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Motorcycle riders without helmets or any other type of safety equipment
Malé, Kaafu Atoll, Maldives
For my video; youtu.be/IW-UtSWZ_yY
Making her way from the section house at Osier toward her next stop at Cumbres Pass, Denver & Rio Grande Western K-36 #489 works west around the sweeping horseshoe curve at Long Creek (MP 321.0.) For much of the 64-mile journey from Antonito, CO to Chama, NM, the old D&RGW San Juan Extension literally follows the contours of the hills above Los Pinos Creek, taking many little, horseshoe and hairpin-shaped detours like this one, in order to keep the grade to the 10,000 ft. high Cumbres Pass manageable. The two towns are physically about 34 miles from each other, so the railroad route required very nearly doubles the distance.
This image was captured during an October 2024 photo shoot on the Cumbres & Toltec Scenic Railroad, which featured the 1925-vintage K-36 #489 on this day. This locomotive is one of two K-36s which the railroad has converted from coal-firing to oil-firing, to help mitigate the wildfire risk during dry seasons.
Encaustic collage on Birch panel.
Part of a recent exhibition where artists were required to respond to an image sent to them.
The image I received was a sculpture by fellow artist John Hall called Brother Sun Sister Moon.
It inspired this response from me involving a local landmark - The Copt Hill - ancient trees known locally as the Seven Sisters, growing over an mesolithic site. The moon, its cycles, the tides skies... kinda evolved. You get the idea.
It measures 60 x 60cms
The trees and the limpets are embedded photographic images, the keys are real, and the barnacles. clouds and surface are pigmented beeswax.
It's a beautiful material to work with.
You can see more here
Just open the Encaustic page.
"The Reader"
You don't require being alone to concentrate.
Kumbh Mela, the largest spiritual gathering of mankind on the Earth, is held every 12 years on the banks of the 'Sangam'- the confluence of the holy rivers Ganga, Yamuna and the mythical Saraswati. Millions of devotees take a holy dip in the sacred water during the mela. Maha Kumbha Mela held only at Prayag, once in every 144 years.
It is believed that at the historic moment of the Maha Kumbh Mela, the river turns itself into sanctity spots filled with ‘Amrita’ (Panacia or elixir of immortality). The pilgrims get once in a lifetime chance to bathe in the spirit of holiness, auspiciousness and salvation.
As mythology tells us, when Gods (Devtas) and Demons (Asura) used to reside on Earth, Gods were under the influence of a curse that gave birth of fear in them eventually making them weak. Brahma (the Creator) advised them to churn the milky ocean to obtain the elixir of immortality (Amrita). And Kumbh was the spot chosen to store the nectar of immortality recovered from Samudramanthan.
For 12 heavenly days and 12 heavenly nights, equivalent to 12 Earthly years, Gods were chased by Demons for the possession of Amrita. During the chase for the Amrita, few drops of this elixir out of its ‘Kumbha’ (Pot) fell on four places now known as Allahabad, Haridwar, Ujjain and Nasik. The whole Kumbha mela (carnival) and its cycle is a remembrance of that Mythological story. The mela takes place in all these four places. Out of these the one celebrated at the Holy Sangam in Allahabad is the largest and believed to be the holiest one. Thus the Kumbh Mela became one of the main festivals of Hindus as well as the largest spiritual gathering of mankind on Earth.
Recent interview : 121clicks.com
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© 2013 Apratim Saha All Rights Reserved. Unauthorised use or reproduction for any reason is prohibited.
Waste Management and Texarkana have delivered these huge trash and recycle bins that we are REQUIRED to use starting on Monday. They are way too big and I will bet that most of them will stay street side in many neighborhoods in TXK. Don't get me wrong, I am all for recycling and we have been doing it since it was instituted in TXK years ago. But these cans are too big. We wouldn't fill the trash can or the recycle bin up in 3 months! They are 8 inches taller than the brick wall we have built to hide the trash cans. And on top of that the outrageous color stands out like a sore thumb. I called the city spokesman Vicki Melde when this was proposed and got no answer when I asked if they were required and expressed concern as to the size. They have this is Shreveport LA and the trash cans just stay on the street in many areas. I am starting a picture campaign on my flickr site of UGLY trash cans in Texarkana, I may start a group if I get enough pics.
So, once a week, we are required to drag this UGLY trash can out to the street for 3 bags of trash. We are not allowed to used a smaller can or put the bags on the street. Sounds like discrimination to older and handicapped people to me. I understand you can call the city and make arrangements to have the can moved to the street for you. Are they going to come back and put them back in place every week? I would really like some answers to these questions, but get none when I call the city.
Another problem. When I dragged these out for the picture, they had ice on them. Later when I went back to put them back, the ice had melted and I didn't notice it. When I pulled it back to roll it, well you know where the water went. This will be fun with all the rain that we have here.
NOTE: This Photo-Shoot requires some imagination on your part, dear viewers. The models are suppose to be "leaping" in mid air :)
BNTM Episode 07: The Girls Who Take a Dive
Photo-Shoot 07: Jumpsuit Editorial
Now on YouTube: www.youtube.com/watch?v=wwTS-ctnUHg
Vote for Model of the Moment: bntm.tumblr.com/post/6628465501/model-of-the-moment
Dressed as required for the Brompton World Challenge section of the Prudential Ride London event on which I did the 47 mile route but actually did 53 (85km). M6L with 44t
Nice comments without copied/pasted group icons are welcome. .
As Flickr is a sharing site I only add my pictures to public groups, .
Photography experience courses available, please email for details.
The full portfolio available from Stock photography by Tim Large at Alamy
Photographer:- TimLarge
Location:- Burtle, Somerset, UK
©TimothyLarge
Croatia
Ston
summer break
Ston is a settlement and a municipality in the Dubrovnik-Neretva County of Croatia, located at the south of isthmus of the Pelješac peninsula.
After the Republic of Dubrovnik acquired the Pelješac in 1334, it required the protection of Ston. First, in thirty years, one of the longest defense walls in Europe was erected on one side of the peninsula, and according to a unique project, two new towns were planned: southern Ston and northern Little Ston with the aim of encompassing people to preserve the boundaries and work in solanas the state had acquired. Between 1461 and 1464, the Florentine architect Michelozzo commissioned the building of the wall by the order of the Dubrovnik Republic. The Great Wall is 1200 m long, and was built to ensure protection from neighbours. The chronicles state that the construction of the wall lasted for 18 months and cost 12,000 ducats.
The fortress of Ston was one of the largest construction projects of the time, with an original length of 7000 m, consisting of the walls of Ston and Little Ston. The Great Wall consists of three fortresses, and the walls and fortresses are flanked by 10 rounds of 31 squares and 6 semi-circular bastions. The complex defense corps has been shaped over the course of four centuries, due to the development of weapons.
The walls were of great importance because they were defending the saltworks that gave 15,900 ducats every year to the Dubrovnik Republic, the shellfish farm and the city itself.
In 1667, about 0.5 km of walls were destroyed in a catastrophic earthquake, and the walls were significantly damaged in the earthquakes in 1979 and 1996.
In 2004, work on the restoration of obsolete walls was started, with the aim of facilitating visits to the area between Ston and Little Ston. It was assumed that the works would be completed by May 2008, but only the original part of the Ston Bridge was rebuilt. The reconstruction of the Great Wall in Ston, worth about five million kuna (€673,000), was completed, and it was announced that the stone walls with public entrance fee will be opened in May 2009. Part of the wall is open to the public since October 2009 for a fee. Until 2013, the original part of the city, the road have been restored. It takes 15 minutes to get to the first part, and 30 minutes to get from the Great to the Small Wall. Today the greater part of the walls have been restored.
Growing and training plants for bonsai requires patience and time and expertise (and a vision). This is not an old one, some in the collection at Longwood Gardens are much older....but I really like the "rhyming" going on here. Requires a substantial, heavy pot (I imagine)....and also includes careful pruning of the root system, as well as training the foliage.
The appalling state of decay of the canopy over "Platform 3" at Penrith North Lakes Station.
This platform is not really required for embarking and disembarking passengers as "P3" is really just part of the Down Passing Loop created since the demise of the former branch to Keswick.
Actually this used to be P4, as the former bay platform used to be designated P3 back in the day.
Either way the canopy is so badly decayed that it has had to be fenced off to prevent access to the general public.
I frequently have a chunter to myself about this kind of thing when I see reports of shiny new railway infrastructure "Down South".
Tiny and beautiful. Found this while crawling around trying to shoot wild asters. Can't seem to find it again ;( Perhaps a coleus?
I decided a different box was required for my Dinky Concrete Mixer 690 as an alternative to my original rather battered striped box and fancied the illustrated version. A repro was far too expensive so…a few ‘borrowed’ pics off ebay sellers of original models with boxes , Adobe Photo Shop and some jiggery pokery and I have one using an Atlas Guy van box as donor – not perfect but is passes muster and all for less than £10! The Atlas box is slightly longer but the correct width. And I know some of the typefaces are not quite right but they look the part!
I wanted a grand tribute to the great state of Indiana and its once and never again governor with such low base approval. This is representative of the pens the gov thought could corral the subspecies that required separation and subjugation... women. He signed a bill forcing women to disclose their reasons for terminating pregnancies and criminalizing doctors who provided the service, forcing Indianaian women to call him and report on their periods as long as the governor was so concerned with their private matters. The protest was called Periods for Pence. The gov called for full investigations and funerals for still borns. Perhaps he could keep all lesser women penced up here! Black burkas would be nice, then all women would represent the requisite flock of sheep, black sheep. And Pence would be the shepherd with staff and crook to keep the subspecies in subjugation. There could be big trouble if T-Rump also herds his bikini bare bimbos from Bosnia in the same pen. Girl fights galore, go T-Rump! Hell hath no fury like bimbos scorned. We'll need full media coverage and a large percentage of beer sales. We could hold a wake at the same time, called "A Penance for Pence." Are coffin nails silver?
We tracked down the Gold Hill road to review the fence and aspen groves I visited earlier. The lighting had more punch on this day. I was searching this spot of aspen cloaked in showy fall coats The color was generally short of peak on my first day but looks primo up here in the wide opens. This "snake" fence wanders down the line and I was forced to climb it so I could find to shoot down the line. I returned with my normal-zoom. This is my shot. I looked and looked but never found the line shack that is supposed to be here somewhere. It might be covered in aspen.
The grade of the Denver, Boulder & Western Railroad grade made it up to Gold Hill station to service the town that was already in production for a couple of decades before Croffut toured Colorado. The old railroad grade remains largely intact for trail and 4X use. The route west from Gold Hill Station toward Ward pinches in pretty good with recent (decades) aspen growth. Sawmill Road road drops over the edge here and cuts through the old grade on its way to Lefthand canyon. The intersection is right here. There was not much altitude gain from Gold Hill Station to the grade below here so the route engineering was successful. The original railroad, floated by the Union Pacific, was named The Greeley, Salt Lake and Pacific around the 1885 Croffut date. During the heyday of railroad building, most paper, coupon and budding lines included the name, Pacific, in the hopes of garnering big funding. This line, too, had Pacific dreams. They started drilling a majestic tunnel through the Continental Divide at Yankee Doodle Lake on the Moffat Line. There is no way they could have climbed Pennsylvania Gulch up to the multitudes at their prospective tunnel anyway. Their terminus was Sunset, Colorado, west of Boulder before the flood. The Colorado & Northwestern Railroad, The Switzerland Trail, was organized and the company relaid grade and track up to Sunset then switch backed north on the way up to Ward, Colorado then took a break until the reorganization as the Denver, Boulder & Western Railroad. It was then nicknamed the Switzerland Trail. The company started grading and laying rail up a second switchback south from Sunset to start gaining altitude on a new branch that headed through the New Cardinal area for Eldora. Naturally, Cardinal began migrating closer to the railroad grade. Usually rail development companies shook down the camps and mine owners for bond sales as they surveyed and graded nearby.
Staying aloft requires forward motion. To remain inside a thermal column, eagles navigate in circular paths, steering with tails and wings. Thus they create lazy circles in the sky. Many circling birds within a thermal is called a kettle of eagles. I saw these Bald Eagles following a thermal column across the Boundary Bay sky in Delta BC Canada
Being a silk moth, the luna moth does not consume any food as an adult; the energy required during the adult phase accumulates during the caterpillar stage, thus the absence of a proboscis, the mouth found on most other species of butterflies and moths
I was thrilled to find this luna moth, one of two I saw here today!
State Parks are great!
The best of our 848 captures are in a mini-themed album:
• Outing to Oconee State Park, SC – 2021APR13
◦ Moody Spring – 2021APR13 – SC Highway 107
◦ Oconee State Park – 2021APR13 – Mountain Rest, SC
◦ Wigington Overlook – 2021APR13 – SC Highway 413
Hope you enjoy 35% of these 155 luna captures I took today!
At Bentsen-Rio Grande Valley State Park in south Texas, USA, they are serious about their rules. This particular day they had a male crab spider, Xysticus sp., enforcing their wristband mandate. November 12, 2021.
Is there any other sort of visual art that requires such a combination of speed, timing and accuracy? And do those constraints change throughout the year, month to month and sometimes minute to minute?
This was originally going to be called Seventeen Sun Circles which sounds like a much cooler number than five.
But I started too late and the evenings are really drawing in fast and I started to run out of thorns. If I wanted to make seventeen circles then by the time I had finished it would be dark and I would have missed my chance.
Of course musicians and dancers have to be accurate, fast and timely. Perhaps painters have to apply their paint in a particular fashion so it does or doesn't dry. A stone sculptor must tap the chisel just right to reveal the shape within the rock, whilst the bronze must be at the right temperature for correct casting. All important technical skills for artists in a myriad of disciplines. But, as I have never followed these disciplines, their subtleties pass my by.
The materials I use come from nature and change and grow and decay all the time. Leaves rip, tear, dry out, shed fixing thorns, curl up and go brown. You need to be accurate so that you aren't fixing them over and over as they cannot take the punishment. Wood and sticks dry out and contract, will snap and not be moist enough to be pierced with thorns. Colours fade and everything becomes brittle so you need to be fast too if you want to bring your ideas into fruition.
I try to incorporate the elements themselves into what I create, the sun, the moisture in the air, the temperature all play a part and as you become more skilled with the materials, you reveal more and more about how they behave. You notice the subtle nuances in everything: the height of the stream, the angle of the sun, which new plants grow at different points throughout the year.
This may sound like I am bemoaning the variability of what I use but that couldn't be further from the truth. Does paint change throughout the year? Will a piece of music die off in autumn and return once again in spring? The more time I spend making land art the more gifts Mother Nature throws up for me to discover.
I may have set off to make seventeen circles but I had to adapt. Therein lies the essence of land art. I had to experience and feel the change in the movement of the sun, the drawing in of the evenings and the impending dark time I feel within.
Nothing ever stands still, everything is in constant flux and making natural art sculptures from anything I find around me opens a little window into the world of nature and all her wonderful and fascinating nuances.
By the way - I am still hibernating. I made this is in September. I'm off back to my cave...
DM&N 2-10-2 506 on display at NRM in Green Bay. The Missabe's Santa Fe type locomotives were well documented while operating on home rails.
The Class 01 of standard locomotives (Einheitsdampflokomotive) was the first design of steam express passenger locomotives built by the unified Boreatic Railway League. While multiple railway companies had been operating across the main island of Borea for decades, no single railway company proved willing to shoulder the cost of long-distance railway bridges and ferries to the myriad islands. In 1920, the Council agreed to consolidate the largest mainland railway companies into a single state-owned entity, capable of the large-scale investment required to bridge the straights. The Grey Gates, the great suspension bridge crossing Omburg Harbor, is a product of such investment; so is the Class 01.
A 4-6-2 "Specific" layout, the Class 01 is designed to be fast, versatile, and able to be repaired in any railyard with standardized equipment. The Class 01 is limited to routes capable of handling its 20-ton axle load (as well as yards with turntables long enough to maneuver it). Though demand has started off slow, railway executives expect that the Class 01 will eventually be the most common engine hauling passenger express routes across the Boreatic League- and perhaps even beyond!
My Blythe Re-Dedication:
After being immersed in many things that required my time and attention, I'm rededicating myself to Blythe and the world of imagination offered by her and dolls in general.
*******************
Roxy is excited to be headed off to Stanford University. Here, she stands with her new surf board and TV in front of her poster of one of the most famous buildings on the campus, Hoover Tower, its architectural style causing it to be deemed "Hoover's Last Erection." "I think that's a bit silly," says Roxy.
Roxy might also realize her ideas that she can go surfing between classes and watch TV anytime she wants are silly. Being from the Northeast, she has yet to realize that there's no beach close enough to campus for a quick trip before class; and that studying will reduce greatly the time she has for TV watching. Still, that's all okay.
Roxy: "I'm looking forward to a whole new set of experiences! It'll be an adjustment but that's what growing up is all about!"
Purchase signed print here.
chancenkosigomez.com/shop/myth-of-tomorrow
One of the last grand adventures taken in 2025 was to Quenca, Ecuador. My purpose there was to tell stories through photography and filmmaking. I traveled throughout the region, learning about the Indigenous Andean Culture. The country was absolutely breathtaking as my eyes and heart took in the lands of the original Kanari people. This photograph was taken while visiting the primary sacred site for Mother Mary devotion. This is the southwest part of Ecuador, 28 km from Cuenca in El Cajas National Park. The park is well known for its rugged terrain that features picturesque landscapes characterized by valleys nestled in the Grandfather Mountains of Pachamama. This was one of those photographic moments that required a fair amount of patience to compose. For me, this photograph embodies the message of presence. I titled the piece, “Myth of Tomorrow,” because we only ever have now. Yes, another important reminder because where we place our will, action, reason, and emotion determines the quality of this very moment. Tomorrow is not the experience, only the one where we stand. For the animals im sure I was an anomaly for their simple way of existence. Standing a couple of meters away, dialing in an accurate light reading, one of the subjects' attention was pulled while the other was completely absorbed in grazing. The foreground needed to be properly illuminated since the sun was directly in front of me. Just before the trip, I acquired a couple of camera flashes from Lightpix that could be wirelessly synced together, paired with the Leica M6. In addition, I was experimenting with Kodak’s Tri-X 400 film-stock & an orange filter to get stronger black and white results.
Canyonlands National Park is an American national park located in southeastern Utah near the town of Moab. The park preserves a colorful landscape eroded into numerous canyons, mesas, and buttes by the Colorado River, the Green River, and their respective tributaries. Legislation creating the park was signed into law by President Lyndon Johnson on September 12, 1964.
The park is divided into four districts: the Island in the Sky, the Needles, the Maze, and the combined rivers—the Green and Colorado—which carved two large canyons into the Colorado Plateau. While these areas share a primitive desert atmosphere, each retains its own character. Author Edward Abbey, a frequent visitor, described the Canyonlands as "the most weird, wonderful, magical place on earth—there is nothing else like it anywhere."
In the early 1950s, Bates Wilson, then superintendent of Arches National Monument, began exploring the area to the south and west of Moab, Utah. After seeing what is now known as the Needles District of Canyonlands National Park, Wilson began advocating for the establishment of a new national park that would include the Needles. Additional explorations by Wilson and others expanded the areas proposed for inclusion into the new national park to include the confluence of Green and Colorado rivers, the Maze District, and Horseshoe Canyon.
In 1961, Secretary of the Interior Stewart Udall was scheduled to address a conference at Grand Canyon National Park. On his flight to the conference, he flew over the Confluence (where the Colorado and Green rivers meet). The view apparently sparked Udall's interest in Wilson's proposal for a new national park in that area and Udall began promoting the establishment of Canyonlands National Park.
Utah Senator Frank Moss first introduced legislation into Congress to create Canyonlands National Park. His legislation attempted to satisfy both nature preservationists' and commercial developers' interests. Over the next four years, his proposal was struck down, debated, revised, and reintroduced to Congress many times before being passed and signed into creation.
In September, 1964, after several years of debate, President Lyndon B. Johnson signed Pub.L. 88–590, which established Canyonlands National Park as a new national park. Bates Wilson became the first superintendent of the new park and is often referred to as the "Father of Canyonlands."
The Colorado River and Green River combine within the park, dividing it into three districts called the Island in the Sky, the Needles, and the Maze. The Colorado River flows through Cataract Canyon below its confluence with the Green River.
The Island in the Sky district is a broad and level mesa in the northern section of the park, between the Colorado and Green rivers. The district has many viewpoints overlooking the White Rim, a sandstone bench 1,200 feet (370 m) below the Island, and the rivers, which are another 1,000 feet (300 m) below the White Rim.
The Needles district is located south of the Island in the Sky, on the east side of the Colorado River. The district is named for the red and white banded rock pinnacles which are a major feature of the area. Various other naturally sculpted rock formations are also within this district, including grabens, potholes, and arches. Unlike Arches National Park, where many arches are accessible by short to moderate hikes, most of the arches in the Needles district lie in backcountry canyons, requiring long hikes or four-wheel drive trips to reach them.
The Ancestral Puebloans inhabited this area and some of their stone and mud dwellings are well-preserved, although the items and tools they used were mostly removed by looters. The Ancestral Puebloans also created rock art in the form of petroglyphs, most notably on Newspaper Rock along the Needles access road.
The Maze district is located west of the Colorado and Green rivers. The Maze is the least accessible section of the park, and one of the most remote and inaccessible areas of the United States.
A geographically detached section of the park located north of the Maze district, Horseshoe Canyon contains panels of rock art made by hunter-gatherers from the Late Archaic Period (2000-1000 BC) pre-dating the Ancestral Puebloans. Originally called Barrier Canyon, Horseshoe's artifacts, dwellings, pictographs, and murals are some of the oldest in America. The images depicting horses date from after 1540 AD, when the Spanish reintroduced horses to America.
Since the 1950s, scientists have been studying an area of 200 acres (81 ha) completely surrounded by cliffs. The cliffs have prevented cattle from ever grazing on the area's 62 acres (25 ha) of grassland. According to the scientists, the site may contain the largest undisturbed grassland in the Four Corners region. Studies have continued biannually since the mid-1990s. The area has been closed to the public since 1993 to maintain the nearly pristine environment.
Mammals that roam this park include black bears, coyotes, skunks, bats, elk, foxes, bobcats, badgers, ring-tailed cats, pronghorns, desert bighorn sheep, and cougars. Desert cottontails, kangaroo rats and mule deer are commonly seen by visitors.
At least 273 species of birds inhabit the park. A variety of hawks and eagles are found, including the Cooper's hawk, the northern goshawk, the sharp-shinned hawk, the red-tailed hawk, the golden and bald eagles, the rough-legged hawk, the Swainson's hawk, and the northern harrier. Several species of owls are found, including the great horned owl, the northern saw-whet owl, the western screech owl, and the Mexican spotted owl. Grebes, woodpeckers, ravens, herons, flycatchers, crows, bluebirds, wrens, warblers, blackbirds, orioles, goldfinches, swallows, sparrows, ducks, quail, grouse, pheasants, hummingbirds, falcons, gulls, and ospreys are some of the other birds that can be found.
Several reptiles can be found, including eleven species of lizards and eight species of snake (including the midget faded rattlesnake). The common kingsnake and prairie rattlesnake have been reported in the park, but not confirmed by the National Park Service.
The park is home to six confirmed amphibian species, including the red-spotted toad, Woodhouse's toad, American bullfrog, northern leopard frog, Great Basin spadefoot toad, and tiger salamander. The canyon tree frog was reported to be in the park in 2000, but was not confirmed during a study in 2004.
Canyonlands National Park contains a wide variety of plant life, including 11 cactus species,[34] 20 moss species, liverworts, grasses and wildflowers. Varieties of trees include netleaf hackberry, Russian olive, Utah juniper, pinyon pine, tamarisk, and Fremont's cottonwood. Shrubs include Mormon tea, blackbrush, four-wing saltbush, cliffrose, littleleaf mountain mahogany, and snakeweed
Cryptobiotic soil is the foundation of life in Canyonlands, providing nitrogen fixation and moisture for plant seeds. One footprint can destroy decades of growth.
According to the Köppen climate classification system, Canyonlands National Park has a cold semi-arid climate ("BSk"). The plant hardiness zones at the Island in the Sky and Needles District Visitor Centers are 7a with an average annual extreme minimum air temperature of 4.0 °F (-15.6 °C) and 2.9 °F (-16.2 °C), respectively.
The National Weather Service has maintained two cooperative weather stations in the park since June 1965. Official data documents the desert climate with less than 10 inches (250 millimetres) of annual rainfall, as well as hot, mostly dry summers and cold, occasionally wet winters. Snowfall is generally light during the winter.
The station in The Neck region reports an average January temperature of 29.6 °F and an average July temperature of 79.3 °F. Average July temperatures range from a high of 90.8 °F (32.7 °C) to a low of 67.9 °F (19.9 °C). There are an average of 45.7 days with highs of 90 °F (32 °C) or higher and an average of 117.3 days with lows of 32 °F (0 °C) or lower. The highest recorded temperature was 105 °F (41 °C) on July 15, 2005, and the lowest recorded temperature was −13 °F (−25 °C) on February 6, 1989. Average annual precipitation is 9.33 inches (237 mm). There are an average of 59 days with measurable precipitation. The wettest year was 1984, with 13.66 in (347 mm), and the driest year was 1989, with 4.63 in (118 mm). The most precipitation in one month was 5.19 in (132 mm) in October 2006. The most precipitation in 24 hours was 1.76 in (45 mm) on April 9, 1978. Average annual snowfall is 22.8 in (58 cm). The most snowfall in one year was 47.4 in (120 cm) in 1975, and the most snowfall in one month was 27.0 in (69 cm) in January 1978.
The station in The Needles region reports an average January temperature of 29.7 °F and an average July temperature of 79.1 °F.[44] Average July temperatures range from a high of 95.4 °F (35.2 °C) to a low of 62.4 °F (16.9 °C). There are an average of 75.4 days with highs of 90 °F (32 °C) or higher and an average of 143.6 days with lows of 32 °F (0 °C) or lower. The highest recorded temperature was 107 °F (42 °C) on July 13, 1971, and the lowest recorded temperature was −16 °F (−27 °C) on January 16, 1971. Average annual precipitation is 8.49 in (216 mm). There are an average of 56 days with measurable precipitation. The wettest year was 1969, with 11.19 in (284 mm), and the driest year was 1989, with 4.25 in (108 mm). The most precipitation in one month was 4.43 in (113 mm) in October 1972. The most precipitation in 24 hours was 1.56 in (40 mm) on September 17, 1999. Average annual snowfall is 14.4 in (37 cm). The most snowfall in one year was 39.3 in (100 cm) in 1975, and the most snowfall in one month was 24.0 in (61 cm) in March 1985.
National parks in the Western US are more affected by climate change than the country as a whole, and the National Park Service has begun research into how exactly this will effect the ecosystem of Canyonlands National Park and the surrounding areas and ways to protect the park for the future. The mean annual temperature of Canyonlands National Park increased by 2.6 °F (1.4 °C) from 1916 to 2018. It is predicted that if current warming trends continue, the average highs in the park during the summer will be over 100 °F (40 °C) by 2100. In addition to warming, the region has begun to see more severe and frequent droughts which causes native grass cover to decrease and a lower flow of the Colorado River. The flows of the Upper Colorado Basin have decreased by 300,000 acre⋅ft (370,000,000 m3) per year, which has led to a decreased amount of sediment carried by the river and rockier rapids which are more frequently impassable to rafters. The area has also begun to see an earlier spring, which will lead to changes in the timing of leaves and flowers blooming and migrational patterns of wildlife that could lead to food shortages for the wildlife, as well as a longer fire season.
The National Park Service is currently closely monitoring the impacts of climate change in Canyonlands National Park in order to create management strategies that will best help conserve the park's landscapes and ecosystems for the long term. Although the National Park Service's original goal was to preserve landscapes as they were before European colonization, they have now switched to a more adaptive management strategy with the ultimate goal of conserving the biodiversity of the park. The NPS is collaborating with other organizations including the US Geological Survey, local indigenous tribes, and nearby universities in order to create a management plan for the national park. Right now, there is a focus on research into which native plants will be most resistant to climate change so that the park can decide on what to prioritize in conservation efforts. The Canyonlands Natural History Association has been giving money to the US Geological Survey to fund this and other climate related research. They gave $30,000 in 2019 and $61,000 in 2020.
A subsiding basin and nearby uplifting mountain range (the Uncompahgre) existed in the area in Pennsylvanian time. Seawater trapped in the subsiding basin created thick evaporite deposits by Mid Pennsylvanian. This, along with eroded material from the nearby mountain range, became the Paradox Formation, itself a part of the Hermosa Group. Paradox salt beds started to flow later in the Pennsylvanian and probably continued to move until the end of the Jurassic. Some scientists believe Upheaval Dome was created from Paradox salt bed movement, creating a salt dome, but more modern studies show that the meteorite theory is more likely to be correct.
A warm shallow sea again flooded the region near the end of the Pennsylvanian. Fossil-rich limestones, sandstones, and shales of the gray-colored Honaker Trail Formation resulted. A period of erosion then ensued, creating a break in the geologic record called an unconformity. Early in the Permian an advancing sea laid down the Halgaito Shale. Coastal lowlands later returned to the area, forming the Elephant Canyon Formation.
Large alluvial fans filled the basin where it met the Uncompahgre Mountains, creating the Cutler red beds of iron-rich arkose sandstone. Underwater sand bars and sand dunes on the coast inter-fingered with the red beds and later became the white-colored cliff-forming Cedar Mesa Sandstone. Brightly colored oxidized muds were then deposited, forming the Organ Rock Shale. Coastal sand dunes and marine sand bars once again became dominant, creating the White Rim Sandstone.
A second unconformity was created after the Permian sea retreated. Flood plains on an expansive lowland covered the eroded surface and mud built up in tidal flats, creating the Moenkopi Formation. Erosion returned, forming a third unconformity. The Chinle Formation was then laid down on top of this eroded surface.
Increasingly dry climates dominated the Triassic. Therefore, sand in the form of sand dunes invaded and became the Wingate Sandstone. For a time climatic conditions became wetter and streams cut channels through the sand dunes, forming the Kayenta Formation. Arid conditions returned to the region with a vengeance; a large desert spread over much of western North America and later became the Navajo Sandstone. A fourth unconformity was created by a period of erosion.
Mud flats returned, forming the Carmel Formation, and the Entrada Sandstone was laid down next. A long period of erosion stripped away most of the San Rafael Group in the area, along with any formations that may have been laid down in the Cretaceous period.
The Laramide orogeny started to uplift the Rocky Mountains 70 million years ago and with it, the Canyonlands region. Erosion intensified and when the Colorado River Canyon reached the salt beds of the Paradox Formation the overlying strata extended toward the river canyon, forming features such as The Grabens. Increased precipitation during the ice ages of the Pleistocene quickened the rate of canyon excavation along with other erosion. Similar types of erosion are ongoing, but occur at a slower rate.
Utah is a landlocked state in the Mountain West subregion of the Western United States. It borders Colorado to its east, Wyoming to its northeast, Idaho to its north, Arizona to its south, and Nevada to its west. Utah also touches a corner of New Mexico in the southeast. Of the fifty U.S. states, Utah is the 13th-largest by area; with a population over three million, it is the 30th-most-populous and 11th-least-densely populated. Urban development is mostly concentrated in two areas: the Wasatch Front in the north-central part of the state, which is home to roughly two-thirds of the population and includes the capital city, Salt Lake City; and Washington County in the southwest, with more than 180,000 residents. Most of the western half of Utah lies in the Great Basin.
Utah has been inhabited for thousands of years by various indigenous groups such as the ancient Puebloans, Navajo, and Ute. The Spanish were the first Europeans to arrive in the mid-16th century, though the region's difficult geography and harsh climate made it a peripheral part of New Spain and later Mexico. Even while it was Mexican territory, many of Utah's earliest settlers were American, particularly Mormons fleeing marginalization and persecution from the United States via the Mormon Trail. Following the Mexican–American War in 1848, the region was annexed by the U.S., becoming part of the Utah Territory, which included what is now Colorado and Nevada. Disputes between the dominant Mormon community and the federal government delayed Utah's admission as a state; only after the outlawing of polygamy was it admitted in 1896 as the 45th.
People from Utah are known as Utahns. Slightly over half of all Utahns are Mormons, the vast majority of whom are members of the Church of Jesus Christ of Latter-day Saints (LDS Church), which has its world headquarters in Salt Lake City; Utah is the only state where a majority of the population belongs to a single church. A 2023 paper challenged this perception (claiming only 42% of Utahns are Mormons) however most statistics still show a majority of Utah residents belong to the LDS church; estimates from the LDS church suggests 60.68% of Utah's population belongs to the church whilst some sources put the number as high as 68%. The paper replied that membership count done by the LDS Church is too high for several reasons. The LDS Church greatly influences Utahn culture, politics, and daily life, though since the 1990s the state has become more religiously diverse as well as secular.
Utah has a highly diversified economy, with major sectors including transportation, education, information technology and research, government services, mining, multi-level marketing, and tourism. Utah has been one of the fastest growing states since 2000, with the 2020 U.S. census confirming the fastest population growth in the nation since 2010. St. George was the fastest-growing metropolitan area in the United States from 2000 to 2005. Utah ranks among the overall best states in metrics such as healthcare, governance, education, and infrastructure. It has the 12th-highest median average income and the least income inequality of any U.S. state. Over time and influenced by climate change, droughts in Utah have been increasing in frequency and severity, putting a further strain on Utah's water security and impacting the state's economy.
The History of Utah is an examination of the human history and social activity within the state of Utah located in the western United States.
Archaeological evidence dates the earliest habitation of humans in Utah to about 10,000 to 12,000 years ago. Paleolithic people lived near the Great Basin's swamps and marshes, which had an abundance of fish, birds, and small game animals. Big game, including bison, mammoths and ground sloths, also were attracted to these water sources. Over the centuries, the mega-fauna died, this population was replaced by the Desert Archaic people, who sheltered in caves near the Great Salt Lake. Relying more on gathering than the previous Utah residents, their diet was mainly composed of cattails and other salt tolerant plants such as pickleweed, burro weed and sedge. Red meat appears to have been more of a luxury, although these people used nets and the atlatl to hunt water fowl, ducks, small animals and antelope. Artifacts include nets woven with plant fibers and rabbit skin, woven sandals, gaming sticks, and animal figures made from split-twigs. About 3,500 years ago, lake levels rose and the population of Desert Archaic people appears to have dramatically decreased. The Great Basin may have been almost unoccupied for 1,000 years.
The Fremont culture, named from sites near the Fremont River in Utah, lived in what is now north and western Utah and parts of Nevada, Idaho and Colorado from approximately 600 to 1300 AD. These people lived in areas close to water sources that had been previously occupied by the Desert Archaic people, and may have had some relationship with them. However, their use of new technologies define them as a distinct people. Fremont technologies include:
use of the bow and arrow while hunting,
building pithouse shelters,
growing maize and probably beans and squash,
building above ground granaries of adobe or stone,
creating and decorating low-fired pottery ware,
producing art, including jewelry and rock art such as petroglyphs and pictographs.
The ancient Puebloan culture, also known as the Anasazi, occupied territory adjacent to the Fremont. The ancestral Puebloan culture centered on the present-day Four Corners area of the Southwest United States, including the San Juan River region of Utah. Archaeologists debate when this distinct culture emerged, but cultural development seems to date from about the common era, about 500 years before the Fremont appeared. It is generally accepted that the cultural peak of these people was around the 1200 CE. Ancient Puebloan culture is known for well constructed pithouses and more elaborate adobe and masonry dwellings. They were excellent craftsmen, producing turquoise jewelry and fine pottery. The Puebloan culture was based on agriculture, and the people created and cultivated fields of maize, beans, and squash and domesticated turkeys. They designed and produced elaborate field terracing and irrigation systems. They also built structures, some known as kivas, apparently designed solely for cultural and religious rituals.
These two later cultures were roughly contemporaneous, and appear to have established trading relationships. They also shared enough cultural traits that archaeologists believe the cultures may have common roots in the early American Southwest. However, each remained culturally distinct throughout most of their existence. These two well established cultures appear to have been severely impacted by climatic change and perhaps by the incursion of new people in about 1200 CE. Over the next two centuries, the Fremont and ancient Pueblo people may have moved into the American southwest, finding new homes and farmlands in the river drainages of Arizona, New Mexico and northern Mexico.
In about 1200, Shoshonean speaking peoples entered Utah territory from the west. They may have originated in southern California and moved into the desert environment due to population pressure along the coast. They were an upland people with a hunting and gathering lifestyle utilizing roots and seeds, including the pinyon nut. They were also skillful fishermen, created pottery and raised some crops. When they first arrived in Utah, they lived as small family groups with little tribal organization. Four main Shoshonean peoples inhabited Utah country. The Shoshone in the north and northeast, the Gosiutes in the northwest, the Utes in the central and eastern parts of the region and the Southern Paiutes in the southwest. Initially, there seems to have been very little conflict between these groups.
In the early 16th century, the San Juan River basin in Utah's southeast also saw a new people, the Díne or Navajo, part of a greater group of plains Athabaskan speakers moved into the Southwest from the Great Plains. In addition to the Navajo, this language group contained people that were later known as Apaches, including the Lipan, Jicarilla, and Mescalero Apaches.
Athabaskans were a hunting people who initially followed the bison, and were identified in 16th-century Spanish accounts as "dog nomads". The Athabaskans expanded their range throughout the 17th century, occupying areas the Pueblo peoples had abandoned during prior centuries. The Spanish first specifically mention the "Apachu de Nabajo" (Navaho) in the 1620s, referring to the people in the Chama valley region east of the San Juan River, and north west of Santa Fe. By the 1640s, the term Navaho was applied to these same people. Although the Navajo newcomers established a generally peaceful trading and cultural exchange with the some modern Pueblo peoples to the south, they experienced intermittent warfare with the Shoshonean peoples, particularly the Utes in eastern Utah and western Colorado.
At the time of European expansion, beginning with Spanish explorers traveling from Mexico, five distinct native peoples occupied territory within the Utah area: the Northern Shoshone, the Goshute, the Ute, the Paiute and the Navajo.
The Spanish explorer Francisco Vázquez de Coronado may have crossed into what is now southern Utah in 1540, when he was seeking the legendary Cíbola.
A group led by two Spanish Catholic priests—sometimes called the Domínguez–Escalante expedition—left Santa Fe in 1776, hoping to find a route to the California coast. The expedition traveled as far north as Utah Lake and encountered the native residents. All of what is now Utah was claimed by the Spanish Empire from the 1500s to 1821 as part of New Spain (later as the province Alta California); and subsequently claimed by Mexico from 1821 to 1848. However, Spain and Mexico had little permanent presence in, or control of, the region.
Fur trappers (also known as mountain men) including Jim Bridger, explored some regions of Utah in the early 19th century. The city of Provo was named for one such man, Étienne Provost, who visited the area in 1825. The city of Ogden, Utah is named for a brigade leader of the Hudson's Bay Company, Peter Skene Ogden who trapped in the Weber Valley. In 1846, a year before the arrival of members from the Church of Jesus Christ of latter-day Saints, the ill-fated Donner Party crossed through the Salt Lake valley late in the season, deciding not to stay the winter there but to continue forward to California, and beyond.
Members of the Church of Jesus Christ of Latter-day Saints, commonly known as Mormon pioneers, first came to the Salt Lake Valley on July 24, 1847. At the time, the U.S. had already captured the Mexican territories of Alta California and New Mexico in the Mexican–American War and planned to keep them, but those territories, including the future state of Utah, officially became United States territory upon the signing of the Treaty of Guadalupe Hidalgo, February 2, 1848. The treaty was ratified by the United States Senate on March 10, 1848.
Upon arrival in the Salt Lake Valley, the Mormon pioneers found no permanent settlement of Indians. Other areas along the Wasatch Range were occupied at the time of settlement by the Northwestern Shoshone and adjacent areas by other bands of Shoshone such as the Gosiute. The Northwestern Shoshone lived in the valleys on the eastern shore of Great Salt Lake and in adjacent mountain valleys. Some years after arriving in the Salt Lake Valley Mormons, who went on to colonize many other areas of what is now Utah, were petitioned by Indians for recompense for land taken. The response of Heber C. Kimball, first counselor to Brigham Young, was that the land belonged to "our Father in Heaven and we expect to plow and plant it." A 1945 Supreme Court decision found that the land had been treated by the United States as public domain; no aboriginal title by the Northwestern Shoshone had been recognized by the United States or extinguished by treaty with the United States.
Upon arriving in the Salt Lake Valley, the Mormons had to make a place to live. They created irrigation systems, laid out farms, built houses, churches, and schools. Access to water was crucially important. Almost immediately, Brigham Young set out to identify and claim additional community sites. While it was difficult to find large areas in the Great Basin where water sources were dependable and growing seasons long enough to raise vitally important subsistence crops, satellite communities began to be formed.
Shortly after the first company arrived in the Salt Lake Valley in 1847, the community of Bountiful was settled to the north. In 1848, settlers moved into lands purchased from trapper Miles Goodyear in present-day Ogden. In 1849, Tooele and Provo were founded. Also that year, at the invitation of Ute chief Wakara, settlers moved into the Sanpete Valley in central Utah to establish the community of Manti. Fillmore, Utah, intended to be the capital of the new territory, was established in 1851. In 1855, missionary efforts aimed at western native cultures led to outposts in Fort Lemhi, Idaho, Las Vegas, Nevada and Elk Mountain in east-central Utah.
The experiences of returning members of the Mormon Battalion were also important in establishing new communities. On their journey west, the Mormon soldiers had identified dependable rivers and fertile river valleys in Colorado, Arizona and southern California. In addition, as the men traveled to rejoin their families in the Salt Lake Valley, they moved through southern Nevada and the eastern segments of southern Utah. Jefferson Hunt, a senior Mormon officer of the Battalion, actively searched for settlement sites, minerals, and other resources. His report encouraged 1851 settlement efforts in Iron County, near present-day Cedar City. These southern explorations eventually led to Mormon settlements in St. George, Utah, Las Vegas and San Bernardino, California, as well as communities in southern Arizona.
Prior to establishment of the Oregon and California trails and Mormon settlement, Indians native to the Salt Lake Valley and adjacent areas lived by hunting buffalo and other game, but also gathered grass seed from the bountiful grass of the area as well as roots such as those of the Indian Camas. By the time of settlement, indeed before 1840, the buffalo were gone from the valley, but hunting by settlers and grazing of cattle severely impacted the Indians in the area, and as settlement expanded into nearby river valleys and oases, indigenous tribes experienced increasing difficulty in gathering sufficient food. Brigham Young's counsel was to feed the hungry tribes, and that was done, but it was often not enough. These tensions formed the background to the Bear River massacre committed by California Militia stationed in Salt Lake City during the Civil War. The site of the massacre is just inside Preston, Idaho, but was generally thought to be within Utah at the time.
Statehood was petitioned for in 1849-50 using the name Deseret. The proposed State of Deseret would have been quite large, encompassing all of what is now Utah, and portions of Colorado, Idaho, Nevada, Wyoming, Arizona, Oregon, New Mexico and California. The name of Deseret was favored by the LDS leader Brigham Young as a symbol of industry and was derived from a reference in the Book of Mormon. The petition was rejected by Congress and Utah did not become a state until 1896, following the Utah Constitutional Convention of 1895.
In 1850, the Utah Territory was created with the Compromise of 1850, and Fillmore (named after President Fillmore) was designated the capital. In 1856, Salt Lake City replaced Fillmore as the territorial capital.
The first group of pioneers brought African slaves with them, making Utah the only place in the western United States to have African slavery. Three slaves, Green Flake, Hark Lay, and Oscar Crosby, came west with this first group in 1847. The settlers also began to purchase Indian slaves in the well-established Indian slave trade, as well as enslaving Indian prisoners of war. In 1850, 26 slaves were counted in Salt Lake County. Slavery didn't become officially recognized until 1852, when the Act in Relation to Service and the Act for the relief of Indian Slaves and Prisoners were passed. Slavery was repealed on June 19, 1862, when Congress prohibited slavery in all US territories.
Disputes between the Mormon inhabitants and the federal government intensified after the Church of Jesus Christ of Latter-day Saints' practice of polygamy became known. The polygamous practices of the Mormons, which were made public in 1854, would be one of the major reasons Utah was denied statehood until almost 50 years after the Mormons had entered the area.
After news of their polygamous practices spread, the members of the LDS Church were quickly viewed by some as un-American and rebellious. In 1857, after news of a possible rebellion spread, President James Buchanan sent troops on the Utah expedition to quell the growing unrest and to replace Brigham Young as territorial governor with Alfred Cumming. The expedition was also known as the Utah War.
As fear of invasion grew, Mormon settlers had convinced some Paiute Indians to aid in a Mormon-led attack on 120 immigrants from Arkansas under the guise of Indian aggression. The murder of these settlers became known as the Mountain Meadows massacre. The Mormon leadership had adopted a defensive posture that led to a ban on the selling of grain to outsiders in preparation for an impending war. This chafed pioneers traveling through the region, who were unable to purchase badly needed supplies. A disagreement between some of the Arkansas pioneers and the Mormons in Cedar City led to the secret planning of the massacre by a few Mormon leaders in the area. Some scholars debate the involvement of Brigham Young. Only one man, John D. Lee, was ever convicted of the murders, and he was executed at the massacre site.
Express riders had brought the news 1,000 miles from the Missouri River settlements to Salt Lake City within about two weeks of the army's beginning to march west. Fearing the worst as 2,500 troops (roughly 1/3rd of the army then) led by General Albert Sidney Johnston started west, Brigham Young ordered all residents of Salt Lake City and neighboring communities to prepare their homes for burning and evacuate southward to Utah Valley and southern Utah. Young also sent out a few units of the Nauvoo Legion (numbering roughly 8,000–10,000), to delay the army's advance. The majority he sent into the mountains to prepare defenses or south to prepare for a scorched earth retreat. Although some army wagon supply trains were captured and burned and herds of army horses and cattle run off no serious fighting occurred. Starting late and short on supplies, the United States Army camped during the bitter winter of 1857–58 near a burned out Fort Bridger in Wyoming. Through the negotiations between emissary Thomas L. Kane, Young, Cumming and Johnston, control of Utah territory was peacefully transferred to Cumming, who entered an eerily vacant Salt Lake City in the spring of 1858. By agreement with Young, Johnston established the army at Fort Floyd 40 miles away from Salt Lake City, to the southwest.
Salt Lake City was the last link of the First Transcontinental Telegraph, between Carson City, Nevada and Omaha, Nebraska completed in October 1861. Brigham Young, who had helped expedite construction, was among the first to send a message, along with Abraham Lincoln and other officials. Soon after the telegraph line was completed, the Deseret Telegraph Company built the Deseret line connecting the settlements in the territory with Salt Lake City and, by extension, the rest of the United States.
Because of the American Civil War, federal troops were pulled out of Utah Territory (and their fort auctioned off), leaving the territorial government in federal hands without army backing until General Patrick E. Connor arrived with the 3rd Regiment of California Volunteers in 1862. While in Utah, Connor and his troops soon became discontent with this assignment wanting to head to Virginia where the "real" fighting and glory was occurring. Connor established Fort Douglas just three miles (5 km) east of Salt Lake City and encouraged his bored and often idle soldiers to go out and explore for mineral deposits to bring more non-Mormons into the state. Minerals were discovered in Tooele County, and some miners began to come to the territory. Conner also solved the Shoshone Indian problem in Cache Valley Utah by luring the Shoshone into a midwinter confrontation on January 29, 1863. The armed conflict quickly turned into a rout, discipline among the soldiers broke down, and the Battle of Bear River is today usually referred to by historians as the Bear River Massacre. Between 200 and 400 Shoshone men, women and children were killed, as were 27 soldiers, with over 50 more soldiers wounded or suffering from frostbite.
Beginning in 1865, Utah's Black Hawk War developed into the deadliest conflict in the territory's history. Chief Antonga Black Hawk died in 1870, but fights continued to break out until additional federal troops were sent in to suppress the Ghost Dance of 1872. The war is unique among Indian Wars because it was a three-way conflict, with mounted Timpanogos Utes led by Antonga Black Hawk fighting federal and Utah local militia.
On May 10, 1869, the First transcontinental railroad was completed at Promontory Summit, north of the Great Salt Lake. The railroad brought increasing numbers of people into the state, and several influential businessmen made fortunes in the territory.
Main article: Latter Day Saint polygamy in the late-19th century
During the 1870s and 1880s, federal laws were passed and federal marshals assigned to enforce the laws against polygamy. In the 1890 Manifesto, the LDS Church leadership dropped its approval of polygamy citing divine revelation. When Utah applied for statehood again in 1895, it was accepted. Statehood was officially granted on January 4, 1896.
The Mormon issue made the situation for women the topic of nationwide controversy. In 1870 the Utah Territory, controlled by Mormons, gave women the right to vote. However, in 1887, Congress disenfranchised Utah women with the Edmunds–Tucker Act. In 1867–96, eastern activists promoted women's suffrage in Utah as an experiment, and as a way to eliminate polygamy. They were Presbyterians and other Protestants convinced that Mormonism was a non-Christian cult that grossly mistreated women. The Mormons promoted woman suffrage to counter the negative image of downtrodden Mormon women. With the 1890 Manifesto clearing the way for statehood, in 1895 Utah adopted a constitution restoring the right of women's suffrage. Congress admitted Utah as a state with that constitution in 1896.
Though less numerous than other intermountain states at the time, several lynching murders for alleged misdeeds occurred in Utah territory at the hand of vigilantes. Those documented include the following, with their ethnicity or national origin noted in parentheses if it was provided in the source:
William Torrington in Carson City (then a part of Utah territory), 1859
Thomas Coleman (Black man) in Salt Lake City, 1866
3 unidentified men at Wahsatch, winter of 1868
A Black man in Uintah, 1869
Charles A. Benson in Logan, 1873
Ah Sing (Chinese man) in Corinne, 1874
Thomas Forrest in St. George, 1880
William Harvey (Black man) in Salt Lake City, 1883
John Murphy in Park City, 1883
George Segal (Japanese man) in Ogden, 1884
Joseph Fisher in Eureka, 1886
Robert Marshall (Black man) in Castle Gate, 1925
Other lynchings in Utah territory include multiple instances of mass murder of Native American children, women, and men by White settlers including the Battle Creek massacre (1849), Provo River Massacre (1850), Nephi massacre (1853), and Circleville Massacre (1866).
Beginning in the early 20th century, with the establishment of such national parks as Bryce Canyon National Park and Zion National Park, Utah began to become known for its natural beauty. Southern Utah became a popular filming spot for arid, rugged scenes, and such natural landmarks as Delicate Arch and "the Mittens" of Monument Valley are instantly recognizable to most national residents. During the 1950s, 1960s, and 1970s, with the construction of the Interstate highway system, accessibility to the southern scenic areas was made easier.
Beginning in 1939, with the establishment of Alta Ski Area, Utah has become world-renowned for its skiing. The dry, powdery snow of the Wasatch Range is considered some of the best skiing in the world. Salt Lake City won the bid for the 2002 Winter Olympics in 1995, and this has served as a great boost to the economy. The ski resorts have increased in popularity, and many of the Olympic venues scattered across the Wasatch Front continue to be used for sporting events. This also spurred the development of the light-rail system in the Salt Lake Valley, known as TRAX, and the re-construction of the freeway system around the city.
During the late 20th century, the state grew quickly. In the 1970s, growth was phenomenal in the suburbs. Sandy was one of the fastest-growing cities in the country at that time, and West Valley City is the state's 2nd most populous city. Today, many areas of Utah are seeing phenomenal growth. Northern Davis, southern and western Salt Lake, Summit, eastern Tooele, Utah, Wasatch, and Washington counties are all growing very quickly. Transportation and urbanization are major issues in politics as development consumes agricultural land and wilderness areas.
In 2012, the State of Utah passed the Utah Transfer of Public Lands Act in an attempt to gain control over a substantial portion of federal land in the state from the federal government, based on language in the Utah Enabling Act of 1894. The State does not intend to use force or assert control by limiting access in an attempt to control the disputed lands, but does intend to use a multi-step process of education, negotiation, legislation, and if necessary, litigation as part of its multi-year effort to gain state or private control over the lands after 2014.
Utah families, like most Americans everywhere, did their utmost to assist in the war effort. Tires, meat, butter, sugar, fats, oils, coffee, shoes, boots, gasoline, canned fruits, vegetables, and soups were rationed on a national basis. The school day was shortened and bus routes were reduced to limit the number of resources used stateside and increase what could be sent to soldiers.
Geneva Steel was built to increase the steel production for America during World War II. President Franklin D. Roosevelt had proposed opening a steel mill in Utah in 1936, but the idea was shelved after a couple of months. After the attack on Pearl Harbor, the United States entered the war and the steel plant was put into progress. In April 1944, Geneva shipped its first order, which consisted of over 600 tons of steel plate. Geneva Steel also brought thousands of job opportunities to Utah. The positions were hard to fill as many of Utah's men were overseas fighting. Women began working, filling 25 percent of the jobs.
As a result of Utah's and Geneva Steels contribution during the war, several Liberty Ships were named in honor of Utah including the USS Joseph Smith, USS Brigham Young, USS Provo, and the USS Peter Skene Ogden.
One of the sectors of the beachhead of Normandy Landings was codenamed Utah Beach, and the amphibious landings at the beach were undertaken by United States Army troops.
It is estimated that 1,450 soldiers from Utah were killed in the war.
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Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).[8] The disease was first identified in December 2019 in Wuhan, the capital of China's Hubei province, and has since spread globally, resulting in the ongoing 2019–20 coronavirus pandemic.[9][10] As of 26 April 2020, more than 2.89 million cases have been reported across 185 countries and territories, resulting in more than 203,000 deaths. More than 822,000 people have recovered.[7]
Common symptoms include fever, cough, fatigue, shortness of breath and loss of smell.[5][11][12] While the majority of cases result in mild symptoms, some progress to viral pneumonia, multi-organ failure, or cytokine storm.[13][9][14] More concerning symptoms include difficulty breathing, persistent chest pain, confusion, difficulty waking, and bluish skin.[5] The time from exposure to onset of symptoms is typically around five days but may range from two to fourteen days.[5][15]
The virus is primarily spread between people during close contact,[a] often via small droplets produced by coughing,[b] sneezing, or talking.[6][16][18] The droplets usually fall to the ground or onto surfaces rather than remaining in the air over long distances.[6][19][20] People may also become infected by touching a contaminated surface and then touching their face.[6][16] In experimental settings, the virus may survive on surfaces for up to 72 hours.[21][22][23] It is most contagious during the first three days after the onset of symptoms, although spread may be possible before symptoms appear and in later stages of the disease.[24] The standard method of diagnosis is by real-time reverse transcription polymerase chain reaction (rRT-PCR) from a nasopharyngeal swab.[25] Chest CT imaging may also be helpful for diagnosis in individuals where there is a high suspicion of infection based on symptoms and risk factors; however, guidelines do not recommend using it for routine screening.[26][27]
Recommended measures to prevent infection include frequent hand washing, maintaining physical distance from others (especially from those with symptoms), covering coughs, and keeping unwashed hands away from the face.[28][29] In addition, the use of a face covering is recommended for those who suspect they have the virus and their caregivers.[30][31] Recommendations for face covering use by the general public vary, with some authorities recommending against their use, some recommending their use, and others requiring their use.[32][31][33] Currently, there is not enough evidence for or against the use of masks (medical or other) in healthy individuals in the wider community.[6] Also masks purchased by the public may impact availability for health care providers.
Currently, there is no vaccine or specific antiviral treatment for COVID-19.[6] Management involves the treatment of symptoms, supportive care, isolation, and experimental measures.[34] The World Health Organization (WHO) declared the 2019–20 coronavirus outbreak a Public Health Emergency of International Concern (PHEIC)[35][36] on 30 January 2020 and a pandemic on 11 March 2020.[10] Local transmission of the disease has occurred in most countries across all six WHO regions.[37]
File:En.Wikipedia-VideoWiki-Coronavirus disease 2019.webm
Video summary (script)
Contents
1Signs and symptoms
2Cause
2.1Transmission
2.2Virology
3Pathophysiology
3.1Immunopathology
4Diagnosis
4.1Pathology
5Prevention
6Management
6.1Medications
6.2Protective equipment
6.3Mechanical ventilation
6.4Acute respiratory distress syndrome
6.5Experimental treatment
6.6Information technology
6.7Psychological support
7Prognosis
7.1Reinfection
8History
9Epidemiology
9.1Infection fatality rate
9.2Sex differences
10Society and culture
10.1Name
10.2Misinformation
10.3Protests
11Other animals
12Research
12.1Vaccine
12.2Medications
12.3Anti-cytokine storm
12.4Passive antibodies
13See also
14Notes
15References
16External links
16.1Health agencies
16.2Directories
16.3Medical journals
Signs and symptoms
Symptom[4]Range
Fever83–99%
Cough59–82%
Loss of Appetite40–84%
Fatigue44–70%
Shortness of breath31–40%
Coughing up sputum28–33%
Loss of smell15[38] to 30%[12][39]
Muscle aches and pains11–35%
Fever is the most common symptom, although some older people and those with other health problems experience fever later in the disease.[4][40] In one study, 44% of people had fever when they presented to the hospital, while 89% went on to develop fever at some point during their hospitalization.[4][41]
Other common symptoms include cough, loss of appetite, fatigue, shortness of breath, sputum production, and muscle and joint pains.[4][5][42][43] Symptoms such as nausea, vomiting and diarrhoea have been observed in varying percentages.[44][45][46] Less common symptoms include sneezing, runny nose, or sore throat.[47]
More serious symptoms include difficulty breathing, persistent chest pain or pressure, confusion, difficulty waking, and bluish face or lips. Immediate medical attention is advised if these symptoms are present.[5][48]
In some, the disease may progress to pneumonia, multi-organ failure, and death.[9][14] In those who develop severe symptoms, time from symptom onset to needing mechanical ventilation is typically eight days.[4] Some cases in China initially presented with only chest tightness and palpitations.[49]
Loss of smell was identified as a common symptom of COVID‑19 in March 2020,[12][39] although perhaps not as common as initially reported.[38] A decreased sense of smell and/or disturbances in taste have also been reported.[50] Estimates for loss of smell range from 15%[38] to 30%.[12][39]
As is common with infections, there is a delay between the moment a person is first infected and the time he or she develops symptoms. This is called the incubation period. The incubation period for COVID‑19 is typically five to six days but may range from two to 14 days,[51][52] although 97.5% of people who develop symptoms will do so within 11.5 days of infection.[53]
A minority of cases do not develop noticeable symptoms at any point in time.[54][55] These asymptomatic carriers tend not to get tested, and their role in transmission is not yet fully known.[56][57] However, preliminary evidence suggests they may contribute to the spread of the disease.[58][59] In March 2020, the Korea Centers for Disease Control and Prevention (KCDC) reported that 20% of confirmed cases remained asymptomatic during their hospital stay.[59][60]
A number of neurological symptoms has been reported including seizures, stroke, encephalitis and Guillain-Barre syndrome.[61] Cardiovascular related complications may include heart failure, irregular electrical activity, blood clots, and heart inflammation.[62]
Cause
See also: Severe acute respiratory syndrome coronavirus 2
Transmission
Cough/sneeze droplets visualised in dark background using Tyndall scattering
Respiratory droplets produced when a man is sneezing visualised using Tyndall scattering
File:COVID19 in numbers- R0, the case fatality rate and why we need to flatten the curve.webm
A video discussing the basic reproduction number and case fatality rate in the context of the pandemic
Some details about how the disease is spread are still being determined.[16][18] The WHO and the U.S. Centers for Disease Control and Prevention (CDC) say it is primarily spread during close contact and by small droplets produced when people cough, sneeze or talk;[6][16] with close contact being within approximately 1–2 m (3–7 ft).[6][63] Both sputum and saliva can carry large viral loads.[64] Loud talking releases more droplets than normal talking.[65] A study in Singapore found that an uncovered cough can lead to droplets travelling up to 4.5 metres (15 feet).[66] An article published in March 2020 argued that advice on droplet distance might be based on 1930s research which ignored the effects of warm moist exhaled air surrounding the droplets and that an uncovered cough or sneeze can travel up to 8.2 metres (27 feet).[17]
Respiratory droplets may also be produced while breathing out, including when talking. Though the virus is not generally airborne,[6][67] the National Academy of Sciences has suggested that bioaerosol transmission may be possible.[68] In one study cited, air collectors positioned in the hallway outside of people's rooms yielded samples positive for viral RNA but finding infectious virus has proven elusive.[68] The droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.[16] Some medical procedures such as intubation and cardiopulmonary resuscitation (CPR) may cause respiratory secretions to be aerosolised and thus result in an airborne spread.[67] Initial studies suggested a doubling time of the number of infected persons of 6–7 days and a basic reproduction number (R0 ) of 2.2–2.7, but a study published on April 7, 2020, calculated a much higher median R0 value of 5.7 in Wuhan.[69]
It may also spread when one touches a contaminated surface, known as fomite transmission, and then touches one's eyes, nose or mouth.[6] While there are concerns it may spread via faeces, this risk is believed to be low.[6][16]
The virus is most contagious when people are symptomatic; though spread is may be possible before symptoms emerge and from those who never develop symptoms.[6][70] A portion of individuals with coronavirus lack symptoms.[71] The European Centre for Disease Prevention and Control (ECDC) says while it is not entirely clear how easily the disease spreads, one person generally infects two or three others.[18]
The virus survives for hours to days on surfaces.[6][18] Specifically, the virus was found to be detectable for one day on cardboard, for up to three days on plastic (polypropylene) and stainless steel (AISI 304), and for up to four hours on 99% copper.[21][23] This, however, varies depending on the humidity and temperature.[72][73] Surfaces may be decontaminated with many solutions (with one minute of exposure to the product achieving a 4 or more log reduction (99.99% reduction)), including 78–95% ethanol (alcohol used in spirits), 70–100% 2-propanol (isopropyl alcohol), the combination of 45% 2-propanol with 30% 1-propanol, 0.21% sodium hypochlorite (bleach), 0.5% hydrogen peroxide, or 0.23–7.5% povidone-iodine. Soap and detergent are also effective if correctly used; soap products degrade the virus' fatty protective layer, deactivating it, as well as freeing them from the skin and other surfaces.[74] Other solutions, such as benzalkonium chloride and chlorhexidine gluconate (a surgical disinfectant), are less effective.[75]
In a Hong Kong study, saliva samples were taken a median of two days after the start of hospitalization. In five of six patients, the first sample showed the highest viral load, and the sixth patient showed the highest viral load on the second day tested.[64]
Virology
Main article: Severe acute respiratory syndrome coronavirus 2
Illustration of SARSr-CoV virion
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel severe acute respiratory syndrome coronavirus, first isolated from three people with pneumonia connected to the cluster of acute respiratory illness cases in Wuhan.[76] All features of the novel SARS-CoV-2 virus occur in related coronaviruses in nature.[77] Outside the human body, the virus is killed by household soap, which bursts its protective bubble.[26]
SARS-CoV-2 is closely related to the original SARS-CoV.[78] It is thought to have a zoonotic origin. Genetic analysis has revealed that the coronavirus genetically clusters with the genus Betacoronavirus, in subgenus Sarbecovirus (lineage B) together with two bat-derived strains. It is 96% identical at the whole genome level to other bat coronavirus samples (BatCov RaTG13).[47] In February 2020, Chinese researchers found that there is only one amino acid difference in the binding domain of the S protein between the coronaviruses from pangolins and those from humans; however, whole-genome comparison to date found that at most 92% of genetic material was shared between pangolin coronavirus and SARS-CoV-2, which is insufficient to prove pangolins to be the intermediate host.[79]
Pathophysiology
The lungs are the organs most affected by COVID‑19 because the virus accesses host cells via the enzyme angiotensin-converting enzyme 2 (ACE2), which is most abundant in type II alveolar cells of the lungs. The virus uses a special surface glycoprotein called a "spike" (peplomer) to connect to ACE2 and enter the host cell.[80] The density of ACE2 in each tissue correlates with the severity of the disease in that tissue and some have suggested that decreasing ACE2 activity might be protective,[81][82] though another view is that increasing ACE2 using angiotensin II receptor blocker medications could be protective and these hypotheses need to be tested.[83] As the alveolar disease progresses, respiratory failure might develop and death may follow.[82]
The virus also affects gastrointestinal organs as ACE2 is abundantly expressed in the glandular cells of gastric, duodenal and rectal epithelium[84] as well as endothelial cells and enterocytes of the small intestine.[85]
ACE2 is present in the brain, and there is growing evidence of neurological manifestations in people with COVID‑19. It is not certain if the virus can directly infect the brain by crossing the barriers that separate the circulation of the brain and the general circulation. Other coronaviruses are able to infect the brain via a synaptic route to the respiratory centre in the medulla, through mechanoreceptors like pulmonary stretch receptors and chemoreceptors (primarily central chemoreceptors) within the lungs.[medical citation needed] It is possible that dysfunction within the respiratory centre further worsens the ARDS seen in COVID‑19 patients. Common neurological presentations include a loss of smell, headaches, nausea, and vomiting. Encephalopathy has been noted to occur in some patients (and confirmed with imaging), with some reports of detection of the virus after cerebrospinal fluid assays although the presence of oligoclonal bands seems to be a common denominator in these patients.[86]
The virus can cause acute myocardial injury and chronic damage to the cardiovascular system.[87] An acute cardiac injury was found in 12% of infected people admitted to the hospital in Wuhan, China,[88] and is more frequent in severe disease.[89] Rates of cardiovascular symptoms are high, owing to the systemic inflammatory response and immune system disorders during disease progression, but acute myocardial injuries may also be related to ACE2 receptors in the heart.[87] ACE2 receptors are highly expressed in the heart and are involved in heart function.[87][90] A high incidence of thrombosis (31%) and venous thromboembolism (25%) have been found in ICU patients with COVID‑19 infections and may be related to poor prognosis.[91][92] Blood vessel dysfunction and clot formation (as suggested by high D-dimer levels) are thought to play a significant role in mortality, incidences of clots leading to pulmonary embolisms, and ischaemic events within the brain have been noted as complications leading to death in patients infected with SARS-CoV-2. Infection appears to set off a chain of vasoconstrictive responses within the body, constriction of blood vessels within the pulmonary circulation has also been posited as a mechanism in which oxygenation decreases alongside with the presentation of viral pneumonia.[93]
Another common cause of death is complications related to the kidneys[93]—SARS-CoV-2 directly infects kidney cells, as confirmed in post-mortem studies. Acute kidney injury is a common complication and cause of death; this is more significant in patients with already compromised kidney function, especially in people with pre-existing chronic conditions such as hypertension and diabetes which specifically cause nephropathy in the long run.[94]
Autopsies of people who died of COVID‑19 have found diffuse alveolar damage (DAD), and lymphocyte-containing inflammatory infiltrates within the lung.[95]
Immunopathology
Although SARS-COV-2 has a tropism for ACE2-expressing epithelial cells of the respiratory tract, patients with severe COVID‑19 have symptoms of systemic hyperinflammation. Clinical laboratory findings of elevated IL-2, IL-7, IL-6, granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon-γ inducible protein 10 (IP-10), monocyte chemoattractant protein 1 (MCP-1), macrophage inflammatory protein 1-α (MIP-1α), and tumour necrosis factor-α (TNF-α) indicative of cytokine release syndrome (CRS) suggest an underlying immunopathology.[96]
Additionally, people with COVID‑19 and acute respiratory distress syndrome (ARDS) have classical serum biomarkers of CRS, including elevated C-reactive protein (CRP), lactate dehydrogenase (LDH), D-dimer, and ferritin.[97]
Systemic inflammation results in vasodilation, allowing inflammatory lymphocytic and monocytic infiltration of the lung and the heart. In particular, pathogenic GM-CSF-secreting T-cells were shown to correlate with the recruitment of inflammatory IL-6-secreting monocytes and severe lung pathology in COVID‑19 patients.[98] Lymphocytic infiltrates have also been reported at autopsy.[95]
Diagnosis
Main article: COVID-19 testing
Demonstration of a nasopharyngeal swab for COVID-19 testing
CDC rRT-PCR test kit for COVID-19[99]
The WHO has published several testing protocols for the disease.[100] The standard method of testing is real-time reverse transcription polymerase chain reaction (rRT-PCR).[101] The test is typically done on respiratory samples obtained by a nasopharyngeal swab; however, a nasal swab or sputum sample may also be used.[25][102] Results are generally available within a few hours to two days.[103][104] Blood tests can be used, but these require two blood samples taken two weeks apart, and the results have little immediate value.[105] Chinese scientists were able to isolate a strain of the coronavirus and publish the genetic sequence so laboratories across the world could independently develop polymerase chain reaction (PCR) tests to detect infection by the virus.[9][106][107] As of 4 April 2020, antibody tests (which may detect active infections and whether a person had been infected in the past) were in development, but not yet widely used.[108][109][110] The Chinese experience with testing has shown the accuracy is only 60 to 70%.[111] The FDA in the United States approved the first point-of-care test on 21 March 2020 for use at the end of that month.[112]
Diagnostic guidelines released by Zhongnan Hospital of Wuhan University suggested methods for detecting infections based upon clinical features and epidemiological risk. These involved identifying people who had at least two of the following symptoms in addition to a history of travel to Wuhan or contact with other infected people: fever, imaging features of pneumonia, normal or reduced white blood cell count, or reduced lymphocyte count.[113]
A study asked hospitalised COVID‑19 patients to cough into a sterile container, thus producing a saliva sample, and detected the virus in eleven of twelve patients using RT-PCR. This technique has the potential of being quicker than a swab and involving less risk to health care workers (collection at home or in the car).[64]
Along with laboratory testing, chest CT scans may be helpful to diagnose COVID-19 in individuals with a high clinical suspicion of infection but are not recommended for routine screening.[26][27] Bilateral multilobar ground-glass opacities with a peripheral, asymmetric, and posterior distribution are common in early infection.[26] Subpleural dominance, crazy paving (lobular septal thickening with variable alveolar filling), and consolidation may appear as the disease progresses.[26][114]
In late 2019, WHO assigned the emergency ICD-10 disease codes U07.1 for deaths from lab-confirmed SARS-CoV-2 infection and U07.2 for deaths from clinically or epidemiologically diagnosed COVID‑19 without lab-confirmed SARS-CoV-2 infection.[115]
Typical CT imaging findings
CT imaging of rapid progression stage
Pathology
Few data are available about microscopic lesions and the pathophysiology of COVID‑19.[116][117] The main pathological findings at autopsy are:
Macroscopy: pleurisy, pericarditis, lung consolidation and pulmonary oedema
Four types of severity of viral pneumonia can be observed:
minor pneumonia: minor serous exudation, minor fibrin exudation
mild pneumonia: pulmonary oedema, pneumocyte hyperplasia, large atypical pneumocytes, interstitial inflammation with lymphocytic infiltration and multinucleated giant cell formation
severe pneumonia: diffuse alveolar damage (DAD) with diffuse alveolar exudates. DAD is the cause of acute respiratory distress syndrome (ARDS) and severe hypoxemia.
healing pneumonia: organisation of exudates in alveolar cavities and pulmonary interstitial fibrosis
plasmocytosis in BAL[118]
Blood: disseminated intravascular coagulation (DIC);[119] leukoerythroblastic reaction[120]
Liver: microvesicular steatosis
Prevention
See also: 2019–20 coronavirus pandemic § Prevention, flatten the curve, and workplace hazard controls for COVID-19
Progressively stronger mitigation efforts to reduce the number of active cases at any given time—known as "flattening the curve"—allows healthcare services to better manage the same volume of patients.[121][122][123] Likewise, progressively greater increases in healthcare capacity—called raising the line—such as by increasing bed count, personnel, and equipment, helps to meet increased demand.[124]
Mitigation attempts that are inadequate in strictness or duration—such as premature relaxation of distancing rules or stay-at-home orders—can allow a resurgence after the initial surge and mitigation.[122][125]
Preventive measures to reduce the chances of infection include staying at home, avoiding crowded places, keeping distance from others, washing hands with soap and water often and for at least 20 seconds, practising good respiratory hygiene, and avoiding touching the eyes, nose, or mouth with unwashed hands.[126][127][128] The CDC recommends covering the mouth and nose with a tissue when coughing or sneezing and recommends using the inside of the elbow if no tissue is available.[126] Proper hand hygiene after any cough or sneeze is encouraged.[126] The CDC has recommended the use of cloth face coverings in public settings where other social distancing measures are difficult to maintain, in part to limit transmission by asymptomatic individuals.[129] The U.S. National Institutes of Health guidelines do not recommend any medication for prevention of COVID‑19, before or after exposure to the SARS-CoV-2 virus, outside of the setting of a clinical trial.[130]
Social distancing strategies aim to reduce contact of infected persons with large groups by closing schools and workplaces, restricting travel, and cancelling large public gatherings.[131] Distancing guidelines also include that people stay at least 6 feet (1.8 m) apart.[132] There is no medication known to be effective at preventing COVID‑19.[133] After the implementation of social distancing and stay-at-home orders, many regions have been able to sustain an effective transmission rate ("Rt") of less than one, meaning the disease is in remission in those areas.[134]
As a vaccine is not expected until 2021 at the earliest,[135] a key part of managing COVID‑19 is trying to decrease the epidemic peak, known as "flattening the curve".[122] This is done by slowing the infection rate to decrease the risk of health services being overwhelmed, allowing for better treatment of current cases, and delaying additional cases until effective treatments or a vaccine become available.[122][125]
According to the WHO, the use of masks is recommended only if a person is coughing or sneezing or when one is taking care of someone with a suspected infection.[136] For the European Centre for Disease Prevention and Control (ECDC) face masks "... could be considered especially when visiting busy closed spaces ..." but "... only as a complementary measure ..."[137] Several countries have recommended that healthy individuals wear face masks or cloth face coverings (like scarves or bandanas) at least in certain public settings, including China,[138] Hong Kong,[139] Spain,[140] Italy (Lombardy region),[141] and the United States.[129]
Those diagnosed with COVID‑19 or who believe they may be infected are advised by the CDC to stay home except to get medical care, call ahead before visiting a healthcare provider, wear a face mask before entering the healthcare provider's office and when in any room or vehicle with another person, cover coughs and sneezes with a tissue, regularly wash hands with soap and water and avoid sharing personal household items.[30][142] The CDC also recommends that individuals wash hands often with soap and water for at least 20 seconds, especially after going to the toilet or when hands are visibly dirty, before eating and after blowing one's nose, coughing or sneezing. It further recommends using an alcohol-based hand sanitiser with at least 60% alcohol, but only when soap and water are not readily available.[126]
For areas where commercial hand sanitisers are not readily available, the WHO provides two formulations for local production. In these formulations, the antimicrobial activity arises from ethanol or isopropanol. Hydrogen peroxide is used to help eliminate bacterial spores in the alcohol; it is "not an active substance for hand antisepsis". Glycerol is added as a humectant.[143]
Prevention efforts are multiplicative, with effects far beyond that of a single spread. Each avoided case leads to more avoided cases down the line, which in turn can stop the outbreak in its tracks.
File:COVID19 W ENG.ogv
Handwashing instructions
Management
People are managed with supportive care, which may include fluid therapy, oxygen support, and supporting other affected vital organs.[144][145][146] The CDC recommends that those who suspect they carry the virus wear a simple face mask.[30] Extracorporeal membrane oxygenation (ECMO) has been used to address the issue of respiratory failure, but its benefits are still under consideration.[41][147] Personal hygiene and a healthy lifestyle and diet have been recommended to improve immunity.[148] Supportive treatments may be useful in those with mild symptoms at the early stage of infection.[149]
The WHO, the Chinese National Health Commission, and the United States' National Institutes of Health have published recommendations for taking care of people who are hospitalised with COVID‑19.[130][150][151] Intensivists and pulmonologists in the U.S. have compiled treatment recommendations from various agencies into a free resource, the IBCC.[152][153]
Medications
See also: Coronavirus disease 2019 § Research
As of April 2020, there is no specific treatment for COVID‑19.[6][133] Research is, however, ongoing. For symptoms, some medical professionals recommend paracetamol (acetaminophen) over ibuprofen for first-line use.[154][155][156] The WHO and NIH do not oppose the use of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen for symptoms,[130][157] and the FDA says currently there is no evidence that NSAIDs worsen COVID‑19 symptoms.[158]
While theoretical concerns have been raised about ACE inhibitors and angiotensin receptor blockers, as of 19 March 2020, these are not sufficient to justify stopping these medications.[130][159][160][161] Steroids, such as methylprednisolone, are not recommended unless the disease is complicated by acute respiratory distress syndrome.[162][163]
Medications to prevent blood clotting have been suggested for treatment,[91] and anticoagulant therapy with low molecular weight heparin appears to be associated with better outcomes in severe COVID‐19 showing signs of coagulopathy (elevated D-dimer).[164]
Protective equipment
See also: COVID-19 related shortages
The CDC recommends four steps to putting on personal protective equipment (PPE).[165]
Precautions must be taken to minimise the risk of virus transmission, especially in healthcare settings when performing procedures that can generate aerosols, such as intubation or hand ventilation.[166] For healthcare professionals caring for people with COVID‑19, the CDC recommends placing the person in an Airborne Infection Isolation Room (AIIR) in addition to using standard precautions, contact precautions, and airborne precautions.[167]
The CDC outlines the guidelines for the use of personal protective equipment (PPE) during the pandemic. The recommended gear is a PPE gown, respirator or facemask, eye protection, and medical gloves.[168][169]
When available, respirators (instead of facemasks) are preferred.[170] N95 respirators are approved for industrial settings but the FDA has authorised the masks for use under an Emergency Use Authorisation (EUA). They are designed to protect from airborne particles like dust but effectiveness against a specific biological agent is not guaranteed for off-label uses.[171] When masks are not available, the CDC recommends using face shields or, as a last resort, homemade masks.[172]
Mechanical ventilation
Most cases of COVID‑19 are not severe enough to require mechanical ventilation or alternatives, but a percentage of cases are.[173][174] The type of respiratory support for individuals with COVID‑19 related respiratory failure is being actively studied for people in the hospital, with some evidence that intubation can be avoided with a high flow nasal cannula or bi-level positive airway pressure.[175] Whether either of these two leads to the same benefit for people who are critically ill is not known.[176] Some doctors prefer staying with invasive mechanical ventilation when available because this technique limits the spread of aerosol particles compared to a high flow nasal cannula.[173]
Severe cases are most common in older adults (those older than 60 years,[173] and especially those older than 80 years).[177] Many developed countries do not have enough hospital beds per capita, which limits a health system's capacity to handle a sudden spike in the number of COVID‑19 cases severe enough to require hospitalisation.[178] This limited capacity is a significant driver behind calls to flatten the curve.[178] One study in China found 5% were admitted to intensive care units, 2.3% needed mechanical support of ventilation, and 1.4% died.[41] In China, approximately 30% of people in hospital with COVID‑19 are eventually admitted to ICU.[4]
Acute respiratory distress syndrome
Main article: Acute respiratory distress syndrome
Mechanical ventilation becomes more complex as acute respiratory distress syndrome (ARDS) develops in COVID‑19 and oxygenation becomes increasingly difficult.[179] Ventilators capable of pressure control modes and high PEEP[180] are needed to maximise oxygen delivery while minimising the risk of ventilator-associated lung injury and pneumothorax.[181] High PEEP may not be available on older ventilators.
Options for ARDS[179]
TherapyRecommendations
High-flow nasal oxygenFor SpO2 <93%. May prevent the need for intubation and ventilation
Tidal volume6mL per kg and can be reduced to 4mL/kg
Plateau airway pressureKeep below 30 cmH2O if possible (high respiratory rate (35 per minute) may be required)
Positive end-expiratory pressureModerate to high levels
Prone positioningFor worsening oxygenation
Fluid managementGoal is a negative balance of 0.5–1.0L per day
AntibioticsFor secondary bacterial infections
GlucocorticoidsNot recommended
Experimental treatment
See also: § Research
Research into potential treatments started in January 2020,[182] and several antiviral drugs are in clinical trials.[183][184] Remdesivir appears to be the most promising.[133] Although new medications may take until 2021 to develop,[185] several of the medications being tested are already approved for other uses or are already in advanced testing.[186] Antiviral medication may be tried in people with severe disease.[144] The WHO recommended volunteers take part in trials of the effectiveness and safety of potential treatments.[187]
The FDA has granted temporary authorisation to convalescent plasma as an experimental treatment in cases where the person's life is seriously or immediately threatened. It has not undergone the clinical studies needed to show it is safe and effective for the disease.[188][189][190]
Information technology
See also: Contact tracing and Government by algorithm
In February 2020, China launched a mobile app to deal with the disease outbreak.[191] Users are asked to enter their name and ID number. The app can detect 'close contact' using surveillance data and therefore a potential risk of infection. Every user can also check the status of three other users. If a potential risk is detected, the app not only recommends self-quarantine, it also alerts local health officials.[192]
Big data analytics on cellphone data, facial recognition technology, mobile phone tracking, and artificial intelligence are used to track infected people and people whom they contacted in South Korea, Taiwan, and Singapore.[193][194] In March 2020, the Israeli government enabled security agencies to track mobile phone data of people supposed to have coronavirus. The measure was taken to enforce quarantine and protect those who may come into contact with infected citizens.[195] Also in March 2020, Deutsche Telekom shared aggregated phone location data with the German federal government agency, Robert Koch Institute, to research and prevent the spread of the virus.[196] Russia deployed facial recognition technology to detect quarantine breakers.[197] Italian regional health commissioner Giulio Gallera said he has been informed by mobile phone operators that "40% of people are continuing to move around anyway".[198] German government conducted a 48 hours weekend hackathon with more than 42.000 participants.[199][200] Two million people in the UK used an app developed in March 2020 by King's College London and Zoe to track people with COVID‑19 symptoms.[201] Also, the president of Estonia, Kersti Kaljulaid, made a global call for creative solutions against the spread of coronavirus.[202]
Psychological support
See also: Mental health during the 2019–20 coronavirus pandemic
Individuals may experience distress from quarantine, travel restrictions, side effects of treatment, or fear of the infection itself. To address these concerns, the National Health Commission of China published a national guideline for psychological crisis intervention on 27 January 2020.[203][204]
The Lancet published a 14-page call for action focusing on the UK and stated conditions were such that a range of mental health issues was likely to become more common. BBC quoted Rory O'Connor in saying, "Increased social isolation, loneliness, health anxiety, stress and an economic downturn are a perfect storm to harm people's mental health and wellbeing."[205][206]
Prognosis
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The severity of diagnosed cases in China
The severity of diagnosed COVID-19 cases in China[207]
Case fatality rates for COVID-19 by age by country.
Case fatality rates by age group:
China, as of 11 February 2020[208]
South Korea, as of 15 April 2020[209]
Spain, as of 24 April 2020[210]
Italy, as of 23 April 2020[211]
Case fatality rate depending on other health problems
Case fatality rate in China depending on other health problems. Data through 11 February 2020.[208]
Case fatality rate by country and number of cases
The number of deaths vs total cases by country and approximate case fatality rate[212]
The severity of COVID‑19 varies. The disease may take a mild course with few or no symptoms, resembling other common upper respiratory diseases such as the common cold. Mild cases typically recover within two weeks, while those with severe or critical diseases may take three to six weeks to recover. Among those who have died, the time from symptom onset to death has ranged from two to eight weeks.[47]
Children make up a small proportion of reported cases, with about 1% of cases being under 10 years, and 4% aged 10-19 years.[22] They are likely to have milder symptoms and a lower chance of severe disease than adults; in those younger than 50 years, the risk of death is less than 0.5%, while in those older than 70 it is more than 8%.[213][214][215] Pregnant women may be at higher risk for severe infection with COVID-19 based on data from other similar viruses, like SARS and MERS, but data for COVID-19 is lacking.[216][217] In China, children acquired infections mainly through close contact with their parents or other family members who lived in Wuhan or had traveled there.[213]
In some people, COVID‑19 may affect the lungs causing pneumonia. In those most severely affected, COVID-19 may rapidly progress to acute respiratory distress syndrome (ARDS) causing respiratory failure, septic shock, or multi-organ failure.[218][219] Complications associated with COVID‑19 include sepsis, abnormal clotting, and damage to the heart, kidneys, and liver. Clotting abnormalities, specifically an increase in prothrombin time, have been described in 6% of those admitted to hospital with COVID-19, while abnormal kidney function is seen in 4% of this group.[220] Approximately 20-30% of people who present with COVID‑19 demonstrate elevated liver enzymes (transaminases).[133] Liver injury as shown by blood markers of liver damage is frequently seen in severe cases.[221]
Some studies have found that the neutrophil to lymphocyte ratio (NLR) may be helpful in early screening for severe illness.[222]
Most of those who die of COVID‑19 have pre-existing (underlying) conditions, including hypertension, diabetes mellitus, and cardiovascular disease.[223] The Istituto Superiore di Sanità reported that out of 8.8% of deaths where medical charts were available for review, 97.2% of sampled patients had at least one comorbidity with the average patient having 2.7 diseases.[224] According to the same report, the median time between the onset of symptoms and death was ten days, with five being spent hospitalised. However, patients transferred to an ICU had a median time of seven days between hospitalisation and death.[224] In a study of early cases, the median time from exhibiting initial symptoms to death was 14 days, with a full range of six to 41 days.[225] In a study by the National Health Commission (NHC) of China, men had a death rate of 2.8% while women had a death rate of 1.7%.[226] Histopathological examinations of post-mortem lung samples show diffuse alveolar damage with cellular fibromyxoid exudates in both lungs. Viral cytopathic changes were observed in the pneumocytes. The lung picture resembled acute respiratory distress syndrome (ARDS).[47] In 11.8% of the deaths reported by the National Health Commission of China, heart damage was noted by elevated levels of troponin or cardiac arrest.[49] According to March data from the United States, 89% of those hospitalised had preexisting conditions.[227]
The availability of medical resources and the socioeconomics of a region may also affect mortality.[228] Estimates of the mortality from the condition vary because of those regional differences,[229] but also because of methodological difficulties. The under-counting of mild cases can cause the mortality rate to be overestimated.[230] However, the fact that deaths are the result of cases contracted in the past can mean the current mortality rate is underestimated.[231][232] Smokers were 1.4 times more likely to have severe symptoms of COVID‑19 and approximately 2.4 times more likely to require intensive care or die compared to non-smokers.[233]
Concerns have been raised about long-term sequelae of the disease. The Hong Kong Hospital Authority found a drop of 20% to 30% in lung capacity in some people who recovered from the disease, and lung scans suggested organ damage.[234] This may also lead to post-intensive care syndrome following recovery.[235]
Case fatality rates (%) by age and country
Age0–910–1920–2930–3940–4950–5960–6970–7980-8990+
China as of 11 February[208]0.00.20.20.20.41.33.68.014.8
Denmark as of 25 April[236]0.24.515.524.940.7
Italy as of 23 April[211]0.20.00.10.40.92.610.024.930.826.1
Netherlands as of 17 April[237]0.00.30.10.20.51.57.623.230.029.3
Portugal as of 24 April[238]0.00.00.00.00.30.62.88.516.5
S. Korea as of 15 April[209]0.00.00.00.10.20.72.59.722.2
Spain as of 24 April[210]0.30.40.30.30.61.34.413.220.320.1
Switzerland as of 25 April[239]0.90.00.00.10.00.52.710.124.0
Case fatality rates (%) by age in the United States
Age0–1920–4445–5455–6465–7475–8485+
United States as of 16 March[240]0.00.1–0.20.5–0.81.4–2.62.7–4.94.3–10.510.4–27.3
Note: The lower bound includes all cases. The upper bound excludes cases that were missing data.
Estimate of infection fatality rates and probability of severe disease course (%) by age based on cases from China[241]
0–910–1920–2930–3940–4950–5960–6970–7980+
Severe disease0.0
(0.0–0.0)0.04
(0.02–0.08)1.0
(0.62–2.1)3.4
(2.0–7.0)4.3
(2.5–8.7)8.2
(4.9–17)11
(7.0–24)17
(9.9–34)18
(11–38)
Death0.0016
(0.00016–0.025)0.0070
(0.0015–0.050)0.031
(0.014–0.092)0.084
(0.041–0.19)0.16
(0.076–0.32)0.60
(0.34–1.3)1.9
(1.1–3.9)4.3
(2.5–8.4)7.8
(3.8–13)
Total infection fatality rate is estimated to be 0.66% (0.39–1.3). Infection fatality rate is fatality per all infected individuals, regardless of whether they were diagnosed or had any symptoms. Numbers in parentheses are 95% credible intervals for the estimates.
Reinfection
As of March 2020, it was unknown if past infection provides effective and long-term immunity in people who recover from the disease.[242] Immunity is seen as likely, based on the behaviour of other coronaviruses,[243] but cases in which recovery from COVID‑19 have been followed by positive tests for coronavirus at a later date have been reported.[244][245][246][247] These cases are believed to be worsening of a lingering infection rather than re-infection.[247]
History
Main article: Timeline of the 2019–20 coronavirus pandemic
The virus is thought to be natural and has an animal origin,[77] through spillover infection.[248] The actual origin is unknown, but by December 2019 the spread of infection was almost entirely driven by human-to-human transmission.[208][249] A study of the first 41 cases of confirmed COVID‑19, published in January 2020 in The Lancet, revealed the earliest date of onset of symptoms as 1 December 2019.[250][251][252] Official publications from the WHO reported the earliest onset of symptoms as 8 December 2019.[253] Human-to-human transmission was confirmed by the WHO and Chinese authorities by 20 January 2020.[254][255]
Epidemiology
Main article: 2019–20 coronavirus pandemic
Several measures are commonly used to quantify mortality.[256] These numbers vary by region and over time and are influenced by the volume of testing, healthcare system quality, treatment options, time since the initial outbreak, and population characteristics such as age, sex, and overall health.[257]
The death-to-case ratio reflects the number of deaths divided by the number of diagnosed cases within a given time interval. Based on Johns Hopkins University statistics, the global death-to-case ratio is 7.0% (203,044/2,899,830) as of 26 April 2020.[7] The number varies by region.[258]
Other measures include the case fatality rate (CFR), which reflects the percent of diagnosed individuals who die from a disease, and the infection fatality rate (IFR), which reflects the percent of infected individuals (diagnosed and undiagnosed) who die from a disease. These statistics are not time-bound and follow a specific population from infection through case resolution. Many academics have attempted to calculate these numbers for specific populations.[259]
Total confirmed cases over time
Total deaths over time
Total confirmed cases of COVID‑19 per million people, 10 April 2020[260]
Total confirmed deaths due to COVID‑19 per million people, 10 April 2020[261]
Infection fatality rate
Our World in Data states that as of March 25, 2020, the infection fatality rate (IFR) cannot be accurately calculated.[262] In February, the World Health Organization estimated the IFR at 0.94%, with a confidence interval between 0.37 percent to 2.9 percent.[263] The University of Oxford Centre for Evidence-Based Medicine (CEBM) estimated a global CFR of 0.72 percent and IFR of 0.1 percent to 0.36 percent.[264] According to CEBM, random antibody testing in Germany suggested an IFR of 0.37 percent there.[264] Firm lower limits to local infection fatality rates were established, such as in Bergamo province, where 0.57% of the population has died, leading to a minimum IFR of 0.57% in the province. This population fatality rate (PFR) minimum increases as more people get infected and run through their disease.[265][266] Similarly, as of April 22 in the New York City area, there were 15,411 deaths confirmed from COVID-19, and 19,200 excess deaths.[267] Very recently, the first results of antibody testing have come in, but there are no valid scientific reports based on them available yet. A Bloomberg Opinion piece provides a survey.[268][269]
Sex differences
Main article: Gendered impact of the 2019–20 coronavirus pandemic
The impact of the pandemic and its mortality rate are different for men and women.[270] Mortality is higher in men in studies conducted in China and Italy.[271][272][273] The highest risk for men is in their 50s, with the gap between men and women closing only at 90.[273] In China, the death rate was 2.8 percent for men and 1.7 percent for women.[273] The exact reasons for this sex-difference are not known, but genetic and behavioural factors could be a reason.[270] Sex-based immunological differences, a lower prevalence of smoking in women, and men developing co-morbid conditions such as hypertension at a younger age than women could have contributed to the higher mortality in men.[273] In Europe, of those infected with COVID‑19, 57% were men; of those infected with COVID‑19 who also died, 72% were men.[274] As of April 2020, the U.S. government is not tracking sex-related data of COVID‑19 infections.[275] Research has shown that viral illnesses like Ebola, HIV, influenza, and SARS affect men and women differently.[275] A higher percentage of health workers, particularly nurses, are women, and they have a higher chance of being exposed to the virus.[276] School closures, lockdowns, and reduced access to healthcare following the 2019–20 coronavirus pandemic may differentially affect the genders and possibly exaggerate existing gender disparity.[270][277]
Society and culture
Name
During the initial outbreak in Wuhan, China, the virus and disease were commonly referred to as "coronavirus" and "Wuhan coronavirus",[278][279][280] with the disease sometimes called "Wuhan pneumonia".[281][282] In the past, many diseases have been named after geographical locations, such as the Spanish flu,[283] Middle East Respiratory Syndrome, and Zika virus.[284]
In January 2020, the World Health Organisation recommended 2019-nCov[285] and 2019-nCoV acute respiratory disease[286] as interim names for the virus and disease per 2015 guidance and international guidelines against using geographical locations (e.g. Wuhan, China), animal species or groups of people in disease and virus names to prevent social stigma.[287][288][289]
The official names COVID‑19 and SARS-CoV-2 were issued by the WHO on 11 February 2020.[290] WHO chief Tedros Adhanom Ghebreyesus explained: CO for corona, VI for virus, D for disease and 19 for when the outbreak was first identified (31 December 2019).[291] The WHO additionally uses "the COVID‑19 virus" and "the virus responsible for COVID‑19" in public communications.[290] Both the disease and virus are commonly referred to as "coronavirus" in the media and public discourse.
Misinformation
Main article: Misinformation related to the 2019–20 coronavirus pandemic
After the initial outbreak of COVID‑19, conspiracy theories, misinformation, and disinformation emerged regarding the origin, scale, prevention, treatment, and other aspects of the disease and rapidly spread online.[292][293][294][295]
Protests
Beginning April 17, 2020, news media began reporting on a wave of demonstrations protesting against state-mandated quarantine restrictions in in Michigan, Ohio, and Kentucky.[296][297]
Other animals
Humans appear to be capable of spreading the virus to some other animals. A domestic cat in Liège, Belgium, tested positive after it started showing symptoms (diarrhoea, vomiting, shortness of breath) a week later than its owner, who was also positive.[298] Tigers at the Bronx Zoo in New York, United States, tested positive for the virus and showed symptoms of COVID‑19, including a dry cough and loss of appetite.[299]
A study on domesticated animals inoculated with the virus found that cats and ferrets appear to be "highly susceptible" to the disease, while dogs appear to be less susceptible, with lower levels of viral replication. The study failed to find evidence of viral replication in pigs, ducks, and chickens.[300]
Research
Main article: COVID-19 drug development
No medication or vaccine is approved to treat the disease.[186] International research on vaccines and medicines in COVID‑19 is underway by government organisations, academic groups, and industry researchers.[301][302] In March, the World Health Organisation initiated the "SOLIDARITY Trial" to assess the treatment effects of four existing antiviral compounds with the most promise of efficacy.[303]
Vaccine
Main article: COVID-19 vaccine
There is no available vaccine, but various agencies are actively developing vaccine candidates. Previous work on SARS-CoV is being used because both SARS-CoV and SARS-CoV-2 use the ACE2 receptor to enter human cells.[304] Three vaccination strategies are being investigated. First, researchers aim to build a whole virus vaccine. The use of such a virus, be it inactive or dead, aims to elicit a prompt immune response of the human body to a new infection with COVID‑19. A second strategy, subunit vaccines, aims to create a vaccine that sensitises the immune system to certain subunits of the virus. In the case of SARS-CoV-2, such research focuses on the S-spike protein that helps the virus intrude the ACE2 enzyme receptor. A third strategy is that of the nucleic acid vaccines (DNA or RNA vaccines, a novel technique for creating a vaccination). Experimental vaccines from any of these strategies would have to be tested for safety and efficacy.[305]
On 16 March 2020, the first clinical trial of a vaccine started with four volunteers in Seattle, United States. The vaccine contains a harmless genetic code copied from the virus that causes the disease.[306]
Antibody-dependent enhancement has been suggested as a potential challenge for vaccine development for SARS-COV-2, but this is controversial.[307]
Medications
Main article: COVID-19 drug repurposing research
At least 29 phase II–IV efficacy trials in COVID‑19 were concluded in March 2020 or scheduled to provide results in April from hospitals in China.[308][309] There are more than 300 active clinical trials underway as of April 2020.[133] Seven trials were evaluating already approved treatments, including four studies on hydroxychloroquine or chloroquine.[309] Repurposed antiviral drugs make up most of the Chinese research, with nine phase III trials on remdesivir across several countries due to report by the end of April.[308][309] Other candidates in trials include vasodilators, corticosteroids, immune therapies, lipoic acid, bevacizumab, and recombinant angiotensin-converting enzyme 2.[309]
The COVID‑19 Clinical Research Coalition has goals to 1) facilitate rapid reviews of clinical trial proposals by ethics committees and national regulatory agencies, 2) fast-track approvals for the candidate therapeutic compounds, 3) ensure standardised and rapid analysis of emerging efficacy and safety data and 4) facilitate sharing of clinical trial outcomes before publication.[310][311]
Several existing medications are being evaluated for the treatment of COVID‑19,[186] including remdesivir, chloroquine, hydroxychloroquine, lopinavir/ritonavir, and lopinavir/ritonavir combined with interferon beta.[303][312] There is tentative evidence for efficacy by remdesivir, as of March 2020.[313][314] Clinical improvement was observed in patients treated with compassionate-use remdesivir.[315] Remdesivir inhibits SARS-CoV-2 in vitro.[316] Phase III clinical trials are underway in the U.S., China, and Italy.[186][308][317]
In 2020, a trial found that lopinavir/ritonavir was ineffective in the treatment of severe illness.[318] Nitazoxanide has been recommended for further in vivo study after demonstrating low concentration inhibition of SARS-CoV-2.[316]
There are mixed results as of 3 April 2020 as to the effectiveness of hydroxychloroquine as a treatment for COVID‑19, with some studies showing little or no improvement.[319][320] The studies of chloroquine and hydroxychloroquine with or without azithromycin have major limitations that have prevented the medical community from embracing these therapies without further study.[133]
Oseltamivir does not inhibit SARS-CoV-2 in vitro and has no known role in COVID‑19 treatment.[133]
Anti-cytokine storm
Cytokine release syndrome (CRS) can be a complication in the later stages of severe COVID‑19. There is preliminary evidence that hydroxychloroquine may have anti-cytokine storm properties.[321]
Tocilizumab has been included in treatment guidelines by China's National Health Commission after a small study was completed.[322][323] It is undergoing a phase 2 non-randomised trial at the national level in Italy after showing positive results in people with severe disease.[324][325] Combined with a serum ferritin blood test to identify cytokine storms, it is meant to counter such developments, which are thought to be the cause of death in some affected people.[326][327][328] The interleukin-6 receptor antagonist was approved by the FDA to undergo a phase III clinical trial assessing the medication's impact on COVID‑19 based on retrospective case studies for the treatment of steroid-refractory cytokine release syndrome induced by a different cause, CAR T cell therapy, in 2017.[329] To date, there is no randomised, controlled evidence that tocilizumab is an efficacious treatment for CRS. Prophylactic tocilizumab has been shown to increase serum IL-6 levels by saturating the IL-6R, driving IL-6 across the blood-brain barrier, and exacerbating neurotoxicity while having no impact on the incidence of CRS.[330]
Lenzilumab, an anti-GM-CSF monoclonal antibody, is protective in murine models for CAR T cell-induced CRS and neurotoxicity and is a viable therapeutic option due to the observed increase of pathogenic GM-CSF secreting T-cells in hospitalised patients with COVID‑19.[331]
The Feinstein Institute of Northwell Health announced in March a study on "a human antibody that may prevent the activity" of IL-6.[332]
Passive antibodies
Transferring purified and concentrated antibodies produced by the immune systems of those who have recovered from COVID‑19 to people who need them is being investigated as a non-vaccine method of passive immunisation.[333] This strategy was tried for SARS with inconclusive results.[333] Viral neutralisation is the anticipated mechanism of action by which passive antibody therapy can mediate defence against SARS-CoV-2. Other mechanisms, however, such as antibody-dependent cellular cytotoxicity and/or phagocytosis, may be possible.[333] Other forms of passive antibody therapy, for example, using manufactured monoclonal antibodies, are in development.[333] Production of convalescent serum, which consists of the liquid portion of the blood from recovered patients and contains antibodies specific to this virus, could be increased for quicker deployment.[334]
This scene required 3 days of careful preparation, planning beforehand and a bit of luck, of course.
First, we had to figure out where the stags usually cross this active fork of the river. Just 2 days prior to this photo, due to low water, they could cross that shoal with the water barely covering their hock, which looked much less dramatic. Luckily, the water level ran high rather quickly in just a couple of days.
The rut was reaching its peak, stags were rutting in all direction. It was a challenge to get to the riverbank still in dark with the rutting stags not noticing our presence. We made it somehow, set up a photoblind, me and my photographer fellows were ready to go. Two stags were rutting just above the riverbank, where we were sitting.
This was the first stag to cross the river, which I encountered at least two more times during the rutting season by the way. Later in that sequence, he was rutting in the water, as well. 15 minutes later the other stag crossed the river, also.
It was a morning to remember!
Malurus cyaneus (male)
Copyright - All Rights Reserved. Use of any kind requires my written consent, thanks for looking. Faves and comments are very much appreciated.
Taken on September 01, 02 and 03, 2019.
I have the pleasure to show that capture, which required 12 HOURS of photo exposure, and 4 hours of treatment.
Captured with 2 special filters (Ha and OIII), you can see oxygen in blue, and hydrogen in red.
NGC 6960 is a nebula of ionized gas and dust located about 1,400 light-years from Earth in constellation Cygnus. It is the portion of the Cygnus Loop called Western Veil. The other two portions are Eastern Veil and Pickering's Triangle.
The Cygnus Loop (in which the witch broom is located) forms a supernova remnant whose explosion would date back to about ten thousand years. This object is very large and very fragmented
-----------------------------
NGC 6960 : La nébuleuse du balai de sorcière.
Prise le 01, 02 et 03 septembre 2019.
J'ai le plaisir de vous faire découvrir ma capture, qui a nécessité 12 HEURES de pose photo, et 4H de traitement.
Capturée avec 2 filtres spéciaux (Ha et OIII), vous pouvez apercevoir l'oxygène qui est en bleu, et l'hydrogène en rouge.
NGC 6960 est une nébuleuse constituée de gaz ionisé et de poussière située à environ 1 400 années-lumière de la Terre dans la constellation du Cygne. Elle constitue la portion des Dentelles du Cygne appelée Petite Dentelle. Les deux autres portions sont La Grande Dentelle et le Triangle de Pickering.
Les Dentelles du Cygne (dans lequel se trouve le balai de sorcière) forment un rémanent de supernova dont l'explosion remonterait à une dizaine de milliers d'années. Cet objet est très vaste et très morcelé.
What’s left of old steamboat jetty, used for dropping off supplies to locals on Loch Ness. I guess the Tesco Home Delivery Service may have a nail in that coffin…
The last five months (May-September 2023) required me to move a lot for a variety of professional and personal reasons. It was the first time in several years that I entered airplanes without carrying my DSLR camera. This resulted in me tinkering and thinking with my mobile phone camera, surpassing my snobbish attitude towards it as means of photographic expression. Visiting an old favourite antique store of mine, I was exposed to wallet-sized black and white pictures, very fashionable in the 1920s-1960s. Phenomenologically, I thought, these little pictures carried significance similar to the one carried by the myriads of photos nowadays stored on mobile phones. I tried to combine the sensory experience of black and white with the ease of mobile phone shooting, itself resembling certain types of pinhole cameras. Themes are the same as in my earlier photography: decayed and rusty patterns of disintegration, emptiness of spaces, outlier figures of the everyday, street signs and letters, nonhuman friends, naturecultures, and psychopolitically haunted scenes. Places include: Canada (Toronto), Greece (Athens, Thessaloniki, Alonnisos, Aghia, Larissa, Eleftheroupoli, Kavala), Scotland (Edinburgh), England (Manchester), France (Paris), Belgium (Brussels).
[Update] I have continued collecting such images throughout 2024. New places visited: Dublin, Rotterdam, Glasgow, Copenhagen, London, Stirling, Peebles, Amsterdam, Dundee, Madrid.
Bringing Burj Khalifa to life required a combination of visionary ideals and solid science. In the process, the project amassed an awe-inspiring number of facts, figures, and statistics.
World Records
At over 828 metres (2,716.5 feet) and more than 160 stories, Burj Khalifa holds the following records:
• Tallest building in the world
• Tallest free-standing structure in the world
• Highest number of stories in the world
• Highest occupied floor in the world
• Highest outdoor observation deck in the world
• Elevator with the longest travel distance in the world
• Tallest service elevator in the world
The last five months (May-September 2023) required me to move a lot for a variety of professional and personal reasons. It was the first time in several years that I entered airplanes without carrying my DSLR camera. This resulted in me tinkering and thinking with my mobile phone camera, surpassing my snobbish attitude towards it as means of photographic expression. Visiting an old favourite antique store of mine, I was exposed to wallet-sized black and white pictures, very fashionable in the 1920s-1960s. Phenomenologically, I thought, these little pictures carried significance similar to the one carried by the myriads of photos nowadays stored on mobile phones. I tried to combine the sensory experience of black and white with the ease of mobile phone shooting, itself resembling certain types of pinhole cameras. Themes are the same as in my earlier photography: decayed and rusty patterns of disintegration, emptiness of spaces, outlier figures of the everyday, street signs and letters, nonhuman friends, naturecultures, and psychopolitically haunted scenes. Places include: Canada (Toronto), Greece (Athens, Thessaloniki, Aghia, Larissa, Eleftheroupoli, Kavala), Scotland (Edinburgh), France (Paris), Belgium (Brussels).
Investment Opportunity/Rake in the Profits
Our astute president supports a smart policy of forest management to eliminate wildfires. Rake the forests, he says.
In California alone there are 33 million acres of forestlands, over half controlled and managed by the federal government. This innovative policy will require putting our national production of rakes into hyperdrive. It is time to invest in rake companies NOW!!.
This message has been approved by Finland's President, Sauli Niinisto.
This photo was taken by an Asahi Pentax 6 X 7 medium format film camera with a Super-Takumar/6X7 1:2.4/105mm lens and Zenza Bronica 67mm SY44•2C(Y1) filter using Adox CHS 100 II film, the negative scanned by an Epson Perfection V600 and digitally rendered with Photoshop.