Microsoft System Blamed for New Jersey Vaccine-Booking Glitches

New Jersey officials are blaming Microsoft systems that were supposed to help vaccination efforts for allegedly glitching over the past five weeks, hindering the ability for a smooth vaccination rollout in the state. 

The state’s Microsoft system for running the vaccination rollout has had issues daily from booking appointments to losing registrations, state government officials told Bloomberg News

State officials blamed issues they said seem to stem from Microsoft not having enough employees staffed to deal with the issues and having employees in time zones that make them unavailable to help during business hours.

Vaccination rollout has been a major operation for states struggling to keep track of vaccinations and standardize strict guidelines for who medical facilities are allowed to vaccinate. 

Microsoft told Bloomberg that they know of some issues with the system in New Jersey, but did not comment further. 

“We are working with the state of New Jersey to deliver vaccinations as quickly, safely and efficiently as possible, and that includes addressing some technical issues,” a Microsoft spokesperson told Bloomberg.

Hospital and county websites have picked up the slack in New Jersey where the Microsoft system has failed, Bloomberg reported. More than 1.2 million vaccinations have reportedly been scheduled in the state. 

New Jersey was hit hard by the coronavirus pandemic, with more than 700,000 confirmed cases and more than 22,000 deaths from COVID-19, according to The New York Times.

Joe Biden is still aiming for 100 million people to be vaccinated within his first 100 days in office, but the process has been difficult, involving delivery delays, scheduling issues and vaccine hesitancy.

By Lexi Lonas

Tags MicrosoftJoe BidenNew Jerseycoronavirus vaccineCoronavirus

Bloomberg Quicktake: Now

Five weeks of stumbles by Microsoft Corp. on New Jersey’s Covid-19 vaccine-booking software have left the state pushing for daily fixes on almost every part of the system and doubting it will ever operate as intended, according to members of Governor Phil Murphy’s administration. The glitches — and attempted fixes that forced one megasite to go off-line temporarily — have led New Jersey to rely more on the county- and hospital-operated websites that are working well and have helped schedule more than 1.2 million doses in the most densely-populated state in the country.

Officials say those systems are successfully booking thousands of people. They fear the state’s booking portal, run on Microsoft software and functioning for just a limited number of residents, won’t withstand broad demand as eligibility eventually is opened to millions of more people. Health care has become a major focus for Microsoft, which unveiled a package of industry-specific cloud software in May. The world’s largest software company, which has hired executives with medical backgrounds, also has been researching machine learning and artificial intelligence tools for areas including clinical trials and patient care. In late January, the Redmond, Washington-based company touted its Microsoft Vaccination Management platform — usable by those seeking shots and by health providers — to register, schedule, track supplies and otherwise streamline the biggest inoculation effort in U.S. history.

The platform has yet to work correctly for New Jersey in the state’s effort to inoculate its residents against the coronavirus, according to two administration officials who asked not to be identified discussing contractual issues. Governor Murphy and State Health Commissioner Judith Persichilli acknowledged there was an issue with Microsoft in a Feb. 10 briefing, but didn’t go into detail about the problems. Since the state’s website went live Jan. 5, the software has booked thousands of appointments. But it’s also blocked users, lost registrations, double-booked residents and crashed for periods of five minutes to three days, the officials said. Though Microsoft has worked daily on the troubles, the officials said they had no confidence that they’ll get all the features called for in its contract with the company. In a statement, Microsoft acknowledged difficulties with booking shots but didn’t specify the problems. “We are working with the state of New Jersey to deliver vaccinations as quickly, safely and efficiently as possible, and that includes addressing some technical issues,” a Microsoft spokesperson said in an email.

The New Jersey officials declined to say whether the state is considering canceling the Microsoft contract, but said they are seeking solutions and workarounds of all kinds. The cost of the contract wasn’t readily available. New Jersey was among the earliest and hardest-hit U.S. states by Covid-19, recording almost 21,000 deaths with a lab-confirmed link to the disease caused by the coronavirus. Murphy, a first-term Democrat running for re-election this year, has committed to vaccinating 4.7 million people, or 70% of the state’s population, by late June. So far, New Jersey has administered nearly 1.2 million doses, representing a tenth of the population who have received at least one dose, according to the Bloomberg Vaccine Tracker. State officials said Microsoft appears to be using too few staffers, with some key personnel in overseas time zones that leave them unavailable during U.S. business hours. The officials said they’ve conferred with other states using versions of the same software, which is built on the Microsoft Dynamics customer-relationship management platform.

The task appears to be going smoother, they said, in places that asked for fewer applications — just scheduling, say, rather than more complex services. Subscribe to our YouTube channel:​ Bloomberg Quicktake brings you live global news and original shows spanning business, technology, politics and culture. Make sense of the stories changing your business and your world. To watch complete coverage on Bloomberg Quicktake 24/7, visit​, or watch on Apple TV, Roku, Samsung Smart TV, Fire TV and Android TV on the Bloomberg app. Have a story to tell? Fill out this survey for a chance to have it featured on Bloomberg Quicktake:​ Connect with us on… YouTube:​ Breaking News on YouTube:…​ Twitter:​ Facebook:​ Instagram:


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Japanese Supercomputer Shows How Coronavirus Spreads In A Dining Setting

Earlier this month, the Centers for Disease Control and Prevention (CDC) revised its guidance to say that the Covid-19 virus can “linger in the air for minutes to hours” and occur between people spaced more than six feet apart.  

This followed a CDC study last month that found that adults with Covid-19 were twice as likely to have dined out at a restaurant within two weeks prior to being infected.

A new simulation from the Fugaku supercomputer in Japan demonstrates how the seating arrangement can make a difference to how easily the coronavirus is transmitted to dining companions at the same table. Recommended For You

Japanese researchers from Kobe University and the research giant Riken tasked Fugaku, the world’s fastest supercomputer, to model how the coronavirus spreads in a typical dining situation. The simulation shows the emission and flow of aerosol particles when four people are sitting a table and speaking without masks on.

The first takeaway from the Fugaku simulation is that the seating arrangement matters. When an infected individual speaks to dining companions seated across the table, four times as many exhaled aerosol droplets reach the person seated directly across the table compared to the person seated diagonally from the speaker.

The person seated next to an infected person is the most at risk. When an infected person turns his head sideways to speak to the dining companion next to him, that individual is exposed to more than five times the amount of exhaled droplets than the individual directly across the table from the speaker.

This research also implies that diners can further reduce risk by keeping face masks on when conversing before food arrives and after they have finished eating.

“When people with Covid-19 cough, sneeze, sing, talk, or breathe they produce respiratory droplets,” explains the CDC guidance. “These droplets can range in size from larger droplets (some of which are visible) to smaller droplets. Small droplets can also form particles when they dry very quickly in the airstream.”

A second takeaway from the same Japanese research is that humidity levels can have a significant impact on how easily droplets are transmitted. The scientists found that fewer droplets are dispersed when humidity is higher, which suggests that the use of humidifiers in indoor settings may help limit infections if window ventilation is not possible.

Public health experts like Dr. Anthony Fauci, the nation’s top infectious disease expert, have expressed concern about dining in dry, heated indoor environments during the the winter months. “People will be spending more time indoors, and that’s not good for combating a respiratory-borne virus,” Fauci told MSNBC.

Toward that effort, the leaders of New York City and Chicago and other cities are creating initiatives to make outdoor dining a reality throughout the coming winter.

Fugaku is the product of a $1 billion, decade-long mission by several thousand developers from the government-run Riken Center for Computational Science and computer maker Fujitsu. Since the pandemic began, Fugaku has been creating simulations that demonstrate the ease with which the coronavirus spreads in various settings, including on trains, in work spaces and in classrooms.


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Suzanne Rowan Kelleher

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I’m always looking for new ways to travel better, smarter, deeper and cheaper, and spend a lot of time watching trends at the intersection of travel and technology. As a longtime freelance travel writer, I’ve contributed hundreds of articles to Conde Nast Traveler, CNN Travel, Travel Leisure, Afar, Reader’s Digest, TripSavvy, Parade,, Good Housekeeping, Parents, Parenting, Esquire, Newsweek, The Boston Globe and scores of other outlets. Over the years, I’ve run an authoritative family vacation-planning site; interviewed Michelin-starred chefs, ship captains, taxi drivers and dog mushers; reviewed hundreds of places to stay, from stately castles and windswept lighthouses to rustic cabins and kitschy motels; ridden the iconic Orient Express; basked in the glory of Machu Picchu; and much more. Follow me on Instagram (@suzannekelleher) and Flipboard (@SRKelleher).



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After Push From Experts, World Health Organization Says It’s Possible COVID-19 Spreads by Air


he World Health Organization (WHO) on Thursday heeded calls from more than 200 scientists, who urged the global health authority to acknowledge that COVID-19 may spread by air.

Previously, the WHO said contact with large respiratory droplets, like those expelled in a sick person’s cough or sneeze, appeared to be the primary way COVID-19 spreads. But in a highly publicized letter published earlier this week, a large group of scientists argued the WHO’s guidance neglected to adequately address another important route of transmission: inhaling tiny respiratory particles generated by a sick person, which can remain suspended in the air indoors for hours.

In a scientific brief published Thursday, the WHO allowed that “short-range aerosol transmission, particularly in specific indoor locations, such as crowded and inadequately ventilated spaces over a prolonged period of time with infected persons cannot be ruled out.” Still, it maintained that further studies on airborne transmission are needed, and said the evidence is strongest for respiratory droplet transmission.

The WHO hinted at its evolving opinion during a press briefing on Tuesday, when Maria Van Kerkhove, the agency’s technical lead for COVID-19, said its scientists had been “talking about the possibility of airborne transmission and aerosol transmission.” Many of the scientists who signed the letter on airborne transmission celebrated her comments.

“Nice work, team Indoor Air,” signatory Joseph Allen, an indoor air expert and assistant professor at the Harvard T.H. Chan School of Public Health, tweeted on Tuesday.

In addition to making peace with the scientific community, the WHO’s recognition could change public-health officials’ disease-prevention advice, especially as more indoor spaces reopen to the public. That could mean new standards for indoor ventilation, for example, or mandates for wearing face masks inside stores, restaurants and other public facilities.

The WHO’s new scientific brief also addressed another COVID-19 controversy: the role asymptomatic people play in spreading the virus.

Van Kerkhove sparked a flurry of confusion last month, when she said it was “very rare” that people without symptoms of coronavirus infect others—a statement seemingly contrary to months of public-health messaging. Van Kerkhove later qualified her comments, emphasizing that asymptomatic spread is possible but happens with unknown frequency.

The WHO’s new brief echoes her comments. “While someone who never develops symptoms can also pass the virus to others,” it says, “it is still not clear to what extent this occurs and more research is needed in this area.”

By:  Jamie Ducharme



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This Startup Might Finally Cure Sickle Cell Disease After A Century Of Racist Neglect


The painful blood disorder, which mostly affects Black people, is just one of thousands of rare diseases that could be cured by Beam Therapeutics’ revolutionary gene editing technology.

Beam Therapeutics CEO John Evans loves rocket launches—and not just the ones that succeed. He makes his team watch all the SpaceX failures, too, when the unmanned rockets explode. “For the first many years, all the rockets crash and there’s a lot of failure along the way, and then suddenly, they start working,” he says.

Gene editing, Evans believes, is on a similar trajectory, poised for a series of successful launches in the years ahead. “The stuff we can do now in genome editing would have seemed like magic five or ten years ago,” he says, as technological advancements suddenly have biotechs competing to cure rare genetic diseases long out of reach.

The first generation of gene editing was Crispr, a technology developed in 2012 that can target and cut sections of DNA like a pair of scissors. Now Cambridge, Massachusetts-based Beam is pioneering Crispr 2.0. Its advancement, known as base editing, works more like a pencil, which can target a single misspelling in the DNA code allowing for much greater precision, says Evans, who is 43. Beam’s technology, which has yet to be tested in humans, could theoretically cure thousands of the genetic diseases caused by single letter misspellings, known as point mutations. Topping the company’s targets is sickle cell disease—a point mutation that predominantly affects Black people and has been neglected through more than a century of racist attitudes.

Beam, which was founded in 2017, went public in February and now has a market cap of $1.5 billion despite having no revenues and losing $95 million over the past year. What the company does have is 12 research programs for 10 different rare diseases, including beta thalassemia, another inherited blood disorder, and two types of blood cancer. None of the treatments have been cleared for clinical trials, but the company hopes to file a slew of applications in 2021.

Sickle cell disease is the most promising opportunity. It’s the most common inherited blood disorder in the United States, affecting about 100,000 people. The disease produces abnormal hemoglobin, the molecule that helps red blood cells carry oxygen throughout the body. While normal red blood cells are shaped like doughnuts, sickle cells look like pointy crescent moons (thus the name), which clog up blood vessels and cut off oxygen supply to the bones and organs, causing “excruciating pain,” explains Dr. Robert Liem, director of the comprehensive sickle cell program at the Lurie Children’s Hospital of Chicago.

With one out of every 365 Black babies born with sickle cell, the disease has an ugly racial history. By the mid-1900s, the presence of sickle-shaped cells in the blood viewed under a microscope were a “marker for race,” says Shawn Bediako, professor of psychology at the University of Maryland Baltimore County, who focuses on stigma in healthcare. “When people who were not Black had sickle cell disease then the societal assumption was that then that person wasn’t completely white,” even though the disease is found in people of many other ethnicities. In the 1960s, the Black Panther Party began to champion the right to health and implemented a national sickle cell screening program in the wake of government inaction.

But racist attitudes and a lack of federal funding still persist today. Sickle cell patients, who can end up in hospital emergency departments with serious pain, waited, on average, 25% longer than general patients and 50% longer than patients with bone fractures to be seen, according to a study in the American Journal of Emergency Medicine. Sickle cell received an average of $812 in federal research funding per person over the last decade, while cystic fibrosis, a lung disease that predominantly affects white people, received more than $2,800 per person, even though sickle affects three times as many people, according to a paper in JAMA Network Open. “If we really have to have this debate about whether or not Black life matters, I think we need look no further than sickle cell and how it’s been treated as a medical condition to indicate that it really doesn’t,” says Bediako.

Sickle cell was the first “molecular disease” discovered, revealing how a change in one single amino acid could disrupt blood and oxygen supply to the entire body. The first drug to treat sickle cell, hydroxyurea, wasn’t approved until 1998, even though the disease has been known in the medical literature since 1910, with three more drugs coming to market since 2017. The only cure is a bone marrow transplant, which is limited to a small percentage of patients who have a matching sibling donor. But Beam is hoping to change that with its potentially curative base editing technology. “We’re going to go in and land our editor right on the mutation that causes sickle cell and change it to something that’s normal,” Evans says.

Base editing was pioneered in 2016 in the lab of David Liu, a core faculty member at the Broad Institute and a professor at Harvard University, along with postdoctoral fellows Alexis Komor, now an assistant professor at the University of California San Diego, and Nicole Gaudelli, the head of gene editing technologies at Beam. Liu cofounded Beam in 2017 along with Feng Zhang, a professor at the McGovern Institute at the Massachusetts Institute of Technology and core faculty member at the Broad Institute, and Dr. J. Keith Joung, endowed chair in pathology at Massachusetts General Hospital and professor at Harvard Medical School. This is the second of three gene editing companies the scientific power trio has founded since 2013, along with Cambridge-based Editas Medicine, which is developing Crispr-based therapeutics, and Durham, North Carolina-based Pairwise Plants, which is using both Crispr and base editing to develop more nutritious crops. In 2019, Liu founded Prime Medicine, a third generation “search and replace” genome editing technology, which he likens to a word processor.

“I certainly, in my wildest dreams, never imagined this kind of precise capability to edit the genome,” says Dr. Francis Collins of the National Institutes of Health.

Liu calls the human genome the “most important gift your parents ever gave you.” It’s made up of 6 billion combinations of four letters known as bases: A, T, G, and C. A person with sickle cell disease has one base pair misspelling at a crucial location in their adult hemoglobin gene: a ‘T-A’ where there should be an ‘A-T’. That typo, which appears twice among the 6 billion letters, is the difference between normal hemoglobin and the abnormal hemoglobin that causes the rigid crescent-shaped cells.

Beam is the first company to try to directly fix the base pair misspelling, though they can’t yet switch a T to an A. Instead, Beam switches the T to a C and the A to a G. While it appears odd to swap one typo for another, the new typo mimics a natural phenomenon, known as the Makassar variant, which results in functional red blood cells instead of the sickle shape.

Beam is also trying another approach to curing the disease: Introducing a second mutation in a different location to override the production of sickle hemoglobin. It mimics a naturally occurring phenomenon in which a person has two sets of sickle hemoglobin genes, but doesn’t show signs of the disease. The reason? A different mutation in the fetal hemoglobin gene, which usually turns off in favor of adult hemoglobin as people age, but remains turned on and producing normal hemoglobin. “They won the genetic lottery after losing it twice,” says Liu. Both programs showed promising results in mice.

Liu, 47, prefers to focus on his academic and research pursuits, rather than commercialization of the technologies, as do his cofounders Zhang and Joung. The trio like to hire well-credentialed executives to run their companies, like Evans, who has a track record of successfully bringing precision medicines from the lab to the market.

In 2009, Evans, who earned an MBA from Wharton and a Masters in biotechnology from the University of Pennsylvania, was an early employee at Agios Pharmaceuticals, then a tiny biotech with a pre-clinical target related to cancer metabolism. The following year he helped broker a unique alliance between Cambridge-based Agios and big biopharma Celgene, ultimately leading to two FDA approvals for treatments for acute myeloid leukemia in the span of ten years, which sounds like a long time, but is much faster than the usual drug development timeline.

“Celgene, gave us $130 million dollars upfront to explore this area of biology and Agios was able to preserve commercial right, and many other important features, so it was a very creative deal,” says David Schenkein, the former CEO of Agios and a general partner at Mountain View, California-based venture firm GV (formerly known as Google Ventures), which invested in Beam.

After eight years at Agios, Evans left to become a venture partner at Arch Venture Partners, an early investor in Beam. In late 2016, he met Liu in his office in Cambridge to discuss the company, which was in stealth mode at the time. “I couldn’t sleep that night, I was so excited about it,” Evans recalls.

Since base editing is a platform, rather than a single drug, once the technology works in one disease, it will likely work in others. “That ease of retargeting is going to mean that as we get it up and running, we can very quickly go through and treat a whole bunch of diseases and create a kind of sustainable flow of new medicines,” says Evans. He started in an interim CEO role at Beam and officially took the top job in January 2018.

Beam can’t attack every disease so Evans has pursued strategic partnerships and licensing agreements with other gene editing companies, including Editas, Prime and another Cambridge-based biotech called Verve, which is using base editing to develop heart disease therapies. Joung is a Verve cofounder, and Evans serves on the boards of Prime and Verve. “It’s kind of a divide and conquer approach, where we’re reducing redundancy and now I think more diseases, more patients are potentially going to benefit from the technology than otherwise,” Evans says.

Of course, it’s impossible to predict whether Beam’s technological edge with base editing will ultimately prevail over earlier Crispr technologies that have the first-mover advantage, says David Nierengarten, a biotechnology analyst at Wedbush Securities. But what sets Beam apart so far based on their work in mice is “more efficient” gene editing, meaning that “higher numbers of modified cells” will get into patients, says Nierengarten.

Small Targets

Beam is researching a number of other rare diseases it hopes to treat, or even cure, with its precision gene editing technology. Here are the seven it has disclosed.

Sickle Cell Disease

Estimated U.S. Patients: 100,000

Inherited blood disorder causes severe pain.

Beta Thalassemia

Estimated U.S. Patients: 1,000-2,000

Inherited blood disorder causes severe anemia.

T-Cell Acute Lymphoblastic Leukemia

Estimated U.S. Patients: 500-1,000 per year

Fast-growing blood cancer.

Acute Myeloid Leukemia

Estimated U.S. Patients: 20,000 per year

Fast-growing blood cancer.

Alpha-1 Antitrypsin Deficiency

Estimated U.S. Patients: 60,000

Inherited disorder causes lung and liver disease.

Glycogen Storage Disoder 1a

Estimated U.S. Patients: 1,400

Inherited disorder where body can’t store sugar.

Stargardt Disease

Estimated U.S. Patients: 5,500

Inherited eye disorder causes progressive vision loss.

Beam has one key advantage: with its technology, the DNA double helix doesn’t need to be cut, like with first generation Crispr technologies. This means greater precision with less risk of random insertions and deletions of code.

Beam’s true test will come next year, when the company plans to apply for authorization from the U.S. Food and Drug Administration to begin clinical trials in humans. Even in these early stages, Dr. Francis Collins, director of the National Institutes of Health, the $41.7 billion (2020 budget) federal research agency, says he’s “really excited” about the potential of base editing to take on the 7,000 rare diseases caused by DNA misspellings.

“By delivering this kind of base editor to the right tissue at the right time, you can imagine many of these [rare diseases] becoming treatable, maybe even curable,” says Collins, who is working with Liu on an NIH-funded research project using base editing (currently in mice) to correct the point mutation for progeria, a disease that causes children to rapidly age and die by the time they are teenagers. “I certainly, in my wildest dreams, never imagined this kind of precise capability to edit the genome, where you could go and find one letter out of 3 billion that needed to be fixed, and provide the apparatus to do that with relatively little risk of causing trouble elsewhere,” Collins says reflecting on his career and the rapid progress in gene editing over the past few years.

But one of the big technical challenges ahead for many diseases will be refining the delivery methods of successfully getting base editors into the patient’s body. While the sickle cell therapy can be done outside the body and inserted, for other diseases, like progeria, the base editor will have to be directly inserted into the patient, and there are several methods being developed. “You have to come up with a delivery system that is going to take that base editing apparatus and efficiently and safely get it to the cells where it needs to do its magic,” says Collins. “And that’s a big challenge.”

The other hurdle on the horizon will be affordability. Existing gene therapies tend to be outrageously expensive. Novartis, for instance, made headlines in 2019 for charging $2.1 million for Zolgensma, a breakthrough cure for spinal muscular atrophy. The majority of adult sickle cell patients don’t even have access to hydroxyurea, which is the cheapest generic treatment on the market. “We just have a long way to go before we can realistically say that a substantial number of patients might benefit from these therapies,” says Dr. Liem, who chaired the American Society of Hematology clinical practice guidelines on sickle cell disease. While gene therapies are exciting, “the vast majority of patients out there still need basic care,” says Liem.

But Evans hopes Beam can fundamentally change the rules of engagement. “We’re going to have profound impacts for patients’ lives in the very near future,” he says, since patients who participate in phase one could potentially leave the trial cured of sickle cell. “That’s the amazing thing about these one-time therapies.”

This post was updated at 11:30 am ET July 10 to incorporate two additional co-inventors of base editing.

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I am a staff writer at Forbes covering health care. I was previously a health care reporter for POLITICO covering the European Union from Brussels and the New Jersey Statehouse from Trenton. I am a Knight-Bagehot Fellow in business and economics reporting at Columbia University. Email me at or find me on Twitter @katiedjennings.


Nearly Half of Coronavirus Spread May Be Traced to People Without Any Symptoms


One of the more insidious features of the new coronavirus behind COVID-19 is its ability to settle into unsuspecting hosts who never show signs of being sick but are able to spread the virus to others.

In a study published June 3 in the Annals of Internal Medicine, researchers at the Scripps Research Translational Institute reviewed data from 16 different groups of COVID-19 patients from around the world to get a better idea of how many cases of coronavirus can likely be traced to people who spread the virus without ever knowing they were infected. Their conclusion: at minimum, 30%, and more likely 40% to 45%.

Such so-called asymptomatic spread is unique for a respiratory virus; most cause symptoms and disease once they infect their hosts. SARS-CoV-2, the virus responsible for COVID-19, is, however, particularly wily because it can also infect hosts silently and use them as unwitting pawns in its infectious campaign. “The range we found is extraordinarily high,” says Dr. Eric Topol, director and founder of the Institute and one of the authors of the paper. “That means the range of what can happen with SARS-CoV-2 is from no symptoms to [death]. That’s not at all similar to any virus or pathogen we’ve experienced that has killing potential in the past. What we have here is an extraordinary spectrum, including this quiet, stealth mode of infecting somebody.”

Topol and his co-author, Daniel Oran, searched for published and unpublished studies that included asymptomatic people and focused on 16 different groups of people screened or tested for COVID-19 around the world. Among others, these included a cohort of more than 13,000 people in Iceland who volunteered to be tested for COVID-19 (the largest group included), as well as residents of Vo, Italy; passengers on the Diamond Princess cruise ship where an outbreak occurred; visitors to homeless shelters in Boston and Los Angeles; prison inmates; college students; and nursing home residents in King County, WA.

Five of these studies included follow up testing of the participants; they showed that only a small fraction of people who were asymptomatic when they tested positive the first time then went on to develop symptoms. That allowed the researchers to distinguish between people who are pre-symptomatic—those who test positive but eventually go on to develop symptoms—and those who are truly asymptomatic, and test positive for COVID-19 but never develop obvious symptoms. Among the more than 2300 people sampled in the Vo population, none of the 41% who had no symptoms when they tested positive ever developed symptoms over a 14 day period.

That wouldn’t be worrisome if it weren’t for other research beginning to show that levels of virus in people who are asymptomatic are similar to those among people who develop symptoms. That suggests that while they may not be outwardly showing any signs of illness, asymptomatic people are still carrying a potentially dangerous burden of infectious virus that they can spread to others.

Another concern, says Topol, is that the virus may be damaging the bodies of asymptomatic in other, silent ways. Among the 331 passengers on the Diamond Princess cruise ship who tested positive but did not have symptoms, 76 people had CT scans of their lungs and nearly half showed signs of lung tissue damage typical of coronavirus infection. “People who are getting infection without symptoms are actually doing a lot of damage to their bodies and they don’t know it,” says Topol. Another small study in South Korea that studied 10 asymptomatic people from a group of 139 COVID-19 patients supports these findings.

Putting all of the data together, he says, supports “basically the reason why we have to all wear masks—because nobody knows who is an asymptomatic carrier. The person doesn’t know it and the person’s contacts don’t know it. That has enormous implications and it’s an area we need to study more, on how to test people without symptoms on a very large scale to understand these people better and follow them to determine precisely their ability to transmit [the virus].”

Given that public health officials aren’t testing the entire population, there are still huge gaps in understanding what asymptomatic disease, he says. Are people infected but not showing symptoms because their immune systems are better at controlling the virus, or because the virus they harbor is somehow less potent? Or are these people asymptomatic because they have immunity to other, more prevalent coronaviruses that are responsible for the common cold and therefore already might already have a level of protection against SARS-CoV-2 as well?


Another question that the data raise involves how long asymptomatic people are infectious. In Topol’s analysis, the cases from U.S. aircraft carrier U.S.S. Theodore Roosevelt suggests that they may be able to spread the virus for longer than the presumed 14 days, which would have wide-ranging implications for public health policies focused on reopening cities and states safely—and further support the need for wearing masks in public settings.

While widespread testing of populations would be a way to capture more of these asymptomatic cases, and help public health officials to educate these people about the need for social distancing and other measures to prevent the spread of the virus, Topol says there’s a need for other options as well. He and his team are studying changes in heart rate that could be captured on smartwatch apps and fitness bands and might signal possible infection. Such changes may not be useful on an individual level, since heart rate changes can be attributable to a number of different factors including stress and heart disease. However, if, for example, resting heart rate levels for a specific community rise and remain high for a period of time, that could indicate a possible COVID-19 cluster and flag individuals and their doctors to increase testing and follow up care in the community.

“If even a portion of the 100 million Americans who have a smartwatch or fitness band are involved, then we could go in and do studies for information we are missing now—antigen testing, antibody testing and we can look for transmissibility,” says Topol. “The priorities during a pandemic are absolutely to look after the sick. But we also shouldn’t miss how important this area of asymptomatic spread is to understand. For every one person who is sick, there are a whole lot of people who have the virus and don’t know it.”

By Alice Park


The World Health Organization is walking back a comment suggesting that the spread of COVID-19 from an asymptomatic person is rare. Dr. Ashish K. Jha, director of the Harvard Global Health Institute, joins CBSN to discuss when patients are the most contagious, and a new Harvard Medical School study which suggests the coronavirus may have been in China as early as August.

13.9% Of New Yorkers Test Positive For Coronavirus Antibodies—Still Not Enough To Foster Herd Immunity

13.9% of people surveyed in New York tested positive for COVID-19 antibodies—a whopping 10 times higher than the state’s presumed infection rate, but still far from what would be considered herd immunity from the pandemic.


Herd immunity happens when over 60% of the population develops immunity—antibodies—to a disease, a phenomenon that usually occurs when a population is vaccinated against a virus.

In the new study cited by New York Governor Andrew Cuomo on 3,000 people across the state, 13.9% exhibited COVID-19 antibodies (21% in New York City), implying that 2.7 million people across the state had been exposed to COVID-19, according to Bloomberg, 10-times higher than the presumed infection rate.

Dr. Nate Favini, medical lead at preventative health clinic Forward, told Forbes he’s skeptical about the antibody tests, and cautions against opening up the country to reach herd immunity, saying that would require infecting four-times the amount of people who’ve had the virus—all over the country—leading to a much higher number of deaths by possibly overwhelming hospital resources.

It is unclear whether, and for how long, those with COVID-19 antibodies are immune to second-time infection, as the CDC says survivor immunity is “not yet understood.”

Further, the validity of antibody tests have been widely criticized, as many on the market are not approved by the FDA.

Favini also thinks that more information about how the study was conducted is needed to accept and understand these numbers.

Critical quote

“For people who want to argue that we should just open up the county and let everyone get coronavirus so we can get to herd immunity: You’d have to go through all the cases and all the deaths that New York has experienced—you’d have to go through four-times that, all around the country,” said Favini.

Key background

It may be that COVID-19 is much more common than we initially thought, though this is contested. On Thursday, a new model out of Northeastern University, as reported by New York Times, shows that cities with major COVID-19 outbreaks could’ve had 28,000 cases on March 1, which is contrary to the popular model that showed only 23 cases by this time in the major cities. As of April 22, it also appears that the first COVID-19 death was in California on February 6, rather than February 29 in Washington.

Further reading

Autopsies Now Say California⁠—Not Washington State⁠—Has First Known U.S. Coronavirus Deaths (Forbes)

Coronavirus Model Used By White House Predicts 10% Increase In Death Toll (Forbes)

Hidden Outbreaks Spread Through U.S. Cities Far Earlier Than Americans Knew, Estimates Say (New York Times)

1 in 5 New Yorkers May Have Had Covid-19, Antibody Tests Suggest (New York Times)

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Source: 13.9% Of New Yorkers Test Positive For Coronavirus Antibodies—Still Not Enough To Foster Herd Immunity

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The infection rate of the coronavirus in New York is slowing, but the state could soon see the full scope of the virus as it begins antibody testing this week. Gov. Andrew Cuomo says antibody testing will help provide the “first true snapshot” of how much of a hold COVID-19 has on the state. On Sunday, the governor toured a testing lab on Long Island, using it as a launching pad for the state’s newest drive toward understanding and defeating the coronavirus. “We’re going to sample people in this state… to find out if they have the [antibodies] that will help us for the first time, what percentage of the population actually has had the coronavirus, and is now at least short term immune to the virus,” the governor said.

Autopsies Now Say California⁠—Not Washington State⁠—Has First Known U.S. Coronavirus Deaths

The medical examiner in Santa Clara, California, confirmed Tuesday that two COVID-19 deaths happened there in early February, becoming the country’s first known coronavirus fatalities⁠—and possibly providing clues about how early the virus was spreading in the U.S.


The Los Angeles Times reported that two people in Santa Clara County infected with coronavirus died ⁠on February 6 and February 17⁠; an additional COVID-19 death was confirmed March 6.

Tissue samples were used to determine the Santa Clara County deaths were from coronavirus, and were confirmed by the Centers for Disease Control, the New York Times reported.

Prior to Tuesday, the first report of a U.S. COVID-19 fatality was on February 29 in Kirkland, Washington, and officials later determined two people who died in the area February 26 also had the virus.

The two California residents who died in February did not have travel histories that would have exposed them to COVID-19, according to the New York Times.

The newly confirmed deaths suggest COVID-19 was spreading earlier than was previously believed—likely “back in December,” Santa Clara County executive and medical doctor Jeffrey V. Smith told the Los Angeles Times.

“This wasn’t recognized because we were having a severe flu season,” Smith said, adding, “Symptoms are very much like the flu. If you got a mild case of COVID, you didn’t really notice. You didn’t even go to the doctor.”

Crucial quote

“These three individuals died at home during a time when very limited testing was available only through the [CDC]. Testing criteria set by the CDC at the time restricted testing to only individuals with a known travel history and who sought medical care for specific symptoms,” said the Santa Clara County medical examiner in a statement. “As the Medical Examiner-Coroner continues to carefully investigate deaths throughout the county, we anticipate additional deaths from COVID-19 will be identified.”

What we don’t know

Why it took months to confirm the Santa Clara County deaths were caused by COVID-19, the New York Times reported.

Key background

Gene sequencing conducted in Washington State showed that the coronavirus might have been spreading there for weeks, with January 20 being the date for the state’s first confirmed case, according to a March 1, 2020, New York Times report. U.S. officials determined cases in travelers from abroad that same month, but did not confirm community spread of COVID-19 for weeks. Other possible indications that the virus was spreading earlier than was believed include the Grand Princess cruise ship that set sail from San Francisco, California on February 11, with passengers that later displayed symptoms. Researchers also believe that the virus was spreading in New York by the middle of February.

Further reading

Autopsies reveal first confirmed U.S. coronavirus deaths occurred in Bay Area in February (Los Angeles Times)

Coronavirus Death in California Came Weeks Before First Known U.S. Death (New York Times)

Most New York Coronavirus Cases Came From Europe, Genomes Show (New York Times)

4 More Die From Coronavirus In Washington State, Bringing U.S. Toll To 6 (Forbes)

Another Cruise Ship Is Possibly Linked To Coronavirus⁠—Including California’s First Death (Forbes)

Forbes’ Time Line Of The Coronavirus (Forbes)

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Source: Autopsies Now Say California⁠—Not Washington State⁠—Has First Known U.S. Coronavirus Deaths

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‘One World: Together At Home’ Concert: Stars Support COVID-19 Coronavirus Efforts

Lady Gaga performs during “One World: Together At Home” global broadcast and digital special held … [+]

Getty Images for Global Citizen

This concert didn’t have the onstage dancers, the multi-barrel confetti cannons, or the fancy sets, unless, of course, you count the beer, candle, and enormous book next to the Rolling Stones’ Keith Richards. But that didn’t keep the “One World: Together At Home” concert that was broadcast and live-streamed on Saturday from being memorable. What made this concert striking wasn’t just the star-studded line-up. It was also the stated purpose: to honor front-line healthcare workers and support the World Health Organization (WHO) during this COVID-19 coronavirus pandemic.

The event was a collaboration between the WHO and Global Citizen, an international advocacy organization. The roll call for the concert read like a response to a request to “name as many musicians as you can in 30 seconds.” Lang Lang, Rita Ora, Black Coffee, Common, Ellie Goulding, Jacky Cheung, Usher, Taylor Swift, Paul McCartney, the Rolling Stones, John Legend, Stevie Wonder, Jennifer Lopez, Billie Ellish, and Celine Dion were just some of the musicians who performed. Lady Gaga curated the event and also performed during the six hour telecast.

The concert included some new collaborations such as the finale with Celine Dion, Lasy Gaga, Lang Lang, Andrea Bocelli and John Legend performing “The Prayer.”

With social distancing measures in place, the musicians of course didn’t gather in a stadium or concert hall but instead performed separately in various locations. Many of the performances were stripped down, without the typical concert technology, special effects, and camera work, which was in many ways refreshing. It was less embellished production and more Zoom meeting-esque, except that it was probably more entertaining than your typical work meeting and everyone appeared to be wearing pants.

The performances were interspersed with scenes from the front lines, anecdotes from front line healthcare professionals like Esther Choo, MD, Dara Kass, MD, Lane Rolling, MD, Lakshman Swamy, MD, and Shuhan He, MD, and thank you statements from folks like Bill and Melinda Gates, Samuel Jackson, Oprah Winfrey, Heidi Klum, and Matthew McConaughey. All right, all right, all right. And a trio of late night TV hosts, Jimmy Fallon, Jimmy Kimmel and Stephen Colbert, hosted the event. This gave you chance to see that Fallon has what appears to be a faux tree and a large egg-shaped chair in what looked like his den.

Besides honoring health care workers, another purpose of the event was to encourage people to stay at home, hence the name “Together At Home.” On the list of fun things to do, social distancing can fall below “trying to suck in your eyebrows with a vacuum cleaner.” It isn’t easy to disrupt your life by staying at home but, as I have described previously for Forbes, doing so can reduce transmission of the SARS-CoV2, flatten the curve, and, in turn, keep already overworked healthcare workers from being completely overwhelmed.

An additional goal of the concert was to raise awareness and money for the WHO COVID-19 Solidarity Response Fund. Bloomberg Philanthropies helped support the One World: Together At Home initiative, including committing $8 million to this Fund. This support is part of the Bloomberg Philanthropies COVID-19 Response Initiatives that was started last month to assist with the global response to this nasty, nasty virus. The broadcast included a pre-taped video from Mike Bloomberg, founder of Bloomberg Philanthropies and three-term mayor of New York City.

Other partners for the One World: Together At Home initiative include Analog Devices, Cisco, Citi, Coca-Cola, GSK, IBM, Johnson & Johnson, Proctor and Gamble, Pepsi, State Farm, Target, Teneo, Verizon, Vodafone, Verizon, and WW International.

The WHO started the COVID-19 Solidarity Response Fund WHO in an attempt to raiseat least $675 million to support its Strategic Preparedness and Response Plan for the COVID-19 coronavirus pandemic through April 2020. As described by the WHO on its website, this plan includes:

  • “Putting in place activities to Track and understand the spread of the virus”
  • “Ensuring patients get the care they need.”
  • “Buying and ship essential supplies such as masks, gloves and protective wear for frontline workers.”
  • “Producing evidence based guidelines and advice, and make sure health workers and responders get the information and training to detect and treat affected patients.”
  • “Producing guidance for the general public and for particular groups on measures to take to prevent the spread and prevent themselves and others.”
  • “Accelerating efforts to develop vaccines, tests and treatments.”

Reasonable things to do, right? Well, all of this requires money to do, and the WHO hasn’t exactly been flush with funding. And some people actually think it’s a good idea to threaten or even pull funding to the WHO in the middle of a pandemic.

It’s not every day that you see so many top musicians come together to honor health care professionals. But 2020 has not been your typical year, except perhaps for those who normally sit at home in teepees of toilet paper. Doctors, nurses, and various health care workers around the world routinely make many sacrifices and take risks to care for patients. This year the sacrifices and risks are even higher for many, especially with horrendous shortages of needed personal protective equipment (PPE) such as masks and the need to stay separate from family and friends. So it can make a difference to know that people are listening.

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I am a writer, journalist, professor, systems modeler, computational and digital health expert, avocado-eater, and entrepreneur, not always in that order. Currently, I am a Professor of Health Policy and Management at the City University of New York (CUNY) School of Public Health, Executive Director of PHICOR (@PHICORteam), Professor By Courtesy at the Johns Hopkins Carey Business School, and founder and CEO of Symsilico. My previous positions include serving as Executive Director of the Global Obesity Prevention Center (GOPC) at Johns Hopkins University, Associate Professor of International Health at the Johns Hopkins Bloomberg School of Public Health, Associate Professor of Medicine and Biomedical Informatics at the University of Pittsburgh, and Senior Manager at Quintiles Transnational, working in biotechnology equity research at Montgomery Securities, and co-founding a biotechnology/bioinformatics company. My work has included developing computational approaches, models, and tools to help health and healthcare decision makers in all continents (except for Antarctica) and has been supported by a wide variety of sponsors such as the Bill and Melinda Gates Foundation, the NIH, AHRQ, CDC, UNICEF, USAID and the Global Fund. I have authored over 200 scientific publications and three books. Follow me on Twitter (@bruce_y_lee) but don’t ask me if I know martial arts.

Source: ‘One World: Together At Home’ Concert: Stars Support COVID-19 Coronavirus Efforts

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The Rolling Stones perform “You Can’t Always Get What You Want” during One World: Together At Home on April 18. 
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How Do You Tell Others to Observe Social Distancing Rules?

New Yorkers heed advice to wear masks to help control the spread of the coronavirus as they sit in Central Park in New York City on April 11, 2020.

Deciding when to comment on someone’s behavior in society’s shared spaces has always been complicated. If someone doesn’t pick up after their dog, do you point it out? If someone cuts you off on the highway, do you yell out your window? What about that smoker on the corner—do you tell them cigarettes are bad for you? What if the smoker is a pregnant woman?

The line between righteous and self-righteous is hard to discern in the best of times, and now there’s a pandemic. New rules about physical distancing and personal hygiene mean new questions about what to do when someone isn’t following them. Nowadays, if someone stands too close to you at the grocery store or coughs into the air on the bus or is walking around without a mask, do you say something? If a non-essential business is continuing to fill its shop with customers, do you call it out?

TIME asked several experts in medical ethics and health policy. The upshot: yes, it can make sense to respond when people aren’t following orders that have been put in place to protect oneself and others. But the way you do it really matters, for the sake of decency and results.

“At least for now, we don’t have treatment or vaccines. All we’ve got is behavior. And there is evidence that the behavior works, if we’re diligent about it,” says Arthur Caplan, director of the Division of Medical Ethics at New York University’s Grossman School of Medicine. “We shouldn’t be obnoxious, we shouldn’t get nasty,” Caplan says. “But in this day and age, I think you can speak up.” It could, directly or indirectly, save lives.

When it comes to changing people’s minds or behavior, shame and blame generally don’t work as well as empathy and the benefit of the doubt. And a pandemic is a time when extenuating circumstances are widespread. “Everyone is stressed out and fearful for their own health,” says Northeastern University law professor Aziza Ahmed, an expert in health law. “We have to be sensitive to what other people have the capacity to do.”

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Studies on disaster preparedness have found that one of the best ways to get other people to adopt new habits is to model them. “The literature shows that people will change their behavior if there are three conditions in place: they know what to do, why to do it and they see other people like themselves also doing it,” says Monica Schoch-Spana, a medical anthropologist and senior scholar at the Johns Hopkins Center for Health Security. A crucial part of this, she says, is that authority figures, from political leaders to pastors, are all repeating the same message, to the point that people are “swimming in a sea” of it.

Those waters are murky in the United States, where the response to the pandemic has been politically polarized and messages have been mixed. In Los Angeles, Mayor Eric Garcetti ordered residents to wear masks when visiting essential businesses that remain open; on Twitter, he posted a new profile picture in which he’s wearing one. Meanwhile, in Washington, D.C., President Donald Trump has said he won’t be wearing a mask because the Centers for Disease Control and Prevention have recommended it, not ordered it, and “I just don’t want to.”

The absence of clarity and consistency from leaders gives individuals more reason to spread the message about best practices themselves (including, yes, wearing a mask). It also gives them more reason to reserve judgment when they do it. “You’re trying to frame it in a way that will motivate people’s behavior, where it’s not like you’re calling them stupid or accusing them of indifference,” Caplan says. “What you’re trying to do is appeal with carrots, not sticks.”

The changing guidance around masks helps illustrate why unwillful ignorance is possible. The CDC at first recommended that only sick people and those caring for them wear masks. Then, as it became more clear that people could spread the disease without appearing sick—making their coughs and sneezes just as dangerous—the CDC recommended everyone wear them. That “why to do it” message goes against our general understanding of what masks are for, and public health experts have had trouble getting it across. “You’re not wearing the mask to protect you, you’re wearing the mask to protect others,” says Stuart Finder, director of the Center of Healthcare Ethics at Cedars-Sinai Medical Center. “And there are a lot of people who still don’t understand that.”

Even if people have read the latest guidelines, there could be personal reasons they’re not abiding by them. “You can’t assume you know what is inhibiting someone from engaging in the correct behavior,” Schoch-Spana says. Some black Americans, for example, have reported that concerns about being associated with gangs or perceived as criminals have made them reluctant to wear face coverings. A homeless person has an understandable reason for not being home by curfew. Someone could be failing to stay six feet away from you on the sidewalk because they are blind. You might also encounter a person who doesn’t believe in science and dismisses the risks.

Among the tactics experts suggest for handling these situations is the “it’s not you, it’s me” approach: If you’re at the grocery store and someone is standing right behind you, don’t yell, “Move back!” Instead, emphasize that since you or anyone could have the virus without knowing it, it’s best to stay six feet apart, in case they hadn’t heard. Use cues where you can, like the tape many open businesses have started putting on the floor to show customers how to line up at a proper distance.

If you live in a place like Michigan or Laredo, Texas, where the government is issuing $1,000 fines for violations of social distancing rules, position your reminder as an attempt to protect their wallet. If you live in a state like Hawaii, where at least three people have been arrested for flouting quarantine orders, position it as an attempt to protect their liberty. In general, says Finder, “you want to find ways that reinforce that ‘we’re in this together,’ versus ‘You’re not doing what I want you to do.’”

In rare cases, people have gotten violent during such encounters. At an emergency room in New York City, an 86-year-old woman reportedly lost her balance and grabbed the IV pole of another patient, a 32-year-old woman, thereby violating the social distancing rule to stay six feet away from others. The younger woman allegedly pushed her, causing her to fall, sustain a head injury and die.

Not following the guidelines is dangerous. Not coughing into one’s sleeve can endanger someone else’s life. But, Finder says, “If I respond with a kind of violent or authoritative approach, there is actually danger there too.”

However tactfully one approaches the situation, these kinds of interactions carry risks of escalation. In New Jersey, a grocery store worker asked a customer who was standing near her to move back. Instead, he allegedly stepped closer and coughed toward her, laughing and saying he had the coronavirus. The man is now among the many people that the New Jersey attorney general has issued charges against, as people continue to violate executive orders relating to COVID-19.

There is a difference between being a good neighbor and being a vigilante who takes it upon themselves to inform every person they can, on the street or on Instagram, about what they should and should not be doing. As Caplan puts it, “You don’t have to be the town watchman. We don’t need public health crossing guards.” There are law enforcement officials for that.

Schoch-Spana, of Johns Hopkins, says it is reasonable to handle the situation yourself when there is an invasion of your personal space. “It makes sense to say something when someone is encroaching on your health and well-being,” she says. “You have every right to try and correct that behavior, but it should be done politely and with knowledge-sharing and with positive modeling.”

By Katy Steinmetz April 13, 2020

Source: How Do You Tell Others to Observe Social Distancing Rules?

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How To Stop Face Masks From Fogging Up Your Glasses

As areas of the country make plans to reopen, wearing a face mask could become the new normal. The Centers for Disease Control recommended last week that all Americans wear a cloth face mask in public. And other states and cities have gone further. New York, New Jersey, Maryland and Los Angeles County all require residents to wear masks in public spaces and inside businesses.

But following local and CDC guidelines is nearly impossible when you also wear glasses, which can fog up and prevent you from seeing the very moment you walk outside. According to an 2011 article published in the Annals of The Royal College of Surgeons of England, wearing a mask directs your warm exhaled air upwards, which then condenses on the cooler surface of the lens, forming “tiny droplets that scatter the light and reduce the ability of the lens to transmit contrast.”

Here are some ways you can prevent glasses fog:

  • Put a tissue inside the top of the mask: If you fold a tissue horizontally and put it between your face and the top of your mask—so it sits over the bridge of your nose— the moisture from your breath will be absorbed by the tissue instead of hitting your glasses lenses.
  • Buy a mask that molds to your nose: Masks that have a flexible wire allow you to mold it around the bridge of your nose, blocking the warm exhaled air from your mouth. Los Angeles Apparel sells such “flexible” masks.
  • Wash your glasses with soapy water: According to The Royal College of Surgeons of England article, washing your glasses with soapy water leaves behind a thin film that reduces surface tension and causes the water molecules to spread out evenly into a transparent layer, thus de-fogging your glasses.

If you’re still looking for a cloth mask, U.S. Surgeon General Jerome Adams suggests using an old t-shirt and two rubber bands.

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Source: How To Stop Face Masks From Fogging Up Your Glasses

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