WHO Walks Back Comments On Asymptomatic Transmission : Consider This from NPR George Floyd's killing by police sparked protests around the world. Because of the coronavirus, attendance at Floyd's Houston funeral was limited and mourners were encouraged to wear masks.

People of color have been hit hard by the coronavirus because of risk factors including chronic health conditions and less access to health care. Experts say scientists need better data on who's getting sick and public health officials need to communicate better with communities of color.

A top official from the World Health Organization walked back a statement Monday in which she said transmission from asymptomatic carriers of the virus is "very rare."

A small but growing number of kids have a dangerous reaction to coronavirus called multi-inflammatory syndrome, which can cause inflamed hearts, lungs and other organs.

Plus, one man built an art piece he calls a 'Doorway To Imagination' in his social distancing-created free time.

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This episode was recorded and published as part of this podcast's former 'Coronavirus Daily' format.
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Kids And COVID-19; Mixed Messages On Asymptomatic Spread

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Kids And COVID-19; Mixed Messages On Asymptomatic Spread

Kids And COVID-19; Mixed Messages On Asymptomatic Spread

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KELLY MCEVERS, HOST:

Since the start of June, 14 states and Puerto Rico have set records. Looking at the seven-day average of new cases this month, The Washington Post reported those places have seen their highest-ever number of cases. The states include Alaska, Florida, California, South Carolina. Many of them have hot spots in small counties like Lincoln County, Ore., and three counties in northern Utah. Texas is also on that list. Texas, of course, is where George Floyd was laid to rest on Tuesday in his hometown of Houston.

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MIA WRIGHT: But in the tradition of the African American church, this will be a home-going celebration. Come on. I want to say it again. This will be a home-going celebration.

MCEVERS: The number of people who could come to The Fountain of Praise church was limited to hundreds of people to maintain social distancing. The church usually can hold thousands. Mia Wright is co-pastor there.

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WRIGHT: First, we do ask you to keep your mask on within the sanctuary. We thank God for that. If anyone...

MCEVERS: Coming up, the mysterious illness affecting children who might have had the virus. This is CORONAVIRUS DAILY from NPR. I'm Kelly McEvers. It's Tuesday, June 9.

Back in March, Dr. Uche Blackstock, a physician and founder of a group called Advancing Health Equity, could see all this coming - the risk factors for people of color.

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UCHE BLACKSTOCK: So I think, you know, many of us who have done work within health equity and have been paying attention to racial health disparities - we were very concerned from the beginning.

MCEVERS: People of color are less likely to have insurance or access to health care. They also have higher rates of chronic conditions like diabetes and high blood pressure. And they are more likely to catch the disease because so many of them are essential workers.

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BLACKSTOCK: So essentially, what we had was, you know, a crisis within a crisis.

MCEVERS: So what can public health officials do about it? For one thing, Blackstock says, scientists need better data on the race and ethnicity of who is getting sick. Last week, the federal government finally required states to collect that data, starting August 1.

(SOUNDBITE OF ARCHIVED NPR BROADCAST)

BLACKSTOCK: But aside from that, we really need there to be targeted, widespread testing in the communities that are being disproportionately impacted, walk-up testing and mobile testing for people without cars.

MCEVERS: And public health officials need to communicate better with communities of color.

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ROBERT REDFIELD: Yeah. Obviously, we're very concerned that our public health message isn't resonating.

MCEVERS: CDC Director Robert Redfield, testifying in front of Congress last week, seemed to be aware of that problem.

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REDFIELD: We continue to try to figure out how to penetrate the message with different groups.

MCEVERS: And it's not just messages about the importance of wearing a mask or social distancing. It's about, if you are a person of color who gets sick, knowing you can trust public health officials.

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ALICIA FERNANDEZ: One of the key aspects within contact tracing is that the sick person gets called up and is asked, tell me everyone you've been in contact with, starting two days before you became sick.

MCEVERS: Dr. Alicia Fernandez, an internist at Zuckerberg San Francisco General and an expert in health care disparities in Latino and immigrant health - she says after you test positive, if you get a call from a contact trace worker, you have to make a lot of quick decisions about how much information you want to share.

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FERNANDEZ: What if someone you work with is undocumented? What if they're in a mixed-status family? What if you simply don't know what the authorities are going to do with this information? And I think there, issues of trust are key.

MCEVERS: That's why, in addition to knowing someone's race and ethnicity, Fernandez says states should be tracking the preferred language of people who test positive.

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FERNANDEZ: So that we know it's Vietnamese who are affected over here. It's Tagalog speakers who are affected over there. We also really need to make sure on the federal level and at every level that there is consistent education to communities in the languages they speak. This is the time to realize that the health of each of us depends on the health of all of us.

MCEVERS: Dr. Alicia Fernandez and Uche Blackstock talked to NPR's Morning Edition.

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MCEVERS: On Monday, a top health official at the World Health Organization made a mistake. In a conference call with reporters, epidemiologist Maria Van Kerkhove said it is very rare for people without symptoms to transmit the virus to someone else. On Tuesday, she went on Facebook Live to clarify.

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MARIA VAN KERKHOVE: I was responding to a question at the press conference. I wasn't stating a policy of WHO or anything like that. I was just trying to articulate what we know. And in that, I used the phrase very rare, and I think that that's misunderstanding to state that asymptomatic transmission globally is very rare.

MCEVERS: NPR global health correspondent Jason Beaubien helped make sense of what happened with Mary Louise Kelly on All Things Considered.

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MARY LOUISE KELLY: May I ask you just to cut to the chase? Can people who do not have symptoms transmit the virus or not?

JASON BEAUBIEN: Yes, they can. There's documented evidence of people who are not showing any symptoms transmitting this virus to others. And there are studies in laboratories that have also found that there's transmissible virus in infected people who have not yet gotten sick or may never get sick with COVID.

KELLY: So for those of us still confused by her clarification today, why was she saying it is very rare for people who don't have symptoms to spread the virus?

BEAUBIEN: So this comes down to the terms here. And let's first start with asymptomatic. Van Kerkhove - she's a scientist, and she's using asymptomatic to refer to something very specific here - coronavirus carriers who are infected but never end up getting sick. And there have been some cases where they have passed on the virus to others. And then there's what Van Kerkhove calls pre-symptomatic. These are people who've been infected, haven't yet gotten sick but will get sick. And they definitely can spread the virus. And there's plenty of evidence of this.

KELLY: But if both these groups have got the virus and both can spread the virus, why is the distinction between asymptomatic and pre-symptomatic so important from a transmission point of view?

BEAUBIEN: Because the pre-symptomatics (ph) potentially pose a far greater danger to transmit than the asymptomatics (ph). But until one of them starts showing symptoms, you can't tell them apart. And what Van Kerkhove had been saying yesterday at the press conference - saying it was very rare to see documented cases of an asymptomatic person transmitting the virus onto someone else - that doesn't mean it doesn't happen. They are probably less likely to transmit it, but that hasn't been proven. And Van Kerkhove was trying to say this in the context of, if we could just go after the symptomatic cases, contain those, we can bring these outbreaks under control.

KELLY: How common is it, by the way, to have a carrier who is asymptomatic?

BEAUBIEN: So again, we don't have a solid answer on that either. The virus is new. Studies are ongoing. There's different studies that are coming up with wildly different rates of potentially asymptomatic carriers.

But just today, the CDC actually released results of an investigation that it did on that outbreak on the USS Theodore Roosevelt. And they had a - roughly a thousand service members test positive on there, and that was the one that they had to pull into Guam. In that study, the CDC investigators found 18% of the sailors who tested positive for coronavirus had the virus in their bodies, but 18% of them showed no symptoms at all. The CDC, however, did not look at whether those asymptomatics did or did not transmit the virus onto others.

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MCEVERS: NPR global health correspondent Jason Beaubien with All Things Considered host Mary Louise Kelly.

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MCEVERS: A small number of kids are having a dangerous reaction to the coronavirus. At Children's National Hospital in Washington, D.C., doctors are seeing as many as 50 kids with what they're calling multi-inflammatory syndrome in children, or MIS-C. It's rare, but it's serious. Kids are ending up with inflamed hearts, lungs and other organs.

Most of the MIS-C patients at Children's National don't have the virus itself, but they do have the antibodies, which means MIS-C might happen after a child has recovered from COVID-19 - a kind of overreaction of their immune system. But the CDC says they still don't know the exact cause. Weekend Edition host Lulu Garcia-Navarro talked to one mother whose son was diagnosed.

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LULU GARCIA-NAVARRO: The first sign that something was wrong came with stomach pains. It was April 30, and 9-year-old Kyree McBride wasn't feeling well.

TAMMIE HAIRSTON: I thought it was something that he ate, but then it went away.

GARCIA-NAVARRO: That's Tammie Hairston, his mom. She and Kyree live in the D.C. area. And she says, later that Thursday...

HAIRSTON: He had a slight fever. And I gave him Tylenol and didn't think no more of it after the fact because the fever had broke.

GARCIA-NAVARRO: But it came back. Worried about the coronavirus, Hairston took him to the hospital, where they told him to take him home and monitor him. The fever, though, didn't break.

HAIRSTON: So by Wednesday night, he started developing a red eye. And I looked at his eyes. It was, like, a real slightness of redness. And, like, most people probably wouldn't have picked it up.

GARCIA-NAVARRO: At that point, a friend called her about a new condition she'd seen in the news. It's called multi-inflammatory syndrome in children, or MIS-C.

HAIRSTON: So I just immediately got up because I got scared. I was like, let me immediately take him to the emergency room. Something is just not right with him.

GARCIA-NAVARRO: Finally, Kyree was admitted to Children's National Hospital in Washington, D.C.

HAIRSTON: When they admitted him, I really - I cried. I broke down in the hospital because for seven days, I was strong. I was, you know, doing what I supposed to do as a mother.

GARCIA-NAVARRO: Kyree's blood work showed he had some kind of infection, but all his coronavirus tests come back negative. An antibody test, though, showed that Kyree had been infected at some point with the coronavirus that causes COVID-19.

HAIRSTON: We just don't know when. No one's been around us. He didn't show anything. We - he hadn't been sick prior to then.

GARCIA-NAVARRO: The doctors told her they thought he had MIS-C. Dr. Roberta DeBiasi is the chief of pediatric infectious diseases at Children's National. She says they've been using a variety of medication to treat the symptoms of the condition, which can mimic another relatively rare inflammatory condition called Kawasaki disease.

ROBERTA DEBIASI: What we're really trying to prevent is injury to the coronary artery, which are medium-sized blood vessels that feed the heart with blood.

GARCIA-NAVARRO: And because MIS-C is believed to be a reaction to a past coronavirus infection and appears to take hold once the child has antibodies, there is something else that worries Dr. Michael Bell. He's chief of critical care at Children's National, and we interviewed him inside the pediatric ICU.

MICHAEL BELL: There may be concerns of who to vaccinate. If kids are going to get a vaccine, it's going to cause antibodies. I'm assuming the whole world's going to want a vaccine at some point, and vaccinating a bunch of kids who all get sick with this syndrome would be a problem. So we aren't in any way certain that it's going to happen with the vaccine, but we're - obviously, that's a concern.

GARCIA-NAVARRO: Which is why it's important for any vaccine to be studied extensively. I asked Kyree what all this has been like for him.

Was that scary?

KYREE MCBRIDE: No.

HAIRSTON: Yes, it was.

GARCIA-NAVARRO: No.

HAIRSTON: He was scared of all the needles.

GARCIA-NAVARRO: After his checkup this past week, the doctors gave him a heart monitor because his heart is now arrhythmic. The doctors at Children's National Hospital emphasized that multi-inflammatory syndrome in children is rare, and there have only been three deaths from the syndrome in the United States so far. But Tammie Hairston is still worried.

HAIRSTON: I'm always, like, feeling his head and making sure he don't have any more fevers and asking him, you know, every hour on the hour, are you OK? Are you feeling OK? Let me feel your head.

GARCIA-NAVARRO: Her advice to other parents - be watchful. And if in doubt, take your child to the hospital.

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MCEVERS: NPR's Lulu Garcia-Navarro.

It's been a stressful couple of months for David North. On top of the pandemic and all the extra time he's spending at home in rural Maryland, his husband has been having some health issues.

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DAVID NORTH: He's doing good now. But dealing with the stress, I spend a lot of time outside, and I have yard projects. I found some old wood behind one of our sheds. And for some reason, I thought of, let me build myself a door. And it doesn't really open. It - but it looks like a door.

MCEVERS: North described the door to our colleague Sarah McCammon on All Things Considered.

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SARAH MCCAMMON: It looks almost like, you know, something you'd see in a secret garden or a little...

NORTH: (Laughter) Yeah. Yeah.

MCCAMMON: A little hut in the forest.

NORTH: Yes. Yes.

MCCAMMON: And then it's just surrounded by all this kind of brambly wood and vines, it almost looks like, around it.

NORTH: It looks kind of surreal.

MCEVERS: David calls it his Doorway to Imagination. And when his niece, public radio host and correspondent Kimberly Adams, tweeted a picture of it, it went viral. You really have to see it to understand why. And the point of the doorway, he says, isn't to imagine actually escaping through it.

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NORTH: It's not an escape. I believe it's a catharsis.

MCCAMMON: Yeah. What's the difference between escape and catharsis for you?

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NORTH: Catharsis is accepting the realities of the problems that happen in our lives and doing something constructive with it, processing it.

MCEVERS: David North. His husband, by the way, is also named David. Photos of his door out behind their house - which, by the way, they call Camp Davids - is in the link in our episode notes. We also want to say NPR reporter Brakkton Booker contributed to today's episode. For more on the coronavirus, you can stay up to date with all the news on your local public radio station and on npr.org.

I'm Kelly McEvers. We'll be back with more tomorrow.

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