The coronavirus pandemic is a serious health risk, which is why countries around the world are racing to find vaccines and treatments. Nearly 1,000,000 cases of COVID-19 have been confirmed globally, and by the time you read this, the death toll will have surpassed 50,000.
Some potential treatments listed here were previously in clinical testing for other diseases, such as cancer, allowing the trials for COVID-19 to be fast-tracked. Many arent aimed at the coronavirus itself but instead will hopefully reduce some of the severe side effects the disease causes, like hyperinflammation and respiratory distress.
Notably, many of the proposed treatments have gone through U.S. Food and Drug Administration (FDA) approval for other uses or are currently going through that process, meaning the route to getting approved for a clinical trial to study their effects on COVID-19 patients is shorter and faster than it would be for a new drug. Some of these are being utilized under compassionate use rules, meaning they arent part of clinical trials but are being administered to COVID-19 patients in life-threatening situations.
The path from trial to treatment is long and complex. As new treatments and vaccines make their way to new phases, well update this list. For now, weve excluded those in preclinical phases.
Note: These drugs are all in the early stages of testing for efficacy against COVID-19 and taking them without supervision can have tragic consequences. An Arizona man died after reportedly taking a form of chloroquine used to clean fish tanks. Youll see a long list of potential treatments below, but many of them wont progress to wider testing or use, because theyll prove either unsafe or ineffective.
A vaccine would prevent people from getting sick, instead of treatments to alleviate the system or kill the disease once it has already infected you. Often, vaccines either use an inactive (dead) or live attenuated (less potent) version of the pathogen to build up the bodys defenses. By introducing these weakened forms to the immune system, it can start making antibodies without having to battle the virus itself. Once the body has made antibodies once, it has been trained to recognize the pathogen and can start making them again if the actual virus finds its way inside. Immunity from an inactive vaccine may not last as long, while live-attenuated types have implications for immunocompromised people. In addition, such vaccines havent proven effective for some viruses, like HIV.
Currently, there is no approved vaccine for COVID-19. Coronaviruses caused SARS in the early 2000s and MERS in 2012. The two epidemics were contained before vaccines were created, but some work was started for both. Some companies are building on that research to find a vaccine for COVID-19, which is caused by a novel coronavirus. The Coalition for Epidemic Preparedness Innovations, or CEPI, is an organization helping to accelerate vaccine development. About 35 companies and academic institutions are searching for a COVID-19 vaccine; two in phase-1 clinical trials, and over 40 in preclinical development. A few have begun testing in animals, while biotech firm Modernas attempt has started human trials.
Despite how quickly the research is being developed, there are some aspects of the process that cant be sped up, like widespread testing for side-effects and dosing. Even then, there are logistical hurdles to scaling production and distributing vaccines to affected countries. Experts are predicting it will take 18 months for a vaccine to be widely available.
Non-replicating viral vector; Adenovirus Type 5 vector (Ad5-nCoV): Adenoviruses are common viruses that can lead to bronchitis or pneumonia. Theyve been heavily studied as potential vectors for vaccines, to deliver the antigens that stimulate the production of protective antibodies. These viral vectors can also bolster the immune response in ways traditional vaccines do not.
CanSino Biologics is testing a vaccine candidate in healthy adults, the first phase of clinical testing. In 2017, the company, collaborating with the Chinese Academy of Military Medical Sciences Bioengineering Institute, developed an ebola vaccine. The potential COVID-19 vaccine, AD5-nCoV, is based on the same technology. Its a non-replicating viral vector, so it can infect cells but has been rendered incapable of multiplying. Johnson & Johnson is working on a similar type of vaccine, which will be ready for phase one trials in September.
RNA; LNP-encapsulated mRNA (mRNA 1273): The National Institute of Allergy and Infectious Diseases (NIAID) and Modernas potential vaccine builds on research into the MERS virus. Its a messenger RNA or mRNA vaccine, where a bit of the viruss genetic material gets injected into your muscle. The role of mRNA is to carry genetic information from DNA needed to make proteins. The RNA is packaged in lipid nanoparticles (LNPs), to help effectively deliver it. The mRNA would deliver instructions to cells on how to make proteins to fight the virus. No RNA vaccines have even been approved for human use, but this effort is one of several backed by CEPI.
Monoclonal antibodies (mAb) are used in treatments for cancer and ebola. Made in a laboratory, these molecules work as substitute antibodies, according to the Mayo Clinic, boosting or mimicking the bodys immune system to attack the virus. They can do so in a variety of ways, including flagging cells for destruction and binding to different types of cells. The majority of those being researched for COVID-19 are in the pre-clinical phase, but several are in clinical trials right now.
Actemra (tocilizumab): Small proteins known as cytokines are part of the bodys immune response, released when theres an infection. Inflammation is a side effect, as blood and other fluids flow to the source of infection. A cytokine storm is when an abundance of the proteins cause hyperinflammation, which can lead to serious complications and death. It has been reported in SARS and MERS patients and could be causing some of the more severe symptoms in some people with COVID-19. Interleukins are one group of cytokines. Actemra is a rheumatoid arthritis drug that blocks interleukin-6 (IL-6) to keep it from attacking healthy tissue when the immune system overreacts. It helped several critical COVID-19 patients recover, but a controlled clinical study needs to be performed, according to The Wall Street Journal.
Avastin (bevacizumab): In healthy adults, vascular endothelial growth factor (VEGF) promotes the formation of new blood vessels and is important for healing wounds. Some COVID-19 patients have been shown to have elevated levels of VEGF, possibly due to hypoxia (low blood oxygen) and inflammation. Avastin is a VEGF blocker and has been used to treat several types of cancer for over 15 years. A clinical trial at the Qilu Hospital of Shandong University in Jinan, China will assess its effectiveness at treating shortness of breath.
Gimsilumab: Gimsilumab is a monoclonal antibody that targets a pro-inflammatory cytokine known as a granulocyte-macrophage colony-stimulating factor (GM-CSF). Its presence can elevate the expression of pro-inflammatory cytokines, causing a kind of feedback loop that increases inflammation. GM-CSF has been found in elevated levels of COVID-19 patients admitted to the ICU, according to pharmaceutical company Roivant. It wants to test Gimsilumab as a treatment for acute respiratory distress syndrome (ARDS). The condition is caused by fluid build-up in the lungs air sacs and the breakdown of surfactant, so that lungs cant fully inflate. Targeting GM-CSF represents a promising strategy for curbing lung damage while allowing time for the virus to clear, Dr. Elizabeth Volkmann, founder and co-director of the UCLA Connective Tissue Disease-Related Interstitial Lung Disease Program, said in Roviants press release.
Kevzara (sarilumab): Like Actemra, Kevzara is a rheumatoid arthritis drug that blocks IL-6. Dr. Naimish Patel told The Wall Street Journal why blocking that cytokine could help COVID-19 patients recover: Even though the virus is diminishing, its sending signals to the immune system to keep attacking. Hes head of global development for immunology and inflammation for Sanofi, which makes Kevzara, along with Regeneron.
Leronlimab (PRO 140): CCR5 is a protein on the surface of white blood cells that plays an important role in the way HIV develops in the human body. Leronlimab is a monoclonal antibody being studied as a potential treatment for HIV. It binds to the CCR5 receptor, which inhibits the release of inflammatory cytokines. Biotechnology company CytoDyn modified its clinical trial to evaluate Leronlimabs effect on severe cases of COVID-19.
PD-1 blocking antibody: There are two types of tolerance in your immune system. Central tolerance is the main way it distinguishes your own cells from outside threats, while peripheral tolerance keeps the body from over-reacting when it encounters allergens or microbes. Usually, the protein programmed cell death-1 (PD-1) helps limit T cell activity during infection to reduce inflammation. But if PD-1 binds to another protein, PD-L1, it prevents T cells from attacking cancerous cells. Monoclonal antibodies that block PD-1 are known as immune checkpoints inhibitors (ICIs). Theyve shown success in treating various types of tumors by preventing PD-1 from binding with PD-L1, freeing T cells to target the tumor. Thymosin, meanwhile, targets PD-L1. A clinical trial at Southeast University in China will study the efficacy of PD-1 and thymosin in COVID-19 patients with severe pneumonia caused by lymphocytopenia (low levels of lymphocytes, including T cells).
Sylvant (siltuximab): Another monoclonal antibody that blocks the action of IL-6, siltuximab is approved by the U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMA) to treat multicentric Castleman disease (MCD). This rare lymph node disease acts similarly to lymphoma, causing an overgrowth of cells. Doctors at Papa Giovanni XXIII Hospital in Italy will observe its effects on patients with COVID-19, in the hopes it will reduce inflammation in those with severe respiratory disorders.
TJM2 (TJ003234): TJM2, like Gimsilumab, is a monoclonal antibody that targets pro-inflammatory cytokine GM-CSF. In November 2019, the FDA approved it for clinical trials to treat rheumatoid arthritis. I-Mab Biopharma, which makes TJM2, is a U.S.- and China-based biopharmaceutical company. It will now explore the mAbs effectiveness in fighting cytokine storming in patients with serious reactions to COVID-19.
There are a variety of antiviral drugs for diseases like hepatitis, the flu, and herpes many of which could potentially be repurposed to fight coronavirus. They work in different ways to stop the replication of viruses. For example, some flu antivirals are neuraminidase inhibitors. Neuraminidases are enzymes that cut acids and proteins on the surface of virus envelopes, releasing the replicated virus to infect new cells. Neuraminidase inhibitors can help reduce the amount of new viruses that are released inside the human body. The hope is that some of these antivirals will also stop the replication of COVID-19 once a patient has contracted it, lessening the duration or severity of the disease.
Arbidol (umifenovir): This broad-spectrum antiviral blocks virus entry into healthy cells by inhibiting membrane fusion. Its not currently approved by either the EMA or FDA, though it is available in Russia and China. A study at the Guangzhou 8th Peoples Hospital in China will observe its effect on patients with COVID-19. Though people are selling Arbidol on eBay in the U.K., the Medicines and Healthcare Regulatory Agency told The New Statesman, Not only are they breaking the law, they are acting with total disregard of your health.
ASC09: HIV requires protease enzymes to reproduce. Protease inhibitors prevent newly replicated viruses from maturing and invading healthy white blood cells. To see if the same disruption works on COVID-19, China-based biotechnology company Ascletis Pharma will test ASC09 in clinical trials.
Azvudine: Azvudine is a nucleoside reverse transcriptase inhibitor (NRTI). HIV uses the enzyme reverse transcriptase in reverse transcription, converting RNA into DNA. Inhibitors block the enzyme, preventing the virus from replicating. The clinical trial for Azvudines efficacy against COVID-19 will take place at the Peoples Hospital in Guangshan County, China.
Favilavir/Favipiravir/T-705/Avigan: Favipiravir is a broad-spectrum antiviral thats been utilized in Japan to treat influenza. Inside cells, it mimics the organic compound purine and eventually becomes included in the viruss RNA strand as it grows. Exactly how Favipiravir inhibits viral RNA synthesis once its incorporated is unclear, but there is some indication it could be used in COVID-19 patients as well. In clinical trials in China, patients who received the medication tested negative for the virus after a median of four days; those who didnt receive it took 11 days to test negative, according to The Guardian.
Ganovo (danoprevir): Ascletis Pharma developed Ganovo as a direct-acting antiviral agent (DAA) to treat hepatitis C. The efficacy of DAAs in general has been called a monumental advance over previous hepatitis C therapies. Ganovo inhibits the viruss protease, which is necessary for its replication. The effectiveness of Ganovo, in combination with another protease inhibitor (ritonavir), will be tested at Chinas Ninth Hospital of Nanchang.
Kaletra/Aluvia (lopinavir/ritonavir): Kaletra is a combination of protease inhibitors ritonavir and lopinavir, used to treat HIV. Earlier this year, The New England Journal of Medicine published the results of a study of 199 patients with severe COVID-19 patients at Jin YinTan Hospital in China. Those that received the lopinavir-ritonavir treatment saw no difference in the mortality rate. Future trials in patients with severe illness may help to confirm or exclude the possibility of a treatment benefit, according to the authors of the study.
Prezcobix (darunavir): Like ASC09, Prezcobix is a protease inhibitor, used to treat HIV, in conjunction with a pharmacokinetic enhancer. Cobicistat is one such drug, which slows the breakdown of Prezcobix, allowing it to stay in the body for longer and at a higher concentration. Johnson & Johnson sent Prezcobix to Chinese health authorities in January to gauge its effectiveness in treating COVID-19. The companys chief scientific officer, Paul Stoffels, told The Wall Street Journal that studying the drugs effects in ill patients could help researchers find a treatment that works.
Remdesivir: This drug has gotten more press than many of the other potential treatments. Its a broad-spectrum antiviral, and has been studied as a treatment for Middle East respiratory syndrome (MERS), a respiratory illness that is caused by the same family of viruses as COVID-19. Gilead, the company that makes Remdesivir, hoped the drug would work against Ebola, but it wasnt nearly as effective as two other drugs at preventing death from the disease. Some experts are hopeful that it will have more luck with COVID-19, and there are several clinical trials underway.
Truvada (emtricitabine and tenofovir): You may have seen commercials for this drug for whats known as PrEP (pre-exposure prophylaxis). When taken properly, it can reduce the risk of HIV infection. Truvada is a combination of two antiretroviral medications: emtricitabine and tenofovir. Both prevent HIV from replicating, and while they work in different ways, each blocks the reverse transcriptase enzyme needed for reproduction. The Sichuan Academy of Medical Sciences and Sichuan Provincial Peoples Hospital are conducting the clinical trial for Truvada against COVID-19.
Xofluza (baloxavir marboxil): Endonuclease is an enzyme that initiates flu virus replication. Polymerase acidic endonuclease inhibitors, like Xofluza, interfere with that replication. Xofluza received FDA approval in 2018 to treat the flu, and now the First Hospital Affiliated of Zhejiang Universitys Medical School wants to research the drug as a treatment option for COVID-19 patients with pneumonia.
Cellular therapy replaces or repairs damaged cells or tissues and is used in a range of diseases. Many types of cells have been studied for this purpose, including stem, progenitor, and primary cells. Cell therapy is being used and researched for everything from inflammatory bowel disease to cancer. CAR T-cell, for example, is a therapy in which doctors modify a patients T cells to identify and go after cancer cells.
Mesenchymal stem cells: Stem cells can self-renew through cell division and can also differentiate into different types of cells, like bone cells or liver cells. Mesenchymal stem cells (MSCs) are adult stem cells and can be taken from either humans or animals. Pneumonitis, or the inflammation of the walls in the air sacs of the lungs, is one potential side-effect of COVID-19. There has been some research on using MSCs to treat lung damage caused by radiation for cancer treatment. Chinas Institute of Basic Medicine is conducting clinical trials to see the cell therapys effect on COVID-19 patients with pneumonitis.
MultiStem: Biotech company Athersys created MultiStem, a stem cell product made from multipotent adult progenitor cells (MAPCs) derived from bone marrow. MPACs can self-renew and differentiate into several cell types. Acute respiratory distress syndrome (ARDS) is similar to pneumonia; it makes it difficult for the lungs to fully inflate and can lead to serious complications and death. MultiStem already underwent an early-stage clinical trial for treating ARDS, and the results showed the patients had lower mortality rates and were off ventilators more quickly than those who didnt receive the treatment. The company is working with the FDA to fast-track a clinical trial testing for COVID-19, according to WKSU.
RNA therapies are a fairly recent development and are being studied to treat several diseases, including macular degeneration and Zika. The therapies work in a few different ways, either by targeting nucleic acids (DNA or RNA), targeting proteins, or encoding proteins. A therapy might prevent messenger RNA from being translated into protein or it might encode a normal version of a protein instead of a mutated one. Right now, the potential RNA therapies for COVID-19 are all in preclinical phases.
There are a number of other treatments scientists are researching to see if they can help alleviate some of the severe symptoms of COVID-19. They dont necessarily fit into the categories above.
APN01: Scientists have found that during infection, COVID-19s viral trimeric spike protein binds to human receptor angiotensin-converting enzyme 2 (ACE2). One study showed that deactivating ACE2 caused severe lung injury in mice infected with a strain of avian influenza while administering recombinant human ACE2 was effective at lessening the damage. APN01 is a recombinant human angiotensin-converting enzyme 2 (rhACE2) created by Aperion Biologics to treat acute lung injury (ALI), acute respiratory distress syndrome (ARDS), and pulmonary arterial hypertension (PAH). The company began a clinical trial with APN01 on COVID-19 patients in February. A similar trial is underway at the First Affiliated Hospital of Guangzhou Medical University.
Chloroquine/Hydroxychloroquine: These two antimalarial drugs have been getting a lot of attention, though their efficacy as a treatment for COVID-19 is still unknown. Malaria is caused by a parasite, while COVID-19 is caused by a virus. The reason some researchers are looking at these drugs as potential coronavirus treatments is that chloroquine and other drugs were able to block coronaviruses from infecting cells in laboratory testing. These drugs were researched as possible treatments for MERS during the 2012 outbreak. The mechanism by which these malarial drugs would work against COVID-19 is uncertain, but one hypothesis is they change cells surface acidity, so the virus cant infect them. Or chloroquines might activate the immune system. Chloroquine and hydroxychloroquine have not been appropriately evaluated in controlled studies, not to mention that they have numerous and, in some cases, very deadly side effects, Katherine Seley-Radtke, professor of chemistry and biochemistry at the University of Maryland, wrote at The Conversation. There are a few clinical trials underway looking into their efficacy.
Gilenya (fingolimod): Multiple sclerosis causes the bodys own immune system to attacknerves insulating layer, or myelin. The presence of pro-inflammatory white blood cells in the central nervous system can also damage the myelin sheath. A sphingosine 1-phosphate receptor modulator is believed to keep certain white blood cells (lymphocytes) from leaving the lymph nodes and crossing the blood-brain barrier, where they would further damage nerve cells. Pneumonia is an acute inflammatory response that develops in some people with COVID-19, and the First Affiliated Hospital of Fujian Medical University wants to test this MS drugs effectiveness on reducing its severity.
Jakafi/Jakavi (ruxolitinib): Myelofibrosis is a somewhat rare blood cancer in which fibrous scar tissue replaces spongy bone marrow. Many patients with this and a couple of other types of blood cancer have an acquired mutation in the Janus Kinase 2 gene. It causes bone marrow to produce too many abnormal blood cells. Janus kinase inhibitors, or JAK inhibitors, block the function of these enzymes. Because of their role in cytokine production, JAK inhibitors are also used to treat inflammatory diseases, including rheumatoid arthritis. (Cytokines are a normal part of the bodys response to infection, but an overabundance can lead to hyperinflammation.) Patients with severe reactions to COVID-19 could have an excess of cytokines causing lung inflammation. A clinical trial at Tongji Medical College of Huazhong University of Science and Technology will study the effect of Jakafi and mesenchymal stem cells on COVID-19 patients with pneumonia.
Losartan: Angiotensin is a peptide hormone that constricts blood vessels and raises blood pressure. Angiotensin II receptor antagonists or blockers are prescribed for hypertension because they block the hormone. Losartan is one such drug, and the University of Minnesota is conducting clinical trials to see its effect on lung inflammation in COVID-19 patients.
Methylprednisolone/corticosteroids: Methylprednisolone is a synthetic corticosteroid, which mimics how the bodys hormones work to reduce inflammation. Corticosteroids are used to treat a plethora of conditions, from asthma to lupus to arthritis. Though they were used during severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) outbreaks, the World Health Organization doesnt currently advise the use of corticosteroids for COVID-19, according to a February article from The Lancet. Clinical trials for glucocorticoid therapy are going forward at Peking Union Medical College Hospital and Tongji Hospital.
Novaferon: Interferons are cytokine mediators that alert the immune system when theres a viral infection. Lab-made interferons are used to treat several diseases, including hepatitis B. Exactly how interferons affect the virus is unclear, but its thought to interfere with its life cycle, while also boosting cell-mediated immunity. Novaferon is one man-made interferon used to treat hepatitis B, and the First Affiliated Hospital of Zhejiang University Medical School will study whether its effective against COVID-19.
Rebif (interferon beta-1a): Interferon beta-1a is an interferon used to treat multiple sclerosis. Exactly how Rebif, an interferon made by Merck KGaA, works in MS patients isnt known, but it does lessen inflammation and reduce the bodys immune response that damages the myelin sheath. The French Institut National de la Sant et de la Recherche Mdicale (INSERM) will use Rebif in a clinical trial, to see if it similarly reduces inflammation in COVID-19 patients.
Washed microbiota transplantation: Some people who take antibiotics end up wiping out their colon of the healthy bacteria that help stave off clostridium difficile (C. difficile), which can lead to a serious infection. Fecal microbiota transplantation (FMT) reintroduces healthy bacteria via a donors stool, transferred by colonoscopy or another procedure. The washed microbiota process is a way of purifying the sample beforehand. A clinical trial at the Second Affiliated Hospital of Nanjing Medical University is doing a clinical trial on the procedure to examine its effect on COVID-19 patients with antibiotic-associated diarrhea.
A tiger at the Bronx Zoo has been infected with the coronavirus, in what is believed to be a case of what one official called human-to-cat transmission.
This is the first instance of a tiger being infected with Covid-19, according to the federal Agriculture Department, which noted that although only one tiger was tested, the virus appeared to have infected other animals as well.
Several lions and tigers at the zoo showed symptoms of respiratory illness, according to a statement by the department. They are expected to recover.
Public health officials believe that the large cats caught Covid-19, the disease caused by the coronavirus, from a zoo employee.
Thats the assumption, that one of the keepers who was asymptomatic or shedding the virus before they were sick was the source of the infection, Dr. Paul Calle, chief veterinarian at the Bronx Zoo, said in a phone interview.
While the zookeepers generally keep a barrier between themselves and the cats, they do get within a few feet of the animals. During the course of feeding and doing enrichment they will come within feet of them but on opposite sides of the barrier, he said.
The tiger, a 4-year-old Malayan tiger named Nadia, appeared visibly sick by March 27.
Her sister Azul and two Amur tigers are also sick. They live in the zoos Tiger Mountain enclosure. Another tiger that lives in the same place has not exhibited any clinical signs, according to a statement by the zoo.
There is no evidence that other animals in other areas of the zoo are showing symptoms, the Agriculture Department said.
Lyndsay M. Cole, assistant director of public affairs for the departments animal and plant inspection service, said there have been no reports of sickened animals in other zoos in the United States.
The Bronx Zoo, one of the largest in the United States and one of New Yorks top attractions, houses roughly 6,000 animals.
And zoos, unlike museums or Broadway theaters, cannot entirely shut down. Animals still need to be cared for and checked on. Penguin chicks might require help after they hatch. Captive tigers, alligators and grizzly bears probably should not be left to their own devices.
The animals that we care for rely on us for everything, Jim Breheny, the director of the Bronx Zoo, told The Times last week before the coronavirus case had been confirmed.
The zoo closed to the public on March 16 and since then about 300 workers of its 700-plus staff were deemed essential to care for animals and maintain the zoos operations.
They are split in half into two teams, which report on alternating weeks, maintaining social distancing to protect the animals, while providing hay to American bison or offering fish to hungry Magellanic penguins.
The animals are blissfully unaware of what the rest of us have been going through, said Mr. Breheny, whose first job at age 14 was staffing the zoos camel rides.
The tiger was the only animal tested because the procedure involved general anesthesia, the Agriculture Department said. While there were other tigers and lions showing similar symptoms, the veterinarian wanted to limit the potential risks of general anesthesia to one animal, it said.
We had a sick tiger and we needed to treat the tiger and know what the cause of the illness was so we could care for it, Dr. Calle said.
A pet cat in Belgium recently tested positive for the coronavirus, but the American Veterinary Medical Association said that not enough was known to change the current view that neither cats nor dogs appear to be able to pass the virus to people.
A scientific study in China, which has not yet been peer reviewed, found that the virus reproduces efficiently in cats and can be transmitted by respiratory droplets, but this was in laboratory conditions. The report did not say what kind of symptoms the cats experienced, if any.
Another report, which has also not yet been peer reviewed, concluded on the basis of blood tests that cats had been infected in Wuhan. The World Organisation for Animal Health says that there is no evidence that cats or dogs spread the disease to humans, but that anyone who is sick should take precautions in contact with their animals as they would with people.
There have been no known reports of pets becoming sick with Covid-19 in the United States. But the Agriculture Department recommended that people who have the virus limit contact with animals.
If you are sick with Covid-19, avoid contact with your pet, including petting, snuggling, being kissed or licked, and sharing food, the department said.
Christine Hauser and James Gorman contributed reporting.
Olivia and Raul De Freitas are currently on their honeymoon, at a five-star resort, in the Maldives, a nation composed of more than a thousand tiny, idyllic islands in the Indian Ocean, like a trail of smashed crystals scattered on a slab of blue glass. For years the subject of fantasy photo spreads in glossy magazines, featuring luxe bungalows on stilts, in unreal aquamarine water, it was an obvious choice for their romantic getaway.
The couple arrived just married from South Africa, where they are citizens, on Sunday, March 22, planning to stay for six days. For a 27-year-old teacher and a 28-year-old butcher, the holiday was an extravagance, Ms. De Freitas said. But since they hadnt lived together before exchanging vows, it would be a short, firecracker of a launch to their marriage.
Still, they had some concerns about the trip, considering the mounting travel restrictions imposed in light of the new coronavirus outbreak around the world. But nothing specific that would affect them had been announced, and their travel agent assured them that, whatever policy was forthcoming, all South African citizens would be allowed back home. Go ahead and have a great time, they were told.
By Wednesday, they received notice that their countrys airports would all be closed by midnight Thursday. Flights back to South Africa are five hours to Doha, Qatar, a three-hour layover, and then nine hours to Johannesburg so even if they scrambled, and even if they could get a flight, the complexities of leaving their remote island ensured theyd never make it home in time.
As much of the world rapidly ground to a halt, the few other guests still at the resort last week escaped to their respective countries. The last of them to leave, Americans, had to wrangle permission for a flight to Russia, before returning to the United States.
The couple considered taking the hour-and-a-half speedboat ride to the main island and trying their luck at the airport. But the Maldives had also announced their own lockdown around the same time, banning any new foreign travelers. If they left the resort, they might not be allowed back in. So, they stayed.
Mr. De Freitas, described by his wife as the calm one, took the strange turn of events in stride. This would all get sorted out, and, besides, they were in paradise. Ms. De Freitas, naturally, shared some of her husbands delight, but sensed a logistical nightmare worthy of Kafka was about to ensue.
They reached out to the South African Consulate in the Maldives, and the closest South African Embassy, in Sri Lanka, for help. A representative told them, via WhatsApp, that there were around 40 other South Africans spread among the Maldives, and that their option home would be to hire a chartered jet, at their own expense, for $104,000.
Everyone could split the cost, the message noted, but the government had only connected with around half of the 40 people; of those 20, many were unable or refusing to pay. The fewer the number of people on board, the more expensive each share would become. Even so, after several days of discussions between South African representatives and the Maldivian Foreign Ministry, the flight still hasnt been approved.
By Sunday, they were the only guests at their resort, the Cinnamon Velifushi Maldives, which normally is at capacity this time of year, catering to some 180 guests. (Room rates start at $750 a night, its website still says.) The resort comprises the entirety of its speck of an island. There is nowhere to go. The couple reign like benign yet captive sovereigns over their islet. The days are long and lazy. They sleep in, snorkel, lounge by the pool, repeat.
The resorts full staff are at hand, because of the presence of the two guests. Government regulations wont allow any Maldivians to leave resorts until after they undergo a quarantine that follows their last guests departure. Accustomed to the flow of a bustling workday, and the engagement with a full house of guests, most of the staff, having grown listless and lonely, dote on the couple ceaselessly. Their room boy checks on them five times a day. The dining crew made them an elaborate candlelit dinner on the beach. Every night performers still put on a show for them in the resorts restaurant: Two lone audience members in a grand dining hall.
At breakfast, nine waiters loiter by their table. Hostesses, bussers and assorted chefs circulate conspicuously, like commoners near a celebrity. The couple has a designated server, but others still come by to chat during meals, topping off water glasses after each sip, offering drinks even though brimming cocktail glasses stand in full view, perspiring. The diving instructor pleads with them to go snorkeling whenever they pass him by.
Theres something forlorn, unsettling even, about wandering an empty space thats supposed to be full. Reclining alone, amid the silent, abandoned bank of beach chairs, the equatorial sun shimmers off the sea to the horizon, browning skin and bleaching driftwood. Weve started playing a lot of table tennis and snooker, Ms. De Freitas said. Mr. De Freitas has also taken to joining staff soccer games in the afternoons.
Somewhere, beyond all this, the world roils. After an early panic and local quarantine around an ill tourist, there have been fewer than two dozen reported total cases of the new coronavirus on Maldivian islands; the majority of people diagnosed have recovered already.
Most recently, theyd heard that flight permissions are supposed to be sorted out by Monday, April 6. That was an extension from April 1, so these dates seem to merely be optimistically penciled in. No matter: The latest wrinkle, they were told, is that the Maldivian airline crew assigned for the charter wont fly anyway, needing to rest for a day before their return flight to the Maldives. But the South African government said if they deplane theyll be quarantined there for 14 days. This is, apparently, a deal breaker. And a flight originating from their home country is not being offered as an option.
The lockdown in South Africa is supposed to last until April 16. But, like everywhere, decrees about travel and movement are continually changing.
Its incredible that we get this extra time, Ms. De Freitas said. But the financial toll is weighing on them, heavily. Though the couple has been paying a generously discounted rate, the bill grows ever larger. Each day that ticks by is a chip taken out of their savings that had been set aside for a house down payment.
To their escalating endless honeymoon debt, they can add the unknown price of two tickets on what may likely be a near-vacant 200-seat jet. Everyone says they want to be stuck on a tropical island, until youre actually stuck, Ms. De Freitas said. It only sounds good because you know you can leave.
On Sunday, April 5, according to the couple, they were given an hours notice by the embassy, communicating via WhatsApp, to pack their bags. After saying their goodbyes and thank-yous, they were taken by speedboat to another five-star resort, where South Africans in the Maldives, about two dozen in all, are being consolidated. The local government told them it would subsidize a large portion of the cost of their stay.
Their return date home? Still unknown.
As for their original hotels staff, they have been told they must remain for two weeks after the guests departure. According to the hotel management, they have been, and are still being, paid.
Editors Note: After publication, this article was updated to reflect new conditions.
Executive Summary
The coronavirus crisis has led to new consumer behaviors and sentiments. The author recommends five ways for brands to serve and grow their customers, mitigate risk, and take care of their people during this difficult time: 1) Present with empathy and transparency; 2) Use media in more agile ways; 3) Associate your brand with good; 4) Track trends and build scenarios; 5) Adapt to new ways of working to keep delivering.
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In times of crisis, it may be hard for marketers to know where to begin. In just a few short weeks, people have shifted into protection mode, focused on themselves, their families, their employees, their customers, and their communities. Social media reflects this, with pleas for fellow citizens to follow government safety guidelines. People have crossed partisan lines to build bridges within their neighborhoods and communities and unify against an invisible force.
With social distancing keeping many people at home, were also seeing major shifts in behavioral trends. Consumers have returned to broadcast and cable television and other premium media sources for credible information. They are also seeking more in the way of escapism and entertainment downloading gaming apps, spending even more time on social media, and streaming more movies and scripted programming. And between remote working arrangements and live-streamed workout classes, college lectures, and social engagements, we are testing the bandwidth of our homes in a largely pre-5G world.
Meanwhile, the need for physical goods is placing pressure on new channels, with demand for e-commerce rising to new levels. For those who do venture out, grocery and convenience stores are the source for essentials, but supply is inconsistent. Health and safety concerns are driving more customers toward frictionless payment systems, such as using mobile phones to pay at check-out without touching a surface or stylus.
Some of these behavior changes may be temporary, but many may be more permanent. As people move beyond the current mode of survival, the momentum behind digital-experience adoption is unlikely to reverse as people are forced by circumstances to try new things. With so much changing so fast during this difficult time, what actions can brands take to serve and grow their customer base, mitigate risk, and take care of their people ?
People feel vulnerable right now. Empathy is critical. Many banks, for example, have moved to waive overdraft fees, recognizing the hardship on their customers. SAP has made its Qualtrics Remote Work Pulse platform free to companies who might be rapidly transitioning to new ways of working. Such instances show humility in the face of a force larger than all of us.
The nuances of brand voice are more delicate than ever. Brands that use this time to be commercially exploitative will not fare well. Better to do as Guinness did in the period surrounding St. Patricks Day, when the company shifted its focus away from celebrations and pub gatherings and instead leaned into a message of longevity and wellbeing. In these moments, we dont have all the answers, and we need to acknowledge that. If you make pledges, even during uncertain times, you have to be able to deliver on what you say.
To quickly pivot creative messages as circumstances change, marketers will want to build more rapid-response operating models internally and with agencies. Access to remote production and creative capacity will become particularly important as the crisis evolves. Nike, for example, immediately moved to adopt a new message: Play inside, play for the world. And in order to promote social distancing and show a commitment to public safety, Chiquita Brands removed Miss Chiquita from their logo. Im already home. Please do the same and protect yourself, its Instagram caption read.
Beyond creative, as the mix of actual media platforms used by consumers changes quickly, marketers should consider modifying their media mix. For example, with digital entertainment spiking, marketers may want to amplify their use of ad-supported premium video streaming and mobile gaming. Similarly, as news consumption peaks while consumers jostle to stay informed, brands should not fear that adjacency, given the level of engagement and relevance. News may simply be an environment that requires more careful monitoring of how frequently ads appear to avoid creative being over-exposed, which can damage brand equity.
People will remember brands for their acts of good in a time of crisis, particularly if done with true heart and generosity. This could take the form of donating to food banks, providing free products for medical personnel, or continuing to pay employees while the companys doors are closed. Adobe, for example, immediately made Creative Cloud available to K-12 institutions, knowing this was a moment to give rather than be purely commercial. Consumers will likely remember how Ford, GE, and 3M partnered to repurpose manufacturing capacity and put people back to work to make respirators and ventilators to fight coronavirus. And people appreciate that many adult beverage companies, from Diageo to AB InBev, repurposed their alcohol-manufacturing capabilities to make hand sanitizer, alleviating short supplies with their Its in our hands to make a difference message.
Feel-good content that alleviates anxiety and promotes positive messaging will go a long way to enhancing the brand. However, companies need to show that their contributions are material and not solely for commercial benefit. Consumers recognize authenticity and true purpose.
Frequent tracking of human behavioral trends will help marketers gain better insights in real time. Marketers will want to measure sentiment and consumption trends on a regular basis to better adapt messaging, closely observing the conversation across social-media platforms, community sites, and e-commerce product pages to look for opportunities and identify looming crises more quickly. Companies should consider quickly building dashboards with this kind of data to fuel the right decisions.
Marketers will also want to consider building deeper connections with their C-suite colleagues to provide insights to executives who, increasingly, will be involved with marketing choices. The marketing team should work closely with finance and operations to forecast different scenarios and potential outcomes, depending on how long the crisis lasts.
Its encouraging how quickly many companies were able to transition to remote working arrangements. Deploying collaboration technologies can seamlessly provide chat, file sharing, meeting and call capabilities, enabling teams to stay connected and remain productive. Already, virtual happy hours are emerging as the new normal to build team morale. Partners are pitching remotely, recognizing that an in-face sales call is unlikely to transpire for weeks to come. Leaders have to do their best to transition each element of the operating modelfrom marketing, to sales, to serviceto this new normal. New sources of innovation and even margin improvement will emerge out of our current discomfort.
We are in the acknowledge-and-adapt phase of the Covid-19 pandemic. But we also have to plan for lifebeyond the crisis. As we navigate what we know, marketing leaders must work externally to keep their brands and customer journeys as whole as possible, while working internally to do three things:
Unquestionably, there is a forced acceleration of the digital transformation agenda as we recognize how quickly customers and employees have embraced digitally enabled journeys and experiences.
Brands are all having to think, operate, and lead in new ways during these uncertain and unprecedented circumstances, and we will all have to learn together with both confidence and humility.
The views reflected in this article are the views of the authors and dont necessarily reflect the views of the global EY organization or its member firms.
U.S. President Donald Trump (R) greets Russian President Vladimir Putin (L) during their bilateral meeting at the G20 Osaka Summit 2019, in Osaka, Japan on June 28, 2019.
Mikhail Svetlov | Getty Images
During World War II, American and Russian soldiers fought side by side against a common enemy. We achieved victory together. Who can forget the images of allied soldiers embracing each other on the banks of the Elbe on April 25, 1945, nearly 75 years ago?
Those images stand as a symbol of international unity in the face of a global threat. Now is surely the time to collaboratively tackle a challenge that threatens us all today.
Just as our grandfathers stood shoulder to shoulder to defend our values and secure peace for future generations, now our countries must show unity and leadership to win the war against the coronavirus. This war has already affected the lives of billions of people and may lead to hundreds of thousands of deaths.
To change the views on Russia in an election year may be an insurmountable challenge. But so it also seemed in 1941, when the U.S. and the Soviet Union put behind the differences of the past to fight the common enemy.
Kirill Dmitriev
CEO, Russian Direct Investment Fund
Despite many differences, Russia and the United States have a lot in common. We love our families and want them to be healthy. We know how to work as a team in the face of adversity and are ready to make sacrifices for our values and communities.
In recent years, there has been too much attention paid to our differences and too little to opportunities to work together on global issues. In fact, we have allowed the culture of fear to emerge with business leaders and even scientists, causing them to be afraid to talk about U.S.-Russia cooperation.
The time has come to improve relations by focusing our efforts on three areas: (1) jointly fighting the coronavirus, (2) reducing the impact of the inevitable global economic recession and (3) developing a platform for future cooperation in confronting terrorism, nuclear proliferation and climate change.
As the sovereign wealth fund of Russia, we realized in early January when we established our network of top investment funds in 18 countries, that the coronavirus pandemic could have a devastating global impact.
Jointly with our partners, we focused on the best available technologies to address it.We formed partnerships in China, Japan and the U.S. to invest in some of the most accurate, quick and mobile virus testing systems in the world. We identified a top venture capital firm in the U.S., who will be our co-investor in this technology.
The usual critics from both sides, who will attack this op-ed as "trying to solve the insolvable" or as another "propaganda stunt" are stuck in the past and are not offering a viable alternative forward.
Kirill Dmitriev
CEO, Russian Direct Investment Fund
This joint U.S.-Japan-Russia consortium will provide an important and scalable testing solution for the U.S. market. Through our partners, we are already providing testing solutions in Europe, the Middle East, Africa and Latin America, working jointly with many nations to slow down the spread of the virus through extensive testing.
We formed partnerships to test and manufacture drugs that showed significant clinical potential and supported collaboration between U.S. and Russian pharma companies. Our doctors and scientists must work together on creating and testing a vaccine.
We can exchange best practices regarding hospital and manufacturing processes, and exchange medical equipment and supplies where possible, while jointly coordinating our efforts to help other countries. Just as we supported financially part of the medical supply cargo that Russia delivered to New York, so we hope to facilitate medical supply shipments from the U.S. after the U.S. coronavirus peak.
In short, the coronavirus challenge can be best addressed through a coordinated global response, including a close partnership between the U.S. and Russia.
At last year's World Economic Forum in Davos, we discussed extensively with our global partners that the global debt burden is too high. We highlighted that it stood at over 300% of global GDP, compared with just over 200% preceding the 2008-2009 economic crisis.
We noted that any significant shock could lead to the downward spiral of a debt crisis and an inevitable world recession in an inter-connected world.
We could not have predicted, however, that the tsunami of the coronavirus would lead to such significant supply and demand-side shocks, dramatically reducing global demand and paralyzing economic activity.
In times like this, new approaches to explore close collaboration between the U.S., Russia and other countries are needed to stabilize energy and other markets, to coordinate policy responses and to revitalize economic activity.
For example, Russia proposed to jointly undertake significant oil output cuts with the U.S., Saudi Arabia and other countries to stabilize markets and secure employment in the oil industry.
We have always called for closer cooperation between our countries. Having studied and worked in the U.S., I am well aware of the entrepreneurial and creative spirit of the U.S. And having worked in Russia, I recognize that Russia's position is best understood by acknowledging the many U.S. businesses that successfully operate here.
Our fund is working to continue cooperation between Russian and U.S. companies supported by many in both countries. We believe that we need to resume top-level business dialogue proposed by our President soon.
The world needs strong platforms for cooperation between our governments, our businesses and our people. As citizen exchanges are difficult during stay-at-home orders, maybe citizen diplomacy groups can foster better online dialogue to help our people understand each other better.
Many minds are set in a self-reinforcing news cycle. The usual critics from both sides, who will attack this op-ed as "trying to solve the insolvable" or as another "propaganda stunt" are stuck in the past and are not offering a viable alternative forward. Their blame game, trite cliches and inability to offer viable solutions is a road to nowhere.
To change the views on Russia in an election year may be an insurmountable challenge. But so it also seemed in 1941, when the U.S. and the Soviet Union put behind the differences of the past to fight the common enemy.
By focusing on our similarities rather than on our differences, and by being more open to cooperation, we can improve the state of the world and help to defeat the threats that we all face at this difficult time.
Kirill Dmitriev is chief executive officer of the Russian Direct Investment Fund, a sovereign wealth fund with $10 billion under management and strategic partnerships totaling another $40 billion.
It would be unethical to experimentally manipulate viral dose in humans for a pathogen as serious as the coronavirus, but there is evidence that dose also matters for the human coronavirus. During the 2003 SARS coronavirus outbreak in Hong Kong, for instance, one patient infected many others living in the same complex of apartment buildings, resulting in 19 dead. The spread of infection is thought to have been caused by airborne viral particles that were blown throughout the complex from the initial patients apartment unit. As a result of greater viral exposure, neighbors who lived in the same building were not only more frequently infected but also more likely to die. By contrast, more distant neighbors, even when infected, suffered less.
Low-dose infections can even engender immunity, protecting against high-dose exposures in the future. Before the invention of vaccines, doctors often intentionally infected healthy individuals with fluid from smallpox pustules. The resulting low-dose infections were unpleasant but generally survivable, and they prevented worse incidents of disease when those individuals were later exposed to smallpox in uncontrolled amounts.
Despite the evidence for the importance of viral dose, many of the epidemiological models being used to inform policy during this pandemic ignore it. This is a mistake.
People should take particular care against high-dose exposures, which are most likely to occur in close in-person interactions such as coffee meetings, crowded bars and quiet time in a room with Grandma and from touching our faces after getting substantial amounts of virus on our hands. In-person interactions are more dangerous in enclosed spaces and at short distances, with dose escalating with exposure time. For transient interactions that violate the rule of maintaining six feet between you and others, such as paying a cashier at the grocery store, keep them brief aim for within six feet, only six seconds.
Because dose matters, medical personnel face an extreme risk, since they deal with the sickest, highest-viral-load patients. We must prioritize protective gear for them.
For everyone else, the importance of social distancing, mask-wearing and good hygiene is only greater, since these practices not only decrease infectious spread but also tend to decrease dose and thus the lethalness of infections that do occur. While preventing viral spread is a societal good, avoiding high-dose infections is a personal imperative, even for young healthy people.
At the same time, we need to avoid a panicked overreaction to low-dose exposures. Clothing and food packaging that have been exposed to someone with the virus seem to present a low risk. Healthy people who are together in the grocery store or workplace experience a tolerable risk so long as they take precautions like wearing surgical masks and spacing themselves out.
Monday's biggest developments
[3:03 p.m.] A fourth Texas execution has been delayed because of the new coronavirus. At the request of prosecutors, the trial court moved Billy Joe Wardlow's execution from April 29 to July 8, according to the Titus County District Clerk's office.
The Texas Court of Criminal Appeals has already halted the three other executions that were scheduled in March and April issuing 60-day stays in the cases of John Hummel, Tracy Beatty and Fabian Hernandez. In two orders, the court said the decisions were made "in light of the current health crisis and the enormous resources needed to address that emergency."
Prosecutors in Tarrant and Smith counties were against stopping the first two executions; El Paso's district attorney did not file a response in Hernandez's case. Those counties must wait 60 days before requesting a new execution date, which must be set more than 90 days in advance. Aside from Wardlow's new July date, five other executions are scheduled in Texas from May to September. Jolie McCullough
[2:30 p.m.] Speaker Dennis Bonnen, R-Angleton, is asking Texas House members staff to consider volunteering their time to help the Texas Workforce Commission, which has been overloaded with Texans trying to file unemployment insurance claims.
There are no public servants better trained to be in the trenches fighting this battle for Texans than those who already dedicate themselves each day to serving our constituents, and who are familiar with the processes and duties of being responsive to them, Bonnen wrote in an email to the House this afternoon.
Hundreds of thousands of out-of-work Texans have applied for relief over the past few weeks. The sudden spike has prompted jammed phone lines and website servers crashing at the agency.
According to Bonnen, the agency has a couple more call centers one with 150 operators and another with 200 set to come online to help respond to the spike. The agency has, among other things, also moved 200 employees to its call centers and hired 100 additional operators, according to the speaker. Cassi Pollock
[1:15 p.m.] Texas reported 464 more cases of the new coronavirus Monday, an increase of about 7% over the previous day, bringing the total number of known cases to 7,276. Six new counties reported their first cases Monday; more than half of the states 254 counties have reported at least one case.
Harris County has reported the most cases, 1,395, followed by Dallas County, which has reported 1,112 cases.
The state has reported 13 additional deaths, bringing the statewide total to 140 an increase of about 10% from Sunday. Harris County reported three additional deaths, bringing its total to 20 deaths, more than any other county.
As of Monday, 1,153 patients are currently hospitalized in Texas. At least 85,357 tests have been conducted. Chris Essig
[10:37 a.m.] Texas has set up road checkpoints along the Louisiana border as it increases enforcement of Gov. Greg Abbotts executive order requiring visitors from the neighboring state to self-quarantine for 14 days.
Abbott and Texas House Speaker Dennis Bonnen tweeted about the checkpoints Sunday, with the latter describing them as roadway screening stations to gather [required] forms for self-quarantining. Abbotts order, issued March 29, requires drivers coming in to Texas from Louisiana to fill out a form designating a quarantine location in Texas.
On Sunday, April 5, 2020, checkpoints and screening of vehicles by the Texas Department of Public Safety began on all roadways entering Texas from Louisiana, the Louisiana State Police wrote Sunday morning on Facebook, attaching photos of signs pointing drivers off of highways to checkpoints.
DPS said in a statement that the checkpoints will be in the Texas counties that border Louisiana and located on major roadways in these counties, including interstate highways and other high-volume routes. Drivers entering Texas from Louisiana should be prepared to stop, the department said.
DPS initially said it did not plan to establish checkpoints at the border but vowed to vigorously enforce Abbotts multiple self-quarantine requirements. He has also mandated 14-day self-quarantines for air travelers from Louisiana, as well as New York, New Jersey, Connecticut, California, Washington, Atlanta, Chicago, Detroit and Miami. Patrick Svitek
[ 10 a.m.] The Texas Supreme Court on Monday morning extended its pause on eviction proceedings another 10 days.
Evictions are now halted until April 30; the court's prior order put them on pause until April 20. At the end of the period, the Chief Justice Nathan Hecht can choose to renew the order again.
There is one exception: Landlords may proceed with eviction cases only if the actions of the occupants pose an imminent threat of physical harm to the landlord, the landlords employees or other tenants, or if the occupants are engaging in criminal activity.
With thousands of Texans losing their jobs as the COVID-19 pandemic has shut down businesses, renters and landlords are both worried about how theyll make ends meet.
Some cities and counties have opted to ban evictions for even longer than the Texas Supreme Court has ordered. Austin has instituted a 60-day grace period. Earlier this month, Dallas County Judge Clay Jenkins halted evictions through May 18. Sami Sparber
Deaths were relatively flat across the region.
For days, officials in and around New York sought indications that the coronavirus was nearing a peak in the region the U.S. epicenter of the pandemic and might start leveling off.
And for days, the death toll climbed faster and faster. In New York State, for instance, it rose by more than 200, then more than 400, then 630 people in a single day.
But on Monday, for the second day in a row, officials found reasons for hope even as hundreds of people continued to die and thousands clung to life on ventilators.
On both Sunday and Monday, fewer than 600 deaths from the virus were reported in New York: 594 on Sunday, 599 on Monday, Gov. Andrew M. Cuomo said.
In New Jersey, Gov. Philip D. Murphy reported a similar trend: 71 reported deaths on Monday, and 86 on Sunday, after a three-day streak when deaths had broken triple digits.
And in Connecticut, Gov. Ned Lamont on Monday reported a one-day death toll of 17, the smallest number since last Wednesday.
Mr. Cuomo said the data suggested that the spread of the virus in New York was nearing its apex, but he emphasized that the state remained in a dire, unsustainable state of emergency.
If we are plateauing, we are plateauing at a very high level and there is tremendous stress on the health care system, he said.
Here were the latest numbers from the day:
Deaths in New York State: 4,758, up 599 from 4,159 on Sunday morning.
Confirmed cases: 130,689, up from 122,031 in New York. In New York City, 72,181, up from 67,551.
Hospitalized in New York State: 16,837, up 2 percent from 16,479 on Sunday. It was the third straight day of single-digit percentage growth, after a long period when hospitalizations were growing 20 to 30 percent a day.
In intensive care: 4,504, up 2 percent from 4,376 on Sunday. The day-over-day increase, 128, was the smallest in at least two weeks. Last week, the number of people in intensive care beds, which have ventilators, was growing by more than 300 people a day.
Even if the infection curve is flattening, the viruss daily toll remains horrific.
New York City reported a one-day total of 219 deaths on Monday morning, bringing the citys death toll to 2,475. Before the virus outbreak, the average death rate in New York City was 158 people a day, meaning the virus is now killing considerably more people in the city than all other causes combined.
Mr. Cuomo asserted that New York had done all it could to prevent the loss of lives that could have been saved.
Have we saved everyone? he said. No. But have we lost anyone because we didnt have a bed or we didnt have a ventilator, or we didnt have health care staff? No.
In a notable shift from previous weeks, when he pleaded for more ventilators from the federal government and other states, he said New York was now adequately stocked.
We dont need any additional ventilators right now, he said.
State officials said on Monday that its June Regents examinations for high school students would be canceled. Many high school students in New York State take the exams, which help determine graduation eligibility, in June.
It was not clear whether the August Regents, which give students a second chance to qualify for a state diploma, would also be canceled. The Board of Regents, led by chancellor Betty Rosa, is expected to announce more details about the August exams and how the changes will affect graduation requirements on Tuesday.
The state had already canceled standardized exams planned for the spring for students in grades three through eight.
New York City schools had been scheduled to closed starting Thursday through the end of next week for Passover, Good Friday, and spring break. Students are now expected to continue their remote learning during that time.
The state has said that remote instruction must continue, regardless of whether districts like New York City had spring break scheduled.
The teachers union sent out an email on Friday berating the city for making teachers work on major religious holidays. The citys education department and the union subsequently struck a deal that gives teachers four extra days off that can be used for religious holidays.
With the number of city residents dying of the virus outpacing the systems capacity to handle them, officials are considering temporarily burying people in mass graves in a park, the chairman of the City Councils health committee, said on Monday.
It will be done in a dignified, orderly and temporary manner, the chairman, City Councilman Mark Levine, wrote on Twitter. But it will be tough for NYers to take.
Mr. Levine said temporary interment could avoid scenes like those in Italy, where the military was forced to collect bodies from churches and even off the streets.
Mayor Bill de Blasio said no such plan had been put in place.
If we need to do temporary burials to be able to tide us over to pass the crisis and then work with each family on their appropriate arrangements, we have the ability to do that, he said when asked about Mr. Levines comment later on Monday.
But he said the city was not at the point that were going to go into that.
Governor Cuomo said at his noon briefing that he had heard nothing about such a possibility.
I have heard a lot of wild rumors but I have not heard anything about the city burying people in parks, Mr. Cuomo said.
After the mayor and governor weighed in and after Mr. Levines comments caused a panic among some New Yorkers the councilman wrote on Twitter that what he was describing was a contingency plan and that if the death rate drops enough it will not be necessary.
In an interview, Mr. Levine, who represents Upper Manhattan, declined to identify which park or parks might be used, but he said, I presume it would have to be a large park with some inaccessible areas that are out of the way of the public.
Temporary burials are part of a 2008 plan prepared by the city medical examiners office to deal with a pandemic. Tier One of the plan involves storing bodies in freezer trucks and easing restrictions on crematories. The cityhas already taken those steps.
Mr. Murphy said on Monday that there had been 3,663 new confirmed virus cases in New Jersey since the day before, bringing the states total to 41,090. He also noted the 86 new deaths, which brought New Jerseys total to 1,003.
Mr. Murphy arrived at the news conference where he delivered the numbers wearing a face mask, which he removed before speaking.
Our protocol has been that when were in any setting with more than a modest amount of folks, were going to wear our masks, including for press conferences, both coming in and leaving, he said.
The governor shared data showing that while the number of positive case results continued to rise, there had been a decline in the growth rate over the past week, from 24 percent day-over-day on March 30 to about 12 percent as of Monday.
This means that our efforts to flatten the curve are starting and I say starting to pay off, even with the lag time in getting testing result back from the labs, Mr. Murphy said.
P-P-E.
Every day.
And every day.
P-P-E.
That was the call-and-response outside Harlem Hospital Center on Monday, as dozens of nurses protested for more personal protective equipment.
On the sidewalk out the hospital, the names of health care workers who died after treating coronavirus patients were written in brightly colored chalk.
The Manhattan hospital has been inundated with virus patients, including some who were transferred from hospitals in Queens and the Bronx.
But the hospital staff has been stretched thin and critical workers have been provided with little protective equipment, nurses said. The hospital has only a small number of respiratory therapists, and staff members get one N95 mask to wear for five 12-hours shifts, said Sarah Dowd, a staff nurse who helped organize the protest.
We deserve better, she said, reciting a list of demands that includes at least one mask a day for hospital workers, and more nurses, doctors, respiratory therapists.
The Harlem nurses were joined by counterparts from other public and private hospitals in the city. The protesters held signs that read, Patients before Profits and Who Will Care for You When We Are Dead?
Foluke Fashakin, a nurse who was at Harlem Hospital, said that nurses were wearing the same equipment to treat those who were infected and those who were not.
We are not comfortable with this kind of system, she said.
New York City will end a pilot program that had closed some streets in each borough to vehicles, officials said on Monday.
A spokeswoman for Mr. de Blasio said that the initiative, which was started to create more space for pedestrians, required 80 city police officers to shut each six- to seven-block stretch.
Officials decided after a two-week trial that not enough people were taking advantage of the program to justify it, according to the spokeswoman, Jane Meyer.
Mr. de Blasio had said on Sunday that he wanted to continue testing the program because bad weather might have discouraged people from going outside during the two weeks it was in effect.
Scott Stringer, New York Citys comptroller, lashed out at President Trump on Monday over his response to the coronavirus outbreak, blaming the president for the death of his mother, Arlene Stringer-Cuevas.
Donald Trump has blood on his hands, and he has my moms blood on his hands he wrote on Twitter.
Mr. Stringer faulted Mr. Trump for the fact that the 1,000 beds on a Navy hospital ship sent to New York amid the crisis were reserved for patients were not infected with the virus.
Ms. Stringer-Cuevas, 86, died on Friday. She was the first woman to represent Manhattans Washington Heights neighborhood on the City Council.
Mr. Stringer, who called his mother a a genuine trailblazer in announcing her death, described the difficulty of mourning with restrictions in place.
Perhaps the thing I struggle with the most is, how do you mourn at a time where you cant connect with people? he said.
Crime has plummeted in New York City and across the state since the governor announced a stay-at-home order more than three weeks ago, data released on Monday shows.
In New York City, the number of felony and misdemeanor cases dropped a collective 43.3 percent from March 18 to March 24, compared with the same period in 2019, according to the New York State Division of Criminal Justice Services.
All other regions in the state experienced an even greater decline over the same period: a drop of nearly 69 percent in misdemeanors and felonies.
The number of felonies specifically dipped 33 percent in New York City and 60 percent in the rest of the state.
Reporting was contributed by Jonah Engel Bromwich, Joseph Goldstein, Matthew Haag, Elizabeth A. Harris, Andy Newman, Eliza Shapiro, Liam Stack and Katie Van Syckle.
Things moved quickly after that. On Sunday, my doctors scheduling nurse called and said we needed to do the procedure while there were still operating rooms available. My wife worried about how significantly the procedure would affect my life. But we have also come to grips with the reality that my cancer is not going away. I know there will be a lot of limitations, even if the surgery is successful, but at least I will have some kind of life.
On Monday morning, my doctor called to say the surgery was set for the next day. A pre-op nurse called to go over the procedure: no eating or drinking after midnight, use a special antibacterial soap before arriving at the hospital, plan to stay for at least four days to recover. My wife and I scrambled around the house, preparing to close it up for a week. We were just about to leave for the two-hour drive to the hospital when the nurse called back. She said Duke University Hospital was now requiring the results of virus testing prior to admitting anyone for surgery. They didnt have a test to give me; just a policy that required me to get one. I contacted my physician in Winston-Salem, but he said the hospital there was only testing patients who had been admitted with serious virus symptoms. Almost as quickly as it had been scheduled, the surgery was canceled.
I dont know how long it will be before there are enough tests available that someone like me can get one. But unlike other people who might just be curious about whether they are infected or not, I have a clock ticking in my body. While I wait for the test, this cancer could metastasize. By the time they can perform the surgery, it might be a moot point.
Im not a political person. I dont belong to either party. For the most part, I dont care who is running the country, but I expect that in times of crisis that government uses its resources to take care of its citizens. And right now I dont see that happening.
There are not enough masks. There are not enough tests. There is not enough personal protective equipment for health care providers. When President Donald Trump says there is, its clear that hes not listening to experts and scientists. He may be talking about a few virus response centers, but hes not talking about most of the country. Hes definitely not giving enough consideration to the rest of Americans who also have serious medical needs.
This virus has already killed tens of thousands of people and infected millions others. We all wake up to stories of overrun hospitals and bodies stacked in refrigerated trucks. The news is horrible. But officials need to know that thats not even the whole story of Covid-19. There are tens of thousands, if not hundreds of thousands, of trickle down cases like mine. When I hear about people who arent getting pacemakers installed or getting care they need, I feel betrayed. My whole family is struggling mightily. I worry about dying before I should. I worry about what day-to-day life will look like for my wife. I want to play ball in the front yard with my grandsons and go to their sporting events. I want to resume as much of my life as I can after the surgery. But without masks and gloves and virus testsbasic things that our health care system should always have in good supplythose simple joys might disappear for people like me.
Federal inquiries have begun to determine how the nations testing capacity turned into such a debacle. The Centers for Disease Control and Prevention had manufacturing errors with the first test it devised for public health labs around the country, and so testing in the states stalled as the virus began to spread in Washington State, New York and California. The Food and Drug Administration, charged with approving the test, was so frustrated that the agency pushed for the C.D.C. to stop making it on site and instead send it to Integrated DNA Technologies, an outside lab.
The F.D.A., for its part, was slow to recognize the danger of the pandemic, and how critical testing by commercial labs and hospitals would be as the virus spread.
In early March, the nations two largest commercial labs, Quest Diagnostics and LabCorp, started testing, and they have acknowledged that their labs around the country were overwhelmed. Quests backlog is 80,000, according to the company, down from 160,000 on March 25. LabCorp says it has caught up, and now has a turnaround of four to five days from pickup.
Supplies of test swabs have gotten so low that most hospitals test only their most vulnerable patients, typically those being admitted.
Wendy Bost, a spokeswoman for Quest, which introduced its coronavirus tests on March 9, said the company had ramped up its testing and could now process more than 35,000 tests per day over 200,000 each week at its 12 labs around the country. Last week, Quest asked hospitals to identify health care workers and symptomatic patients for priority processing and she said the company was providing results now on an average of a day for that population.
To date, Quest has processed nearly 550,000 coronavirus tests, Ms. Bost said. The current turnaround time for other patients, she said, is now two to three days although she acknowledged there was a longer wait in the areas most affected, like Chicago, New York, New Jersey and Miami.
LabCorp has four labs running, also averaging about 35,000 to 40,000 coronavirus tests each day, the company said. Mike Geller, a LabCorp spokesman, said it had tested about 500,000 samples, and that the time for processing varied, based on demand.
