Doctors have drawn up plans to infuse British coronavirus patients and their carers with blood plasma harvested from hyperimmune people who have recovered from the infection in an attempt to save lives.
The experimental treatment will be directed at patients who are admitted to hospital with pneumonia caused by the virus in the hope that it reduces the number who end up on ventilators in intensive care units (ICUs).
Those in close contact with Covid-19 patients, such as NHS staff and family members, are also in line to be offered the treatment in an effort to stem the spread of the illness and further reduce pressure on the health service.
The procedure relies on the fact that people who have recovered from Covid-19 have antibodies in their blood plasma that maintain a defence against the infection. The aim is to identify those who are hyperimmune to the virus and invite them to donate blood for the treatment.
So-called convalescent plasma would be given to patients and their contacts in a number of clinical trials that are under consideration with medical funding bodies.
Prof David Tappin, a senior research fellow at the University of Glasgow, has applied to the National Institute for Health Research to run two clinical trials with convalescent plasma.
Start-up will need to be faster than is normal, with most other trials usually taking months or years to get approvals and to begin, he said.
The World Health Organization is recommending that people take simple precautions to reduce exposure to and transmission of the coronavirus, for which there is no specific cure or vaccine.
The UN agencyadvisespeople to:
Many countries are now enforcing or recommending curfews or lockdowns. Check with your local authorities for up-to-date information about the situation in your area.
In the UK, NHS advice is that anyone with symptoms shouldstay at home for at least 7 days.
If you live with other people,they should stay at home for at least 14 days, to avoid spreading the infection outside the home.
The trials will look for evidence that convalescent plasma can reduce infections in carers so they can continue their work, prevent patients deteriorating to the point that they require ventilation in ICUs, and improve the condition of those who are already severely ill, to reduce deaths and free up the much-needed ventilators, he said.
Trials need to be undertaken, otherwise we will not know if this intervention is effective and worthwhile, Tappin said. It may not be a silver bullet, or it may work for instance to stem the development of Covid-19 infection in contacts such as healthcare workers and their families, but not perhaps be as effective to treat severely ill patients being ventilated.
Prof Robert Lechler, the president of the Academy of Medical Sciences and executive director of Kings Health Partners, comprising Kings College London and three major London hospitals, said the group intended to conduct parallel trials of convalescent plasma.
NHS Blood and Transplant has already begun work to identify potential donors, a spokesperson said.
Plasma from patients who have recovered from Covid-19 will contain antibodies that their immune systems have produced in fighting the virus. That plasma can be transfused to very poorly patients whose own immune systems are struggling to develop their own antibodies. The plasma transfusion is therefore intended to provide the poorly patient with antibodies from a recovered patient to help their body fight the Covid-19 virus.
Symptoms are defined by the NHS as either:
NHS advice is that anyone with symptoms shouldstay at home for at least 7 days.
If you live with other people,they should stay at home for at least 14 days, to avoid spreading the infection outside the home.
After 14 days, anyone you live with who does not have symptoms can return to their normal routine. But, if anyone in your home gets symptoms, they should stay at home for 7 days from the day their symptoms start.Even if it means they're at home for longer than 14 days.
If you live with someone who is 70 or over, has a long-term condition, is pregnant or has a weakened immune system, try to find somewhere else for them to stay for 14 days.
If you have to stay at home together, try to keep away from each other as much as possible.
After 7 days, if you no longer have a high temperature you can return to your normal routine.
If you still have a high temperature, stay at home until your temperature returns to normal.
If you still have a cough after 7 days, but your temperature is normal, you do not need to continue staying at home. A cough can last for several weeks after the infection has gone.
Staying at home means you should:
You can use your garden, if you have one. You can also leave the house to exercise but stay at least 2 metres away from other people.
If you have symptoms of coronavirus, use theNHS 111 coronavirus serviceto find out what to do.
Source:NHS Englandon 23 March 2020
The blood products will be screened to ensure they are safe to transfuse.
The UK effort has been fuelled by a grassroots collaboration in the US in which 100 laboratories have joined forces to produce convalescent plasma for patients pouring into hospitals across the country. After receiving approval from the Food and Drug Administration, doctors in the US are now able to give plasma to patients under compassionate use rules.
Prof Arturo Casadevall, an infectious disease specialist at Johns Hopkins University in Baltimore, Maryland, who is involved in the US effort, said infusions of antibodies may be more effective if they are given early on to wipe out the virus before it causes serious damage. Potentially, he said, an infusion of convalescent plasma could protect people from the virus for several weeks.
On Friday, Chinese researchers reported that convalescent plasma appeared to help Covid-19 patients on ventilation, but the study involved only five patients.
Casadevall has shared the US procedures with Tappin and Lechler to help them develop the procedure in the UK. I said, the best thing you can do is try and establish a network in the UK because ultimately all this is going to have to be done locally, he said.
If you look at history, this has a good chance of working. But it is a new virus and with a new virus you dont know until you know. The Chinese have been using it and they are reporting good results, but it needs to be tested. This is not a panacea or a miracle cure; its something to try and put in place to see if we can help stem the epidemic, he said. I think you are going to need it in the UK.
The Food and Drug Administration has approved a molecular test that can diagnose novel coronavirus infections within a matter of minutes.
The test, created by Abbott Laboratories, is highly portable and can be used in a wide variety of settings, from hospital emergency rooms to urgent care clinics to physicians offices. The company says it expects to start shipping the kit out to health care providers next week, and that it will be able to deliver 50,000 tests a day by April 1.
Abbotts coronavirus test will be run on its ID NOW platform, which is already used for rapidly diagnosing patients who are sick with things like influenza and strep throat. The test looks for fragments of the coronavirus genome in samples picked up through a throat or nose swab. It can deliver positive results in as little as five minutes, and negative results within 13 minutes. Its about the size of a toaster, and weighs less than 7 pounds.
With rapid testing on ID NOW, healthcare providers can perform molecular point-of-care testing outside the traditional four walls of a hospital in outbreak hotspots, said Abbott president and COO Robert Ford.
If distributed effectively, the test could help expand national testing capacity, better allowing public health experts to understand which populations are most at risk of infection, and helping state and federal officials better plan response strategies.
Such a test would also dramatically reduce testing backlog currently, many Americans who are able to access testing face long wait times. In fact, test results can take over a week, a delay that endangers particularly high-risk individuals. For these reasons, Eric Feigl-Ding, an epidemiologist and health economist at the Harvard T. H. Chan School of Public Health, called the new test a game changer in dealing with the outbreak. The Abbot Lab test will give fast point of care immediately, and hopefully more accurately than old test, he tweeted on Friday.
The Abbott test also has the potential to play a significant role in accelerating the speed at which health care providers make crucial decisions about identifying and isolating people infected with coronavirus.
This is really going to provide a tremendous opportunity for front-line caregivers, those having to diagnose a lot of infections, to close the gap with our testing, John Frels, vice president of research and development at Abbott Diagnostics, told Bloomberg News. A clinic will be able to turn that result around quickly, while the patient is waiting.
Currently, the wait time is much longer than the Abbott test allows for. Quest Diagnostics and LabCorp, two major private companies, say that on average they deliver results in four to five days. Many reports suggest it can take a week or more to get test results back.
That waiting time poses a particularly serious problem for high-risk patients who may need to stop treatment for other health problems to isolate. For example, a cancer patient in Ohio reported waiting over a week to get results back on a coronavirus test and his doctors were forced to pause his cancer care while waiting for those results.
Shortening wait times for tests is also a crucial tool for policymakers and public health officials quicker diagnoses should help the government and health care system have a more accurate assessment of how many cases are actually popping up in real time and assist them in understanding whether measures to prevent Covid-19s spread are working.
Testing in the US is well behind the countrys international peers. In the past week, the number of coronavirus tests conducted in the US surpassed the number of tests done in Italy and South Korea two countries that dealt with serious outbreaks and have been testing aggressively for the virus. But according to the New York Times, the US still lags behind both countries in terms of tests per capita: While South Korea has conducted about 700 tests per 100,000 people, and Italy about 600 tests per 100,000 people, the US has done fewer than 200 tests per 100,000 people.
Even with that low rate of testing, the US has more confirmed cases of coronavirus than any other country in the world, a fact some experts believe means the country has a number of unconfirmed cases that faster testing could help reveal.
According to the Times report, published Thursday, about 65,000 coronavirus tests are being performed a day in the US, but experts say that 150,000 tests are needed a day to identify and separate infected patients quickly and Abbotts test would go a long way toward helping the US reach that number.
Ansell and Michael Bryan live in Wellington, the harbor-side capital of New Zealand. For the next four weeks -- at least -- the couple won't be able to see each other in person.
"At first, we didn't really understand the rules -- we kind of thought, it will be fine, we'll be able to see each other once or twice a week," says 25-year-old Ansell, who has been with her boyfriend for five years. "And then it kind of dawned on us that that's probably not good."
Bryan invited her to stick out the lockdown in his flat, but another flatmate's girlfriend was already staying. Besides, she wanted to be at her own place -- and it was a bit small for him to stay with her.
So instead, the couple -- who met while working at a local pizza chain -- will spend the next few weeks chatting virtually, even though they live around 8 kilometers (5 miles) apart. They already text each other good morning and good night, but instead of in-person hang outs, their immediate future looks set to feature constant texting and watching Netflix shows together but apart.
"It's very tempting (to meet up), and it's frustrating because it's like, oh surely we could just meet up and hug," Ansell says. "But you can't -- that destroys the whole purpose of it."
As countries impose strict lockdown measures and travel restrictions to combat the coronavirus pandemic, couples all over the world are facing similar predicaments. While some -- like Ansell -- are choosing to stay apart, others have found coronavirus has brought them closer together.
The question of how couples should handle lockdowns is so widespread that it was even brought up at a press conference last week with Jenny Harries, the United Kingdom's deputy chief medical officer.
Together, apart
On the other side of the world in the United Kingdom, 21-year-old James Marsh and his girlfriend Kiera Leaper were due to celebrate their one-year anniversary on Monday.
Instead, the country went into lockdown.
The pair -- who study together at the University of Leeds -- had seen it coming. When it looked like the country could go into lockdown, the pair squeezed in one last hangout before Marsh retreated to his family home at the opposite end of the country from Leaper. The lockdown is set to continue for at least three weeks.
"We normally see each other every day, we stay with each other pretty much every night," Marsh said. "To go from that to this is obviously quite a big change.
"This will be the longest time we've gone without seeing each other since we've been officially together."
So far, the couple have FaceTimed every day, and spend time together with their friends on online video chat platform Houseparty. They're trying to keep busy -- Marsh with his course work, and Leaper with exercise.
But there are challenges. Marsh and many of his friends are in the final months of their three-year undergraduate degrees, and they're sad they won't get to celebrate together. "We'll just sort of go away with coronavirus being the memory of our third year," he said.
And while technology was helpful for keeping Marsh and his girlfriend connected, it wasn't the same as being in the same room, he said.
Even so, he thinks this time apart will strengthen their relationship.
"I think it's really important to be able to tackle stuff like this ... you can't always just rely on that person being there if you want to stick it out for the long haul," Marsh said.
"You might get a job that requires you to go away for work or stuff like that, and you can't have a dependency on that person in that case."
Secret love
Hemangay, a University of Delhi student, hasn't heard his boyfriend's voice for about a week.
The 19-year-old, who asked not to use his real name as he is not out to his parents, lives with his family in New Delhi, the capital of India. For the past few months, he's been dating his 22-year-old boyfriend -- in secret.
That means no one is allowed outside. Public transport is shut, so Hemangay wouldn't be able to make it to his boyfriend's house on the other side of Delhi, anyway.
And because Hemangay can't take walks, he hasn't been able to phone his boyfriend -- he's too worried that his parents would find out about their relationship if he calls him from the family home.
"I'm still a student, I'm not that independent that I can go out and survive my life on my own terms," he said. "Once I become independent, then maybe I can take that risk."
"Since I'm not out with my family, I just can't openly contact him or chat with him," he said. "It's really tough for us to communicate."
So for the next few weeks at least, one of the only ways they can communicate is messaging over WhatsApp. It's a far cry from their normal lives, when they would meet up almost every day after university. Hemangay last saw his boyfriend two weeks ago, before the measures -- and they had no idea what was to come. "That is the worst part about this, that I didn't know this would be the last time," he said.
Hemangay is dreading the next few weeks of separation, but he knows there's nothing he can do.
"I have never felt so helpless in my entire life," he said.
Love in a time of uncertainty
April was meant to be the light at the end of the tunnel for Isobel Ewing, 30, who has been in a long distance relationship with her boyfriend.
Ewing, a broadcast journalist, moved to Budapest, Hungary in mid-January. She had been looking forward to April, when she would see her boyfriend of almost two years, Sam Smoothy, for the first time in months. A professional skier, Smoothy had been in North America for a few months, and had planned to come and spend time with her in Hungary.
But coronavirus has thwarted those plans.
That meant Smoothy was forced to go back to New Zealand instead of Hungary -- and their plans were on hold.
Now, Smoothy is in New Zealand, self-isolating at Ewing's family holiday home. Ewing needs to stay in Budapest for work. She works from her Budapest apartment, and goes for runs in the hills and alongside the Danube River. They don't know when they'll be able to see each other again.
"With long distance you get used to being apart," Ewing said. "But it's so key to have that time together to look forward to. And then to just have that plucked out from under us ... I'm kind of still processing it."
Moving faster
For three years, Anika, 32, has wanted to marry her partner, but things outside their control kept getting in the way.
Finally, the New Delhi-based couple set their dates. They would register their marriage in court on March 20, hold a big dance party on April 10 with 400 people, and then have the wedding ceremony on April 12.
Then the coronavirus outbreak happened.
As the Indian government began taking more measures -- including suspending all tourist visas -- the couple grew more worried about their wedding. Anika, who asked not to use her real name for privacy reasons, started thinking of a plan B.
As the situation evolved, their wedding plans kept changing. Finally, with only days to spare, they decided they would get married on March 20, and hold a small ceremony after the court proceedings.
"That entire week was pretty traumatic," she said, adding that they ended up uninviting guests to keep numbers down to 30 or so people for social distancing purposes. "We were sending last minute messages just apologizing to people."
In the end, it was a sweet, intimate wedding, Anika says. There were nods to the crisis unfolding outside -- the couple updated their wedding hashtag to #loveinthetimeofcorona, and kept sanitizing and fumigating the space.
"Sometimes it's destiny," she said. "At that time yes, you feel stressed and disappointed. But now in retrospect, I think it was perfect."
Even though it wasn't the wedding they had dreamed of, Anika and her husband didn't want to postpone it. In India, it's not culturally acceptable for couples to live together before marrying. Now, the pair have gone straight into life together -- under lockdown.
"We had been seeing each other for a really long time, we'd been planning this wedding for a really long time," she said.
"We didn't want to postpone it again. What if something else went wrong? What if nothing changes? We wanted to start our lives together -- we didn't want to wait."
China's national liquor offered bottles of their premium product as a reward to health-care workers who traveled to Wuhan to help fight coronavirus. But there was a catch. Zhang Peng/LightRocket via Getty Images hide caption
China's national liquor offered bottles of their premium product as a reward to health-care workers who traveled to Wuhan to help fight coronavirus. But there was a catch.
Pan-fried buns with beef filling, shrimp stir-fried with seasonal bamboo shoots, roasted chicken and seared scallops such dishes are on the menu for the Shanghai medical staff who recently returned from Wuhan in Hubei province, the epicenter of China's COVID-19 outbreak. To show its gratitude for the 1,649 now-quarantined workers, the city has cooked up a free 14-day meal plan for them.
In Hangzhou city in Zhejiang province, the city's Federation of Trade Unions is saying "thank you" by handing out 2,000 yuan ($280) cash to the families of 122 medics, who will also get paid leave to recuperate after "winning the battle of epidemic prevention and control."
Meanwhile, in Guizhou province, residents are wondering: Is a reward still a reward if the heroes have to pay for it?
In the poverty-stricken province, Guizhou Liquor Exchange, a trading platform that promotes liquor trading, investment and storage, took the appreciation game in a questionable direction. It recently offered each of the 1,443 front-line medical workers back from Hubei the opportunity to buy up to six bottles of the nation's most sought-after liquor a locally produced, 106 proof Maotai liquor called Feitian at 1,499 yuan ($210) per bottle.
A bottle of Feitian could fetch from 2,000 yuan ($280) to 300,000 yuan ($42,200), depending on the year it was made and market demand.
Produced by the state-owned Kweichow Moutai Group in Guizhou, Maotai liquor is the Chinese answer to premium scotch. Known as China's national liquor, it's often served on official occasions and holiday dinner tables. In 1972, Chinese premier Zhou Enlai made a Maotai toast to then-President Richard Nixon, who was warned prior to the banquet not to drink it. (He did anyway.)
Although the Group sold 142,000 tons of liquor worth more than 100 billion yuan ($14 billion) in 2019, it's not enough for those thirsty for Maotai. Fake Maotai liquors are all over the market, retailing at similar price points. Some fans make pilgrimages to Maotai town, where each visitor is allowed to buy two bottles. On the Chinese e-commerce site Tmall, Feitian liquor is available each day, with a limit of two bottles per 180 days. It's snapped up in seconds.
While $2,106 for six might be a steal, consider the per capita disposable income of an urban resident in Guizhou: 20,397 yuan ($2,870) in 2019. That's one reason the offer has been derided as a crass publicity stunt.
"They [Guizhou Liquor Exchange] are shameless," said a commenter on Weibo, the Chinese equivalent of Twitter. "It's just a couple bottles of liquor. Can't they just give for free?"
"This is how you treat our heroes?" another opined.
"Do you think regular medical workers can afford it?" one asked.
Others think it's a good deal, especially given the resale market.
"Do you not know how expensive Maotai liquor is? Isn't this a reward?" one netizen asked.
"I think it's pretty good," another said. "They can make money by reselling these liquors."
As criticism became increasingly heated, the Guizhou government stepped in, asking Guizhou Liquor Exchange to immediately stop using the pandemic for marketing purposes.
The Exchange has not yet commented.
Where did the virus causing the current pandemic come from? How did it get to a food market in Wuhan, China, from where it is thought to have spilled over into humans? The answers to these questions are gradually being pieced together, and the story they tell makes for uncomfortable reading.
Lets start at the beginning. As of 17 March, we know that the Sars-CoV-2 virus (a member of the coronavirus family that causes the respiratory illness Covid-19) is the product of natural evolution. A study of its genetic sequence, conducted by infectious disease expert Kristian G Andersen of the Scripps Research Institute in La Jolla, California, and colleagues, rules out the possibility that it could have been manufactured in a lab or otherwise engineered. Puff go the conspiracy theories.
The next step is a little less certain, but it seems likely that the original animal reservoir for the virus was bats. Andersens team showed like the Chinese before them that the sequence of Sars-CoV-2 is similar to other coronaviruses that infect bats.
Since other bat coronaviruses have transited to humans via an intermediate animal host, it seems likely that this one did too. That animal was probably one that some Chinese people like to eat, and that is therefore sold in wet markets (those that sell fresh meat, fish, seafood and other produce). This animal may have been the scaly mammal called a pangolin. That cant be conclusively proved, but several groups have found sequence similarities between Sars-CoV-2 and other coronaviruses that infect pangolins.
If this is indeed the route the virus took to humans, it has two critical interfaces: one between us and the intermediate host, possibly a pangolin, and one between that host and bats. Most of the attention so far has been focused on the interface between humans and the intermediate host, with fingers of blame being pointed at Chinese wet markets and eating habits, but both interfaces were required for the pandemic to ignite. So where and how did the spillover from the bat to the pangolin or other wild or semi-wild intermediate host occur?
Our study does not directly shed light on the geographical origin of the virus, says Andersen. However, all the available evidence shows that it was inside China.
Case closed then, and President Trump is right to call Sars-CoV-2 the Chinese virus. Well, no, because if you want to understand why this pandemic happened now and not, say, 20 years ago since Chinese peoples taste for what we in the west consider exotic fare is not new you have to include a number of other factors. We can blame the object the virus, the cultural practice but causality extends out into the relationships between people and ecology, says evolutionary biologist Rob Wallace of the Agroecology and Rural Economics Research Corps in St Paul, Minnesota.
Starting in the 1990s, as part of its economic transformation, China ramped up its food production systems to industrial scale. One side effect of this, as anthropologists Lyle Fearnley and Christos Lynteris have documented, was that smallholding farmers were undercut and pushed out of the livestock industry. Searching for a new way to earn a living, some of them turned to farming wild species that had previously been eaten for subsistence only. Wild food was formalised as a sector, and was increasingly branded as a luxury product. But the smallholders werent only pushed out economically. As industrial farming concerns took up more and more land, these small-scale farmers were pushed out geographically too closer to uncultivable zones. Closer to the edge of the forest, that is, where bats and the viruses that infect them lurk. The density and frequency of contacts at that first interface increased, and hence, so did the risk of a spillover.
Its true, in other words, that an expanding human population pushing into previously undisturbed ecosystems has contributed to the increasing number of zoonoses human infections of animal origin in recent decades. That has been documented for Ebola and HIV, for example. But behind that shift has been another, in the way food is produced. Modern models of agribusiness are contributing to the emergence of zoonoses.
Take flu, a disease that is considered to have high pandemic potential, having caused an estimated 15 pandemics in the past 500 years. There is clearly a link between the emergence of highly pathogenic avian influenza viruses and intensified poultry production systems, says spatial epidemiologist Marius Gilbert of the Universit Libre de Bruxelles in Belgium.
The reasons, many of which were documented in Wallaces 2016 book Big Farms Make Big Flu, include the density with which chickens, turkeys or other poultry are packed into factory farms, and the fact that the birds in a given farm tend to be near genetic clones of one another having been selected over decades for desirable traits such as lean meat. If a virus gets introduced into such a flock, it can race through it without meeting any resistance in the form of genetic variants that prevent its spread. Both experimental manipulations and observations in the real world have demonstrated that this process can result in a ratcheting up of the viruss virulence. If it then spills over into humans, we are potentially in trouble.
In a paper published in 2018, Gilberts group reviewed historical conversion events, as they call them when a not-very-pathogenic avian flu strain became much more dangerous, and found that most of them had occurred in commercial poultry systems, and more frequently in wealthy countries. Europe, Australia and the US had generated more of them than China.
That doesnt let China off the hook. Two highly pathogenic forms of avian flu H5N1 and H7N9 have emerged in that country in recent decades. Both infect humans, though not easily (yet). The first human cases of H7N9 were reported in 2013, and there were small annual outbreaks thereafter. But, says Gilbert, nothing was done until the virus turned out to be pathogenic for chickens as well. Then it became an important economic issue and China started to mass-vaccinate its poultry against H7N9, and that ended the transmission to humans.
China is one of the worlds major exporters of poultry, but its poultry industry is not wholly Chinese-owned. After the recession of 2008, for example, New York-based investment bank Goldman Sachs diversified its holdings and moved into Chinese poultry farms. So if China has its share of responsibility for spillover events, it isnt alone. That is why Wallace insists on talking about relational geographies rather than absolute geographies, when it comes to identifying the causes of disease. Or as he puts it: Follow the money.
Not everybody sees a straightforward link between factory farming and new and dangerous forms of flu. Michael Worobey, an evolutionary biologist at the University of Arizona, points out that before they were brought into factory farms, poultry were kept outside. The factory model may ramp up virulence, he says, but it probably protects a flock from being infected by a virus in the first place.
Still, Worobey doesnt doubt that farming and other human-animal interactions have shaped our disease ecology. His group collects the sequences of flu viruses from a range of animal hosts, including humans, and plots them on a family treeto try to understand how flu has evolved over time. Flu is constantly mutating thats the reason the seasonal flu vaccine has to be updated each year but it mutates at different rates in different hosts, which means that his flu family tree is informative both about the parentage and intermediate host of each strain and about the approximate timing of past spillover events.
Its possible though by no means certain that flu first became a disease of humans after the Chinese domesticated ducks about 4,000 years ago drawing that animal reservoir into human communities for the first time. But humans can also catch flu from, and give flu to, pigs another animal we have lived alongside for millennia. A few years ago, Worobey suggested controversially that birds might not always have been the main intermediate host for human flu viruses. Until about a century ago, he reported, people may have caught flu from horses. Around the time that motor vehicles supplanted horses as transport, poultry farming was expanding in the western hemisphere, and its possible, Worobey argued, that birds then took over as the main intermediate host of flu for humans.
Not everyone buys that scenario. Wendy Barclay, a virologist at Imperial College London, says that if horses were once the main intermediate host for flu, most avian viruses would contain the mammalian adaptation, and they dont. David Morens of the US National Institute of Allergy and Infectious Diseases in Bethesda, Maryland, thinks that it is more likely that the horse was a temporary detour, and that the main intermediate host of flu for humans has always been birds especially wild ones. But all agree that humans have shaped these host-pathogen relationships, through our use of land and other animal species. And as Worobey points out, the sheer size of the human population today means that in the 21st century, we are doing so on an unprecedented scale. He estimates, for example, that domesticated ducks probably outnumber wild ones by now.
And were not just talking about birds. Gilbert believes a ratcheting up of viral virulence is happening in pig herds, too. Porcine reproductive and respiratory syndrome (PRRS), a disease of pigs that was first described in the US in the late 1980s, has since spread to herds across the worldand strains detected recently in China are more virulent than the early American ones. A 2015 study carried out by Martha Nelson of the US National Institutes of Health and colleagues mapped the genetic sequences of swine flu viruses and found that Europe and the US the largest global exporters of pigs are also the largest exporters of swine flu.
There have been claims on social media, sometimes posted by vegans, that if we ate less meat there would have been no Covid-19. Interestingly, some of these have been blocked by mainstream news organisations as partly false. But the claims are also partly true. Though the links they draw are too simplistic, the evidence is now strong that the way meat is produced and not just in China contributed to Covid-19.
It is clear that to prevent or at least slow the emergence of new zoonoses, as Fearnley and Lynteris have argued, Chinas wet markets will need to be better regulated. But we also need to look behind those markets, at how our food is produced globally.
Though it may not feel like it now, Wallace says, we have been lucky with Sars-CoV-2. It appears to be far less lethal that either H7N9 which kills around a third of those it infects or H5N1, which kills even more. This gives us an opportunity, he says, to question our lifestyle choices because chicken isnt cheap if it costs a million lives and vote for politicians who hold agribusiness to higher standards of ecological, social and epidemiological sustainability. Hopefully, he says, this will change our notions about agricultural production, land use and conservation.
Newborns and babies have so far seemed to be largely unaffected by the coronavirus, but three new studies suggest that the virus may reach the fetus in utero.
Even in these studies, the newborns seemed only mildly affected, if at all which is reassuring, experts said. And the studies are small and inconclusive on whether the virus does truly breach the placenta.
I dont look at this and think coronaviruses must cross across the placenta, said Dr. Carolyn Coyne of the University of Pittsburgh, who studies the placenta as a barrier to viruses. She was not involved in the new work.
Still, the studies merit concern, she said, because if the virus does get through the placental barrier, it may pose a risk to the fetus earlier in gestation, when the fetal brain is most vulnerable.
Pregnant women are often more susceptible to respiratory infections such as influenza and to having more complications for themselves and their babies as a result. Its still unclear whether pregnant women are more likely to contract the new coronavirus, said Dr. Christina Chambers, a perinatal epidemiologist at the University of California in San Diego.
We dont have any knowledge of that at all that is a complete open question at this point, she said. Its also unclear what effect the virus has on the fetus, she added.
The placenta usually blocks harmful viruses and bacteria from reaching the fetus. And it allows in helpful antibodies from the mother that can keep the fetus safe from any germs, before and after birth.
Still, a few viruses do get through to the fetus and can wreak havoc. The most recent example is Zika, which can cause microcephaly and profound neurological damage, especially if contracted in the first and second trimesters.
Neither the new coronavirus, nor its more familiar cousins, has seemed to belong to this more dangerous category. If so, we would be seeing higher levels of miscarriage and preterm delivery, Dr. Coyne said.
A study of nine infants in Wuhan, China, published in March in The Lancet, also concluded that the new coronavirus did not seem to cross from mother to fetus.
But in two of the new studies, published yesterday in JAMA, doctors found antibodies in newborns that recognize the virus, suggesting that it does get through to the fetus.
Both studies found high levels of antibodies in the infants called immunoglobulin G, which are known to be ferried from mother to fetus through the placenta. But in three infants, the studies also found evidence of another type of antibody, called immunoglobulin M, that recognize the coronavirus. These antibodies are too large to move across the placenta.
In one of the studies, researchers found high IgM levels in an infant two hours after birth. IgM levels rise over days, so the finding argues against the newborn having been exposed to the virus during delivery.
The virus could potentially cross the placental barrier, maybe thats what were seeing, Dr. Coyne said.
A major shortcoming of the new studies, she said, is that the researchers did not test the placenta, cord blood or the amniotic fluid for the virus. Throat swabs of the newborns did not test positive for genetic material from the virus.
Their evidence for possible vertical transmission was still indirect, based on only serologic data, said Dr. Wei Zhang, an epidemiologist at Northwestern University who worked on the Lancet study. As such, he said, the data from the JAMA papers do not prove vertical transmission.
A third study, published yesterday in JAMA Pediatrics, also suggested the possibility of vertical transmission. In that study, three of 33 newborns born to women infected with the coronavirus showed mild signs of illness. The doctors said they could not rule out transfer of the virus from mother to fetus as the source.
Some answers may be forthcoming from studies now underway. Dr. Chambers said she and her colleagues have begun enrolling pregnant women with suspected or confirmed cases of coronavirus infection into a study that will track them through delivery and also follow their children up to 1 year of age. They also plan to test for the virus in breast milk.
Similar projects have also begun at the University of California, San Francisco, Harvard University and at the Cedars-Sinai Hospital in Los Angeles.
Dr. Coyne said of the virus, Any damage that it would impart in utero may be difficult to know right now till we go through the full cycle of pregnancy and delivery.
He never saw his family again.
Kaminski died days later of covid-19, the disease caused by the novel coronavirus. Because of fears of contagion, no visitors, including his family, were allowed to see him at Mt. Sinai Hospital before he died.
"It seemed so surreal," said Diane Siegel, Kaminski's daughter in law. "How could someone pass so quickly and with no family present?"
Mitzi Moulds, Kaminski's companion of 30 years, was quarantined herself, having also contracted the coronavirus. She worried Kaminski would wake up and think she'd abandoned him.
"Truthfully, I think he died alone," said Bert Kaminski's, one of Steve's sons. "Even if a doctor was there."
As the coronavirus stalks victims around the world, one of its scariest aspects is how it seems to feed on our deepest fears and prey on our primal instincts, like the impulse to be close to people we love when they are suffering and near death.
In a painful irony, the very thing we need in moments of fear and anxiety could also kill us.
Many hospitals and nursing homes have closed their doors and placed covid-19 patients in isolation wards to prevent the disease from spreading. One doctor called it "the medical version of solitary confinement."
Priests are administering last rites over the telephone while families sit helplessly at home.
The isolation extends beyond coronavirus patients. Amy Tucci, president of the Hospice Foundation of America, estimates that 40% of hospice patients are in hospitals or nursing homes, many of which have placed strict restrictions on visitors. Their families, too, are worried about loved ones dying without them.
"We crave closure," said Maryland psychologist Dr. Kristin Bianchi, "so it's only natural we would want to be there in our loved one's final moments. We want to bear witness to that process and say our last goodbyes."
Something about dying alone seems to haunt us. To some it may suggest the deceased's life lacked love and worth, and that in the end they were forgotten.
But some medical experts challenge the idea that scores of people are dying unaccompanied in hospitals right now. In many instances, they said, hospital staff are standing vigil by patients' bedsides during their last moments.
It's not ideal, they say, but they're not quite the lonely deaths we may imagine.
As a lung specialist and member of the Optimum Care Committee at Massachusetts General Hospital, Dr. Emily Rubin is on the frontlines of the pandemic.
But Rubin said the situation is evolving rapidly as the virus spreads. In some cases, the hospital may connect families and covid-19 victims electronically instead of in person. Other times, nurses and other hospital staff will step in to stand vigil.
"Even if the disease is too mighty, the ethic of not abandoning people is so strong," Rubin said. "We feel like being present with people at the end of life is a huge part of what we do.
"People in a hospital are not dying alone."
Still, shepherding patients through the last stages of life can take an emotional and physical toll on doctors, nurses and other hospital staff, Rubin acknowledged.
"The devastating image of the lonely deaths of coronavirus patients in Italy hangs over us all," Lamas wrote. "Talking with one of the nurse practitioners in our hospital's new Covid-19 I.C.U. one recent night, I asked what worried her most. 'Patients dying alone,' she replied quickly."
But some hospice chaplains question notions of "lonely deaths," saying that in their experience, some people want to approach the end by themselves.
"I don't think dying alone has to always be a bad thing," said the Rev. C. Brandon Brewer, a hospice chaplain in Maryland. "What we've done is make it into something that it doesn't have to be."
When we think about dying alone, we're really talking about two separate things, psychologists say: The fear that people we love will die alone, and the fear that we ourselves will stare down death solo.
"It creates in almost everyone a sense of terror," said Bianchi, of the Center for Anxiety & Behavioral Change in Rockville, Maryland. "We want to be be able to cushion the experience from what we believe will be a painful and difficult experience. We also want to be there because we imagine ourselves in that scenario."
"People feel a sense of guilt. What could I have done better? How could I have stopped this?" she said. "Part of that is just part of the normal grief process."
This relentless pandemic, which brings deaths shockingly quickly, heightens the anxiety. Many people can't get to their loved one's bedsides to whisper last goodbyes or reconcile old grudges.
Secular and religious end-of-life rituals, too, have been stripped away. Hospice care, for example.
"Hospice is all about being able to provide an environment where people can review their life and say their goodbyes and their sorries and hold hands and kiss one another and then -- poof! -- all of that is just gone overnight," said Tucci, of the Hospice Foundation. "It's a nightmare."
At the same time, many funeral homes have cut way back on memorials, burials and other rituals used to commemorate departed friends and family.
"Even when there are people around to support us during times of mourning, it can be an extremely isolating experience," said Bianchi. "Take that, and then put someone into forced isolation, like we are now, and it can be absolutely agonizing."
It happens too often to be a coincidence, hospice chaplains say.
Family members will maintain a constant vigil, spending hours, even days, by their loved one's deathbed. And then, when they leave for a few moments to make a sandwich or take a shower, their beloved dies.
"There's no coincidence in my mind," said Brewer, the hospice chaplain in Maryland. "This is an intentional process."
Egan agreed. "Ask anyone who has worked in hospice and they will have dozens of stories like this. "I think a lot of people want to die alone."
In other words, there's a difference between dying alone and dying lonely.
"Dying alone is not necessarily dying without love. It is simply in some cases the absence of another person in the room," said Brewer. "And if that's what someone wants, that's OK. It doesn't mean they were forsaken."
In a certain sense, Egan added, we all die alone, even if we are surrounded by people we love. Often, as we die, our bodies are breaking down and our minds are elsewhere. The conscious experience of death is, by nature, solitary.
And the movie image of someone imparting profound last words upon his deathbed, encircled by his faithful family? That's a comforting fiction, hospice chaplains said.
"That is not how it happens," Egan said. "Many people are not responsive at the end. Their bodies are busy doing something else."
Before Steve Kaminski died, a nurse practioner at Mt. Sinai set up a group call so he could hear his family's voices one last time.
His face brightened, the nurse told family members, as each offered their tearful goodbyes or said, hoping against hope, that they'd see him when he left the hospital.
On a ventilator, Kaminski himself could say nothing.
When he died days later, it was a sudden and stunning ending to 86 years of vibrant life, said Bert Kaminski, Steve's son.
But Bert Kaminski said he took some solace from a dinner he shared recently with his father and his father's longtime partner. They went to a Vietnamese restaurant, drained a bottle of Merlot and then feasted on ice cream. His father was his usual bon vivant self, Bert remembers.
"People shouldn't take it for granted that there is time to connect with them later, particularly older family members," Kaminski said.
"This thing can come very suddenly. No visitors. No final words."
People in Wuhan, China, line up at a facility that tests discharged COVID-19 patients as well as individuals who had been held in isolation. Feature China/Barcroft Media via Getty Images hide caption
People in Wuhan, China, line up at a facility that tests discharged COVID-19 patients as well as individuals who had been held in isolation.
A spate of mysterious second-time infections is calling into question the accuracy of COVID-19 diagnostic tools even as China prepares to lift quarantine measures to allow residents to leave the epicenter of its outbreak next month. It's also raising concerns of a possible second wave of cases.
From March 18-22, the Chinese city of Wuhan reported no new cases of the virus through domestic transmission that is, infection passed on from one person to another. The achievement was seen as a turning point in efforts to contain the virus, which has infected more than 80,000 people in China. Wuhan was particularly hard-hit, with more than half of all confirmed cases in the country.
But some Wuhan residents who had tested positive earlier and then recovered from the disease are testing positive for the virus a second time. Based on data from several quarantine facilities in the city, which house patients for further observation after their discharge from hospitals, about 5%-10% of patients pronounced "recovered" have tested positive again.
Some of those who retested positive appear to be asymptomatic carriers those who carry the virus and are possibly infectious but do not exhibit any of the illness's associated symptoms suggesting that the outbreak in Wuhan is not close to being over.
NPR has spoken by phone or exchanged text messages with four individuals in Wuhan who are part of this group of individuals testing positive a second time in March. All four said they had been sickened with the virus and tested positive, then were released from medical care in recent weeks after their condition improved and they tested negative.
Two of them are front-line doctors who were sickened after treating patients in their Wuhan hospitals. The other two are Wuhan residents. They all requested anonymity when speaking with NPR because those who have challenged the government's handling of the outbreak have been detained.
One of the Wuhan residents who spoke to NPR exhibited severe symptoms during their first round of illness and was eventually hospitalized. The second resident displayed only mild symptoms at first and was quarantined in one of more than a dozen makeshift treatment centers erected in Wuhan during the peak of the outbreak.
But when both were tested a second time for the coronavirus on Sunday, March 22, as a precondition for seeking medical care for unrelated health issues, they tested positive for the coronavirus even though they exhibited none of the typical symptoms, such as a fever or dry cough. The time from their recovery and release to the retest ranged from a few days to a few weeks.
Could that second positive test mean a second round of infection? Virologists think it is unlikely that a COVID-19 patient could be re-infected so quickly after recovery but caution that it is too soon to know.
Under its newest COVID-19 prevention guidelines, China does not include in its overall daily count for total and for new cases those who retest positive after being released from medical care. China also does not include asymptomatic cases in case counts.
"I have no idea why the authorities choose not to count [asymptomatic] cases in the official case count. I am baffled," said one of the Wuhan doctors who had a second positive test after recovering.
These four people are now being isolated under medical observation. It is unclear whether they are infectious and why they tested positive after their earlier negative test.
It is possible they were first given a false negative test result, which can happen if the swab used to collect samples of the virus misses bits of the virus. Dr. Li Wenliang, a whistleblowing doctor who later died of the virus himself in February, tested negative for the coronavirus several times before being accurately diagnosed.
In February, Wang Chen, a director at the state-run Chinese Academy of Medical Sciences, estimated that the nucleic acid tests used in China were accurate at identifying positive cases of the coronavirus only 30%-50% of the time.
Another theory is that, because the test amplifies tiny bits of DNA, residual virus from the initial infection could have falsely resulted in that second positive reading.
"There are false positives with these types of tests," Dr. Jeffrey Shaman, a professor of environmental health sciences at Columbia University, told NPR by email. Shaman recently co-authored a modeling study showing that transmission by individuals who did not exhibit any symptoms was a driver of the Wuhan outbreak.
How real is China's recovery?
On Tuesday, Hubei province, where Wuhan is the capital, said it would relax lockdown measures that have now been in place for more than two months and begin letting residents leave cities the following day. Wuhan said it would begin lifting its quarantine measures and letting residents leave two weeks later, on April 8.
To leave Wuhan, residents must first test negative for the coronavirus, according to municipal authorities. Such screenings will identify some remaining asymptomatic virus carriers. But the high rate of false negatives that Chinese doctors have cited means many with the virus could pass undetected.
Last Thursday, Wuhan reported for the first time since the outbreak began that it had no new cases of the virus from the day before a milestone in China's virus containment efforts. The city reported a zero rise in new cases for the following four days.
Assessing asymptomatic carriers
But Caixin, an independent Chinese news outlet, reported earlier this week that Wuhan hospitals were continuing to see new cases of asymptomatic virus carriers, citing a health official who said he had seen up to a dozen such cases a day.
Responding to inquiries about how the city was counting asymptomatic cases, Wuhan's health commission said Monday that it is quarantining new asymptomatic patients in specialized wards for 14 days. Such patients would be included in new daily case counts if they develop symptoms during that time, authorities said.
"Based on available World Health Organization data, new infections are mainly transmitted by patients who have developed symptoms. Hence [asymptomatic cases] may not be the main source of transmission," the commission said.
A researcher at China's health commission told reporters Tuesday that asymptomatic carriers "would not cause the spread" of the virus. Zunyou Wu, the researcher, explained this was because the authorities were isolating people who had close contact with confirmed patients. Wu did not explain how they would identify asymptomatic carriers who had no close contact with confirmed patients.
Addressing growing public concern of asymptomatic patients, China's Premier Li Keqiang urged during Thursday's senior-level government meeting that "relevant departments must ... truthfully, timely, and openly" answer questions, such as whether these patients are infectious and how the course of the outbreak may change.
Research suggests that the spread can be caused by asymptomatic carriers. Studies of patients from Wuhan and other Chinese cities who were diagnosed early in the outbreak suggest that asymptomatic carriers of the virus can infect those they have close contact with, such as family members.
"In terms of those who retested positive, the official party line is that they have not been proven to be infectious. That is not the same as saying they are not infectious," one of the Wuhan doctors who tested positive twice told NPR. He is now isolated and under medical observation. "If they really are not infectious," the doctor said, "then there would be no need to take them back to the hospitals again."
Geoff Brumfiel contributed reporting from Washington, D.C.
STOCKHOLM When the coronavirus swept into the Scandinavian countries, Norway and Denmark scrambled to place extensive restrictions on their borders to stem the outbreak. Sweden, their neighbor, took a decidedly different path.
While Denmark and Norway closed their borders, restaurants and ski slopes and told all students to stay home this month, Sweden shut only its high schools and colleges, kept its preschools, grade schools, pubs, restaurants and borders open and put no limits on the slopes.
In fact, Sweden has stayed open for business while other nations beyond Scandinavia have attacked the outbreak with various measures ambitious in their scope and reach. Swedens approach has raised questions about whether its gambling with a disease, Covid-19, that has no cure or vaccine, or if its tactic will be seen as a savvy strategy to fight a scourge that has laid waste to millions of jobs and prompted global lockdowns unprecedented in peacetime.
By Saturday, Norway, population 5.3 million, had more than 3,770 coronavirus cases and 19 deaths; Denmark, population 5.6 million, reported 2,200 cases and 52 deaths; Sweden, with 10.12 million people, recorded more than 3,060 cases and 105 deaths.
A recent headline in the Danish newspaper Politiken, encapsulates the question ricocheting around Europe, Doesnt Sweden take the corona crisis seriously?
There is no evidence that Swedes are underplaying the enormity of the disease rampaging across the globe. The countrys leader and health officials have stressed hand washing, social distancing and protecting people over the age of 70 by limiting contact with them.
But peer into any cafe in the capital, Stockholm, and groups of two or more people can be seen casually dining and enjoying cappuccinos. Playgrounds are full of running, screaming children. Restaurants, gyms, malls and ski slopes have thinned out but are still in use.
The state epidemiologist, Anders Tegnell, said in an interview that Swedens strategy is based on science and boiled down to this: We are trying to slow the spread enough so that we can deal with the patients coming in.
Swedens approach appeals to the publics self-restraint and sense of responsibility, Mr. Tegnell said. Thats the way we work in Sweden. Our whole system for communicable disease control is based on voluntary action. The immunization system is completely voluntary and there is 98 percent coverage, he explained.
You give them the option to do what is best in their lives, he added. That works very well, according to our experience.
Swedens method flies in the face of most other nations stricter strategies. India is attempting a lockdown that affects 1.3 billion people. Germany has banned crowds of two or more people, except for families. In France, residents are asked to fill in a form stating the purpose of each errand when they leave their homes; each trip requires a new form. Britain has deployed police officers to remind residents to stay home.
Still, while Sweden may appear to be an outlier in Scandinavia and in much of the wider world, it is too soon to say whether its approach will yield the same results as other countries. And the Swedish authorities could still take stronger action as coronavirus hospitalizations rise.
In explaining Swedens current strategy, experts point to other underlying factors: The country has high levels of trust, according to the historian Lars Tragardh, and a strict law in the Constitution prohibits the government from meddling in the affairs of the administrative authorities, such as the public health agency.
Therefore, you dont need to micromanage or control behavior at a detailed level through prohibitions or threat of sanctions or fines or imprisonment, Mr. Tragardh said in a phone interview. That is how Sweden stands apart, even from Denmark and Norway.
The government has deferred to the agencys recommendations to fight the virus, which has infected more than 600,000 people and killed more than 27,000 worldwide by Saturday. If the health agency were to say that closing borders and shutting down all of society was the best way to go, the government would most likely listen.
Mr. Tragardh said Swedes level of trust was manifested in other ways: Not only do citizens have confidence in public institutions and governmental agencies and vice versa, but high social trust exists among citizens, as well.
That is evident in the countrys approach to the virus. Norway did not completely shut its 1,000-mile land border with Sweden, but most people returning from abroad must enter a two-week quarantine (Reindeer herders and daily commuters are exempt.) Finland closed the borders of its most populous region which has 1.7 million people and includes the capital, Helsinki for three weeks to fight the outbreak there.
Norway limited groups outdoors to no more than five people, and those indoors must keep a distance of more than six feet (except relatives). Denmark closed its borders, sent public workers home with pay and encouraged all other employees to work from home. It shut nightclubs, bars, restaurants, cafes and shopping centers, and banned gatherings of more than 10 people outdoors.
Sweden initially banned gatherings of 500.
Early in the outbreak, some event organizers suggested they would try to get around the crowd limit by allowing precisely 499 ticket holders into their venues. (That stopped when cases of Covid-19 were confirmed among staff members.)
Mr. Tegnell, the state epidemiologist, said that is why bans dont work: People find ways around the rules.
He also said he did not believe Sweden was a maverick and did not understand its neighbors strategy. Closing borders at this stage of the pandemic, when almost all countries have cases, to me does not really make sense, he said. This is not a disease that is going to go away in the short term or long term. We are not in the containment phase. We are in the mitigation phase.
He also said that closing schools had not been ruled out.
The Netherlands, which reported more than 9,700 cases of the virus and 639 deaths by Saturday, is taking a similar approach to Swedens. On March 16, Prime Minister Mark Rutte said his country of 17.1 million was opting for a controlled spread among groups at the least risk of getting seriously ill. He argued that it was too late to shut down the country completely.
A majority of Swedes, 52 percent, support the measures to contain the virus, according to a survey conducted by the newspaper Svenska Dagbladet and published on Tuesday. But 14 percent said that too little consideration was being given to public health in order to benefit the economy.
There is growing concern as Swedes prepare to travel to their country houses and to the ski slopes for Easter, even though the public health agency has asked citizens to reconsider such trips. (Norway announced a cabin ban to prevent residents from going to their country homes.)
Even Prime Minister Mette Fredriksen of Denmark issued a warning about its neighbor on Monday: Dont go on a ski vacation in Sweden!
Last week, a cluster of Covid-19 cases was traced to an aprs-ski party at a Swedish alpine center, Are, prompting officials to close an aerial tram and gondola and shut bars and nightclubs. Hundreds of Covid-19 cases in Scandinavia have stemmed from vacationers returning from ski trips in Italy which has the most cases in Europe and in Austria.
The public health agency denies this.
In the meantime, the infection curve in Sweden has started to rise sharply, and on Friday the government tightened the limit on crowds to no more than 50 people.
Some residents like Elisabeth Hatlem, a hotelier, are of two minds about the Swedish approach. She is grateful that she can keep her business open. But she and her partner do not like sending their six children to school amid the pandemic.
For us, a total lockdown is a disaster, she said. But I am worried Sweden will explode at some point. I feel like Im living in a huge experiment, and I was never asked if I wanted to sign up.
Christina Anderson reported from Stockholm, and Henrik Pryser Libell from Oslo. Follow Ms. Anderson on Twitter @candersonSTO and Mr. Libell @hlibell.
By the time she could get to the Bronx, he had texted to say he was on the way to the hospital. Which one? she asked. Einstein, he wrote. It was their last communication.
Just a week or so earlier, Aiyana Greens phone had died. Lee, eight years older, was concerned that he could not reach her over several hours. He went to New Jersey to bang on her door at 2 a.m. to make sure she was OK.
He was the best big brother, she said.
She rushed to the hospital, but could not get inside.
I just wanted to hold his hand. I wanted to be near him, she said, crying as she retold the story. I kept telling the doctor, if you keep saying my name to him, I promise hes going to live. Keep saying Aiyana, Aiyana, Aiyana. Please. But I know they were so overwhelmed.
She spent much of Thursday figuring out funeral and burial plans. They will be limited to 10 people.
Had Green, Duck or Edwards died any other way, at any other time, the New York basketball community would hold big funerals, big celebrations of life.
Relatives of Duck and Edwards did not respond to messages. But the Green family wanted to get a message out.
I want people to stay inside so we can get through this a lot faster and I can personally get out of this nightmare, Greens daughter, Bria Natalie, said. She cried. I want people to know my dad was loved by all, and he wanted people to love each other. And I would do anything to have him back.
