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July 13, 2020 -- Coronavirus cases, hospitalizations and deaths will continue to increase in the U.S. as states and cities struggle to stop the spread of the virus, several top coronavirus experts said Friday during a COVID-19 session at the AIDS 2020 Virtual Conference.

The U.S. is now in the middle of a “very serious problem,” Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, said at the beginning of the session.

Fauci provided background on the coronavirus and showed a time-lapse map of the growth of cases across the world.

“Truly, what we saw before us was the somewhat frightening but nonetheless real emergence of a true global pandemic,” he said. “It just went on and on and just got worse and worse and worse.”

About 40% of infected people spread the virus without knowing it, either because they’re asymptomatic or pre-symptomatic, Fauci said, which means they don’t have symptoms or are contagious before they show symptoms. This alone makes it difficult for public health officials to trace people’s contacts and prevent the spread of the virus, he added.

The wide spectrum of symptoms and disease has “puzzled but also disturbed me the most,” Fauci said. Some people have no symptoms at all while others have mild respiratory issues that require little treatment, moderate illness that turns into pneumonia but doesn’t require oxygen, severe disease that requires oxygen support, or critical disease that leads to shock, multi-organ failure and death.

“I have never seen a virus, in which the same pathogen with little change, has ranged” in this way, he said. “It is extraordinary that range … from nothing to death.”

Cases have increased in the U.S. during the past three weeks, and the death toll is expected to increase soon as the spread of the virus continues in large cities, Deborah Birx, MD, the White House Coronavirus Task Force coordinator, said during the session.

The high percentage of positive tests in California, Texas, Arizona, Florida, Georgia and South Carolina show where the current community transmission is, she said. The “cut line” for a high rate is 10%, and now 28 states have a rising number of cases or positive rate.

Recent actions will determine what the numbers look like next.

“I’m not sure that we have the full information from the protests yet,” she said. “We are starting to see early rises in cases in some of our metro areas, and we need to track that very carefully.”

The recent increase in COVID-19 cases across the U.S. has triggered an “emergency county alert” in 154 counties, she added. Public health officials are looking at those counties to try to stop the spread of the virus, especially among asymptomatic people.

“We really need to increase our footprint directly into the communities,” she said. “These are events sometimes happening in households, sometimes a party leading to significant spread.”

Closing bars, limiting indoor dining to less than 50% of typical capacity and wearing face masks could reduce the spread, she said, especially in areas with higher than 5% positive test rates.

“Each of us can contribute to the health of the nation by wearing masks, reducing our indoor interactions, decreasing our gatherings in indoor settings and moving a lot of our activities outside,” she said.

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International AIDS Society, “AIDS 2020 Virtual Conference, COVID-19 Conference.”

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