What you need to know about coronavirus on Monday, July 20

releases illustration of the Coronavirus.

It doesn't end with a negative test.

Covid-19 survivors are discovering scary long-term effects of the disease. Strolls that feel like climbing Mount Everest. Brain fog and problems with short-term memory make reading, writing and speaking harder. Chronic fatigue, breathlessness, and muscle pain turn simple everyday tasks into difficult chores. Returning to work is out of the question.

In Europe, where the peak of Covid-19 infections has now passed, thousands of people say they are far from fully recovered. Health authorities are starting to offer rehabilitation services to survivors suffering from wide-ranging effects of the disease.

"What surprises me the most is that even the patients that have not spent any time in the ICU are extremely feeble: there is no evidence of a cardiological or pulmonary problem, but they are not even able to walk up a flight of stairs," said Dr. Piero Clavario, director of a post-Covid rehab institute attended in Genoa, Italy. "Most show a serious muscle weakness. A 52-year-old nurse had to go back to work after having recovered from Covid, but she just couldn't physically make it."

When the pandemic first ravaged the world, it was mostly older people who were thought to be the most at risk. However, more younger people are now getting infected. And many are reporting lingering health problems months after contracting the disease.

Research now indicates that Covid-19 is a multi-system disease that can damage not only the lungs, but the kidneys, liver, heart, brain, nervous system, skin and gastrointestinal tract. And while it is still true that the majority of cases are relatively mild, roughly 20% suffer severe symptoms.

"One out of five patients are going to get a severe form of the disease," said Dr. Luis Ostrosky-Zeichner, a professor of medicine at the University of Texas McGovern Medical School. "This is a lottery you do not want to win."


Q: How long do I need to isolate to prevent transmission of the virus?

A: The US Centers for Disease Control and Prevention has updated its guidance for people who are isolating at home with Covid-19 to prevent transmission of the virus.

Someone who has tested positive for Covid-19 and has symptoms may discontinue isolation 10 days after the symptoms first appeared, so long as 24 hours have passed since the last fever without the use of fever-reducing medications, and if symptoms such as coughing and shortness of breath have improved.

People with Covid-19 symptoms isolating at home and with access to tests can leave isolation if a fever has passed without the use of medication, if there is an improvement in symptoms, and if tests taken more than 24 hours apart come back negative, according to the guidelines published Friday.

A person without symptoms can discontinue isolation 10 days after the first positive test and if they have not subsequently developed symptoms. People who have tested positive for Covid-19 and are asymptomatic can also discontinue isolation if the results of two tests taken more than 24 hours apart come back negative.

Send your questions here. Are you a health care worker fighting Covid-19? Message us on WhatsApp about the challenges you're facing: +1 347-322-0415.


49 hospitals in Florida have no ICU beds left

In Florida's Miami-Dade County, intensive care units are at about 127% capacity, with 398 beds for 507 patients. Daily new cases have tripled in just a month in the Sunshine State, with more than 12,000 Floridans confirmed as newly infected on Sunday alone.

The numbers are trending in an alarming direction. The state now has more than 350,000 cases and 4,982 deaths, state data shows. If Florida was a country, it would rank seventh on the global tally of the most infected nations.

Martha Baker, the president of a union representing health care professionals at Jackson Health, told CNN affiliate WFOR the local health care system was at a crisis moment. "We're just, I say, dancing on the head of a pin, hoping we can keep dancing," she said. "Fifteen nurses in the ICUs alone called in sick today, just at Jackson Main."

Coronavirus and deforestation rip through the world's lungs

There is no telling how grim things might get for Brazilians left largely unprotected by President Jair Bolsonaro. The country has reported more than 2 million coronavirus cases. Almost 80,000 people have died.

But while Bolsonaro's pandemic management influences immediate life and death for Brazilians, the far-right populist sometimes known as the "Trump of the Tropics" also manages protection of the Amazon, Bill Weir reports. And in the middle of a man-made climate crisis, earth scientists say this gives him an undue -- and scary -- influence over all of life as we know it. For generations.

How India got to 1 million cases

India hit yet another daily record today, recording more than 40,000 new coronavirus cases. On Friday, it became the third country after the United States and Brazil to report one million total cases.

India remained relatively unaffected back in February and March, when coronavirus outbreaks took off in other parts of Asia. When the country of 1.3 billion locked down on March 25, it had around 520 cases and 10 deaths. But for many, lockdown was difficult -- if not impossible. Around one sixth of the urban population lives in densely-packed slums where social distancing was not an option.

Sanjay Rai, the president of the Indian Public Health Association, says the lockdown helped delay the outbreak, allowing authorities to manufacture more personal protective equipment kits. But those early steps didn't allow India to avoid the outbreak altogether. Since the nationwide lockdown lifted, some states have enforced their own restrictions -- or even resumed lockdowns. Despite that, India has gone from 500 cases to more than one million in four months.

Mask up!

Starting today, people in Arkansas must wear masks in public. The state has joined a growing list of places that have issued mask mandates in recent days and weeks. Experts have repeatedly said that masks are among the most powerful tools in the battle against the virus -- and Dr. Anthony Fauci, America's leading infectious disease expert, has urged governors and mayors to be "as forceful as possible" to get people to wear them.

The push for masks is not unique to the US. Face coverings are now mandatory in enclosed spaces in France. In the UK, people already have to wear them on public transport. Starting Friday they'll become mandatory in shops in England too, bringing it into line with Scotland. Hundreds of demonstrators, some wearing masks, gathered in London yesterday to protest the rule.

In the US, the issue of masks has turned into a full-blown political debate. Georgia Governor Brian Kemp is suing Atlanta Mayor Keisha Lance Bottoms over the city's mask mandate. And President Donald Trump, who for months refused to wear a mask in public, told Fox News he wouldn't consider a national mask mandate. "No, I want people to have a certain freedom. And I don't believe in that, no. I don't believe in the statement that if everyone wore a mask, everything disappears ... with that being said, I'm a believer in masks. I think masks are good," he said.



So, about masks -- they do next to nothing if you don't wear them properly. Yep, even the cloth coverings touted as the best thing since social distancing have instructions. We've laid them out for you, based on guidance from the CDC and the World Health Organization.

The most important bit: Masks are effective only if they cover your mouth, nose and chin. And however tempting it may be to remove your mask for a moment, doing that could expose your fingers and face to the very virus you're trying to avoid.


"A lot of things about Covid are very, very simple, but we try to make them much more complicated. There are relatively few things we can do, and in one of those is consistently wearing a mask. And it isn't a question of following every citizen around every day with a policeman to make sure they're wearing a mask. It's an issue of consistent leadership." -- Dr. James Curran, dean of Emory University's Rollins School of Public Health

CNN Chief Medical Correspondent Dr. Sanjay Gupta talks to Curran about setbacks that may have been caused by inconsistent leadership through this pandemic. Listen Now.

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