Category Archives: Human Behavior

I read with interest the recent MedPage Today article "Demanding Thanksgiving Abstinence is Not Public Health." In it, Vinay Prasad, MD, MPH, argues that as public health officials, we should not be admonishing Americans to avoid Thanksgiving altogether during this COVID-19 resurgence. We should be more compassionate, he says, understanding that people are human beings with needs, and that many are going to do Thanksgiving the way they want to anyway. And knowing this, we should figure out how to listen to what people are telling us and work with them on ways to reduce risk without torpedoing their basic need for holiday connectedness after a long year of isolation.

This is our classic "harm reduction" approach, which is adapted from public health work with people who struggle with substance abuse, and reflects "a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use," or in this case, not adopting behaviors that increase the risk of COVID-19. Harm reduction is also defined as "a movement for social justice built on a belief in, and respect for, the rights of people who use drugs."

I agree with the harm reduction approaches for this ongoing pandemic proposed by Dr. Prasad and others, as shaming people into behavioral submission to prevent spread of the novel coronavirus isn't the answer. Where I differ is that there is indeed even more nuance to this topic than the article suggests.

First, when we say that telling people to avoid Thanksgiving is an "abstinence-only" approach, we are automatically creating parallels to historical and current public health language and approaches with substance abuse, teen pregnancy, and the HIV epidemic. In these examples, abstinence-only speaks to people simply avoiding behavior that can lead to untoward consequences such as IV drug use or sex.

While there are parallels here to Thanksgiving, in general principle abstaining from substance abuse or certain sexual behaviors embodies a lifestyle change, not a skipping of a one-time holiday that, to be honest, is a luxury, not a necessity. Moreover, just stopping a behavior may be achievable for some, but not for others, so more realistic options must be offered.

Second, since we are using language from public health approaches with substance abuse and the HIV epidemic, it is useful to refresh our memories as to what actually happened back then. During the early 1980s when HIV first began to emerge, we knew that condoms worked, but to be honest, not everyone liked using them and/or could get access to them. Additionally, we didn't have any medications or effective treatments for HIV, so people were dying in droves. We didn't even have the prospect of a vaccine on the horizon to look forward to -- and still don't 40 years later.

While flying by the seat of our pants trying to handle the HIV epidemic that was decimating white gay communities, people who used IV drugs, and in Black and Latin communities, we sometimes encouraged drastic measures like telling people to avoid sex and IV drug use altogether.

The public health messaging was often judgmental and laced with stigma, but one could argue that we were in a crisis situation at the time and needed to do what was needed for the health of our communities while we waited on our government to even acknowledge that HIV existed and that treatments could be developed. Sound familiar?

Back then, I remember people being scared -- even without the public health messaging. I recall this because I was petrified as well. We didn't need a doctor or public health official to tell us how serious HIV was, as we saw it every week in the obituaries or when a friend suddenly didn't show up for a social gathering. People were here one day and gone the next.

Many were reluctant to have sex back then, even with condoms, while others listened to scientists and that, combined with what they were seeing on the ground, was enough to encourage additional precautions.

We live in different times now. There is a campaign to discredit science, facts, and truth. Healthcare workers who risk their lives daily to treat people with COVID-19 are being smeared in political and media outlets as greedy people just out to make a buck off the pandemic. Many are burned out, have become sick, and/or died from the virus, and some have suffered such tremendous mental health trauma from witnessing death on a daily basis that they have resorted to taking their own lives.

So as a medical community, we should give our colleagues a little wiggle room for knee-jerk reactions to social media clickbait when hearing about people not taking this pandemic as seriously as we know it is.

Truth is, we don't have comparable harm reduction tools for COVID-19 -- like needle exchange programs for IV drug use and pre-exposure prophylaxis for HIV prevention. Until the vaccine arrives, which may be months away, all we have in our toolkit are masks, handwashing, and physical distancing. That's all we got.

You'll have to excuse many medical and public health professionals if they resort to endorsing "abstinence-only" COVID-19 prevention approaches as a temporary solution for holiday gatherings. They are not trying to imprison anyone by suggesting they skip Thanksgiving this year -- they are merely trying to save lives and salvage what little is left of their physical and mental health in the process.

Finally, public health is indeed a service industry in that its primary purpose is to serve our communities. However, the fundamental flaw in declaring it a service industry like Walmart or Target, is that we are charged with the ethical responsibility of trying to educate and empower people beyond thinking only for themselves and their families when it comes to epidemics and disease states, as well as challenging them to understand how their behaviors may affect others as well.

This is the basic distinction between one-on-one clinical encounters and public health. The former simply focuses on what's best for the patient, while the latter considers both the patient and our larger communities. It's a formidable task when living in a country that thrives on and rewards narcissistic behavior like a prize won at a county fair.

There is no "right" way for public health officials to respond to this never-seen-in-our-lives-before pandemic. There is just a continuum of options that may be employed that should be patient-centered and appreciate human behavior and the desire for connectedness that COVID-19 has discarded like proverbial trash.

This is especially true when treatments for the virus are both expensive and limited, and the vaccine may be months away from reaching a general population that so desperately needs it.

While avoiding Thanksgiving altogether may not be the flavor for everyone's public health palate, given the circumstances and urgency of this situation where many still are not wearing masks or maintaining distance by choice, it may not be too unreasonable as a short-term suggestion.

Our job as public health officials shouldn't be to avoid "abstinence-only" speak altogether, but rather to figure out how to better communicate this as a temporary strategy so that our families, friends, and communities may consider it without shame, stigma, or feelings of coercion.

It may not be fruitful to lecture communities on how to react to this pandemic, but it is equally unproductive to lecture healthcare workers on how to react as well. We are all going through this together.

David Malebranche, MD, MPH, is a board-certified internal medicine, HIV, and sexual health physician who resides in Atlanta.

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Op-Ed: Let's Not Lecture Healthcare Workers This Thanksgiving - MedPage Today

Human Behavior

Ways your Healthcare Company is Breaking the Law Without Realizing it – MedPage Today

November 24, 2020 medical

According to the U.S. Department of Health & Human Services' Breach Portal, sometimes called the "Wall of Shame," 418 breaches of HIPAA were reported in 2019. Some 34.9 million Americans had their protected health information (PHI) compromised. How is this still happening?

Healthcare companies and practices make the biggest mistake by believing human behavior can be perfect all the time. For example, the employee may not have their encrypted work phone with them, so they choose to use their personal phone to send patient information. Email had the worst breaches ever in 2019.

Also resulting from this assumption about human behavior, healthcare providers cheap out and refuse to pay for sufficient security measures for their network. A cheap security system may not contain proper firewalls and leave devices vulnerable, while wholly unencrypted devices can be a nightmare. Healthcare employees leave their cell phones, laptops, or iPads in their vehicles while they run out for coffee or to the grocery. And what happens next? The vehicles are broken into, and PHI is at risk.

Several occurrences of this type took place involving employees at the Dallas Children's Hospital. An unencrypted, non-password protected Blackberry was lost at the DFW airport in November 2009, and Children's reported the breach to the Office of Civil Rights (OCR) in January 2010. It contained the electronic PHI of 3,800 patients.

Later, an unencrypted laptop was stolen from Children's in April 2013, containing electronic PHI of 2,462 patients. However, the hospital failed to report the theft. The OCR fined Children's $3.2 million for HIPAA noncompliance on these two data breaches.

This brings up another big tip: The OCR will be much more forgiving to those who report their own breach events, rather than being found out or reported by someone outside the organization.

Even then, Dallas Children's Hospital, which is part of Children's Health, the seventh-largest pediatric healthcare provider in the U.S., did not take encryption seriously and continued to issue unencrypted Blackberries and laptops to employees until 2013, despite being notified about the necessity for encryption back in 2007.

In addition, companies need to reinforce a "minimum information necessary" motto with their employees. Employees only need to access the patient information and medical history necessary for treatment or for payment. Snooping -- just simply being nosy -- can qualify as a violation and can lead to major fines. The world witnessed this when a UCLA Health System researcher went to jail for reading 323 confidential records held by the university's school of medicine, which contained medical records of various California celebrities.

Another common mistake is when paper PHI is disposed of incorrectly. Making sure medical records are shredded is of extreme importance. In Montgomery, Alabama, records were discovered in a garbage truck and all over the ground around the truck. They included names, numbers, x-rays, ultrasound, MRIs, and were clearly labeled "Radiology Department, Baptist Medical Center."

Here are a couple other tips to protect patients' privacy:

The easiest of slip-ups in HIPAA compliance come from conversational violations or "loose lips." A common example of this is when doctors and nurses talk about a patient at the coffee bar, elevator, or in the hallways with others around. Believe it or not, it happens all the time.

One alarming example of this was in a medium-sized hospital. There were many patients around, and the doctors and nurses were holding private conversations. An associate chief medical officer said, "Maybe we should open up the death rooms!" When asked what that was, he responded, "We only use them to talk away from the gathering family members whose loved one is about to die." Protected health information comes in all forms, positive and negative. I advised him to open the rooms for all conversations involving PHI, including if someone was cured of cancer. That is private information too!

While it may be fun to create this rapport or engage in such jocularity at work, non-compliant verbiage can become a very expensive joke.

These aspects cover the waterfront for HIPAA's privacy and security rules, but it is best for every healthcare provider to have at least one in-house compliance person. Said compliance professionals should attend webinars to keep themselves constantly informed as to how providers are being breached and save their employers millions of dollars in fines born of carelessness.

Concomitantly, healthcare CEOs must develop up-to-date strict policies and mandatory compliance training quarterly. It is also recommended to prohibit access to work emails, communications, and attachments using personal cellphones.

David Silva, CHC, CPHQ, is a healthcare compliance and quality professional with over 15 years of experience in leading teams in investigations, assessments, corrective action plan creation, and validation audits.

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Ways your Healthcare Company is Breaking the Law Without Realizing it - MedPage Today

Human Behavior

How safe is it to go to indoor movie theaters during the COVID-19 pandemic? – Gazettextra

November 24, 2020 medical

Remember what it was like going out to see a movie?

Even though movie theaters have implemented protocols to protect guests and staff during the COVID-19 pandemic, and many of the measures have been met with praise from experts, the exhibition industry remains in a state of crisis. Indoor theaters have been closed in Los Angeles County since mid-March, and Gov. Gavin Newsom pulled the "emergency brake" on the rest of the state last week, shutting down many indoor businesses in California, including most movie theaters. Even when these restrictions lift, the industry will be anxious to reopen safely.

And in many other states, the question remains: With the national totals surpassing 12 million infections, more than 255,000 Americans dead and daily numbers surging to record highs, just how risky is it to see a movie indoors?

The argument from the exhibition industry to keep theaters open relies on confidence in the COVID-19 protocols theaters are putting in place including mask mandates, enhanced cleaning, automatic seating gaps between parties, limited auditorium capacity, staggered showtimes and other measures. They say no outbreaks have yet been traced back to movie attendance.

"That's not just (in) the U.S. but anywhere in the world," said Patrick Corcoran, vice president and chief communications officer of the National Assn. of Theater Owners, which introduced the "CinemaSafe" program that theaters can opt into. "There have been people who have worked at movie theaters or who have attended movie theaters who have had it, but it hasn't been passed on to others in that environment through any tracing."

"The guidance looks great on paper," said Dr. Peter Chin-Hong, an infectious disease specialist at UC San Francisco. "If you have a well-ventilated movie theater and people keep their masks on for the whole time and they are socially distant, and you don't go to the movies when you're sick ... it's probably going to be a relatively safe environment."

However, he notes those protocols can easily be defeated by the actions of others. "You can have a lot of recommendations, but at the end of the day, it's really human behavior."

And while Chin-Hong agrees there are "no documented COVID cases linked to movie attendance to date globally," he adds, "the absence of an association does not mean that there have not been any transmissions."

To help unpack this debate, The Times spoke with two industry spokespeople Corcoran and Chanda Brashears, vice president of investor relations and public relations of Cinemark Theaters; and three public health experts Chin-Hong, Dr. Georges Benjamin, executive director of the American Public Health Assn. and Dr. Annabelle De St. Maurice of UCLA.

The experts praised many of the industry's safety measures right up to the point of entering the auditorium. Once inside, though, the hazards increase, they agreed, mostly because of choices patrons make.

Mask mandates

Everyone interviewed for this article agreed mask wearing was key. CinemaSafe guidelines state, however, "face coverings may be removed for the limited purpose and limited time period necessary to consume food and beverages, if approved by state or local health authorities."

Benjamin, an internal medicine specialist and Maryland's former secretary of health, said, "Just like in a restaurant, you take a mask off to eat popcorn or drink, etc. And of course, when you do that, if you're infected, you will expel virus." Especially, he noted, if you laugh or scream at the movie.

De St. Maurice, a physician who specializes in pediatrics and infectious disease and is the co-chief infection prevention officer for UCLA Health, agreed, "How often are they going to pull the mask back up? And movies make you laugh and shout."

The health experts expressed concern that even proper social distancing might not be enough protection for a long period of exposure (say an average visit of two hours) to people who are not wearing masks. Benjamin invoked the CDC's definition of "community-related exposure" to infected individuals, even asymptomatic ones: "within six feet for a total of 15 minutes or more." In such cases, the CDC recommends those exposed "stay home until 14 days after last exposure," entering quarantine protocols.

"The activity within a movie theater is very different from what you have at a bar or a restaurant," Corcoran countered. "You don't have people facing each other." The duration of attendance helps mitigate risk, he added, as opposed to in a restaurant or bar, where "people finish eating, and they get up and leave, (replaced by) more people."

Cinemark has added employees whose sole job it is to make sure staff and patrons are following COVID-19 rules, Brashears said.

Still, De St. Maurice noted, enforcement could be an issue: "You may get pushback and a lot of these employees are teenagers and may not feel comfortable correcting an adult. You want to keep the theater open, and you want to keep your customers happy."

Seating and social distancingSocial distancing is defined by the CDC as maintaining six feet from people not in your household. Theaters have tried to enforce this by reducing crowds with staggered showtimes, fewer choices at concession stands, etc. AMC and Cinemark are among those that have instituted ticket-buying systems that automatically insert a one-seat buffer on either side of parties for a total of two seats separating parties from others. However, if most cinema seats are about two feet wide, that's only about a four-foot buffer.

Brashears said most of Cinemark's seats are wider-than-normal "recliners" and "rockers," so two adjacent would meet the six-foot standard.

Some auditoriums are laid out in a "stadium seating" configuration, in which rows are elevated as they progress backward.

"I think the other challenge is the stadium seating," said De St. Maurice. "You're coughing and there's droplets. Where are they going to land? Below you."

Corcoran noted that stadium seating starts with a greater distance between heads, in part because of the incline: "That distance is probably sufficient."

Ventilation

The chains tout their ventilation systems, including MERV 13 filters being installed in auditoriums. However, data wasn't available about the rate of air exchanges (the number of times per hour a ventilation system can replace the air in a room with new air from outside), which experts say matters most.

"It sounds like they've installed some MERV 13 filters in some areas, but I think without improving your air exchanges. And those filters are really expensive," De St. Maurice said, wondering if they're in every auditorium. "Optimizing air exchanges would be helpful. Opening doors so that you can get some outdoor air.

"If you think about it, if one person is sick and air just keeps recirculating, then you get into trouble. There was a restaurant in China, in Guangzhou, where the air was recirculating and (droplets) had spread more than six feet because the air basically just kept going in this loop. People who were sitting within that loop but maybe farther than six feet from the index case became infected as a result."

Brashears said, "In Cinemark theaters, the air comes straight down and then out through the side vents. We're bringing in a consistent flow of outside air, because we recognize how important that is." She also pointed out Cinemark's emphasis on "elimination of pollutants using MERV filters and integrating bipolar ionization."

Reducing crowds

The experts uniformly praised the exhibitors' masked employees, limited capacity, staggered showtimes, removal of shared condiments, cashless transactions and reduced menus.

"It's not about the menu," explained De St. Maurice. "It's about theoretically having fewer people waiting in line trying to decide what to get. Having a sign posted that says 'Don't wait in a line' isn't quite as effective as structuring things so that people are less inclined to wait in the line or really don't have to."

Off-peak hours are likely safer as well, Benjamin added. "Obviously, if they clean it real well at night, you're probably better off in the morning. You're probably better off when you have less people in the theater."

Local conditions and other concerns

All three health experts said extra caution should be exercised where infection positivity rates are higher, because any public activities would be more dangerous.

De St. Maurice said, "Whatever we can do to reduce transmission within the community is really important to keep these luxuries in our lives and allow those who are working in these industries to be able to work again."

An optimal movie theater scenario would include no concessions being sold and would have flexible schedules for workers and "good sick leave policies," De St. Maurice said, "so they could stay home when feeling ill, rather than being incentivized to work through it."

And while the experts were bullish on many of the steps taken, they were bearish on others taking patrons' temperatures, enhanced cleaning and wearing gloves, for instance. Benjamin pointed out gloves can transport contaminants just as well as bare skin can and if improperly used, can create a false sense of security. He also cited studies indicating the risk of fomite transmission (infection via touching surfaces) to be low.

Chin-Hong said, "People need to be flexible because things may change. The science is only as good as if people adhere to what's going on. Just like with a playground, you can have the guidance, but if you have a screaming child running by you ... you can't always control that environment, and I think that (the) unknown is what is probably most anxiety provoking about all of this."

So how safe is going to an indoor movie?

For perspective, The Times asked experts to rate the safety of certain activities on a scale from 0-100, 0 being the least likely to result in COVID-19 infection and 100 being the most dangerous. Among the activities listed, they separately agreed indoor moviegoing was among the riskiest. Benjamin declined to provide ratings but put moviegoing in the range of going to an indoor restaurant.

Outdoor restaurant: 10

Grocery store: 15-20 (or 30-40 if people congregate)

Commercial airliner: 40-50

Outdoor event, not socially distanced, masks not enforced: 40-50

Indoor movie: 50-60 (up to 75 if people are laughing, shouting, singing along)

Indoor bar, masks and social distancing not enforced: 80

As of this writing, the CDC lists moviegoing among its higher risk activities.

One solution that seems to address most of the experts' concerns, however, is the "Private Watch Party." In that option, up to 20 patrons can buy out a theater for a screening for $99-$149 (at Cinemark), eliminating the wild card of strangers' behavior within the auditorium. Brashears said the chain had sold upward of 50,000 of the events.

"At the end of the day, it all comes down to the consumer. Consumers have to play a part for us to operate safely," she said.

Corcoran recommended patrons visit the websites of the theaters they want to attend, to educate themselves on the specific protocols in place.

Chin-Hong said, "Being proactive rather than reactive is probably the best summary statement, but it not only depends on where you are, but who you are, how you determine what risk is. Maybe you're older or you have medical (concerns); you may decide the juice isn't worth the squeeze."

Distributed by Tribune Content Agency, LLC

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How safe is it to go to indoor movie theaters during the COVID-19 pandemic? - Gazettextra

Human Behavior

Malcolm Gladwell and his tipping point – The Jakarta Post – Jakarta Post

November 24, 2020 medical

While some people take things in life as facts or accept a because its so explanation of matters like unconscious bias when meeting new people or the reasoning behind spur-of-the-moment decisions, author and journalist Malcolm Gladwell seeks to unravel the mysteries behind the ordinary.

In his best-selling debut bookThe Tipping Point, he examined the so-called tipping point in various formats like how patient zero can lead to a global pandemic or how even one person can jumpstart a trend, in a more benign example.

In the book, he outlined three factors or agents of change: The Law of the Few or the Pareto principle, where 80 percent of consequences are caused by 20 percent of the causes; The Stickiness Factor, where the specific content of a message can provide a memorable impact; and The Power of Context, which stipulates that human behavior is always context-sensitive to the environment.

When it was published in 2000,The Tipping Pointresonated greatly with readers, and the book sold millions of copies, landing it a place on theNew York Times bestsellers list and resulting in it being named one of the 21stcenturys 100 best books byThe Guardianin 2019.

Other books by Gladwell also explore oft overlooked themes, like decision making (Blink,2005), high achievers (Outliers,2008), underdogs (David and Goliath, 2013), and dealing with the unknown (Talking to Strangers,2019).

With his flair for mixing anecdotes and research notes, its no wonder that Gladwell was named as one of the 100 Most Influential People byTIMEin 2005 and was even considered again in 2011.

When asked what exactly drives him to take a closer look at these issues, the Canadian said he was curious by nature and enjoyed looking at things from unusual perspectives.

Once Ive written something, I never go back and reread it. Once Im finished with it, Ive lost interest in it and Im on to the next thing. So maybe theres something in my restlessness that keeps me inspired, he said in an interview on the heels of IDEAFest attended byThe Jakarta Post.

However, he also observed that many people, as they grow older, tend to lose their appetite for new things even as they gain new experiences along the way.

Gladwell said he tries his best to expose himself to new ideas and new people, as he does not wish to become stale, in the way he thinks some older journalists and writers are.

Even the age-old obstacle of writers block is a non-issue for him, something he attributed to his early days working at a newspaper.

I had to write nearly every day, and that cured me of any writers block. You cant be a newspaper reporter if you have writers block. I think its impossible, right?

The writing was not the hard part, he said. Instead, it was the thinking that came before the writing process, such as establishing the topic, researching, finding sources and so on.

By the time it comes to writing, I feel like all the hard work has been done, and then Im just putting things on the page. Its the preparation for writing thats the challenge.

Recipe for success: Malcolm Gladwell, the author of five 'New York Times' bestsellers, finds himself enjoying looking at things both overlooked and misunderstood. (Courtesy of gladwellbooks.com/epost-robot)

When the topic inevitably turned to the current pandemic after all,he did say inThe Tipping Pointthat ideas, messages and behaviors spread like viruses do Gladwell took a rather diplomatic approach in saying that the handling was not as good as expected.

But at the same time, its a really difficult problem for us, dealing with a contagious disease particularly one where we dont have a good understanding of who its going to affect the worst, how it spreads, how to treat it, Gladwell said.

If COVID was something that struck every fall and we were in the tenth year of COVID, we would be responding in a very different way. Weve never had this in this form before.

He also noted previous pandemics like the influenza pandemic of the late 1950s and the 1918 Spanish flu, but said there were few who could remember those times, which highlighted the needs for society to practice dealing with challenges like COVID-19.

He said he was not surprised that it had been difficult, for democratic countries in particular, to make sure everyone behaved appropriately.

I expect by the time this happens again and it will happen again well do a much better job.

As sheltering in place has been made mandatory in a wide variety of locations, Gladwell said that his productivity had increased, but at the same time, he missed many things that traveling offered.

Think about all the things Ive missed. Ive never been to Indonesia before. I would have met you all in person. I would have experienced its culture for the first time. There are a thousand unexpected experiences I would have had that Ill never have now, he said.

So I really do think that although I have more time for myself, the cost of the pandemic is much greater than the benefit for someone like me. Im someone who, for my work, needs to be exposed to new ideas, new people and new cultures. Thats being denied to me.

Traveling, he said, offered the chance to meet people and find ways they were similar and dissimilar to himself.

I feel like every culture in the world has something to teach us. We dont know in advance what that is. Thats why you travel, Gladwell said.

If I knew in advance what I would learn from going to Indonesia, I would just read a book. You pick up something different every time you experience something, so my mind would be entirely open to what I would learn. (ste)

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Malcolm Gladwell and his tipping point - The Jakarta Post - Jakarta Post

Human Behavior

City and health officials say hospitalization and positive rates for COVID-19 have plateaued – KELOLAND.com

November 24, 2020 medical

SIOUX FALLS, S.D. (KELO) There is some slightly good news to report tonight when it comes to COVID-19.

Health officials in Sioux Falls say the rates of positive tests and hospitalizations appear to have plateaued in the past two weeks.

But theyre also warning people to not let their guard down especially as we head into the holiday season.

The city of Sioux Falls mask mandate went into effect on Saturday to help slow the spread of COVID-19.

Today at a news conference, Mayor Paul TenHaken said people are complying.

After two days with that, theres been very few problems, at least that Ive heard about, TenHaken said.

Even though theres no penalty for not complying with the mask mandate, the mayor says he thinks people are taking it seriously.

The mandate comes at a time when positivity and hospitalization rates in Sioux Falls have plateaued over the past 14 days.

Health officials say the next two months will be crucial, though, in helping slow the spread.

Human behavior over Thanksgiving and Christmas is going to weigh in to what the positivity rates are, hospitalization rates are, the death rates are in the next couple of months, Dr. Mike Elliot of Avera Health said.

While the world waits for the approval of a vaccine, both hospitals in Sioux Falls are using a new drug to treat COVID-19 patients.

We started using the new monoclonal antibody treatment that was approved last week and that is available for infusion, they show great promise in reducing rates of hospitalizations, Dr. Mike Wilde of Sanford Health said.

Over the past couple of weeks, in general, hospitalizations have remained flat, we are all thankful for that, Id love to tell you weve turned the corner, but its too darn early to say that for sure, Dr. Elliot said.

Thats why they still want people to continue following CDC guidelines, including wearing a mask.

Over 500 businesses have now signed on to the Safer Sioux Falls pledge.

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City and health officials say hospitalization and positive rates for COVID-19 have plateaued - KELOLAND.com

Human Behavior

Information Overload Helps Fake News Spread, and Social Media Knows It – Scientific American

November 24, 2020 medical

Consider Andy, who is worried about contracting COVID-19. Unable to read all the articles he sees on it, he relies on trusted friends for tips. When one opines on Facebook that pandemic fears are overblown, Andy dismisses the idea at first. But then the hotel where he works closes its doors, and with his job at risk, Andy starts wondering how serious the threat from the new virus really is. No one he knows has died, after all. A colleague posts an article about the COVID scare having been created by Big Pharma in collusion with corrupt politicians, which jibes with Andy's distrust of government. His Web search quickly takes him to articles claiming that COVID-19 is no worse than the flu. Andy joins an online group of people who have been or fear being laid off and soon finds himself asking, like many of them, What pandemic? When he learns that several of his new friends are planning to attend a rally demanding an end to lockdowns, he decides to join them. Almost no one at the massive protest, including him, wears a mask. When his sister asks about the rally, Andy shares the conviction that has now become part of his identity: COVID is a hoax.

This example illustrates a minefield of cognitive biases. We prefer information from people we trust, our in-group. We pay attention to and are more likely to share information about risksfor Andy, the risk of losing his job. We search for and remember things that fit well with what we already know and understand. These biases are products of our evolutionary past, and for tens of thousands of years, they served us well. People who behaved in accordance with themfor example, by staying away from the overgrown pond bank where someone said there was a viperwere more likely to survive than those who did not.

Modern technologies are amplifying these biases in harmful ways, however. Search engines direct Andy to sites that inflame his suspicions, and social media connects him with like-minded people, feeding his fears. Making matters worse, botsautomated social media accounts that impersonate humansenable misguided or malevolent actors to take advantage of his vulnerabilities.

Compounding the problem is the proliferation of online information. Viewing and producing blogs, videos, tweets and other units of information called memes has become so cheap and easy that the information marketplace is inundated. Unable to process all this material, we let our cognitive biases decide what we should pay attention to. These mental shortcuts influence which information we search for, comprehend, remember and repeat to a harmful extent.

The need to understand these cognitive vulnerabilities and how algorithms use or manipulate them has become urgent. At the University of Warwick in England and at Indiana University Bloomington's Observatory on Social Media (OSoMe, pronounced awesome), our teams are using cognitive experiments, simulations, data mining and artificial intelligence to comprehend the cognitive vulnerabilities of social media users. Insights from psychological studies on the evolution of information conducted at Warwick inform the computer models developed at Indiana, and vice versa. We are also developing analytical and machine-learning aids to fight social media manipulation. Some of these tools are already being used by journalists, civil-society organizations and individuals to detect inauthentic actors, map the spread of false narratives and foster news literacy.

The glut of information has generated intense competition for people's attention. As Nobel Prizewinning economist and psychologist Herbert A. Simon noted, What information consumes is rather obvious: it consumes the attention of its recipients. One of the first consequences of the so-called attention economy is the loss of high-quality information. The OSoMe team demonstrated this result with a set of simple simulations. It represented users of social media such as Andy, called agents, as nodes in a network of online acquaintances. At each time step in the simulation, an agent may either create a meme or reshare one that he or she sees in a news feed. To mimic limited attention, agents are allowed to view only a certain number of items near the top of their news feeds.

Running this simulation over many time steps, Lilian Weng of OSoMe found that as agents' attention became increasingly limited, the propagation of memes came to reflect the power-law distribution of actual social media: the probability that a meme would be shared a given number of times was roughly an inverse power of that number. For example, the likelihood of a meme being shared three times was approximately nine times less than that of its being shared once.

This winner-take-all popularity pattern of memes, in which most are barely noticed while a few spread widely, could not be explained by some of them being more catchy or somehow more valuable: the memes in this simulated world had no intrinsic quality. Virality resulted purely from the statistical consequences of information proliferation in a social network of agents with limited attention. Even when agents preferentially shared memes of higher quality, researcher Xiaoyan Qiu, then at OSoMe, observed little improvement in the overall quality of those shared the most. Our models revealed that even when we want to see and share high-quality information, our inability to view everything in our news feeds inevitably leads us to share things that are partly or completely untrue.

Cognitive biases greatly worsen the problem. In a set of groundbreaking studies in 1932, psychologist Frederic Bartlett told volunteers a Native American legend about a young man who hears war cries and, pursuing them, enters a dreamlike battle that eventually leads to his real death. Bartlett asked the volunteers, who were non-Native, to recall the rather confusing story at increasing intervals, from minutes to years later. He found that as time passed, the rememberers tended to distort the tale's culturally unfamiliar parts such that they were either lost to memory or transformed into more familiar things. We now know that our minds do this all the time: they adjust our understanding of new information so that it fits in with what we already know. One consequence of this so-called confirmation bias is that people often seek out, recall and understand information that best confirms what they already believe.

This tendency is extremely difficult to correct. Experiments consistently show that even when people encounter balanced information containing views from differing perspectives, they tend to find supporting evidence for what they already believe. And when people with divergent beliefs about emotionally charged issues such as climate change are shown the same information on these topics, they become even more committed to their original positions.

Making matters worse, search engines and social media platforms provide personalized recommendations based on the vast amounts of data they have about users' past preferences. They prioritize information in our feeds that we are most likely to agree withno matter how fringeand shield us from information that might change our minds. This makes us easy targets for polarization. Nir Grinberg and his co-workers at Northeastern University recently showed that conservatives in the U.S. are more receptive to misinformation. But our own analysis of consumption of low-quality information on Twitter shows that the vulnerability applies to both sides of the political spectrum, and no one can fully avoid it. Even our ability to detect online manipulation is affected by our political bias, though not symmetrically: Republican users are more likely to mistake bots promoting conservative ideas for humans, whereas Democrats are more likely to mistake conservative human users for bots.

In New York City in August 2019, people began running away from what sounded like gunshots. Others followed, some shouting, Shooter! Only later did they learn that the blasts came from a backfiring motorcycle. In such a situation, it may pay to run first and ask questions later. In the absence of clear signals, our brains use information about the crowd to infer appropriate actions, similar to the behavior of schooling fish and flocking birds.

Such social conformity is pervasive. In a fascinating 2006 study involving 14,000 Web-based volunteers, Matthew Salganik, then at Columbia University, and his colleagues found that when people can see what music others are downloading, they end up downloading similar songs. Moreover, when people were isolated into social groups, in which they could see the preferences of others in their circle but had no information about outsiders, the choices of individual groups rapidly diverged. But the preferences of nonsocial groups, where no one knew about others' choices, stayed relatively stable. In other words, social groups create a pressure toward conformity so powerful that it can overcome individual preferences, and by amplifying random early differences, it can cause segregated groups to diverge to extremes.

Social media follows a similar dynamic. We confuse popularity with quality and end up copying the behavior we observe. Experiments on Twitter by Bjarke Mnsted and his colleagues at the Technical University of Denmark and the University of Southern California indicate that information is transmitted via complex contagion: when we are repeatedly exposed to an idea, typically from many sources, we are more likely to adopt and reshare it. This social bias is further amplified by what psychologists call the mere exposure effect: when people are repeatedly exposed to the same stimuli, such as certain faces, they grow to like those stimuli more than those they have encountered less often.

Such biases translate into an irresistible urge to pay attention to information that is going viralif everybody else is talking about it, it must be important. In addition to showing us items that conform with our views, social media platforms such as Facebook, Twitter, YouTube and Instagram place popular content at the top of our screens and show us how many people have liked and shared something. Few of us realize that these cues do not provide independent assessments of quality.

In fact, programmers who design the algorithms for ranking memes on social media assume that the wisdom of crowds will quickly identify high-quality items; they use popularity as a proxy for quality. Our analysis of vast amounts of anonymous data about clicks shows that all platformssocial media, search engines and news sitespreferentially serve up information from a narrow subset of popular sources.

To understand why, we modeled how they combine signals for quality and popularity in their rankings. In this model, agents with limited attentionthose who see only a given number of items at the top of their news feedsare also more likely to click on memes ranked higher by the platform. Each item has intrinsic quality, as well as a level of popularity determined by how many times it has been clicked on. Another variable tracks the extent to which the ranking relies on popularity rather than quality. Simulations of this model reveal that such algorithmic bias typically suppresses the quality of memes even in the absence of human bias. Even when we want to share the best information, the algorithms end up misleading us.

Most of us do not believe we follow the herd. But our confirmation bias leads us to follow others who are like us, a dynamic that is sometimes referred to as homophilya tendency for like-minded people to connect with one another. Social media amplifies homophily by allowing users to alter their social network structures through following, unfriending, and so on. The result is that people become segregated into large, dense and increasingly misinformed communities commonly described as echo chambers.

At OSoMe, we explored the emergence of online echo chambers through another simulation, EchoDemo. In this model, each agent has a political opinion represented by a number ranging from 1 (say, liberal) to +1 (conservative). These inclinations are reflected in agents' posts. Agents are also influenced by the opinions they see in their news feeds, and they can unfollow users with dissimilar opinions. Starting with random initial networks and opinions, we found that the combination of social influence and unfollowing greatly accelerates the formation of polarized and segregated communities.

Indeed, the political echo chambers on Twitter are so extreme that individual users' political leanings can be predicted with high accuracy: you have the same opinions as the majority of your connections. This chambered structure efficiently spreads information within a community while insulating that community from other groups. In 2014 our research group was targeted by a disinformation campaign claiming that we were part of a politically motivated effort to suppress free speech. This false charge spread virally mostly in the conservative echo chamber, whereas debunking articles by fact-checkers were found mainly in the liberal community. Sadly, such segregation of fake news items from their fact-check reports is the norm.

Social media can also increase our negativity. In a recent laboratory study, Robert Jagiello, also at Warwick, found that socially shared information not only bolsters our biases but also becomes more resilient to correction. He investigated how information is passed from person to person in a so-called social diffusion chain. In the experiment, the first person in the chain read a set of articles about either nuclear power or food additives. The articles were designed to be balanced, containing as much positive information (for example, about less carbon pollution or longer-lasting food) as negative information (such as risk of meltdown or possible harm to health).

The first person in the social diffusion chain told the next person about the articles, the second told the third, and so on. We observed an overall increase in the amount of negative information as it passed along the chainknown as the social amplification of risk. Moreover, work by Danielle J. Navarro and her colleagues at the University of New South Wales in Australia found that information in social diffusion chains is most susceptible to distortion by individuals with the most extreme biases.

Even worse, social diffusion also makes negative information more sticky. When Jagiello subsequently exposed people in the social diffusion chains to the original, balanced informationthat is, the news that the first person in the chain had seenthe balanced information did little to reduce individuals' negative attitudes. The information that had passed through people not only had become more negative but also was more resistant to updating.

A 2015 study by OSoMe researchers Emilio Ferrara and Zeyao Yang analyzed empirical data about such emotional contagion on Twitter and found that people overexposed to negative content tend to then share negative posts, whereas those overexposed to positive content tend to share more positive posts. Because negative content spreads faster than positive content, it is easy to manipulate emotions by creating narratives that trigger negative responses such as fear and anxiety. Ferrara, now at the University of Southern California, and his colleagues at the Bruno Kessler Foundation in Italy have shown that during Spain's 2017 referendum on Catalan independence, social bots were leveraged to retweet violent and inflammatory narratives, increasing their exposure and exacerbating social conflict.

Information quality is further impaired by social bots, which can exploit all our cognitive loopholes. Bots are easy to create. Social media platforms provide so-called application programming interfaces that make it fairly trivial for a single actor to set up and control thousands of bots. But amplifying a message, even with just a few early upvotes by bots on social media platforms such as Reddit, can have a huge impact on the subsequent popularity of a post.

At OSoMe, we have developed machine-learning algorithms to detect social bots. One of these, Botometer, is a public tool that extracts 1,200 features from a given Twitter account to characterize its profile, friends, social network structure, temporal activity patterns, language and other features. The program compares these characteristics with those of tens of thousands of previously identified bots to give the Twitter account a score for its likely use of automation.

In 2017 we estimated that up to 15 percent of active Twitter accounts were botsand that they had played a key role in the spread of misinformation during the 2016 U.S. election period. Within seconds of a fake news article being postedsuch as one claiming the Clinton campaign was involved in occult ritualsit would be tweeted by many bots, and humans, beguiled by the apparent popularity of the content, would retweet it.

Bots also influence us by pretending to represent people from our in-group. A bot only has to follow, like and retweet someone in an online community to quickly infiltrate it. OSoMe researcher Xiaodan Lou developed another model in which some of the agents are bots that infiltrate a social network and share deceptively engaging low-quality contentthink of clickbait. One parameter in the model describes the probability that an authentic agent will follow botswhich, for the purposes of this model, we define as agents that generate memes of zero quality and retweet only one another. Our simulations show that these bots can effectively suppress the entire ecosystem's information quality by infiltrating only a small fraction of the network. Bots can also accelerate the formation of echo chambers by suggesting other inauthentic accounts to be followed, a technique known as creating follow trains.

Some manipulators play both sides of a divide through separate fake news sites and bots, driving political polarization or monetization by ads. At OSoMe, we recently uncovered a network of inauthentic accounts on Twitter that were all coordinated by the same entity. Some pretended to be pro-Trump supporters of the Make America Great Again campaign, whereas others posed as Trump resisters; all asked for political donations. Such operations amplify content that preys on confirmation biases and accelerate the formation of polarized echo chambers.

Understanding our cognitive biases and how algorithms and bots exploit them allows us to better guard against manipulation. OSoMe has produced a number of tools to help people understand their own vulnerabilities, as well as the weaknesses of social media platforms. One is a mobile app called Fakey that helps users learn how to spot misinformation. The game simulates a social media news feed, showing actual articles from low- and high-credibility sources. Users must decide what they can or should not share and what to fact-check. Analysis of data from Fakey confirms the prevalence of online social herding: users are more likely to share low-credibility articles when they believe that many other people have shared them.

Another program available to the public, called Hoaxy, shows how any extant meme spreads through Twitter. In this visualization, nodes represent actual Twitter accounts, and links depict how retweets, quotes, mentions and replies propagate the meme from account to account. Each node has a color representing its score from Botometer, which allows users to see the scale at which bots amplify misinformation. These tools have been used by investigative journalists to uncover the roots of misinformation campaigns, such as one pushing the pizzagate conspiracy in the U.S. They also helped to detect bot-driven voter-suppression efforts during the 2018 U.S. midterm election. Manipulation is getting harder to spot, however, as machine-learning algorithms become better at emulating human behavior.

Apart from spreading fake news, misinformation campaigns can also divert attention from other, more serious problems. To combat such manipulation, we have recently developed a software tool called BotSlayer. It extracts hashtags, links, accounts and other features that co-occur in tweets about topics a user wishes to study. For each entity, BotSlayer tracks the tweets, the accounts posting them and their bot scores to flag entities that are trending and probably being amplified by bots or coordinated accounts. The goal is to enable reporters, civil-society organizations and political candidates to spot and track inauthentic influence campaigns in real time.

These programmatic tools are important aids, but institutional changes are also necessary to curb the proliferation of fake news. Education can help, although it is unlikely to encompass all the topics on which people are misled. Some governments and social media platforms are also trying to clamp down on online manipulation and fake news. But who decides what is fake or manipulative and what is not? Information can come with warning labels such as the ones Facebook and Twitter have started providing, but can the people who apply those labels be trusted? The risk that such measures could deliberately or inadvertently suppress free speech, which is vital for robust democracies, is real. The dominance of social media platforms with global reach and close ties with governments further complicates the possibilities.

One of the best ideas may be to make it more difficult to create and share low-quality information. This could involve adding friction by forcing people to pay to share or receive information. Payment could be in the form of time, mental work such as puzzles, or microscopic fees for subscriptions or usage. Automated posting should be treated like advertising. Some platforms are already using friction in the form of CAPTCHAs and phone confirmation to access accounts. Twitter has placed limits on automated posting. These efforts could be expanded to gradually shift online sharing incentives toward information that is valuable to consumers.

Free communication is not free. By decreasing the cost of information, we have decreased its value and invited its adulteration. To restore the health of our information ecosystem, we must understand the vulnerabilities of our overwhelmed minds and how the economics of information can be leveraged to protect us from being misled.

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Information Overload Helps Fake News Spread, and Social Media Knows It - Scientific American

Human Behavior

What The University Of Illinois Learned From Reopening Amid The Pandemic – – Illinois Newsroom

November 24, 2020 medical

URBANA When University of Illinois at Urbana-Champaign officials decided to reopen in the midst of the COVID-19 pandemic, they launched an ambitious plan to keep the virus at bay. The approach included mandatory twice-a-week testing, using a saliva-based test developed by its own researchers.

The campus own modelers predicted early on that, with the testing program and other restrictions in place, there would be no more than 500 cases by Thanksgiving break, when classes shift to entirely virtual and most students leave campus.

But the true number of coronavirus cases at the University of Illinois turned out to be much higher: more than 3,800 among all students and employees. Campus officials say at least 3,091 cases have occurred among the estimated 35,000 to 38,000 students living on or near campus, roughly 8% of the student body.

Now, those higher-than-expected case numbers are leading the university to change its approach to combating the virus. Those helping develop campus reopening plans like university epidemiologist Rebecca Smith are looking more closely at ways to modify student behavior.

What went wrong

Smith says the campus initial approach while informed by research that shows frequent mass testing is a critical component to safely reopening college campuses relied too heavily on technology. It did not take into consideration certain aspects of human behavior that could thwart reopening plans.

The biggest lesson is that technology cannot save us from a pandemic, she says.

The majority of students, faculty and staff did an amazing job at adhering to campus requirements, Smith says. But a minority of students and employees made decisions that suggest they dont believe the virus is a risk to them and are not concerned about protecting the broader community.

The models the campus relied on assumed that people would not defy public health orders and do things like host or attend parties while knowingly infected with the virus.

There was just the assumption that telling somebody that they were infected meant that they were to isolate, Smith says. We didnt think that people would choose to ignore isolation orders.

Modelers also did not expect that students would ignore contact tracers calls and voicemails. And they assumed the contact tracing process carried out by the local health department would occur more quickly than it did.

With the nature of this virus, even a small number of people flouting the rules can cause major outbreaks and thats what played out at the University of Illinois.

The campus saw a spike in coronavirus cases early on in the semester, prompting campus officials to add new restrictions and warn of the potential for shutting the campus back down.

The effort to clamp down on spread worked, Smith says, and new daily cases even dipped into the single digits for a time.

But as the virus prevalence in the community ticked up, even small gatherings like football watch parties, Halloween get-togethers of 10 people or less led to spread. Smith says students also traveled off campus more frequently than they expected, likely bringing the virus back with them.

Both the campus and the state are suffering from the fact that borders dont mean anything to a virus, she says. So right now, what were seeing on campus a lot is just the statewide spread of the virus coming onto our campus.

What went well

While there was a lot of concern early on that bringing students back would spread the virus into the community, Smith says testing and contact tracing data show no indication that that happened.

Champaign-Urbana Public Health Administrator Julie Pryde confirmed that student cases appeared to remain on campus.

There are also no signs of virus spread linked to in-person classroom settings. Rather, clusters among students tend to be either their social networks or their residences. And those two overlap, so its hard to tease them apart, Smith says.

Smith also notes that the purpose of modeling was never to make a firm prediction on how many cases would occur by the end of the semester. Rather, epidemiological modeling helps researchers compare different scenarios and make decisions about what efforts are likely to lead to the best outcomes.

She adds, People took that number [of 500 cases] and said: This is whats going to happen. Modelers will never say that. So, yes, the prediction was not correct compared to the reality, but I would not have expected it to be because there was so much we didnt know at that time.

Most other campuses that reopened only tested people with symptoms of known exposure, Smith says.

But the University of Illinois attempted whats known as a whole population surveillance program, [which] is understood by infectious disease epidemiologists as the best way to find and control a disease that spreads through asymptomatic infection, Smith says.

This is particularly important on college campuses, since college-age students who contract the virus are most likely to show few or no symptoms.

So we know that with the majority of our cases, if we had only tested [people with symptoms], we would not have found them, she says.

Pryde notes that Champaign County, which includes the university, has completed more than 1 million tests about 12% of all testing done in the entire state of Illinois.

Rapid, frequent testing is crucial, Pryde says. And [the University of Illinois] figured out a way to do that. That, coupled with the mitigation efforts, are really a model for the country.

Looking ahead

Despite these efforts, more people contracted the virus than university officials had hoped.

So going forward, Smith says the university is taking a new approach.Hard scientists, like herself, who have been mostly focused on the technological aspects of reopening, are now working closely with University of Illinois social scientists and communications experts to develop a strategy that better accounts for human behavior.

Countries that have done well at controlling the spread of the virus have a culture with a less individualistic mindset and more emphasis on care of the entire community, Smith says.

This is something that everybody at all levels of pandemic control knows: In order to control the pandemic, we have to care for other people and we have to make those choices, Smith says.

The big question is: How do you shift the culture of a college campus?

The University of Illinois is now conducting surveys and focus groups with students to learn what strategies may be more successful at motivating them to make choices that protect the health of the entire community. Smith says these efforts are ongoing.

Before we can actually change peoples minds and attitudes about how to keep everybody safe, we have to understand why theyre making the choices that they are, she says.

These strategies will be important both for the success of the spring semester and down the road when students will be asked to be immunized once a vaccine becomes available.

Meanwhile, campus officials want students who are staying in the Champaign-Urbana area between now and January to be tested at a campus testing site every other day especially if they travel away from the area and return.

The biggest change for the spring semester involves starting a week later than usual on Jan. 25 and having students return a week before classes start to quarantine until they receive two negative coronavirus test results.

Smith expects another bump in COVID-19 cases in January, as students return to campus during a time when theres likely to be even more widespread community transmission.

But shes hopeful the immediate test-and-quarantine approach, along with strategies developed in tandem with campus social scientists, will help control the spread of the virus.

This story was produced by Side Effects Public Media, a news collaborative covering public health.

Christine Herman is a reporter atIllinois Public Media. Follow her on Twitter: @CTHerman

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What The University Of Illinois Learned From Reopening Amid The Pandemic - - Illinois Newsroom

Human Behavior

Officials say COVID-19 safety measures must continue even as vaccine is on the way, numbers improve – KELOLAND.com

November 24, 2020 medical

SIOUX FALLS, S.D. (KELO) Hospitalizations that have leveled off, coronavirus cases that have decreased over the past several days and an expected vaccine are causes for optimism but not for backing off on safety measures when it comes to the pandemic, officials said during the Nov. 23 city of Sioux Falls coronavirus news conference.

Averas Dr. Mike Elliot stressed the need to continue to wear masks. Its clear that masks work. They work the best when they adopt this as a community effort, Elliot said. We support mask mandates both at the state level and local level.

There has been a re-energizing of efforts such as hand washing, mask wearing and physical social distancing in an effort to reduce the spread of the coronavirus, said Dr. Mike Wilde of Sanford.

The public needs to continue masking, socially distancing, hand washing and other actions to curb the spread of COVID-19, said Jill Franken, the director of the Sioux Falls Health Department.

When asked if the two health care organizations had sought a change in the state policy on mask mandates:

We support CDC guidelines, Wilde said. Our role is to support CDC guidelines.

Wilde said he couldnt speak as to whether Sanford Health has asked the governor to change any coronavirus policies such as establishing a statewide mask mandate.

Elliot repeated that Avera has supported local and statewide mask mandates.

The state has had more than 392 COVID-19 deaths in November alone, Elliot said. Total COVID-19 deaths in the state so far total more than flu total deaths from the past 10 years combined, Elliot said.

Id love to tell you weve turned the corner but its too soon, Elliot said.

Human behavior over the Thanksgiving and Christmas holidays will have a big impact on coronavirus deaths, hospitalizations and cases in the months that follow, Elliot said.

Wilde advised the public to carefully consider their holiday plans. For example, his family will have only a small family gathering.

Both doctors and Franken said they were optimistic about three new vaccines on the horizon and new treatments for COVID-19.

The local health department is working with the state and others to be ready when vaccines arrive, Franken said.

Not only does the public need to maintain its physical health, but also it mental health.

Franken said people need to daily ask themselves how they are doing in terms of their mental health. Feelings of sadness or anxiety are very real emotions, she said.

Take time every single day to reflect on how you are feeling, Franken said. People are not alone and help is available through the local Helpline or Live Well Sioux Falls or through their primary care provider, Franken said.

Keep reading

Your Guide To Coronavirus

KELOLAND News is covering the COVID-19 pandemic. This is your guide to everything you need to know to prepare. We also have the latest stories from across the globe feeding into this page.

Online Gambling, Gaming Addiction Has Increased During COVID-19: Tips That Can Help – Healthline

November 24, 2020 medical

If youve recently experienced serious withdrawal when not playing video games or gambling online, you could be living in lockdown with a serious addiction.

While addiction is most commonly associated with substances like alcohol, certain human behaviors can be addictive, too.

Internet gaming disorder or gambling disorder are whats called process addictions. And with so many people stuck in their homes right now, these struggles are amplified.

People are isolated by themselves at home, said Dr. Scott Teitelbaum, a professor in psychiatry and neuroscience at the University of Floridas College of Medicine and medical director of the UF Health Florida Recovery Center.

He added hes seeing more people for these types of addictions.

Life is hard, and people are always looking for something to soothe themselves, and some people get pathologic attachment, Teitelbaum told Healthline.

John Gillen, director of Cassiobury Court, a drug and alcohol rehab center in the United Kingdom, told Healthline that hes seen a rise in these addictions the past few years, and the pandemic has only exacerbated them.

Because of the COVID situation, were opening a new residential treatment center because the demand is becoming that high, Gillen said.

In the three centers, I would say that we have two from each center who have come to us as a result of active, chronic gaming, whether it would be gaming or other forms of internet misuse, shall we say, he said. These are all people under the age of 28. I would say thats definitely going to increase come early next summer.

Healthline asked several experts to explain addictions to activities such as video games, online gambling, and day trading, as well as how to identify if you have a problem and how to get help.

Process addictions are behaviors that activate the brains reward center in the way that certain substances do, explained Dr. Lawrence Weinstein, the chief medical officer at American Addiction Centers in St. Petersburg, Florida.

Taking part in this particular behavior will increase the level of dopamine in the brain, and the pleasure obtained from this behavior reinforces that the person will engage in the behavior again in the future, he told Healthline. Disorders involving feeding, eating, shopping, and exercising are all examples of process addictions.

When lockdowns and shutdowns were the new reality in April, the National Council on Problem Gambling warned that people with gambling problems may be affected more severely by the pandemic due to increased individual health risks, shifting gambling preferences, and cuts in funding for services.

Weinstein told Healthline that an increase in process disorders like online gaming and gambling is due to the many mental health consequences of the pandemic.

In both instances, social isolation as a result of social distancing, financial and economic worries, difficulties with employment, and other stressors may cause people to initiate online gaming/gambling as a stress reliever or exacerbate existing problematic behavior, he explained.

The circumstances of being housebound with a limited amount of activities available are almost ripe for online gaming because of the ability to maintain enjoyable and social communication, Weinstein said.

Online gaming was even encouraged in the early stages of the pandemic with a joint campaign between the World Health Organization and the video game industry, he said.

The uncertainty of these financially difficult times can be a driving factor in an increase of online gambling, Weinstein added.

Stress is a trigger, Teitelbaum said. As a rule, any of these things substance abuse disorders, gambling online, gaming they become issues of isolation anyhow. Ive seen the pandemic be a trigger for a spiraling down.

Teitelbaum has treated people who have an addiction to day trading an activity thats been dubbed a pastime for many during the pandemic and says that its just another form of gambling.

Its the action, he said. You need the money to do it. But its the action, the anticipation of the action, thats what you become addicted to.

Teitelbaum noted that these disorders are challenging to identify because theyre harder to monitor.

Its harder to keep people away. Its kind of like compulsive overeating. You cant tell people not to eat, he explained. Youre telling people not to be on the internet.

While the pandemic makes it more difficult for people to socialize, other modes of interacting can enter the picture.

With the amount of decreased social interaction that we have due to COVID, people are looking for more ways to interact and also get positive reinforcement for the social interaction they are able to do, said Dr. Denis Godwin Antoine II, the director of the motivated behaviors unit at Johns Hopkins Hospital in Maryland and an assistant professor of psychiatry and behavioral sciences. I think that theres an opportunity for online gaming to increase that social interaction.

These disorders may be harder to notice right now simply because we arent living life as we did before.

I think its become harder to identify when it is a problem because any type of social disorder is defined by an impairment in social function, Antoine told Healthline.

The best approach, he said, is to look at the big picture in terms of whats going on at home and on the job, as well as other responsibilities to make sure that those roles are being met adequately.

Examine regular activities of daily life, such as eating and sleeping, to see whether any of those behaviors have gone in a bad direction.

Just by asking a person how frequently theyre playing a game or trading stocks wouldnt give the most accurate picture as to how it impacts their social environment, Antoine explained.

The new edition of the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5), which is the handbook for mental health professionals, includes diagnostic criteria for both internet gaming disorder and gambling disorder, Weinstein noted.

A preoccupation or obsession with internet games, withdrawal when not playing them, and loss of interest in other life activities are on the list of diagnostics for internet gaming disorder, which is in the section for conditions that warrant further research.

The need to gamble with increasing amounts of money to achieve the desired excitement, irritability when trying to cut down or stop gambling, and repeated unsuccessful efforts to control gambling are among the list of criteria for gambling disorder.

Weinstein said a doctor would diagnose a process addiction after they identify a certain number of specific symptoms.

Based on the number of symptoms met, the mental health professional can then determine the severity of the disorder, he said.

Antoine said that in his experience, people struggling with online gaming and gambling dont typically deal with that issue alone.

They have other issues that come into the picture, such as low social support from family and friends or very high psychosocial stressors, and theyre looking for an outlet that is easy to access, he said. Thats usually where the gambling and the gaming problems come in.

Teitelbaum agreed that a process disorder could be tied to other issues.

You need to look at the whole person, everything, not just the existence of co-occurring disorders, but trauma, you have to look at the whole picture, he said. Many of these disorders dont stand alone.

Antoine suggested connecting with a mental health professional, such as a psychiatrist or therapist, who is trained to identify the DSM-5 criteria for diagnosis.

Telehealth has been a helpful path for diagnosis during the pandemic.

There has actually been an increase in telehealth utilization, and a lot of these disorders can be at least diagnosed with a history of what has been happening in a persons life, Antoine said. Some people are more comfortable with telehealth than they are in person. So, for some individuals, it may be a better option.

There are no known medications approved by the Food and Drug Administration to treat these disorders, but there are therapies for commonly co-occurring mental health issues like depression or bipolar disorder.

I have treated patients in the past with untreated bipolar disorder who are very driven to spend money and gamble, and that comes up very often, Antoine said. But in terms of for specifically pathological gambling, there are no approved medications at this time.

Weinstein said that treatment for process addiction commonly comes in the form of cognitive behavioral therapy (CBT).

CBT is a problem-focused form of psychotherapy in which the patient and therapist actively work together to identify and change patterns of thinking or behavior that may lead to self-destructive actions, he said. Through CBT, patients identify risky or triggering situations and learn coping skills that can then be utilized to prevent a relapse.

Teitelbaum supports a well-rounded approach.

You want to look [at], do they have a co-occurring mental health disorder that they need pharmacologic treatment for? Once again, you go case by case. You really want to know your patient, he said.

Ive always said good treatment isnt this or that its this plus that, Teitelbaum explained. You have to look at your individual patient and figure out, OK, whats the neurobiology? What do I need to do pharmacologically? And how else can I help?

Theres no one magic bullet, according to Teitelbaum.

I think good treatment is always a combination of appropriate integrated pharmacotherapy, group therapy, individual therapy, and family therapy, he said. Looking for other things that they find peace and joy doing.

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Online Gambling, Gaming Addiction Has Increased During COVID-19: Tips That Can Help - Healthline

Human Behavior

The Virus Surge, Once Centered in the Midwest, Is Accelerating in 45 U.S. States – The New York Times

November 24, 2020 medical

Heres what you need to know:A drive-through testing site in Oakland, Calif., on Thursday.Credit...Jim Wilson/The New York Times

When infections began rising sharply in the U.S. in September, the growth was driven largely by outbreaks in the Upper Midwest. States like North Dakota and Wisconsin soon became the hardest hit in the nation, relative to their size, and the region continues to struggle.

Now, though, with the whole countrys daily average of new cases is as high as it has ever been over 171,000 the most rapid growth is happening elsewhere. Nine states are reporting more than twice as many new cases a day as they did two weeks ago, and none of them are in the Midwest.

The surges in those states Arizona, California, Delaware, Louisiana, Maryland, New Hampshire, New Mexico, Pennsylvania and Vermont reflect a still-escalating national crisis. Officials warn that it will only get worse if people disregard warnings about travel and get-togethers for the approaching holidays.

Let me be very clear: A Thanksgiving gathering this year may very well lead to a funeral, said Gov. Michelle Lujan Grisham of New Mexico, whose state is home to five of the 10 metropolitan areas in the country where new case reports are rising the fastest. The virus is at large, the governor said. Know the risks and respect them.

Forty-five states are seeing sustained increases, and 17 states added more cases in the seven-day period that ended Sunday than in any other week of the pandemic. Major metropolitan areas that are reporting new cases at or near record levels are all across the continent: Pittsburgh. Albuquerque. Baltimore. San Diego.

Some that have been bad for a while, like El Paso, are coping with the flood of hospitalizations that generally follow a couple of weeks behind a rising tide of new cases. A major hospital group in Arizona, Banner Health, began banning most visitors from its facilities Sunday night because of the worsening spread of the virus.

And where the hospitals come under intense strain, officials are turning, however reluctantly, to impose or reimpose restrictions in the hope of flattening the curve. In Los Angeles County, Calif., which has been averaging more than 3,500 cases a day lately, officials said on Sunday that barring indoor restaurant dining was no longer sufficient, and that outdoor dining would have to shut down as well.

Unfortunately, if our cases and hospitalizations continue to increase, we will need to issue further restrictions to protect our health care system and prevent more deaths, said Barbara Ferrer, the county public health director.

The drugmaker AstraZeneca announced on Monday that an early analysis of some of its late-stage clinical trials, conducted in the United Kingdom and Brazil, showed that its coronavirus vaccine was 70.4 percent effective in preventing Covid-19, suggesting that the world could eventually have at least three working vaccines and more supply to help curb the pandemic.

The British-Swedish company, which has been developing the vaccine with the University of Oxford, became the third major vaccine developer this month to announce encouraging early results, following Pfizer and Moderna, which both said that their vaccines were about 95 percent effective in late-stage studies.

AstraZenecas results are a reassuring sign of the safety of the vaccine. It came under global scrutiny after AstraZeneca temporarily paused its trials in September to investigate potential safety issues after a participant in Britain developed a neurological illness.

Oxford and AstraZeneca said they would submit their data to regulators in Britain, Europe and Brazil and seek emergency authorization.

The company said its early analysis was based on 131 coronavirus cases. The trials used two different dosing regimens, one of which was 90 percent effective in preventing Covid-19 and the other of which was 62 percent effective.

The regimen that was 90 percent effective involved using a halved first dose and a standard second dose. Oxford and AstraZeneca also said that there were no hospitalized or severe cases of the coronavirus in anyone who received the vaccine, and that they had seen a reduction in asymptomatic infections, suggesting that the vaccine could reduce transmission.

AstraZenecas vaccine is expected to come with relatively simple storage requirements, which would be an asset once it gets rolled out. The company has said it anticipates the vaccine will require refrigeration, though it has not provided details about how long and at what temperature it can be kept. Modernas vaccine can be kept for up to a month at the temperature of an ordinary refrigerator. Pfizers can be kept for up to 5 days in conventional refrigerators, or in special coolers for up to 15 days, but otherwise needs ultracold storage.

AstraZeneca has said it aims to bring data from its studies of its vaccine being conducted overseas to the Food and Drug Administration which would mean that the agency will likely review and authorize a vaccine before late-stage data are ready on how well the vaccine works in American participants. British regulators already have been conducting a so-called rolling review of the vaccine.

Today marks an important milestone in our fight against the pandemic, AstraZenecas chief executive, Pascal Soriot, said. This vaccines efficacy and safety confirm that it will be highly effective against Covid-19 and will have an immediate impact on this public health emergency.

Professor Andrew Pollard, the chief investigator of the Oxford Vaccine Trial, said that these findings show that we have an effective vaccine that will save many lives.

AstraZenecas results could significantly strengthen the global effort to produce enough vaccine to create population immunity: The price of the shot, at $3 to $4, is a fraction of that of some other potential vaccines, and AstraZeneca has pledged to make it available at cost around the world until at least July 2021 and in poorer countries in perpetuity.

transcript

We are now coming into the high social season Thanksgiving, Christmas. Its the high social season, social activity goes way up in this season. That is a bad combination. Just factor out the current rate of increase. You know, where we are in three weeks? Six thousand cases. Thats before we go into 37 days of the highest socialization period of the year. Yellow Zone in New York City is 2.5, reduces house of worship gatherings. Orange Zone reduces mass gatherings, more businesses close; high risk in an Orange Zone, schools close to clean and test, and then can reopen if they test and the positivity rate is low. New York City, Upper Manhattan is going to become a Yellow Zone. Basically, the Washington Heights area is 3.3. Staten Island, part is a Yellow Zone, part is an Orange Zone. Staten Island is a problem. The number of hospitalizations in Staten Island have gone over the last three weeks they basically tripled 33 to 91. Its a consequence of action.

As Thanksgiving approaches, Gov. Andrew M. Cuomo of New York on Monday announced new restrictions in parts of the state where virus cases are rising, including New York City, and issued a grim warning that the state was on track for a further resurgence of the virus.

The new restrictions included a zone in Upper Manhattan, the first time the state has rolled back reopening in the borough under its program of targeting so-called microclusters.

These are dangerous times that were in, Mr. Cuomo said at a news conference in New York City.

Over the last three weeks, the number of people hospitalized with the virus in the state has more than doubled, to 2,724 on Monday from 1,227 on Nov. 2. The number is a far cry from the peak of the pandemic in the spring, when more than 18,000 people were hospitalized.

But Mr. Cuomo warned that if current patterns held, the state would hit 6,000 hospitalizations in another three weeks. The increase could become steeper, he said, if people continued gathering for Thanksgiving and Christmas in the coming weeks, which he called 37 days of the highest socialization of the year.

The governor again warned residents not to travel for the holidays. The state has currently imposed a 10-person limit on private gatherings in hopes of limiting small parties that he has said have contributed to the resurgence of the virus in the state this fall.

Parts of Upper Manhattan, including Washington Heights, will now be a yellow zone under the states tiered, color-coded restriction system. Gatherings will be limited to 25 people, with houses of worship limited to 50 percent capacity. Restaurants can serve only up to 4 people at a table.

Mr. Cuomo also announced an orange zone, the second level of limits, in southern parts of Staten Island. In those areas, indoor dining will close, as will some nonessential businesses deemed to be high risk, such as gyms and personal-care services. All gatherings will be limited to 10 people, with houses of worship limited to 33 percent capacity and 25 people maximum. Other parts of the borough will become a yellow zone.

Staten Island is a problem, Mr. Cuomo said.

The borough has been a hot spot for the virus in the city in recent months. Mr. Cuomo said that hospitalizations there had increased enough that Staten Island was facing a capacity issue. As a result, the state will open an emergency coronavirus patient facility in the South Beach neighborhood, a move reminiscent of field hospitals set up in the spring, when New York City was one of the hardest hit places in the country.

The state also announced new yellow zones in parts of Long Island, including Great Neck, Riverhead and Hampton Bays, and expanded yellow and orange zones upstate, around the cities of Rochester and Syracuse.

transcript

The national restrictions in England will end on the 2nd of December, and they will not be renewed. From next Wednesday, people will be able to leave their home for any purpose, and meet others in outdoor public spaces subject to the Rule of 6. Collective worship, weddings and outdoor sports can resume, and shops, personal care, gyms and the wider leisure sector can reopen. But without sensible precautions, we would risk the virus escalating into a winter or new-year surge. The incidence of the disease is, alas, still widespread in many areas. So were not going to replace national measures with a free for all the status quo ante-Covid were going to go back instead to a regional tiered approach, applying the toughest measures where Covid is most prevalent. I cant say that Christmas will be normal this year. But in a period of adversity, time spent with loved ones is even more precious for people of all faiths and none. We all want some kind of Christmas. We need it. We certainly feel we deserve it. But what we dont want is to throw caution to the winds and allow the virus to flare up again, forcing us all back into lockdown in January.

Gyms, stores and hair salons will be allowed to reopen in England next week, Prime Minister Boris Johnson said Monday, telling lawmakers that for the first time since the spread of the coronavirus the country could see a route out of the pandemic.

Speaking to Parliament by video link, Mr. Johnson said that he would lift a national lockdown on Dec. 2, as expected, and that England would then return to a regionalized system of restrictions based on three tiers of controls.

However, the new plan will keep substantial restrictions on pubs and restaurants a move that risks friction with some of Mr. Johnsons own lawmakers, who fear that the hospitality trade will be hit hard by the limitations.

Crucially, the government has not yet announced which parts of the country will be subjected to which set of restrictions, though that information is expected later this week.

Mr. Johnson, who has been quarantining since last week after being exposed to a member of Parliament who tested positive, hailed the progress announced by the team at Oxford University developing a vaccine with the British-Swedish drugmaker AstraZeneca, adding that the scientific cavalry is in sight.

There have been at least 1.5 million confirmed cases of coronavirus in the United Kingdom, according to Public Health England. As of Monday morning, 55,024 people had died.

Under the plan to ease restrictions, gyms, stores and hair salons will reopen and collective worship, weddings and outdoor sports will be allowed to resume in all parts of England.

But in the worst-affected parts of the country, pubs and restaurants will stay closed except for takeout service.

In some other areas, people will only be able to drink in pubs if they are also eating a meal. Those pubs will, however, be allowed to stay open until 11 p.m., an hour later than had been allowed immediately before the lockdown began, though the bars will have to take last orders for alcohol at 10 p.m.

Some spectators will be allowed into sports events, though even in the least-affected parts of England, crowds will be limited to a maximum of 4,000, and in some parts of the country none will be allowed.

The package outlined by Mr. Johnson reflected his desire to prevent another surge in virus cases while seeking not to antagonize his backbench lawmakers, who have threatened to rebel over lockdown measures.

Gov. Gavin Newsom of California has gone into quarantine, along with his family, after three of the governors children were exposed to a state highway patrol officer who later tested positive for the coronavirus.

The governors whole family Mr. Newsom; his partner, Jennifer Siebel Newsom; and their four children tested negative for the virus on Sunday, but will stay apart from other people for two weeks anyway, in compliance with state guidelines, his office said.

We are grateful for all the officers that keep our family safe and for every frontline worker who continues to go to work during this pandemic, the governor said on Twitter.

The Newsoms learned of the exposure on Friday evening, the governors office said. The whole family waited until Sunday to be tested in order to reduce the likelihood of a false negative result (it can take time for the virus to build up to detectable levels after infection). The governor and his partner did not come in direct contact with the officer.

One of the Newsom children was already in quarantine after a classmate tested positive, Politico reported on Friday. The governor has come under fire for sending his children back to their private school classrooms while many public schools in the state remained closed and most families had to adapt to at-home learning.

Mr. Newsom has also faced outrage over his recent decision to attend a birthday dinner at a restaurant in Napa Valley with members of several other households.

With infections and hospitalizations each rising at an alarming rate in the state, officials announced a curfew last week, and some counties and the state have reimposed sweeping restrictions they had been gradually lifting.

According to a New York Times database, the state has reported an average of 11,802 new cases a day over the last week, a sharp increase from a month ago. The figure exceeds the states earlier peak of just over 10,000 new cases a day in late July.

The curfew bars nearly all Californians from being away from their homes from 10 p.m. to 5 a.m. except for essential purposes, and is scheduled to last through Dec. 21.

In Los Angeles County, where indoor dining has been shuttered for months and virus cases are still surging, health officials took the additional step on Sunday of closing down outdoor dining to reduce the possibility for crowding and the potential for exposure. That order takes effect on Wednesday, just before Thanksgiving.

An expert committee charged with deciding which Americans should be first in line for a coronavirus vaccine met on Monday afternoon to discuss a number of questions before it votes likely by mid-December on final recommendations for the Centers for Disease Control and Prevention.

After the group, the Advisory Committee on Immunization Practices, delivers its recommendations, the C.D.C. director, Dr. Robert R. Redfield, will quickly decide whether to approve them. That will be the final step, after a review by the Food and Drug Administration and its own advisory committee on vaccines, before the first doses of vaccine are shipped nationwide.

A subgroup of the committee had already suggested that health care workers, who total about 21 million, should be the first to be vaccinated. On Monday, it recommended also including residents of long-term care facilities in that initial group. Next would be essential workers, then adults with high-risk medical conditions and those who are 65 or older.

Some of the questions the committee considered Monday included:

Whether people who have already had Covid-19 should not be vaccinated until there is ample supply. Dr. Robert Atmar, a committee member and infectious disease specialist at Baylor College of Medicine in Houston, said that at the beginning, where its a resource-limited vaccine, my opinion is that we need to try and target as best we can to those that we know are susceptible. But another committee member, Dr. Grace Lee, a pediatrics professor at Stanford University School of Medicine, pushed back, saying that much remains unknown about long-term immunity.

Whether essential workers like police, firefighters, teachers and transportation workers should be the second group to get the vaccine. To me, the issue of ethics is very significant, very important for this country and clearly favors the essential worker group, said Dr. Peter Szilagyi, a professor of pediatrics at the University of California, Los Angeles, noting that the group included a high proportion of minority, low-income and low-education workers.

Efforts to contain the coronavirus pandemic last spring quickly became politicized, forcing officials and citizens around the world to choose between public health and personal freedom. In the United States, the tension broke down roughly along ideological lines, with many blue states taking containment measures seriously, and red states less so.

In a new analysis, a team of researchers provided some of the first hard evidence of how the political divide drove behavior. The paper, posted Monday by the journal Nature Human Behavior, found that one measure of partisan hostility the intensity of distrust and animosity toward the other side, red or blue correlated both with peoples attitudes toward containment policies, and how they behaved.

The findings were based on interviews with more than 2,400 adults, conducted once in the summer of 2019 and again in April of this year.

The research team, led by James Druckman, a political scientist at Northwestern University, found that the average Democrat is more worried, is more likely to have changed behaviors and is more supportive of policies to stop the spread of infections than the average Republican, although there were substantial overlaps in attitudes.

The research team, which included scientists from the University of Arizona, Stony Brook University and the University of Pennsylvania, determined that in the hardest hit areas, these differences shrank. In effect, concern for personal and family safety blunted the effect of partisanship, as most everyone responded to the local outbreak.

These findings have implications for understanding how best to combat COVID-19, the authors concluded. Since partisan hostility underlies partisan gaps, policymakers will need to devise different strategies to bring the parties together on these issues.

More travelers were screened at airport security checkpoints on Sunday than on any day since the pandemic took hold in March, a worrying sign that people flying to visit their families for Thanksgiving could increase the spread of the coronavirus.

A little more than one million people were screened by the Transportation Security Administration on Sunday, according to federal data published on Monday. That number is about half of what it was in 2019, but it represents a big increase from the spring, when less than a half a million people flew on any given day.

The Centers for Disease Control and Prevention and Dr. Anthony Fauci, the countrys top infectious disease expert, have been strongly discouraging holiday travel for fear that it would increase the number of new infections, which have surged in recent weeks as the weather turns colder and more people spend time indoors.

Airlines have said that flying is safe because of the precautions the industry has put in place, like high-end air filtration. They also point to the relatively few published cases of the coronavirus being spread during a flight. But the science on in-flight safety is far from settled, and travelers would still be at risk of contracting or spreading the virus at airports and once they are at their destination.

The increase in travel during the holidays has been encouraging for airlines. But it wont be enough to offset the deep losses they have suffered during the pandemic. The nations largest airlines have collectively reported tens of billions of dollars in losses so far this year, and analysts expect demand to remain weak for a couple of years or more. The industry is hoping that the incoming Biden administration and Congress will give airlines more aid early next year.

When a taxi deposited Mallory Guy in front of an apartment building in Cheonan, South Korea, after a 14-hour flight from Atlanta, a Korean couple was waiting for her with open arms.

It was the first time since she was 7 months old that Ms. Guy, 33, had been in the country where she was born. It was also her first time seeing her birth parents since she was sent to the United States more than three decades ago.

For some adoptees, birth family reunions had become a rite of passage. Then came the pandemic. The pilgrimages back to South Korea dwindled. Many adoptees canceled long-planned reunions after the governments quarantine rules for foreign visitors made the trips too costly and time-consuming.

When Ms. Guy arrived in South Korea in September, she did not know whether she would be allowed to spend the two weeks at her biological parents home or be forced to stay at a costly government hotel. The South Korean Embassys website said only that such decisions were made on a case-by-case basis.

Her parents made Korean food for her and American snacks like peanut butter and jelly. (They also stocked up on milk, because they had heard that Americans love milk.) They even bought her an exercise bike, because she had told them during calls that she enjoyed using her Peloton.

After two weeks of immersion in her parents home, Ms. Guy took a coronavirus test, as mandated by the government, so she could leave quarantine and explore her home country with her family.

When a testing administrator asked her when she had last left the country for the United States, I told her 1987, and she looked super-confused.

The worker asked again, and Ms. Guy confirmed that she understood the question.

After telling her 1987 four more times, Ms. Guy said, she finally wrote it down.

Senator Kelly Loeffler of Georgia, a Republican who is campaigning in a high-stakes runoff election that could determine control of the Senate, plans to get back out on the campaign trail after receiving her second consecutive negative coronavirus test, a campaign spokesman said on Monday.

This comes after Ms. Loefflers campaign on Sunday said she was isolating out of an abundance of caution after a series of coronavirus tests delivered mixed messages about whether she had contracted the disease.

According to Stephen Lawson, a campaign spokesman, a rapid test Ms. Loeffler took Friday morning came back negative, but a second test she also took that morning a polymerase chain reaction, or P.C.R., test, which is considered more accurate returned a positive result on Friday evening.

In between her receipt of the two conflicting test results, Ms. Loeffler attended campaign-related events on Friday, including a rally with Vice President Mike Pence and Senator David Perdue of Georgia, Mr. Lawson said.

Ms. Loeffler, 49, received another P.C.R. test on Saturday morning. But it was inconclusive, Mr. Lawson said of the results, which came in Saturday evening. On Sunday afternoon, Mr. Lawson issued another statement saying that the senators previously inconclusive P.C.R. results were retested overnight and the results thankfully came back negative. The negative result on Monday was also from a P.C.R. test.

He added: Out of an abundance of caution, she will continue to self-isolate and be retested again to hopefully receive consecutive negative test results. We will share those results as they are made available. She will continue to confer with medical experts and follow C.D.C. guidelines.

Ms. Loeffler notified those with whom she had sustained contact while she awaits further test results, he said.

Ms. Loeffler has held recent events with prominent Republicans, including Mr. Pence, Senator Tom Cotton of Arkansas and Mr. Perdue, who is also engaged in a runoff election that could determine control of the Senate. On Sunday, a campaign spokesman said Mr. Perdue was remaining at home until he had more details about the health status of Ms. Loeffler.

Mr. Perdue, 70, has encouraged people to wear masks to help stop the spread of the coronavirus. But he has also appeared at rallies where people did not wear masks. A Friday tweet from Ms. Loeffler includes a picture that shows the two senators in an indoor setting without masks.

A spokesman for Mr. Pence, Devin OMalley, said also on Sunday that as he awaits a confirmatory test from Senator Loeffler, Vice President Pence is in regular consultation with the White House Medical Unit and will be following C.D.C. guidelines as he has in other circumstances when he has been a close contact.

The last time Mr. Pence was deemed a close contact was last month when his chief of staff, Marc Short, tested positive.

Mr. Pence continued to campaign then, with the White House saying that he was performing essential duties that exempted him from Centers for Disease Control and Prevention guidelines calling for people to quarantine for 14 days after exposure to the virus.

Ms. Loeffler, a businesswoman who is the Senates richest member, was temporarily appointed to her Senate seat late last year. She faces the Rev. Dr. Raphael G. Warnock, a Democrat, in an election on Jan. 5, when Georgia voters will also decide between Mr. Perdue and his opponent, Jon Ossoff, a Democrat.

ISLAMABAD, Pakistan Pakistan announced Monday that schools across the country will close for six weeks beginning Nov. 26 as the government confronts a sharp rise in new coronavirus cases. The positivity rate was 7 percent in the past 24 hours with at least 34 deaths, health officials said, a worrying increase compared to the past several weeks.

Students will continue taking classes from home until Dec. 24, said Shafqat Mahmood, Pakistans federal education minister, during a news conference in Islamabad on Monday.

All educational institutions will be opened on Jan. 11, 2021, after reviewing Covid-19 cases situation in the first week of January, Mr. Mahmood said, noting that winter break for students would begin Dec. 25 and end on Jan. 10.

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