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Uncertainty has been the trademark of both the economic and public health crises caused by the coronavirus. Occasionally thats not a bad thing like in the emerging consensus that the initial models for case fatality rates and ICU beds needed were too high. But over the last few days, several new reports on the nature of the coronavirus showed how much more we need to learn about the virus before the effects of reopening the country can be fully anticipated. Below are four such alarming studies though approach with some caution, as the clinical understanding of the outbreak continues to change as testing expands.
Lets begin with the most morbid detail: Thailand is now reporting the first fatal case of coronavirus that was transmitted from a deceased patient to a medical examiner. Not just the medical examiners, but morgue technicians and the people in funeral homes need to take extra care, Angelique Corthals, a professor of pathology at CUNYs John Jay College of Criminal Justice, told BuzzFeed News. With the high daily death count pushing the capacity of morgues in cities across the country, the concern that bodies could transmit the virus is especially alarming, considering pictures from Sinai-Grace Hospital in Detroit showing bodies piled in vacant spaces in the facility.
For the vast majority of those who contract the virus and live, the Los Angeles Times reported on some potential and distressing long-term effects of COVID-19 coming out of a study published in China:
In a study posted this week, scientists in China examined the blood test results of 34 COVID-19 patients over the course of their hospitalization. In those who survived mild and severe disease alike, the researchers found that many of the biological measures had failed to return to normal.
Chief among the worrisome test results were readings that suggested these apparently recovered patients continued to have impaired liver function. That was the case even after two tests for the live virus had come back negative and the patients were cleared to be discharged.
At the same time, as cardiologists are contending with the immediate effects of COVID-19 on the heart, theyre asking how much of the damage could be long-lasting. In an early study of COVID-19 patients in China, heart failure was seen in nearly 12% of those who survived, including in some who had shown no signs of respiratory distress.
While concerning, the size of the study is far too small to draw a big-picture, epidemiological understanding of COVID-19s long-term effects on the body. Another caveat noted by the LA Times: The assessment of organ failure in coronavirus survivors is complicated by that fact that patients with disorders that affect the heart, liver, blood and lungs face a higher risk of becoming very sick with COVID-19 in the first place. That makes it difficult to distinguish COVID-19 after-effects from the problems that made patients vulnerable to begin with especially so early in the game.
Another study from researchers at Fudan University in Shanghai and the New York Blood Center provides more harrowing evidence for the long-term consequences of contracting the virus. According to the findings published in the journal Cellular & Molecular Immunology, when the researchers initiated contact between COVID-19 and lab-grown T lymphocytes better known as T cells the virus disabled the cells, which help identify and eliminate pathogens in the body. The researchers also found that SARS, a related coronavirus, could not infect T cells. The study found that COVID-19s damage to the T lymphocytes resembled that caused by HIV.
Though some doctors in the U.S. are stockpiling hydroxychloroquine for personal and family use, a small study in Brazil casts doubt on its efficacy for widespread use to treat the coronavirus. Countering some preliminary evidence that the antimalarial drug touted by the president effectively treats COVID-19, a study on its use on 81 hospitalized patients was halted after those taking a higher dose experienced irregular heart rates and increased risk of fatal heart arrhythmias. Like in U.S. hospitals, hydroxychloroquine was being administered with the antibiotic azithromycin commonly known as Z-Pak which also increases the risk of fatal heart arrhythmias in some patients.
But a trace of good news aside from the significant progress of decreased hospitalizations in New York is the anticipated hiring spree for contact tracing, which determines who confirmed patients interacted with while they were infected, simply by asking them. If federal and state governments are able to employ the vast number of tracers needed to determine the full level of community spread, it will have a significant impact on both the economic and public health crises. This will be the only way to contain further spread of COVID-19 once the initial surge is past, and get into the suppression phase, Tom Frieden, a former director of the Centers for Disease Control and Prevention, told STAT News. We need an army of 300,000 people.
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Dr. Padgetts team at EvergreenHealth decided to transfer him to cardiac specialists at Swedish Health Services in Seattle. Dr. Matt Hartman, a cardiologist there, said it was clear that Dr. Padgetts condition was rapidly worsening and that if they did not do something, he would not survive.
We didnt know if this was someone who was just going to die no matter what we do, he said. We think with his age, and the fact that theres no other major comorbidity or problem, that we should at least give it a try.
The team decided to hook Dr. Padgett up to a machine known as an ECMO that could essentially serve as both an artificial heart and lung, taking his blood out of his body, oxygenating it and returning it to him. While such procedures are most often done in the surgery suites, in this case it was all done in the intensive care unit, to prevent the spread of the coronavirus elsewhere in the hospital.
We brought the operating room to him, said Dr. Samuel Youssef, a cardiac surgeon at Swedish.
The team also began consulting with oncologists. Indicators of inflammation in Dr. Padgetts body were astonishingly high, suggesting that he was potentially dealing with a cytokine storm, a dangerous phenomenon in which the immune systems of otherwise healthy people overreact in fighting the coronavirus.
The doctors administered the drug tocilizumab, often used for cancer patients who can have similar immune system reactions. They added high-dose vitamin C after seeing reports that it might be beneficial. These experimental treatments had also been tried on another patient, a 33-year-old woman, with some success.
Over that week in mid-March, there were signs of improvement. As his inflammation numbers came down and his lungs started to provide more oxygen, the team began scaling back the ECMO machine, until they finally removed it on March 23.
Four days later, on March 27, the breathing tube was removed. Slowly, after two weeks in a sedated coma, Dr. Padgett began to wake up.
The U.N. secretary general, Antonio Guterres, and Pope Francis have both called for a cessation of all global conflicts to focus on what Mr. Guterres called the true fight of our lives. Last week Saudi Arabia announced a cease-fire in its war against Houthi rebels in Yemen, and armed groups have indicated a desire to stop fighting in Colombia, Cameroon and the Philippines. The Afghan government and the Taliban have both begun efforts to stem the spread of the virus. And Russia may find the burden of supporting Syrian troops or secessionists in western Ukraine excessive if Covid-19 begins to take a heavy toll on the economy.
But the Islamic State has called on its followers to ramp up their efforts. The Houthis have not reciprocated Saudi Arabias cease-fire, and fighting has escalated in parts of sub-Saharan Africa.
It is understandable that governments of rich nations have focused first and foremost on the crisis within their own borders. Nothing like the coronavirus has ever overwhelmed so much of the world in such short order, or with such cataclysmic force. Yet it is dismaying that a danger that confronts the entire world, that is likely to hurt the entire global economy, has led to so little global cooperation and has been met with so little global leadership.
This is a crisis in which the United States could have emerged as the leader. The country still may do so. But on top of the widely chronicled failures at home, the Trump administration has provided little inspiration for the world. The response in Europe has also been marked by confusion and disunity: The president of the European Unions main science organization resigned last week in protest of the bloc's handling of the crisis. The World Health Organization, meanwhile, is under heavy fire from critics who say its complicated relationship with China may have undermined its mission.
That is not likely to change, especially while the disease continues to ravage the United States, Italy, Spain and many other countries in the Northern Hemisphere, and most especially in an American presidential election year, when the struggle against Covid-19 is likely to become only more politicized.
But the weakness of Washington should not prevent the brain trust of the developed world the think tanks, news media, universities and nongovernmental organizations from focusing on a strategy for the next and possibly most brutal front in the struggle against the scourge of the coronavirus. Many organizations have already begun to do so, recognizing that this may be the defining struggle of our era, and that if ever the world demanded a global response, this is it.
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ATLANTA Twelve days before New Orleans celebrated Mardi Gras Day, the citywide pre-Lenten bash that would pack thousands of visitors onto the streets, Sarah A. Babcock, the director of policy and emergency preparedness for the city health department, prepared a list of bullet points about the troubling disease that had already sickened thousands in China but had only infected 13 known patients in the United States.
The chance of us getting someone with coronavirus is low, Ms. Babcock advised community health providers, according to internal emails obtained by Columbia Universitys Brown Institute for Media Innovation and reviewed by The New York Times.
The projection proved to be terribly off base, as New Orleans would soon erupt into one of the largest hot spots for the coronavirus in the U.S., with one of the nations highest death rates. Experts now believe that the multiweek Mardi Gras festivities likely served to accelerate the spread of the highly contagious disease in the New Orleans area.
In recent days, city officials, including Mayor LaToya Cantrell, have pushed back forcefully against any suggestion that they had erred by not canceling the celebrations. And they have found support among public health experts, who note that no major events were being canceled around the country in the run-up to Mardi Gras Day, on Feb. 25, when there were still only 15 confirmed cases of the coronavirus in the country.
I think we all were thinking that this was not going to be a huge issue, quite frankly, and then exponential growth started, said Dr. Carlos del Rio, Chair of the Hubert Department of Global Health at the Rollins School of Public Health of Emory University.
At the time, he added, I think the mayor would have been executed if she would have said, Lets cancel Mardi Gras.
Still, the emails, more than 2,200 pages in all, offer insight into how one major American city began planning in mid-January for the viruss eventual arrival, even as it continued to prepare for its signature annual party.
The plans were predicated on a misunderstanding one seen not just in New Orleans of how widely the virus had potentially already spread in the city and across the country.
Dr. Jennifer Avegno, director of the New Orleans Health Department, said that the citys focus before Mardi Gras was on visitors who might bring the virus with them. But there was no way for us to know if we had community spread, she said, because we could not test for it.
There was also a tragedy of timing: It was on Mardi Gras Day itself, as floats were rolling through the streets, that the Centers for Disease Control and Prevention issued its starkest warning up to that point that the virus would almost certainly spread in the U.S., and that cities should begin planning social distancing measures.
Ms. Cantrell, in a March 26 interview on CNN, defended the decision not to cancel Mardi Gras, noting that no red flags had been raised by federal officials at that point. On the day before Fat Tuesday, in fact, President Trump had tweeted: The Coronavirus is very much under control in the USA.
When its not taken seriously at the federal level, its very difficult to transcend down to the local level in making these decisions, Ms. Cantrell told CNN. But when the experts told me that social gatherings would be an issue, I moved forward with canceling them.
That was long after the last Mardi Gras floats had passed through the city.
On Friday, the C.D.C. released a report stating that Mardi Gras had occurred at a time when canceling mass gatherings was not yet common in the United States. It also described Louisianas elevated number of cases and its temporarily high population density because of an influx of visitors during Mardi Gras celebrations in mid-February.
The Mardi Gras season officially began this year, as it does every year, 12 nights after Christmas, when a 150-year-old carnival krewe, the Twelfth Night Revelers, held an elegant society ball. The next day, Chinese authorities thousands of miles away announced they had isolated the new coronavirus that had been sickening residents of Wuhan, the capital of Hubei Province in China.
By mid-January, according to the internal New Orleans emails, city and state officials were circulating and digesting the latest updates on the disease from the federal government, which advised them to look out for patients with a fever and symptoms of a lower respiratory illness, like a cough or shortness of breath, as well as a history of traveling from Wuhan.
On Jan. 21, Ms. Babcock circulated a statement among colleagues meant for the news media that said the departments emergency preparedness team had been monitoring the coronavirus for the past few weeks and began weekly conference calls with the CDC last week.
At this time, the note continued, the CDC is only recommending screening at airports that receive flights directly from Wuhan, China.
On Jan. 23, Chinese authorities closed off Wuhan, and its 11 million residents, in an effort to curb the spread there. Two days later, Dr. Avegno, the head of the New Orleans Health Department, told colleagues that the uptick in cases in China was coming fast and furious.
From that point, the emails show, the city appeared to go into a more concerted coronavirus preparation mode.
William T. Salmeron, the chief of Emergency Medical Services for the city, told his colleagues that workers should take routine exposure control precautions as they would in dealing with any respiratory illness. Those included getting the travel history of anyone with symptoms, giving patients surgical masks, and moving up to gloves, gown, protective eyewear and an N95 mask if travel history risk factors warrant.
At this time the potential risk of infection in the US is LOW, he wrote.
Collin M. Arnold, director of the citys homeland security office, sent an email to Dr. Avegno and other city officials on Jan. 27, suggesting they should probably get together and discuss public safety concerns during Mardi Gras and on the parade route.
The New Orleans Police Department, he said, had been asking about personal protective equipment and general concerns (they shake a lot of hands and come in contact with a lot of people on the route every day). He suggested putting together a guide sheet for all responders that would offer them common sense mitigation tasks.
That same day, Tyrell Morris, the executive director of the citys 911 service, told city officials about a questionnaire and worksheet that the International Academies of Emergency Dispatch was suggesting they use for all suspected coronavirus patients.
Dr. Emily Nichols, the medical director for the citys emergency medical services, suggested they add a question asking suspected carriers whether they had been within six feet of another person thought to be infected with the virus.
In late January, the city health departments emergency preparedness branch emailed local health care facilities with updates on an active shooter training set for Jan. 30 at Lambeth House, a retirement community in Uptown New Orleans. Lambeth House would eventually emerge as the site of one of the worst outbreaks in the South, with at least 13 residents dying from Covid-19.
The city was alive to the possibility of the virus arriving by air or by sea.
On Jan. 28, Mr. Salmeron proposed a meeting of city, state and airport officials to discuss emergency response actions to ill passengers arriving at the local airport. The president of the Louisiana Maritime Association reminded city officials that the Coast Guard would review incoming ships to the port of New Orleans.
A multiagency meeting was scheduled for Feb. 5, with Ms. Babcock telling state health officials that the city was trying to make sure that everyone is prepared for coronavirus before Mardi Gras.
The day of the meeting, the mayors office posted a news item on the citys website noting that the federal government had not recommended screening at Louis Armstrong New Orleans International Airport, and had begun rerouting all flights with passengers from China to one of 11 other airports where screening was taking place.
Our publichealth and health care systems are ready for Mardi Gras, it said, and the coronavirus poses a very low risk to the Carnival celebrations.
In an email sent Feb. 26, the day after Mardi Gras Day, Dr. Avegno made it clear that, while the city was taking the coronavirus threat seriously, officials were not yet planning to call for strict measures to limit its spread.
Im a little hesitant to put in the social distancing stuff but since CDC mentioned it, we probably should she wrote. I added some words to make it more clear we werent going to run around willy-nilly quarantining people, but would be following state/federal guidance.
Daily sit reps, or situation reports, began going out to New Orleans officials beginning March 3. While acknowledging the spread of the virus was a rapidly evolving situation, the city did not recommend any closures because the state had no confirmed cases.
A few days later, on March 9, the first presumptive coronavirus patient in Louisiana was identified in New Orleans a resident of nearby Jefferson Parish who was in a city hospital. Reports began surfacing of people in other states, including Arkansas, Texas and Tennessee, who had been to Mardi Gras and were testing positive for the virus.
The next day, Ms. Cantrell canceled a number of beloved street-level events that have traditionally served as raucous addenda to Mardi Gras parades celebrating St. Josephs Day and St. Patricks Day, and Super Sunday, in which the citys Mardi Gras Indian tribes display their beaded and feathered suits.
By March 16, three people had died from complications of Covid-19 in Louisiana and there were 136 confirmed cases in the state. Gov. John Bel Edwards ordered the closures of bars, gyms, and cinemas, and limited restaurants to takeout and delivery service.
Dr. Avegno said city and state officials had moved as quickly as they could once they realized what they were facing.
We shut down parades, we shut down schools within a week, completely changing our way of life, Dr. Avegno said. I cant think of anything more drastic than shutting down the bars of New Orleans.
Over the next several weeks, the virus continued its unabated spread across Louisiana.
By Monday, state officials had reported more than 10,500 coronavirus cases in Orleans Parish and the adjacent suburb of Jefferson Parish. Across the state, at least 840 residents infected with the coronavirus have died.
Richard Fausset reported from Atlanta and Derek Kravitz, a data journalist at Columbia Universitys Brown Institute for Media Innovation, from New York.
WASHINGTON A crew member from the aircraft carrier Theodore Roosevelt who had the novel coronavirus died on Monday, in a poignant punctuation to the plea from the ships captain two weeks ago for help from the Navy because sailors dont need to die.
The death of the sailor came as Navy officials continued to struggle to combat the infection that has crippled the nuclear-powered ship, now docked in Guam. The name of the sailor is being withheld until 24 hours after family members are notified, Navy officials said.
The entire department is deeply saddened by the loss of our first active-duty member to Covid-19, Defense Secretary Mark T. Esper said in a statement. Adm. Michael M. Gilday, the chief of naval operations, called the death a great loss for the ship and for our Navy.
The death is already wrapped up in what has become a story of disjointed leadership in the Navy, where top officials pitted themselves against the ships captain and medical crew in the battle to contain the disease. Pleading for more help from the Navy to swiftly evacuate the ship as the virus spread, Capt. Brett E. Crozier implored officials to put concerns for the health of the sailors ahead of concerns for the ships ability to maintain military readiness should a war crop up.
We are not at war, Captain Crozier said in a March 30 letter to officials. Sailors dont need to die. Three days later, Captain Crozier was fired by Thomas B. Modly, the acting Navy secretary. Mr. Modly resigned five days later.
As of Monday, 585 Roosevelt crew members had the coronavirus, including Captain Crozier.
The same day that Captain Crozier was writing his letter, the sailor tested positive for Covid-19, Navy officials said. He was evacuated from the ship and placed in isolation on the American naval base on Guam, along with four other sailors.
On April 5, the sailor was admitted to the emergency department at the Guam naval hospital with respiratory issues and was discharged shortly afterward, military officials said. He returned to the isolation house, where health care providers did twice-daily checks, officials said.
At 8:30 a.m. on April 9, the sailor was found unresponsive during one of the checks and taken to the hospitals intensive care unit.
On Monday, military officials said that there were at least four other sailors from the Roosevelt in the hospital and that they were in stable condition.
The fate of Captain Croziers career now lies in the hands of Admiral Gilday, the Navys top uniformed official. He told reporters last week that the investigation of the Roosevelt matter, which he ordered, was complete and that he had started to review the findings.
Results could be made public this week, Navy officials said on Monday.
The inquiry, conducted by Adm. Robert P. Burke, a former submarine captain who is the vice chief of naval operations, relied on interviews with more than a dozen Navy personnel aboard the Roosevelt and in Captain Croziers chain of command, according to people familiar with the scope of the investigation.
Admiral Gilday said he had not ruled out any courses of action, including the potential of reinstating Captain Crozier, if that was where the investigation led.
I am taking no options off the table, Admiral Gilday said, adding that he had not spoken to the captain, who is in quarantine on Guam after testing positive for the coronavirus.
The pivotal issue, Admiral Gilday said, is why Captain Crozier felt compelled to send his four-page letter outside normal communications channels, and whether it illustrated a breakdown in communications with his chain of command.
Before the results are made public, Admiral Gilday will consult with Mr. Esper; the new acting Navy secretary, Jim McPherson; and Gen. Mark A. Milley, the chairman of the Joint Chiefs of Staff, Pentagon officials said on Monday.
Former top Navy officials said the service would probably be criticized regardless of what actions it took.
No matter the direction recommended, the critics of the action will align, said Sean OKeefe, who was the Navy secretary under President George Bush. The investigation will force actions regardless of whether they are popular or not.
Meanwhile, health care providers at the naval hospital on Guam have been directed by top levels of the Navy to begin a research project on the quarantined Roosevelt sailors that examines the serology of the coronavirus, to learn more about how the immune system responds to the infection, according to military officials.
The project has drawn anger from some of the providers because of a lack of any defined research protocol, compounded by safety concerns over the amount of protective equipment required and their already strained reserves. Some have refused to participate on ethical grounds.
In another sign of how the coronavirus has upended military deployments, the Navy said on Monday that the aircraft carrier Harry S. Truman, wrapping up a five-month tour to the Middle East, would remain at sea off the East Coast for at least three more weeks in case the warship and its Covid-free crew were needed elsewhere before returning to its home port in Norfolk, Va.
John Ismay contributed reporting.
BEIRUT, Lebanon Qatar has locked down tens of thousands of migrant workers in a crowded neighborhood, raising fears it will become a coronavirus hotbed. Companies in Saudi Arabia have told foreign laborers to stay home then stopped paying them. In Kuwait, an actress said on TV that migrants should be thrown out into the desert.
The oil-rich monarchies of the Persian Gulf have long relied on armies of low-paid migrant workers from Asia, Africa and elsewhere to do the heavy lifting in their economies, and have faced longstanding criticism from rights groups for treating those laborers poorly.
Now, the coronavirus pandemic has made matters worse, as migrants in Gulf States have found themselves locked down in cramped, unsanitary dorms, deprived of income and unable to return home because of travel restrictions.
Some are running out of food and money and fear they have no place to turn in societies that often treat them like an expendable underclass.
Nobody called us, said Mohamed al-Sayid, an Egyptian restaurant worker stuck with seven friends in a one-room apartment in Jeddah, Saudi Arabia, after they lost their jobs. Nobody checked on us at all. Im not afraid of corona. Im afraid well die from hunger.
Lockdowns and the resulting economic downturns have dealt harsh blows to migrant communities across the globe, including in Southeast Asia and inside India. But the sheer numbers and diversity of migrants in Persian Gulf countries mean that damage to their health and finances will echo across continents.
It is hard to overstate the role of migrant labor in the Gulf, where jobs in construction, sanitation, transportation, hospitality and even health care are dominated by millions of workers from Pakistan, India, Bangladesh, Nepal, the Philippines and elsewhere. They often work and live in substandard conditions to earn more than they could at home.
More than one-third of Saudi Arabias 34 million people are foreigners, as are about half the populations of Bahrain and Oman, according to the Central Intelligence Agencys World Factbook. In Kuwait, foreigners outnumber citizens by more than two to one; in Qatar and the United Arab Emirates, that ratio is nearly nine to one.
As the virus has spread, Gulf countries have imposed lockdowns and other restrictions aimed at limiting contagion that have dramatically slowed their economies.
Many of these losses have trickled down to the laborers. Some earn as little as $200 per month, and many amassed substantial debts to recruiters and middlemen before they had even begun working.
Lost income will not only affect the workers, but also their home countries, which receive billions of dollars in remittances every year.
Also, there are indications that the virus has hit migrants particularly hard. Saudi Arabias health ministry said on April 5 that more than half of its cases of Covid-19, the disease the virus causes, were foreigners. The kingdom has reported more than 4,000 cases.
Qatar, in the midst of a construction boom to prepare to be host of the World Cup in 2022, found hundreds of cases in an industrial zone where many migrants live. The government said it had isolated the infected for treatment and locked the area down, creating fears the virus would continue to spread inside the isolated area.
There is this innate discrimination in the system itself which is suddenly not going to disappear, said Vani Saraswathi, associate editor of Migrant-Rights.org, an advocacy group. It is going to get more stark as this crisis keeps growing.
Advocates for workers say measures the Gulf governments have announced to shore up their economies and slow the viruss spread do not do enough to protect laborers.
King Salman of Saudi Arabia announced last month that he would cover the treatment of anyone suffering from Covid-19 in the kingdom, including foreigners. But a $2.4 billion aid package that will partially cover the salaries of private sector workers applies only to Saudi citizens.
The United Arab Emirates passed a new regulation empowering companies to grant paid and unpaid leave and cut wages temporarily or permanently for noncitizen employees. While such changes are to be done by mutual agreement, labor advocates say workers have little real leverage against their employers.
There seems to be a disconnect in these countries about how much they need these workers, Ms. Saraswathi said. Their societies would literally fall apart if these workers were not there, but there is very little empathy for their situation.
Although Gulf governments have issued strict stay-at-home orders and closed businesses deemed nonessential, some migrant-heavy sectors, like construction and oil and gas, have kept working, potentially exposing workers to the virus.
Many laborers also live in camps where as many as 10 men share rooms, a fertile environment for contagion.
If it spreads in the camps, it is wildfire, so all of these countries should have an interest in keeping this under control, said Hiba Zayadin, a Gulf researcher for Human Rights Watch.
Qatar has earmarked more than $800 million to help companies pay their employees and issued regulations shortening the workday to try to stem the viruss spread. But workers say the policies are not always applied on the ground.
A Kenyan oil worker in Qatar said he used to ride to work on a crowded bus with 60 other people, but the employees complained and the company reduced capacity to 30 men per bus. He still shares a room in a company compound with three others, in a ward with only six bathrooms for 450 men.
Crowding is the problem, and washing hands is almost unrealistic, he said by phone, speaking on condition of anonymity for fear of punishment by his employer.
His company provides food, but in a communal dining hall that is often crowded.
It is not in any way social distancing, he said. It is only God who is protecting people.
Gulf countries have banned unionization and other activism aimed at improving workers conditions, leaving laborers with few places to turn if their employers violate their contracts or fail to pay them.
Last month, Totzky de la Cruz, a Filipino restaurant worker in Saudi Arabia, was told with 16 of his colleagues to stop working and that no work meant no pay. The men were not paid their final salary, and food allowances their employer promised have not arrived.
We are left to help and rely on each other, Mr. de la Cruz said. Whoever has extra money among us would have to support the others.
The most vulnerable workers, advocates say, are those without contracts who freelance on the local market.
Women who work as in-house maids often have nowhere to turn if their employers abuse them, and day laborers have no company responsible for their well-being. Lockdowns mean they cant go out to look for work, or sometimes even to buy food.
We cant go out because the police are very strict, said Islamuddin Iqbal, a Pakistani day laborer in Oman who has been stuck in a room with four other men for more than a month.
The men used to venture out to buy bread, but the bakery closed, so they are left with only the rice in their room.
Our supplies are running out fast, Mr. Iqbal said by phone. We have started to eat less, to save what we are left with.
Hwaida Saad contributed reporting from Beirut, Lebanon; Salman Masood from Islamabad, Pakistan; and Jason Gutierrez from Manila.
Other evidence supports this model. A recent peer-reviewed study led by a team from Erasmus University, in the Netherlands, published data from 12 patients showing that they had developed antibodies after infection with SARS-CoV-2. Several of my colleagues and students and I have statistically analyzed thousands of seasonal coronavirus cases in the United States and used a mathematical model to infer that immunity over a year or so is likely for the two seasonal coronaviruses most closely related to SARS-CoV-2 an indication perhaps of how immunity to SARS-CoV-2 itself might also behave.
If it is true that infection creates immunity in most or all individuals and that the protection lasts a year or more, then the infection of increasing numbers of people in any given population will lead to the buildup of so-called herd immunity. As more and more people become immune to the virus, an infected individual has less and less chance of coming into contact with a person susceptible to infection. Eventually, herd immunity becomes pervasive enough that an infected person on average infects less than one other person; at that point, the number of cases starts to go down. If herd immunity is widespread enough, then even in the absence of measures designed to slow transmission, the virus will be contained at least until immunity wanes or enough new people susceptible to infection are born.
At the moment, cases of Covid-19 have been undercounted because of limited testing perhaps by a factor of 10 in some places, like Italy as of late last month. If the undercounting is around this level in other countries as well, then a majority of the population in much (if not all) of the world still is susceptible to infection, and herd immunity is a minor phenomenon right now. The long-term control of the virus depends on getting a majority of people to become immune, through infection and recovery or through vaccination how large a majority depends on yet other parameters of the infection that remain unknown.
One concern has to do with the possibility of reinfection. South Koreas Centers for Disease Control and Prevention recently reported that 91 patients who had been infected with SARS-CoV-2 and then tested negative for the virus later tested positive again. If some of these cases were indeed reinfections, they would cast doubt on the strength of the immunity the patients had developed.
An alternative possibility, which many scientists think is more likely, is that these patients had a false negative test in the middle of an ongoing infection, or that the infection had temporarily subsided and then re-emerged. South Koreas C.D.C. is now working to assess the merit of all these explanations. As with other diseases for which it can be difficult to distinguish a new infection from a new flare-up of an old infection like tuberculosis the issue might be resolved by comparing the viral genome sequence from the first and the second periods of infection.
For now, it is reasonable to assume that only a minority of the worlds population is immune to SARS-CoV-2, even in hard-hit areas. How could this tentative picture evolve as better data come in? Early hints suggest that it could change in either direction.
It is possible that many more cases of Covid-19 have occurred than have been reported, even after accounting for limited testing. One recent study (not yet peer-reviewed) suggests that rather than, say, 10 times the number of detected cases, the United States may really have more like 100, or even 1,000, times the official number. This estimate is an indirect inference from statistical correlations. In emergencies, such indirect assessments can be early evidence of an important finding or statistical flukes. But if this one is correct, then herd immunity to SARS-CoV-2 could be building faster than the commonly reported figures suggest.
Meanwhile, New Yorks health-care system was sinking into chaos, as COVID-19 cases swamped hospitals. That day, there were more 911 calls than there had been on September 11, 2001. Some Fokkers, however, felt that it was important not to get swept up in apocalyptic tales or media reports, or to fall for the Chicken Littles. They mocked Jim Cramer, the host of the market program Mad Money, on CNBC, for predicting a great depression and wondering if anyone would ever board an airplane again. Anecdotes, hyperbole: the talking chuckleheads sowing and selling fear.
As in epidemiology, the basis of the financial markets, and of arguments about them, is numbersdata and their deployments. Reliable data about COVID-19 have been scarce, mainly because, in the shameful absence of widespread testing, no one knows how many people have or have had the virus, which would determine the rate of infection and, most crucially, the fatality rate. The numerator (how many have died) is known, more or less, but its the denominator (how many have caught it) that has been the object of such speculation. If I had a roll of toilet paper for every finance guys analysis of the death rate Ive been asked to read, Id have toilet paper. Most of these calculations, it seems, are arguments for why the rate is likely to be much, much lower than the medical experts have concluded. The less lethal it is, the better the comparison to the flu, and therefore the easier it is to chide everyone for getting so worked up over it. As Lawrence White, a professor of economics at George Mason University, tweeted, Almost everyone talking about the #coronavirus is displaying strong confirmation bias. Which only goes to prove what Ive always said.
Still, its hard for a coldhearted capitalist to know just how cold the heart must go. Public-health professionals make a cost-benefit calculation, too, with different weightings. Whats the trade-off? How many deaths are tolerable? Zero? Tens of thousands, as with the flu? Or whatever number it is that will keep us from slipping into a global depression? The public-health hazards of deepening unemployment and povertymental illness, suicide, addiction, malnutritionare uncounted.
Financial people love to come at you with numbers, to cluck over the innumeracy of the populace and the press, to cite the tyranny of the anecdote and the superior risk-assessment calculus of the guy who has an understanding of stochastic volatility and some skin in the gameeven when that skin is other peoples. But while risk and price are intertwined, value and values are something else entirely. It can be hard to find the right math for those.
In the months following the first tidings of COVID-19 from China, Trump played down its potential impactattempting to jawbone a virus, or at least the perception of it. But a virus, unlike a President, doesnt care how its perceived. It gets penetration, whether you believe in it or not. By the time, later in March, that he acknowledged the scale of the pandemic (and sought to convince those who hadnt been paying attention that hed been paying attention all along, except to the extent that hed been distracted), it had long been abundantly clear that he cared more about the economic damageeven if it was only in relation to his relection prospects, or to the fate of his hotel and golf-resort businessesthan about any particular threshold regarding loss of life or the greater good. Others, perhaps on his behalf, have tried to expand his position. For a few days, the message, reinforced by the likes of Glenn Beck (Id rather die than kill the country) and Dan Patrick, the soon-to-be-seventy lieutenant governor of Texas (If thats the exchange, Im all in), was that we might have to sacrifice our elders for the sake of the economy. The politics of it were perverse. Many of the same people who had cited death panels in the fight against Obamacare were now essentially arguing the opposite. One mans cost controls are another mans eugenics.
For Trump, the economy is basically the stock market. Hes obsessed with it, much the way he fixates on television ratings. The stock market is, among other things, a great mood indicator. But it isnt the economynot even close. As were now discovering, to more horror than surprise, the cessation of commercial activitytravel, tourism, entertainment, restaurants, sports, construction, conferences, or really any transactions, in significant volume, be they in lawyering, accounting, book sales, or sparkplugsmeans no revenue, no ability to make payroll or rent, mass layoffs, steep declines in both supply and demand, and reverberations, up and down the food chain, of defaults on debt. Thats the economy.
This brutal shock is attacking a body that was already vulnerable. In the event of a global depression, a postmortem might identify COVID-19 as the cause of death, but, as with so many of the viruss victims, the economy had a prexisting conditiondebt, instead of pulmonary disease. Corporate debt, high-yield debt, distressed debt, student debt, consumer debt, mortgage debt, sovereign debt. Its as if the virus is almost beside the point, a trader I know told me. This was all set up to happen.
The trader was one of those guys who had been muttering about a financial collapse for a decade. The 2008 bailout, with the politically motivated and, at best, capricious sorting of winners and losers, rankled, as did the ongoing collusion among the big banks, the Federal Reserve, and politicians of both parties. Hed heard that the smart money, like the giant asset-management firms Blackstone and the Carlyle Group, was now telling companies to draw down their bank lines, and borrow as much as they could, in case the lenders went out of business or found ways to say no. Sure enough, by Marchs end, corporations had reportedly tapped a record two hundred and eight billion dollars from their revolving-credit linesa revolver frenzy, as the financial blog Zero Hedge put it, in publishing a list of the companies that managed to get their money in time. Corporate America had hit up the pawnshop, en masse. In a world where we talk, suddenly, of trillions, two hundred billion may not seem like a lot, but it is: in 2007, the subprime-mortgage lender Countrywide Financial, in drawing down just $11.5 billion, helped bring the system to its knees.
It is hard to navigate out of the debt trap. Creditors can forgive debtors, but that process, especially at this level, would be almost impossibly laborious and fraught. Meanwhile, defaults flood the market with collateral, be it buildings, stocks, or aircraft. The price of that collateral collapseshaircuts for baldheadsleading to more defaults. The market in distressed debt has already ballooned to about a trillion dollars.
As April arrived, businesses, large and small, decided not to pay rent, either because they didnt have the cash on hand or because, with a recession looming, they wanted to preserve what cash they had. Furloughed or fired employees, meanwhile, faced similar decisions, as landlords sent threatening reminders. Would property owners, without their monthly nut, be able to finance their own debts? And what of the banks, with all the bad paper? In the last week of March, an additional 6.6 million Americans filed jobless claims, doubling the previous weeks record. In New York State, where nearly half a million new claims had been filed in two weeks, the unemployment-insurance trust began to teeter toward insolvency. Come summer, there would be no money left to pay unemployment benefits.
The coronavirus pandemic has crippled America. So far, the virus has killed more than 20,000 people in the United States and has sickened more than 500,000 people.
Its clear now that the US government was woefully unprepared for the pandemic, and thats been reflected in its messaging to the public since the start.
The Centers for Disease Control and Prevention (CDC), for instance, didnt tell the country to stop gathering in groups until March 15 weeks after a top CDC official announced that the virus would begin spreading throughout the US. And after telling Americans for months that they should not wear masks unless they are sick, the government formally flipped that advice on April 3 and said that everyone should wear some kind of covering on their face in certain public settings.
Much of the mainstream media amplified this slow and muddled reaction to the rapidly spreading virus. Since alarming reports about Covid-19 began to emerge from China in January, the media often provided information to Americans that later proved to be wrong, or at least inadequate.
For instance: While President Trump has been correctly pilloried for describing the coronavirus as less dangerous than the flu, that message was commonplace in mainstream media outlets throughout February. And journalists including my colleagues at Vox were dutifully repeating exhortations from public health officials not to wear masks for much of 2020.
As we head into the next phase of the pandemic, and as the stakes mount, its worth looking back to ask how the media could have done better as the virus broke out of China and headed to the US.
Why didnt we see this coming sooner? And once we did, why didnt we sound the alarm with more vigor?
If you read the stories from that period, not just the headlines, youll find that most of the information holding the pieces together comes from authoritative sources youd want reporters to turn to: experts at institutions like the World Health Organization, the CDC, and academics with real domain knowledge.
The problem, in many cases, was that that information was wrong, or at least incomplete. Which raises the hard question for journalists scrutinizing our performance in recent months: How do we cover a story where neither we nor the experts we turn to know what isnt yet known? And how do we warn Americans about the full range of potential risks in the world without ringing alarm bells so constantly that theyll tune us out?
Lets be clear: Journalists have been doing crucial reporting about what the US government got wrong as the pandemic advanced, and what US leaders could have done to prepare America. They provided analysis that put the news in context. And they have also provided important on-the-ground dispatches from places around the world that have been devastated by the disease often at great personal risk starting at its epicenter in Wuhan, China.
But when it came to grappling with a new disease they knew nothing about, journalists most often turned to experts and institutions for information, and relayed what those experts and institutions told them to their audience.
And given that the Covid-19 coronavirus is brand new, even the best-meaning experts and institutions gave conflicting information, some of which now has proven to be inaccurate or up for debate. That includes National Institute of Allergy and Infectious Diseases director Anthony Fauci, who is now the most trusted official in the federal government when it comes to the Covid-19 response, but as late as February was calling the risk from coronavirus minuscule and warning people to worry instead about influenza outbreak, which is having its second wave.
Theres a line between doing aggressive reporting and kind of acting in the role of a public health agency, Joe Kahn, the New York Timess managing editor, told Recode. And you never have a degree of complete certainty about the medical analysis, and the epidemiology.
That degree of uncertainty is much larger when it comes to a new virus that moves around the world as quickly as a plane. Its a problem that comes built into the reporting. Perhaps the only solution journalists have is to simply say: The experts we talked to arent sure, but theyre trying to find out.
Laura Helmuth, who was the health and science editor at the Washington Post and recently left to become editor-in-chief of Scientific American, says acknowledging gaps in knowledge is crucial but not easy.
One thing that science journalists have been getting better at is not just saying what we do know, but what we dont know, she says. But most journalists arent accustomed to doing that.
And that assumes the journalists themselves have the expertise to ask the right experts. Mainstream journalists who know how to read and understand academic research reports are a select group and have been for decades. Many midsize newspapers once employed dedicated science journalists, but those jobs have been dwindling for years. (One reason that Stat, a publication that launched in 2015, which specializes in medical and science reporting, has been so valuable during this crisis is that it employs dozens of expert journalists who once did this work for other outlets.)
But Zeynep Tufekci, a professor at the University of North Carolinas School of Information and Library Science who specializes in the intersection between technology and society, argues that the mainstream media should have been able to understand the threat facing the country much earlier.
Writing in the Atlantic on March 24, she says the threat should have been obvious as early as January 29, when a New England Journal of Medicine paper described the viruss speed, cunning, and lethality. Tufekci shared the paper on Twitter and said that with an urgent enormous effort, this could be contained. But back then, widespread lockdowns and enforced social distancing for everyone regardless of their symptoms were hard to imagine, even for Tufekci. For all of us, washing hands often and not touching ones face and self-isolating if feverish are the sensible stepsas in any flu season, she tweeted.
Tufekcis critique is that many journalists who covered the outbreak in the first couple of months of the year werent analytical enough: Thus from the end of January through most of February, a soothing message got widespread traction, not just with Donald Trump and his audience, but among traditional media in the United States, which exhorted us to worry about the flu instead, and warned us against overreaction. It seemed sensible, grown-up, and responsible.
Some of that advice shows up in memes that highlight headlines from a range of respected media outlets that now seem terribly misleading after new information came to light. (You wont find any Vox headlines in the collage below on flu comparisons, but as many people have pointed out, my colleagues at Vox published some stories and tweets with similar angles.)
But, again: Those stories didnt just materialize out of reporters heads. They were informed by experts trying to make sense of something they hadnt seen before.
For instance, Maimuna Majumder, an epidemiologist at Harvard Medical School, told BuzzFeed News in late January in a story originally titled Dont Worry About The Coronavirus. Worry About The Flu that some worst-case projections about the diseases velocity were absolutely premature and hyperbolic.
A January 29 piece from Axios explained, Why we panic about coronavirus, but not the flu. It quoted an infectious diseases physician at the University of Nebraska, an epidemiologist at the University of Michigan, and a professor of preventive medicine at Vanderbilt University to make the argument that the flu should be Americans real concern.
The same was true for a much-discussed Recode piece from February 13 that looked at the way Silicon Valley was responding to the virus. That story relied on information from the CDC as well as an infectious disease physician at Stanford Health Care, who said that the chances are astonishingly low that you would come into contact with a coronavirus infection at work or in a public setting. Building on those interviews, it repeated the argument that the fact remains that, so far, the flu has impacted far more people. Though true at the time, this clearly missed where the virus was headed.
But even now, months after we first learned about the virus, scientists are still learning the nitty-gritty of how it spreads and the extent to which it lingers in airborne droplets and aerosols that can infect others. That makes it hard to answer a question like, can you contract the virus just by breathing in the same space as someone whos infected? We dont know the full answer and may not for some time, and thats why the institutions that employ these experts have been giving journalists and the public contradictory advice along the way.
That back-and-forth can be jarring, even if weve become accustomed to continual contradictions from our government leaders. The Trump administration has conditioned Americans to a reality where the president routinely announces something in the morning, backtracks it shortly afterward, and later pretends he never said it. So when he does say something, its pored over immediately to check for falsehoods and (usually) treated with appropriate skepticism.
You can argue that American newsrooms should use the same kind of scrutiny when it comes to pronouncements from institutions including ones like the CDC, which generally dont make news. But its not a stance Americans are used to seeing, particularly in the middle of a catastrophe, when people want reassurance and guidance.
An obvious but important point: All of the coverage were discussing here doesnt include Fox News and the rest of the pro-Trump media infrastructure, because it would be unrealistic to expect useful coverage from that infrastructure. With the narrow exception of Tucker Carlson, that apparatus simply provided an echo chamber and feedback loop for Trumps messaging, so that when Trump said he expected the virus to miraculously disappear, they said the same, and when he said it was time to take it seriously, they did the same. This did a deadly disservice to an enormous swath of the country, which takes its cues from those outlets. But its not surprising. Misinformation from the Trump administration is the biggest challenge, Helmuth says. Really good reporters are wasting a ton of time refuting misinformation from the White House.
But even if youre inclined to give the media a pass for its performance before the pandemic hit the US, what about the second phase? When we knew it was coming and that it would be bad?
You cant argue that Americans had mixed messaging by that point: On February 25, CDC official Nancy Messonnier told reporters that she expected to see the coronavirus appear in the US via community spread meaning people would become infected without knowingly coming into contact with other infected people and that disruption to everyday life might be severe.
But even after that, worrisome news about the spread and effects of the virus, which was moving across Asia and showing up in Europe, competed with coverage of the Democratic primary and other stories of the moment, like Harvey Weinsteins sentencing for sexual assault. And stories that did cover the virus often focused on the Trump administrations moves like his decision to put Mike Pence (theoretically) in charge of a virus response team instead of plainly telling Americans that they could be facing huge death tolls and a devastated economy.
I think people were worried about being alarmist, MSNBC host Chris Hayes told Recode. But Hayes also says that figuring out the right degree of alarm to sound is a basic problem for journalists.
In a fundamental, definitional way, news is bad at communicating risk, he said. Telling you about a plane crash is news, but it doesnt convey the risk of flying it overstates it, by giving it prominence. The same with local crime stories. Meanwhile, telling you about a pandemic thats about to overtake the country, kill tens of thousands of people, and crater the economy is very hard to do when it hasnt happened yet, but theres a chance it could.
This core challenge for journalists wont go away after the pandemic: There are always going to be threats that could eventually lead to disaster, but most of them dont. If we holler every time we see one, well be wrong and no one will listen to us. If we dont holler when theres a real one, we will have let down our audience.
I first started poking a few weeks ago at the idea of whether the mainstream media should have been more alarmist about the coronavirus sooner. When I talked to Brian Stelter, CNNs media reporter, on March 10, he told me he didnt want to cause undue fear in his coverage, and that extended to the way he edited the on-air chyrons that ran during his Reliable Sources show.
For instance, Stelter said at the time that he was stripping out the word deadly whenever he saw the phrase deadly virus.
Everyone knows its a deadly virus, he said. You dont have to call it deadly virus every time. Its a virus. We dont call the flu the deadly flu.
As Stelter noted, a lot of this comes down to packaging: How and when do you communicate the most important news to people, and how do you balance the need to not scare them prematurely with the need to scare them into action?
The media should be screaming about it, says Laura Helmuth. They should be saying that the states that dont have stay-at-home orders are killing people, that politicizing this is killing people.
In some cases, the screaming was there, but you had to work to hear it. You wouldnt find it in a headline or the top of a newscast, but if you absorbed the whole thing, youd find news that would scare you into some kind of action.
My sort-of come-to-Jesus moment started on February 27 when I listened to Times reporter Donald McNeil on the papers Daily podcast. He said the worst-case scenario was a repeat of the 1918 flu pandemic, which killed 50 million people worldwide and at least 675,000 in the United States.
In that version, McNeil said calmly: Everybody in the US would know somebody who dies.
Its most gripping in audio form, but I want to pull out a section here:
Donald G. McNeil Jr.Some big chunk of the country 30, 40, 50 percent are likely to get a new virus when it blows through. And if you dont get it in the first wave, you might get it in the second wave.
Michael BarbaroAnd 2 percent lethality rate of 50 percent of the country. I dont want to do that math. Its really, really awful.
McNeilIts a lot of people. It means, you know, you dont die, 80 percent of people have mild cases. But you know somebody who dies.
BarbaroThats pretty horrible Okay. Now, the best-case scenario.
McNeil The best-case scenario is one of these drugs works, and basically everybody gets sick next year, but everybody who is hospitalized gets a drug that keeps them from dying and keeps them from going into deep, deep, deep respiratory distress. And we have the equivalent of a bad flu season. And then everybody says, Oh, the media, they blew it out of proportion again. You know, its all ridiculous. And, you know, I get blamed.
That was enough for me sort of. I didnt change my plans to travel to Los Angeles the following week, but I did start assuming that the rest of my spring plans were going to be up in the air. And I told my family that we should start buying food not in panic, but slowly. And I wondered how The Dailys millions of listeners would respond.
But, again, if you just scanned the title of that days Daily episode, you might not realize that a New York Times reporter was projecting that the best-case scenario for America was that everybody gets sick over the next year but could be saved from serious illness via yet-to-be-developed drugs. And that the worst case was more American deaths than we suffered in World War II. That Title: The Coronavirus Goes Global.
The truth is, theres no good answer to this. You can be as diligent about your sourcing as possible and still get it wrong if the experts you talk to get it wrong. And you can err on the side of not scaring people, when scaring people into action may be the only thing that saves their lives. I dont know that well do better next time, and we may just have to live with it no matter how early the warnings are.
Lets end by traveling back in time to January 27, to watch an exchange you probably didnt see when it aired: CNBCs Brian Sullivan interviewing former Utah Gov. Mike Leavitt, who was also the head of the Department of Health and Human Services from 2005 to 2009.
Leavitt was arguing that if the coronavirus made it to the US, it would be nearly impossible to confine it. But you can see Sullivan struggling, in real time, with how much fear to strike in his audience.
Mike LeavittThere will be a period of time, if this starts to spread, where people will need to change their behavior. These will be the same kind of provisions that every family, every business, every community, every employer, needs to be thinking about, not just for a pandemic virus but for many kinds of emergencies.
Brian SullivanBut we also have to walk, I would imagine, that very fine and difficult line, Governor, which is: You dont want to scare people unnecessarily. We do have five cases. Nobody is minimizing any of those five cases or what is happening. But you also dont want to create a situation where people may begin to act irrational.
Leavitt[Pause] So heres the problem. Anything you say in advance of a pandemic seems alarmist. Anything that youve done after it starts is inadequate.
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