Journalist/developer. Interactive editor @frontlinepbs. Builder of @HomicideWatch. Sinophile for fun. Past: @WBUR, @NPR, @NewsHour.
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How We Designed The Look Of Our 2020 Forecast

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An election year in the FiveThirtyEight newsroom is unlike any other year. We started off by launching our Democratic primary forecast in January, and once Joe Biden had effectively clinched the nomination in April, we were ready to hit the gas on our general election forecast. But 2020 has its own agenda: a global pandemic, a crashing U.S. economy, changes to the way we conduct elections, and a reckoning with systemic racism and police brutality.

This week, however, we kicked off our main event: We launched our 2020 presidential election forecast on Wednesday. We put a lot of thought into how to forecast an election amid world-altering events, and into how to design and let users interact with that forecast. How do you present a forecast that communicates what we know but also what we don’t know and what might change? That question became especially pressing given the added uncertainty introduced by COVID-19, but we’ve been thinking about it for years, especially after the 2016 election.

Our impression was that people who read a lot of our coverage in the lead-up to 2016 and spent a good amount of time with our forecast thought we gave a pretty accurate picture of the election — polls showed Clinton leading, but not by much, and President Trump had a clear chance of winning given his advantage in crucial battleground states. People who were looking only at our top-line forecast numbers, on the other hand, thought we bungled it. Given the brouhaha after the 2016 election, we knew we had to thoughtfully approach how we delivered the forecast. When readers came looking to see who was favored to win the election, we needed to make sure that information lived in a well-designed structure that helped people understand where those numbers are coming from and what circumstances were affecting them.

Building the foundation

We started by putting some major goals for the design on paper. We aimed to:

  • Construct a clear narrative that helps readers better understand how the election actually works.
  • Focus almost exclusively on the model and put related information into other projects.
  • Help users find our other content, like video, podcasts and stories, to give the model context.
  • Design for desktop and mobile devices so readers can have a great experience no matter how they access the forecast.
  • Use art to let that weird visual quality that FiveThirtyEight is known for shine.

In the 2016 and 2018, we built straightforward interfaces: a sidebar and a series of modules that weren’t really linked by a narrative flow.

One of our goals this time was to form a narrative, so we figured, why not rethink how the user explores the election? This time around, we considered a number of experimental experiences, including interfaces where readers could shuffle the House, Senate and presidential forecasts like a deck of cards, or ones where users could sort of choose their own adventure.

Sketches of potential user experience flows we considered during the concept phase.

Sketches of potential user experience flows we considered during the concept phase.

Ultimately, we chose a fairly simple structure for displaying the presidential forecast, leaving behind some of the more complicated user experiences. The final version is modular and the pieces of the forecast are visualized on cards. Each card gives the reader a different lens on the election. Some also offer a chance to explore deeper by switching tabs or hovering on elements like dots or lines. This structure also helped us nail our goal of designing for flexibility. Adapting for smaller screen sizes and other platforms (like social media, TV and video) was much easier because each piece of content was designed to stand alone.

A few early versions of what became the final design, with placeholder data and annotations.

A few early versions of what became the final design, with placeholder data and annotations.

Designing the floor plan

Now that we had a sound foundation, we needed great data visualizations to build on it. To iron out what we wanted to show in this year’s forecast, we sifted through all the work we’ve done before. We surveyed past forecasts and documented what every chart aimed to accomplish and how successful we felt it was.

The list of visualizations from 2016 that we used to decide which might be good candidates to carry into the most recent forecast.

The list of visualizations from 2016 that we used to decide which might be good candidates to carry into the most recent forecast.

This approach helped us prioritize visualizations that effectively communicate what is most valuable to readers. We divvied up the design of the individual graphics across our team of visual journalists. To ensure some consistency in the results, we asked each person to consider a standard set of questions about their design.

Choosing the most expensive couch

No visualization in this forecast received more design attention than the top line, which is what we call the chart that shows the overall chances of a candidate or party winning the election.

Whether we show the chances in percentages or odds, this is the portion of an election forecast that is most anticipated — and has the most potential to be misunderstood. In 2016, we aimed for simplicity, both visually and conceptually. In 2018, we leaned into the complexity of the forecast. For 2020, we wanted to land somewhere in between. We also knew we wanted to try to lift the curtain a little on how that top-line chart comes to exist in the first place.

To really oversimplify things: Each candidate’s odds of winning at least 270 electoral votes come from their chances of winning in each state1 and D.C. To get from polling averages to probabilities, we simulate the election thousands of times to account for a whole bunch of uncertainties: How accurate will the polls be overall? What if they’re off in only certain states? What if Trump beats his polls, but only in the Midwest? What if Biden overperforms in the states hit hardest by the pandemic? What if the economy improves a ton between now and Election Day? What if it gets worse? What if the coronavirus or vote-by-mail laws affect turnout? I could go on, but let’s stop there.

Those simulations give us a universe of possibilities, and focusing on the scope of that universe is eventually how we chose the design for the top-line chart.

We came up with dozens of concepts, from dead-simple bar charts and conventional visualization types to universes within universes.

A selection of the top-line charts we experimented with to evoke the “universe of possibility” concept we wanted to convey.

A selection of the top-line charts we experimented with to evoke the “universe of possibility” concept we wanted to convey.

In each iteration we tried to add a visual twist to the design. Some were relatively undemanding. Others were … pretty bizarre! We tried to get creative rather than boxing ourselves into things we knew would work. Ultimately, we landed on two elements to lead off the forecast.

First — before we get to any numbers — we give the reader the headline and a sense of the range of possible electoral outcomes in the form of a grid of maps:

There are a number of ways a candidate can win, depending on which states they put in their column. Each of these maps represents one simulated scenario. We want to prime readers to focus on the states as the drivers of the overall odds, and we want to tease the idea of multiple possible outcomes.

Second, we follow the maps with a chart that we affectionately call “the ball swarm,” a reference to a type of chart sometimes called a bee swarm:

Similar to the grid of maps, the ball swarm shows readers 100 representative electoral outcomes from our model. The dots huddle on an x-axis showing how many votes a candidate wins the Electoral College by in each scenario. Hover over each of the dots to see how the map shook out in that simulation.

Those maps — some of which you’ve already seen at the top of the forecast — are intended to hammer home how the states power the overall probabilities and show the huge range of potential outcomes that would be consistent with the data currently being input into the model. Forecasting an election is more like predicting the weather than predicting whether a coin will land on heads or tails; it’s complicated, and one of the chief benefits of building a model is to measure the real-world uncertainty about the outcome. We hope the ball swarm’s universe of 2020 outcomes communicates that uncertainty.

Our guess is that you won’t see something like the ball swarm in other publications’ election coverage and we hope that you think it’s as weird and informative as we do. As for the rest of our presidential forecast, let our forecast mascot Fivey Fox guide you through it. There’s more to come from the forecast and no doubt from 2020, so buckle up and give it a scroll!

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Should I send my child back to school? This is the latest science on coronavirus and kids.

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We are a few weeks away from back-to-school season, and debate around school reopening is intensifying. Meanwhile, the science around children and COVID-19 is still evolving. One thing is clear: the decision-making process will be unique for each district, school, and family. Here, we answer some of the most pressing questions:

Can children catch COVID-19?

Yes, but they are less likely than adults. A study published in Science has shown that children under age 14 are between one-third and one-half as likely as adults to contract the virus. Another group of researchers looked at 2,000 children and teachers in schools around the German state of Saxony. Tests were carried out in several schools after reopening where there had been known outbreaks of the virus. There were few coronavirus antibodies among children and teachers indicating that only some of them had gotten the disease.

Around 7% of confirmed COVID-19 cases in the U.S. have been among children younger than 18, according to the Centers for Disease Control and Prevention. However, older Americans now represent a lower percentage of infections than they did at the start of the outbreak. Most schools around the country closed in March as the virus began to circulate more widely. That could explain why fewer children got sick.

What happens to kids when they get coronavirus?

Severe impact from COVID-19 is rare for children – most recover within one to two weeks.

"We tested over 8,000 children and the vast majority of these children are having mild symptoms," said Roberta DeBiasi, the chief of pediatric infectious diseases at Children's National Hospital in Washington, D.C.

People less than 18 years old are less likely to have severe disease including shortness of breath. Some children have developed a multisystem inflammatory disorder, dubbed MIS-C. It is a condition where different body parts become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs.

However, this complication is also rare. In addition, there are only 36 deaths among children under age 14 or 0.03% of total patients who died from COVID-19 nationwide, as of July 22

Researchers don't know why children seem to be doing better than adults. There are a couple of theories around.

One of them is that children might have a decreased number of the receptors that the virus requires to enter the cells of the body and then grow in those cells.

A child's immune system is designed to sense and respond to new potential threats. It could be better prepared and fit to react to the novel coronavirus than an adult's. With aging, malnutrition, immunosuppression, and long-term diseases, the immune system loses the ability to adapt to novelty.

However, if a person gets the coronavirus, there is no guarantee that the disease won't return. 

"If we take the percentage of patients that actually have measurable antibody in their blood, we don't know yet for sure if that antibody, even if it's present at the time that we can detect it, if that is also the type of antibody that will completely protect you from a future infection, " DeBiasi said. 

There are also a couple of studies that show coronavirus antibodies may disappear after mere months in some people. 

Will coronavirus spread in classrooms?

The virus that causes COVID-19 is primarily spread by respiratory droplets and recent evidence suggests that in some cases, people can become infected with COVID-19 through aerosol transmission.

American classrooms are typically crowded with a few dozen children who, without social distancing and mask-wearing, could spread respiratory droplets to those around them and breathe in those droplets. Students are usually in classrooms for extended periods of time, plenty to facilitate exposure to virus-carrying droplets in the air. And older students often mix with dozens of new students in different classes throughout the day. That’s why a main recommendation from the CDC in reopening schools is to have students of all ages and abilities wear masks and to keep them at least six feet apart as often as possible. The CDC also recommends that schools consider keeping students in cohorts, so that they take as many classes as possible with the same group.

It is also possible to get the virus if you touch your eyes, nose, or mouth after coming into contact with a contaminated surface. Students share toys, remotes, computers, restrooms, chairs, and travel in tight hallways, so schools may indeed facilitate the spread of the disease.

Do children transmit COVID-19?

Yes. A study from South Korea has found that children younger than 10 transmit the novel coronavirus to others much less often than adults do, but the risk is not zero. And those between the ages of 10 and 19 can spread the virus at least as well as adults do.

Researchers studying family clusters in several countries found that children were not likely to be patient zero in their households, only being responsible for around 10% of clusters. In one example, a child with COVID-19 came into contact with more than a hundred children at a ski resort but none got sick.

However, children are also less likely than adults to show symptoms, so the studies may have underestimated the number of children who set off the chain of transmission within their households.

"If children are talking or laughing, or singing or shouting, or sneezing or coughing, and no one thinks that they're infected, but in fact they are, that could be a way to further the spread of the virus out into the population," said Steven L. Zeichner, a professor of pediatrics and microbiology at the University of Virginia.

Other studies have also suggested that the large number of contacts for schoolchildren, who interact with dozens of others for a good part of the day, may cancel out their smaller risk of infecting others.

What about COVID-19 and teachers?

The average age of teachers in U.S. schools is nearly 43. Older teachers tend to work at smaller public and private schools, according to the research by the National Center for Education Statistics. The elderly are at elevated risk for severe illness and death from COVID-19.

What are the plans to reopen schools?

While schools in the U.S. are not yet in session, we have seen some international examples. Some schools have closed temporarily if just one student was diagnosed with COVID-19. Others have stayed open even when multiple children or staff got the disease, sending only affected and direct contacts into quarantine. Some schools also started requiring masks and implemented social distancing measures. Please check with your local school district for specific guidance.

Reopening will require more work for parents and schools. Kids will need to wear a mask, wash hands often, and cover coughs and sneezes with a tissue, as recommended by CDC

Schools that open will need to implement additional cleaning and disinfection procedures, particularly for hallways, playgrounds, cafeterias and shared workspaces, like libraries. By estimates, the average school district will spend an additional $1.8 million on health and safety measures to reopen.

There are various safety strategies being practiced at schools around the world, which includes combinations of requiring masks, reducing the number of students per classroom, temperature checks, social distancing, and increased hand-washing. Some countries have limited in-person classes to younger students who seem to be at lower risk of contracting and spreading COVID-19.

Recent studies of COVID-19 predict that school closures alone would prevent only 2% to 4% of deaths, much less than other social distancing interventions. A preprint study focusing on five-day closure of nearly all schools in the Seattle metropolitan area estimated that the school closure resulted in a reduction of just a little over 5% in coronavirus infections. 

Can social isolation harm my kids?

Continued closures risk “scarring the life chances of a generation of young people,” according to an open letter published last month and signed by more than 1500 members of the United Kingdom’s Royal College of Paediatrics and Child Health (RCPCH). American Academy of Pediatrics (AAP) has advocated for “having students physically present in school” as well.

Social isolation may bring a range of psychological harms. In one study published in JAMA Pediatrics, researchers in Hubei province in China, the origin of the pandemic, examined a sample group of 2,330 schoolchildren for signs of emotional distress. The kids had been locked down for an average of 33.7 days. Even after that single month, 22.6% of them reported depressive symptoms and nearly 19% were experiencing anxiety.

Children who already suffer from depression and anxiety may be at a higher risk. In the aftermath of 9/11, adolescents’ level of distress closely tracked whether or not they had a history of such conditions.

Should schools stay closed?

There is no one-size-fits-all approach when it comes to the question of whether the schools should be opened or closed. Experts continue to say schools should make that decision primarily on whether COVID-19 is spreading in their region. In much of the country, coronavirus is spiking right now.

"Each particular school, district or county has to look with their health department at what the daily increase in cases is, or the seven day average of increases in cases and get a handle on whether or not the virus is in control in their region or their county or not," DeBiasi said. 

Next, schools should consider whether they might be able to implement safety measures, like maintaining social distance, and decreasing class sizes. The third level is individual families.  

"In a family that has many elderly people living in a household, or has immunocompromised parents or other children in the household, the decision for that family to send their child into a school in person may be completely different than a household where there are no elderly people," DeBiasi said.

Some of the kids may also be more vulnerable than others. The children and young adults over 15 years of age were more likely to require critical care in a study led by DeBiasi. She and her colleagues examined the medical records of symptomatic children and young adults who sought treatment at Children’s National for COVID-19 between March 15 and April 30. The majority of children hospitalized had an underlying condition. 

Young patients with underlying neurological conditions, such as cerebral palsy, microcephaly, or global developmental delay were significantly more likely to require hospitalization. Other common underlying diseases included congenital heart disease, cancer and blood disorders. Immunosuppressed patients and the ones with a disease that would cause them to potentially have trouble breathing may also be in greater danger.

President Donald Trump believes 'tough' CDC school reopening guidelines should be changed

President Donald Trump criticizes the CDC guidelines for the upcoming school year. Which includes children, teachers, and staff getting regularly tested.

USA TODAY

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HarlandCorbin
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My son should be starting 9th grade. Other than this year with the plague, he has been in-person for school the entire time. This year, he will be moving to a cyber school. He has asthma, and our community seems hellbent on bucking any kind of guidance that would inconvenience them. Like wearing masks. Or distancing. The scary thing is that we are in PA, a state that has been doing well against COVID. And we're in a part of the state that isn't so much of a trump-centric craphole.

Why Do Patients Lose Ability To Smell?

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New research led by scientists at Harvard University Medical School explains one of the many mysteries of COVID-19: why people infected with the virus temporarily lose their sense of smell.

The loss of smell has been the most common neurological symptom of the virus. The study's lead author, Dr. Sandeep Robert Datta, said their findings about why that happens was a surprise and could lead towards eventual treatments for a range of neurological disorders caused by the virus.

Harvard neuroscientists took a close look at a specialized type of sensory neurons in the nose that detect and transmit smells to the brain.

"Our intuition, and I think the intuition of many other people, would be that the virus would attack these sensory neurons and damage or kill these neurons, and that's how we lose our sense of smell," said Datta, an associate professor of neurobiology in the Blavatnik Institute at Harvard Medical School. The study Datta led was published Friday in the journal Science Advances.

"But in looking at our data, we got a big surprise," he said. "Which is that it seems like the virus is not actually capable of attacking the neurons that live in your nose."

Instead, the scientists discovered that two other kinds of cells that support those neurons are being attacked. Those cells can regenerate more quickly.

"And so we think, on the whole, this is good news, and suggests that people who lose their sense of smell, for the most part, are going to go on to get their sense of smell back," Datta said.

That's what doctors have seen as the epidemic has progressed — most patients regain their sense of smell in several weeks.

"We finally have clues that lead us to understand how it is the virus might attack your sense of smell," Datta said, "which leads us to theories about how it might attack your neurological systems more generally."

In addition to a loss of smell, the virus has caused a number of other neurological symptoms, including altered consciousness, difficulty concentrating, sensory motor deficits, and strokes. Datta said he's hopeful that this new understanding of what cells the virus attacks in the nose might prove useful in understanding those other symptoms.

"I think that points the way to important strategies for treatments, both for people who've lost their sense of smell and for people who are suffering from various neurological consequences of COVID, as well," he said.

The study also looked at a part of the brain called the olfactory bulb that's responsible for getting information from the nose, and found the neurons there are also not infected by the coronavirus.

"It's possible, even given our research, that the virus will infect some types of neurons," Datta acknowledged. "At least for now, our best guess is that it's mostly attacking vascular cells that help to feed the brain. I think that changes our strategies for how we might manage the virus and manage neurological symptoms that are associated with COVID going down the road."

COVID-19 patients have also lost their sense of taste, and Datta said that's more than just a side effect of losing the ability to smell.

"It's clear from the data that are available now that the coronavirus independently attacks your sense of taste as well," he said, adding that the same sorts of supporting cells may be attacked for taste, too.

"In preliminary analysis that has been done by colleagues of mine, it appears that the virus does not attack neurons that transmit information about taste," he said.

More research needs to be done to verify the paper's conclusion, Datta said, and to understand how the virus attacks the brain. He said a lack of access to autopsy studies has hampered that kind of study.

And while most patients who survive COVID-19 regain a sense of smell, Datta said some do not.

"And although I think to most people, that doesn't seem like very much of a big deal, we know from other people who have lost our sense of smell that it's a huge risk factor for depression and other kinds of psychological changes," he said. "Because we, as humans, even though we don't think about our sense of smell very much, are deeply emotionally dependent on our sense of smell for our day-to-day well-being."

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cheap, quick, at-home rapid test is needed, experts say

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One major reason COVID-19 is raging out of control across much of the country: the current system of testing catches only a tiny fraction of people while they are contagious. 

It's now clear as many as 40% of people who contract the coronavirus that causes the disease don't know they have it. Others are contagious a few days before they know they're sick. If more people knew when they were infectious, they would likely stay home and not pass on the virus, slowing or even stopping the outbreak.

But the test that's most commonly used to diagnose COVID-19, known as a PCR test, requires analysis in a lab using expensive equipment. With the current surge in cases in Southern and Western states, and a shortage of supplies to run the tests, it routinely takes three to five days – often a week or longer – to return results.

More than 750,000 tests are conducted a day in the United States with more than 50,000 new positives nearly every day this month. 

A growing chorus of scientists argue that while PCR may be a good tool in hospitals to identify precisely how much virus a patient is carrying, it's not enough to stop the pandemic.

Instead, people need to know they're contagious when they're contagious, which means they should be tested at least a few times a week.

"That could be one of our most important interventions as we come into the fall to prevent large outbreaks from happening," said Stephen Kissler, a research fellow at the Harvard T.H. Chan School of Public Health.

"I'm on board with (this) thinking," agreed Dr. Benjamin Pinsky, medical director of the clinical virology laboratory at Stanford University. "I think that would be quite useful."

Someone who tests negative could visit an aging parent or grandparent without worrying about risking their lives. Teachers could walk into their classrooms with confidence, knowing that no one was harboring the virus. The dental chair would get a little less scary.

"We still are not in a circumstance where we have quick turnaround diagnostics the way we need," Dr. Francis Collins, director of the National Institutes of Health said in Friday webinar.

Making tests faster, cheaper, easier

A rapid, low-cost diagnostic is technologically feasible and getting closer to reality.

At Massachusetts Institute of Technology, researchers are collaborating with a team at 3M to develop and scale such a test. Before the pandemic, MIT chemical engineer Hadley Sikes had developed prototypes to detect malaria, tuberculosis and dengue. 

If one for COVID-19 works, it could deliver results within 10 minutes. All someone would need to do is add a bodily fluid to a specially made piece of paper that changes color to indicate a positive or negative. No formal training or fancy machines needed.

The National Institutes of Health is supporting development of this test and others with money, daily advice and a Shark-Tank-like competition, Sikes said. It's part of a $1.5 billion federal initiative called Radical Acceleration of Diagnostics (or RADx) to speed the pace of diagnostic development.

"The world needs as many useful tests as possible as fast as possible," Sikes said.

Her team's goal is to develop millions of these pregnancy-test like diagnostics every day, first in the United States and then around the world. Although Sikes said she couldn't commit to a specific timeline, theoretically, tens of millions of these tests could be produced in time for the start of school in September.

How much does accuracy matter?

An early review of this type of rapid test showed it accurately identified people with COVID-19 only about half the time. But it was the right half, said Dr. Michael Mina, an assistant professor of epidemiology at Harvard T. H. Chan School of Public Health, who has been leading the effort to develop a fast, frequent testing approach.

This test might miss some people with low levels of virus in their system, but most of those would already be on the road to recovery, with such low levels they'd unlikely be contagious.

Whether you're infectious or not depends on how much virus your body is producing, Sikes said.

As someone is falling ill, the virus reproduces incredibly quickly, so they wouldn't stay at low levels for more than a few hours, Mina said on a recent This Week in Virology podcast. Odds are slim the person would test themselves in that exact window and miss a burgeoning infection.

And even if the test overlooked a few infected people, another test a few days later when they are more infectious would almost certainly be positive, Mina said.

Dave O'Connor, a professor of pathology and laboratory medicine at the University of Wisconsin-Madison, said tests can miss lots of people with low levels of the virus and yet have a profound impact on transmission. 

"You'll still have some embers" with a rapid, less accurate test, O'Connor said. But much of the COVID-19 transmission seems to come from super-spreaders – people with extraordinarily high viral loads in a position to infect a lot of other people. "If that's correct, then those are the people you'll need (to identify) to extinguish much of the fire."

And a rapid test taken frequently should be able to do that.

There would still be a role, O'Connor and others said, for PCR testing, in doctor's offices and hospitals, where a precise diagnosis could be crucial for treatment. Other types of tests are also in use or under development, each with strengths and weaknesses, suitable in different contexts, said Stanford's Pinsky, who is developing another type of test, as is O'Connor.

Waiting on regulatory approval

A big hang-up now is that regulators haven't yet signed off on this type of rapid test, out of concern for its accuracy. And companies are not pursuing approval for such tests, because they don't think the FDA will give its okay, Mina said. 

"No one is stepping forward because the message they are receiving clearly from the FDA is that the tests must approach the analytical sensitivity of PCR," he said. "But this should not be the criteria. It neglects how the tests are used."

For its part, the U.S. Food and Drug Administration said it has approved six so-called point of care (POC) tests, which return results quickly – though these cannot be done without a lab or a trained professional. 

"For accuracy/sensitivity of POC tests, the FDA remains committed to facilitating the availability of reliable, efficient diagnostic tests for COVID-19," according to FDA spokeswoman Nicole Mueller. "The agency considers the level of sensitivity in connection with the potential benefits and potential risks of any diagnostic test when evaluating an (Emergency Use Authorization) request."

Daniel Larremore, a co-author with Mina on the paper reviewing the tests, said regulators may be particularly leery of allowing less sensitive tests because of criticism they faced earlier in the pandemic. To try to relieve a logjam of testing in March, the FDA opened the door to more than 200 antibody tests, later recalling authorization for many that proved useless.

"There may be some scars there from the past decision," said Larremore, a mathematician and assistant professor at the University of Colorado Boulder's Biofrontiers Institute.

The FDA's rules are well intentioned, said O'Connor, but providing the highest quality of data may not be as important when so many people are sick and suffering.

"The enormous burden of cases right here and now and the impact it's going to have on society, especially when schools have a tough time reopening, demands innovation, demands creativity, and demands that the government enable types testing and types of novel approaches that might never be considered under other, non-pandemic situations," he said. 

Nate Grubaugh, an assistant professor of epidemiology at Yale University, said it's unlikely enough rapid tests could be made quickly enough to transform the pandemic. And he worries that while each individual test would be low-cost, doing them repeatedly would end up being expensive, creating another disparity between poor and wealthy communities.

Fundamentally, "speed and availability of testing need to go up dramatically across the country," said Grubaugh, who is developing a test that relies on saliva instead of sampling from the upper nose as is done with PCR tests. "It'll be a combination of lots of things that get us there." 

Contact Weintraub at <a href="mailto:kweintraub@usatoday.com">kweintraub@usatoday.com</a>

Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.

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As Schools Consider Reopening, How Much Can Kids Spread Coronavirus? : Shots

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Research suggests that kids tend to get infected with the coronavirus less often, and have milder symptoms than adults. There's less consensus on how much kids can spread the illness. Dan Kenyon/Getty Images hide caption

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Research suggests that kids tend to get infected with the coronavirus less often, and have milder symptoms than adults. There's less consensus on how much kids can spread the illness.

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As scientists study the burden of COVID-19 around the globe, it's pretty clear that despite some cases of serious illness, kids tend to get infected with the coronavirus less often and have milder symptoms compared to adults.

"It seems consistently, children do have lower rates of infection than adults," says Dr. Alison Tribble, a pediatric infectious disease specialist at C.S. Mott Children's Hospital at the University of Michigan.

What's much less understood is the extent to which kids can spread the illness among themselves — or to the adults with whom they come in close contact.

A lack of testing early in the pandemic has been part of the problem, says Dr. Judy Guzman-Cottrill, an infectious disease pediatrician at Oregon Health and Science University. "We need more robust epidemiologic studies to evaluate how children are part of the transmission chain," she says.

Given the uncertainty, the decisions on how to safely reopen schools are tricky.

"Kids don't seem to be super spreaders," says Dr. Aaron Carroll, a pediatrician at Indiana University School of Medicine. But, since most schools around the country closed in March as the virus began to circulate more widely, it's really an unanswered question.

"Schools will now be the experiment," Carroll says. "We're going to see a bunch of schools open with varying levels of control, and then we will see what happens."

There are a handful of preliminary studies from other countries that suggest there's less transmission of the virus from kids to adults or kids to other kids, especially among younger children.

For instance, a study from Switzerland included children who were diagnosed with COVID-19 at a hospital in Geneva. Contact tracers identified the children's household contacts. They found that the child was the suspected spreader of the virus in only three of the 39 cases.

When It Comes To Reopening Schools, 'The Devil's In The Details,' Educators Say

Another analysis from Australia included nine students and nine adults, who were infected with the coronavirus and came into contact with more than 700 other students and more than 125 staff members. The researchers found that only two infections were known to be linked to these exposures.

In a commentary published in Pediatrics, two pediatric infectious disease experts concluded that while these studies are "far from definitive, the [research] provides early reassurance that school-based transmission could be a manageable problem."

However, as testing of children has increased, scientists are learning more. Just last week, a top health official in Victoria, Australia, cautioned that child-to-child transmission is "more apparent" than was previously understood, as more kids have started to be tested.

Other recent research suggests that the age of children may be a factor. Data from contact tracing in South Korea suggest that older children are more likely to spread the virus to their close contacts compared to younger children, particularly in a home setting. Researchers analyzed thousands of contacts of about 5,700 coronavirus patients (from January through March of 2020), looking at the age of the first infected person in a household. In homes where the first person infected in a cluster was 10 to 19, about 19% of their household contacts got COVID-19. In contrast, only 5.3% of the household contacts of younger children aged 0 to 9 were known to be infected.

Note: schools were closed during the period of the study, so it's not clear how the classroom environment influences risk.

And, adding to the concern, there are also some signs that reopening schools can increase the spread of the virus. For instance, researchers analyzed what happened after many students returned to school in Germany in late May. While rates of infection did not appear to increase among teachers and staff, the infection rate did increase among students. The study, which is released in pre-print, concludes that the increase may be attributed to the difficulty of social distancing when schools are at full capacity.

But the returning students in this analysis encompassed a mix of grades including many older students. In contrast, the return of groups of younger students in Germany earlier in May did not seem to correspond with increased cases.

Overall, it's difficult to tease out the specific effect of school closures since so many communities around the globe simultaneously took other steps aimed at slowing the spread of the virus, including stay-at-home advisories.

But many experts agree that the rate of community spread is an important factor in determining whether to return to in-person instruction. The more widely the virus is circulating in a community, the riskier it is to open schools.

"It is reassuring that in other countries that successfully did reopen schools, they didn't in general experience large outbreaks in their schools," says Anita Cicero, deputy director of the Johns Hopkins Center for Health Security.

But she points out that these countries that successfully reopened schools had low community transmission on the date they reopened.

"For instance in Japan, South Korea, Finland and France, each of those countries had about 1 or fewer cases per 100,000 people when they reopened," she says. In contrast, there are currently some U.S counties with 80 or more new daily cases per 100,000.

Green, Yellow, Orange Or Red? This New Tool Shows COVID-19 Risk In Your County

And while there's no standard metric for determining what rate of community spread is too high to have schools open, many epidemiologists say that when a county has more than 25 new cases a day per 100,000, the county is considered in the "red" zone and should consider shelter-in-place advisories, which would include keeping schools closed.

"So we really need to be doing all we can to drive those numbers down so that we can return children to school buildings," Cicero says.

Given the fact that the virus is still circulating widely in many areas of the U.S., experts say school reopening plans must include measures to safeguard students and teachers.

"The way we can do this safely is really by having very strong plans laid out ahead of time as to how to essentially limit interactions," says Dr. Bill Miller, an epidemiologist and physician at Ohio State University.

This is why many school plans call for pods or splitting classrooms into smaller groups to "make bubbles of kids," as Miller describes it, so that you're not crossing groups of kids across different classes. Limiting class sizes also makes social distancing more feasible.

Overall, when it comes to opening schools, "I think the benefits outweigh the risks," Miller says. But, he cautions that many places in the country have infection rates that are spiraling upward. "So it's really going to take a lot of attention and caution, and at any point I think it would be appropriate to pull the trigger and say, no, we can't [open]," he says, or that we need to close schools again.

To have the best chance of successfully remaining open, "schools should consider postponing bringing kids back into the classroom in regions where there is substantial community transmission of the virus," Cicero says.

"This should be a national priority," she says, "It's measurably more important than reopening bars and restaurants."

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The Vast World of Islam, in 300 Recipes

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“Whereas other writers are likely to modernize or do their own takes and innovations, I believe Anissa is a traditionalist and a purist,” Ms. Roden said.

For “Feast,” Ms. Helou traveled to more countries than she could count, including some she had never been to, like Indonesia and Senegal. But political instability barred her from visiting certain countries, including Syria, where she has not gone since October 2010. The dish on the book’s cover, kabab karaz, comes from Aleppo, Syria, a place that was once famous for its pepper, but is now better known for its condition of ruin.

Kabab karaz is a dish of ground lamb meatballs cooked in a pool of pitted sour cherries, raw cane sugar and pomegranate molasses. The meatballs take on the appearance of tiny marbles glossed with ruby-red sauce; the dish’s tartness is energetic, but not disorienting. Once the meatballs are tender, you pile them on a bed of pita bread triangles drizzled with butter, dusting them with chopped parsley and toasted pine nuts.

Ms. Helou considers Aleppo the “gastronomic capital of the Middle East,” she said.

And kabab karaz epitomizes the soul of the city. “The food culture of Aleppo is probably the most interesting of the food cultures of the Middle East,” she said. “It’s steeped in culinary lore.”

She got the recipe from Maria Gaspard-Samra, a chef who taught cooking classes in Aleppo before the city’s destruction.

If Aleppo has now become synonymous with decay, Ms. Helou would do her part to keep its signature recipe alive. She started by writing it down.

Recipe: Meatballs in Sour Cherry Sauce (Kabab Karaz)

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