There are about 300,000 births every month in the United States. That wont change as Covid-19 continues its march across the country.
Health systems are doing the best they can under immensely difficult circumstances to treat very sick patients, stem the spread of the virus, and keep those on the front lines healthy. Health providers are balancing life-and-death decisions on many levels, from considering universal do-not-intubate or do-not-resuscitate orders for severely ill Covid-19 patients to rationing ventilator care.
As is always the case, the weaknesses in our strained health care infrastructure are disproportionately affecting the most vulnerable people, and that includes pregnant women.
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Lessons from the first hardest-hit states show us how difficult it will be to strike the right balance between the needs of expectant parents and the needs of a health care system in the throes of an unprecedented fight. Several New York City health systems, for example, issued a rule that would have forced women in labor to go it alone without a partner, doula, or other support person. The New York State Department of Health and the governor quickly rescinded it after an outcry from patients.
Across the nation, expectant parents are worried, exploring options for birthing and often hearing different answers regarding where they can give birth and who can accompany them. Doulas, for example, advocate for women during birth and help them navigate the health care system. They, too are at risk for getting the virus, or spreading it, when protective equipment is in short supply.
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These challenges will confront us for a while. What steps can we take in the short-term to make things better to promote maternal and infant health?
First, we should be prioritizing pregnant women for Covid-19 testing across the nation. In New York, the impetus for the decision to ban labor partners was tied to the fact that five of the seven pregnant women with confirmed Covid-19 were asymptomatic, so they werent tested. Testing pregnant women can allow hospitals to take immediate appropriate precautions during labor and give moms better information when exploring birthing options to choose from and when they take their babies home.
Second, we need to expand the ability of pregnant women to get care via telemedicine (video and/or phone) with an expanded perinatal care team involving midwives, doctors, and doulas. This does not solve the issue of where to give birth, but expanding the use of telemedicine would enable some pregnant women to stay home and participate in prenatal and postpartum visits via videoconference or the phone without coming into a clinic and putting themselves and their babies at risk of exposure to the virus. Telehealth should be covered by Medicaid, which finances nearly half of all births in the U.S.
Third, as health care capacity is stretched, we should be investing now in non-hospital sites of care, such as birthing centers, or repurposing ambulatory surgery centers for pregnant women at low risk of complications. Since connection to social services are strained during this pandemic, we also should foster and reimburse the integration of nonphysician providers like midwives and support persons like doulas who can help low-income women navigate the health care system and leverage local resources to connect to social needs like food and housing.
Fourth, we should permanently extend Medicaids postpartum coverage from 60 days to a full year. Women are at risk of getting sick or dying up to one year after pregnancy. Expanding coverage is critically important during the Covid-19 pandemic, when there is a real risk of health system capacity being overwhelmed and there is a need to follow-up with women after giving birth to address safety, anxiety, depression, and other medical concerns.
A crisis can sometimes lead to something better. This pandemic is stretching our public health and health care capacity in ways that most of us have never experienced. We must ensure it doesnt harm those who are pregnant or their newborns. But rather than feeling defeated, we should see this as an opportunity to build the robust maternity system the U.S. sorely needs.
Laurie Zephyrin, M.D., is vice president of health care delivery system reform at The Commonwealth Fund.
Berkeley, a city on lockdown since March 17, on April 9 reported its first COVID-19- related death. Photo: Pete Rosos
A Berkeley resident in their 40s has died of COVID-19, the city of Berkeley announced Thursday afternoon.
The resident, who had been hospitalized, died Wednesday, said city spokesman Matthai Chakko.
This first Berkeley resident to die from COVID-19 had underlying health problems, which data shows makes people more likely to suffer severe illness from this new coronavirus, according to a prepared statement from the city. People over 60 are also more susceptible to severe illness, but the virus affects all ages.
Chakko said the city is able to share age and underlying health condition status because those are risk factors that wont reveal the persons identity. But the city will not be sharing the patients sex: Gender is not a risk factor, he said.
There is no treatment for COVID-19, the city said Thursday, noting that staying at home as much as possible is the most powerful antidote to limit infection.
As of Thursday, Berkeley had tallied 34 total cases of lab-confirmed COVID-19, including 24 people who had recovered. On Wednesday, the city said eight people had been hospitalized as the infection spread, including five who went into the ICU.
According to the city, the patient who died appears to have gotten the virus in the community, rather than through direct contact with someone known to have been infected.
The virus has been spreading in silent ways through our community, a key factor prompting Berkeleys Health Officer and six others to declare a shelter-in-place on March 16, the city said. An invisible threat, the COVID-19 virus can be carried and spread by apparently healthy people. It can move onto objects they touch. It travels through the air by sneezing, coughing or just talking near another person.
Because COVID-19 is so infectious, the city has advised everyone to wear a cloth face covering over their nose and mouth when in any public setting where you cannot maintain 6-feet of space, including grocery stores and pharmacies. Anyone may be unknowing carriers of this deadly virus, the city said Thursday.
In the prepared statement, Mayor Jesse Arregun expressed his condolences to the family of the patient who died.
I am deeply saddened at the news of the first COVID-19 death in Berkeley, Arregun said. We all have the power to reduce the spread of this virus and the deaths and heartache it creates. We all must follow the shelter in place order to protect ourselves, our neighbors, friends, family, and those most at risk. Together, we can get through these difficult times.
Alameda County as a whole, including Berkeley, now has 17 lab-confirmed fatalities from COVID-19. The county had reported 640 cases outside Berkeley as of Wednesday. County figures for Thursday had not been updated as of publication time.
Approximately 4,400 COVID-19 cases have been reported in the Bay Area, with 117 fatalities, according to online records reviewed daily by Berkeleyside. Statewide, there have been about 19,100 cases and 506 deaths.
This tragic death is a reminder that none of us can afford to dismiss the threat from this disease, said Dr. Lisa Hernandez, Berkeleys health officer. It can affect anyone with consequences as severe as death. We will never know how this person could have contributed to our community over the decades of life they should have had.
This death is also a sad reminder of the urgency to shelter in place, she said.
The city has shared a list of steps everyone can take to make our whole community safer:
Find more resources on the city website.
Berkeleyside relies on reader support so we can remain free to access for everyone in our community. Donate to help us continue to provide you with reliable, independent reporting.
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One of the greatest challenges of the coronavirus pandemic is that all levels of policy makers need to make decisions with imperfect information. Scientists still dont know everything about how this virus is transmitted, and due to the lack of widespread testing, they also dont know, exactly, how prevalent it is. They dont know if the virus will show a strong seasonal effect, and decreased during the summer. They dont know how this will all end.
One way they are trying to answer these questions is through modeling. Specifically, infectious disease models are tools based on mathematical formulations that try to game out whats possible in the future. These models are varied, often confusing to interpret, and are not crystal balls, especially because the ideal data isnt yet available. But they are a large part of what government leaders use to make decisions, influencing how resources are allocated to health care facilities and how social distancing orders are issued to the public.
In this piece, Im going to try to explain the utility of coronavirus models and how to think about them when you see them reported in the news. Ill also explain a big idea to make these models work better in the future.
But before that, I think its key to stress what we dont need them for. We dont need them to know that were in a very, very dangerous situation.
Whats very important is not the details of the model, its that this is a virus that can crush health care, says Bill Hanage, an epidemiologist who studies infectious diseases at Harvard. Thats not a model result, thats an observation. We know it because of Wuhan, we know it because of Italy, because of Spain, we know it because, now, of New York.
In New York state, thousands have died, and hospitals are at, or exceeding capacity and struggling with equipment shortages. Covid-19 is a freight train, as Hanage calls it, and it has rammed into not just New York but several other parts of the US.
But the models also show that the country is nearing the peak in daily deaths. And people should continue to listen to their mayors and governors and stay at home. Modeling plays a very important role for public decision-making, and it can help the public know that they, are, in fact, doing the right thing by staying home.
Leaders have tough choices to make in the weeks and months ahead, as the outbreak plays out differently in states. Models can help predict rates of new infections, and estimate when the strain on the hospital system could peak. In early April, Washington, DC, Mayor Muriel Bowser said that modeling projects a surge in DC area hospitals during the summer. Like all models, we hope this one will be proved wrong, she told MSNBC. But shes preparing for it anyway. We are preparing for many people to come through our hospitals.
Forecasting disease outbreaks is an immense challenge. Models incorporate many different types of data into their projections. There are a head-spinning number of potential inputs. (And some models dont use these inputs at all, but just rely on projecting data from earlier in the outbreak.)
A model can input the biology of the virus: How does it spread, how quickly does it infect, how quickly does it lead to symptoms, how quickly does it replicate to a level where it can jump from person to person? (Note: A lot of these variables are still not completely known.)
It can account for human biology: How does the immune system mount a response to this virus, how many people will become immune after exposure, and for how long? Also, how many people can get infected with the virus, and have the ability to spread it, but never feel sick themselves? (A lot of this isnt perfectly understood either.)
It also should, ideally, reflect how human society works: How many people do we come into contact with each day, and how does this vary in different communities, rural and urban? Models need to account for that; in a big country like the United States, outbreaks are going to be regional, with varying intensities and responses.
It needs to be realistic about the capacities of health care systems: How many beds are available for Covid-19 patients, how quickly will they fill up, how many doctors and nurses are there to serve them, how many ventilators are there, and how many patients will need them, and when?
Then, theres chaos: How do people react to the news that tens of thousands are dying from a virus that probably started with a bat, and how might that influence the model?
The question of how will an outbreak progress is clearly immense. In a common modeling approach called SIR (SIR stands for susceptible, infected, recovered) scientists are trying to figure how many people are susceptible to a disease, how many of them will become infected, and at what rate and where. But then, as more people recover from the disease, and become immune, that decreases the number of those who are susceptible.
To sum up: This stuff is complicated! That we can get any insight into the future, considering the variables, is a miracle. Yet scientists are trying, and their efforts are valuable.
Hanage explains there are basically two main types of models being used to try to plot out the course of this pandemic: statistical models and mechanistic models.
Lets start by explaining statistical models.
The Institute for Health Metrics and Evaluation (IHME) has the most commonly cited models and it includes separate projections for every state. Dr. Deborah Birx, the White House coronavirus response coordinator, has referenced it. Hanage explains this model is whats known as a statistical model.
The IHME, based out of the University of Washington, looks at data of how Covid-19 outbreaks have progressed around the world. It takes that data and then tries to project what the epidemic curve will look like as new outbreaks form in new areas based on what social distancing actions are being taken. The goal is to predict the time of peak hospital strain in an area, and the number of deaths.
To use Hanages metaphor: Its looking at how fast and hard the freight train has hit on other stops of its journey, and predicting it will hit that fast and hard when it gets to new stops.
This model makes some assumptions, namely, that the conditions for the previous freight train collisions will be similar in the future.
Earlier in the outbreak, the model was mainly fed from data in China, which imposed extreme social distancing measures. And so it assumes some high level of social distancing will continue into the future. That makes this a best-case scenario model, Carl Bergstrom, a computational biologist at the University of Washington, assessed on Twitter. Its now also drawing from current social distancing actions in the US.
The IHME model assumes this behavior will continue. And its creators are transparent about this limitation. The projection, the IHME explains on its FAQ page, only covers the next four months and does not predict how many deaths there may be if there is a resurgence at a later point or if social distancing is not fully implemented and maintained. The hardest thing to model in all of this, is not the virus, but human behavior.
The IHME model projections have changed over the course of the outbreak, as its creators have input new data from new outbreaks, new social distancing measures, and new resources (like ventilators) that have become available. (The model is regularly updated with new data).
This has actually led the models to decrease their death toll projection for the US a few times, most recently from 81,766 to 60,415, or about 25 percent. This doesnt mean the model has been wrong or shortsighted. It means collective actions have been working.
Also keep in mind: The IHME death toll projections come with a huge range of error. In the model, deaths per day are expected to peak soon in the US. As of April 10, its two days away, and the error the shaded area, spans roughly 4,000 deaths per day.
I think its key not to get fixated on the exact numbers, Dominique Heinke, an epidemiologist in Massachusetts, says. You can look at a range of models and say, we can expect it to be at least this bad. Again, we know this: The freight train is coming, and in many places, is already here.
Whats the good use of a forecast model if it changes all the time? Well, it reflects the complexity of the problem these models are trying to solve. For example, weather forecasters use atmospheric models to predict the weather, and as they gather more data on temperature, humidity, and barometric pressure, their forecasts become more accurate and, thus, often change.
Unlike the weather, which were all accustomed to understanding and incorporating forecast into whatever decision you make, unlike the weather [here] we actually influence the outcome, says Caitlin Rivers, a professor at the Johns Hopkins Center for Health Security. So people see the numbers, and they are motivated then to be more aware, stay home, and using good hygiene and doing all the things that really change that outcome.
The models change, because our actions change. The models could change for the worse if local governments declare premature victories and decrease social distancing measures too early.
By keeping an eye on the model, we can tell how the virus is circulating in our own communities: in some places, cases and deaths are still going up, in some places they are starting to come down, says Ali Mokdad, a professor at IHME and chief strategy officer for population health at the University of Washington. We can also use the model to ask what businesses we should open first as we recover: The key issue as we go into recovery mode is to do it in stages so we dont have a second wave of infections that will hurt us even more in terms of mortality and the economy.
Unless testing can be scaled up, some social distancing measures may have to be kept in place until there is a vaccine available, which can take a year or more. What happens in the scenario when social distancing measures are relaxed, but then put in place again if cases spike again? Im not sure we can model that, Hanage says.
The other type of model decision makers are using is a mechanistic model. These models are designed to help policy makers understand the impacts specific policies and actions may have on a diseases course. These models also make a lot of assumptions, and often present very wide ranging scenarios.
A good example of a mechanistic model comes from the Imperial College of London.
In the middle of March, it provided a scary wake-up call to the UK government to take more action. Their model looked at what would happen in Great Britain and in the United States if the countries did nothing. It took what it knew about the transmissibility of the virus and put it into a model designed for the flu a caveat right off the bat, as Covid-19 is not the flu.
(Transmissibility here is often called the R0, or R-naught, its the average number of new cases expected to be spawned by each case of an illness. Note: The value of the R0 is still just an estimation).
In the scenario where nothing is done, the models authors found, there could be 510,000 deaths in Great Britain, and 2.2 million in the US. And that was not accounting for the potential negative effects of health systems being overwhelmed on mortality, the authors report.
That made headlines. But their model didnt just report the worst-case scenario. It tried to game out the impact of various social distancing policies, and tried to make estimates for many different R0 figures. The estimates ranged, for Great Britain, from just 5,600 deaths assuming a low R0 of 2, and the most aggressive social distancing, and 550,000 deaths assuming an R0 of 2.6 and no social distancing measures.
If youre a leader of a country, looking at that spread, you know what you need to do: implement social distancing measures. Thats what the UK did. Later, when one of the models authors told the UK government in testimony that the deaths in Great Britain would probably number around 20,000, he was not revising the model, as some critics complained. Instead, he was reflecting that range of possibilities presented in the model.
Again, the point of these models is not to precisely predict the future, its to influence the future, and choose a good course of action.
Thats helpful. But again, as with the statistical model, these mechanistic models cant game out every possible future.
Recently, Columbia University put out a model (with a handy interactive map) that tries to predict which US counties will have their health care systems overwhelmed, under different social distancing scenarios, and when.
The model also attempts to help hospitals by gaming out how different coping strategies in hospitals (i.e. converting operating room beds to Covid-19 care beds, for one example, and modifying ventilators for use in multiple patients for another) could mitigate the problem, and help save lives.
The prediction is grim for the crush on hospital systems, which is expected to soon move from the northeast United States, to southern counties, as the outbreak starts to impact more and more rural areas. (Keep in mind: As outbreaks in some cities taper off, outbreaks in other areas may just be getting started.)
Its a complicated model. Its trying to predict hospital bed demand, ICU bed demand, ventilator demand, Jeff Shaman, an infectious disease modeler at Columbia explains. Its a mathematical description of transmission at county scale, where the counties are linked by movement between them based on ... travel patterns, and understanding that those have waned over time because of this ongoing Covid crisis.
It tries to account for a lot, but it cant account for everything. Something it cant account for: the possibility that health care workers get sick and have to leave work, leaving these hospital systems more strained. Were in the process right now on establishing a national database on staffing levels, Charles Branas, chair of epidemiology, at Columbia says. Its been challenging to build this airplane while it is flying, quite frankly.
That doesnt mean the model is useless. It can still help guide decision-making. You can look at the map and see which counties are still overwhelmed in their best-case scenarios. Those could potentially be first-choice counties for supplementary resources, Branas says.
I asked these Columbia researchers how theyd like the public to think of their model.
These are not forecasts, they are projections, were dealing with a very, very uncertain environment, Shaman stressed. The degree to which people are social distancing ... is changing day-to-day. It is difficult to pin down whats going on. Were making multiple projections because we dont know what people will do. We do it because we would like some window into the future. So we can assess: Are we on a really bad trajectory no matter what we do? Or are we on a good trajectory no matter what we do? Or is it incumbent upon us to make certain decisions so we can more certainly move to a better outcome?
(Another mechanistic model to check out: The University of Pennsylvania has a tool for regional leaders to input their own observations, and see how an outbreak might impact their areas hospitals.)
Theres a lot thats still unknown about the coronavirus, and the pandemic.
There will be people writing papers 100 years from now about what actually happened, there will be people making discoveries about the relative rates of increase in San Francisco vs New York, Hanage says.
Rivers, the Johns Hopkins epidemiologist, hopes, in the future, well get better at this. Like the US has the National Weather Service a government agency staffed to create weather models and test their predictive power she hopes to see the creation of a National Infectious Disease Forecasting Center.
The reason that we have accurate weather forecast today, is because there was a federal agency responsible for weather forecast, she says.
We need to learn from the modeling approaches being used now, to make better models for the future. The weather service does this for hurricanes: You can clearly see in the weather service data how hurricane forecast tracks (i.e. forecast models) have greatly improved over time. Rivers doesnt see that as an accident. The weather models have improved because theres a centralized service to study and create them.
She says there needs to be some central agency collecting these models in an archive, so that researchers later on can figure out which ones worked the best, and why. It could then incorporate that understanding to better forecast future outbreaks.
Right now, there are a lot of models. There are a lot of projections. Were not sure which ones will be most accurate, or useful. Dont end up being obsessed with a specific number, Hanage gives a final piece of advice. Just end up recognizing the number is large. Thats the best way to think about it.
Hanage offers another potentially helpful metaphor: A very, very good physicist will be able to model what will happen if you walk out into the interstate and say exactly where your body parts might land, but the fact that another model puts the body parts in another place, doesnt alter the central conclusion that youre going to get run down by a car, he says.
For now, the biggest message from all of them is that social distancing measures are indeed saving lives. The models predicted that weeks ago and that prediction is coming true. We can all feel good about our sacrifices because of that.
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This is less of a newspaper column for general readers than an open letter to public health officials in America a missive, really: Figure out if majority-black cities are suffering more than others, and if so focus a significant part of your fight against the coronavirus, both resources and research, there.
The reason: Of the limited race-specific data we have so far, some of the greatest death disparities weve seen, where black people are dying at much higher rates than their percentage of the population, are in majority-black cities.
This week, New York City finally got around to releasing race-specific data. This revealed a disproportionate impact on both black and Hispanic people, but the disparities were not as great as in some other cities.
Black people make up 22 percent of the population of New York City, but represent 28 percent of the deaths from the virus. Hispanics make up 29 percent of the city, but represent 34 percent of the deaths. (Even without large disparities, the numbers are big because there are millions of black and Hispanic people in the city.)
Now compare that to the breathtaking numbers we are seeing from cities with a black majority or plurality New Orleans, Milwaukee, Chicago where black people represent 70 to 80 percent of the deaths, though their percentages of the population dont come close to that.
Michigan has released data that show a disproportionate impact on black people, but it didnt break out race data for Detroit, the states largest city, which also happens to be majority black. But, as The Detroit Free Press reported Friday, Combined, Wayne County and the city of Detroit have about half of the entire states cases of coronavirus 47 percent for a total of at least 5,069 cases.
California has had much success in controlling the spread and impact of the virus. Partly, that is because the state and its cities took early and strong actions. But it is not lost on me that there isnt a single majority black city in the state.
At the same time, states with small black populations have fared far better. Washington State, with one of the first outbreaks in this country, hasnt seen the explosion of cases that New York has seen. There again, black people are only 4 percent of the population in the state.
We urgently need more data. We need to know if what we are seeing in early data from majority-black cities is a pattern or not. Every city, state and the federal government must gather and publicize the data now.
And this is the reason: There are more than 1,200 majority-black cities in America and the number is rising. The overwhelming number of those cities are in the South, where many governors, almost all Republican, dragged their feet in taking action against the virus.
We simply cant allow more of those cities to become the next New Orleans.
I am not able to explain why this might be happening. Scientists will have to do that and they may have to do it in retrospect. The urgent need now will be to simply stop the dying.
It may be that these majority black cities simply have more essential workers who are also black. The issues of co-morbidities may be more acute there. There may be more poverty. There may be more people without cars and depending on public transportation.
Whatever the case, lets set the data now, and if they show what I suspect they will, lets shift our focus to these majority-black cities.
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BySamuel Volkin
Several nations in the European Union are among those most impacted by the COVID-19 pandemic, with more than 275,000 cases in Italy and Spain alone. Already bruised by the exit of the United Kingdom, the unity of the EU is once again being put to the test.
Matthias Matthijs, an associate professor of international political economy at the Johns Hopkins School of Advanced International Studies, researches the politics of economic crises. He joined Johns Hopkins MPH/MBA candidate Samuel Volkin for a brief discussion about the EU's response to the COVID-19 pandemic. The conversation has been edited for length and clarity.
In crisis situations that affect multiple countries, the European Union plays a coordinating role. There are certain matters that are the EU's responsibility, like international trade, then there are issue areas that they have left solely in the control of member states. Public health and fiscal policywhich are the main levers in a crisis like this to make resources available and deal with economic fallouts of people losing their jobsare solely in the domain of member states. So the COVID-19 pandemic is not something the EU is immediately responsible for.
Matthias Matthijs
Associate professor of international political economy
That being said, both public health and fiscal matters cross borders, so what one member state does affects what other member countries do. From this point of view, you'd expect the EU institutions to bring everyone together and agree on a common response.
The initial response was very slow, uncoordinated, and did not show much intra-EU solidarity. Initially because of its commitment to open borders, Europe did not want to enact quarantine restrictions to prevent people from traveling between countries. This is especially problematic when neighboring countries have conflicting quarantine policies. For example, for a while Belgium had a nationwide ban on going to bars and restaurants, but the Netherlands did not. So if people who lived near the border in Belgium wanted to have a night out, they could go to a bar just a few miles north in the Netherlands.
Now, the European Commission, which is the executive branch of the EU responsible for enacting and implementing public policies, is slowly shifting its attention to what is needed for Europeans as a wholeevaluating where there is surplus capacity, where there is more need, and how to share resources. That's happening, but it's been very slow and gradual. The inaction of the EU created a void that the Russians and Chinese tried to fill. The Chinese have been sending medical supplies and health care providers to Rome and Madrid. That is striking for several reasons. First of all, it created the perception that the EU couldn't do it themselves, which was a PR disaster. And secondly, it means that the Americans, who have traditionally played this role, didn't do it.
This pandemic requires an enormous infusion of money up frontnot only to support public health activity, hospitals, and doctors, but also to manage the economic and financial fallout of what is both a supply and a demand shock, as well as money needed to fund vaccine development and therapeutic efforts. EU member states need substantial financial resources for all three.
The initial reluctance by the European Central Bank to intervene in Italian bond markets caused panic among financial market participants. Investors did not trust that the ECB was committed to helping countries in the Eurozone face the economic problems that COVID-19 has caused. They have since reversed themselves with a massive Pandemic Emergency Purchasing Program that has brought back a sense of calm in the markets.
Coverage of how the COVID-19 pandemic is affecting operations at JHU and how Hopkins experts and scientists are responding to the outbreak
A lot of people, including myself, have suggested that Europe should issue a joint corona bond. This would be a Europewide government bond backed jointly by all European governments, making it a very attractive financial instrument for any investor to buy. Corona bonds would raise the money needed to immediately deal with this issue and show great solidarity among EU members.
This has been resisted so far by northern EU member states that have not been as affected by the pandemic. They feel that a jointly issued bond would create moral hazard problems. In other words, German and Dutch voters are worried they will end up paying for the irresponsible fiscal behavior of their Italian and Spanish counterparts, and that the bonds will take away any incentive for the latter two to continue economic and fiscal reforms. Politicians in Rome and Madrid counter that this COVID-19 pandemic has nothing to do with lax fiscal behavior and that the time for EU solidarity is now.
The numbers coming out of Italy and Spain are deeply worrisome. These are countries that have seen a series of austerity policies implemented to reduce budget deficits through spending cuts. It's now being revealed that there has been very limited investment in their national public health systems over the last decade. Italy has the highest death rate, followed by Spain. Austerity is literally killing Italian and Spanish citizens because they simply don't have the public health capacity to deal with this.
"Italy and Spain won't easily forget the help they got from China and Russia. There could be real geopolitical consequences."
The fact that Northern Europe is resisting even symbolic steps toward a joint fiscal response is causing real damage to the relationship between the north and south of Europe. This crisis is the moment of Italy's and Spain's greatest need, and they want to see direct aid from the rest of Europe. Italy could be forced to accept loans from the European Stability Mechanism, but those could come with strict conditions that the country simply cannot accept during a crisis like this. Italy and Spain won't easily forget the help they got from China and Russia. There could be real geopolitical consequences.
Finally, the U.S. has been completely absent from the international arena in this crisis. If you compare this with the previous crisis of 20089, under Presidents Bush and Obama, when the U.S. was very active in coordinating the G20, as well as fiscal and monetary responses, the contrast is stark. President Trump has no interest in playing a similar leadership role, and the Chinese are very keen on filling the void while disabusing the world of the notion that COVID-19 was originally "made in China." It is possible that once this crisis is over, relations between Italy and Russia or China will become warmer and they'll become more skeptical of NATO and the Atlantic alliance that's been the bedrock of the liberal international order led by the United States.
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The COVID-19 pandemic is hitting the U.S. just as the spring allergy season is getting underway, leaving some people to wonder if their symptoms are caused by the novel coronavirus or pollen.
According to Amiinah Kung, MD, allergy and immunology at Northwestern Medicine Central DuPage Hospital, said a fever, or lack thereof, is probably the most important distinction between the two.
"Fevers are hallmark of viral illness, not allergies," she said. "Fever, cough, shortness of breath and flu-like symptoms are COVID-symptoms. Studies don't show a lot of nasal symptoms. Allergies are more sneezing and watery eyes, and you can get a little bit of a cough. Allergies don't cause a fever."
Kung said that many of her patients have been concerned about COVID-19, especially those with asthma, which could put people at a higher risk of having a more severe case if they contract the virus because it can attack the lungs.
"[Asthma] is a co-morbid condition and asthmatics have worse outcomes with COVID-19, so having that diagnosis is a concern. But they're not at more risk for contracting the virus," she said.
Kung reinforces what all health professionals have been saying: maintaining a social distance to minimize exposure, washing hands and sanitizing surfaces and homes.
She cautions against going to the hospital or emergency room at the first sign of a cough, as it could be allergies or a cold, and said monitoring symptoms for a few days is best, unless someone has a severe shortness of breath.
"Take your temperature, thats a good place to start," she said. "A mild cough doesnt mean you have to rush off anywhere. Lack of testing availability means we have to save the tests for those with more severe symptoms. Best thing people can do is stay at home. A lot of people can have mild symptoms [of the virus], which brings confusion. Were doing what we should be doing: staying home and minimizing risk to others."
As the springtime allergy season is just underway, Kung said she doesn't yet know how severe it will be. For those with allergies and/or asthma, managing symptoms is important. Tree pollen is the biggest outdoor trigger now, she explained.
"Patients can go outside and have wheezing and chest tightness and that's just allergies," she said. "Allergists are recommending people take a 24-hour over-the-counter antihistamine and use their daily inhalers. Exercise and allergies can trigger asthma. The sunny, windy days are going to cause more symptoms, so I tell people to keep their windows closed and stay inside. The pollens are also worse in the morning."
Kung reminds people that doctors are available to meet with patients over the phone or online to discuss symptoms if patients are concerned.
"You don't have to come to the ER or go to urgent care. We can help people figure out their symptoms, and if they need to be seen," she said.
Apple and Googles engineering teams have banded together to create a decentralized contact tracing tool that will help individuals determine whether they have been exposed to someone with COVID-19.
Contact tracing is a useful tool that helps public health authorities track the spread of the disease and inform the potentially exposed so that they can get tested. It does this by identifying and following up with people who have come into contact with a COVID-19-affected person.
The first phase of the project is an API that public health agencies can integrate into their own apps. The next phase is a system-level contact tracing system that will work across iOS and Android devices on an opt-in basis.
The system uses on-board radios on your device to transmit an anonymous ID over short ranges using Bluetooth beaconing. Servers relay your last 14 days of rotating IDs to other devices, which search for a match. A match is determined based on a threshold of time spent and distance maintained between two devices.
If a match is found with another user that has told the system that they have tested positive, you are notified and can take steps to be tested and to self-quarantine.
Contact tracing is a well-known and debated tool, but one that has been adopted by health authorities and universities that are working on multiple projects like this. One such example is MITs efforts to use Bluetooth to create a privacy-conscious contact tracing tool that was inspired by Apples Find My system. The companies say that those organizations identified technical hurdles that they were unable to overcome and asked for help.
The project was started two weeks ago by engineers from both companies. One of the reasons the companies got involved is that there is poor interoperability between systems on various manufacturers devices. With contact tracing, every time you fragment a system like this between multiple apps, you limit its effectiveness greatly. You need a massive amount of adoption in one system for contact tracing to work well.
At the same time, you run into technical problems like Bluetooth power suck, privacy concerns about centralized data collection and the sheer effort it takes to get enough people to install the apps to be effective.
Two-phase plan
To fix these issues, Google and Apple teamed up to create an interoperable API that should allow the largest number of users to adopt it, if they choose.
The first phase, a private proximity contact detection API, will be released in mid-May by both Apple and Google for use in apps on iOS and Android. In a briefing today, Apple and Google said that the API is a simple one and should be relatively easy for existing or planned apps to integrate. The API would allow apps to ask users to opt-in to contact tracing (the entire system is opt-in only), allowing their device to broadcast the anonymous, rotating identifier to devices that the person meets. This would allow tracing to be done to alert those who may come in contact with COVID-19 to take further steps.
The value of contact tracing should extend beyond the initial period of pandemic and into the time when self-isolation and quarantine restrictions are eased.
The second phase of the project is to bring even more efficiency and adoption to the tracing tool by bringing it to the operating system level. There would be no need to download an app, users would just opt-in to the tracing right on their device. The public health apps would continue to be supported, but this would address a much larger spread of users.
This phase, which is slated for the coming months, would give the contract tracing tool the ability to work at a deeper level, improving battery life, effectiveness and privacy. If its handled by the system, then every improvement in those areas including cryptographic advances would benefit the tool directly.
How it works
A quick example of how a system like this might work:
Privacy and transparency
Both Apple and Google say that privacy and transparency are paramount in a public health effort like this one and say they are committed to shipping a system that does not compromise personal privacy in any way. This is a factor that has been raised by the ACLU, which has cautioned that any use of cell phone tracking to track the spread of COVID-19 would need aggressive privacy controls.
There is zero use of location data, which includes users who report positive. This tool is not about where affected people are but instead whether they have been around other people.
The system works by assigning a random, rotating identifier to a persons phone and transmitting it via Bluetooth to nearby devices. That identifier, which rotates every 15 minutes and contains no personally identifiable information, will pass through a simple relay server that can be run by health organizations worldwide.
Even then, the list of identifiers youve been in contact with doesnt leave your phone unless you choose to share it. Users that test positive will not be identified to other users, Apple or Google. Google and Apple can disable the broadcast system entirely when it is no longer needed.
All identification of matches is done on your device, allowing you to see within a 14-day window whether your device has been near the device of a person who has self-identified as having tested positive for COVID-19.
The entire system is opt-in. Users will know upfront that they are participating, whether in app or at a system level. Public health authorities are involved in notifying users that they have been in contact with an affected person. Apple and Google say that they will openly publish information about the work that they have done for others to analyze in order to bring the most transparency possible to the privacy and security aspects of the project.
All of us at Apple and Google believe there has never been a more important moment to work together to solve one of the worlds most pressing problems, the companies said in a statement. Through close cooperation and collaboration with developers, governments and public health providers, we hope to harness the power of technology to help countries around the world slow the spread of COVID-19 and accelerate the return of everyday life.
You can find more information about the contact tracing API on Googles post here and on Apples page here including specifications.
Hello and welcome back to our regular morning look at private companies, public markets and the gray space in between.
Airbnbs recent moves in the wake of a global travel slowdown are interesting and worth understanding in chronological order. What it details is a company spending heavily today to keep up its future health. Demand will return to the world travel market in time how much, no one knows and Airbnb wants to be a well-liked participant in the return to form.
Building off our last look at the company, we should understand how Airbnb intends to not only survive, but come out the other side of the pandemic with enough user trust to get back to work.
A worker cleans along the Las Vegas Strip, which is nearly empty without the usual crowds as casinos and other businesses are shuttered during the coronavirus outbreak on March 31. John Locher/AP hide caption
A worker cleans along the Las Vegas Strip, which is nearly empty without the usual crowds as casinos and other businesses are shuttered during the coronavirus outbreak on March 31.
Updated at 11:03 a.m. ET
The COVID-19 pandemic is taking a terrible toll on the world's economy, with full or partial lockdown measures now affecting the livelihood of almost 2.7 billion people more than 4 out of 5 workers in the global workforce of 3.3 billion, according to the International Labour Organization.
The deadly coronavirus has put health care systems under intense stress and delivered "unprecedented shocks to economies and labor markets," leading the ILO to declare in its report on COVID-19, "it is the worst global crisis since the Second World War."
"Workers and businesses are facing catastrophe, in both developed and developing economies," ILO Director-General Guy Ryder said as the agency released the report Tuesday. "We have to move fast, decisively, and together. The right, urgent, measures could make the difference between survival and collapse."
In economic terms, the pandemic will be far worse than the most recent recession, the agency says.
"Huge losses are expected across different income groups but especially in upper-middle income countries," the agency says, estimating a 7% decline in working hours for that group in the current economic quarter a statistic that is equivalent to 100 million full-time workers in 40-hour workweeks.
"This far exceeds the effects of the 2008-9 financial crisis," the ILO report states.
The coronavirus has infected more than 1.3 million people worldwide and caused more than 75,000 deaths, according to a COVID-19 dashboard created by Johns Hopkins University's Whiting School of Engineering, which draws from reported coronavirus statistics in near real time.
For the world's economy, the crisis poses the most risk to vital sectors from food service and business/administrative services to manufacturing and retail, the U.N. agency says.
Combined, those sectors employ 1.25 billion workers almost 38% of the global workforce. Many of them are low-paid and unprepared for a sudden loss of income.
Worldwide, the number of working hours will fall by 6.7% in the current quarter, according to the agency's estimates. That's equivalent to 230 million people working full-time, 40-hour weeks.
Women face serious threats from the pandemic. Female workers account for more than half of the jobs in the food and hospitality sector, meaning their incomes are now jeopardized. But women also comprise more than 70% of the health and social work sector, where millions of workers are now exposed to dire health and economic risks.
The pandemic is dealing a harsh blow to workers in the informal economy a broad sector that includes jobs such as domestic workers and street vendors, and who often lack any social protections. Those jobs make up large portions of the economies in emerging and developing economies such as in India, Nigeria and Brazil.
In India alone, the report states, "about 400 million workers in the informal economy are at risk of falling deeper into poverty during the crisis."
The final extent of the damage, the ILO says, will depend on how the pandemic evolves and how governments respond to the deadly outbreak. And cooperation will be key, in a global economy that is more interconnected than ever.
"The choices we make today will directly affect the way this crisis unfolds and so the lives of billions of people," Ryder said. "With the right measures we can limit its impact and the scars it leaves. We must aim to build back better so that our new systems are safer, fairer and more sustainable than those that allowed this crisis to happen."
By Fernando del Valle and Steve Clark
HARLINGEN Two more residents have died after a health care worker carried the COVID-19 virus into a nursing home and a rehabilitation center, Cameron County officials said.
On Thursday, a 90-year-old woman became the second resident to die after living at Veranda Rehabilitation and Healthcare.
Meanwhile, a 93-year-old woman died after living at Windsor Atrium, where county officials believe a Veranda health care worker introduced the coronavirus.
The deaths bring the Rio Grande Valleys COVID-19 death toll to five.
So far, 15 Veranda residents have tested positive for the virus, including the 90-year-old woman who died and an 81-year-old man whose death was confirmed Monday.
At the nursing home where 45 tests results are pending, 12 employees and two of their relatives have tested positive for the virus.
At Windsor Atrium, nine residents have tested positive, including the 93-year-old woman whose death was confirmed Thursday.
At the rehabilitation center where six test results are pending, three employees have tested positive.
Individuals of the two facilities who have tested positive continue to be in isolation and employees who have pending results are not working at either facility, County Judge Eddie Trevio Jr. said Thursday.
Patients are being monitored and measures continue to be implemented to limit transmission to others, including monitoring all patients for signs and symptoms and use of (personal protective equipment) at all times, he said.
Facilities complying with order
Earlier this week, Trevio issued an emergency management order aimed at nursing homes and rehabilitation centers.
The facilities are adhering to the emergency management order regarding nursing homes and other long-term care facilities which was ordered by this court a few days ago, he said.
Trevio said officials are working to determine the number of employees who worked at the two facilities.
Earlier this week, Cameron County Health Administrator Esmeralda Guajardo said officials believe a health care worker carried the coronavirus from Veranda Healthcare & Rehabilitation to Windsor Atrium.
Were trying to find out (the number) because were concerned thats how it happened. I know theyre still doing the contact tracing on that, Trevio said. Cameron County continues to work with the facilities on contact tracing and testing of employees as needed.
Concerns of staffing shortages
Trevio said officials are planning to issue an order prohibiting health care staff from working at more than one long-term care facility.
We are going to include that in (the countys order) but in speaking to our health authority and also physicians, we were concerned that with all (thats) going on you potentially are already facing staffing shortages, he said. So then the individuals who may be ill or needing care there may not be enough people to do that.
Abbott makes way for nurses aides
On Thursday, Gov. Greg Abbott issued an emergency rule allowing more nurses aides to care for residents in long-term care facilities during the COVID-19 crisis.
This action will expand the eligible pool of direct care workers and help long-term care providers who may face critical staffing shortages, a press release stated.
The rule temporarily allows nursing facilities to hire staff to provide nursing aide services without completing a full certification program during their first four months on the job.
As Texas continues to respond to COVID-19, we are working to make sure our long-term care facilities have adequate staff to care for Texans residing in these facilities, Abbott stated.
Harlingen orders stop to staff sharing
At Harlingen City Hall, officials have expressed concern nursing home health care workers moving between different nursing homes and long-term care facilities are behind a spike in COVID-19 cases.
On Sunday, Dr. Michael Mohan, the citys newly appointed health authority, released orders prohibiting the citys nursing homes and rehabilitation centers from sharing health care staff and transferring residents to other facilities.
Dr. Mohans directive is a result of the recent spike in COVID-19 positive cases, which the city has reason to believe is being caused by the movement of health care staff and health care support staff moving between different nursing homes and long-term care facilities, as well as to and from health care facilities, city spokeswoman Irma Garza stated in a press release.
Verandas response
On Monday, Veranda Administrator Jason Hess stated the nursing home continues to comply with requirements.
As far as the recent health control directive issued by the city of Harlingen, we understand and respect the citys position, Hess stated.
Several of the referenced interventions have previously been the subject of CMS or CDC guidance. With respect to those protocols, Veranda Rehabilitation and Healthcare has been fully compliant since the time the guidance was originally received (if not before), Hess stated.
The facility has always had a robust infection prevention and control plan in place and has expanded this plan in response to the corona virus situation, he stated. We are fully committed to taking action consistent with federal, state and city directives and with keeping our residents and staff safe during these challenging times.
Windsor Atrium reaches out to families
On Sunday, Windsor Atrium Administrator Sandra Basaldua told patients families of two confirmed virus cases at the rehab center.
We have just learned that two patients have tested positive for COVID-19, she wrote. Efforts to mange this development include following the guidelines provided by the Centers for Medicine and Medicaid Services on the restriction of visitation to essential health care personnel only which has been in place since March 13, 2020 and further guidelines from the Centers for Disease Control and Prevention.
