Be Afraid, Be Very Afraid

Your Risk Isn't Just COVID-19 Symptoms, It's What Comes Later
Do you know the long term harms COVID-19 may do to your brain, lungs, heart, kidneys and the rest of your body?

Over 500,000 persons worldwide have died from the disease -- and one quarter of them used to live in the United States. But there is now increasing evidence that may be only part of the damage the disease can do.

There has been a recent upsurge of young people becoming infected.

Unfortunately, if they are willing to ignore their moral obligation to avoid infecting others -- as apparently many are -- their use of analytical tools such as risk assessment, benefit-cost, and opportunity cost could rationalize their ignoring masks, social distancing and hand washing.

What's the worst that could happen? How serious would that be? How likely is it to happen? They may not become infected. If infected they may have no symptoms. If they have symptoms they may be mild and quickly pass. So the benefit of masking up is relatively small, and the cost of avoiding crowds, the opportunity cost of missing out on social opportunities at parties and beaches, is (in their minds) very high. Their behavior -- if one can overlook their selfish disregard of others -- is marginally understandable.

Videos of hundreds of young folks without masks gathered shoulder to shoulder, ignoring the warnings, makes it seem hopeless. How can their behavior be changed?

What if we were to significantly increase the "cost" side of their equation? And how might we do that? We could "start spreading the news" (to borrow a line from Sinatra's "New York") of the serious after effects of COVID-19 infections -- starting with the human brain and cognitive function (to focus the attention of college students).

In the years to come, it may well be medical professionals who focus on the brain and cognitive function who are seeing and helping many post-COVID patients. The reason is that hypoxia, cardiac dysfunction, blood clots, strokes and similar conditions — all of which have been observed, to one degree or another, in those suffering COVID-19 — can all have long-term effects on brain function and cognition.

Wilfred Van Gorp, "Wave of cognitive disorders in young people from COVID-19," The Hill (Dr. Gorp is the former president of the American Academy of Clinical Neuropsychology.)

Here are some more excerpts, this time from the BBC: Zoe Cormier, "How Covid-19 can damage the brain; Some scientists suspect that Covid-19 causes respiratory failure and death not through damage to the lungs, but the brain – and other symptoms include headaches, strokes and seizures," BBC, June 22, 2020

For Julie Helms, it started with a handful of patients admitted to her intensive care unit ...and it was not just their breathing difficulties that alarmed her. "[M]any had neurological problems – mainly confusion and delirium,” she says. “this was completely abnormal. It has been very scary, especially because many of the people we treated were very young – many in their 30s and 40s, even an 18-year-old.” [T]he neurological symptoms in their Covid-19 patients, ranging from cognitive difficulties to confusion ... are signs of “encephalopathy” (the general term for damage to the brain) ...

Now, more than 300 studies from around the world have found a prevalence of neurological abnormalities in Covid-19 patients, including mild symptoms like headaches, loss of smell (anosmia) and tingling sensations (arcoparasthesia), up to more severe outcomes such as aphasia (inability to speak), strokes and seizures. This is in addition to recent findings that the virus, which has been largely considered to be a respiratory disease, can also wreak havoc on the kidneys, liver, heart, and just about every organ system in the body.

“In fact, there is a significant percentage of Covid-19 patients whose only symptom is confusion” – they don't have a cough or fatigue, says Robert Stevens, associate professor of anaesthesiology and critical care medicine at Johns Hopkins Medicine in Baltimore, Maryland. “We are facing a secondary pandemic of neurological disease,” says Stevens. “We’ve now learned that the disease affects many different organ systems: patients can die not only from lung failure, but also neurological manifestations. If you had asked me a month ago if there was any published evidence that Sars-CoV-2 could cross the blood-brain barrier, I would have said no – but there are now many reports showing that it absolutely can,” says Stevens.

In fact, some scientists now suspect that the virus causes respiratory failure and death not through damage to the lungs but through damage to the brainstem, the command centre that ensures we continue to breathe even when unconscious. ... The brain is normally shielded from infectious diseases by what is known as the “blood-brain barrier” – a lining of specialised cells inside the capillaries running through the brain and spinal cord. These block microbes and other toxic agents from infecting the brain. If Sars-CoV-2 can cross this barrier, it suggests that not only can the virus get into the core of the central nervous system, but also that it may remain there, with the potential to return years down the line.

Though rare, this Lazarus-like behaviour is not unknown among viruses: the chickenpox virus Herpes zoster, for example, commonly infects the nerve cells in the spine, later reappearing in adulthood as shingles – roughly 30% of people who experienced chickenpox in childhood will develop shingles at some point in their lives. ... David Nutt, professor of neuropsychopharmacology at Imperial College London, says he himself treated many patients in the 1970s and 1980s who had suffered from severe clinical depression ever since the 1957 influenza pandemic in the UK. “Their depression was enduring and it was solid – it was as if their emotional circuits had all been switched off,” he says, warning that we could see the very same thing happen again, but on a much larger scale. “People who are discharged from the ICU with Covid-19 need to be monitored systematically long-term for any evidence of neurological damage – and then given interventionist treatments if necessary.”

And in Pittsburgh, through the Global Consortium Study of Neurological Dysfunction in Covid-19, Sherry Chou, a neurologist at the University of Pittsburgh, has coordinated scientists from 17 countries to collectively monitor the neurological symptoms of the pandemic, including through brain scans. ... Although the virus’s impact on the lungs is the most immediate and terrifying threat, the lasting impact on the nervous system may be far larger and far more devastating, says Chou. "Recovery from neurological injuries is often incomplete and can take much longer compared to other organ systems (for example, lung), and therefore result in much greater overall disability, and possibly more death,” she says.

The final sentence reads, "Patients experiencing lung failure can be put on a respirator, and kidneys can be rescued with a dialysis machine – and, with some luck, both organs will bounce back. But there is no dialysis machine for the brain."

See also, Julie Helms, et al, Strasbourg University Hospital, Strasbourg, France, "Neurologic Features in Severe SARS-CoV-2 Infection," Letter, New England Journal of Medicine, June 4, 2020.

There may be a subsequent blog post regarding the other medical conditions that can be triggered by COVID-19 infections. Until then, here's a Fortune magazine article that groups the potential consequences by areas of the body: Blood, Brain, Eyes, Gastrointestinal tract, Hands, Heart, Limbs, Liver, Lungs, Kidneys, Nose and tongue, Skin, and Toes. "What are the potential long-term effects of having COVID-19?" Associated Press, Fortune Magazine, June 16, 2020

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Digital Data Deception

What do "analog" and "digital" mean? Analog is approximate, digital is precise. A mercury thermometer, car gas gauge, or bathroom scale are analog -- you estimate numbers from a needle or sliding scale. Digital "readouts" on radios or clocks provide precise numbers.

But precise is not the same as accurate. Have you ever heard someone described as "often wrong but seldom in doubt"? That's digital. After the power outage, the digital clock is still precise -- precisely wrong. The grandmother clock is accurate -- but approximate.

-- Nicholas Johnson (Excerpt from the column "My Grandmother's Clock" in the syndicated column series "Communications Watch," Iowa City Press-Citizen, February 28, 1983)

For the past three months I have been graphing and posting on my Facebook page the reported Iowa COVID-19 cases (Saturdays) and deaths (Mondays).

Now I've stopped. Why? Because for six months now we have been driving, sometimes backwards, on four flat tires, in a ditch alongside a road to nowhere. To continue to watch and report on our odometer mileage, or our average miles per hour -- let alone those digitally precise numbers -- suddenly seems as foolish as it is futile.

I am angry at the politicians whose preeminent focus on reelection and campaign donors' interests have resulted in the avoidable deaths of tens of thousands of Americans. I am disappointed by those Americans who -- while understandably confused by the mixed messages they're receiving -- risk infecting others. And I am dismayed by the total collapse of America's former reputation as an intelligent and compassionate world leader -- while our continued shouts of "We're Number One!," "We're Number One!" are only supported by our world rank in COVID-19 infections and ineffectiveness of our response.

What an embarrassment that when Europe opened to travelers from a list of countries, including Algeria, Montenegro, Morocco, Rwanda, Serbia, Tunisia among others, because of the U.S. failure to intelligently control its COVID-19 spread we were, rationally, excluded from the list. Council Agrees to Start Lifting Travel Restrictions for Residents of Some Third Countries," Council of the European Union, June 30, 2020.

Equally embarrassing for Iowans is that our uncontrolled outbreaks of the virus have placed us on New York's list of states whose citizens must be quarantined for 14 days before entering New York -- or face civil penalties up to $10,000. Marina Villeneuve, "New York adds several states, including Iowa, to travel quarantine list, sends monitors to NYC; New York is urging travelers from eight additional states to self-quarantine for 14 days as it awaits a decision on the reopening of indoor dining in New York City," Associated Press, The Gazette, June 30, 2020; J. David Goodman, "N.Y. Will Impose Quarantine on Visitors From States With Big Outbreaks; New Jersey and Connecticut will also require visitors to quarantine for two weeks. The rule reflects a stark shift in the course of the outbreak," New York Times, June 29, 2020.

Even using the inadequate numbers (as of June 29, 2020), the United States, with 4% of the world's population now has 25% of the world's positive COVID-19 cases -- 2,558,000 -- more than any other country on Earth, and more than the next two nations combined (Brazil and Russia -- both led by authoritarian dictators). (Source: Johns Hopkins Coronavirus Resource Center.)

So what's wrong with the U.S. numbers?

The Numbers We Don't Have

You might start with the fact that roughly 90 percent of Americans (and 90 percent of Iowans) have never been tested. You could even end with that fact. Why go further? We not only don't know the names of infected Americans (and Iowans) we don't even know the accurate numbers of infected persons. It's like fighting a war in Vietnam or Afghanistan in which your enemy refuses to wear a uniform and is otherwise indistinguishable from the friendly folks. We have not a clue how many Americans (and Iowans) are wandering about infecting others. [The CDC reports there have been 32,300,000 U.S. COVID-19 tests -- but that's tests, not people tested. (Source: CDC, COVID-19, Testing Data in the U.S.) Iowa reports 301,300 individuals tested. (Source: "COVID-19 in Iowa"). In other words, in Iowa and the nation as a whole roughly 90 percent of Americans have never been tested.]

As they say on late night TV, "But wait, there's more." You can add to that, if you must, the fact that about 50 percent (we can only guess at that number as well) of those infected with COVID-19 are either (1) in the incubation period (and therefore not now showing symptoms), (2) will never show symptoms, or (3) are experiencing such mild symptoms that they (and others) are unaware they are infected. All of which is made worse by a president who minimizes the threat, sets the bad example of refusing to wear a mask, urges less testing, and is seemingly incapable of understanding that neither the economy nor his political fortunes will improve so long as COVID-19 infections continue to spread (put aside his lack of both focus on the national interest and empathy for those afflicted).

The Numbers We Do Have

Then there's what may be wrong with the numbers we do have. Consider the "COVID-19 deaths." Which deaths qualify and why? Where does the data come from? How might some deaths be missing from the data? Who collects it?

Epidemiologists believe that what's more accurate than counting "COVID-19 deaths" is counting all deaths and comparing those numbers to prior averages. "Measuring excess deaths is crude, but many epidemiologists believe it is the best way to measure the impact of the virus in real time. It shows how the virus is altering normal patterns of mortality and undermines arguments that it is merely killing vulnerable people who would have died anyway." Josh Katz, Denise Lu and Margot Sanger-Katz, "What Is the Real Coronavirus Death Toll in Each State?" New York Times, June 24, 2020. "In places with large coronavirus outbreaks, researchers have recently found thousands of unexpected deaths beyond those captured in the official tally of COVID-19 fatalities." Kathleen McGrory, "Coronavirus may have caused hundreds of additional deaths in Florida; An analysis conducted for the Times shows a spike in unexpected deaths since late March," Tampa Bay Times, May 20, 2020.For a discussion of those and many other variables see the earlier blog post, "Deaths Data," June 16, 2020.

The numbers for "cases" are not of much use for a variety of reasons; those numbers are a function of the number of tests (among other things). Fewer tests, fewer "cases" -- which is why Trump wants less testing. We know nothing about those who haven't been tested. We're not told the number of infected who have no symptoms. There are problems with the test kits and the tests (and having a $26 million, no-bid contract with an inexperienced supplier). The Gazette reported that roughly 10 percent of the tests with those kits came back "inconclusive." Grace King, "Some Test Iowa results 'inconclusive,' Linn County officials say; 334 people tested in first four days of opening Cedar Rapids site," The Gazette, May 13, 2020. On June 26 The Gazette's Lyz Lenz reported that Test Iowa has left a trail of incompetence, inaccuracy, lack of transparency and "unusable" test results. Lyz Lenz, "'Unusable' coronavirus tests results plague Test Iowa," The Gazette, June 26, 2020.

No one has an incentive to report numbers higher than the reality. Many have an incentive to report numbers lower: partisan officeholders who want to minimize the appearance of disaster and chaos in order to maximize their favorability ratings, nursing home owners who know that reports of cases and deaths in their facilities are bad for business (and possible liability), meatpacking plant owners for whom closures can cost millions of dollars.

The Iowa governor announced that nursing homes need not report cases or deaths unless they had an "outbreak" -- which she defined a three or more cases. The Nebraska governor explained that packing plants did not have to report at all. "Vice President Mike Pence encouraged governors on Monday to adopt the administration’s claim that increased testing helps account for the new coronavirus outbreak reports, even though evidence has shown that the explanation is misleading." "Pence Tells Governors to Repeat Misleading Claim on Outbreaks,"New York Times, June 16, 2020. President Trump told his Tulsa gathering, "Here's the bad part, when you test the, when you do testing to that extent, you're going to find more people, you're going to find more cases. So I said to my people, slow the testing down please!" "Trump: 'I said to my people, 'Slow the testing down, please!'" Yahoo News Video, June 21, 2020.

Would anyone deliberately change numbers for political advantage? Consider Florida.

Rebekah Jones worked for the State of Florida, gathering the state's COVID-19 data and presenting it in "dashboard" form online for the public. (Presumably this was analogous to the State of Iowa's "COVID-19 in Iowa" site.) Her story, as reported by NPR, is that the State wanted to open up more businesses, had a plan for doing so that required certain data levels, and was about to launch it before checking the actual current data. Upon officials discovery they could not justify the opening, under the standards of their own plan, she was ordered to change the numbers. She refused to do so and was fired. Laurel Wamsley, "Fired Florida Data Scientist Launches A Coronavirus Dashboard Of Her Own," NPR, June 17, 2020 (text); Rachel Martin, "Florida Scientist Says She Was Fired For Not Manipulating COVID-19 Data," Morning Edition, NPR, June 29, 2020 (7-minute audio; "NPR's Rachel Martin talks to Rebekah Jones, a scientist who was fired from Florida's health department, who is now publishing a coronavirus dashboard of her own to track the state's COVID-19 cases").

How Did We Get Here?

At least since the global pandemic of bubonic plague that reached Europe in 1347 humans have known the benefits of isolating those infected. During the late 20th and early 21st Centuries the best pandemic-fighting strategies have been explained in everything from fiction to films, from plays to playbooks from scientific, government and military experts. It is not, as we say, "rocket science." Indeed, this year has seen common sense successfully applied by responsible governments around the world: Australia, Canada, Georgia (nation), Germany, Hong Kong, Iceland, New Zealand, Singapore, South Korea, Taiwan, Vietnam -- and most recently Thailand (among others).

We have some of the world's most respected epidemiologists. Our CDC was looked to (and often present) everywhere. We'd had experience with pandemics, we'd written the playbooks on how to fight them, step by step. It's common sense. The steps could be laid out in a 15-minute YouTube video.

So why do we have more infected and dead individuals from this coronavirus than any other nation? How could our federal and state governments -- and the American people -- have been so woefully inadequate in their response to this global pandemic when compared with all of the other 193 UN countries and seven billion people on Earth? We can't blame immigration or China. All the successful countries also had immigration and China. (Thailand is even a favorite vacation spot for the Chinese.) No, the reason we have lost nearly twice as many American lives in three months from COVID-19 as we lost in Vietnam in 19 years is largely because (among other things) (1) the federal and state governments failed to start with the most effective strategies (total test-trace-isolate), and (2) delayed so long in doing even the wrong things.

A pandemic spreads rapidly. It's like weeds in a garden, a cockroach infestation, or erosion in a farm field. Stopped at its inception -- when the first COVID-19 cases were reported -- it can be brought under control and eventual elimination relatively quickly and easily (compared with our chaotic disaster of a response). The inevitable subsequent resurgences can also be more easily handled.

Compare our lackadaisical approach with what happened in Beijing a week or so ago.

Beijing’s new infections emerged two weeks ago . . .. As of June 22, the authorities had taken samples from more than 2.9 million people over the previous 10 days . . .. Wu Zunyou, the head of the Chinese Center for Disease Control, said last week that the outbreak was “under control.” In an interview this week . . . he predicted the number of cases would not exceed 400.

(Source: "China says it has tamed an outbreak in Beijing, at least for now" (sub-head within story with main headline: "U.S. Hits Another Record for New Coronavirus Cases"), New York Times, June 27, 2020)

In other words, the Chinese were testing in Beijing -- every day -- about the same number of people as Iowa has tested in four months! And as a result the Chinese virtually eliminated a COVID-19 resurgence from one of the world's largest cities in a couple weeks.

Or, if you'd prefer something a little closer to the size of many Iowa towns, check out one of my first columns on the importance of testing, "How to Eliminate COVID-19," The Gazette, April 4, 2020 (Vo, Italy, tested everyone in the city and eliminated any threat from COVID-19 in about three weeks).

There are many physical and mental health, economic, social, educational and other consequences of our delay. But the most dramatic is the number of predictable, unnecessary, preventable deaths. Joseph Guzman, "Experts: 90 percent of US coronavirus deaths could have been avoided if measures had been taken just two weeks earlier; Two medical experts say issuing social distancing measures just two weeks earlier could have drastically changed the trajectory of coronavirus deaths in the United States," The Hill, April 16, 2020.

The most efficient, speedy and effective way to deal with a COVID-19 (or other viral) global pandemic, knowing they happen from time to time, is to:

(1) prepare for it in advance. ("Preventing disasters is part of the job description of those getting the big bucks to lead corporations and government. ... Leaders’ performance should be judged by not what they propose to prevent 'next time' but by what they failed to do to prevent 'this time.'” Nicholas Johnson, "'Never Again' is Not Enough in Response to School Shootings," USA Today, March 6, 2018)

(2) Once informed of a potential pandemic anywhere (as we were repeatedly during the November 2019 through February 2020 period) be on the lookout for the first cases in the U.S.

(3) Immediately respond (in hours, not days, weeks or -- as in our case -- months) with the test-contact-trace-treat-separate/quarantine/isolate-test-again response with everyone showing symptoms and those with whom they've come in contact.

(4) "Wash, rinse, repeat." In other words, keep after each case as it pops up. The goal is to prevent the exponential explosion of a disease spreading throughout the population. This approach is designed to, ultimately, produce the entire elimination of the coronavirus (as was done globally with smallpox). This is the most cost-effective, economy-protecting, life saving, efficient way to quickly battle COVID-19.

This approach was available to us during January and even February. It is no longer (except for small pockets of infected persons). As of today there are 2.6 million confirmed cases. Some estimate the total number (including the untested) would be 10 to 20 times that number. Dan Mangan, "Coronavirus cases are likely 10 to 20 times higher in US than reported, former FDA chief Gottlieb says," CNBC, April 21, 2020; Joel Achenbach, "Antibody tests support what’s been obvious: Covid-19 is much more lethal than the flu," Washington Post, April 28, 2020.

There are, of course, other approaches to COVID-19 none of which have been, so far, successful in eliminating it. Because there is no vaccine, cure or treatment for the disease none of these options are fully satisfactory.

(1) "Herd immunity": A nation just waits until, finally, everyone has been infected -- this appears to be some American politicians' current unspoken favorite by default. This has three drawbacks. It maximizes the number of deaths. It takes a very, very long time. And the scientists don't yet know if it will work. If you are infected, and don't die, does that mean you can never get it again? They don't know. Even if you are immune, does that mean you can't give it to others? They don't know. And, if either are true, how long does your immunity last? They don't know.

(2) "Hospital capacity": focus on the ability of the healthcare system to handle the infected and dying. So long as the community, or state, has enough hospitals, healthcare workers, beds, intensive care facilities, ventilators, other equipment, and PPE you're OK. The problems with this one are that it is hard to predict the caseload, imposes excessive burdens on healthcare workers, and it does little to nothing by way of reducing the spread of the disease.

(3) "Mitigation": monitor and enforce efforts designed to minimize the rate and extent of spreading the disease, such as closing places where the disease is most likely to spread (e.g., bars, indoor arenas), wearing masks, maintaining six-foot distancing between people, forbidding groups of more than six (or 50). This approach requires acceptance of the ongoing numbers of infected, dying and dead from the coronavirus so long as those numbers are steady, or increasing only slightly ("flattening the curve"). That is mitigation advocates' benchmark for decisions regarding opening or closing businesses and events. Such measures may slow the rate of increase in infected persons, but it neither eliminates the virus nor provides any information about the roughly half of the infected who are without symptoms.

(4) "Mitigation light": the difference between "mitigation" and "mitigation light" is like the difference between those who follow "the ten commandments" and those who consider them "the ten suggestions."

At this point in time probably the best bet is to do what you and I can to encourage national and state leaders to crank up the enforcement of the epidemiologists' recommendations and their acceptance as national standards -- while complying with them ourselves.

I wish I had better news for you, I really do. But I don't. This is my current take on our current condition and probable future. Meanwhile, I pull such comfort as I can, while keystroking in the living room, from the rhythmic, if approximate, tick-tock, tick-tock from my 120-year-old grandmother's clock in the kitchen.

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How You Can Help Fight COVID-19

"[I]n early May [Iowa Governor Kim] Reynolds . . . stopped announcing daily cases and deaths on TV . . . [and] sending out those statistics with news releases to the media and posts to the governor's website . . . at a time she is increasing the ability of Iowans to sit down for a meal at a restaurant, get a haircut, work out at a gym and go shopping [saying] 'Iowans are going to take the responsibility to decide if they are ready to go out and participate at the businesses or go to a restaurant.'"

Vanessa Miller, "As Iowa Reopens, Stat's Virus Data Elusive; Citing Lack of Help from Reynolds, Some Keep Their Own Tallies," The Gazette, May 17, 2020, p. A1

In other words, we're being asked to make our own decisions about avoiding COVID-19 -- and at a time when our Governor has stopped reporting deaths during daily video reports, and otherwise obfuscating what data remains.

What to do? I guess we'll have to gather our own data. Fortunately there's a way to do that -- one that takes less than a minute a day, costs nothing, and is risk free.

Willing to help? Read on.

What I'm talking about is the creation of Professor Tim Spector, MD, Genetic Epidemiology, King’s College London, and Professor Andrew Chan, MD, MPH, Harvard Medical School and Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health.

It's an app for either iPhone or Android called Covid Symptom Tracker, and over 3.6 million people have downloaded the app and report in every day on their symptoms. If you are symptom-free, as thankfully I have been, it literally talkes less than a minute to click on the app, select the "me" profile, click on the "I have never had a COVID test," and "I feel physically normal."

If enough people in your county have signed up your app then displays the number of people in your county who are reporting COVID symptoms.

I am in Johnson County, Iowa, and at the time of writing we need an additional 223 people (May 17; today, July 3, we need 188) to participate to get that report.

To get the app go to your app store and search for "covid symptom tracker." It should be at the top of the list. If not, look for the logo displayed here.

And thank you! Spread the word.

More about Covid Symptom Tracker

To find out more about this project from those who created and run it: https://covid.joinzoe.com/us/about

And see:

Andrew Jacobs, "App Shows Promise in Tracking New Coronavirus Cases, Study Finds; The app, which allows people to record their symptoms, was remarkably effective in predicting infections. The most reliable indicators, researchers found, were loss of smell and taste," New York Times, May 13, 2020, p. A4 ("In the absence of widespread on-demand testing, public health officials across the world have been struggling to track the spread of the coronavirus pandemic in real time. A team of scientists in the United States and the United Kingdom says a crowdsourcing smartphone app may be the answer to that quandary.

"In a study published Monday in the journal Nature Medicine, researchers found that an app that allows people to check off symptoms they are experiencing was remarkably effective in predicting coronavirus infections among the 2.5 million people who were using it between March 24 and April 21.")

Charlotte Jee, "A New App Might Help Researchers Monitor the Spread of Coronavirus," MIT Technology Review, March 25, 2020

David M. Halbfinger, "How Are You Feeling? Surveys Aim to Detect Covid-19 Hot Spots Early; Scientists have persuaded Britons and Israelis to fill out questionnaires about their health, to get ahead of the coronavirus by getting resources to the right place. The U.S. is next," New York Times, April 1, 2020

"COVID-19 Symptom Tracker App," News, Massachusetts General Hospital, March 31, 2020

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Andrew Chan, COVID-19, Covid Symptom Tracker, epidemiology, Governor Kim Reynolds, symptoms, Tim Skpector, Vanessa Miller