Arderns style would be interestinga world leader in comfy clothes just casually chatting with millions of people!and nothing more, if it wasnt for the fact that her approach has been paired with policies that have produced real, world-leading results.
Since March, New Zealand has been unique in staking out a national goal of not just flattening the curve of coronavirus cases, as most other countries have aimed to do, but eliminating the virus altogether. And it is on track to do it. COVID-19 testing is widespread. The health system has not been overloaded. New cases peaked in early April. Twelve people have died as of this writing, out of a population of nearly 5 million.
As a collection of relatively isolated islands at the bottom of the South Pacific, New Zealand was in a favorable position to snuff out the virus. Because we had very few cases wash up here, we could actually work toward an elimination strategy, Clark said. It is undoubtedly an advantage to be sitting down on the periphery [of the world], because you have a chance to see whats circulating from abroad.
But Arderns government also took decisive action right away. New Zealand imposed a national lockdown much earlier in its outbreak than other countries did in theirs, and banned travelers from China in early February, before New Zealand had registered a single case of the virus. It closed its borders to all nonresidents in mid-March, when it had only a handful of cases.
Michael Baker and Nick Wilson, two of New Zealands top public-health experts, wrote last week that while the countrys ambitious strategy may yet fail, early intervention bought officials time to develop measures that could end the transmission of the coronavirus, such as rigorously quarantining at the countrys borders and expanding COVID-19 testing and contact tracing.
Jackson, the international-relations scholar, said that the decision by Arderns government to unveil its four-level alert system (it moved to Level 4 in late March) at the outset of the crisis was great at getting us ready psychologically for a step-up in seriousness, a model that couldnt be more different from Trumps What will I do today? approach.
The success, of course, isnt all Arderns doing; its also the product of an impressive collective effort by public-health institutions, opposition politicians, and New Zealanders as a whole, who have largely abided by social-distancing restrictions.
And that collective may be fraying. Although the government has unveiled many economic-stimulus measures, some opposition politicians and public-health experts are now demanding that the lockdown, which may be eased this week, be rolled back even further. They accuse the government of overreacting and argue that Australia has managed to reduce new coronavirus cases without the severe lockdown that New Zealand has endured.
Since its formation in 2008, the Tesla Quartet has been showered with critical accolades, released two recordings, hired a manager and lined up a full schedule at major concert halls around the world.
Even so, life as a professional string quartet has been a hand-to-mouth existence. The four players, aged 34 to 38, have long relied on relatives, friends and concert presenters for temporary housing, while stashing their few possessions in a storage locker. Only during the past year did their advance bookings give them the confidence and means to rent their own apartments in New York.
And then, in early March, their delicate world fell apart.
Tesla was scheduled to perform at Rockefeller University in Manhattan on March 6, and was wrapping up several weeks of rehearsals of Tchaikovskys First Quartet, when one of the violinists, Michelle Lie, opened her email. The university was canceling its next three recitals starting with Teslas, the following day.
Then came the following weeks scheduled performance at the Century Association, which suspended operations along with many of New Yorks other private clubs.
Teslas members Ms. Lie and Ross Snyder, violins; Edwin Kaplan, viola; and Serafim Smigelskiy, cello had been aware of the rapidly spreading coronavirus, but only now did it start to affect them personally. They decided to take a week off and regroup.
Then came a cascade of cancellations and postponements. Foreign travel was suspended. By late March, their performance calendar through June, which had been full, was bare.
Classical musicians are typically paid only after a performance is over, so the players suddenly confronted the prospect of no income for the foreseeable future. They doubted the few remaining summer festivals on their schedule would come through.
Soon they realized that simply being together could be a risk. A quartet is, by its nature, an intimate gathering. Players cant sit more than six feet apart and still hear each other, breathe together or respond to what are often subtle visual cues. Even transportation posed hazards: Mr. Kaplan and Mr. Smigelskiy used to take the subway to the apartment Mr. Snyder and Ms. Lie share in Brooklyn for rehearsals. In addition to their livelihoods, their musical identity was at stake.
The plight of four young musicians, however talented, may seem insignificant in the larger scheme of the pandemic: 22 million Americans have filed for unemployment insurance in the last four weeks. Still, there are over 41,000 professional musicians and singers in the United States, according to the Bureau of Labor Statistics, and those numbers dont include self-employed musicians like Teslas members. And all those musicians also help support an extensive but fragile ecosystem of managers, agents, concert presenters and halls, all of whom depend on performances for their livelihoods.
Beyond the numbers, musicians play an outsize role in the cultural life of the nation from symphony orchestras and operas to chamber music festivals; from Broadway pits to Nashville recording studios and national concert tours. Everything has now been canceled for the foreseeable future; it seems unlikely that performances will return this summer, and possibly beyond.
Even before the coronavirus, the string quartet was an endangered species. A few quartets, like the Juilliard, Guarneri and Emerson, are household names, at least for classical music lovers. But for most players, life in a small ensemble is a financial struggle even in the best of times.
Id met the members of Tesla named for the inventor, before the electric car became a well-known brand in 2017 at a chamber music program at Stanford, where Tesla won the top prize. Tesla was unusual in that its members didnt have to support themselves by doing other jobs or teaching although they, like those in other groups, relied on freelance gigs to supplement their quartet income. (Those gigs, of course, have also been canceled.)
Oni Buchanan, the founder and director of Ariel Artists, Teslas manager, said the quartet faces an existential crisis. They were lucky they didnt need five other sources of income. Their career was taking off. But now they have nothing.
For that matter, neither does Ms. Buchanan, a classical pianist who went into arts management after graduating from New England Conservatory rather than embarking on the grueling competition circuit. Ariel typically earns 20 percent of its clients fees, but only if they perform.
Right now I have no income, Ms. Buchanan said. She added that she has one full-time employee, but I cant afford to keep him much longer.
When Teslas players realized they couldnt rehearse which they usually did for four hours a day, five days a week they started to experiment with virtual practice sessions. Digital applications like Zoom dont work well because of lags in the transmission of images and sound; in music, timing is everything.
They ended up settling on a system in which one player would lay down a track; the others could then listen and play over it. Mr. Smigelskiy mixed the tracks using Adobe software and posted the finished product to YouTube. Every few days since March 21, Tesla has added another short variation on a Russian theme, which the members are calling Quarantunes.
Were trying to use technology to give a pretty good approximation of a live performance, said Mr. Kaplan, the violist. Its the only way music can exist right now.
Mr. Smigelskiy said the group chose lighthearted music to divert people from the virus. Were not playing the Barber Adagio, he said, referring to Samuel Barbers solemn Adagio for Strings.
But YouTube cant replicate the experience of live, simultaneous music-making. Theyre being very innovative, but virtual practice isnt sustainable over the long haul, said Ms. Buchanan. Its very depressing for them. They feed off each others energy.
Nor does YouTube generate any income.
Three of Teslas members have applied for assistance under the recent economic rescue packages, which made self-employed and freelance workers eligible for up to 39 weeks of unemployment insurance. They also qualify for the $600 weekly payment offered by the federal government through July. But none have yet been approved or received any funds; Mr. Smigelskiy hasnt yet been able to get through to New Yorks unemployment-insurance system.
Ms. Lies eligibility was complicated by her Korean nationality and the need to renew her United States visa. Before the pandemic, the Trump administration had been denying visas to anyone receiving unemployment benefits, on grounds they were at risk of becoming public charges. So Ms. Lie has been reluctant to apply for the benefits.
A number of private funds have sprung up to assist struggling artists, and Tesla applied to several. But most of the funds were overwhelmed within hours of accepting applications. So far theyve gotten only one positive response: $250 each from Artist Relief Tree, which now has a waiting list of over 5,500 applicants.
Ms. Buchanan has pleaded with concert presenters to break with tradition and pay half the quartets fee up front for new bookings. A few have agreed. And the Tippet Rise Arts Center in Montana, backed by the wealthy philanthropists and artists Peter and Cathy Halstead, said it would pay Teslas full fee for this summer and rebook them for next year in the increasingly likely event that the centers August festival is canceled.
But few classical music venues have the Halsteads deep pockets or large endowments; many run a deficit and depend on charitable contributions. While nonprofit organizations are eligible for low-interest loans under the federal stimulus legislation, some of which may later be forgiven, many may not survive the loss of months of programming and ticket revenue, to say nothing of donations threatened by the economic downturn.
The entire musical ecosystem is endangered.
So far weve managed to pay the rent, said Mr. Snyder, the Tesla violinist. But if this continues for several more months, I dont know. We were homeless for three years. I hope thats not where were headed again.
It did not have to be this way. If the Trump administration had not bungled testing, if it were not to this day jerking and lurching in obedience to the presidents latest ego demand, we could by now begin to see the way to a safer reopening in the next few weeks.
As is, the United States will be nearly as blind in May as it was in March. The testing regime remains bottlenecked and slow. Contact tracing barely exists. The people called back to work in the next few weeks will wear masks and stand farther apart from one another. But we are nowhere near the point of promptly identifying sick workers and effectively isolating them while they remain infectious.
The plans for a May return imply acceptance of significant infection and higher casualties. Pro-Trump talkers boast that they will volunteer for these risks themselves. Broadcaster Glenn Beck said on March 25:
I would rather have my children stay home and all of us who are over 50 go in and keep this economy going and working even if we all get sick. Id rather die than kill the country.
Those words were spoken from Becks home studio. The day before, Texas Lieutenant Governor Dan Patrick (also a former radio host) said something similar on Fox News to Tucker Carlson, who was broadcasting from his home studio.
My message: Lets get back to work, lets get back to living, lets be smart about it, and those of us who are 70-plus, well take care of ourselves.
But that is not how the pattern of sacrifice will be felt in real life. The Trump administration still has not built an effective testing-and-tracing system, almost half a year after the president received his first formal warning about the pandemic in his daily intelligence brief on January 3.
The coronavirus as Americans know it is not an equal-opportunity killer. The research arm of American Public Media reported on April 17 that 27 percent of those killed by COVID-19 to date have been African American, more than twice their share of the population. Grocery workers are dying in the dozens, at least 41 as of April 12, according to The Washington Post, with thousands more fallen sick.
Thanks to the lockdown rules adopted by most states in March, coronavirus deaths per day are projected to subside to below 1,000 by May 1, from the more than 2,000 a day of mid-April. If the lockdown continues a little longer, that number could tumble to below 100 a day by mid-May.
But to look at casualties as numbers on the curve is to misunderstand what the Fox talkers and the Trump donors are telling us. The political calculus of Trumps Plan A depends less on containing the total number of casualties than on confining the casualties to people deemed expendable.
A story from South Dakota is pertinent here. The states governor, Kristi Noem, resisted stay-in-place orders for her low-density state. As she said, South Dakota is not New York City. Then the state was hit by an outbreak at a Sioux Falls pork-packing plant: 634 cases among employees, plus hundreds more among those employees contacts, principally their relatives. Yet the Smithfield-plant outbreak has not changed Noems approach. The plants workforce, the BBC reports, was made up largely of immigrants and refugees from places like Myanmar, Ethiopia, Nepal, Congo and El Salvadornot Republican voters.
Ronald Morris: The administration screwed up. These inmates were over the Covid-19 virus, but they werent supposed to be released back out there yet, and so when they realized this, they went back an hour and a half later and grabbed em and put them back in the isolation unit. And when they did that, that freaked those inmates out because theyre scared of getting this [expletive], and they thought theyd just released the virus into that unit and contaminated them. The problem was, they didnt educate the inmates on whats going on. Its basic corrections 101, communicating with the inmate population. Go down there and town hall them and educate them. They didnt do that they kicked em out and then jerked them back up, and you think, Oh, hell, they just brought an infected person down here, and now were all going to get this [expletive].
Don Cain, via email: I know one thing is, if I do pass, my family has one heck of a suit.
On April 17, a Bureau of Prisons spokeswoman responded to a detailed request for comment with a statement: We want to point out that following a recent visit to F.C.C. Oakdale, the C.D.C. and the Louisiana Office of Public Health commended F.C.C. Oakdale staff and confirmed their compliance with current C.D.C. guidance for Covid management in correctional facilities. We direct you to our public website for detailed information about how the B.O.P. is taking aggressive steps to mitigate the spread of Covid in all of our facilities, including F.C.C. Oakdale.
Ronald Morris, via text, April 10: Another inmate death six. Positive inmates: 49. Positive staff: 26.
Correctional Officer 1: You dont know. This could be the day that you have a temperature. Or this is going to be the day that you come in contact with somebody thats going to get you sick. Every day when I come home kind of starts my 14 days over, where I cant have contact with my family. Its weighing on my wife, and its weighing on me. Im starting to become a little withdrawn and short. I know that my stress rubs on to her and then rubs off to the kids. And its not just us. Im sure its the health care providers, Im sure its the local parish and state law enforcement, federal law enforcement, firefighters. I mean, we all probably feel the exact same way. We have no choice.
Mayor Paul: We dont have a morgue at the Oakdale hospital. They have run in a portable morgue. Its an 18-wheeler on the loading dock. I understand it is for all the surrounding hospitals if needed.
Correctional Officer 2: Were still releasing inmates if its time for them to be released. When theyre going to leave here, theyre going to get on a Greyhound bus, probably change two or three different buses. Ones going, lets say, to Houston, one is going to Georgia; we send inmates all over the United States. We send inmates to Puerto Rico. We send inmates everywhere. I have brought up that if we know that theyre getting out, then why are we not putting them in quarantine? Because an inmate could not have a fever 12 hours before he leaves, get on a plane or a bus, and as soon as he gets home, he tests positive. Well, then hes contaminated all those people.
Financial markets can be bewildering at the best of times. But the coronavirus has made the task of understanding them so much harder.
The markets are supposed to anticipate economic developments. Yet early in the year, stocks ignored the looming pandemic. Only after the coronavirus hit hard in the United States did prices collapse like a deflating balloon.
By late March, thanks to the intervention of the Federal Reserve, stocks began rising sharply, even though the death toll was rising, unemployment claims were skyrocketing and the economy was shriveling.
These momentum shifts raise critical questions for ordinary people who have put their savings into the markets.
Have we seen the worst of it or will the recent stock gains, amid a devastating global health crisis, prove to be ephemeral? With so many medical, epidemiological and economic issues still unresolved, how can an ordinary person survive the treacherous financial shifts that are now so commonplace?
Our quarterly report on investing cant answer these pressing questions about the markets definitively. But it provides plenty of analysis and, perhaps, some clues about what may lie ahead.
Aspects of the current downturn resemble those of previous episodes in financial history. But the unique and lethal character of the pandemic adds considerable complexity to any market analysis. In a survey of what investors have experienced so far this year, our reporter says strategists can see more clearly the farther out they look.
The gigantic bond market isnt merely a critical source of funding for corporations and governments. It is also a primary source of income and stability for investors, especially during periods of economic turmoil when the stock market plummets.
In an analysis of the bond market, we found that core mutual funds holding long-term Treasuries generally held up well during the latest downturn. But riskier bonds were hammered and the prices of some large exchange-traded funds came under pressure until the Fed stepped in.
Despite financial problems nearly everywhere else, one enormous sector of the economy continues to be well funded: what President Eisenhower called the military-industrial complex. Companies with rich military contracts appear to be well hedged against recession.
But few mutual funds and E.T.F.s concentrate sufficiently in military stocks to make them an efficient way of investing in the sector. For that, you will probably need to hold individual stocks, our reporter found.
In a satirical essay, our columnist found that scores of businesses have suddenly started to care deeply about him. He suspects its because they desperately need his money.
For other views of the financial world, take a deeper look at our report:
As some governors consider easing social distancing restrictions, new estimates by researchers at Harvard University suggest that the United States cannot safely reopen unless it conducts more than three times the number of coronavirus tests it is currently administering over the next month.
Level needed
to safely
reopen
152 tests
tests per 100,000 people
(7-day average)
tests per 100,000 people
(7-day average)
Level to reopen
152 tests
An average of 146,000 people per day have been tested for the coronavirus nationally so far this month, according to the COVID Tracking Project, which on Friday reported 3.6 million total tests across the country. To reopen the United States by mid-May, the number of daily tests performed between now and then should be 500,000 to 700,000, according to the Harvard estimates.
That level of testing is necessary to identify the majority of people who are infected and isolate them from people who are healthy, according to the researchers. About 20 percent of those tested so far were positive for the virus, a rate that the researchers say is too high.
If you have a very high positive rate, it means that there are probably a good number of people out there who have the disease who you havent tested, said Ashish Jha, the director of the Harvard Global Health Institute. You want to drive the positive rate down, because the fundamental element of keeping our economy open is making sure youre identifying as many infected people as possible and isolating them.
The researchers said that expanded testing could reduce the rate to 10 percent, which is the maximum rate recommended by the World Health Organization. In Germany, that number is 7 percent, and in South Korea, it is closer to 3 percent.
There is variation in the rate of testing and positive results among states, but most need to administer more tests to get to the level the researchers suggest a minimum of about 152 tests per 100,000 people each day.
District of Columbia
D.C.
Notes: Testing levels shown are a 7-day moving average. Reporting methods and regularity can vary. Some decreases in testing can be because of a gap in reporting or a change in the reporting method. Only places with consistent and reliable data from the COVID Tracking Project are included.
In most states, people who had severe symptoms, worked in health facilities or were otherwise hospitalized were given priority for testing. The goal of the testing level recommended by the researchers would be to test nearly everyone who has mild or severe flulike symptoms, and an average of 10 contacts for each person who tests positive for the virus.
A shortage of test kits and technical flaws in the United States significantly delayed more widespread testing of the virus, letting it spread undetected for weeks. With more than 695,000 cases as of Friday, the country has the highest number of known cases in the world.
Health experts said that if the U.S. had tested earlier and more, the outbreak would have been better contained. Caitlin Rivers, an assistant professor at the Johns Hopkins Center for Health Security, said that since that did not happen and the virus spread rapidly, it has made sense to prioritize testing for those in hospitals in recent weeks.
It does make sense, given constraints, to focus on people with severe illness, because you need that information to guide their care, Dr. Rivers said.
In mid-May, however, when the researchers estimate infections will have subsided somewhat and states are looking to reopen their economies, Dr. Jha believes vastly expanded testing will be crucial.
I want to be able to identify everybody who is even mildly symptomatic, he said. So when I wake up one morning and have a sore throat and a fever, I should be able to go get tested. And then I want to be able to test all of my contacts if I turn out to be positive, so that I can do the test, trace and isolate strategy thats so critical to allowing us to open up and stay open.
New Jersey currently has the highest positive rate among all states about half of the 157,000 coronavirus tests that it has conducted so far have come back positive. That suggests that many of the people in the state who have the coronavirus have not been tested. And recently, testing in New Jersey has started to decline.
Level needed
to safely
reopen
152 tests
tests per 100,000 people
(7-day average)
tests per 100,000
people (7-day
average)
Level to reopen
152 tests
Note: Estimated cases are five times the number of cases identified. The researchers estimate that at least 80 percent of people who have the virus have not been tested.
The states testing has been hindered by setbacks, including long lines at testing facilities and a shortage of health care workers and testing swabs.
Christopher Neuwirth, an assistant commissioner at New Jerseys Health Department, said the states recent lag in testing could also indicate that fewer people are trying to get tested.
In the days and weeks up until testing was available, there was a huge pent-up demand, Mr. Neuwirth said. After that, he said, the public became more aware of the criteria for testing. People really paid attention and really heard the messaging that you have to be symptomatic.
That messaging will have to be reversed, Dr. Jha said, once testing is expanded.
We need to switch from saying to people, if you have mild symptoms, if youre not feeling super sick, dont come and stay at home, to if you have any symptoms, you need to come in to get tested right away, he said.
How does coronavirus enter the body, and why does it become fatal for some compared to just a cough or fever for others? USA TODAY
Abby Adair Reinhard pressed her iPhone tighter to her ear, straining to hear the soft rhythm of her father's breath.
In. Out. In. Out.
Five miles away, in a hospital bed in Rochester, New York, her father lay dying.
At first, his breaths were steadywhite noise that any other day would fade into the background.As the hours passed, his breathing became harder. Tortured. Heavy with mucus.
Reinhard a mom, a wife and a daughter spent the next day and a half listening to her father die, praying he could hear her voice. Moment by moment, she detailed those agonizing hoursin a wrenching Facebook post.
The terror Ive felt today is unlike anything I've ever experienced, and I can only imagine how hard it has been for you, Dad. Im so sorry you are going through this nightmare.
Don Adair, 76, was a father of four and agrandfather of five. A retired attorney who doted on his family, he'd traveled with them to Europe, sat on the floor to open Christmas presents, grinned wide at their graduations and bounced them on his knee.
Abby Adair Reinhard's father, Don, lived in the Rochester, N.Y., area his entire life, except for when he was in college and law school.(Photo: Handout photo Abby Adair Reinhard)
Now, he lay alone in a bed, isolated from other patients at Highland Hospital. He'd fallen at home a few days earlier, and hospital staffers werehelping him fight a minor infection.
Not a problem, Reinhard thought at first. Her dad, her rock, never got sick.
Then he developeda fever and a cough coronavirus.
Reinhard, 41,called her brother, Tom, in Texas. It was late on April 4. They wondered whether an asymptomatic patient in the hospital had passed along the infection. They talked about how the prognosis was good, how his symptoms were minor.
It's a conversation so manyAmericans are having, fretting late at night, consulting doctors and scouring the internet for signs of hope, looking at the statistics that say most people will never get really sick.
"He was very strong, physically. I'm sure he'll be fine, is what I told myself," she said. "We went to bed thinking, chances are he's going to be OK."
Don Adair was the grandfather of five children, including Leo.(Photo: Abby Adair Reinhard handout.)
Her husband made the kids french toast. They watched online Palm Sunday services, in whichthe pastor urged them to approach uncertainty with faith,not with fear.
Then came the call. A Highland nurse said things Reinhard tried to understand: "Aspiration ... deterioration ... suffering ... not much time.
Thenurse put the phone to Adair's ear. He couldn't talk, but he could listen.
Pacing in her bathroom,Reinhard struggled to catch her own breath, to hidehersobs from her three kids. To listen. To speak.
"I love you," she said.
"Thank you."
"I'm sorry."
"Iforgive you."
You settled down in between coughs, and I searched my heart for what to say.
I talked about our precious times at the lake. I remembered you playing your guitar around the campfire, and I clung to that image as if it were my saving grace.
The lyrics of those old campfire songs seemed so fitting now Milk and honey on the other side and Hes got the whole world in his hands.
Laundry overflowed the basket in the corner. She talked, listened, prayed. She felt like part of herwas outside her own body. It was too much to take in.
After half an hour, she realized she could conference in her siblings Tom, Carrie inNorth Carolinaand Emily inDenmark. They stayed on the phone for hours, singing more campfire songs, telling stories, remembering their childhood.
Over the next many hours, our conversation with you is one I will treasure for the rest of my life. Although we were each sitting in Dallas, Raleigh, Copenhagen or Rochester, we were together, unpacking memories we had stored away long ago. The lake, the Cape, and our Europe trip. Games, projectsand important conversations. We also sang more campfire songs. I pray that you could hear it all.
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Don Adair raised four children, including, from left, Abby, Carrie and Tom.(Photo: Handout photo from Abby Adair Reinhard)
Reinhardbroke away from the call to talk to thedoctors. She threwa winter coat over her yoga pants and sweatshirt and headed outside.
It wasn't cold,but she wasn't warm.
Walking her neighborhood, sobbing, she listened through her headphones as the doctors laid out his prognosis:He was so far gone, they told her, putting him on a ventilator would only prolong the inevitable. His lungs, destroyed by the infection, would probably never recover.
She read and reread her father's living will. He was so strong, and she wanted to hope. Butshe knew what he would want: Pain relief only. No ventilator. No dialysis. No CPR. When she made the decision, the doctor sounded relieved.
She saw her neighbors, and her neighbors saw her, crying on the side of the road. Their first instinct was to hug. They didn't. They couldn't.
Her decision made, Reinhard returned home and dialedback into her father's room. Thenurses propped the phone on his pillow, so his childrencould hear him breathe.
As she listened to his breath, Reinhard settled at a desk and began to type. She wanted to capture the experience, absorb it.
It feels so good to laugh and cry. To be connected on the phone with you and my brother and sisters. To bring the images of us from earlier years back to life. It also feels good to hear you breathe. That rhythmic, white noise is the background music to our call.
At times, his breathing fell silent. Long seconds, a minute.She held her own breath, fearing what silence meant.
Breathe, Dad. We need to hear you breathe.
Then, finally, he would inhale, and shelet out a long, grateful sigh.
I have never loved and appreciated breath the way I love and appreciate breath right now.
Evening fell, andReinhard and her husbandput their kids to bed. She typed out her feelings during the long hours and fell asleep to her father's breath.
Monday came. Adair was still hanging on. His breathing becameharder, his lungs thick with the mucus that has come to define many coronavirus cases. Reinhardlikened the sound to someone using a straw in a cup of paste. She wondered: Should she have pushed the doctors to put him on a ventilator?
My own chest is feeling tight now, as I imagine your lungs filling, while the virus seeps in. You just moaned softly, and I dont know if youre trying to say you love us, or if youre in pain.
I pray you can see angels behind your closed eyes. That you can feel their love and ours. That you can hear us on the other end of the phone. That you can sense the stirrings of your soul even while your body is becoming numb.
OK, here come faint, short flicks of white noise. Thank God. I just said the Lords Prayer, in short bursts between my attempts at squelching my sobs so my kids cant hear me. I feel the pressure of the wailing behind my eyes, as I whimper like a dog, and wipe the tears away. I feel it in my throat now too, the pressure.
Grief is a strange thing. It comes in unpredictable waves. At one point earlier, I felt slightly guilty because I actually felt OK. And now here I am, pushing back against a huge wave of pain as it crests and I try to breathe through it. Im breathing. You're breathing. Were OK.
The Adair family visits Chteau de Versailles in France on a family vacation.(Photo: Abby Adair Reinhard handout.)
The phone went silent. Ten minutes without a sound.
Youre back! The phone had slipped. Thank you, God. Now we hear short, shallow breaths each one a miracle. Youre here. Were here. With obvious relief, we're each telling you again how much we love you. Baby Skylar is hiccupingon Carries line. This is life, and this is death. The newborn baby on the phone with the grandfather shell never meet.
We hear you, Dad.
She could hear the nurses repositioning him. They were heroes, she thought, risking their lives for his comfort.Goodnight, Don," she heard one say. "Ill see you tomorrow.
The siblings tired. The stories slowed. Reinhard ate a slice of pizza. Her 8-year-old daughter, Caroline, popped in to ask if Grandpa Don sounded better. Reinhard told her, truthfully, that he sounded more calm.
"Yes!" Caroline said. "There have been a lot of recoveries." Then her smile faded. "And a lot of deaths."
I wonder how the coronavirus will shape my kids and their generation? I think now about what shaped you and your fellow Boomers. Vietnam... a war against communism in a distant land. Today its the coronavirus ... a war waged against droplets in the air, all around us.
Don Adair died April 6.(Photo: Handout photo from Abby Adair Reinhard.)
Reinhard and her siblings agreed to take a break. They needed to care forthemselves, as their father would have wanted. They went to sleep, but no one hung up.
Just after midnight, another call came in. She knew what it was. She braced for it.
Gone. Youre gone.
She'd been on the line with him almost 36 hours. If she'd stayed on just one more hour, she could have been with him when he died. Maybe he didn't want his kids to hear him go.
If I'm honest, maybe part of me didn't want to hear your last gasps of air.
She looked down at her iPhone, still connected to his hospital line.
"I love you, Dad," she said in to the phone.
She paused for a few moments. She pressed the red button to end the call.
Here comes the pain again. So heavy.
First, she emailed her writing to friends and family. They shared it with others. It inspired her husband's colleague to reach out to his estranged father. Moved by their reconciliation, Reinhard posted her writingpublicly to Facebook. She wanted people to understand the toll of the virus.
As a business owner, she understands why people are aching to get back to work. She has 36 employees, and she worries about them, too.
Abby Adair Reinhard wrote down her experiences in the death of her father and shared them on Facebook.(Photo: Courtesy photo)
Reinhard hopes her words can help other Americansunderstand that coronavirus isn't an abstract threat affecting only big cities. It's everywhere. It takes loved ones who should have lived healthy lives for years to come.
"To experience that threat on an emotional level makes it more real," she said. "To be 6 feet apart from your mom when you're crying? I haven't been able to hug my mom."
They buried Adair in the lonely new way a few words, the Lord's Prayer and "Amazing Grace." Ninepeople and fiveminutes at agraveside at the family plot 10 miles from where he died. Her siblings couldn't be there. She sent them a video.
"Can you imagine? Seeing a video of your dad's burial?"
Easter came, and her son turned 7.
Shestill talks to her father. She can still hear him breathing on the other end of the line.
I hear myself gasping as well. He, no longer in his body. And I, not quite in mine.
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Twenty-four low- and middle-income countries, including Mexico, Nigeria and Cambodia, have paused or postponed such programs, according to the Measles and Rubella Initiative.
In the United States and other wealthier countries, parents typically make appointments to follow a routine vaccine schedule at clinics or private pediatric offices. In poorer countries, however, large numbers of infants and children are inoculated in communal settings, like marketplaces, schools, churches and mosques.
There are also concerns about potential outbreaks in North America and Europe, which do not have national inoculation programs. Because of Covid-19 fears, American pediatric practices are beginning to report significant drops in well-child visits, including those for routine vaccines.
Even in resource-rich settings there is a danger of measles raising its ugly head in the not-too-distant future, said Dr. Beate Kampmann, director of the Vaccine Centre at the London School of Hygiene and Tropical Medicine.
In 2019, the United States reported 1,282 measles cases, its highest in more than 25 years.
Conceding that its effort to count the nations population has been hamstrung by the pandemic, the Census Bureau said it would ask Congress for a four-month delay in delivering the population data used to reapportion the House of Representatives and political districts across the country.
In a news release, the bureau said the new deadline would mean that state legislatures would get final figures for drawing new district maps as late as July 31, 2021. Delivery of that data normally begins in February.
The bureau also said it would extend the deadline for collecting census data, now Aug. 15, to Oct. 31, and would begin reopening its field offices which have been shuttered since mid-March sometime after June 1.
Got a minute? Here's how you can help slow the spread of Coronavirus COVID-19 in under 60 seconds. USA TODAY
Even before the first horrific phase of the COVID-19 pandemic has run its course, scientists are worried aboutthe second wave of the disease.
It could crashworse than the first, killing tens of thousands of people who did such a good job of sheltering in place they remain virgin ground for the virus. Or it could be a mere swell, with so many people having been infected without symptoms that levels of immunity are higher than realized.
There is no crystal ball to look to, because so many crucial pieces of information remainmissing.
Are people who've had COVID-19immune? How long does immunity last? Will the virus play out likeinfluenza and the common cold, peaking during cooler months and fallingduring warmer ones? Is itsdeadly path undeterred whatever the weather?
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Until theres a vaccine its unfortunately not unlikely that we may see a second wave or even a third wave, said Peter Marks, director of the U.S. Food and Drug Administrations Center for Biologics Evaluation and Research, which oversees vaccines.
I shudder to think of that, but I think we have to be realistic."
Health care worker Ludnie Emile prepares to test patients for COVID-19 at a drive-thru coronavirus testing station in Palm Springs, Fla. on March 19.(Photo: Greg Lovett, The Palm Beach Post/ USA TODAY Network)
The first question on every doctors mind is whether someone who hashad COVID-19 is immune, and if sofor how long. People who've had mumpsare immune from it for life. Versions of the common coldcaused by different types of coronavirus seeimmunity wanewithin a year. Variations are wide.
COVID-19 is such a new disease that there is no solid dataon the immunity of survivors. But given its similarities to coronaviruses such as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), it's expected to conveyat least some immunity.
Thats good news because so many people have contracted COVID-19 from SARS-CoV-2, the virus that causes the disease. Many moreprobably have had it asymptomatically and didnt know. Both groups likely have some immunity.
A class war? A global power shift?How experts see the future after coronavirus.
What percentage of the population is immuneis impossible to know because the United States doesnt yet have widespread testing, experts say. An answer is likely months away. Even if immunity isn'tlifelong, the virus may have infected enough people to make it hardfor it to find new victims.
It would mean wed be getting to herd immunity through natural immunity even before a vaccine is developed, said Marc Lipsitch, a professor of epidemiology at Harvards Chan School of Public Health, whoco-wrote a paper in the journal Science modelingwhat COVID-19 might look like after the initial pandemic has passed.
When itcomes back, its likely to hit hardest areas not severely infected the first time, said Gregory Poland, a professor of medicine at the Mayo Clinic in Rochester, Minnesota, and editor-in-chief of the journal Vaccine.
This outbreak has predominantly been on the two coasts. Wave 2 will be in the interior of the county where there are a lot of susceptible people, he said.
America has suffered great loss before.Here's how we may learn to cope with coronavirus death toll.
Another factor is whetherthe virus survives longer in cooler, drier weather. Thatswhy the flu is more common in winter, its virus survives longer and people are more likely to be indoors in close contact.
We have no idea really whether this is going to bounce back the moment people start going back outdoors or if the warmer weather is actually going to help us out, said Michael Mina, a professor of epidemiology at the Center for Communicable Disease Dynamics at Harvard's Chan School of Public Health.
If it doesnthappen in the summer, wed all be very surprised if we dont see some reemergence in the fall, he said.
Fact check: Sunlight does not kill the new coronavirus
In that case, COVID-19s sweet spotcould be the same as influenza, roughly October to May, with a peak between October and November, modeling suggests. If it does behave like influenza, it will move to the Southern hemisphere for winter there, then return to the Northern hemisphere for its cold months.
To anthropomorphize, the virus will come back here looking for new victims, Poland said.
The first wave of the disease, which the world isexperiencingnow, hit so hard because no one had immunity. It could eventually fall into a pattern ofyearly reoccurrence, like influenza.
If compounded with the annual wave of winter flu, the nations hospitals would be further taxed.
A fall spike also seems likely as children go back to school, said Mike Reid, a professor of infectious disease at the University of California-San Francisco.
To preventthat, wide-scale testing will need to be available, and contact tracing must be in place tofind everyone who hasbeen exposed and get them to self-isolate for at least 14 days.
Given the potential for repeated waves, the more that can be put in place to rapidly jump on every new spike and ring-fence every infected individual with wraparound health services is going to be crucial, Reid said.
When will life return to normal?Expert says US testing is too far behind to know
Experts say how we behave will play a large part in the size and severity ofsubsequent waves. People can help by remaining vigilant about washing their hands, continuingto socially distance and wear masks in public.
Add to that more surveillance andwidely available tests, chances improvethe second waveis smaller than the first.
As states begin to ease restrictions, theUnited States will effectively become a massive series of experiments.Epidemiologists will be watching carefully, Lipsitch said.
Some areas will reopen schools, while otherwill have staggered school days, so not all students are thereat the same time. The same will happen inworkplaces,even as more workfrom home. Some areas will cocoon the elderly, taking special care they are not exposed. Others may create passports for people who are immune, if there's data showing infectionconfers immunity.
There are many things we can do, and we dont know how any of them will work yet, Lipsitch said.
Doing temperature testing in schools and businesses,as is now done in Asia, could be helpful.
Its not the most sensitive test in the world, but it is a screen that keeps people conscious that they have an obligation not to infect other people, said Barry Bloom, a professor of public health at Harvards Chan School of Public Health.
Staying Apart, Together: This newsletter will help you cope with the coronavirus pandemic
Vigilance will be key, experts say.
No one can say when the coast is clear, said William Hanage, a professor of epidemiology at Harvards Chan School of Public Health.
COVID-19 is easy enough to spread and has a long enough incubation period its possible to go from 100 known cases one week to 65,000 a few weeks later. One slip and we couldsee it resurging, he said.
Theres a cautionary tale from the 2003 outbreak of SARS in Toronto, which infected 375 people there and killed44. The city tookexpanded precautions beginning in March, but they were lifted in Maywhen it appeared theoutbreak was over. It wasnt.
Toronto took the brakes off," Hanage said. "Theyhad a flare, and it took them weeks to get it back under control.
Contact reporter Elizabeth Weise at eweise@usatoday.com
The former leader of the Global Rapid Response Team at the Centers for Disease Control and Prevention on Friday explained what we know about the COVID-19 pandemic. (April 10) AP Domestic
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About a month ago, Medical News Today started a series aiming to bring together the more encouraging research that emerges around COVID-19. We continue with this Special Feature that focuses on an incoming vaccine and other potential treatments for this new coronavirus and the disease it causes.
With this series, we aim to remind our readers that while COVID-19 causes great sorrow and loss around the world, the resulting global emergency has also meant that scientists are working at an unprecedented pace. They are making progress that is easy to overlook among the worrying numbers of new cases and deaths.
Two recent MNT articles COVID-19: 5 reasons to be cautiously hopeful and COVID-19: Physical distancing, drug trials offer hope looked at the latest developments in potential treatments, vaccines, and the outcomes of infection control measures during the pandemic.
We continue our series with this third Special Feature, which continues to monitor progress in the areas mentioned above.
Stay informed with live updates on the current COVID-19 outbreak and visit our coronavirus hub for more advice on prevention and treatment.
We focus on a vaccine that some researchers believe may be available by the fall and round up expert opinions on this promising development. We also cover an app-based social tracing system that could help create intelligent physical distancing instead of national lockdowns.
We previously reported that the World Health Organization (WHO) have launched a global megatrial that involves testing four potential treatments for COVID-19. Remdesivir, initially developed to treat Ebola, was one of those four potential treatments.
Now, scientists from the University of Alberta in Edmonton, Canada, say that remdesivir is showing promise in in vitro experiments.
The same team had previously demonstrated that remdesivir effectively combatted another coronavirus, MERS-CoV. It did so by blocking polymerases, which are enzymes that allow the virus to replicate.
Study co-author Prof. Matthias Gtte explains, If you target the polymerase, the virus cannot spread, so its a very logical target for treatment.
He continues to report the results of the teams new experiments: We obtained almost identical results as we reported previously with MERS, so we see that remdesivir is a very potent inhibitor for coronavirus polymerases.
Prof. Gtte goes on to explain, These coronavirus polymerases are sloppy, and they get fooled, so the inhibitor gets incorporated many times, and the virus can no longer replicate.
Still, the author cautions, Weve got to be patient and wait for the results of the randomized clinical trials.
Another hopeful finding comes from researchers from Cornell University in Ithaca, NY. These scientists also started their research efforts by drawing parallels with other coronaviruses, such as SARS-CoV and MERS-CoV.
Namely, they looked at the spike protein that coronaviruses have and zoomed in further on the fusion peptides these are short-chain amino acids that the spike proteins contain.
Whats really interesting about SARS-CoV and MERS-CoV, and this new virus, SARS-CoV-2, is this particular part of the protein, the fusion peptide, is almost exactly the same in those three viruses, explains study co-author Prof. Susan Daniel.
The new study found that calcium ions enable fusion peptides to help coronaviruses penetrate healthy cells through a process called membrane fusion. This offers a potential target for a new antiviral treatment.
The team has already secured funding to start developing an antibody that could stop this process by targeting SARS-CoV-2s fusion peptide.
Blocking the fusion step is significant because the fusion machinery doesnt evolve and change as fast as other parts of the protein do. Its been built to do a particular thing, which is to merge these two membranes together. So if you can develop antiviral strategies to reduce that efficiency, you could have potentially very broadly-acting treatments.
Prof. Susan Daniel
Sarah Gilbert, a professor of vaccinology at Oxford Universitys Jenner Institute in the United Kingdom, and her team may soon be closing in on a vaccine for SARS-CoV-2.
The approach uses a harmless chimpanzee virus to carry the fragment of SARS-CoV-2 that is required for immunity, explains Ian Jones, Professor of virology at the University of Reading, U.K.
Colin Butter, an associate professor of bioveterinary science at the University of Lincoln in the UK, explains: Professor Gilberts team [] have made a recombinant vaccine against the SARS-CoV-2 virus by taking a virus that is entirely harmless to humans, the Chimp Adenovirus designated ChAdOx1, and inserting into it the spike protein gene from the [new] coronavirus.
Prof. Gilbert believes that the vaccine will be available for general use by the fall, which could prevent a potential second wave of the new coronavirus.
That is just about possible if everything goes perfectly, Prof. Gilbert told The Times in an interview. The researchers are set to put the new vaccine into human trials in the next 2 weeks.
The researcher explains that during the pandemic, scientists can fast-track the process through which the vaccine reaches the population by doing many of the necessary steps in parallel.
First, there is the need to manufacture the vaccine for clinical studies under tightly controlled conditions, certified and qualified we need ethical approval and regulatory approval. Then, the clinical trial can start with 500 people in phase I.
This is always in healthy adults aged about 18 to 55, and usually the primary read-out from a phase 1 study is safety, Prof. Gilbert explains. Then we can do phase 2, looking at a wider age range; in this case, we are going to increase the age range, 55 to 70 plus. We are looking at safety in the older age group, [and] we expect to see weaker immune responses.
The researcher explains that she and her team plan to spread their studies across different countries so that they can reduce the time it takes to test the vaccine.
[I]ts vital we go fast before a high proportion [of the population] become infected. But it also means we are going to need to do studies in different countries because the amount of virus transmission is affected by the lockdowns.
The vaccine could get approval under emergency use legislation, meaning that in an emergency situation, if the regulators agree, its possible to use a vaccine earlier than in normal circumstances, Prof. Gilbert adds.
It is worth noting that other experts have expressed concern over Prof. Gilberts estimates.
Prof. David Salisbury, for example, says, [I]t is not just the availability of the first dose that we need to focus on. We need to know by when there will be sufficient doses to protect all of the at-risk population, probably with two doses, and that means industrial-scale manufacturing that governments do not have.
The approach in itself, however, is viable, and the research group benefits from a lot of credibility in the scientific community. The approach has been extensively tested in other situations, so there is indeed a good chance it will work as designed, says Prof. Jones.
The [research] group has a long history of success in this area, adds Dr. Butter. On the basis of this prior experience, it would be reasonable to assume that the vaccine would induce antibody and cellular immune responses, both of which may be important in controlling the virus in an individual.
Any final roll-out will almost certainly need a level of manufacturing the [U.K.] does not readily have, so transfer to and liaison with an external manufacturer may also need to be tackled. But the roadmap is clear, lets hope they get there.
Prof. Ian Jones
Tissue plasminogen activator (tPA) is a drug designed and approved to prevent blood clots in people who have had a stroke, pulmonary embolism, or heart attack.
Now, a new trial to test its benefits for relieving acute respiratory distress syndrome (ARDS) in people with COVID-19 is underway.
TPA acts as an anticoagulant. This means it prevents blood clotting by breaking down fibrin. Fibrin can form plugs in the airways and contributes to small clots in the blood vessels of the lungs.
In patients with COVID-19, these small microfibrin plugs in the air sacs lead to ARDS. As a result, these patients require ventilators to be able to breathe.
Were hearing anecdotally that a subset of patients with COVID-19-induced ARDS are clotting abnormally around their catheters and [intravenous] lines, explains Dr. Michael B. Yaffe, Ph.D., an acute care surgeon at the Beth Israel Deaconess Medical Center (BIDMC) in Boston, MA.
Dr. Yaffe is also the senior author of the study that proposed repurposing tPA to treat COVID-19 complications.
We suspect these patients with aggressive clotting will show the most benefit from tPA treatment, and this new clinical trial will reveal whether thats the case, says Dr. Yaffe.
The scientists have started to recruit some of the COVID-19 patients admitted to the BIDMC for the trial. The team also hopes to find biomarkers that can help identify patients who are most likely to benefit from the treatment.
If effective and safe for the treatment of ARDS in patients with COVID-19, tPA could save lives by reducing recovery time and freeing up more ventilators for other patients in need.
Christopher D. Barrett, clinical trial investigator
Another finding that may help relieve the pressure on public health systems is a mobile app-based contact tracing system.
The authors of the new project explain that such a system could help reduce the rate at which the virus spreads while also mitigating some harmful effects of a full national lockdown.
Dr. David Bonsall senior researcher at Oxford Universitys Nuffield Department of Medicine, clinician at Oxfords John Radcliffe Hospital both in the UK, and co-lead of the project explains how the system works.
He says, The mobile app concept weve mathematically modeled is simple and doesnt need to track your location. It uses a low energy version of Bluetooth to log a memory of all the app users with whom you have come into close proximity over the last few days.
If you then [contract the virus], these people are alerted instantly and anonymously and advised to go home and self-isolate. If app users decide to share additional data, they could support health services to identify trends and target interventions to reach those most in need.
The findings could pave the way for intelligent [physical] distancing, avoiding the social and economic effects of full lockdowns.
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