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Good morning.
Were covering the debate over reopening the U.S. economy, a major deal to reduce oil production, and deadly storms in the Southeast.
Gov. Philip Murphy of New Jersey, a Democrat, said of returning to a semblance of life before the coronavirus outbreak: Its not job No. 1, because right now the house is on fire and job No. 1 is to put the fire out.
Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, said that reopening the country would not be an all or none proposition and that restrictions must be lifted gradually to prevent a resurgence of cases. He also said that more lives could have been saved if the country had been shut down earlier.
Here are the latest updates from the U.S. and around the world, as well as maps of the pandemic.
Were also tracking the viruss growth rate in hundreds of U.S. metro areas.
In other developments:
Prodded by President Trump, OPEC, Russia and other oil producers agreed to reduce output by 9.7 million barrels a day in May and June, close to 10 percent of the worlds production. Demand for oil is down about 35 percent since the start of the crisis.
The Daily: In todays episode, Americans discuss how their lives have changed during the pandemic.
Perspective: In an opinion piece for The Times, Joe Biden outlines his strategy for reopening the U.S. economy.
The details: Weve compiled expert guidance on several subjects, including health, money and travel.
The Times is providing free access to much of our coronavirus coverage, and our Coronavirus Briefing newsletter like all of our newsletters is free. Please consider supporting our journalism with a subscription.
The obstetrics unit at the Brooklyn Hospital Center, where nearly 200 babies have been born since the beginning of March, has been transformed during the pandemic, with mothers-to-be confined to their rooms. Multiple doctors and nurses have gotten sick.
Some pregnant women have fallen extremely ill, but doctors are winning battles for their lives and their childrens. So far, not one mother or baby has been lost.
Another angle: Gov. Andrew Cuomo insisted that he had the final say on when New York Citys public schools will reopen. Mayor Bill de Blasio has said they will remain closed through the end of June.
Related: New York State still has hundreds of coronavirus-linked deaths each day, but hospitalization rates and other data suggest that the spread of the virus has slowed, Mr. Cuomo said on Sunday. Heres the latest from our Metro desk.
Epidemiologists have praised the aggressive stay-at-home orders in California, Oregon and Washington for helping to limit the spread of the coronavirus, a contrast to relatively slower moves in New York State and elsewhere.
As of this morning, there have been more than 9,300 virus-related deaths in New York, compared with just over 1,200 total for the three Pacific Coast states.
Some say the effects of the western states moves have been overlooked in a country where news outlets are concentrated in New York City and Washington, D.C.
Quotable: California and the Bay Area response is impressive because it was done before there were obvious and tangible risks, said Dr. Robert Wachter at the University of California, San Francisco. New York acted in a more predictable way.
Another angle: Space and privacy have emerged as a class divide: more valuable than ever to those who have it and potentially fatal to those who dont.
They include a group of veteran black actresses who have overcome the odds to achieve long Hollywood careers. Above, clockwise from left: Taraji P. Henson, Mary J. Blige, Angela Bassett, Lynn Whitfield, Halle Berry and Kimberly Elise.
Deadly storms in the South: At least 11 people were killed as tornadoes hit Mississippi and other states. More severe weather is expected through this morning.
Chernobyl fires: Firefighters have struggled to control wildfires burning through radioactive forest around the abandoned nuclear plant in Ukraine. Radiation levels there are considerably lower than they were immediately after the 1986 accident but still pose risks.
Snapshot: Above, tulips in the Netherlands. Lockdowns have led growers to destroy hundreds of millions of flowers, upending a season that brings in about 7 billion euros ($7.6 billion).
Metropolitan Diary: In this weeks column, a sharp comeback, a turtle in trouble and more reader tales of New York City.
What were reading: This Guernica magazine essay about a writers enduring love for Dolly Parton. This gorgeous reflection on childhood, beauty and origin stories has me blasting my own Dolly Parton albums, says Anna Holland, an editor in London.
Now, a break from the news
Cook: Coconut macaroons, two simple ways. They might just be the easiest and most forgiving of any cookie.
Read: Vanessa Friedman on Bill Cunninghams photographs of Easter parades past in New York City. Dwight Garner reviews a collection of poems by Hannah Sullivan. And speaking of poetry, heres some for children, with pictures.
Cope: Heres how to manage a refund for that vacation that isnt happening. Art can help put the pandemic in perspective. And Tara Parker-Pope has a definitive guide to face masks.
We have more ideas about what to read, cook, watch and do while staying safe at home.
During the pandemic, The Times has enhanced its service journalism: answers to questions people are asking, and solutions to problems theyre experiencing.
Elisabeth Goodridge and Karen Barrow are two Times journalists now assigned to that coverage. Heres a taste of their approach, edited from their discussion with Times Insider.
Where have you found support?
Elisabeth: Service journalism is coming from every single corner of the newsroom. Its coming from Business, from Metro, from Parenting, from Health. Its pretty much the entire newsroom.
How does this differ from what you normally do?
Elisabeth: I am usually the deputy travel editor. What I have been doing is figuring out what service stories are needed now. There are three ways Im approaching it. First, what kind of stories are we hearing from our reporting? Second, what reader questions are coming in? Third, were reviewing what people are searching for on Google. Then, actually, fourth is whatever comes out of Karens mind.
Karen: My logic, having been an editor for Smarter Living for a couple of years, is that if Im wondering about it, a lot of other people probably are.
What does an average day look like for you?
Karen: We both have kids, so were balancing that. Theyre all home. I find myself constantly checking Slack and email and furiously working during windows when theyre busy with other things.
Elisabeth: I have been waking up early to get as much work done as I can before my son is awake. We have a lot of meetings. Theres just so much news. In the afternoon, Im doing a lot of editing. Were taking ideas from our own lives, because we know that other people are having these issues, too.
How do you decompress?
Elisabeth: You have to walk around. Drink water.
I think everyone needs to be really disciplined, and I need to start taking my own advice on making sure that we know this is a marathon, not a sprint. And additionally, being good to my mental health, being good to all my co-workers and everyone I know.
Karen: I have a dog who Ive never loved more because he gets me out of the house twice a day.
Thats it for this briefing. See you next time.
Chris
Thank youMelissa Clark provided the recipe, and Theodore Kim and Jahaan Singh the rest of the break from the news. The Back Story is based on reporting by Danya Issawi. You can reach the team at briefing@nytimes.com.
P.S. Were listening to The Daily. Todays episode is about life in the U.S. during the pandemic. Heres todays Mini Crossword, and a clue: Prayer ender (four letters). You can find all our puzzles here. Sam Sifton, the founding editor of NYT Cooking, and our restaurant critics will discuss the effects of the coronavirus pandemic on the restaurant industry during a group call with readers at 4 p.m. Eastern today. R.S.V.P. here.
Covid-19 symptoms vary widely, and undertesting in many countries means that many people may have already had the coronavirus without having received a positive diagnosis. Is it possible to find out, and how should you behave if you think you may have been infected?
Dr William Hillmann: Antibody tests are being developed but are not in widespread clinical use yet. The antibody testing would allow us to check blood samples for antibodies against coronavirus to tell whether somebody has had it. I, and I think many others, are anxiously awaiting for those to become available.
Hillmann: Coronavirus is actually quite a significant spectrum of symptoms, from people who are entirely asymptomatic and would have no idea that they have it to people with very mild, cold-like symptoms runny nose, congestion, sore throat to people with more flu-like symptoms high fevers, muscle aches, shortness of breath and cough. Loss of smell and taste are also symptoms. All the way up to people with severe illness, who were seeing in the hospital with respiratory failure, requiring ICU care.
Its impossible right now to say what the true prevalence of the disease in the US is since we are still prioritizing testing for people who are sick or in the hospital or who are healthcare workers. Were not doing widespread testing that South Korea and some European countries have done to get a sense of how many people are asymptomatic or have such minimal symptoms that they attribute it to allergies or something else.
Hillmann: A significant proportion of people who are totally asymptomatic are contagious for some portion of time. We just dont know [for how long] at this point, because we dont have the kind of testing available to screen for asymptomatic infections.
When people are symptomatic, theyre contagious. A day or two before they become symptomatic, theyre likely contagious as well. A virus builds up and starts to shed, and then after symptoms resolve, people can still be contagious for a couple of days. We have some evidence of viral shed even a couple of weeks after symptoms are resolved. Its hard to know if thats actual live virus, which is still able to infect somebody, or if thats just dead virus that the body is shedding.
Dr David Buchholz: We all have to be role models. If were all in it together, we all should be doing social distancing.
Hillmann: Since theres no real way to know at this point who might have had it, unless youre symptomatic, you get a swab and are definitively diagnosed with it, I would just act as if you hadnt had it. Keep doing all of those things that we all should be doing at this point: social distancing and hand hygiene. I think universal mask-wearing in public is a reasonable recommendation based on what we know about the wide spectrum of symptoms, and the fact that people can be asymptomatic and still be shedding the virus.
Buchholz: I would, absolutely. Im in New York, and it was definitely in the community before we knew it. So, yeah, any family members and close friends, maybe somebody you work next to, I think I would just alert them, especially if it was in the last 14 days. If its been more than 14 days, they would have gotten sick by now if they had significant exposure.
Hillmann: Its up to every individual about what they feel is right. That being said, with the surge in infections that were seeing in places like New York, if you were symptomatic at one point but were not tested, and you were in close contact with somebody, I think you should tell them.
Buchholz: Theres not been any evidence that anyones gotten it more than once. Someone with a normal immune system that can react to the virus and get better should have immunity for quite some time, at least a year, if not lifelong.
There have been reports out of China suggesting people are testing positive for Covid-19 a second time. Most scientists think it is an issue around the inaccuracy of the testing and not that people are having two separate cases of the disease.
Experts
Dr David Buchholz, senior founding medical director, primary care, assistant professor of pediatrics, Columbia University Irving medical center
Dr William Hillmann, associate inpatient physician director at Massachusetts general hospital
Due to the unprecedented and ongoing nature of the coronavirus outbreak, this article is being regularly updated to ensure that it reflects the current situation at the date of publication. Any significant corrections made to this or previous versions of the article will continue to be footnoted in line with Guardian editorial policy.
This is the most important thing recovered patients can do to help.
Once a person recovers from Covid-19, his or her blood contains antibodies in its plasma that can fight the virus. Those antibodies can be extracted from a donors blood and given to a severely ill patient via transfusion, with the hope that the donors antibodies will help the patient recover.
The use of convalescent plasma plasma from people convalescing, or recovering to treat illnesses has been around for a century, as doctors used the process to treat patients as far back as the Spanish flu in 1918. More recently, the treatment has been used on patients with polio, measles, SARS and other illnesses, and there is anecdotal evidence and new data that show it could be effective in treating patients with severe cases of Covid-19, according to Dr. Pampee Young, chief medical officer of the American Red Cross.
We certainly are getting anecdotal reports in, Dr. Young said, that seem to be very positive, adding that some people who have received convalescent plasma are stabilizing and requiring less oxygen.
Still, there is not yet conclusive evidence the procedure will be effective in treating Covid-19, and the process is very early on.
A spokeswoman for the Mount Sinai Health System in New York said that about 30 patients had received the treatment so far, with a few hundred more expected in the coming weeks. Dr. Young said the Red Cross collected only one donation of convalescent plasma the week of March 30 with several more expected last week, and that it could be as long as half a year until it is definitively known whether it works.
Still, with a small, but growing, body of research that is indicating positive results, we can be somewhat optimistic about convalescent plasma as being an effective therapy, Dr. Young said.
To qualify, donors must pass normal blood-donation requirements and be symptom-free of Covid-19 for at least 14 days, and, in most cases, must have positive results from a test. (Other restrictions may apply, depending on the organization.) Recovered patients can donate once every 28 days, and the process to donate can take 90 minutes to two and a half hours.
While the coronavirus pandemic has stalled much of the world's activity, China has kept up its aggression in the disputed South China Sea actions that analysts said could deepen the mistrust between Washington and Beijing.
China's continued hostility toward its Southeast Asian neighbors in the contested waters appear at odds with the soft power that Beijing has sought to portrayas the outbreak in the mainland receded. In the past few weeks, China has sent help to countries hit hard by the pandemic and rallied for global coordination in managing the outbreak.
But the sinking of a Vietnamese fishing boat by a Chinese surveillance vesselearlier this monthonce again brought into the spotlight Beijing's multi-year assertions in the South China Sea, in which it claims nearly the entire waterway.Other main claimants to the resource-rich waterway include the Philippines, Vietnam, Malaysia, Taiwan and Brunei.
"Fundamentally, China has not let the Covid-19 outbreak dampen its pursuit of foreign policy issues. In addition to the South China Sea, Beijing has also authorized air force flights around Taiwan in the past month," Kelsey Broderick, China analyst at consultancy Eurasia Group, told CNBC in an email.
"China may be hoping to both send a message to other countries involved in the South China Sea that China will not back down under any circumstances, and send a message to a domestic population about the strong leadership of the party," she added.
The coronavirus, which has infected over two million people globally, first appeared in the Chinese city of Wuhan in December last year. There have been accusations both domestically and internationally that Chinese authorities ignored early warnings about the outbreakand attempted to downplay its severity.
Collin Koh, an expert on maritime security at Singapore's Nanyang Technological University (NTU), told CNBC there were "speculations" about whether the pandemic would hamper China's ability to "maintain vigil over issues of national defense and security concerns."
"This would send the wrong signal back home and to the international community that there's a let-up in asserting such interests that concern sovereignty and rights," he said,explaining that could be why China has had to maintain its activity in the South China Sea.
"What I observe is that, since the outbreak till present, there's no rolling back at all," said Koh, a senior fellow at the S. Rajaratnam School of International Studies, a think tank within NTU.
Issues surrounding the South China Sea have for years been a point of contention in the relationship between the U.S. and China the world's top two economies competing for geopolitical influence in Asia Pacific.
The U.S. doesn't claim any parts of the South China Sea as its own but has long promoted the "freedom of navigation" by air and sea across the waterway, which Washington has accused Beijing of militarizing.
The U.S. has conducted activities including surveillance and military exercises in the area that is also a vital commercial shipping route, where an estimated $3.4 trillion of the world's trade passed through in 2016, according to think tank Center for Strategic and International Studies.
Meanwhile, the U.S.Energy Information Administration (EIA) estimated thatmore than 30% of the world's maritime crude oil tradeor an estimated 15 million barrels per day passed through those waters in 2016. Data by the EIA also showed that the South China Sea is rich in resources, containing some 11 billion barrels of oil and 190 trillion cubic feet of natural gas in proved and probable reserves can be found there.
Following the sinking of the Vietnamese fishing boat, the U.S. hit out at China, saying it's "seriously concerned" by reports of what Beijing did.
"This incident is the latest in a long string of PRC actions to assert unlawful maritime claims and disadvantage its Southeast Asian neighbors in the South China Sea," the U.S. Department of State said in a statement, referring to China's formal name, People's Republic of China.
"We call on the PRC to remain focused on supporting international efforts to combat the global pandemic, and to stop exploiting the distraction or vulnerability of other states to expand its unlawful claims in the South China Sea," the statement read.
We don't need extraneous crises right now, we've certainly got enough on our plate with this once-in-a-century kind of global crisis that we're all facing right now.
Susan Thornton
senior fellow at Yale University's law school
In response, China's Ministry of Foreign Affairs accused the U.S. of sending "warships and planes to make waves in the South China Sea" and attempting to "negate China's legitimate claims and stir up troubles."
"At present, the world is in a crucial period of jointly combating the pandemic. While fighting the pandemic at home, China is doing its utmost to support and help other countries in need, which has won universal praise from the international community," said a Chinese foreign ministry spokesmanZhao Lijian.
"China urges the US to stop linking the pandemic with maritime issues and focus on domestic and international anti-epidemic response instead of doing otherwise," Zhao added.
Such an exchange could contribute to "a worsening relationship around foreign policy issues" between the U.S. and China, said Broderick of Eurasia Group.
She added that in the coming weeks, the U.S. may be "especially sensitive to China's attempts to leverage its Covid-19 aid for more leadership in international institutions like the (United Nations) or for a stronger leadership role in Asia."
Further mistrust between the U.S. and China is also unnecessary at a time when countries globally should be working together to fend off a fast-spreading coronavirus disease, said Susan Thornton, a lecturer and senior fellow at Yale University's law school.
She told CNBC's "Squawk Box Asia" that both countries should focus on getting their respective economies back on track, and set aside "other issues that are still pending."
"We don't need extraneous crises right now, we've certainly got enough on our plate with this once-in-a-century kind of global crisis that we're all facing right now," she said.
Nevertheless, China's sinking of the Vietnamese fishing vessel in a part of the South China Sea claimed by both sides reflects the ongoing tensions among countries involved in a complicated and decades-long territorial dispute.
... my concern is that any of the claimants, China in particular, might simply use this window of delay to further consolidate and strengthen its position in the (South China Sea).
Collin Koh
Nanyang Technological University
China claims large swatches of the sea based on what Beijing said are nine dashes delineating Chinese historical territory in olden maps. The so-called "nine-dash line" overlaps with territorial claims by several parties, and forms the basis for China's actions ranging from drilling for oil to creating artificial islandsin the disputed waters.
A number of claimants including China, Taiwan, Vietnam, Malaysia and the Philippines also contest over some islands, reefs and shoals in the South China Sea.
In 2016, an international tribunal dismissed the nine-dash line as legally baseless a ruling that China ignored.
Koh from Singapore's NTU said a resolution to the dispute is "a long way off" even though the claimants have made some progress in negotiating a joint "code of conduct." The framework, initially aimed to finalize next year, will form the basis to manage and resolve the territorial dispute.
"However, the pandemic might have thrown uncertainties into the works. And my concern is that any of the claimants, China in particular, might simply use this window of delay to further consolidate and strengthen its position in the (South China Sea)," he said.
"And we do see now how China is already doing that."
Many Americans have been living under lockdown for a month or more. Were all getting antsy. The president is talking about a light at the end of the tunnel. People are looking for hope and reasons to plan a return to something anything approximating normalcy. Experts are starting to speculate on what lifting restrictions will look like. Despite the relentless, heroic work of doctors and scientists around the world, theres so much we dont know.
We dont know how many people have been infected with Covid-19.
We dont know the full range of symptoms.
We dont always know why some infections develop into severe disease.
We dont know the full range of risk factors.
We dont know exactly how deadly the disease is.
We dont have answers to more detailed questions about how the virus spreads, including: How many virus particles does it even take to launch an infection? How far does the virus travel in outdoor spaces, or in indoor settings? Have these airborne movements affected the course of the pandemic?
We dont know for sure how this coronavirus first emerged.
We dont know how much China has concealed the extent of the coronavirus outbreak in that country.
We dont know what percentage of adults are asymptomatic. Or what percentage of children are asymptomatic.
We dont know for certain if the virus will subside as the Northern Hemisphere enters the warmer months of spring and summer, as other viruses do. The director of the Centers for Disease Control and Prevention is bullish. Other experts, not so much.
We dont know the strength and duration of immunity. Though people who recover from Covid-19 likely have some degree of immunity for some period of time, the specifics are unknown.
We dont yet know why some whove been diagnosed as fully recovered from the virus have tested positive a second time after leaving quarantine.
We dont know why some recovered patients have low levels of antibodies.
We dont know the long-term health effects of a severe Covid-19 infection. What are the consequences to the lungs of those who survive intensive care?
We dont yet know if any treatments are truly effective. While there are many therapies in trials, there are no clinically proven therapies aside from supportive care.
We dont know for certain if the virus was in the United States before the first documented case.
We dont know when supply chains will strengthen to provide health care workers with enough masks, gowns and face shields to protect them.
In America, we dont know the full extent to which black people are disproportionately suffering. Fewer than a dozen states have published data on the race and ethnic patterns of Covid-19.
We dont know if people will continue to adhere to social distancing guidelines once infections go down.
We dont know when states will be able to test everyone who has symptoms.
We dont know if the United States could ever deploy the number of tests as many as 22 million per day needed to implement mass testing and quarantining.
We dont know when well be able implement full-scale serological testing.
We dont know if full-scale serological testing will accurately determine immunity.
We dont know if we can implement test and trace contact tracing at scale.
We dont know whether smartphone location tracking could be implemented without destroying our privacy.
We dont know if or when researchers will develop a successful vaccine.
We dont know how many vaccines can be deployed and administered in the first months after a vaccine becomes available.
We dont know how a vaccine will be administered who will get it first?
We dont know if a vaccine will be free or costly.
We dont know if a vaccine will need to be updated every year.
We dont know how, when we do open things up again, we will do it.
We dont know if people will be afraid to gather in crowds.
We dont know if people will be too eager to gather in crowds.
We dont know what socially distanced professional sports will look like.
We dont know what socially distanced workplaces will look like.
We dont know what socially distanced bars and restaurants will look like.
We dont know when schools will reopen.
We dont know what a general election in a pandemic will look like.
We dont know what effects lost school time will have on children.
We dont know if the United Statess current and future government stimulus will stave off an economic collapse.
We dont know whether the economy will bounce back in the form of a v curve
Or whether itll be a long recession.
Or whether itll be a Great Depression.
Or whether itll be a Greater Depression.
We dont know when we might be able to return to a new normal.
We dont know when any of this will end for good.
There is, at present, no plan from the Trump White House on the way forward.
As of noon Sunday, April 12, 2020, there were at least 901 documented cases of the novel coronavirus in Long Beach-area communities, according to the Los Angeles County Department of Public Health.
Totals for Long Beach are provided by the citys health department. The rest are from LA County.
Between Thursday and Sunday, there were 129 new cases in Long Beach-area communities.
The Long Beach-area communities with the most cases of COVID-19 are the city of Long Beach with 350, Downey with 101, and South Gate with 96.
MAP: This map shows how coronavirus has struck much of LA County
Outside of the Long Beach area, communities in the South Bay have a total of 1,059 cases.
There could be more cases in any of these areas. The county is still investigating 688 possible COVID-19 cases and hasnt yet released information on where those patients live in the county.
And due to the limited availability of COVID-19 tests, officials have said there are many more people infected with the novel coronavirus than are represented in these numbers.
As of noon Sunday across Los Angeles County, the health departments of LA County and the cities of Pasadena and Long Beach have recorded 9,210 confirmed cases of COVID-19, the disease caused by the novel coronavirus.
Of the 9,210 patients with positive COVID-19 tests, 2,246 have been hospitalized.
There have been 302 deaths in the county due to the virus.
For complete totals, check the health departments coronavirus location page at http://publichealth.lacounty.gov/media/Coronavirus/locations.htm and the Pasadena and Long Beach health department sites.
April 9, 2020: 772 coronavirus cases in the Long Beach area
April 8, 2020: 716 coronavirus cases in the Long Beach area
April 7, 2020: 652 coronavirus cases in the Long Beach area
April 5, 2020: 533 coronavirus cases in the Long Beach area
April 2, 2020: 308 coronavirus cases in the Long Beach area
April 1, 2020: 275 coronavirus cases in the Long Beach area
March 31, 2020: 245 coronavirus cases in the Long Beach area
March 30, 2020: 207 coronavirus cases in the Long Beach area
March 27, 2020: 121 coronavirus cases in the Long Beach area
March 25, 2020: 65 coronavirus cases in the Long Beach area
A man runs over London's Millennium Bridge, as life in Britain continues during the nationwide lockdown to combat the coronavirus pandemic. Glyn Kirk/AFP via Getty Images hide caption
A man runs over London's Millennium Bridge, as life in Britain continues during the nationwide lockdown to combat the coronavirus pandemic.
On this broadcast of The National Conversation, an infectious disease expert answers your questions on the transmission and containment of the coronavirus. We'll also hear about the global fight against the pandemic and efforts to continue to slow the spread.
K.J. Seung is surprised to be hiring and training new workers in Boston.
His public health nonprofit, Partners in Health, specializes in helping the poorest people in developing nations tracking down contacts of Ebola patients in Liberia and Sierra Leone; running child health and HIV clinics in Haiti; and operating tuberculosis control programs in Peru. But now it is advertising for 500 people to help do whats known as contact tracing to try to control Covid-19 in Massachusetts.
Its the first step in the next stage of fighting the pandemic. Boston-based Partners in Health has trained 12,000 community health workers in countries including Malawi, Mexico, and Rwanda and now it will help train a battalion of workers in Massachusetts to interview everyone diagnosed with Covid-19 and find other people who may have been infected by them. This old-fashioned, shoe-leather public health approach contained the SARS outbreak in 2003 and 2004, and public health experts agree it will be vital to eventual control of the new disease.
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We never thought we would be doing this kind of work here, Seung, senior health and policy adviser for tuberculosis at Partners In Health, told STAT. We never thought we would be in a once-in-100-year pandemic, either.
Combined with more widespread testing, contact tracing is seen as an essential part of the strategy for keeping the coronavirus in check after the first wave recedes and the economy reopens. But the work is highly labor-intensive, and public health departments across the U.S. have been woefully underfunded for years.
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This is going to test the capacity of the existing public health system, said Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials. I dont know if we have enough staff in public health departments to do that.
Hence the hiring spree kicking off in Massachusetts and a few other places.
Partners in Health is working with state officials in Massachusetts, who say they will eventually deploy nearly 1,000 people to do contact tracing.
In San Francisco this weekend, three dozen volunteer nurses, medical students, and librarians started training at the University of California, San Francisco the first of an expected 100 people who will supplement the citys 10-person contact-tracing workforce.
We are providing the people to make phone calls, we are working on standard scripts, we are working on IT solutions, training, and we are fielding teams of contact tracers, said George Rutherford, UCSFs head of disease and global epidemiology.
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, argues Tom Frieden, a former director of the Centers for Disease Control and Prevention. We need an army of 300,000 people, he told STAT.
The current CDC director, Robert Redfield, said last week that a substantial expansion of public health fieldworkers will be needed to undertake aggressive contact tracing what I call block and tackle.
Speaking to NPR on Thursday, he said it would be premature to say how CDC would expand contact tracing but that planning was far along.
But Frieden said he doubted the federal government would help much immediately. Until the federal response is more coherent, each state is going to be on its own, he said.
Normally, the CDC would be taking the lead, Plescia added. Right now, they are pretty maxed out. It is the state and local governments who will have to train people and have a system that works.
The $2 trillion stimulus package signed into law last month creates a $150 billion Coronavirus Relief Fund for states and local and tribal governments, plus gives $4.3 billion via the CDC to help in responding to the pandemic. The money is not earmarked for epidemiology but states could, in theory, use some of the money for hiring workers to do contact tracing.
It will require a much larger effort than the mass deployment that eventually conquered SARS.
Unlike SARS, Covid-19 has spread easily and quickly from person to person. It took SARS more than a year to infect 8,000 people, killing close to 800 of them. Since December, Covid-19 has been diagnosed in more than in the United States alone.
We are going to have to handle it with an extreme amount of effort, said Frieden, who is now president and CEO of the nonprofit Resolve to Save Lives. I think of it as a four key actions: test, isolate the infected, contact trace, and then follow up the contacts. And each of those four things needs to be going really, really well and at a massive scale.
Right now, countries, cities, and states are struggling just to treat the onslaught of Covid-19 patients. Most are relying on shelter-in-place, stay-at-home, and social isolation orders to prevent spread. The idea is to bend the curve of infection, spreading out new infections over a greater time so that hospitals and clinics can cope better.
But bending the curve doesnt mean transmission will stop. Only a small percentage of the population anywhere will have been infected and presumably immune in the coming months, Frieden noted.
We are not going to get herd immunity soon, he said. It will come back. Even in the worst hot spots, only 5% to 10% of people will have been infected.
A usable vaccine is likely a year or longer from the market, and groups are only beginning to test potential treatments. Until we develop a vaccine or viable treatment strategy, ongoing testing, isolation, monitoring, and contact tracing will be a necessary to contain the epidemic and prevent another spike, Plescia said.
So Frieden and others are pressing for an army of public health workers armed with diagnostic tests to track down every case quickly.
We are going to have to be able to test every patient with pneumonia in the country within minutes or hours, Frieden said.
The concept is once you get down to a manageable number of cases and scale up the public health system, then you will be able to pounce on any case or cluster to proactively identify cases, identify contacts, and follow up on those contacts. And when you get those things done, you can prevent the clusters from becoming outbreaks, prevent outbreaks from becoming epidemics, and prevent the epidemics from driving us into our homes again.
This approach may have helped Hong Kong and South Korea get a quick handle on their epidemics, said David Holtgrave, dean of the School of Public Health at the University at Albany in New York.
They didnt do so much of physical distancing by shutting down whole cities and whole regions. They did more in the way of using testing data and contact tracing data to see who should be quarantining themselves or isolating themselves, Holtgrave said.
David Harvey, executive director of the National Coalition of STD Directors, has seen a steady drop in the number of staff in state and local health agencies trained to track down contacts of patients with sexually transmitted diseases, even as STD rates have soared. These same workers would have been immediately available to work on coronavirus. Now states will have to hire a fresh corps. We need to radically increase the numbers of these positions in order to help the country recover, he said.
Twenty years ago, this workforce had a high of 5,000 or 6,000 people, Harvey told STAT. Today it is only 1,600. The reality is that we at least need a work force of 30,000 people.
Frieden puts the needed number at 10 times that.
Luckily, potential workers are right at hand, with so many jobs lost to Covid-19 over the past weeks. There are a lot of people out there, Frieden said. There are college graduates, people working at social service agencies, social workers, child health workers, people doing Meals on Wheels.
Technology can help, and numerous apps are being developed to speed up the process of tracking down contacts. But public health experts said such tools wont eliminate the need for thousands of new workers.
Costs would be relatively low maybe $720 million for 30,000 workers, said Harvey.
States are not even close to having enough workers, and most state health departments contacted by STAT said they had not begun to think that far ahead. Florida, a state with the one of the smallest epidemiology work forces, hired 100 people in one weekend last month, according to the Tampa Bay Times.
Plus, there are other barriers, Holtgrave noted. To diagnose cases, many more tests are needed. And any in-person contact will require personal protective equipment, also in short supply.
Thats why Partners in Health plans to start workers out on the back end, interviewing patients who have already been diagnosed to find their contacts.
We are not knocking on doors, Seung said. People are working in their homes and they are making phone calls.
One piece of good news its not hard to find people who want to do the work. Seung says his office has received more than 5,000 applications for the 500 jobs.
People are really grasping to do something, he said.
AMSTERDAM For tulip growers in the Netherlands, Friday the 13th of March this year was a true horror show. When tulip stems came up at the countrys largest flower market in Aalsmeer, the prices stalled over and over again at zero.
Frank Uittenbogaard, a director of JUB Holland, a 110-year-old family farm in Noordwijkerhout, made the tough decision to destroy his tulip stems 200,000 of them.
That hurt a lot, he said in a telephone interview on Thursday. Its very painful because you start in July with digging the bulbs and you have to give them the right treatment to plant them in October, and later move them to the greenhouse. We had very good quality tulips this year. I took my bike and went cycling when they did it because I couldnt handle it.
He wasnt the only grower who had to dump tulips: About 400 million flowers, including 140 million tulip stems, were destroyed over the past month, estimates Fred van Tol, manager of international sales for Royal FloraHolland, the largest cooperation of flower and plant producers in the Netherlands.
Demand for tulips dropped precipitously as flower shops around the globe have shut down because of the outbreak, consumers have gone into lockdown and celebrations have been canceled.
This virus hit us right in the middle of the tulip sales, Mr. van Tol said. In total, four weeks out, the turnover is still 50 percent lower than last year.
Usually, the period from March through May including the weeks in which International Womens Day, Easter and Mothers Day fall is the Dutch flower industrys strongest season. It pulls in 7 billion euros ($7.6 billion), with an average of $30 million in flowers sold daily. Tulip growers put their wares up for sale starting in March, when the flowers begin to bloom. Tulip season usually lasts about eight weeks.
Some parts of the industry have been hit harder than others because of the coronavirus outbreak, said Mr. van Tol, depending on the market that producers or distributors serve, with losses from about 10 percent up to about 85 percent.
The Netherlands, which has recorded more than 24,400 coronavirus cases and 2,643 deaths, has put in place a moderate social policy to combat the spread of the virus without going into a full lockdown. Schools, restaurants, bars, museums, sports facilities and gyms are closed until April 28. Most events of more than 30 people have been banned until June 1.
Small shops, however, such as florists and garden shops, can remain open as long as customers maintain a social distance of 1.5 meters (just under 5 feet) from each other and shop employees.
While growers and distributors that primarily serve the local market are still able to sell flowers and plants domestically, those flower businesses that rely on international trade are worse off.
Jan de Boer, the general director and owner of Barendsen, a global flower export company based in the Dutch village of Aalsmeer, said that he had lost 90 percent of his seasonal revenues so far. He typically has 60 full-time employees this time of year, and now, he says, he has work for only six. The Dutch government is paying those salaries, he said, so that hasnt hurt his business for the moment.
What is my biggest problem? he said. My client Viking River Cruises is not going to have one American customer on a boat this year. I will lose all of the business with them, so for me thats half a million or a million euros.
He has also lost all business to countries where florists are closed, including Italy, Spain and France.
At the same time, millions of visitors who trek annually to the blooming tulip fields in the flower-growing region of Lisse have canceled trips, and the effects have rippled out to related businesses. The Keukenhof, the largest flower park in the Netherlands, typically welcomes 1.5 million visitors a year during its eight-week opening that coincides with the blooming of the tulips.
But this year, because of the governments anti-coronavirus measures, the park has been shut down from its scheduled opening day, March 21, until its scheduled closing date, May 10. That will cost it an estimated $25 million in revenues.
Nature doesnt listen to all the regulations, said Bart Siemerink, managing director of the Keukenhof. We have a splendid spring in the Netherlands, and now the park is really looking beautiful. Were doing our best to bring that to people stuck at home.
People can still view the untrammeled gardens online, via Keukenhof Virtually Open, until the flowers bloom again next year.
The 25 staff gardeners, meanwhile, continue to maintain the park. Mr. de Boer said he expected Dutch flowers to bounce back.
Im optimistic because people will always need flowers, to connect, to be together, to tell a story, he said. Im optimistic about the flowers, but Im not optimistic about how to finance the gap. If you cant make up for the losses, youre out of the game. So I will do my utmost to survive.
Its more than money, he added. Its a passion.
The men who beat Mehboob Ali did so without mercy. Dragging him to a field in the village of Harewali, on the fringes of north-west Delhi, the group hit him with sticks and shoes until he bled from his nose and ears. Ali was a Muslim, recently returned home from a religious gathering, and the Hindu mob was quite certain he was part of a so-called Islamic conspiracy to spread coronavirus to Hindus nationwide. His attackers believed the devout 22-year-old must be punished before he carried out corona jihad.
The allegations were entirely false, but according to video footage and his family, the men who beat Ali on 5 April were in little doubt of his guilt, demanding: Tell us who else is behind this conspiracy. Ali was then taken to a nearby Hindu temple and told to renounce Islam and convert to Hinduism before they would allow him to go to hospital.
Five days after the attack Alis family was still in fear of also being accused of spreading the virus. If we file a police case, the Hindus will not let us live in the village, said one family member, who asked not to be named. Police confirmed that due to his attendance at a Muslim convention in Bhopal a few weeks back, Ali was being held in the isolation ward of Lok Nayak Jai Prakash Narayan hospital in Delhi as a corona suspect, though he had no symptoms.
The attack on Ali is symptomatic of the growing demonisation of Indias Muslim community, who are being accused, without any basis, of conducting a malevolent campaign to spread Covid-19 to the Hindu majority.
Already a minority under attack it is just weeks since Hindu mobs attacked Muslims in religious riots in Delhi Muslims have now seen their businesses across India boycotted, volunteers distributing rations called coronavirus terrorists, and others accused of spitting in food and infecting water supplies with the virus. Posters have appeared barring Muslims from entering certain neighbourhoods in states as far apart as Delhi, Karnataka, Telangana and Madhya Pradesh.
The troubles began when the gathering of an Islamic missionary organisation, Tablighi Jamaat, held in mid-March in the south Delhi neighbourhood of Nizamuddin, was singled out by police and government as being responsible for the spread of coronavirus across India. The convention, which had been given the go-ahead by the Delhi authorities, was attended by about 8,000 people, including hundreds of foreigners. It soon became apparent that many at the convention had unknowingly picked up Covid-19 and brought it back to towns and villages across India.
Across the country, police were ordered to round up anyone associated with the organisation. So far, more than 27,000 Tablighi Jamaat members and their contacts have been quarantined in about 15 states. In Uttar Pradesh, the police offered up to 10,000 rupees (105) for information on anyone who had attended the gathering.
In a statement this week, the Indian Scientists Response to Covid-19 group said the available data does not support the speculation that the blame for the coronavirus epidemic in India lies mainly with Tablighi Jamaat. The scientists emphasised that while testing for coronavirus is extremely low across India, a disproportionate number have been of members of Tablighi Jamaat, as per a government order, therefore heavily skewing the figures.
Yet the test results were swiftly seized upon by members of the ruling ruling Hindu nationalist Bharatiya Janata party (BJP), who claimed Tablighi Jamaat members had intended to infect millions as part of an Islamic conspiracy and were carrying out corona terrorism.
Senior BJP leaders accused Tablighi Jamaat of carrying out a Talibani crime, described their members as human bombs, but in the guise of coronavirus patients, and called for Tablighi Jamaat leaders to be both hanged and shot. Kapil Mishra, a local BJP leader notorious for hate speeches, tweeted: Tablighi Jamaat people have begun spitting on the doctors and other health workers. Its clear, their aim is to infect as many people as possible with coronavirus and kill them.
Though quickly debunked, the rumours of Tablighi Jamaat members refusing to go into quarantine, assaulting hospital staff and throwing bottles of urine at Hindus quickly spread.
Hashtags such as coronaJihad, CoronaTerrorism and CoronaBombsTablighi began to trend on Twitter in India. Mainstream Indian media repeatedly asserted that Tablighi Jamaat members were coronavirus superspreaders.
Dr Zafarul-Islam Khan, chairman of the Delhi Minorities Commission, said that while Tablighi Jamaat had been shortsighted in holding the convention, there were dozens of examples of government, political parties and other religious groups who also flouted the coronavirus restrictions and gathered in large numbers.
He added: But the whole focus is being directed only on Muslims. In the past few days, we have noted a new wave of attacks on Muslims across the country. There is talk of social boycott of Muslims, harassment of Muslims by Hindutva groups and Muslims are even being harassed by police in various areas.
There has been a concentration of attacks against Muslims in Karnataka, where a BJP MP, Anant Kumar Hegde, has denounced Tablighi Jamaat as terrorists. Shortly after, an audio clip began to be shared widely over WhatsApp, urging people not to allow Muslim fruit and vegetable sellers into their areas, claiming they were spreading the virus through their produce.
Sayed Tabrez, 23, and his mother, Zareen Taj, 39, were among seven Muslim volunteers who were assaulted by a gang of local BJP members on 4 and 6 April, as they tried to distribute food to impoverished people in the Marathahalli and Dasarahalli districts of Karnataka.
Some 20 local BJP members came on motorbikes and started shouting at us, saying, You are not allowed to give out rations you are Muslims so you all are terrorists spreading the disease. We know you are spitting in the rations and have come from Tablighi Jamaat to spread the virus, said Tabrez. Two days later, about 25 local BJP members followed them in vehicles before attacking Tabrez, his mother and the other volunteers with bats. Police have since arrested two people.
It is not an isolated incident. Manohar Elavarthy of the NGO Swaraj Abhiyan, which has been distributing lockdown rations, said dozens of attacks had been carried out against their Muslim volunteers in the past few days, including some by police.
In Mangalore this week, posters started appearing that said Muslims were no longer allowed in certain neighbourhoods. No Muslim trader will be allowed access to our hometown until the coronavirus is completely gone, read a sign in Alape. In the Hindu-dominated village of Ankanahalli, a video seen by the Guardian shows Mahesh, the village panchayat president, issuing a warning that if any Hindu in the village is caught fraternising with a Muslim you will be fined 500 to 1,000 rupees.
The hijacking of coronavirus as an excuse for discrimination comes after a growing state-sponsored campaign to turn Muslims into second-class citizens in India, as part of the BJPs agenda of Hindu nationalism. Attacks on Muslims have become commonplace and the recent citizenship amendment act, passed by the BJP in December, prompted millions to take to the streets in protest, saying it discriminated against Muslims.
The situation got so bad last week that it prompted Equality Labs, a US-based south Asian human rights organisation researching Islamophobic hate speech, to release a statement urging the World Health Organization to issue further guidelines against Covid-19 hate speech and disconnect it to religious communities.
Just weeks after the Delhi pogrom where hundreds of Muslim houses and shops were vandalised, an uptick in misinformation and harmful communal language are leading to violence, said Equality Labs executive director, Thenmozhi Soundararajan. The threat of another pogrom still looms.
