Mr. Johnson wrote Monday on Twitter from a hospital in London that he was in good spirits.
Mr. Johnson, 55, first experienced the symptoms of the virus on March 26, was tested that day and received the positive result around midnight, going into self-isolation in Downing Street, but chairing meetings by videolink.
He was originally expected to resume normal working at the end of last week, but on Friday Mr. Johnsons aides said that he still had symptoms, especially a high temperature, and had not ended his self-isolation. In a video statement in which he explained the situation, he still looked unwell.
Several other key figures in the government have self-isolated after suffering symptoms of the coronavirus, including the health secretary Matthew Hancock, who has now returned to work, and the chief medical officer, Chris Whitty. Mr. Johnsons partner, Carrie Symonds, who is pregnant, disclosed on Saturday that she, too, is suffering symptoms.
Mr. Johnson was initially criticized for his slow response to the outbreak, but later moved to place Britain under a virtual lockdown, closing all nonessential shops, banning meetings of more than two people, and requiring people to stay in their homes, except for trips for food or medicine.
Before that his government had tried to take a different tack from the rest of Europe, which moved earlier to close businesses to try to halt the spread of the virus. Some officials, including Sir Patrick Vallance, Englands chief scientific adviser, had said that the government was looking to build up some kind of herd immunity so more people are immune to this disease and we reduce the transmission.
At one news conference in early March, Mr. Johnson described visiting a hospital where he said there were coronavirus patients. I shook hands with everybody, youll be pleased to know, he said, and I continue to shake hands.
The announcement of Mr. Johnsons hospitalization came hours after Queen Elizabeth II issued a rare televised address on Sunday, attempting to rally her fellow Britons to confront the pandemic with the resolve and self-discipline that have seen the nation through its greatest trials.
By Roni Caryn RabinA vaccine that was developed 100 years ago to fight the tuberculosis scourge in Europe is now being tested against the coronavirus by scientists eager to find a quick way to protect health care workers, among others.
The Bacillus Calmette-Guerin vaccine is still widely used in the developing world, where scientists have found that it does more than prevent TB. The vaccine prevents infant deaths from a variety of causes, and sharply reduces the incidence of respiratory infections.
The vaccine seems to train the immune system to recognize and respond to a variety of infections, including viruses, bacteria and parasites, experts say. There is little evidence yet that the vaccine will blunt infection with the coronavirus, but a series of clinical trials may answer the question in just months.
On Monday, scientists in Melbourne, Australia, started administering the BCG vaccine or a placebo to thousands of physicians, nurses, respiratory therapists and other health care workers the first of several randomized controlled trials intended to test the vaccines effectiveness against the coronavirus.
Nobody is saying this is a panacea, said Dr. Nigel Curtis, head of infectious diseases at Royal Childrens Hospital in Melbourne, who planned the trial. What we want to do is reduce the time an infected health care worker is unwell, so they recover and can come back to work faster.
A clinical trial of 1,000 health care workers began 10 days ago in the Netherlands, said Dr. Mihai Netea, an infectious disease specialist at Radboud University Medical Center in Nijmegen. Eight hundred health care workers have already signed up. (As in Australia, half of the participants will receive a placebo.)
Dr. Denise Faustman, director of immunobiology at Massachusetts General Hospital, is seeking funding to start a clinical trial of the vaccine in health care workers in Boston as well. Preliminary results could be available in as little as four months.
We have really strong data from clinical trials with humans not mice that this vaccine protects you from viral and parasitic infections, said Faustman. Id like to start today.
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The scientists cultured bacterial scrapings from cow udders, and continued to culture bovine TB for over a decade until it was weak enough that it no longer caused virulent disease when given to lab animals.
The weakened virus was first used in humans in 1921 and was widely adopted after World War II. Now BCG is primarily used in the developing world and in countries where TB is still prevalent, where it is given to over 100 million babies a year.
Like other vaccines, BCG has a specific target: TB. But evidence accumulating over the past decade suggests the vaccine also has so-called off-target effects, reducing viral illnesses, respiratory infections and sepsis, and appears to bolster the bodys immune system.
The idea is an offshoot of the hygiene hypothesis, which suggests that the modern emphasis on cleanliness has deprived children of exposure to germs. The lack of training has resulted in weakened immune systems, less able to resist disease.
One of the earliest studies hinting at the broad benefits of BCG vaccination was a randomized trial of 2,320 babies in Guinea-Bissau in West Africa, published in 2011, that reported that death rates among low-birth-weight babies were dramatically reduced after vaccination. A follow-up trial reported that infectious-disease mortality rates in low-birth-weight babies who were vaccinated were cut by more than 40%.
Other epidemiological studies including a 25-year study of over 150,000 children in 33 countries have reported a 40% lower risk of acute lower respiratory tract infections in children who received a BCG vaccine. A study in the elderly found that consecutive BCG vaccinations reduced the incidence of acute upper respiratory tract infections.
A recent review by the World Health Organization concluded that BCG had beneficial off-target effects, and recommended doing more trials of the vaccine against a wider range of infections.
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While he described the BCG vaccine as underappreciated, he emphasized that it was not a specific COVID-19 vaccine. BCG also cannot be administered to anyone who has a compromised immune system, because it is a live-attenuated vaccine meaning it contains live but weakened TB.
Faustman said it should not be used in hospitalized patients with active disease, because it may not work fast enough and could interact poorly with other treatments.
Not everyone is convinced BCG holds much promise. Dr. Domenico Accili, an endocrinologist at Columbia University, said he thought efforts to use the vaccine against the coronavirus sound a bit like magical thinking.
While acknowledging that BCG is a non-specific booster of the immune system, he said, we should be able to deploy a more tailored approach.
One question is what effect the vaccine may have in patients whose immune systems overreact to the coronavirus, resulting in what are called cytokine storms. Dr. Randy Cron, an expert on cytokine storms at the University of Alabama at Birmingham, said it was impossible to know.
A recent analysis of the disparate toll the new coronavirus has taken on middle- and high-income countries found a correlation with BCG policies, concluding that countries that did not implement or had abandoned universal BCG vaccination have had more coronavirus infections per capita and higher death rates. (Low-income countries were excluded from the analysis because of unreliable COVID-19 reporting data and generally poor medical systems.)
You can make a new vaccine, Faustman said. Were really smart, and we can do that. But its two years off, and two years is going to be two years too late.
If weve got something generic globally at hand that we can use to make the human host stronger, this is a win-win for the public right away.
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Updated - April 5, 2020 J.Stewart BPharm
COVID-19 is the disease caused by an infection of the SARS-CoV-2 virus, first identified in the city of Wuhan, in China's Hubei province in December 2019. COVID-19 was previously known as 2019 Novel Coronavirus (2019-nCoV) respiratory disease before the World Health Organization (WHO) declared the official name as COVID-19 in February 2020.
The SARS-CoV-2 virus belongs to the family of viruses called coronaviruses, which also includes the viruses that cause the common cold, and the viruses that cause more serious infections such as severe acute respiratory syndrome (SARS), which was caused by SARS-CoV in 2002, and Middle East respiratory syndrome (MERS), which was caused by MERS-CoV in 2012. Like the other coronaviruses, the SARS-CoV-2 virus primarily causes respiratory tract infections, and the severity of the COVID-19 disease can range from mild to fatal. Serious illness from the infection is caused by the onset of pneumonia and acute respiratory distress syndrome (ARDS).
The most common symptoms of COVID-19 include dry cough, fever, and shortness of breath. It is thought that symptoms can appear between 2-14 days after exposure although there have been isolated cases which suggest this may be longer. If you develop symptoms, you should stay at home to prevent the spread of the disease into the community. Wearing a facemask will help prevent the spread of the disease to others.Update: March 10, 2020 -- According to the latest research published in the Annals of Internal Medicine (March 10, 2020), the median incubation period is estimated to be 5 days, and almost all (~98%) patients who have been infected will develop symptoms within 12 days.
The SARS-CoV-2 virus is thought to spread from person-to-person via:
The best way to prevent infection is to avoid exposure to the virus.
The most important way to preventCOVID-19 is to WASH YOUR HANDS.
Wash your hands regularly and thoroughly with soap and water (lather for 20 seconds) OR use an alcohol based (at least 60%) hand sanitizer.
Other actions that help to prevent the spread ofCOVID-19:
What to do if you come into contact with someone who is sick
If you have been exposed to someone who has tested positive for COVID-19, or someone who is showing symptoms of COVID-19, it may take up to two weeks for your symptoms to present. To keep yourself and others safe, you should isolate yourself from other people for 14 days.
What does self-isolation mean?
Self-isolation means staying away from situations where you could infect other people. This means any situation where you may come in close contact with others (face to face contact closer than 3 feet for more than 15 minutes), such as social gatherings, work, school, child care/pre-school centres, university and other education providers, faith-based gatherings, aged care and health care facilities, prisons, sports gatherings, restaurants and all public gatherings.
You should not share dishes, drinking glasses, cups, eating utensils, towels, pillows or other items with other people in your home. After using these items, you should wash them thoroughly with soap and water, place them in the dishwasher for cleaning or wash them in your washing machine.
Scientists are still researching risk factors for COVID-19 but data from China CDC suggest that the elderly, and people suffering from pre-existing medical conditions (such as heart disease, respiratory disease including asthma and COPD, or diabetes) have a higher risk of dying from the disease. There isresearch that suggests that smokers may be more susceptible to the SARS-CoV-2 virus. There is also evidence to suggest that people who usee-cigarettes (vaping)are at much higher risk of developing serious respiratory infections.Update: March 16, 2020 --A Chinese study claims to have found that people with type A blood may be more susceptible to the novel Coronavirus (COVID-19).Update: March 22, 2016 -- CDC now includes people aged 65 years and older, people who live in a nursing home or long-term care facility, and people who are immunocompromised including those receiving cancer treatment as thosewho are at higher risk for severe illness. People with HIV may also be at higherrisk of serious illness.
Currently, there are no FDA approved treatments for COVID-19.Update: March 31, 2020 --FDA Approves Malaria Drugs to Treat COVID-19, Despite Little Proof They Work
Re-opening a nightclub in New York seems crazy at this point, as thats just the kind of setting in which Covid-19 can spread like wildfire. But it wouldnt be crazy if all of the workers and patrons had previously had Covid-19 and recovered from it.
Someday soon there will be millions of people in the U.S. who have recovered from Covid-19. The best evidence suggests that they cant get infected again soon and wont infect others by shedding the virus.
That suggests a path to run essential services more safely and to reopen sectors of the economy faster than would otherwise be possible. New York, Washington, California, and other states with high caseloads should rush to set up credible, verifiable, and voluntary programs to identify individuals as certified recovered from Covid-19. Researchers in Germany have recently proposed a similar program there.
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Federal policymakers are currently being pulled in two directions. One is to close much of the economy and shelter people at home to limit the spread of the virus that causes Covid-19. But we all recoil at the economic and human devastation this creates, so Congress passed a $2 trillion stimulus package geared mostly to keep the economy open and stimulate demand. Yet demand is hard to stimulate when so many things are closed, and it is dangerous to stimulate in ways that increase social contact and spread the virus.
Creating a path for the certified recovered from Covid-19 reduces the tension between jump-starting the economy and letting the virus run rampant.
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Certification could begin by drawing on existing tests and hospital records, starting with individuals who already had both a positive test and matching symptoms. Now that fast antibody and viral tests have FDA approval, new testing will pick up speed. If certification piggybacks on such tests, the U.S. could create a substantial and vital new specialized labor force of the certified recovered in the short term.
Although no one knows with absolute certainty if people with antibodies to the SARS-CoV-2 coronavirus can be re-infected by it, immunity to the coronavirus that causes severe acute respiratory syndrome (SARS) lasted two years. For SARS-CoV-2, monkeys infected with SARS-CoV-2 are known to have developed immunity. And according to Martin Hibberd, an infectious disease expert at the London School of Hygiene and Tropical Medicine, people who have recovered are unlikely to be infected with SARS-CoV-2 again.
These early indications justify starting now to build a certification system. We urgently need to get as many people safely back to work as possible.
Certified recovered people could take up frontline contact positions in medicine and retail to make operations safer. They could work with the elderly and the vulnerable. Certified recovered persons could also work in food preparation. A service that prepared and delivered food only with recovered people would be quite popular. Buses on routes going to hospitals could be driven by recovered drivers. Possibilities abound as trust rebuilds. Just knowing that more and more people have beaten the virus and are back to work would be an immense boost to confidence.
To be sure, health conditions are a private matter, and no one should be forced to certify themselves. That said, demand by individuals to be voluntarily tested and certified could be intense.
The program would be ideal if it allowed undocumented workers to participate without fear or risk. It was cruel to leave them out of the stimulus support. It was also unwise from a public health perspective, as undocumented families will be forced to join an underground economy and work in defiance of local shelter-in-place ordinances, thereby endangering everyone.
One concern is that the uninfected could face job discrimination in certain jobs once a system for verifying the certified recovered is created. Recently reissued guidance from the U.S. Equal Employment Opportunity Commission, however, suggests that the commission sees such discrimination as acceptable. If immunity is important to safely perform a job, then giving preference to those who are certified as recovered is justified, particularly in our present emergency. Getting more people working safely is paramount.
Quickly creating a certification system could speed economic recovery while slowing the virus. And perhaps the certified recovered, after working all day for the rest of us, could safely enjoy dancing the night away.
Aaron Edlin is a visiting scholar at the USC Schaeffer Center for Health Policy and Economics and professor of economics and law at UC Berkeley. Bryce Nesbitt is a co-founder of NextBus, a public transit information company.
President Trump said last week that he hadnt heard about testing in weeks. But right now lets face it tests are being rationed in many parts of the country.
Of course, the seriously ill and essential front-line personnel like doctors, nurses and policemen require and deserve to go to the front of the line for testing.
But there are hundreds of thousands more people who should have been tested at this point, if more tests were available. Testing them would have vastly changed their behavior, their self-care at home, and (perhaps most important) our understanding of Covid-19, so that when it flares locally we would know how to respond in a more nuanced way, rather than shutting society down.
As of this writing I know nearly a dozen people who are presumed Covid. None of them were tested, because they were not sick enough to be admitted to a hospital though all were quite symptomatic. Heres a partial list:
Three 20-something roommates in Brooklyn, two with mild symptoms. One sick enough to visit a hospital, short of breath. No tests. All were told, Assume you have it.
Also presumed Covid: a colleagues daughter and her boyfriend, though he had a rough two-week course, including pneumonia. His oxygen levels, measured at home, never got quite bad enough for admission (and hence, no testing).
And finally, a reporter in San Francisco, who went to a clinic with high fever, total body aches and cough, is now presumed Covid. She was sent home. The next day her strep test came back positive. Assume you have Covid, too, she was told.
It is true that a positive Covid test would not have changed any of their immediate medical treatment. They got inhalers and the medicines they needed. Not knowing probably didnt increase their risk of death. So I dont fault the doctors for not administering them tests at a time of limited resources.
But here is what is outrageous: This resource should not be in such limited supply three months into a global outbreak. Widespread testing has hugely important impact, not just for individuals, but also for society.
For example, If people knew theyd had Covid, and therefore possessed at least some immunity, they could volunteer, once fully recovered, for groups like Meals on Wheels, which is struggling to deliver food to people who cant even in the best of times fend for themselves. They could serve as helpers in nursing homes, whose staffs are stretched thin and where the elderly are living in isolation.
Knowing the result of a test allows rational individual decisions. If a person living in a house with others knows whether he has Covid versus a common cold (and remember, the symptoms of Covid-19 may be very mild in younger people), it greatly affects how he interacts with family and housemates.
If he is Covid positive, it makes sense for him to totally isolate in one room and use a separate bathroom. An elderly relative might be moved out. If he has a common cold, less disruptive precautions are needed.
In this season of allergies sneezes and sniffles and when the country is trying to control the spread of a virus that can produce only mild symptoms in many of those infected, it would be good to be able to test as many essential workers broadly defined as possible to see if they had Covid-19.
This is not just a reference to health care workers, police and firefighters or utility workers. It is also not helpful for a food delivery person or the guy at the grocery counter, for example, to work with it, given how many people are depending on their services.
We test for things like strep and sexually transmitted diseases not just because knowing test results influences treatment should antibiotics be prescribed? but also because the results influence the care and advice for patients activities and contacts.
Finally, and perhaps most important, widespread testing of all those presumed Covid patients who are not hospitalized gives us a far clearer picture of this new viral disease, which we currently have so little data about.
It would allow us to calculate how many people who are infected with the virus get really ill and how many die (the true case fatality rate). We are now more or less clueless about those things, and because of uneven testing, fatality rates vary widely from city to city, state to state and country to country.
Finally, widespread testing would allow us to have a better sense of how transmissible the virus is after more casual contact. We know that the intense exposure of health care personnel in a hospital setting often leads to transmission. But what about the co-worker who sat across the office from you and rarely interacted with you?
Long after his graduate school classes were canceled, my son was belatedly notified that one person in his German class had fallen ill with Covid-19. How many others did, but were never tested?
After this period of lockdown, Covid-19 is likely to come back in lesser waves, and robust testing data would be hugely important in fashioning a targeted response that could be less expansive than the miserable and economically devastating shutdown we are now experiencing. If one student falls ill in a class, should universities once again send all students home and cancel a semester or just close a building? Or even just cancel one class?
Thank goodness that countries like South Korea are doing far more testing that we are, which might give us clues how to respond. But we should be doing much more ourselves.
There have been countless explanations for the lack of tests. Our public health labs are not primed to do testing and the Centers for Disease Control and Prevention was slow to react to a virus many knew was likely to come our way. The agency initially distributed test kits like Senate seats equally to each state lab, rather than where they were most needed. Then the first test kits didnt work.
The list goes on. The Food and Drug Administration only belatedly allowed private and university labs to contribute without the normal regulatory tape. There was a shortage of swabs and a shortage of personal protective equipment for people taking the swabs. Most recently, an Abbott quick test device that Mr. Trump had applauded as a solution a whole new ballgame turned out to be only 5,500 tests, distributed nationally. Yet many millions are needed.
All are plausible explanations and many are true. But no one should be satisfied with them in this, the richest country in the world.
There are concerns, to be sure, about the accuracy of the new tests, with reports of false negatives. But that is no reason not to use what we have; the specificity of newly developed tests can improve with understanding and use. It would be wise for people who test negative to continue rigorously following good Covid hygiene. But it would be a mistake to not expand testing aggressively simply because of reports of false negatives.
Presumed positive may be needed during a period of rationing and shortage. But Assume youre positive as so many New Yorkers are doing is not good individual health care or good policy.
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Executive Summary
Human evolution has wired us to stigmatized sick people. But thats dangerous. During the current pandemic, shunning Covid-19 survivors will exacerbate mental health issues. It also will contribute to the spread of the disease as mildly ill patients will be reluctant to admit they are sick. We need leaders and celebrities to normalize the disease, corporate leaders to make clear that a companys diversity values extend to Covid-19 patients, and managers to make sure there is no stigma around being sick at work. Finally, we all need to reach out to make social contact with people who have been sick or have close friends and family who are sick.Pandemics remind us of how connected we all are. Our shared vulnerability to this virus is a source of solidarity.
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If you dont already, you will soon know someone who has been ill with Covid-19 and survived. They will be our friends, our family, our neighbors and our colleagues. History will judge us by the way we treat them.
Unfortunately, as my and others research makes clear, stigma has exacerbated the suffering from every major infectious disease epidemic in our history, and it will certainly play a role in the current Covid-19 pandemic. Stigma is an evolutionary response: We are hard-wired to physically distance ourselves from others who could infect us. We have an entire suite of evolved reactions, called parasite avoidance, to prevent us from maintaining contact with others who may carry communicable diseases. These reactions are what make us feel disgusted by signs of sickness, such as vomiting or skin lesions, whether or not these signs represent an actual threat to our own health.
There is a moral as well as physical component, as well. We tend to believe that bad things happen to bad people. This just-world fallacy tricks us into thinking that people who are infected with a disease may have done something wrong to deserve it. Maybe people who have become infected with Covid-19 didnt wash their hands long enough, touched their face too much, or didnt socially distance enough. This belief is comforting, helping us believe that we are in control of our own fate. It tells us that if we do everything right, we wont become infected. Yet, we simply dont live in a just world: We could do everything right, wash our hands for 60 seconds instead of just 20, and still become infected with Covid-19.
My decades of research show that stigma harms the mental and physical health of people with disease. This stigma can take the forms of social rejection, gossip, physical violence, and denial of services. Experiencing stigma from others can lead to elevated depressive symptoms, stress, and substance use. Alarmingly, people dont have to experience stigma from others to be negatively affected by it. Just anticipating stigma from other people perhaps because youve already seen sick people be ostracized or judged for their illness can lead to anxiety and stress. Infected people may also internalize stigma, believing that they did something wrong or are a bad person because they became infected with a disease. The fact that many Covid-19 patients are medically isolated compounds the problem patients under such separation orders have been shown to be at greater risk of distress.
Stigma does not only impact people who are sick, but extends to people who have an actual or perceived association with a disease. Family members of people with disease and healthcare providers caring for people with disease are at high risk of experiencing stigma from others during epidemics. In the context of Covid-19, stigma has additionally been directed at Asian Americans and people who have traveled to areas affected by the pandemic.
Stigmatizing anyone during a pandemic poses a threat to everyone. Research from HIV, Ebola, Hansens Disease, and other infectious disease epidemics shows that stigma undermines efforts at testing and treating disease. People who worry that they will be socially shunned if they are sick are less likely to get tested for a disease or seek treatment if they experience symptoms. Because of the just-world fallacy, they may also not believe that they could have a disease after all, theyre a good person who has taken precautions to avoid the illness.
The good news is that scientists working in diverse disease contexts have identified tools that can be leveraged to address stigma during Covid-19, including strategies for both reducing stigma and strengthening resilience, so that even if people are exposed to stigma they may not be as negatively affected by it.
Education is one of the most popular tools to deconstruct stigma. It can dispel harmful stereotypes, such as that Asian Americans are more likely to have Covid-19. Local and national leaders who fall ill to Covid-19 should be open about their diagnosis to help normalize the disease. When NBA star Magic Johnson announced he was HIV positive, HIV testing rates increased dramatically across the nation. In this regard, social media posts from celebrities who have the disease are also likely to help lift the taboo. Ive been reminding colleagues and friends: If Tom Hanks and Rita Wilson can get Covid-19, we all can.
Corporate leaders can clarify that organizational values of inclusion, acceptance, and diversity extend to people who are affected by Covid-19. In some instances, enforcing anti-discrimination policies may be necessary. A patient who is fully recovered from Covid-19 is no longer infectious and should not be treated any differently from his or her colleagues. Corporate leaders can also create clear and confidential guidelines for reporting and responding to Covid-19 cases among employees, so that employees feel safe reporting if they become sick and secure that they will have a job when they have recovered. Organizations should also invest in wellness programs that promote resilience to stigma and other stressors. For example, mindfulness activities help to improve resilience to a wide range of stressors and there are a variety of platforms facilitating access to them.
While leadership is important, we all play a vital role in removing stigma during a pandemic. Indeed, one of our best reduction and resilience tools is simple social support. Employees can schedule virtual coffee hours, lunches, and happy hours with their co-workers to check in on them. We can call and send texts to our neighbors, especially those who have been sick, to update them on our lives and express hope of re-connection after social-distancing measures are lifted. We should also talk openly about the mental health struggles we are all facing opportunities to talk with others about stressors including stigma can promote positive coping and mental well-being.
Although stigma is an evolved reaction to disease, it is not an inevitable one. Stigma divides and turns us against each other, but pandemics remind us of how connected we all are. Our shared vulnerability to this virus is a source of solidarity. We must remember that the virus not people with Covid-19 or affected by Covid-19 is the enemy.
Employee Gina Hansen (right) hands documentation to a client outside the Daniel J. Schaefer Funeral Home in Brooklyn on Thursday. John Minchillo/AP hide caption
Employee Gina Hansen (right) hands documentation to a client outside the Daniel J. Schaefer Funeral Home in Brooklyn on Thursday.
The fast-growing number of cases of COVID-19 around the country is also bringing a surge in the number of deaths. In New York City alone, the death toll is in the thousands and rising steeply every day.
There, and in places such as Detroit, Seattle and New Orleans, funeral directors are struggling to meet the increased demand. Joseph Lucchese, who owns and directs a funeral home in the Bronx, says it's unlike anything he's ever seen and it's dispelled any doubts he once had about the severity of the coronavirus pandemic.
"When this first started, I really thought this was bull****, and it's not," he says. "There is a lot of people dying out there. And it's really, really scary."
Funeral homes in the New York City area are being called on to bury more people. At the same time, because of the coronavirus, they have to take precautions that limit the number of funerals they can conduct each day. Lucchese says, under New York rules, the funerals are limited to no more than 10 people, and he can conduct just three a day.
"In between every family, we'll clean and disinfect every funeral home so there's very little chance of cross-contamination from families," he says.
With the pandemic, the process of transferring bodies from hospitals has changed.
"We go to just about every hospital and nursing home in the Bronx," Lucchese says. "Most of the hospitals have gotten these refrigerated trailers in."
Instead of going into the hospital, he says, sometimes funeral home staff members are asked to wait outside while the hospital does the paperwork.
"You need the doctors to come down and physically sign the death certificate," he explains. It's done electronically, he says, "but it's still overwhelming when they have so many deaths in the hospital."
Mike Lanotte, the head of the New York State Funeral Directors Association, says that in New York City and surrounding suburbs, the deaths are double normal levels.
"There has definitely been a stress on the system," Lanotte says. "Our funeral directors are working at maximum capacity."
One problem, he says, is scheduling burials and cremations. Crematories in New York state have been given permission to extend their operating hours and some, he says, are operating nearly around the clock.
In the Detroit area, where there's also been a sudden rise in the number of deaths from COVID-19, Timothy Schramm directs the Howe-Peterson Funeral homes.
"In an epidemic or pandemic, there's going to be inherent delays at cemeteries or crematories because they can only handle a certain number each day," Schramm says.
A major concern for funeral home staff, as it is for health care workers, is making sure they're protected from contagion.
"We have seen funeral directors who've become ill as a result from getting the virus," Lanotte says about the situation in New York. "We also have some who are simply in quarantine because they've been in close contact with folks who have tested positive."
With the coronavirus, funeral home staff have stepped up the use of personal protective equipment (PPE).
"We have some concerns that they are running very low, if not out of those supplies," he says.
With the new safeguards, Schramm says at his funeral homes in Michigan, they're trying to conserve their supplies.
"Our team goes through a lot of PPEs on a daily basis when you look at a two-person transfer team (and) our embalmers operating in our care centers," he says.
Like hospitals and emergency managers around the country, funeral directors are scrambling to find supply chains with available masks and face shields to keep them operating.
In the New York City area, Lanotte says he believes the next six weeks will be very challenging for funeral homes, as the fatalities from COVID-19 will keep rising.
Patrick Kearns runs four family-owned funeral homes in Queens and Long Island. In the last two weeks of March, he says the numbers began to spike triple what they had been. The pandemic, he says, is tough on families who have to bury loved ones without a funeral or a visitation. It's also tough on his staff.
"It's an extremely emotionally and physically overwhelming task to be in a tractor-trailer that is just full of bodies," he says. "Even if you're a professional who's used at some level of being around death, to be surrounded by that much is really a lot."
David Cruz of member station WNYC/Gothamist contributed to this report.
There are now so few coronavirus cases in China that some days, authorities don't see any local transmission. China has gone from reporting thousands of cases a day in February to reporting one or two a day now. Over the past week, officials with China's National Health Commission reported just five new domestic cases. The total of new cases was higher, but almost all of them were imported cases in travelers who had recently returned from abroad.
China has driven coronavirus transmission down to nearly zero. (Although there's some question among international academics about China's case reporting and whether some cases are being overlooked, it's generally agreed that the nation has suppressed transmission to a very low level.) But some undetected cases are still probably floating around, and the virus can always be brought back in from abroad.
So life has not yet returned to normal. Many restrictions from the health crisis are still in place. Isolation wards are still open for patients even with mild symptoms. Quarantine centers are housing suspected patients and contacts of confirmed patients. Testing labs are still running. And monitoring systems are still on high alert for new cases.
"We are very aware that there could still be a second wave in China. That is possible," says Kylie Ainslie, a research associate at the MRC Center for Global Infectious Disease Analysis at Imperial College London.
"However, we haven't seen that occurring yet."
Ainslie and her colleagues have been looking at how China is emerging from one of the largest lockdowns in human history. They've been analyzing GPS tracking data of human movement to monitor how social restrictions are being eased or tightened in any given area.
"Areas where the outbreak was less had movement restrictions removed sooner," she says. "But that didn't mean completely. It meant first they started major factories and started letting those people who work there go back to work so that they could restart their industries."
Movement restrictions basically orders for people to stay home are still in place for some areas, and some people are still considered to be high risk.
Most factories in Wuhan, which was the epicenter of the outbreak, for instance, have not yet cranked up their production lines.
"One of the things that China is doing is while it is relaxing social distancing measures, it's not removing them entirely," Ainslie says. "And it's not removing them haphazardly."
For instance, schools in much of the country remain closed.
In several provinces where reported cases have gotten down to zero or close to zero for some period of time, case numbers have rebounded. But those upticks have primarily been driven by travelers arriving from Europe.
Ben Cowling, an epidemiologist at the University of Hong Kong, says these "imported" cases are much easier to contain and don't pose as much of a threat of wider transmission.
"There's less opportunity for infections to get into the general community from those travelers because they are being monitored so carefully," Cowling says. Anyone arriving in China must go into 14 days of quarantine where officials can keep a close eye on their health. "So if they do turn out to be infected, which is a small minority, then they're isolated. Their contacts are traced and put into quarantine. And that's going to slow down any any leakage into the general community."
Cowling says public health officials in China and elsewhere have two sets of tools to contain its outbreak social distancing and case management. Social distancing makes it harder for the virus to find new people to infect. Case management tracks down cases and potential cases individually and then isolates them and the virus. China wielded both of these tools aggressively.
"With a lot of testing capacity, they were able to bring down the numbers of infections quickly," Cowling says. "I think more quickly than we will find case numbers decline in New York or northern Italy or Spain or France. And that's because in China, the lockdown was a more extreme version of a lockdown. It was a total lockdown."
People were ordered to stay in their homes and were forbidden from traveling.
"In addition to the lockdown, there was also heavy use of testing, isolation and quarantine," Cowling says. "So all of those measures are like really, really trying very hard to get the numbers down."
China is now in a "suppression" phase of the epidemic. They've gotten transmission down to nearly zero, but some undetected cases are still probably floating around, and the virus can always be brought back in from abroad.
To make sure that another major outbreak doesn't occur, China is experimenting to see how much it can ease off the highly restrictive social distancing while keeping its testing and quarantine apparatus up and running.
"We're going to see within a month or two whether it's possible to get back to relatively normal social mixing and just be able to rely on testing, tracking, isolating, quarantine" to keep the virus at an extremely low level in China, he says.
European countries and the U.S. hope to soon address the challenge of figuring out how to relax social distancing without allowing the virus to come roaring back. But the U.S. may have a harder time doing this than China is. Cowling says one problem facing the U.S. is that there are many different outbreaks that are being managed primarily at the state level and might peak at different times.
"It's possible that New York could be coming out of lockdown, having got the numbers to a low level. But there are other cities where they're having a lot more infections, and it is going to be very difficult to have travel restrictions," Cowling says. "And the worst-case scenario is that infections are kind of bouncing around the U.S. And so, the lockdown is relaxed and then infections come back and then you have to lockdown again and nobody wants that to happen. So it really is a urgent question to figure out what's the best way to suppress transmission across the whole of the U.S."
Watching how China navigates this suppression phase may offer guidance to the U.S. and the rest of the world.
Entertainers from around the world will come together for a global televised special in support of the fight against the coronavirus pandemic, Lady Gaga said during a World Health Organization call Monday.
The singer said the special would take place April 18 and proceeds would go towardfunding protective equipment for health-care professionals.
"We are all so very grateful to all of the health-care professionals across the country and the world who are on the front lines during COVID-19," she said on the call.
The event will be hosted by Jimmy Fallon, Jimmy Kimmel and Stephen Colbert and feature characters from "Sesame Street" as well as a number of musical guests.
The slate of artists includes: Alanis Morissette, Andrea Bocelli, Billie Eilish, Billie Joe Armstrong, Burna Boy, Chris Martin, David Beckham, Eddie Vedder, Elton John, FINNEAS, Idris and Sabrina Elba, J Balvin, John Legend, Kacey Musgraves, Keith Urban, Kerry Washington, Lang Lang, Lizzo, Maluma, Paul McCartney, Priyanka Chopra Jonas, Shah Rukh Khan and Stevie Wonder.
The special will be broadcast live starting at 8 pm ET on ABC, NBC, ViacomCBS Networks and iHeartMedia, as well as on Bell Media networks and platforms in Canada.
Internationally, BBC One will run the program on April 19, with international broadcasters that include beIN Media Group, MultiChoice Group and RTE.
The virtual broadcast will be a multi-hour digital broadcast and will also stream onAlibaba, Amazon Prime Video, Apple, Facebook, Instagram, LiveXLive, Tencent, Tencent Music Entertainment Group, TIDAL, TuneIn, Twitch, Twitter, Yahoo, and YouTube.
"As we honor and support the heroic efforts of community health workers, 'One World: Together at Home' aims to serve as a source of unity and encouragement in the global fight to end COVID-19," Hugh Evans, co-founder and CEO of Global Citizen, said in a statement. "Through music, entertainment and impact, the global live-cast will celebrate those who risk their own health to safeguard everyone else's."
Gilead Sciences (NASDAQ:GILD) has made remdesivir, its Ebola-turned-COVID-19 drug, available to more than 1,700 patients through compassionate-use and expanded-access programs, according to an update from Gilead's chairman and CEO, Daniel O'Day, that was posted on the company's website on Saturday.
The number of COVID-19 patientstreated with remdesivir is likely to go higher. On Friday, EU regulators recommended expanding access to remdesivir for patients who are unable to partake in one of the nine clinical trials testing remdesivir that are ongoing or in the process of being set up.
Because remdesivir isn't approved to treat any disease -- it was never approved to treat Ebola given the lackluster clinical trial results and the waning Ebola virus outbreak -- there wasn't a warehouse full of the drug nor a manufacturing plant set up for large-scale production.
Image source: Getty Images.
Fortunately, Gilead recognized the potential for remdesivir to treat COVID-19 early and increased production at risk. O'Day noted: "Then, as now, there were many unknowns including how long the outbreak would last, at what scale, and whether remdesivir is a safe and effective treatment for COVID-19. We made the decision to invest and scale up regardless, because if remdesivir was going to be needed for patients, we had to be ready."
Through improved production times and increasing manufacturing at external partners, Gilead has been able to manufacture 1.5 million doses, which should be able to treat over 140,000 patients depending on the optimal dose, which is still being determined.
Longer term, Gilead is looking to have enough drug to treat more than 500,000 patients by October and more than 1 million treatment courses by the end of this year.
