors, justices and plaintiffs around the United States and found that many had reservations that innocent Americans were being abused.[9] The New Yorker published a “sprawling investigation” about how cities abuse civil forfeiture to “bolster their cash-strapped coffers by seizing the assets of the poor, often on trumped up charges”.[10] Comedian John Oliver devoted a presentation to a satirical exposure of civil forfeiture in 2014.

Organizations working for reform, as well as helping individual victims, include the Institute for Justice, a libertarian nonprofit law firm in Washington, D.C., which works to end civil forfeiture abuse.[30] It has helped numerous clients recover property seized by the government.[30] The Institute of Justice is helping one forfeiture victim sue the federal district court as well as the mayor, district attorney, and police commissioner in Philadelphia.[12] Scott Bullock, senior attorney at the Institute for Justice, advocates that civil forfeiture should be abolished except for use in enforcing maritime and customs laws, and require that any seizures be linked to criminal convictions of specific people.[57] If that is not possible, Bullock recommends that seized revenues be placed in neutral funds such as drug treatment efforts, that standards of proof for law enforcement be raised to ensure that police provide “clear and convincing evidence” of wrongdoing, that the burden of proof should be moved to government to prove wrongdoing, that seized assets should be tracked such that information is easily accessible by the public, and that the equitable sharing arrangement be abolished.[57] Sometimes victims turn to the American Civil Liberties Union (ACLU) for legal assistance in winning back their seized property.[42]

There has been opposition to civil forfeiture in some lower courts.[16] There have been attempts by lawmakers to introduce legislation to prevent abuses based on civil forfeiture procedures; one proposal was to raise the standard of proof necessary before property could be seized, and require government to prove that an owner of property was involved in an illegal criminal activity before such seizures could happen.[14] There have been class action lawsuits against authorities, such as one in East Texas by black and Latino drivers; the suit alleges that police took $3 million from 2006 to 2008 in 140 separate incidents.[35] One reform effort is to require authorities to keep better records about seized assets.[41]

In 2015, the New Mexico legislature outlawed civil forfeiture.[52] Also in 2015 a number of criminal justice reformers, including the Koch family foundations and the ACLU, announced plans to advocate the reduction of asset forfeitures due to the disproportionate penalty it places on low-income wrongdoers; the forfeiture of private property in such cases often results in the deprivation of the majority of an individual’s wealth.[58]

As civil forfeiture may not be allowed a new practice has emerged. By classifying valuables such as cars, cellphones, and wallets with cash as evidence the police can keep them and by making it very difficult and time consuming to get them back. After 120 days the police can sell the items.[59]

Marijuana legalization and forfeiture

The Drug Enforcement Administration (DEA) has been using civil forfeiture as one way of funding their efforts to combat the use of illegal drugs, including marijuana, which continues to be illegal to possess under Federal law as of 2019.[60][61] According to government figures, the DEA collected $18 million in 2013 as part of its Cannabis Eradication Program.[62] Proponents in favor of legalizing marijuana have objected to this practice, which includes DEA seizures of properties in which marijuana is used and sold. A bill has been proposed in the United States Congress to eliminate this source of funding.[63][64] As more states progress towards legalizing marijuana for medical use and for recreational use, there are more businesses to sell marijuana, sometimes called dispensaries or “weed shops”. A report in The Guardian in 2015 suggested that such shops operated in a “tricky gray zone”, so that even in the 23 states where medicinal cannabis is legal, such dispensaries can be “wiped out by a single visit from law enforcement”.[65] While state law may recognize such establishments as having a legal purpose, federal law does not recognize this, and conflicting interpretations can emerge, which can result in properties being confiscated.[65] It has sparked controversy and, in some instances, public outrage.

See also

References…

https://en.wikipedia.org/wiki/Civil_forfeiture_in_the_United_States

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The Pronk Pops Show 1396, February 11, 2020, Story 1: Divided Democrats Decide New Hampshire’s Radical Extremist Democratic Socialists (REDS) Presidential Candidate in 2020 — The Winner Is Bernie Sanders — Videos– Story 2: Trump Rally in Manchester, New Hampshire Attracts Tens of Thousand — Americans Love A Winner — Videos — Story 3: What Are American Concerned About? Not Climate Change — Videos

Posted on February 12, 2020. Filed under: 2020 Democrat Candidates, 2020 President Candidates, 2020 Republican Candidates, Addiction, Addiction, American History, Amy Klobuchar, Banking System, Bernie Sanders, Bribery, Bribes, Budgetary Policy, Cartoons, Central Intelligence Agency, Climate Change, Clinton Obama Democrat Criminal Conspiracy, Communications, Congress, Constitutional Law, Corruption, Countries, Crime, Culture, Deep State, Defense Spending, Disasters, Donald J. Trump, Donald J. Trump, Donald Trump, Drugs, Economics, Education, Elections, Elizabeth Warren, Empires, Employment, Federal Bureau of Investigation (FBI), Federal Government, Fifth Amendment, Fiscal Policy, Foreign Policy, Fourth Amendment, Fraud, Free Trade, Freedom of Religion, Freedom of Speech, Government, Government Dependency, Government Spending, Health, History, House of Representatives, Human, Human Behavior, Illegal Drugs, Illegal Immigration, Immigration, Impeachment, Independence, Joe Biden, Labor Economics, Language, Law, Legal Drugs, Life, Medicare, Mental Illness, Military Spending, Monetary Policy, National Interest, National Security Agency, News, People, Pete Buttigieg, Philosophy, Photos, Politics, Polls, Progressives, Public Corruption, Public Relations, Radio, Raymond Thomas Pronk, Rule of Law, Second Amendment, Security, Senate, Social Security, Subversion, Surveillance and Spying On American People, Surveillance/Spying, Tax Policy, Taxes, Technology, Trade Policy, Treason, Trump Surveillance/Spying, Unemployment, United States Constitution, United States of America, United States Supreme Court, Videos, Violence, War, Wealth, Welfare Spending, Wisdom | Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |

 

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Story 1: Divided Democrats Decide New Hampshire’s Radical Extremist Democratic Socialist (REDS) Presidential Candidate in 2020 — The Winner Is Bernie Sanders — Videos–

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Left or Liberal?

The Left Ruins Everything

Left but Really Right

Every American Needs To Hear This Speech

‘We’ve got this.’ New Hampshire state officials promise no repeat of Iowa caucus chaos as state holds first in the nation election

  • New Hampshire votes on Tuesday with polls closing at 8 p.m. ET
  • Amy Klobuchar won two of first three small towns that start voting at midnight
  • Candidates are making their closing arguments
  • Bernie Sanders leads in polls
  • Pete Buttigieg is searching for a win
  • Joe Biden is looking ahead to next round of voting in Nevada and South Carolina
  • Officials expect a victor Tuesday night – unlike Iowa caucuses 
  • ‘We’ve got this. We know what we’re doing here,’ Dem chair Ray Buckley said 

Democrats are expected to have a winner Tuesday night after a tumulus start in their presidential primary process and officials hope a victor here offers some clarity on who the party will ultimately name to take on President Donald Trump in November.

‘We’ve got this. We know what we’re doing here. The only way it will last that long if the numbers are so close we have a virtual tie,’ New Hampshire Democratic Party chair Ray Buckley told reporters on a phone call Monday.

‘Everything here is paper ballot. Nothing is connected to the internet. The ballots are immediately impounded by the state police. There is just no question for anyone to have any fear,’ he added.

Amy Klobuchar visits a polling stop in Manchester

Elizabeth Warren brings donuts to a polling site Portsmouth

Small New Hampshire town votes for Bloomberg in primary

Polls close at 8 p.m. ET. Unlike Iowa, where party officials and volunteers run the caucuses, state officials run the New Hampshire primary. Both Republicans and Democrats are voting on Tuesday.

The real contest is among the Democrats, however, as President Trump is expected to win the Republican primary.

But one Democratic winner doesn’t mean the party will have their nomination all wrapped and ready to take on the president, who held a rally in Manchester Monday night to taunt his political rivals.

No single candidate has yet united the Democrats nationally and the current field of contenders represent all corners of the party: young, old, moderate, liberal, pragmatic, hopeful.

And where the candidates enter the field on Tuesday may not be where they exit.

Bernie Sanders held his final campaign rally with Alexandria Ocasio-Cortez Monday night

Bernie Sanders held his final campaign rally with Alexandria Ocasio-Cortez Monday night

Bernie Sanders: The leader in the New Hampshire polls, Sanders wants the victory. He won the 2016 Democratic primary in New Hampshire but lost the nomination that year to Hillary Clinton. He and Pete Buttigieg are fighting over who came out on top in the Iowa caucuses (Buttigieg picked up the most delegates and Sanders is asking for a recanvass). He needs a clear cut New Hampshire victory to boost him to finish what he couldn’t in the last presidential cycle.

‘If we win here tomorrow, I think we’ve got a path to victory for the Democratic nomination,’ the Vermont senator told supporters at one of his rallies on Monday.

He closed out his campaigning Monday evening with over 7,500 attendees with Rep. Alexandria Ocasio-Cortez and a performance by The Strokes.

Pete Buttigieg: Buttigieg touted himself the front runner after Iowa’s caucus debacle but now he needs to show he comes out on top when all the votes are counted. The youngest candidate in the field, he’s come under attack for his lack of experience but has argued his ability to bring out support makes up for never having held national office.

Pete Buttigieg walks and N.H. Rep. Annie Kuster while carrying doughnuts to a poling station in Hopkinton

Pete Buttigieg walks and N.H. Rep. Annie Kuster while carrying doughnuts to a poling station in Hopkinton

‘It feels good out here,’ he told reporters on Monday.

He fell behind Sanders in the latest round of New Hampshire polls and started to down play a victory in the state in its final hours.

‘Look we are competing against home region competition, two New England senators I recognize that, but I still think we’re going to have a great night,’ he told NBC News in an interview that aired on the ‘Today’ show Tuesday morning, referring to Sanders and Elizabeth Warren.

Warren promises to continue fighting ahead of NH primary

But the former mayor was up and out early Tuesday morning, bringing donuts to a polling place in Hopkinton and appearing on MSNBC’s ‘Morning Joe.’

Amy Klobuchar changes into more comfortable shoes after a rally

Amy Klobuchar changes into more comfortable shoes after a rally

Amy Klobuchar: A few polls put her in third place going into Tuesday, giving her momentum in the closing hours of the primary. A bronze medal keeps her campaign viable and the cash flowing in. She’s already guaranteed a spot on the Las Vegas debate stage thanks to her coming out of Iowa with one delegate but a third place finish or higher gives her bid a big boost going into the next round of contests in Nevada and South Carolina.

‘I need your help,’ Klobuchar told a rally in Exeter, New Hampshire, her voice breaking as she spoke the words.

‘Right now we are on the cusp of something really great,’ she said, ‘but I can’t call everyone you know. So I’m asking you to do that today.’

The Minnesota senator won two out of the three small northern New Hampshire towns that gather at their polling places at midnight: Hart’s Location and Millsfield.

Joe Biden and Elizabeth Warren: Polls show them tied for fourth, which is particularly troubling for the former vice president. Both candidates spent Monday explaining why their campaigns are viable and both have announced their next round of campaign stops after Tuesday’s vote is counted.

Joe Biden is looking ahead to the next round of contests

The big question mark is money. Do they have the funds to keep their campaigns afloat until they can rack up a primary win? And when will that win come? Nevada and South Carolina are the next two contests. The pressure will be on.

Warren visited her press bus on Monday to give a rare talk about the state of her campaign. The Massachusetts senator doesn’t typically discuss strategy.

‘I just have to keep fighting. That’s, that’s what it’s all about. I cannot say to all those little girls: ‘This got hard and I quit.’ My job is to persist,’ she said.

Biden also lowered expectations for New Hampshire.

Elizabeth Warren told reporters she has to ‘keep fighting’

‘It’s an uphill race here,’ he told CNN Monday night. ‘We’re running against two senators from neighboring states, has never been a good thing to happen to any other candidates going in the race.’

And he emphasized there are more contests to come.

‘The path is South Carolina, and going into Nevada and Super Tuesday,’ he told NBC News.

Andrew Yang: It’s unclear what path forward he has if he doesn’t have a decent showing in New Hampshire, where he invested both time and money heavily early on.

But, on the other end of this round, Michael Bloomberg and his billions are waiting for which ever Democratic contender emerges from the next round of contests in Nevada and South Carolina.

The former New York City mayor skipped the four early contests to focus his time and money on the Super Tuesday states, where a huge chunk of delegates will be awarded.

But, on Tuesday, all eyes are on New Hampshire and officials claim the contest is wide open.

‘This is anyone’s race to win. I still believe that and I truly do,’ Buckley, the Democratic chair, said Monday. ‘We have multiple candidates representing the perspective of all the voters so they all have choices.’

President Trump got into the action Monday with a rally in Manchester where he suggested Republicans could cause some mischief on Tuesday.

‘I hear a lot of Republicans tomorrow will vote for the weakest candidate possible of the Democrats,’ the president said. ‘My only problem is I’m trying to figure out who is their weakest candidate. I think they’re all weak.’

But only registered Democrats and voters not registered with either party can participate in the state’s Democratic presidential primary.

The spectra of the Iowa caucuses – where problems with an app the party developed to count the votes led to a hand count of paper ballots with delayed and questionable results – has haunted New Hampshire.

The candidates have joked that – as opposed to last week’s contest New Hampshire can count – but under the laughter is the fear that even if the state has a winner, there still won’t be a clear front runner for the nomination.

And that is what worries party elders, who are harboring fears by the time a nominee emerges, that person will be so damaged politically it’ll be 2016 all over again when Donald Trump defeated Hillary Clinton.

President Trump held a rally in Manchester Monday night and suggested Republicans could make some mischief

The Strokes performed at a Bernie Sanders rally Monday night

Sanders is leading by 8 points in the RealClearPolitics polling average of New Hampshire polls but the unexpected can happen.

Polls showed a third of New Hampshire voters remain undecided, making the last 24 hours in the state crucial for the candidates ahead of Tuesday’s primary.

Almost half New Hampshire voters – 47 per cent – are independents and tend to pick their candidates late in the process.

Attendance was heavy at rallies for all the candidates in the last 24 hours, indicating voters are still shopping for a contender to support.

New Hampshire Secretary of State Bill Gardner anticipates turn out Tuesday night 420,000 voters, which would be the most votes cast in a presidential primary when an incumbent is running for re-election.

Trump holds first rally after being acquitted in impeachment trial

Patton (1/5) Movie CLIP – Americans Love a Winner (1970) HD

Story 3: What Are American Concerned About? Not Climate Change — Videos

 

Economy outranks other issues among potential 2020 voters, according to new survey

Policy 2020: Unpacking the issues shaping the 2020 election

America’s Biggest Issues: Spending

Jul 21, 2019
Despite their promises to the contrary, every year, politicians continue to spend hundreds of billions of dollars more than the government takes in. And every year, they put it on the national credit card and the bill grows bigger. That bill currently averages $67,000 for every single American. If you’re a family of three, that’s over $200,000. The Heritage Foundation’s Romina Boccia explains how it’s not too late to save the incredible promise that is America. But first, we have to convince leaders to end their runaway spending habits and adopt spending controls. View more: https://www.heritage.org/budget-and-s…

How to Solve America’s Spending Problem

The Bigger the Government…

Why Private Investment Works & Govt. Investment Doesn’t

Social Security Won’t Give You Security

America’s Debt Crisis Explained

America’s Biggest Issues: Health Care

Dec 14, 2018
Most Americans agree that the health care system in the United States is in need of an overhaul. What many are not in agreement on is how best to do it. As we weigh our options, The Heritage Foundation’s Genevieve Wood explains a few basic facts you need to know. View more: https://www.heritage.org/health-care-…

How the Government Made You Fat

What Creates Wealth?

What’s Wrong with Government-Run Healthcare?

America’s Biggest Issues: Education

Jun 23, 2019
American colleges and universities are failing in one of their most basic missions: to equip students with the tools they need for a career. Many students graduate ill-prepared to earn a living and pay off the debt they’ve accumulated getting their degrees. Forty percent of those who start college don’t finish within six years. Additionally, students are often subject to indoctrination into socialist ideology. They face hostility toward opinions that don’t conform to the predominantly leftist thinking on campus. They’re also immersed in identity politics that pit students of different backgrounds against one another. Despite these problems, colleges continue to raise tuition. The Heritage Foundation’s Lindsey Burke explains how to stop the sharp rise in both college tuition and student debt by getting the federal government out of the student loan business. View more: https://www.heritage.org/education/he…

How the Liberal University Hurts the Liberal Student

America’s Biggest Issues: Welfare

Aug 4, 2019

When President Lyndon Johnson launched his War on Poverty in the 1960s, he pledged to eliminate poverty in America. But more than five decades, several welfare programs, and $25 trillion later, the welfare system has largely failed the poor. The Heritage Foundation’s Genevieve Wood explains that the United States currently spends about a trillion dollars a year on over 90 different federal, state, and local welfare programs. Yet around 12 percent of Americans are still considered poor. We are clearly spending a lot of money so why do we still have such a high poverty rate? View more: https://www.heritage.org/poverty-and-…

There Is Only One Way Out of Poverty

America’s Biggest Issues: Immigration

Apr 29, 2019
Immigration is one of the fundamental building blocks that help make America the unique nation that it is. But the debate over border security and immigration has become toxic because politicians have put politics before principles. And reasonable Americans find themselves trapped between zealots on both sides. So what does a thoughtful agenda for American immigration reform look like? The Heritage Foundation’s Genevieve Wood takes us through four guiding principles to keep us focused on what is best for the welfare of all Americans, both those of today and those of the future. View more: https://www.heritage.org/immigration/…

A Nation of Immigrants

America Wants Legal Immigrants

Illegal Immigration: It’s About Power

America’s Biggest Issues: Environment

Jul 7, 2019
In the 1970s, Americans were told we were in a global cooling crisis and if something weren’t done, we’d enter a new ice age. When that didn’t happen, a few decades later we were told that entire nations could be wiped off the face of the Earth by rising sea levels if the global warming trend was not reversed by the year 2000. Despite the consistent failure of these apocalyptic warnings, that hasn’t stopped climate change alarmism. We’re now being told we only have 12 years to combat climate change and the solution is to fundamentally dismantle the system of free enterprise. That means Washington controls things like how we produce our energy, what food we eat and what type of cars we drive. The question is, even if we believed their alarmist, catastrophic predictions, would their proposals work? The Heritage Foundation’s Nick Loris helps dispel some environmental myths, and explains how America can ensure affordable, reliable, and cleaner energy by keeping our economy growing. View more: https://www.heritage.org/environment/…

Can Climate Models Predict Climate Change?

Is Climate Change Our Biggest Problem?

Climate Activists Use Kids to Fuel Hysteria

Is Climate Change an Existential Threat?

You Can’t Fix Other People, But You Can Fix Yourself

Pew Research 2019 survey: ‘Climate Change’ Still Ranks As Low Priority – 17th place out of 18

By:  – Climate DepotFebruary 11, 2020 11:38 AM with 0 comments

Most Important Problem

Climate Change Still Ranks As Low Priority In Polls

by Donna Laframboise

Recently, I reported on a poll that Gallup has conducted in America every month of every year since 2001. Admirably, it makes no attempt to prompt or influence.

It asks people to name the most important problem facing the country, then it records their answers.

If one seeks honest, genuine insight into ordinary people’s lives, that’s a great approach.

Pew Research Center, another American polling outfit, conducts a different kind of survey. For 25 years (from 1994 to 2019 inclusive), it has read members of the public a long list of pre-selected topics in random order. People have been asked to attach a label to each one.

Should it be a ‘top priority’ for the President and Congress this year? Should it be a lower priority? Is it unimportant? Does it deserve no attention at all?

In 2007, Pew added ‘global warming’ to this list of potential top priorities. In 2016, it started calling it ‘climate change’ instead.

Last year, 44% of respondents told Pew that ‘Dealing with global climate change’ should be a top priority.

That sounds significant until you notice thatevery single item on the list received at least 39% support.

In such cases, raw percentages are meaningless. What matters is how a topic ranks compared to its fellows. Those results couldn’t be clearer.

In 2019, climate change ended up in 17th place out of 18.

70% of people said strengthening the economy should be a top priority.

69% said reducing healthcare costs should be.

68% said the education system needs attention.

Those are very strong numbers, involving more than two-thirds of the population. What came next?

4. ‘Defending the country from future terrorist attacks’ – 67%

5. ‘Taking steps to make the Social Security system financially sound’ – 67%

6. ‘Taking steps to make the Medicare system financially sound’ – 67%

7. ‘Dealing with the problems of poor and needy people’ – 60%

8. ‘Protecting the environment’ – 56%

9. ‘Dealing with the issue of immigration’ – 51%

10. ‘Improving the job situation’ – 50%

11. ‘Reducing crime’ – 50%

12. ‘Dealing with drug addiction’ – 49%

13. ‘Reducing the budget deficit’ – 48%

14. ‘Addressing race relations in this country’ – 46%

15. ‘Strengthening the US military’ – 45%

16. ‘Improving the country’s roads, bridges and public transportation systems’ – 45%

17. ‘Dealing with global climate change’ – 44%

18. ‘Dealing with global trade issues’ – 39%

In other words, another long-running US poll tells us the public’s climate concerns are weak. Ask people if they care about it, and many will say ‘yes.’

But they feel more urgency about a long list of other issues.

‘Dealing with global warming’ ended up in second last place in 2007. Between 2008 and 2013, it ranked last (select a year and then ‘Overall’ here). Here’s what happened after that:

2014: second last

2015 second last

2016 third last (the first year Pew began calling it ‘global climate change’)

2017: second last (see bottom of the page)

2018: second last

2019 second last

Moral of the story: There has never been any evidence that climate change is a top concern for most Americans. This is not a crowd-pleaser or a vote-getter.

https://nofrakkingconsensus.com/2020/02/10/poll-results-climate-is-always-low-priority/

 

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The Pronk Pops Show 1394, February 7, 2020, Story 1: Solid January 2020 Jobs Report: 225,000 New Non-farm Payroll Jobs Created in January and Labor Participation Rate Increased to 63.4% with Over 729,000 New Participants in Labor Force! — Videos — Story 2: U.S. Federal Budgetary Deficits, The National Debt and The Big Four Federal Spending: Social Security, Medicare, Defense and Medicaid — Videos — Story 3: President Trump Answers Big Lie Media Mob Question on Way To North Carolina  — Trump Derangement Syndrome of REDS (Radical Extremist Democratic Socialists) in Congress — Videos

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Story 1: Solid January 2020 Jobs Report: 225,000 New Non-farm Payroll Jobs Created in January and Labor Participation Rate Increased to 63.4% with Over 729,000 New Participants in Labor Force! — Videos —

Alternate Unemployment Charts

The seasonally-adjusted SGS Alternate Unemployment Rate reflects current unemployment reporting methodology adjusted for SGS-estimated long-term discouraged workers, who were defined out of official existence in 1994. That estimate is added to the BLS estimate of U-6 unemployment, which includes short-term discouraged workers.

The U-3 unemployment rate is the monthly headline number. The U-6 unemployment rate is the Bureau of Labor Statistics’ (BLS) broadest unemployment measure, including short-term discouraged and other marginally-attached workers as well as those forced to work part-time because they cannot find full-time employment.

 

Public Commentary on Unemployment

Unemployment Data Series   subcription required(Subscription required.)  View  Download Excel CSV File   Last Updated: February 7th, 2020

The ShadowStats Alternate Unemployment Rate for January 2020 is 21.0%.

http://www.shadowstats.com/alternate_data/unemployment-charts

Watch five experts break down the January jobs report

Outstanding January job report exceeds expectations with 225K jobs added

Kudlow: The economy is booming and jobs are booming

US economy adds 225,000 jobs in January

Mnuchin: We need to grow the economy faster than government spending

U.S. National Debt Clock

https://www.usdebtclock.org/

Will our national debt doom America?

Keiser Report: Economic Ghouls and Predators (E1498)

Keiser Report: All Rescue Roads Lead to the Elite (E1492)

US budget deficit tops $1 trillion as government spending increasesUS budget deficit tops $1 trillion as government spending increases

]

U.S. CBO Doesn’t Expect Economic Growth to Solve Deficit ‘Problem’

Deficits & Debts: Crash Course Economics #9

Deficits and debt | AP Macroeconomics | Khan Academy

63.4%: Labor Force Participation at Trump-Era High As Labor Force Grows by 574,000

By Susan Jones | February 7, 2020 | 8:03am EST

President Donald Trump never misses an opportunity to plug the strong employment picture for which he takes credit, and today he earned more bragging rights:

The Labor Department’s Bureau of Labor Statistics said the economy created 225,000 in January, well above estimates. BLS says notable job gains occurred in construction, in health care, and in transportation and warehousing.

The number of employed Americans dipped in January to 158,714,000 — down 89,000 from December’s record high.

The unemployment rate ticked up a tenth of a point to 3.6 percent in January.

But the labor force participation rate reached a Trump-era high of 63.4 percent, up from 63.2 percent in December, because the civilian labor force increased by 574,000 in January, after accounting for annual adjustments to population controls, BLS said.*

In January, the civilian non-institutional population in the United States was 259,502,000. That included all people 16 and older who did not live in an institution (such as a prison, nursing home or long-term care facility).

Of that civilian non-institutional population, 164,606,000 were participating in the labor force, meaning that they either had a job or were actively seeking one during the last month. This resulted in a labor force participation rate of 63.4 percent, the highest it’s been since June 2013.

The number of Americans counted as not in the labor force — meaning they did not have a job and were not looking for one — dropped by 442,000 in January (after population control adjustments). This number hovers around 95,000,000, partly because of retiring baby boomers.

Among the major worker groups, the unemployment rates for adult men (3.3 percent), adult women (3.2 percent), teenagers (12.2 percent), Whites (3.1 percent), Blacks (6.0 percent), Asians (3.0 percent), and Hispanics (4.3 percent) showed little or no change over the month.

The change in total nonfarm payroll employment for November was revised up by 5,000 from +256,000 to +261,000, and the change for December was revised up by 2,000 from +145,000 to +147,000. With these revisions, employment gains in November and December combined were 7,000 higher than previously reported.

In January, average hourly earnings for all employees on private nonfarm payrolls rose by 7 cents to $28.44. Over the past 12 months, average hourly earnings have increased by 3.1 percent.

The current economic expansion, now in its 11th year, became the longest in U.S. history on July 1, 2019, beating the previous record that lasted from March 1991 through March 2001.

President Trump bragged about the economy Tuesday night in his State of the Union speech:

In just over two years since the election, we have launched an unprecedented economic boom — a boom that has rarely been seen before.  There’s been nothing like it.  We have created 5.3 million new jobs and, importantly, added 600,000 new manufacturing jobs — something which almost everyone said was impossible to do.  But the fact is, we are just getting started.

Wages are rising at the fastest pace in decades and growing for blue-collar workers, who I promised to fight for.  They’re growing faster than anyone else thought possible.  Nearly 5 million Americans have been lifted off food stamps. The U.S. economy is growing almost twice as fast today as when I took office.  And we are considered, far and away, the hottest economy anywhere in the world.  Not even close.

Unemployment has reached the lowest rate in over half a century. African American, Hispanic American, and Asian American unemployment have all reached their lowest levels ever recorded. Unemployment for Americans with disabilities has also reached an all-time low. More people are working now than at any time in the history of our country — 157 million people at work.

*(BLS explained that the January 2020 data includes updated population estimates developed by the Census Bureau’s household survey. “Each year,” BLS said, “the Census Bureau updates the estimates to reflect new information and assumptions about the growth of the population since the previous decennial census. The change in population reflected in the new estimates results from adjustments for net international migration, updated vital statistics, and estimation methodology improvements.”)

https://cnsnews.com/article/national/susan-jones/634-labor-force-participation-trump-era-high

 

Employment Situation Summary

Transmission of material in this news release is embargoed until		USDL-20-0180
8:30 a.m. (EST) Friday, February 7, 2020

Technical information: 
 Household data:	(202) 691-6378  *  cpsinfo@bls.gov  *  www.bls.gov/cps
 Establishment data:	(202) 691-6555  *  cesinfo@bls.gov  *  www.bls.gov/ces

Media contact:		(202) 691-5902  *  PressOffice@bls.gov


		        THE EMPLOYMENT SITUATION -- JANUARY 2020


Total nonfarm payroll employment rose by 225,000 in January, and the unemployment rate
was little changed at 3.6 percent, the U.S. Bureau of Labor Statistics reported today.
Notable job gains occurred in construction, in health care, and in transportation and
warehousing. 

This news release presents statistics from two monthly surveys. The household survey
measures labor force status, including unemployment, by demographic characteristics.
The establishment survey measures nonfarm employment, hours, and earnings by industry.
For more information about the concepts and statistical methodology used in these two
surveys, see the Technical Note.
		 
 ___________________________________________________________________________________
| 									            |
|                Changes to The Employment Situation Data		            |
|									            |
|   Establishment survey data have been revised as a result of the annual           |
|   benchmarking process and the updating of seasonal adjustment factors. In        |
|   addition, several changes have been made to household survey data, including    |
|   the annual update of population estimates. See the notes at the end of the      |
|   news release for more information.                                              |
|___________________________________________________________________________________|


Household Survey Data

Both the unemployment rate, at 3.6 percent, and the number of unemployed persons, at
5.9 million, changed little in January. (See table A-1. For information about annual
population adjustments to the household survey estimates, see the note at the end of
the news release and tables B and C.)

Among the major worker groups, the unemployment rates for adult men (3.3 percent), 
adult women (3.2 percent), teenagers (12.2 percent), Whites (3.1 percent), Blacks
(6.0 percent), Asians (3.0 percent), and Hispanics (4.3 percent) showed little or
no change over the month. (See tables A-1, A-2, and A-3.)

Among the unemployed, the number of reentrants to the labor force increased by
183,000 in January to 1.8 million but was little changed over the year. (Reentrants
are persons who previously worked but were not in the labor force prior to beginning
their job search.) (See table A-11.)

The number of long-term unemployed (those jobless for 27 weeks or more), at 1.2 million,
was unchanged in January. These individuals accounted for 19.9 percent of the unemployed.
(See table A-12.)

After accounting for the annual adjustments to the population controls, the civilian
labor force rose by 574,000 in January, and the labor force participation rate edged 
up by 0.2 percentage point to 63.4 percent. The employment-population ratio, at 61.2
percent, changed little over the month but was up by 0.5 percentage point over the year.
(See table A-1. For additional information about the effects of the population adjustments,
see table C.)

The number of persons employed part time for economic reasons, at 4.2 million, was
essentially unchanged in January. These individuals, who would have preferred full-time
employment, were working part time because their hours had been reduced or they were
unable to find full-time jobs. (See table A-8.)

The number of persons marginally attached to the labor force, at 1.3 million, changed
little in January. These individuals were not in the labor force, wanted and were available
for work, and had looked for a job sometime in the prior 12 months. They were not counted
as unemployed because they had not searched for work in the 4 weeks preceding the survey
for a variety of reasons, such as belief that no jobs are available for them (referred
to as discouraged workers), school attendance, or family responsibilities. Discouraged
workers numbered 337,000 in January, little changed over the month. (See Summary table A.)

Establishment Survey Data

Total nonfarm payroll employment increased by 225,000 in January, compared with an
average monthly gain of 175,000 in 2019. Notable job gains occurred in construction,
in health care, and in transportation and warehousing. (See table B-1. For information
about the annual benchmark process, see the note at the end of the news release and table A.)

In January, construction employment rose by 44,000. Most of the gain occurred in specialty
trade contractors, with increases in both the residential (+18,000) and nonresidential
(+17,000) components. Construction added an average of 12,000 jobs per month in 2019. 

Health care added 36,000 jobs in January, with gains in ambulatory health care services
(+23,000) and hospitals (+10,000). Health care has added 361,000 jobs over the past 12 months. 

Employment in transportation and warehousing increased by 28,000 in January. Job gains
occurred in couriers and messengers (+14,000) and in warehousing and storage (+6,000).
Over the year, employment in transportation and warehousing has increased by 106,000. 

Employment in leisure and hospitality continued to trend up in January (+36,000). Over
the past 6 months, the industry has added 288,000 jobs. 

Employment continued on an upward trend in professional and business services in January
(+21,000), increasing by 390,000 over the past 12 months. 

Manufacturing employment changed little in January (-12,000) and has shown little movement,
on net, over the past 12 months. Motor vehicles and parts lost 11,000 jobs over the month. 

Employment in other major industries, including mining, wholesale trade, retail trade,
information, financial activities, and government, changed little over the month.

In January, average hourly earnings for all employees on private nonfarm payrolls rose by
7 cents to $28.44. Over the past 12 months, average hourly earnings have increased by
3.1 percent. Average hourly earnings of private-sector production and nonsupervisory employees
were $23.87 in January, little changed over the month (+3 cents). (See tables B-3 and B-8.)

The average workweek for all employees on private nonfarm payrolls was unchanged at 34.3
hours in January. In manufacturing, the average workweek remained at 40.4 hours, while
overtime edged down 0.1 hour to 3.1 hours. The average workweek of private-sector production
and nonsupervisory employees edged up by 0.1 hour to 33.6 hours. (See tables B-2 and B-7.)

The change in total nonfarm payroll employment for November was revised up by 5,000 from
+256,000 to +261,000, and the change for December was revised up by 2,000 from +145,000 to
+147,000. With these revisions, employment gains in November and December combined were
7,000 higher than previously reported. (Monthly revisions result from additional reports
received from businesses and government agencies since the last published estimates and from
the recalculation of seasonal factors. The annual benchmark process also contributed to the
November and December revisions.) After revisions, job gains have averaged 211,000 over the
last 3 months. 

_____________
The Employment Situation for February is scheduled to be released on
Friday, March 6, 2020, at 8:30 a.m. (EST).


 ____________________________________________________________________________________
|										     |
|                     Changes to Household Survey Data 				     |
|										     |
|   Effective with this news release, two not seasonally adjusted series previously  |
|   displayed in Summary table A--persons marginally attached to the labor force and |
|   discouraged workers--have been replaced with new seasonally adjusted series. The |
|   new seasonally adjusted series are available in the BLS online database back to  |
|   1994. Not seasonally adjusted data for persons marginally attached to the labor  |
|   force and for discouraged workers will continue to be published in table A-16.   |
|   These series are also available in the BLS online database back to 1994.         |
|                                                                                    |
|   Persons marginally attached to the labor force and discouraged workers are       |
|   inputs into three alternative measures of labor underutilization displayed in    |
|   table A-15. Effective with this news release, data for U-4, U-5, and U-6 in      |
|   table A-15 reflect the new seasonally adjusted series. Changes to historical     |
|   data were negligible. Revised data back to 1994 are available in the BLS online  |
|   database. Not seasonally adjusted series for the alternative measures are        |
|   unaffected.									     |
|										     |
|   Effective with data for January 2020, occupation estimates in table A-13         |
|   reflect the introduction of the 2018 Census occupation classification system     |
|   into the household survey. This occupation classification system is derived      |
|   from the 2018 Standard Occupational Classification (SOC) system. Historical      |
|   data have not been revised. Beginning with data for January 2020, occupation     |
|   estimates are not strictly comparable with earlier years.                        |
|                                                                                    |
|   In addition, industry estimates in table A-14 reflect the introduction of the    |
|   2017 Census industry classification system, which is derived from the 2017       | 
|   North American Industry Classification System (NAICS). The classification        |
|   changes are minor and do not involve re-classification of industries between     |
|   the broader industry sectors.                                                    |
|										     |
|   Beginning with data for January 2020, marital status estimates are not strictly  |
|   comparable with earlier years. Estimates of married persons now refer to those   |
|   in opposite-sex and same-sex marriages. Prior to January 2020, these estimates   |
|   referred only to those in opposite-sex marriages. Persons with a same-sex	     |
|   spouse were previously classified in other marital status categories, such as    |
|   "women who maintain families." These changes affect marital status estimates in  |
|   tables A-9 and A-10. (Note that not all marital status categories are presented  |
|   in these tables. BLS has not separately tabulated estimates for persons with an  |
|   opposite-sex spouse and persons with a same-sex spouse.) Historical data have    |
|   not been revised.						                     |
|____________________________________________________________________________________|


                     Revisions to Establishment Survey Data


In accordance with annual practice, the establishment survey data released today
have been benchmarked to reflect comprehensive counts of payroll jobs for March 2019.
These counts are derived principally from the Quarterly Census of Employment and Wages
(QCEW), which counts jobs covered by the Unemployment Insurance (UI) tax system. The
benchmark process results in revisions to not seasonally adjusted data from April 2018
forward. BLS revised seasonally adjusted data from January 2015 forward. In addition,
both seasonally adjusted and unadjusted data for some series incorporate other
revisions prior to 2015.  

The total nonfarm employment level for March 2019 was revised downward by 514,000
(-505,000 on a not seasonally adjusted basis), or -0.3 percent. The absolute average
benchmark revision over the past 10 years is 0.2 percent. 

The over-the-year change in total nonfarm employment for 2019 was revised from 
+2,108,000 to +2,096,000 (seasonally adjusted). Table A presents revised total nonfarm
employment data on a seasonally adjusted basis from January to December 2019.

All revised historical establishment survey data are available on the BLS website at
www.bls.gov/ces/data/home.htm. In addition, an article that discusses the benchmark
and post-benchmark revisions and other technical issues is available at
www.bls.gov/web/empsit/cesbmart.htm.


Table A. Revisions to total nonfarm employment, January to December 2019, seasonally
adjusted
(Numbers in thousands)
---------------------------------------------------------------------------------------
                 |                                   |                                
                 |                Level              |      Over-the-month change     
                 |---------------------------------------------------------------------
 Year and month  |           |    As     |           |           |    As    |           
                 |    As     |previously | Difference|    As     |previously| Difference
                 |  revised  |published  |           |  revised  |published |           
---------------------------------------------------------------------------------------
                 |           |           |           |           |          |           
       2019      |           |           |           |           |          |           
                 |           |           |           |           |          |           
January......... |  150,134  |  150,587  |    -453   |    269    |    312   |   -43
February........ |  150,135  |  150,643  |    -508   |      1    |     56   |   -55
March........... |  150,282  |  150,796  |    -514   |    147    |    153   |    -6
April........... |  150,492  |  151,012  |    -520   |    210    |    216   |    -6
May............. |  150,577  |  151,074  |    -497   |     85    |     62   |    23
June............ |  150,759  |  151,252  |    -493   |    182    |    178   |     4
July............ |  150,953  |  151,418  |    -465   |    194    |    166   |    28
August.......... |  151,160  |  151,637  |    -477   |    207    |    219   |   -12
September....... |  151,368  |  151,830  |    -462   |    208    |    193   |    15
October......... |  151,553  |  151,982  |    -429   |    185    |    152   |    33
November........ |  151,814  |  152,238  |    -424   |    261    |    256   |     5
December(p)..... |  151,961  |  152,383  |    -422   |    147    |    145   |     2 
---------------------------------------------------------------------------------------
   (p) = preliminary.


                Adjustments to Population Estimates for the Household Survey


Effective with data for January 2020, updated population estimates were incorporated into
the household survey. Population estimates for the household survey are developed by the
U.S. Census Bureau. Each year, the Census Bureau updates the estimates to reflect new
information and assumptions about the growth of the population since the previous decennial
census. The change in population reflected in the new estimates results from adjustments
for net international migration, updated vital statistics, and estimation methodology
improvements. 

In accordance with usual practice, BLS will not revise the official household survey estimates
for December 2019 and earlier months. To show the impact of the population adjustments,
however, differences in selected December 2019 labor force series based on the old and new
population estimates are shown in table B.

The adjustments decreased the estimated size of the civilian noninstitutional population in
December by 811,000, the civilian labor force by 524,000, employment by 507,000, and
unemployment by 17,000. The number of persons not in the labor force was decreased by 287,000.
The total unemployment rate, employment-population ratio, and labor force participation rate
were unaffected.

Data users are cautioned that these annual population adjustments can affect the comparability
of household data series over time. Table C shows the effect of the introduction of new
population estimates on the comparison of selected labor force measures between December 2019
and January 2020. Additional information on the population adjustments and their effect on
national labor force estimates is available at
www.bls.gov/web/empsit/cps-pop-control-adjustments.pdf. 

Population controls for veterans, which are derived from a Department of Veterans Affairs' 
population model and are updated periodically, have also been updated with the release of
data for January 2020. Historical data have not been revised.
Table B. Effect of the updated population controls on December 2019 estimates by sex, race, and Hispanic or Latino ethnicity, not seasonally adjusted
(Numbers in thousands)
Category Total Men Women White Black or
African
Ameri-
can
Asian Hispanic or
Latino
ethnicity

Civilian noninstitutional population

-811 -403 -408 -461 -59 -273 -323

Civilian labor force

-524 -289 -235 -297 -41 -171 -219

Participation rate

0 0 0 0 0 0 -0.1

Employed

-507 -279 -227 -287 -39 -167 -210

Employment-population ratio

0 0 0 0 0 0 0

Unemployed

-17 -10 -9 -10 -2 -4 -9

Unemployment rate

0 0 0 0 0 0 0

Not in labor force

-287 -115 -172 -164 -18 -102 -104

NOTE: Detail may not sum to totals because of rounding. Estimates for the above race groups (White, Black or African American, and Asian) do not sum to totals because data are not presented for all races. Persons whose ethnicity is identified as Hispanic or Latino may be of any race.

Table C. December 2019-January 2020 changes in selected labor force measures, with adjustments for population control effects
(Numbers in thousands)
Category Dec.-Jan.
change, as
published
2020
population
control effect
Dec.-Jan. change, after
removing the
population control
effect(1)

Civilian noninstitutional population

-679 -811 132

Civilian labor force

50 -524 574

Participation rate

0.2 0 0.2

Employed

-89 -507 418

Employment-population ratio

0.2 0 0.2

Unemployed

139 -17 156

Unemployment rate

0.1 0 0.1

Not in labor force

-729 -287 -442

(1) This Dec.-Jan. change is calculated by subtracting the population control effect from the over-the-month change in the published seasonally adjusted estimates.

https://www.bls.gov/news.release/empsit.nr0.htm

 

Employment Situation Summary Table A. Household data, seasonally adjusted

HOUSEHOLD DATA
Summary table A. Household data, seasonally adjusted
[Numbers in thousands]
Category Jan.
2019
Nov.
2019
Dec.
2019
Jan.
2020
Change from:
Dec.
2019-
Jan.
2020

Employment status

Civilian noninstitutional population

258,239 260,020 260,181 259,502

Civilian labor force

163,142 164,347 164,556 164,606

Participation rate

63.2 63.2 63.2 63.4

Employed

156,627 158,536 158,803 158,714

Employment-population ratio

60.7 61.0 61.0 61.2

Unemployed

6,516 5,811 5,753 5,892

Unemployment rate

4.0 3.5 3.5 3.6

Not in labor force

95,097 95,673 95,625 94,896

Unemployment rates

Total, 16 years and over

4.0 3.5 3.5 3.6

Adult men (20 years and over)

3.7 3.2 3.1 3.3

Adult women (20 years and over)

3.6 3.2 3.2 3.2

Teenagers (16 to 19 years)

12.9 12.0 12.6 12.2

White

3.5 3.2 3.2 3.1

Black or African American

6.8 5.6 5.9 6.0

Asian

3.1 2.6 2.5 3.0

Hispanic or Latino ethnicity

4.8 4.2 4.2 4.3

Total, 25 years and over

3.2 2.9 2.8 2.9

Less than a high school diploma

5.7 5.3 5.2 5.5

High school graduates, no college

3.7 3.7 3.7 3.8

Some college or associate degree

3.4 2.9 2.7 2.8

Bachelor’s degree and higher

2.4 2.0 1.9 2.0

Reason for unemployment

Job losers and persons who completed temporary jobs

3,060 2,804 2,686 2,665

Job leavers

816 776 829 836

Reentrants

1,944 1,663 1,655 1,838

New entrants

607 581 551 557

Duration of unemployment

Less than 5 weeks

2,319 2,026 2,065 2,059

5 to 14 weeks

1,999 1,753 1,730 1,755

15 to 26 weeks

898 865 812 887

27 weeks and over

1,259 1,219 1,186 1,166

Employed persons at work part time

Part time for economic reasons

5,105 4,288 4,148 4,182

Slack work or business conditions

3,402 2,634 2,657 2,655

Could only find part-time work

1,413 1,259 1,215 1,294

Part time for noneconomic reasons

20,984 21,532 21,586 22,154

Persons not in the labor force

Marginally attached to the labor force

1,498 1,244 1,230 1,342

Discouraged workers

418 316 289 337

– December – January changes in household data are not shown due to the introduction of updated population controls.
NOTE: Persons whose ethnicity is identified as Hispanic or Latino may be of any race. Detail for the seasonally adjusted data shown in this table will not necessarily add to totals because of the independent seasonal adjustment of the various series. Updated population controls are introduced annually with the release of January data.

 

https://www.bls.gov/news.release/empsit.a.htm

Employment Situation Summary Table B. Establishment data, seasonally adjusted

ESTABLISHMENT DATA
Summary table B. Establishment data, seasonally adjusted
Category Jan.
2019
Nov.
2019
Dec.
2019(P)
Jan.
2020(P)

EMPLOYMENT BY SELECTED INDUSTRY
(Over-the-month change, in thousands)

Total nonfarm

269 261 147 225

Total private

258 247 142 206

Goods-producing

75 45 -5 32

Mining and logging

5 -11 -11 0

Construction

50 -2 11 44

Manufacturing

20 58 -5 -12

Durable goods(1)

21 45 -1 -11

Motor vehicles and parts

-0.3 40.5 1.3 -10.6

Nondurable goods

-1 13 -4 -1

Private service-providing

183 202 147 174

Wholesale trade

6.3 3.0 9.5 8.4

Retail trade

-7.9 -13.9 44.9 -8.3

Transportation and warehousing

46.8 22.6 3.9 28.3

Utilities

0.1 1.0 0.7 -1.4

Information

-11 9 8 5

Financial activities

11 12 5 -1

Professional and business services(1)

-2 37 14 21

Temporary help services

-28.2 2.6 5.9 -1.5

Education and health services(1)

56 73 22 72

Health care and social assistance

37.6 56.7 25.0 47.2

Leisure and hospitality

81 43 36 36

Other services

3 16 3 14

Government

11 14 5 19

(3-month average change, in thousands)

Total nonfarm

195 218 198 211

Total private

188 211 193 198

WOMEN AND PRODUCTION AND NONSUPERVISORY EMPLOYEES
AS A PERCENT OF ALL EMPLOYEES(2)

Total nonfarm women employees

49.7 50.0 50.0 50.0

Total private women employees

48.3 48.6 48.7 48.7

Total private production and nonsupervisory employees

82.4 82.2 82.2 82.2

HOURS AND EARNINGS
ALL EMPLOYEES

Total private

Average weekly hours

34.5 34.3 34.3 34.3

Average hourly earnings

$27.58 $28.34 $28.37 $28.44

Average weekly earnings

$951.51 $972.06 $973.09 $975.49

Index of aggregate weekly hours (2007=100)(3)

110.5 111.2 111.3 111.5

Over-the-month percent change

0.2 -0.1 0.1 0.2

Index of aggregate weekly payrolls (2007=100)(4)

145.8 150.7 151.0 151.6

Over-the-month percent change

0.4 0.3 0.2 0.4

DIFFUSION INDEX
(Over 1-month span)(5)

Total private (258 industries)

62.2 63.4 55.6 59.7

Manufacturing (76 industries)

59.2 61.8 46.1 46.7

Footnotes
(1) Includes other industries, not shown separately.
(2) Data relate to production employees in mining and logging and manufacturing, construction employees in construction, and nonsupervisory employees in the service-providing industries.
(3) The indexes of aggregate weekly hours are calculated by dividing the current month’s estimates of aggregate hours by the corresponding annual average aggregate hours.
(4) The indexes of aggregate weekly payrolls are calculated by dividing the current month’s estimates of aggregate weekly payrolls by the corresponding annual average aggregate weekly payrolls.
(5) Figures are the percent of industries with employment increasing plus one-half of the industries with unchanged employment, where 50 percent indicates an equal balance between industries with increasing and decreasing employment.
(P) Preliminary

NOTE: Data have been revised to reflect March 2019 benchmark levels and updated seasonal adjustment factors.

 

https://www.bls.gov/news.release/empsit.b.htm

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Things You Should Know About the Novel Coronavirus

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Coronavirus Outbreak: Interview with Anthony Fauci, National Institute of Health

Coronavirus: Death toll rises as virus spreads to every Chinese region – BBC News

China’s coronavirus cases now outnumber its cases of SARS

U.S. to officially declare ‘public health emergency’ for novel coronavirus

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‘We’re basically at a pandemic now’: Mayo Clinic physician on coronavirus

Coronavirus Continues Spreading Fast — How Bad Will It Get?

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Public Health Response to Severe Influenza

Jan 23, 2018

Spanish Flu: a warning from history

100 years ago, celebrations marking the end of the First World War were cut short by the onslaught of a devastating disease – the 1918-19 influenza pandemic. Its early origins and initial geographical starting point still remain a mystery but in the Summer of 1918, there was a second wave of a far more virulent form of the influenza virus than anyone could have anticipated. Soon dubbed ‘Spanish Flu’ after its effects were reported in the country’s newspapers, the virus rapidly spread across much of the globe to become one of the worst natural disasters in human history. To mark the centenary and to highlight vital scientific research, the University of Cambridge has made a new film exploring what we have learnt about Spanish Flu, the urgent threat posed by influenza today, and how scientists are preparing for future pandemics.

PrepTalks: John M. Barry “The Next Pandemic: Lessons from History”

Interview – John M. Barry – The Great Influenza

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John Barry: The Pandemic Risk

1918 Flu Pandemic

1918 Spanish Flu historical documentary | Swine Flu Pandemic | Deadly plague of 1918

The 1918 Pandemic: The Deadliest Flu in History

 

US bars foreigners coming from China for now over virus fear

The United States on Friday declared a public health emergency and took drastic steps to significantly restrict entry into the country because of a new virus that hit China and has spread to other nations.

President Donald Trump has signed an order that will temporarily bar foreign nationals, other than immediate family of U.S. citizens and permanent residents, who have traveled in China within the last 14 days. The new restrictions, which take effect at 5 p.m. EST on Sunday, were announced by Health and Human Services Secretary Alex Azar, who is coordinating the U.S. response.

“It is likely that we will continue to see more cases in the United States in the coming days and weeks, including some limited person-to-person transmissions,” Azar said. “The American public can be assured the full weight of the U.S. government is working to safeguard the health and safety of the American people.”

Americans returning from China will be allowed into the country, but will face screening at select ports of entry and required to undertake 14 days of self-screening to ensure they don’t pose a health risk. Those returning from Hubei province, the center of the outbreak, will be subject to up to 14 days of mandatory quarantine.

Beginning Sunday, the U.S. will also begin funneling all flights to the U.S. from China to seven major airports where passengers can be screened for illness.

The virus has infected almost 10,000 people globally in just two months, a troublesome sign that prompted the World Health Organization to declare the outbreak a global emergency. The death toll stood at 213, including 43 new fatalities, all in China.

A public health emergency in the U.S. allows the government to tap additional resources to send to states, such as emergency funding and if necessary drugs or equipment from the national stockpile, and to suspend certain legal requirements.

Dr. Robert Redfield, director of the Centers for Disease Control and Prevention, said that while the risk in the U.S. is low, “I want to emphasize that this is a significant global situation and it continues to evolve.”

There are seven cases of this virus in the U.S. and all were travelers except for a Chicago man who caught it from his wife, who had been in China.

Dr. Anthony Fauci, infectious diseases chief at the National Institutes of Health, said one reason the U.S. stepped up its quarantine measures was an alarming report from Germany that a traveler from China had spread the virus despite showing no symptoms. Fauci contrasted it with the response to recent outbreaks of Ebola, which can’t be spread unless someone is very ill.

At the same time, federal health authorities were recognizing that the test they’re using to detect the virus isn’t always dependable. Redfield said when it was used on some of the people currently in isolation, they’d test positive one day and negative another.

Lawrence Gostin, a Georgetown University expert on public health law, said putting a large number of people under quarantine “is virtually unprecedented in modern American history.”

Declaring a public health emergency “gives HHS added powers, and is warranted. Quarantine of those returning from Hubei is also reasonable given the high risk of exposure to coronavirus in that province,” he said.

He did note that travelers from other parts of China don’t pose as high a risk. “We need to use the least restrictive measure necessary to safeguard the population,” Gostin said.

Deputy Secretary of State Steve Biegun offered America’s “deepest compassion” to the Chinese, noting that the deadly outbreak came during the peak of their holiday season, when everyone would ordinarily be celebrating and not living in fear of contracting the virus.

Biegun said the U.S. is working hard to find donors of supplies and making arrangements for a “robust effort to help the Chinese people get their arms around this outbreak.”

The announcement came hours after the State Department issued a level 4 “Do Not Travel” advisory, the highest grade of warning, and told Americans in China to consider departing using commercial means. “Travelers should be prepared for travel restrictions to be put into effect with little or no advance notice,” the advisory said.

Hours later, Delta Air Lines and American Airlines announced they were suspending all flights between the U.S. and China, joining several international carriers that have stopped flying to China as the virus outbreak continues to spread.

Meanwhile, U.S. health officials issued a two-week quarantine order for the 195 Americans evacuated earlier this week from the Chinese city of Wuhan, provincial capital of Hubei province. It was the first time a federal quarantine has been ordered since the 1960s, when one was enacted over concern about the potential spread of smallpox, the CDC said.

None of the Americans being housed at a Southern California military base has shown signs of illness, but infected people don’t show symptoms immediately and may be able to pass on the virus before they appear sick.

One of the evacuees, Matthew L. McCoy, a theme park designer who lives in China, said the group was very relieved by the quarantine order.

“All of us really want to stay here and make sure we’re all medically clear and the public safe,” he said from the military base.

China counted 9,692 confirmed cases Friday, the vast majority in Hubei province.

The National Health Commission reported 171 cases of people who have been “cured and discharged from hospital.” WHO has said most people who got the illness had milder cases, though 20% experienced severe symptoms. Symptoms include fever and cough, and in severe cases, shortness of breath and pneumonia.

China has placed more than 50 million people in the region under virtual quarantine.

American Airlines said it was halting all flights starting Friday and running through March 27. Delta plans to wait until Feb. 6 to suspend China operations to help travelers in China leave the country. It said the stoppage will continue through April 30. United Airlines announced that it will suspend flights to Beijing, Shanghai and Chengdu but continue flights to Hong Kong.

The U.S. screening airports are John F. Kennedy International in New York, San Francisco International in California, Seattle-Tacoma International in Washington, O’Hare International in Chicago, Hartsfield-Jackson Atlanta International in Georgia, and Daniel K. Inouye International in Hawaii.

The Dow Jones Industrial Average skidded more than 600 points Friday as the outbreak continued to widen, stoking fears that the travel restrictions and other uncertainties caused by the health emergency in the world’s second-largest economy could dent global growth.

Since China informed WHO about the new virus in late December, at least 23 countries have reported cases, as scientists race to understand how exactly the virus is spreading and how severe it is.

Experts say there is significant evidence the virus is spreading among people in China, and WHO noted with its emergency declaration Thursday it was especially concerned that some cases abroad also involved human-to-human transmission. It defines an international emergency as an “extraordinary event” that poses a risk to other countries and requires a coordinated international response.

“The main reason for this declaration is not because of what is happening in China but because of what is happening in other countries,” WHO Director-General Tedros Adhanom Ghebreyesus told reporters in Geneva. “Our greatest concern is the potential for this virus to spread to countries with weaker health systems which are ill-prepared to deal with it.”

A declaration of a global emergency typically brings greater money and resources, but may also prompt nervous governments to restrict travel and trade to affected countries. The announcement also imposes more disease reporting requirements on countries.

The last time the U.S. government ordered a quarantine was in 1963 when a woman named Ellen Siegel was held in quarantine for up to 14 days because she did not present a valid certificate of vaccination against small pox. Siegel had visited Sweden when it still had a case of smallpox and although she had been revaccinated about two months earlier, the vaccination was said to be unsuccessful.

On Friday, the U.S. Embassy in Beijing said it was authorizing the departure of family members and all non-emergency U.S. government employees from Beijing and the consulates in the cities of Chengdu, Guangzhou, Shanghai, and Shenyang. Staff from the Wuhan consulate departed earlier this week.

The decision was made “out of an abundance of caution related to logistical disruptions stemming from restricted transportation and availability of appropriate health care,” the embassy said.

Mike Wester, a businessman in Beijing who has lived in China for 19 years, said he has no plans to leave.

“I feel safer self-quarantining myself here at home than I do risking travel,” Wester said.

He pointed to potential risks from crowds at airports and being required to remove a mask for passport and security checks.

Japan and Germany also advised against non-essential travel and Britain did as well, except for Hong Kong and Macao. Popular holiday and shopping destination Singapore barred Chinese from traveling there, becoming the first Southeast Asian nation to do so.

Tedros said WHO was not recommending limiting travel or trade to China.

“There is no reason for measures that unnecessarily interfere with international travel and trade,” he said. He added that Chinese President Xi Jinping had committed to help stop the spread of the virus beyond its borders.

Although scientists expect to see limited transmission of the virus between people with close contact, like within families, the instances of spread to people who may have had less exposure to the virus is worrying.

In Japan, a tour guide and bus driver became infected after escorting two tour groups from Wuhan. In Germany, five employees of a German auto parts supplier became ill after a Chinese colleague visited, including two who had no direct contact with the woman, who showed no symptoms of the virus until her flight back to China. On Friday, Germany confirmed a sixth case, a child of one of the people already infected.

“That’s the kind of transmission chain that we don’t want to see,” said Marion Koopmans, an infectious diseases specialist at Erasmus University Medical Center in the Netherlands and a member of WHO’s emergency committee.

The new virus has now infected more people globally than were sickened during the 2002-2003 outbreak of SARS, or severe acute respiratory syndrome, a cousin of the new virus. Both are from the coronavirus family, which also includes those that can cause the common cold.

https://apnews.com/9e22f8aabe2f454593b9f9b4c67eb31f

Coronavirus 2020 Outbreak: Latest Updates

photo of coronavirus

This article was last updated on Jan. 31, 2020.Jan. 24, 2020 — News about the coronavirus outbreak that started in Wuhan, China, is changing rapidly. The respiratory infection, which is closely related to SARS and MERS, has been spreading across China, and cases have been diagnosed in several other countries, including the United States. We’ll provide the latest updates on cases, deaths, travel restrictions, and more here.

What is the latest news?

Foreigners who have traveled to China in the past two weeks will be barred from entering the United States, the government said Friday, as the White House declared a national public health emergency over the new coronavirus.

As part of that proclamation, any citizen returning to the U.S. who have been to Hubei province in China in the past 14 days will be under mandatory quarantine for 14 days, which is thought to be the incubation period for the virus. Any citizen who’s been to the rest of China within the past 2 weeks will get a health screening when they get back to the U.S. They’ll then be asked to self-quarantine for 14 days. Their movements will be monitored.

These restrictions take effect beginning at 5 p.m. Sunday.

“The actions we have taken and continue to take compliment the work of China and the World Health Organization to contain the outbreak within China,” Health and Human Services Secretary Alex Azar said.

“This is a significant global situation, but I want to emphasize at this time that the risk to the American public is low,” said CDC Director Robert Redfield, MD.

Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, said the strict precautions are warranted because of “the issue now with this is that there are a lot of unknowns.”

He pointed out that the number of cases “has steeply inclined each and every day.”

We now know for certain that a person without symptoms can transmit the disease, Fauci said.

A new case report published in the New England Journal of Medicine, describes how a woman from China infected 4 co-workers at a German company before she showed any symptoms of the disease herself.

The U.S. measures follows the WHO’s declaration on Thursday that the 2019-nCoV outbreak is a Public Health Emergency of International Concern, or PHEIC and come the same day the CDC issued federal quarantine orders for all 195 U.S. citizens who recently returned to the U.S. after living in China. The quarantine will last 14 days from the date the plane left Wuhan.These are the first federal quarantine orders issued in 50 years, the last coming in the 1960s for smallpox evaluations, CDC officials said.The CDC’s move follows a quarantine issued by Riverside County, CA, after one of the passengers tried to leave March Air Reserve Base Wednesday morning without being cleared by health officials.“This legal order is part of an aggressive public health response, the goal of which is to prevent, as much as possible, community spread of this novel virus in the United States,” said Nancy Messonnier, MD, Director of the CDC’s National Center for Immunization and Respiratory Diseases.”If we take strong measures now, we may be able to blunt the impact of the virus on the United States,” she said.Better to over-prepare, she said.”We are preparing as if this were the next pandemic. But we are hopeful still that this is not, and will not be the case.”Health officials also clarified the distinctions between isolation and quarantine. Isolation is used to keep a person who’s already sick from infecting others. Quarantines restrict the movement of someone who is exposed, but not yet sick.

How many people have been diagnosed with the virus, and how many have died?

According to European CDC, the majority of the confirmed cases – 9,723 – are in China. Another 11 cases are confirmed outside of China in 20 countries. Countries with the most confirmed cases include Thailand and Japan with 14 each. All reported deaths have been in China, and include 17 healthcare workers. Several media outlets are reporting the first two confirmed cases in the U.K. in members of the same family. These cases are not yet reflected in the CDC numbers.

What do we know about cases in the United States?

The six U.S. cases are in Illinois, Washington, California and Arizona. The CDC in total has 241 persons under investigation for coronavirus from 36 states. In addition to the 6 confirmed positive, 114 have tested negative.

On Thursday, a man in Illinois became the first case of person-to-person transmission of the virus in the U.S, the CDC said. He is the sixth confirmed case in the country overall. The man in the most recent case in Illinois is the husband of a Chicago woman diagnosed with the virus after returning from Wuhan. He is hospitalized in isolation and is stable. His wife, who is in her 60s, is also in isolation and in good condition. The Chicago Department of Public Health reported that she had visited China in December and returned to Chicago earlier this month.

In all other U.S. cases so far, patients had recently traveled to Wuhan.

Worldwide there are now more than 9,900 cases and 222 deaths, according to Johns Hopkins University. While the majority of cases center in China, it has been found in the U.S. and these countries: Thailand, Hong Kong, Taiwan, Australia, Macau, Singapore, Japan, South Korea, Malaysia, France, Canada, Vietnam, Nepal, Cambodia, Germany, India, the Philippines, United Arab Emirates, Finland, Sri Lanka, Italy, and Great Britain. There have been no deaths outside China.

California has two patients, one in Los Angeles County and one in Orange County. The patient from Orange County is a man in his 50s. He is in a local hospital in isolation and is in good condition, according to the Orange County Health Care Agency. Los Angeles County officials did not provide additional details about the patient there.

Arizona’s Department of Health Services said its patient is a Maricopa County resident and member of the Arizona State University community who did not live in student housing. The patient is not severely ill and is being kept in isolation.

The first U.S. patient is a man in his 30s from Washington state. He had traveled from Wuhan and entered the country before the screening was in place. He started having symptoms and contacted his doctor. He is in good condition and is in isolation at Providence Regional Medical Center.

The CDC is prioritizing the testing based on a person’s risk.

Nancy Messonnier, MD, Director of the agency’s National Center for Immunization and Respiratory Diseases, said they had posted the blueprints for their diagnostic test on a public server and were working “as fast as we can” to get test kits out to states.

Right now, all the testing for the new coronavirus is taking place at the CDC’s headquarters in Atlanta.

What are public officials doing to contain the virus?

Fears about the virus’ spread led the World Health Organization on Thursday to declare the outbreak a global public health emergency. Soon after, the U.S. State Department issued a level 4 travel advisorytelling people not to travel to China because of the outbreak.

The CDC and State Department have issued strong warnings about travel to and from China, and several airlines, including Delta, United and American, have announced they are ending service to China until the outbreak wanes.

But, commercial flights continue to come and go between the U.S. and China, and the CDC said it was currently evaluating whether or not to restrict the movement of passengers coming in on those flights.

“At this point we’re evaluating the appropriate strategy in light of the new information. There’s really nothing new to share at this point,” said Martin Cetron, MD, Director for the Division of Global Migration and Quarantine at CDC.

Chinese officials have shut down all public transportation to 10 cities, affecting 35 million people. The first was Wuhan, which has a population of about 11 million. In Wuhan, that includes buses, subways, trains, and the airport.

On Wednesday, CDC medical officers and others met a group of about 210 U.S. citizens evacuated from China. Their plane landed at March Air Reserve Base in California, where the evacuees will be monitored for coronavirus symptoms for several days. Anyone showing signs of the disease will be taken to the hospital. The passengers are not officials quarantined for up to two weeks.

In the U.S., the number of airports that will screen passengers from China for symptoms has expanded to 20.

When did the outbreak start?

China first reported the outbreak in Wuhan on Dec. 30, 2019.

Is travel to China safe?

The U.S. State Department issued a level 4 travel advisory telling people not to travel to China because of the outbreak. Some cities in China, such as Wuhan, are closed to travelers.

Travelers who do go should:

  • Avoid contact with sick people.
  • Avoid animals, animal markets, and products that come from animals.
  • Wash their hands often with soap and water, or use an alcohol-based sanitizer if that’s not available.
  • Seek medical care right away for a fever, cough, or difficulty breathing. Tell a health care professional about any travel.

What are the symptoms, and how is the virus diagnosed?

China created a test for the virus and shared that information with other countries. The CDC has developed its own test.

Symptoms include a fever, coughing, and shortness of breath. They may appear 2 to 14 days after you’re exposed to the virus.

What is the source of the virus, and how is it spread?

Health officials are not sure of the source of the virus yet or how easily it can spread. Coronaviruses are found in many different animals, including camels, cattle, cats, and bats. One research paper also suggested snakes as a possible source. The new virus may be linked to a seafood and live animal market in Wuhan that has since been closed

The virus can spread from person to person. Health officials are seeing this happen most often where people are close together and in health care settings. To date, 16 health care workers have been infected.

The CDC believes that severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), two other types of coronavirus, are spread through droplets when someone coughs or sneezes.

Is there a vaccine?

There is no vaccine, but the National Institutes of Health is working on one and hopes to begin testing in several months. That testing would be for safety. If it’s safe, there would be testing to see how well it works.

How is it treated?

There is no specific treatment for the virus. Patients are generally given supportive care for their symptoms, such a fluids and pain relievers. Hospitalized patients may need support with breathing.

https://www.webmd.com/lung/news/20200124/coronavirus-2020-outbreak-latest-updates

Coronavirus

coronavirus is a kind of common virus that causes an infection in your nose, sinuses, or upper throat. Most coronaviruses are not dangerous. Some types of coronaviruses are serious, though. About 858 people have died from Middle East respiratory syndrome (MERS), which first appeared in 2012 in Saudi Arabia and then in other countries in the Middle East, Africa, Asia, and Europe. In April 2014, the first American was hospitalized for MERS in Indiana and another case was reported in Florida. Both had just returned from Saudi Arabia. In May 2015, there was an outbreak of MERS in Korea, which was the largest outbreak outside of the Arabian Peninsula. In 2003, 774 people died from a severe acute respiratory syndrome (SARS) outbreak. As of 2015, there were no further reports of cases of SARS.But In early 2020, following a December 2019 outbreak in China, the World Health Organization identified a new type, 2019 novel coronavirus (2019-nCoV).Often a coronavirus causes upper respiratory infection symptoms like a stuffy nose, cough, and sore throat. You can treat them with rest and over-the-counter medication. The coronavirus can also cause middle ear infections in children.

What Is a Coronavirus?

Coronaviruses were first identified in the 1960s, but we don’t know where they come from. They get their name from their crown-like shape. Sometimes, but not often, a coronavirus can infect both animals and humans.

Most coronaviruses spread the same way other cold-causing viruses do: through infected people coughing and sneezing, by touching an infected person’s hands or face, or by touching things such as doorknobs that infected people have touched.

Almost everyone gets a coronavirus infection at least once in their life, most likely as a young child. In the United States, coronaviruses are more common in the fall and winter, but anyone can come down with a coronavirus infection at any time.

Common Symptoms of Coronavirus

The symptoms of most coronaviruses are similar to any other upper respiratory infection, including runny nosecoughingsore throat, and sometimes a fever. In most cases, you won’t know whether you have a coronavirus or a different cold-causing virus, such as rhinovirus.

https://www.webmd.com/lung/coronavirus#1

Dow plummets 600 points in worst day since August as coronavirus fears grow

Stocks fell sharply on Friday, wiping out the Dow Jones Industrial Average’s gain for January, as investors grew increasingly worried about the potential economic impact of China’s fast-spreading coronavirus.

The Dow dropped 603.41 points, or 2.1%, to 28,256.03 in the 30-stock average’s worst day since August. The S&P 500 had its worst day since October, falling 1.8% to 3,225.52. The Nasdaq Composite dropped 1.6% to 9,150.94.

On Friday, the U.S. declared the coronavirus a public health emergency within the country. Delta, American and United suspended all flights between China and the U.S.

The virus, which was first discovered in the Chinese city of Wuhan, has now spread to at least 18 other countries and has dampened sentiment over global economic growth. China’s National Health Commission confirmed on Friday that there have been 9,692 confirmed cases of the coronavirus, with 213 deaths.

CH 20200131_biggest_dow_drops.png

“There’s fear going into the weekend,” said Ilya Feygin, senior strategist at WallachBeth Capital. “The theme coming into this year was the Fed and Trump are going to bail us out of any problems, but the virus is something neither one can do anything about. That’s a reason to become more fearful.”

Las Vegas Sands, a proxy stock for the coronavirus given the company’s exposure to the Chinese market, fell more than 1%. Airline stocks such as American and United dropped more than 3% each while Delta slid 2.4%. Travel stocks also got hit as the Trump administration imposed tighter travel restrictions to China.

The WHO recognized the deadly pneumonia-like virus as a global health emergency on Thursday, citing concern that the outbreak continues to spread to other countries with weaker health systems. WHO’s designation was made to help the United Nations health agency mobilize financial and political support to contain the outbreak.

“The outbreak of the coronavirus has added another headwind to the near-term outlook for stocks,” said Peter Berezin, chief global strategist at BCA Research, said in a note. “Viruses often become less lethal as they mutate because a virus that kills its host is also a virus that kills itself. Unfortunately, in a world of mass travel, a virus can spread across the globe before it has time to lose potency.”

RT: Coronavirus: Thai Airways disinfecting airplane 200128
Members of the Thai Airways crew prepare themselves before disinfecting the cabin of an aircraft of the national carrier during a procedure to prevent the spread of the coronavirus at Bangkok’s Suvarnabhumi International Airport, Thailand, January 28, 2020.
Athit Perawongmetha | Reuters

Caterpillar shares fell 3% after the industrial giant’s CEO warned about “global economic uncertainty” in the company’s latest quarterly earnings report, in part a reference to the virus. Caterpillar also issued disappointing earnings guidance for 2020.

On the positive side, Amazon shares surged 7.4% after the company posted a quarterly profit and revenue that easily beat analyst expectations. Amazon Web Services, the company’s cloud business, saw stronger-than-expected revenues.

Investors are nearly halfway through the corporate earnings season. More than 70% of the 226 S&P 500 companies that have reported have beaten analyst earnings expectations, FactSet data shows.

Volatile January

The major averages saw an uptick in volatility this month as investors grappled with rising tensions between Iran and the U.S., trade worries with China and the recent coronavirus scare.

The S&P 500 closed marginally lower for January, snapping a four-month winning streak. The Dow also had its first monthly loss since August. The Nasdaq posted a 2% gain in January, its fifth-straight monthly advance.

The Cboe Volatility Index (VIX), widely considered to be the best fear gauge in the market, rose to just around 19 this month from 13.78, a gain of more than 37%.

Stocks could face some seasonal headwinds next month. February has not been the market’s best month historically. Data from The Stock Trader’s Almanac shows the S&P 500 averages a gain of just 0.1%. Investors will also face a number of obstacles in the new month, including worries over how the U.S. presidential election shakes out. Coronavirus fears could also persist in February.

“That’s going to hurt China,” said Tom Martin, senior portfolio manager at GLOBALT. “For an economy that is increasingly trying to transition to the consumer, it’s definitely a headwind.”

“When you start seeing real actions on the part of multinational companies, as well as people trying to put a number on it, it’s no longer something that is not going to have an impact at all,” Martin said.

https://www.cnbc.com/2020/01/31/stock-market-wall-street-in-focus-after-coronavirus-declares-global-emergency.html

Disease Burden of Influenza

Each year CDC estimates the burden of influenza in the U.S. CDC uses modeling to estimate the number of influenza illnesses, medical visits, flu-associated hospitalizations, and flu-associated deaths that occur in the U.S. in a given season. The methods used to calculate these estimates are described on CDC’s webpage, How CDC Estimates the Burden of Seasonal Influenza in the U.S.

CDC uses the estimates of the burden of influenza in the population and the impact of influenza vaccination to inform policy and communications related to influenza.

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How CDC Estimates the Burden of Flu

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Why CDC Estimates the Burden of Flu

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Past Season Estimates

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Frequently Asked Questions about Estimated Flu Burden

Preliminary In-season Disease Burden Estimates

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Weekly preliminary cumulative in-season estimates of flu cases, medical visits, hospitalizations for the 2019-2020 season.

Flu Burden Averted from Vaccination

woman getting vaccine

CDC estimates the burden of flu and the impact of annual flu vaccination in the U.S using a model that estimates the numbers of flu illnesses, medical visits and hospitalization prevented by vaccination.

Figure 1: Estimated Range of Annual Burden of Flu in the U.S. since 2010

The burden of influenza disease in the United States can vary widely and is determined by a number of factors including the characteristics of circulating viruses, the timing of the season, how well the vaccine is working to protect against illness, and how many people got vaccinated. While the impact of flu varies, it places a substantial burden on the health of people in the United States each year.

CDC estimates that influenza has resulted in between 9 million – 45 million illnesses, between 140,000 – 810,000 hospitalizations and between 12,000 – 61,000 deaths annually since 2010.

Table 1: Estimated Influenza Disease Burden, by Season — United States, 2010-11 through 2018-19 Influenza Seasons

Symptomatic Illnesses Medical Visits Hospitalizations Deaths
Season Estimate 95% U I Estimate 95% U I Estimate 95% U I Estimate 95% U I
2010-2011 21,000,000 (20,000,000 – 25,000,000) 10,000,000 (9,300,000 – 12,000,000) 290,000 (270,000 – 350,000) 37,000 (32,000 – 51,000)
2011-2012 9,300,000 (8,700,000 – 12,000,000) 4,300,000 (4,000,000 – 5,600,000) 140,000 (130,000 – 190,000) 12,000 (11,000 – 23,000)
2012-2013 34,000,000 (32,000,000 – 38,000,000) 16,000,000 (15,000,000 – 18,000,000) 570,000 (530,000 – 680,000) 43,000 (37,000 – 57,000)
2013-2014 30,000,000 (28,000,000 – 33,000,000) 13,000,000 (12,000,000 – 15,000,000) 350,000 (320,000 – 390,000) 38,000 (33,000 – 50,000)
2014-2015 30,000,000 (29,000,000 – 33,000,000) 14,000,000 (13,000,000 – 16,000,000) 590,000 (540,000 – 680,000) 51,000 (44,000 – 64,000)
2015-2016 24,000,000 (20,000,000 – 33,000,000) 11,000,000 (9,000,000 – 15,000,000) 280,000 (220,000 – 480,000) 23,000 (17,000 – 35,000)
2016-2017 29,000,000 (25,000,000 – 45,000,000) 14,000,000 (11,000,000 – 23,000,000) 500,000 (380,000 – 860,000) 38,000 (29,000 – 61,000)
Preliminary estimates* Estimate 95% UI Estimate 95% UI Estimate 95% UI Estimate 95% UI
2017-2018* 45,000,000 (39,000,000 – 58,000,000) 21,000,000 (18,000,000 – 27,000,000) 810,000 (620,000 – 1,400,000) 61,000 (46,000 – 95,000)
2018-2019* 35,520,883 (31,323,881 – 44,995,691) 16,520,350 (14,322,767 – 21,203,231) 490,561 (387,283 – 766,472) 34,157 (26,339 – 52,664)

* Estimates from the 2017-2018 and 2018-2019 seasons are preliminary and may change as data are finalized.

Figure 2: Estimated U.S. Influenza Burden, By Season

Influenza Chart Infographic Influenza Burden ChartDownload Flu Burden PowerPoint Presentation Slides ppt icon[PPT – 1 MB]

Supporting Research

https://www.cdc.gov/flu/about/burden/index.html

 

Influenza

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Influenza
Other names Flu, the flu
EM of influenza virus.jpg
Influenza virus, magnified approximately 100,000 times
Specialty Infectious disease
Symptoms Feverrunny nosesore throatmuscle and joint painheadachecoughingfeeling tired[1]
Usual onset One to four days after exposure[1]
Duration ~1 week[1]
Causes Influenza viruses[2]
Prevention Hand washinginfluenza vaccinesurgical masks[1][3]
Medication Neuraminidase inhibitors such as oseltamivir[1]
Frequency 3–5 million severe cases per year[1]
Deaths Up to 650,000 respiratory deaths per year[4][1]

Influenza, commonly known as “the flu“, is an infectious disease caused by an influenza virus.[1] Symptoms can be mild to severe.[5] The most common symptoms include: high feverrunny nosesore throatmuscle and joint painheadachecoughing, and feeling tired.[1] These symptoms typically begin two days after exposure to the virus and most last less than a week.[1] The cough, however, may last for more than two weeks.[1]In children, there may be diarrhea and vomiting, but these are not common in adults.[6] Diarrhea and vomiting occur more commonly in gastroenteritis, which is an unrelated disease and sometimes inaccurately referred to as “stomach flu” or the “24-hour flu”.[6] Complications of influenza may include viral pneumonia, secondary bacterial pneumoniasinus infections, and worsening of previous health problems such as asthma or heart failure.[2][5]

Three of the four types of influenza viruses affect humans: Type A, Type B, and Type C.[2][7] Type D has not been known to infect humans, but is believed to have the potential to do so.[7][8] Usually, the virus is spread through the air from coughs or sneezes.[1] This is believed to occur mostly over relatively short distances.[9] It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes.[5][9] A person may be infectious to others both before and during the time they are showing symptoms.[5] The infection may be confirmed by testing the throat, sputum, or nose for the virus.[2] A number of rapid tests are available; however, people may still have the infection even if the results are negative.[2] A type of polymerase chain reaction that detects the virus’s RNA is more accurate.[2]

Frequent hand washing reduces the risk of viral spread.[3] Wearing a surgical mask is also useful.[3] Yearly vaccinations against influenza are recommended by the World Health Organization (WHO) for those at high risk,[1] and by the Centers for Disease Control and Prevention (CDC) for those six months of age and older.[10] The vaccine is usually effective against three or four types of influenza.[1] It is usually well-tolerated.[11] A vaccine made for one year may not be useful in the following year, since the virus evolves rapidly.[1] Antiviral drugs such as the neuraminidase inhibitor oseltamivir, among others, have been used to treat influenza.[1]The benefit of antiviral drugs in those who are otherwise healthy do not appear to be greater than their risks.[12] No benefit has been found in those with other health problems.[12][13]

Influenza spreads around the world in yearly outbreaks, resulting in about three to five million cases of severe illness and about 290,000 to 650,000 deaths.[4][1] About 20% of unvaccinated children and 10% of unvaccinated adults are infected each year.[14] In the northern and southern parts of the world, outbreaks occur mainly in the winter, while around the equator, outbreaks may occur at any time of the year.[11] Death occurs mostly in high risk groups—the young, the old, and those with other health problems.[1] Larger outbreaks known as pandemics are less frequent.[2] In the 20th century, three influenza pandemics occurred: Spanish influenza in 1918 (40–50 million deaths), Asian influenza in 1957 (two million deaths), and Hong Kong influenza in 1968 (one million deaths).[15] The World Health Organization declared an outbreak of a new type of influenza A/H1N1 to be a pandemic in June 2009.[16] Influenza may also affect other animals, including pigs, horses, and birds.[17]

File:Wikipedia-VideoWiki-Influenza.webm

Video summary (script)

Contents

Signs and symptoms

Most sensitive symptoms for diagnosing influenza[18]
Symptom: sensitivity specificity
Fever 68–86% 25–73%
Cough 84–98% 7–29%
Nasal congestion 68–91% 19–41%
  • All three findings, especially fever, were less sensitive in people over 60 years of age.

Symptoms of influenza,[19][20] with fever and cough the most common symptoms.[18]

Approximately 33% of people with influenza are asymptomatic.[21][22]

Symptoms of influenza can start quite suddenly one to two days after infection. Usually the first symptoms are chills and body aches, but fever is also common early in the infection, with body temperatures ranging from 38 to 39 °C (approximately 100 to 103 °F).[23] Many people are so ill that they are confined to bed for several days, with aches and pains throughout their bodies, which are worse in their backs and legs.[24]

Symptoms of influenza

It can be difficult to distinguish between the common cold and influenza in the early stages of these infections.[29] Influenza symptoms are a mixture of symptoms of common cold and pneumonia, body ache, headache, and fatigue. Diarrhea is not usually a symptom of influenza in adults,[18] although it has been seen in some human cases of the H5N1 “bird flu”[30] and can be a symptom in children.[26] The symptoms most reliably seen in influenza are shown in the adjacent table.[18]

The specific combination of fever and cough has been found to be the best predictor; diagnostic accuracy increases with a body temperature above 38 °C (100.4 °F).[31] Two decision analysis studies[32][33] suggest that during local outbreaks of influenza, the prevalence will be over 70%.[33] Even in the absence of a local outbreak, diagnosis may be justified in the elderly during the influenza season as long as the prevalence is over 15%.[33]

The United States Centers for Disease Control and Prevention (CDC) maintains an up-to-date summary of available laboratory tests.[34] According to the CDC, rapid diagnostic tests have a sensitivity of 50–75% and specificity of 90–95% when compared with viral culture.[35]

Occasionally, influenza can cause severe illness including primary viral pneumonia or secondary bacterial pneumonia.[36][37] The obvious symptom is trouble breathing. In addition, if a child (or presumably an adult) seems to be getting better and then relapses with a high fever, that is a danger sign since this relapse can be bacterial pneumonia.[38]

Sometimes, influenza may have abnormal presentations, like confusion in the elderly and a sepsis-like syndrome in the young.[39]

Emergency warning signs

Signs of dehydration

  • (in infants) Far fewer wet diapers than usual[40]
  • Cannot keep down fluids
  • (in infants) No tears when crying.

Virology

Types of virus

Structure of the influenza virion. The hemagglutinin (HA) and neuraminidase (NA) proteins are shown on the surface of the particle. The viral RNAs that make up the genome are shown as red coils inside the particle and bound to ribonuclearproteins (RNP).

In virus classification, influenza viruses are RNA viruses that make up four of the seven genera of the family Orthomyxoviridae:[41]

These viruses are only distantly related to the human parainfluenza viruses, which are RNA viruses belonging to the paramyxovirus family that are a common cause of respiratory infections in children such as croup,[42] but can also cause a disease similar to influenza in adults.[43]

A fourth family of influenza viruses was identified in 2016 – Influenza D.[44][45][46][47][48][49][50] The type species for this family is Influenza D virus, which was first isolated in 2011.[8]

Influenzavirus A

This genus has one species, influenza A virus. Wild aquatic birds are the natural hosts for a large variety of influenza A.[51] Occasionally, viruses are transmitted to other species and may then cause devastating outbreaks in domestic poultry or give rise to human influenza pandemics.[51] The influenza A virus can be subdivided into different serotypes based on the antibody response to these viruses.[52] The serotypes that have been confirmed in humans are:

Influenzavirus B

Influenza virus nomenclature (for a Fujian flu virus)

This genus has one species, influenza B virus. Influenza B almost exclusively infects humans[52] and is less common than influenza A. The only other animals known to be susceptible to influenza B infection are the seal[58] and the ferret.[59] This type of influenza mutates at a rate 2–3 times slower than type A[60] and consequently is less genetically diverse, with only one influenza B serotype.[52] As a result of this lack of antigenic diversity, a degree of immunity to influenza B is usually acquired at an early age. However, influenza B mutates enough that lasting immunity is not possible.[61] This reduced rate of antigenic change, combined with its limited host range (inhibiting cross species antigenic shift), ensures that pandemics of influenza B do not occur.[62]

Influenzavirus C

This genus has one species, influenza C virus, which infects humans, dogs and pigs, sometimes causing both severe illness and local epidemics.[63][64] However, influenza C is less common than the other types and usually only causes mild disease in children.[65][66]

Influenzavirus D

This genus has only one species, influenza D virus, which infects pigs and cattle. The virus has the potential to infect humans, although no such cases have been observed yet.[8]

Structure, properties, and subtype nomenclature

Influenzaviruses A, B, C, and D are very similar in overall structure.[8][67][68] The virus particle (also called the virion) is 80–120 nanometers in diameter such that the smallest virions adopt an elliptical shape.[69] The length of each particle varies considerably, owing to the fact that influenza is pleomorphic, and can be in excess of many tens of micrometers, producing filamentous virions.[70] However, despite these varied shapes, the viral particles of all influenza viruses are similar in composition.[71] These are made of a viral envelopecontaining two main types of glycoproteins, wrapped around a central core. The central core contains the viral RNA genome and other viral proteins that package and protect this RNA. RNA tends to be single stranded but in special cases it is double.[72] Unusually for a virus, its genome is not a single piece of nucleic acid; instead, it contains seven or eight pieces of segmented negative-sense RNA, each piece of RNA containing either one or two genes, which code for a gene product (protein).[71] For example, the influenza A genome contains 11 genes on eight pieces of RNA, encoding for 11 proteinshemagglutinin (HA), neuraminidase (NA), nucleoprotein (NP), M1 (matrix 1 protein), M2NS1 (non-structural protein 1), NS2 (other name is NEP, nuclear export protein), PA, PB1 (polymerase basic 1), PB1-F2 and PB2.[73]

Hemagglutinin (HA) and neuraminidase (NA) are the two large glycoproteins on the outside of the viral particles. HA is a lectin that mediates binding of the virus to target cells and entry of the viral genome into the target cell, while NA is involved in the release of progeny virus from infected cells, by cleaving sugars that bind the mature viral particles.[74] Thus, these proteins are targets for antiviral drugs.[75] Furthermore, they are antigens to which antibodies can be raised. Influenza A viruses are classified into subtypes based on antibody responses to HA and NA. These different types of HA and NA form the basis of the H and N distinctions in, for example, H5N1.[76] There are 18 H and 11 N subtypes known, but only H 1, 2 and 3, and N 1 and 2 are commonly found in humans.[77][78]

Replication

Host cell invasion and replication by the influenza virus. The steps in this process are discussed in the text.

Viruses can replicate only in living cells.[79] Influenza infection and replication is a multi-step process: First, the virus has to bind to and enter the cell, then deliver its genome to a site where it can produce new copies of viral proteins and RNA, assemble these components into new viral particles, and, last, exit the host cell.[71]

Influenza viruses bind through hemagglutinin onto sialic acid sugars on the surfaces of epithelial cells, typically in the nose, throat, and lungs of mammals, and intestines of birds (Stage 1 in infection figure).[80] After the hemagglutinin is cleaved by a protease, the cell imports the virus by endocytosis.[81]

The intracellular details are still being elucidated. It is known that virions converge to the microtubule organizing center, interact with acidic endosomes and finally enter the target endosomes for genome release.[82]

Once inside the cell, the acidic conditions in the endosome cause two events to happen: First, part of the hemagglutinin protein fuses the viral envelope with the vacuole’s membrane, then the M2 ion channel allows protons to move through the viral envelope and acidify the core of the virus, which causes the core to disassemble and release the viral RNA and core proteins.[71] The viral RNA (vRNA) molecules, accessory proteins and RNA-dependent RNA polymerase are then released into the cytoplasm (Stage 2).[83] The M2 ion channel is blocked by amantadine drugs, preventing infection.[84]

These core proteins and vRNA form a complex that is transported into the cell nucleus, where the RNA-dependent RNA polymerase begins transcribing complementary positive-sense vRNA (Steps 3a and b).[85] The vRNA either is exported into the cytoplasm and translated (step 4) or remains in the nucleus. Newly synthesized viral proteins are either secreted through the Golgi apparatus onto the cell surface (in the case of neuraminidase and hemagglutinin, step 5b) or transported back into the nucleus to bind vRNA and form new viral genome particles (step 5a). Other viral proteins have multiple actions in the host cell, including degrading cellular mRNA and using the released nucleotides for vRNA synthesis and also inhibiting translation of host-cell mRNAs.[86]

Negative-sense vRNAs that form the genomes of future viruses, RNA-dependent RNA polymerase, and other viral proteins are assembled into a virion. Hemagglutinin and neuraminidase molecules cluster into a bulge in the cell membrane. The vRNA and viral coreproteins leave the nucleus and enter this membrane protrusion (step 6). The mature virus buds off from the cell in a sphere of host phospholipid membrane, acquiring hemagglutinin and neuraminidase with this membrane coat (step 7).[87] As before, the viruses adhere to the cell through hemagglutinin; the mature viruses detach once their neuraminidase has cleaved sialic acid residues from the host cell.[80] After the release of new influenza viruses, the host cell dies.

Because of the absence of RNA proofreading enzymes, the RNA-dependent RNA polymerase that copies the viral genome makes an error roughly every 10 thousand nucleotides, which is the approximate length of the influenza vRNA. Hence, the majority of newly manufactured influenza viruses are mutants; this causes antigenic drift, which is a slow change in the antigens on the viral surface over time.[88] The separation of the genome into eight separate segments of vRNA allows mixing or reassortment of vRNAs if more than one type of influenza virus infects a single cell. The resulting rapid change in viral genetics produces antigenic shifts, which are sudden changes from one antigen to another. These sudden large changes allow the virus to infect new host species and quickly overcome protective immunity.[76] This is important in the emergence of pandemics, as discussed below in the section on epidemiology.

Mechanism

Transmission

When an infected person sneezes or coughs more than half a million virus particles can be spread to those close by.[89] In otherwise healthy adults, influenza virus shedding (the time during which a person might be infectious to another person) increases sharply one-half to one day after infection, peaks on day 2 and persists for an average total duration of 5 days—but can persist as long as 9 days.[21] In those who develop symptoms from experimental infection (only 67% of healthy experimentally infected individuals), symptoms and viral shedding show a similar pattern, but with viral shedding preceding illness by one day.[21] Children are much more infectious than adults and shed virus from just before they develop symptoms until two weeks after infection.[90] In immunocompromised people, viral shedding can continue for longer than two weeks.[91]

Influenza can be spread in three main ways:[92][93] by direct transmission (when an infected person sneezes mucus directly into the eyes, nose or mouth of another person); the airborne route (when someone inhales the aerosols produced by an infected person coughing, sneezing or spitting) and through hand-to-eye, hand-to-nose, or hand-to-mouth transmission, either from contaminated surfaces or from direct personal contact such as a handshake. The relative importance of these three modes of transmission is unclear, and they may all contribute to the spread of the virus.[9] In the airborne route, the droplets that are small enough for people to inhale are 0.5 to 5 μm in diameter and inhaling just one droplet might be enough to cause an infection.[92] Although a single sneeze releases up to 40,000 droplets,[94] most of these droplets are quite large and will quickly settle out of the air.[92] How long influenza survives in airborne droplets seems to be influenced by the levels of humidity and UV radiation, with low humidity and a lack of sunlight in winter aiding its survival.[92]

As the influenza virus can persist outside of the body, it can also be transmitted by contaminated surfaces such as banknotes,[95] doorknobs, light switches and other household items.[24] The length of time the virus will persist on a surface varies, with the virus surviving for one to two days on hard, non-porous surfaces such as plastic or metal, for about fifteen minutes on dry paper tissues, and only five minutes on skin.[96] However, if the virus is present in mucus, this can protect it for longer periods (up to 17 days on banknotes).[92][95]Avian influenza viruses can survive indefinitely when frozen.[97] They are inactivated by heating to 56 °C (133 °F) for a minimum of 60 minutes, as well as by acids (at pH <2).[97]

Pathophysiology

The different sites of infection (shown in red) of seasonal H1N1 versus avian H5N1. This influences their lethality and ability to spread.

The mechanisms by which influenza infection causes symptoms in humans have been studied intensively. One of the mechanisms is believed to be the inhibition of adrenocorticotropic hormone (ACTH) resulting in lowered cortisol levels.[98] Knowing which genes are carried by a particular strain can help predict how well it will infect humans and how severe this infection will be (that is, predict the strain’s pathophysiology).[64][99]

For instance, part of the process that allows influenza viruses to invade cells is the cleavage of the viral hemagglutinin protein by any one of several human proteases.[81] In mild and avirulent viruses, the structure of the hemagglutinin means that it can only be cleaved by proteases found in the throat and lungs, so these viruses cannot infect other tissues. However, in highly virulent strains, such as H5N1, the hemagglutinin can be cleaved by a wide variety of proteases, allowing the virus to spread throughout the body.[99]

The viral hemagglutinin protein is responsible for determining both which species a strain can infect and where in the human respiratory tract a strain of influenza will bind.[100] Strains that are easily transmitted between people have hemagglutinin proteins that bind to receptors in the upper part of the respiratory tract, such as in the nose, throat and mouth. In contrast, the highly lethal H5N1 strain binds to receptors that are mostly found deep in the lungs.[101] This difference in the site of infection may be part of the reason why the H5N1 strain causes severe viral pneumonia in the lungs, but is not easily transmitted by people coughing and sneezing.[102][103]

Common symptoms of the flu such as fever, headaches, and fatigue are the result of the huge amounts of proinflammatory cytokines and chemokines (such as interferon or tumor necrosis factor) produced from influenza-infected cells.[29][104] In contrast to the rhinovirus that causes the common cold, influenza does cause tissue damage, so symptoms are not entirely due to the inflammatory response.[105] This massive immune response might produce a life-threatening cytokine storm. This effect has been proposed to be the cause of the unusual lethality of both the H5N1 avian influenza,[106] and the 1918 pandemic strain.[107][108] However, another possibility is that these large amounts of cytokines are just a result of the massive levels of viral replication produced by these strains, and the immune response does not itself contribute to the disease.[109] Influenza appear to trigger programmed cell death (apoptosis).[110]

Prevention

Vaccination

Giving an influenza vaccination

The influenza vaccine is recommended by the World Health Organization (WHO) for high-risk groups, such as pregnant women, children aged less than five years, the elderly, health care workers, and people who have chronic illnesses such as HIV/AIDSasthmadiabetesheart disease, or are immunocompromised among others.[111][112] The United States Centers for Disease Control and Prevention (CDC) recommends the influenza vaccine for those aged six months or older who do not have contraindications.[113][10] In healthy adults it is modestly effective in decreasing the amount of influenza-like symptoms in a population.[114] In healthy children over the age of two years, the vaccine reduces the chances of getting influenza by around two-thirds, while it has not been well studied in children under two years.[115] In those with chronic obstructive pulmonary disease vaccination reduces exacerbations,[116] it is not clear if it reduces asthma exacerbations.[117] Evidence supports a lower rate of influenza-like illness in many groups who are immunocompromised such as those with: HIV/AIDScancer, and post organ transplant.[118] In those at high risk immunization may reduce the risk of heart disease.[119] Whether immunizing health care workers affects patient outcomes is controversial with some reviews finding insufficient evidence[120][121] and others finding tentative evidence.[122][123]

Due to the high mutation rate of the virus, a particular influenza vaccine usually confers protection for no more than a few years. Each year, the World Health Organization predicts which strains of the virus are most likely to be circulating in the next year (see Historical annual reformulations of the influenza vaccine), allowing pharmaceutical companies to develop vaccines that will provide the best immunity against these strains.[124] The vaccine is reformulated each season for a few specific flu strains but does not include all the strains active in the world during that season. It takes about six months for the manufacturers to formulate and produce the millions of doses required to deal with the seasonal epidemics; occasionally, a new or overlooked strain becomes prominent during that time.[125] It is also possible to get infected just before vaccination and get sick with the strain that the vaccine is supposed to prevent, as the vaccine takes about two weeks to become effective.[126]Vaccines can cause the immune system to react as if the body were actually being infected, and general infection symptoms (many cold and flu symptoms are just general infection symptoms) can appear, though these symptoms are usually not as severe or long-lasting as influenza. The most dangerous adverse effect is a severe allergic reaction to either the virus material itself or residues from the hen eggs used to grow the influenza; however, these reactions are extremely rare.[127]

A 2018 Cochrane review of children in good general health found that the live immunization seemed to lower the risk of getting influenza for the season from 18% to 4%. The inactivated vaccine seemed to lower the risk of getting flu for the season from 30% to 11%. Not enough data was available to draw definite conclusions about serious complications such as pneumonia or hospitalization.[115]

For healthy adults, a 2018 Cochrane review showed that vaccines reduced the incidence of lab-confirmed influenza from 2.3% to 0.9%, which constitutes a reduction of risk of approximately 60%. However, for influenza-like illness which is defined as the same symptoms of cough, fever, headache, runny nose, and bodily aches and pains, vaccine reduced the risk from 21.5% to 18.1%. This constitutes a much more modest reduction of risk of approximately 16%. The difference is most probably explained by the fact that over 200 viruses cause the same or similar symptoms as the flu virus.[114] Another review looked at the effect of short and long term exercise before the vaccine, however, no benefits or harms were recorded.[128]

The cost-effectiveness of seasonal influenza vaccination has been widely evaluated for different groups and in different settings.[129] It has generally been found to be a cost-effective intervention, especially in children[130] and the elderly,[131] however the results of economic evaluations of influenza vaccination have often been found to be dependent on key assumptions.[132][133]

Infection control

These are the main ways that influenza spreads

  • by direct transmission (when an infected person sneezes mucus directly into the eyes, nose or mouth of another person);
  • the airborne route (when someone inhales the aerosols produced by an infected person coughing, sneezing or spitting);
  • through hand-to-eye, hand-to-nose, or hand-to-mouth transmission, either from contaminated surfaces or from direct personal contact such as a hand-shake.

Reasonably effective ways to reduce the transmission of influenza include good personal health and hygiene habits such as: not touching your eyes, nose or mouth;[134] frequent hand washing (with soap and water, or with alcohol-based hand rubs);[135] covering coughs and sneezes; avoiding close contact with sick people; and staying home yourself if you are sick. Avoiding spitting is also recommended.[136] Although face masks might help prevent transmission when caring for the sick,[137][138] there is mixed evidence on beneficial effects in the community.[136][139] Smoking raises the risk of contracting influenza, as well as producing more severe disease symptoms.[140][141]

Since influenza spreads through both aerosols and contact with contaminated surfaces, surface sanitizing may help prevent some infections.[142] Alcohol is an effective sanitizer against influenza viruses, while quaternary ammonium compounds can be used with alcohol so that the sanitizing effect lasts for longer.[143] In hospitals, quaternary ammonium compounds and bleach are used to sanitize rooms or equipment that have been occupied by people with influenza symptoms.[143] At home, this can be done effectively with a diluted chlorine bleach.[144]

Social distancing strategies used during past pandemics, such as closing schools, churches and theaters, slowed the spread of the virus but did not have a large effect on the overall death rate.[145][146] It is uncertain if reducing public gatherings, by for example closing schools and workplaces, will reduce transmission since people with influenza may just be moved from one area to another; such measures would also be difficult to enforce and might be unpopular.[136] When small numbers of people are infected, isolating the sick might reduce the risk of transmission.[136]

Diagnosis

29 yr old with H1N1 confirmed

There are a number of rapid tests for the flu. One is called a Rapid Molecular Assay, when an upper respiratory tract specimen (mucus) is taken using a nasal swab or a nasopharyngeal swab.[147] It should be done within 3–4 days of symptom onset, as upper respiratory viral shedding takes a downward spiral after that.[39]

Treatment

People with the flu are advised to get plenty of rest, drink plenty of liquids, avoid using alcohol and tobacco and, if necessary, take medications such as acetaminophen (paracetamol) to relieve the fever and muscle aches associated with the flu.[148][149] In contrast, there is not enough evidence to support corticosteroids as add on therapy for influenza.[150] It is advised to avoid close contact with others to prevent spread of infection.[148][149] Children and teenagers with flu symptoms (particularly fever) should avoid taking aspirin during an influenza infection (especially influenza type B), because doing so can lead to Reye’s syndrome, a rare but potentially fatal disease of the liver.[151] Since influenza is caused by a virus, antibiotics have no effect on the infection; unless prescribed for secondary infections such as bacterial pneumonia. Antiviral medication may be effective, if given early (within 48 hours to first symptoms), but some strains of influenza can show resistance to the standard antiviral drugs and there is concern about the quality of the research.[152] High-risk individuals such as young children, pregnant women, the elderly, and those with compromised immune systems should visit the doctor for antiviral drugs. Those with the emergency warning signs should visit the emergency room at once.[40]

Antivirals

The two classes of antiviral drugs used against influenza are neuraminidase inhibitors (oseltamivirzanamivirlaninamivir and peramivir) and M2 protein inhibitors (adamantane derivatives).[153][154][155]

Neuraminidase inhibitors

Overall the benefits of neuraminidase inhibitors in those who are otherwise healthy do not appear to be greater than the risks.[12] There does not appear to be any benefit in those with other health problems.[12] In those believed to have the flu, they decreased the length of time symptoms were present by slightly less than a day but did not appear to affect the risk of complications such as needing hospitalization or pneumonia.[13] Increasingly prevalent resistance to neuraminidase inhibitors has led to researchers to seek alternative antiviral drugs with different mechanisms of action.[156]

M2 inhibitors

The antiviral drugs amantadine and rimantadine inhibit a viral ion channel (M2 protein), thus inhibiting replication of the influenza A virus.[84] These drugs are sometimes effective against influenza A if given early in the infection but are ineffective against influenza B viruses, which lack the M2 drug target.[157] Measured resistance to amantadine and rimantadine in American isolates of H3N2 has increased to 91% in 2005.[158] This high level of resistance may be due to the easy availability of amantadines as part of over-the-counter cold remedies in countries such as China and Russia,[159] and their use to prevent outbreaks of influenza in farmed poultry.[160][161] The CDC recommended against using M2 inhibitors during the 2005–06 influenza season due to high levels of drug resistance.[162]

Prognosis

Influenza’s effects are much more severe and last longer than those of the common cold. Most people will recover completely in about one to two weeks, but others will develop life-threatening complications (such as pneumonia). Thus, influenza can be deadly, especially for the weak, young and old, those with compromised immune systems, or the chronically ill.[76] People with a weak immune system, such as people with advanced HIV infection or transplant recipients (whose immune systems are medically suppressed to prevent transplant organ rejection), suffer from particularly severe disease.[163] Pregnant women and young children are also at a high risk for complications.[164]

The flu can worsen chronic health problems. People with emphysema, chronic bronchitis or asthma may experience shortness of breath while they have the flu, and influenza may cause worsening of coronary heart disease or congestive heart failure.[165] Smoking is another risk factor associated with more serious disease and increased mortality from influenza.[140]

According to the World Health Organization: “Every winter, tens of millions of people get the flu. Most are only ill and out of work for a week, yet the elderly are at a higher risk of death from the illness. We know the worldwide death toll exceeds a few hundred thousand people a year, but even in developed countries the numbers are uncertain, because medical authorities don’t usually verify who actually died of influenza and who died of a flu-like illness.”[166] Even healthy people can be affected, and serious problems from influenza can happen at any age. People over 65 years old, pregnant women, very young children and people of any age with chronic medical conditions are more likely to get complications from influenza, such as pneumonia, bronchitissinus, and ear infections.[167]

In some cases, an autoimmune response to an influenza infection may contribute to the development of Guillain–Barré syndrome.[168] However, as many other infections can increase the risk of this disease, influenza may only be an important cause during epidemics.[168][169] This syndrome has been believed to also be a rare side effect of influenza vaccines. One review gives an incidence of about one case per million vaccinations.[170] Getting infected by influenza itself increases both the risk of death (up to 1 in 10,000) and increases the risk of developing GBS to a much higher level than the highest level of suspected vaccine involvement (approx. 10 times higher by recent estimates).[171][168]

According to the Centers for Disease Control and Prevention (CDC), “Children of any age with neurologic conditions are more likely than other children to become very sick if they get the flu. Flu complications may vary and for some children, can include pneumonia and even death.”[172]

Influenza encephalitis MRI

Neurological conditions can include:

  • Disorders of the brain and spinal cord
  • Cerebral palsy
  • Epilepsy (seizure disorders)
  • Stroke
  • Intellectual disability
  • Moderate to severe developmental delay
  • Muscular dystrophy
  • Spinal cord injury

These conditions can impair coughing, swallowing, clearing the airways, and in the worst cases, breathing. Therefore, they worsen the flu symptoms.[172]

Epidemiology

Seasonal variations

Seasonal risk areas for influenza: November–April (blue), April–November (red), and year-round (yellow).

Influenza reaches peak prevalence in winter, and because the Northern and Southern Hemispheres have winter at different times of the year, there are actually two different flu seasons each year. This is why the World Health Organization (assisted by the National Influenza Centers) makes recommendations for two different vaccine formulations every year; one for the Northern, and one for the Southern Hemisphere.[124]

A long-standing puzzle has been why outbreaks of the flu occur seasonally rather than uniformly throughout the year. One possible explanation is that, because people are indoors more often during the winter, they are in close contact more often, and this promotes transmission from person to person. Increased travel due to the Northern Hemisphere winter holiday season may also play a role.[173] Another factor is that cold temperatures lead to drier air, which may dehydrate mucus particles. Dry particles are lighter and can thus remain airborne for a longer period. The virus also survives longer on surfaces at colder temperatures and aerosol transmission of the virus is highest in cold environments (less than 5 °C) with low relative humidity.[174] The lower air humidity in winter seems to be the main cause of seasonal influenza transmission in temperate regions.[175][176]

However, seasonal changes in infection rates also occur in tropical regions, and in some countries these peaks of infection are seen mainly during the rainy season.[177] Seasonal changes in contact rates from school terms, which are a major factor in other childhood diseases such as measles and pertussis, may also play a role in the flu. A combination of these small seasonal effects may be amplified by dynamical resonance with the endogenous disease cycles.[178] H5N1 exhibits seasonality in both humans and birds.[179][180]

An alternative hypothesis to explain seasonality in influenza infections is an effect of vitamin D levels on immunity to the virus.[181] This idea was first proposed by Robert Edgar Hope-Simpson in 1965.[182] He proposed that the cause of influenza epidemics during winter may be connected to seasonal fluctuations of vitamin D, which is produced in the skin under the influence of solar (or artificial) UV radiation. This could explain why influenza occurs mostly in winter and during the tropical rainy season, when people stay indoors, away from the sun, and their vitamin D levels fall.

Epidemic and pandemic spread

As influenza is caused by a variety of species and strains of viruses, in any given year some strains can die out while others create epidemics, while yet another strain can cause a pandemic. Typically, in a year’s normal two flu seasons (one per hemisphere), there are between three and five million cases of severe illness and around 650,000 deaths worldwide,[4][1][183] which by some definitions is a yearly influenza epidemic.[1] Although the incidence of influenza can vary widely between years, approximately 36,000 deaths and more than 200,000 hospitalizations are directly associated with influenza every year in the United States.[184][185] One method of calculating influenza mortality produced an estimate of 41,400 average deaths per year in the United States between 1979 and 2001.[186] Different methods in 2010 by the Centers for Disease Control and Prevention (CDC) reported a range from a low of about 3,300 deaths to a high of 49,000 per year.[187]

Roughly three times per century, a pandemic occurs, which infects a large proportion of the world’s population and can kill tens of millions of people (see pandemics section). One study estimated that if a strain with similar virulence to the 1918 influenza emerged today, it could kill between 50 and 80 million people.[188]

Antigenic shift, or reassortment, can result in novel and highly pathogenic strains of human influenza

New influenza viruses are constantly evolving by mutation or by reassortment.[52] Mutations can cause small changes in the hemagglutinin and neuraminidase antigens on the surface of the virus. This is called antigenic drift, which slowly creates an increasing variety of strains until one evolves that can infect people who are immune to the pre-existing strains. This new variant then replaces the older strains as it rapidly sweeps through the human population, often causing an epidemic.[189] However, since the strains produced by drift will still be reasonably similar to the older strains, some people will still be immune to them. In contrast, when influenza viruses reassort, they acquire completely new antigens—for example by reassortment between avian strains and human strains; this is called antigenic shift. If a human influenza virus is produced that has entirely new antigens, everybody will be susceptible, and the novel influenza will spread uncontrollably, causing a pandemic.[190] In contrast to this model of pandemics based on antigenic drift and shift, an alternative approach has been proposed where the periodic pandemics are produced by interactions of a fixed set of viral strains with a human population with a constantly changing set of immunities to different viral strains.[191]

The generation time for influenza (the time from one infection to the next) is very short (only 2 days). This explains why influenza epidemics start and finish in a short time scale of only a few months.[192]

From a public health point of view, flu epidemics spread rapidly and are very difficult to control. Most influenza virus strains are not very infectious and each infected individual will only go on to infect one or two other individuals (the basic reproduction number for influenza is generally around 1.4). However, the generation time for influenza is extremely short: the time from a person becoming infected to when he infects the next person is only two days. The short generation time means that influenza epidemics generally peak at around 2 months and burn out after 3 months: the decision to intervene in an influenza epidemic therefore has to be taken early, and the decision is therefore often made on the back of incomplete data. Another problem is that individuals become infectious before they become symptomatic, which means that putting people in quarantine after they become ill is not an effective public health intervention.[192] For the average person, viral shedding tends to peak on day two, whereas symptoms peak on day three.[21]

History

Etymology

The word Influenza comes from the Italian language meaning “influence” and refers to the cause of the disease; initially, this ascribed illness to unfavorable astrological influences. It was introduced into English in the mid-eighteenth century during a pan-European epidemic.[193] Archaic terms for influenza include epidemic catarrhla grippe (from the French, first used by Molyneaux in 1694),[194] sweating sickness, and Spanish fever (particularly for the 1918 flu pandemic strain).[195]

Pandemics

The difference between the influenza mortality age distributions of the 1918 epidemic and normal epidemics. Deaths per 100,000 persons in each age group, United States, for the interpandemic years 1911–1917 (dashed line) and the pandemic year 1918 (solid line).[196]

Thermal imaging camera and screen, photographed in an airport terminal in Greece during the 2009 flu pandemic. Thermal imaging can detect elevated body temperature, one of the signs of swine flu.

The symptoms of human influenza were clearly described by Hippocrates roughly 2,400 years ago.[197][198] Although the virus seems to have caused epidemics throughout human history, historical data on influenza are difficult to interpret, because the symptoms can be similar to those of other respiratory diseases.[199][194] The disease may have spread from Europe to the Americas as early as the European colonization of the Americas, since almost the entire indigenous population of the Antilles was killed by an epidemic resembling influenza that broke out in 1493, after the arrival of Christopher Columbus.[200][201]

The first convincing record of an influenza pandemic was of an outbreak in 1580, which began in Russia and spread to Europe via Africa. In Rome, over 8,000 people were killed, and several Spanish cities were almost wiped out. Pandemics continued sporadically throughout the 17th and 18th centuries, with the pandemic of 1830–1833 being particularly widespread; it infected approximately a quarter of the people exposed.[194]

The most famous and lethal outbreak was the 1918 flu pandemic (Spanish flu pandemic) (type A influenzaH1N1 subtype), which lasted from 1918 to 1919. It is not known exactly how many it killed, but estimates range from 50 to 100 million people.[196][202][203] This pandemic has been described as “the greatest medical holocaust in history” and may have killed as many people as the Black Death.[194] This huge death toll was caused by an extremely high infection rate of up to 50% and the extreme severity of the symptoms, suspected to be caused by cytokine storms.[203] Symptoms in 1918 were so unusual that initially influenza was misdiagnosed as dengue, cholera, or typhoid. One observer wrote, “One of the most striking of the complications was hemorrhage from mucous membranes, especially from the nose, stomach, and intestine. Bleeding from the ears and petechial hemorrhages in the skin also occurred.”[202] The majority of deaths were from bacterial pneumonia, a secondary infection caused by influenza, but the virus also killed people directly, causing massive hemorrhages and edema in the lung.[204]

The 1918 flu pandemic was truly global, spreading even to the Arctic and remote Pacific islands. The unusually severe disease killed between two and twenty percent of those infected, as opposed to the more usual flu epidemic mortality rate of 0.1%.[196][202] Another unusual feature of this pandemic was that it mostly killed young adults, with 99% of pandemic influenza deaths occurring in people under 65, and more than half in young adults 20 to 40 years old.[205] This is unusual since influenza is normally most deadly to the very young (under age 2) and the very old (over age 70). The total mortality of the 1918–1919 pandemic is not known, but it is estimated that 2.5% to 5% of the world’s population was killed. As many as 25 million may have been killed in the first 25 weeks; in contrast, HIV/AIDS has killed 25 million in its first 25 years.[202]

Later flu pandemics were not so devastating. They included the 1957 Asian Flu (type A, H2N2 strain) and the 1968 Hong Kong Flu (type A, H3N2 strain), but even these smaller outbreaks killed millions of people. In later pandemics antibiotics were available to control secondary infections and this may have helped reduce mortality compared to the Spanish flu of 1918.[196]

Known influenza pandemics[206][207][208] (

)

Name Date Subtype People infected (est.) Deaths Case fatality rate Pandemic Severity Index
1889–1890 flu pandemic
(Asiatic or Russian Flu)[209]
1889–1890 H3N8 or H2N2 ? N/A 1 million 0.15% N/A
1918 flu pandemic
(Spanish flu)[210]
1918–1920 H1N1 33% (500 million)[211] 20 to 100 million 2–3%[212] 5
Asian Flu 1957–1958 H2N2 8-33% (250–1000 million[213]) 1 to 1.5 million <0.2%[214] 2
Hong Kong Flu 1968–1969 H3N2 7-28% (250–1000 million[215]) 0.75 to 1 million <0.2%[216] 2
Russian flu 1977–1978 H1N1 N/A N/A N/A N/A
2009 flu pandemic[217][218] 2009–2010 H1N1/09 10–200 million[219] 105,700–395,600[220] 0.03%[221] N/A
Seasonal flu[t 1] Every year mainly A/H3N2,A/H1N1, and B 5–15% (340–1000 million)[222] 290–650,000/year[223] <0.1%[224] N/A
  1. ^ Not necessarily pandemic, but included for comparison purposes.

The first influenza virus to be isolated was from poultry, when in 1901, the agent causing a disease called “fowl plague” was passed through Chamberland filters, which have pores that are too small for bacteria to pass through.[225] The etiological cause of influenza, the virus family Orthomyxoviridae, was first discovered in pigs by Richard Shope in 1931.[226] This discovery was shortly followed by the isolation of the virus from humans by a group headed by Patrick Laidlaw at the Medical Research Council of the United Kingdom in 1933.[227] However, it was not until Wendell Stanley first crystallized tobacco mosaic virus in 1935 that the non-cellular nature of viruses was appreciated.

The main types of influenza viruses in humans. Solid squares show the appearance of a new strain, causing recurring influenza pandemics. Broken lines indicate uncertain strain identifications.[228]

The first significant step towards preventing influenza was the development in 1944 of a killed-virus vaccine for influenza by Thomas Francis, Jr. This built on work by Australian Frank Macfarlane Burnet, who showed that the virus lost virulence when it was cultured in fertilized hen’s eggs.[229] Application of this observation by Francis allowed his group of researchers at the University of Michigan to develop the first influenza vaccine, with support from the U.S. Army.[230] The Army was deeply involved in this research due to its experience of influenza in World War I, when thousands of troops were killed by the virus in a matter of months.[202] In comparison to vaccines, the development of anti-influenza drugs has been slower, with amantadine being licensed in 1966 and, almost thirty years later, the next class of drugs (the neuraminidase inhibitors) being developed.[231]

Society and culture

Influenza produces direct costs due to lost productivity and associated medical treatment, as well as indirect costs of preventative measures. In the United States, seasonal influenza is estimated to result in a total average annual economic cost of over $11 billion, with direct medical costs estimated to be over $3 billion annually.[232] It has been estimated that a future pandemic could cause hundreds of billions of dollars in direct and indirect costs.[233] However, the economic impacts of past pandemics have not been intensively studied, and some authors have suggested that the Spanish influenza actually had a positive long-term effect on per-capita income growth, despite a large reduction in the working population and severe short-term depressive effects.[234] Other studies have attempted to predict the costs of a pandemic as serious as the 1918 Spanish flu on the U.S. economy, where 30% of all workers became ill, and 2.5% were killed. A 30% sickness rate and a three-week length of illness would decrease the gross domestic product by 5%. Additional costs would come from medical treatment of 18 million to 45 million people, and total economic costs would be approximately $700 billion.[235]

Preventative costs are also high. Governments worldwide have spent billions of U.S. dollars preparing and planning for a potential H5N1 avian influenza pandemic, with costs associated with purchasing drugs and vaccines as well as developing disaster drills and strategies for improved border controls.[236] On 1 November 2005, United States President George W. Bush unveiled the National Strategy to Safeguard Against the Danger of Pandemic Influenza[233] backed by a request to Congress for $7.1 billion to begin implementing the plan.[237] Internationally, on 18 January 2006, donor nations pledged US$2 billion to combat bird flu at the two-day International Pledging Conference on Avian and Human Influenza held in China.[238][239]

In an assessment of the 2009 H1N1 pandemic on selected countries in the Southern Hemisphere, data suggest that all countries experienced some time-limited and/or geographically isolated socio/economic effects and a temporary decrease in tourism most likely due to fear of 2009 H1N1 disease. It is still too early to determine whether the H1N1 pandemic has caused any long-term economic impacts.[240]

Research

Dr. Terrence Tumpey examining a laboratory-grown reconstruction of the 1918 Spanish flu virus in a biosafety level 3 environment.

Research on influenza includes studies on molecular virology, how the virus produces disease (pathogenesis), host immune responsesviral genomics, and how the virus spreads (epidemiology). These studies help in developing influenza countermeasures; for example, a better understanding of the body’s immune system response helps vaccine development, and a detailed picture of how influenza invades cells aids the development of antiviral drugs. One important basic research program is the Influenza Genome Sequencing Project, which was initiated in 2004 to create a library of influenza sequences and help clarify which factors make one strain more lethal than another, which genes most affect immunogenicity, and how the virus evolves over time.[241]

The sequencing of the influenza genome and recombinant DNA technology may accelerate the generation of new vaccine strains by allowing scientists to substitute new antigens into a previously developed vaccine strain.[242] Growing viruses in cell culture also promises higher yields, less cost, better quality and surge capacity.[243] Research on a universal influenza A vaccine, targeted against the external domain of the transmembrane viral M2 protein (M2e), is being done at the University of Ghent by Walter FiersXavier Saelens and their team[244][245][246] and has now successfully concluded Phase I clinical trials. There has been some research success towards a “universal flu vaccine” that produces antibodies against proteins on the viral coat which mutate less rapidly, and thus a single shot could potentially provide longer-lasting protection.[247][248][249]

A number of biologics, therapeutic vaccines and immunobiologics are also being investigated for treatment of infection caused by viruses. Therapeutic biologics are designed to activate the immune response to virus or antigens. Typically, biologics do not target metabolic pathways like anti-viral drugs, but stimulate immune cells such as lymphocytesmacrophages, and/or antigen-presenting cells, in an effort to drive an immune response towards a cytotoxic effect against the virus. Influenza models, such as murine influenza, are convenient models to test the effects of prophylactic and therapeutic biologics. For example, lymphocyte T-cell immunomodulator inhibits viral growth in the murine model of influenza.[250]

Other animals

Influenza infects many animal species, and transfer of viral strains between species can occur. Birds are thought to be the main animal reservoirs of influenza viruses.[251] Most influenza strains are believed to have originated after humans began their intensive domestication of animals about 10,000 years ago.[252] Sixteen forms of hemagglutinin and nine forms of neuraminidase have been identified. All known subtypes (HxNy) are found in birds, but many subtypes are endemic in humans, dogshorses, and pigs; populations of camelsferretscatssealsmink, and whales also show evidence of prior infection or exposure to influenza.[61] Variants of flu virus are sometimes named according to the species the strain is endemic in or adapted to. The main variants named using this convention are: bird fluhuman fluswine fluhorse flu and dog flu. (Cat flu generally refers to feline viral rhinotracheitis or feline calicivirus and not infection from an influenza virus.) In pigs, horses and dogs, influenza symptoms are similar to humans, with cough, fever and loss of appetite.[61] The frequency of animal diseases are not as well-studied as human infection, but an outbreak of influenza in harbor seals caused approximately 500 seal deaths off the New England coast in 1979–1980.[253] However, outbreaks in pigs are common and do not cause severe mortality.[61] Vaccines have also been developed to protect poultry from avian influenza. These vaccines can be effective against multiple strains and are used either as part of a preventative strategy, or combined with culling in attempts to eradicate outbreaks.[254]

Bird flu

Flu symptoms in birds are variable and can be unspecific.[255] The symptoms following infection with low-pathogenicity avian influenza may be as mild as ruffled feathers, a small reduction in egg production, or weight loss combined with minor respiratory disease.[256] Since these mild symptoms can make diagnosis in the field difficult, tracking the spread of avian influenza requires laboratory testing of samples from infected birds. Some strains such as Asian H9N2 are highly virulent to poultry and may cause more extreme symptoms and significant mortality.[257] In its most highly pathogenic form, influenza in chickens and turkeys produces a sudden appearance of severe symptoms and almost 100% mortality within two days.[258] As the virus spreads rapidly in the crowded conditions seen in the intensive farming of chickens and turkeys, these outbreaks can cause large economic losses to poultry farmers.

An avian-adapted, highly pathogenic strain of H5N1 (called HPAI A(H5N1), for “highly pathogenic avian influenza virus of type A of subtype H5N1”) causes H5N1 flu, commonly known as “avian influenza” or simply “bird flu”, and is endemic in many bird populations, especially in Southeast Asia. This Asian lineage strain of HPAI A(H5N1) is spreading globally. It is epizootic (an epidemic in non-humans) and panzootic (a disease affecting animals of many species, especially over a wide area), killing tens of millions of birds and spurring the culling of hundreds of millions of other birds in an attempt to control its spread. Most references in the media to “bird flu” and most references to H5N1 are about this specific strain.[259][260]

HPAI A(H5N1) is an avian disease and there is no evidence suggesting efficient human-to-human transmission of HPAI A(H5N1). In almost all cases, those infected have had extensive physical contact with infected birds.[261] H5N1 may mutate or reassort into a strain capable of efficient human-to-human transmission. The exact changes that are required for this to happen are not well understood.[262] Due to the high lethality and virulence of H5N1, its endemic presence, and its large and increasing biological host reservoir, the H5N1 virus was the world’s pandemic threat in the 2006–07 flu season, and billions of dollars are being raised and spent researching H5N1 and preparing for a potential influenza pandemic.[236]

Chinese inspectors on an airplane, checking passengers for fevers, a common symptom of swine flu

In March 2013, the Chinese government reported three cases of H7N9 influenza infections in humans. Two of whom had died and the third was critically ill. Although the strain of the virus is not thought to spread efficiently between humans,[263][264] by mid-April, at least 82 persons had become ill from H7N9, of which 17 had died. These cases include three small family clusters in Shanghai and one cluster between a neighboring girl and boy in Beijing, raising at least the possibility of human-to-human transmission. WHO points out that one cluster did not have two of the cases lab confirmed and further points out, as a matter of baseline information, that some viruses are able to cause limited human-to-human transmission under conditions of close contact but are not transmissible enough to cause large community outbreaks.[265][266][267]

Swine flu

In pigs swine influenza produces fever, lethargy, sneezing, coughing, difficulty breathing and decreased appetite.[268] In some cases the infection can cause abortion. Although mortality is usually low, the virus can produce weight loss and poor growth, causing economic loss to farmers.[268] Infected pigs can lose up to 12 pounds of body weight over a 3- to 4-week period.[268] Direct transmission of an influenza virus from pigs to humans is occasionally possible (this is called zoonotic swine flu). In all, 50 human cases are known to have occurred since the virus was identified in the mid-20th century, which have resulted in six deaths.[269]

In 2009, a swine-origin H1N1 virus strain commonly referred to as “swine flu” caused the 2009 flu pandemic, but there is no evidence that it is endemic to pigs (i.e. actually a swine flu) or of transmission from pigs to people; instead, the virus spreads from person to person.[270][271] This strain is a reassortment of several strains of H1N1 that are usually found separately, in humansbirds, and pigs.[272]

References…

Further reading

External links

Classification