RAYMONDVILLE A 4-year-old has become the first case of coronavirus confirmed in Willacy County.
On Thursday, Mayor Gilbert Gonzales said health officials were not releasing the childs sex or home town in this sparsely populated farming area.
However, he said the childs infection was not related to travel.
The state health departments Region 11 offices is conducting an investigation to determine whether others have contracted the virus, Frank Torres, the countys emergency management coordinator, said.
The individuals family has been notified and is being treated and (officials are) following up with an investigation to determine whos been in contact with the person or persons infected, Torres said. Theyve been put under quarantine.
Torres urged residents to follow federal guidelines recommending they keep six-foot distances between themselves and others to help prevent the spread of the virus.
We have to make sure we practice social distancing to keep this from spreading, Torres said.
Fernando del Valle is a Reporter for the Valley Morning Star. He can be reached at fdelvalle@valleystar.com or (956) 430-6278.
On March 24, a headline in the Financial Times proclaimed that "Coronavirus may have infected half of UK population," suggesting that many people in the region may have already recovered from and developed some immunity to COVID-19.
But is that actually true?
The news article focused on a new study from the University of Oxford, which has not been peer reviewed or published in a scientific journal. The study authors collected available data about deaths tied to the novel coronavirus, called SARS-CoV-2, reported in both the United Kingdom and Italy, and used these numbers to model how the virus might have spread through the U.K. so far.
In one hypothetical scenario, the authors estimated that viral transmission began 38 days before the first recorded death in the U.K., which took place March 5. They found that, given this start date, 68% of the population would have been infected by March 19. This statistic made headlines in the Financial Times, and later, outlets like the Evening Standard, Daily Mail and The Sun, according to Wired U.K.
But this mathematical narrative rests on several key assumptions that are not backed by real-world data, experts told Wired.
To begin, the authors write that their overall approach "rests on the assumption that only a very small proportion of the population is at risk of hospitabitable illness." In their most extreme model, the authors estimate that just 0.1% of the population, or one in every 1,000 people, will require hospitalization.
"We can already see just by looking at Italy ... that that figure has already been exceeded," Tim Colbourn, an epidemiologist at University College Londons Institute for Global Health, told Wired U.K. In the region of Lombardy alone, more than one in 1,000 people have been hospitalized, and that number continues to grow every day, Wired U.K. reported.
Related: 10 deadly diseases that hopped across species
Several scientists posted additional critiques of the study through the Science Media Centre, an independent U.K.-based press office that works with researchers, journalists and policy makers to disseminate accurate scientific information.
"The work models one of the most important questions how far has the infection really spread in the total absence of any direct data," wrote James Wood, head of the Department of Veterinary Medicine at the University of Cambridge, who researches infection dynamics and disease control. While the paper poses an important question, the assumptions underlying the model leave the authors' conclusions "open to gross over interpretation by others," Wood said.
"As far as I can tell, the model ... assumes that all those infected, whether they are asymptomatic, mildly ill or severely ill are equally infectious to others," Paul Hunter, a professor of medicine at the University of East Anglia, wrote on the Science Media Centre site. "This is almost certainly false." Data suggest that asymptomatic and mildly symptomatic people may actually fuel the rapid spread of COVID-19.
In addition, the model assumes that the U.K. population would become "completely mixed" over time, meaning any given individual has an equal chance of running into another within the region, Hunter wrote. "We do not all have an equal random chance of meeting every other person in the U.K., infected or otherwise," he said. Without some acknowledgement of the structure of social networks within the U.K.; the relative risk of running into a mildly symptomatic or asymptomatic person; and the risk of severe infection tied to different demographics, the simplified model "should not be given much credibility," Hunter said.
In comparison, a recent study from Imperial College London included numbers from several Italian villages where every resident received a diagnostic test and might provide more realistic benchmarks for the extent of infection elsewhere, lead author Niall Ferguson told the Science and Technology Committee, according to Wired U.K. "Those data all point to the fact that we are nowhere near the [Oxford study] scenario in terms of the extent of the infection," Ferguson said.
Despite its flaws, the Oxford paper did highlight an important point, upon which all the Science Media Centre experts and those who spoke to Wired U.K. agreed:
The U.K. needs to determine how many people have already been exposed to SARS-CoV-2 to shape public health policy going forward. This feat can be accomplished with widespread serological testing (blood tests), which would reveal who has antibodies to the novel coronavirus circulating in their blood. The U.K. has ordered 3.5 million antibody tests and must now validate the kits before selling them to the public, Wired U.K. previously reported.
"As the authors say [in their paper], a proper test will come from serological surveys which will tell us how many people have been exposed," Mark Woolhouse, a professor of infectious disease epidemiology at the University of Edinburgh wrote on the Science Media Centre. If data gathered through serological testing does support the Oxford model, it would have "huge implications," Woolhouse added. For instance, the finding would suggest that many people in the U.K. now have immunity against COVID-19, which would help break the chains of viral transmission to those who are still vulnerable. This phenomenon is known as herd immunity.
"It would imply that the main reason why COVID-19 epidemics peak is the build-up of herd immunity," he wrote. "Though that would not change current policy in the UK, which is focused [on] reducing the short-term impact of the epidemic on the [National Health Service], it would change enormously our long-term expectations making a second wave significantly less likely and raising the possibility that the public health threat of COVID-19 will diminish all around the world in the coming months."
Originally published on Live Science.
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Gov. Doug Burgum said at a press conference on Thursday, March 26, that the state has 58 confirmed cases of COVID-19, up from 45 on Wednesday.
This is our biggest increase yet, he said, noting 11 people so far have been hospitalized with the illness in North Dakota.
One of the cases was a child in McIntosh County, according to the North Dakota Department of Health.
Burgum said it is assumed that the numbers of positive cases will continue to rise in the state in the coming days.
It doesnt matter whether or not theres zero positives reported in a county, the governor said. By the end of the week we will assume with the rate of spread that we will have positive cases in every county.
Burgum said one concern is not having enough medical supplies, but promised the state is working around the clock to meet the challenges.
So far, 2,261 people have been tested in North Dakota; 2,203 tests have come back negative.
Burgum did not issue an executive order on Thursday, but said there will be changes to elections and tax filings, the latter being delayed until July 15 without any fear of penalty, according to Tax Commissioner Ryan Rauschenberger.
Among the changes for elections, the state is waiving the requirement to have at least one physical polling location during a primary election in counties that use mail ballots, though he said counties have the ability to opt out.
He also said unemployment claims in the state continue to rise, with just under 14,000 insurance and benefit claims filed in nine days.
Burgum also discussed operating guidelines for child care providers during the pandemic, saying efforts are being made to protect child care providers so their businesses are not only functional now but also after the pandemic.
A male child from McIntosh County was listed among those infected, according to the health department. The child is between the ages of 0-9. On March 18, the state confirmed the virus in a Morton County girl age 10-19.
Other new cases include five from Burleigh County, three from Stark County, two from Cass County, and one each from McIntosh, McHenry and Ward counties.
The McHenry County case was a result of community spread, according to the health department. Most of the cases have so far come from Burleigh and Morton counties.
On Wednesday Minnesota Gov. Tim Walz issued an order that residents shelter in place beginning at 11:59 p.m. Friday, March 27.
For now, there is no shelter-in-place order for North Dakota residents.
Earlier in the day, Lt. Gov. Brent Sanford said there were no plans to immediately issue a shelter-in-place order for North Dakota residents, though that may change as the situation around the coronavirus evolves.
Sanford made the remarks to address concerns of North Dakotans located in the eastern part of the state -- where many work in Minnesota, and are wondering what will happen to them should the order be given. He made the remarks via teleconference call to a gathering of nearly 1,000 members of the Greater North Dakota Chamber of Commerce.
I can tell you that's not the direction that we're headed today, Sanford said. We feel that the restrictions on moving around and the restrictions in the public spaces that have happened, to date, are where we want to be today, so hopefully that answers that question.
Sanford said North Dakota residents and businesses are self-regulating the situation by practicing social distancing and correct flu etiquettes.
These are things that we're doing as North Dakotans and we feel that really is limiting the community spread, Sanford said. We're doing a good job with that, and we want to continue forward with that direction.
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Some of them, previously recognized as CNN Heroes for their work to fix problems in their communities, now find themselves helping stem the tide of the virus.
"Covid-19, aka coronavirus, aka 'Rona' -- what we call it in my neighborhood -- it's pretty scary," Gore told CNN. "I'm not going to lie. It's scary times."
New York City is now considered the epicenter of the outbreak in the United States, with about 60% of the new cases in the country. Gov. Andrew Cuomo says the state is experiencing an "astronomical surge" in cases, which are now doubling every three days.
"I've worked in disaster zones in the past," Gore said, noting his relief work in post-earthquake Haiti, South America and East Africa. "This feels like it's a culmination of all of them."
For Gore, this crisis isn't a typical natural disaster, like Haiti's 2010 earthquake, but he said he sees similarities in terms of lack of resources, access to care, and fear. Shortages of equipment such as ventilators, gloves and masks have been widely reported in New York City.
Tents are set up outside Gore's hospital to assess and contain Covid-19 cases. And Gore is now living at an Airbnb to avoid infecting his family. For how long? He's not sure.
"Right now with coronavirus, we don't know how many patients are going to keep coming in," he said. "We don't know when it's going to end."
But the pandemic has given his work an even greater sense of urgency.
"People that we have out here on the streets ... may be at higher risk in some ways for the Covid infection that's coming," said Withers, who spoke with CNN from the field, where he was helping screen people for the virus. "It's very important ... to not forget members of our community that may not be able to make it to standard testing areas."
Withers' group has been designated by the city's mayor to lead virus management for the homeless. His team is giving out soap and jugs of water, and educating people about how they can protect themselves. They also have masks, tents and sleeping bags available for those who need to isolate but don't want to go to the hospital.
In addition to helping contain the spread of the virus, Withers said he believes his work might help in the larger fight against Covid-19, increasing knowledge of how it's spreading and who may be at the greatest risk.
His mission is now one of the most vital ways to keep the virus from spreading.
"All of a sudden we have woken up to a new reality ... where everyone is talking about handwashing with soap," said Lakhani, a 2017 CNN Hero. "And it is our job to meet that demand and provide as much soap to people around the world as humanly possible, especially right now."
During the past two and a half months, his group has provided 375,000 bars of soap to people in 10 countries, ranging from rural communities in south Asia to people in slum communities in East and South Africa. His team has also started making surgical masks out of recycled hotel linens. But soap -- and hygiene education -- remain his primary focus.
"We are on track, should this virus still persist, to reach 2.5 million people by the end of this year with the soap that they need to keep themselves healthy," Lakhani said.
While they're consumed with battling the virus in their own ways, all of these CNN Heroes see reasons to be positive.
Gore recommends using this time of social distancing for self-reflection, and as an opportunity to find ways to help others.
"Think about who you are and what kind of problems you want to fix," Gore said. "Contemplate these issues that you may have had in the back of your mind that you've always wanted to tackle. ... Try to make the best of these times."
Lakhani said he believes this crisis will ultimately show humanity at its best.
"We can adapt to almost any crisis that we face, and that is something that we should be proud of," he said. "All of a sudden, I feel a sense of closeness to people. ... It is as if the color of our skin and boundaries have just dissipated and dissolved in front of our eyes."
Withers said he, too, feels the lessons we're learning now can help us build a better future.
"We're all in this together. These are our brothers and sisters out here," he said. "Hopefully, the lessons that we learn here of being together and taking care of each other will last far beyond this Covid epidemic."
Dyson the British technology company best known for its high-powered vacuum cleaners, hair dryers, and fans has designed a new ventilator, the CoVent, in the past several days, which it will be producing in order to help treat coronavirus patients, via CNN.
The company reportedly developed the ventilator in 10 days based on Dysons existing digital motor technology. Dyson is still seeking regulatory approval in the UK for the rapidly designed device, but its already received an order from the UK Government for 10,000 ventilators, of which the National Health Service (NHS) is in dire need.
The CoVent is a bed-mounted and portable ventilator, with the option to run on battery power should the need arise. This new device can be manufactured quickly, efficiently and at volume, company founder James Dyson noted in a letter to the company obtained by Fast Company, adding that the CoVent was designed to address the specific clinical needs of Covid-19 patients. Dyson also pledged in the letter to donate an additional 5,000 ventilators to the international effort, 1,000 of which will go to the United Kingdom.
The race is now on to get it into production, Dyson noted in his letter, with a company spokesperson telling CNN that the ventilators would be ready in early April.
Ventilators which provide assisted breathing for patients who are unable to breath themselves are critical for the treatment of severe cases of COVID-19, which causes respiratory symptoms in some patients. Dyson isnt the only major company thats pivoted to ventilator design and production in recent days carmarkers like Ford, Tesla, and General Motors have also pledged to repurpose their plants toward developing the critical treatment devices as shortages around the world continue to grow.
Garbage contaminated with bodily fluids or other infectious materials is becoming a bigger concern for hospitals as they brace for a surge in patients sick with COVID-19 in the US. Patients and health care workers are quickly going through medical supplies and disposable personal protective equipment, like masks. Eventually all that used gear piles up as medical waste that needs to be safely discarded.
In Wuhan, where the novel coronavirus first emerged, officials didnt just need to build new hospitals for the influx of patients; they had to construct a new medical waste plant and deploy 46 mobile waste treatment facilities too. Hospitals there generated six times as much medical waste at the peak of the outbreak as they did before the crisis began. The daily output of medical waste reached 240 metric tons, about the weight of an adult blue whale.
Theres already been an uptick of garbage from personal protective equipment in the US, according to medical waste company Stericycle, which handled 1.8 billion pounds of medical waste globally in 2018. And some things that arent usually considered medical waste, like food, now need to be handled more carefully after coming in contact with a COVID-19 patient. Stericycle didnt provide numbers for how much of an increase its seeing so far, adding that it believes it has the capacity to handle the swell and may add shifts to the companys 50 treatment centers in the US if necessary. Additionally, the drop in elective surgeries might offset some of the rise in waste were seeing from the pandemic, a spokesperson for Stericycle tells The Verge.
Its a rapidly changing environment right now and forecasting volumes is challenging, Stericycle Vice President of Corporate Communications Jennifer Koenig wrote in an email to The Verge. We are closely monitoring the situation with all relevant agencies to determine next steps.
The CDC says that medical waste from COVID-19 can be treated the same way as regular medical waste. Regulations on how to treat that waste vary by location and can be governed by state health and environmental departments, as well as by the Occupational Safety and Health Administration and the Department of Transportation. Generally, to make sure contaminated trash from health care facilities doesnt pose any harm to the public before going to a landfill, its typically burned, sterilized with steam, or chemically disinfected.
Theres more to worry about than waste from medical centers. The disease is spread out beyond hospitals. Some people who have minor symptoms are recovering at home. Others who are asymptomatic might not know that the trash theyre throwing out could be contaminated. That means people may be generating plenty of virus-laden trash. Thats worrying for sanitation workers, as the virus can persist for up to a day on cardboard and for longer on metal and plastic, according to one study of the virus in lab conditions.
But if garbage is properly bagged instead of kept loose and workers are wearing personal protective equipment, especially gloves, then there shouldnt be a risk of catching the virus, David Biderman, CEO of the Solid Waste Association of North America, tells The Verge. Practicing social distancing while on the job, including maintaining appropriate distances from people, may also help reduce sanitation workers risks, says Elise Paeffgen, a partner with the firm Alston & Bird who works on medical waste issues.
People handling health care waste in particular should wear appropriate gear, including boots, aprons, long-sleeved gowns, thick gloves, masks, and goggles or face shields, according to recommendations from the World Health Organization. Luckily, protective efforts so far seem to have paid off. There is no evidence that direct, unprotected human contact during the handling of health care waste has resulted in the transmission of the COVID-19 virus, according to a March 19th technical brief from the WHO. As the pandemic grows, so will the waste, and keeping that garbage safe and contained will continue to be a challenge for communities until the crisis is over.
Self-testing at home to find out whether somebody has had Covid-19 is an efficient way to find out if they are safe to return to work, a senior health official has said.
Prof Yvonne Doyle, the medical director of Public Health England, told the health select committee that finger-prick home tests would be available very soon. We expect that to come within a couple of weeks, but I wouldnt want to promise on that, she said.
It was critical to understand what is going on and allow people to return to work she said. Self-testing was not new and was well understood by the public, with routine tests available such as the pregnancy test. The intention is to allow people to do as much of this as they validly can. It is by far the most efficient way, if the technology will support it, she said.
On Wednesday Prof Sharon Peacock, from Public Health England, told MPs on the science and technology committee that a home test to detect antibodies indicating somebody has had Covid-19 was being evaluated this week in Oxford to make sure it worked as well as is claimed and would be available next week. Government advisers later cautioned that the test might not be ready so quickly.
But the health secretary, Matt Hancock, has said the government has bought 3.5m antibody tests and will buy more.
Governments around the world are all seeking better and faster tests to show whether people have the disease or have had had it and recovered.
Singapore developed an antibody test as early as February. The US Covid-19 co-ordinator, Dr Deborah Birx, has said the US government is interested in it, and private US companies are also developing antibody tests. They include California-based Biomerica, which is selling to Europe and the Middle East, and New York-based Chembio Diagnostics, which is selling to Brazil.
Some are developed now. We are looking at the ones in Singapore, Birx said on Monday at a White House press briefing. We are very quality-oriented. We dont want false positives.
UK firms and academics have also developed self-test kits for Covid-19 that are expected to be available to buy in the coming weeks or months.
One cheap test is made by Mologic, a diagnostic test firm based in Bedford. Another kit has been developed by researchers at three UK universities led by Brunel University.
Mologic has produced the first prototypes of an antibody test for Covid-19, building on its experience of developing a rapid test kit for Ebola. Assessment and validation of the test began this week at the Liverpool School of Tropical Medicine and St Georges, University of London.
The company said it would take three to four months before the test is available in the UK and other countries. It will cost 1 in the UK and will be as simple to use as a home pregnancy test but will use saliva or blood rather than urine, with results ready in 10 minutes.
Mologic, which received 1m from the UK government to develop the test, will be able to make 8m kits a year at facilities in the UK and Senegal. In Senegal it will be sold for less than $1.
These tests could be a game-changer for diagnosis and follow-up of patients both in hospital and in the community, allowing us to detect cases early and isolate patients and their families rapidly, said Dr Emily Adams, a senior lecturer in diagnostics for infectious disease at the Liverpool School of Tropical Medicine.
The test kit developed by researchers at Brunel University London, Lancaster University and the University of Surrey is based on science evaluated in the Philippines to check chickens for viral infections.
The battery-operated handheld device processes nasal or throat swabs that are inserted into it, and delivers the results within 30 to 45 minutes via a smartphone app. The team has approached UK, US and European regulators for approval and is in talks with 60 manufacturers. It could be available to the public within a few weeks.
The device will be priced at 100 and can test six people at once. The test can detect the virus in individuals who show no symptoms because it recognises the DNA structure of the virus in the samples.
U.S. hospitals, public health authorities, and digital health companies have quickly deployed online symptom checkers to screen patients for signs of Covid-19. The idea is simple: By using a chatbot powered by artificial intelligence, they can keep anxious patients from inundating emergency rooms and deliver sound health advice from afar.
Or at least that was the pitch.
Late last week, a colleague and I drilled more than a half-dozen chatbots on a common set of symptoms fever, sore throat, runny nose to assess how they worked and the consistency and clarity of their advice. What I got back was a conflicting, sometimes confusing, patchwork of information about the level of risk posed by these symptoms and what I should do about them.
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A chatbot posted on the website of the Centers for Disease Control and Prevention determined that I had one or more symptom(s) that may be related to COVID-19 and advised me to contact a health care provider within 24 hours and start home isolation immediately.
But a symptom checker from Buoy Health, which says it is based on current CDC guidelines, found that my risk of a serious Novel Coronavirus (COVID-19) infection is low right now and told me to keep monitoring my symptoms and check back if anything changes. Others concluded I was at medium risk or might have the infection.
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Most people will probably consult just one of these bots, not eight different versions as I did. But experts on epidemiology and the use of artificial intelligence in medicine said the wide variability in their responses undermines the value of automated symptom checkers to advise people at a time when above all else they are looking for reliable information and clear guidance.
These tools generally make me sort of nervous because its very hard to validate how accurate they are, said Andrew Beam, an artificial intelligence researcher in the department of epidemiology at the Harvard TH Chan School of Public Health. If you dont really know how good the tool is, its hard to understand if youre actually helping or hurting from a public health perspective.
The rush to deploy these chatbots underscores a broader tension in the coronavirus outbreak between the desire of technology companies and digital health startups to pitch new software solutions in the face of a fast-moving and unprecedented crisis, and the solemn duty of medical professionals to ensure that these interventions truly benefit patients and dont cause harm or spread misinformation. A 2015 study published by researchers at Harvard and several Boston hospitals found that symptom checkers for a range of conditions often reach errant conclusions when used for triage and diagnosis.
Told of STATs findings, Buoys chief executive, Andrew Le, said he would synchronize the companys symptom checker with the CDCs. Now that they have a tool, we are going to use it and adopt the same kind of screening protocols that they suggest and put it on ours, he said. This is probably just a discrepancy in time, because weve been attending all of their calls and trying to stay as close to their guidelines as possible.
The CDC did not respond to a request for comment.
Before I continue, I should note that neither I nor my colleague is feeling ill. We devised a simple test to assess the chatbots and limited the experiment to the web- and smartphone-based tools themselves so as not to waste the time of front-line clinicians. We chose a set of symptoms that were general enough to be any number of things, from a common cold, to the flu, to yes, coronavirus. The CDC says the early symptoms of Covid-19 are fever, cough, and shortness of breath.
The differences in the advice we received are understandable to an extent, given that these chatbots are designed for slightly different purposes some are meant to determine the risk of coronavirus infection, and others seek to triage patients or assess whether they should be tested. They also collect and analyze different pieces of information. Buoys bot asked me more than 30 questions, while Cleveland Clinics and bots created by several other providers posed fewer than 10.
But the widely varying recommendations highlighted the difficulty of distinguishing coronavirus from more common illnesses, and delivering consistent advice to patients.
The Cleveland Clinics tool determined that I was at medium risk and should either take an online questionnaire, set up a virtual visit, or call my primary care physician. Amy Merino, a physician and the clinics chief medical information officer, said the tool is designed to package the CDCs guidelines in an interactive experience. We do think that as we learn more, we can optimize these tools to enable patients to provide additional personal details to personalize the results, she said.
Meanwhile, another tool created by Verily, Alphabets life sciences arm, to help determine who in certain northern California counties should be tested for Covid-19, concluded that my San Francisco-based colleague, who typed in the same set of symptoms, was not eligible for testing.
But in the next sentence, the chatbot said: Please note that this is not a recommendation of whether you should be tested. In other words, a non-recommendation recommendation.
A spokeswoman for Verily wrote in an email that the language the company uses is meant to reinforce that the screening tool is complementary to testing happening in a clinical care situation. She wrote that more than 12,000 people have completed the online screening exam, which is based on criteria provided by the California Department of Public Health.
The challenge facing creators of chatbots is magnified when it comes to products that are built on limited data and guidelines that are changing by the minute, including which symptoms characterize infection and how patients should be treated. A non-peer-reviewed study published online Friday by researchers at Stanford University found that using symptoms alone to distinguish between respiratory infections was only marginally effective.
A week ago, if you had a chatbot that was saying, Here are the current recommendations, it would be unrecognizable from where we are today, because things have just moved so rapidly, said Karandeep Singh, a physician and professor at the University of Michigan who researches artificial intelligence and digital health tools. Everyone is rethinking things right now and theres a lot of uncertainty.
To keep up, chatbot developers will have to constantly update their products, which rely on branching logic or statistical inference to deliver information based on knowledge that is encoded into them. That means keeping up to date on new data that are being published every day on the number of Covid-19 cases in different parts of the world, who should be tested based on available resources, and the severity of illness it is causing in different types of people.
Differences I found in the information being collected by the chatbots seemed to reflect the challenges of keeping current. All asked if I had traveled to China or Iran, but thats where commonality ended. The Cleveland Clinic asked whether I had visited a single country in Europe Italy, which has the second most confirmed Covid-19 cases in the world while Buoy asked whether I had visited any European country. Providence St. Joseph Health, a hospital network based in Washington state, broke out a list of several countries in Europe, including Italy, Spain, France, and Germany.
After STAT inquired about limiting its chatbots focus to Italy, Cleveland Clinic updated its tool to include the United Kingdom, Ireland, and the 26 European countries included in the Schengen area.
The differences also included the symptoms they asked about and the granularity of information they were capable of collecting and analyzing. Buoys bot, which suggested I had a common cold, was able to collect detailed information, such as specific temperature ranges associated with my fever and whether my sore throat was moderate or severe.
But Providence St. Joseph asked only whether I had experienced any one of several symptoms, including fever, sore throat, runny nose, cough, or body aches. I checked yes to that question, and no to queries about whether I had traveled to an affected country or come in contact with someone with a lab-confirmed case of Covid-19. The bot (built, like the CDC one, with tools from Microsoft) offered the following conclusion: You might be infected with the coronavirus. Please do one of the following call your primary care physician to schedule an evaluation or call 911 for a life threatening emergency.
All of the chatbots I consulted included some form of disclaimer urging users to contact their doctors or otherwise consult with medical professionals when making decisions about their care. But the fact that most offered a menu of fairly obvious options about what I should do seemed to undercut the value of the exercise.
Beam, the professor at Harvard, said putting out inaccurate or confusing information in the middle of a public health crisis can result in severe consequences.
If youre too sensitive, and youre sending everyone to the emergency room, youre going to overwhelm the health system, he said. Likewise, if youre not sensitive enough, you could be telling people who are ill that they dont need emergency medical care. Its certainly no replacement for picking up the phone and calling your primary care physician.
If anyone would be enthusiastic about the possibilities of deploying artificial intelligence in epidemiology, Beam would be the guy. His research is focused on applying AI in ways that help improve the understanding of infectious diseases and the threat they pose. And even though he said the effort to deploy automated screening tools is well intentioned and that digital health companies can help stretch resources in the face of Covid-19 he cautioned providers to be careful not to get ahead of the technologys capabilities.
My sense is that we should err to the centralized expertise of public health experts instead of giving people 1,000 different messages they dont know what to do with, he said. I want to take this kind of technology and integrate it with traditional epidemiology and public health techniques.
In the long run Im very bullish on these two worlds becoming integrated with one another, he added. But were not there yet.
Erin Brodwin contributed reporting.
This is part of a yearlong series of articles exploring the use of artificial intelligence in health care that is partly funded by a grant from theCommonwealth Fund.
The failures of the United States initial response to the Covid-19 pandemic are already well established: We were too slow to recognize the threat of the disease and too slow to get diagnostic testing in place, and were ill prepared for the strain on our health care system.
But now, largely, were doing something right: social distancing.
The outright lockdowns of movement in some cities, as well as the less severe policies in place across the country, can slow the spread of the pandemic. And per at least one poll, people are, by and large, complying.
Frustratingly, though, we must be patient in our isolation. The impacts of social distancing lag in case-count data and may take a few weeks to show up. Right now, there are infections out there, in the public, that were seeded long before these orders came into effect. It can take 10 days or more between when a person is infected and when they show symptoms during which they can spread the virus to others.
The social distancing measures in place also arent airtight, so these infections will still seed some others. And just the cases that are already out there are expected to overrun hospitals.
Its important to recognize it could be months until it's safe to lift social distancing restrictions. And the timeline might vary depending on where you live and when the virus strikes the hardest.
We need social distancing because it slows the spread of the disease to manageable levels. When that happens, we can move to a more sustainable mitigation strategy. But well need to be careful. Just look at Hong Kong: After a month of strong control measures, including social distancing, cases are on the rise again, perhaps fueled by residents returning from abroad.
Know this: Ceaseless social distancing is not the only way to end this outbreak. And President Trump paints a false choice between saving lives and saving the economy. We can find a balance. Its just that the current orders of social distancing would need to be replaced by a comprehensive, extremely ambitious plan.
Epidemiologists have been telling me about what it would take to end social distancing safely while fighting the spread of Covid-19. It isnt easy. It will require an immense amount of leadership, coordination, and more sacrifice. It would take a sort of moonshot-level effort. But the tactics they outline arent unfamiliar. Theyre textbook epidemiology they just need to be scaled up to a level never really seen before.
We really do need a Manhattan Project effort to get this stuff in place in really a two- or three-month period, Jeremy Konyndyk, a senior policy fellow at the Center for Global Development, says.
We need social distancing across the country, and we need to keep it in place for some weeks, if not months, to buy time. If social distancing works, is enacted broadly, and is kept up, the number of new infections could decrease. It would give us a pause in the action, to potentially move on from social distancing to a more targeted pandemic strategy. Right now is the time to get plans ready so when that pause comes, we can make things right.
Its understandable that some maybe most people want life to go back to normal already. Trump is anxious too, saying he hopes to reopen the country by Easter, April 12.
But that could be dangerously too soon. Its a nightmare scenario for epidemiologists and health care workers, says Tara Smith, who studies emerging infectious diseases at Kent State University. Imagine the mixing of populations that would happen at Easter if given the all clear people who may be carrying the virus without knowing it, hugging their loved ones, spending hours in close contact, and then everyone going back home afterward.
As when a doctor asks you to consult them before ending a medication, we cannot end social distancing abruptly and without expert advice. (Think about when youre on a course of antibiotic medication you have to complete the whole regimen of pills even when you start feeling better. Social distancing is a little like that.)
And like vaccines, the distancing isnt just for you (although data shows that all age groups and people without preexisting risk factors can fall critically ill from the disease). It crucially protects vulnerable people from the disease. Without it, they become vulnerable again.
If we all just went right back to how things were before, transmission would start again with the same intensity, says Caitlin Rivers, a professor at Johns Hopkins Center for Health Security. Its hard to experience so many restrictions, and so many hardships, and not feel like its not working. We need to recognize that we are doing the right things. You just have to be a little bit patient.
Its worth remembering why were in this situation. The facts remain that we wasted a lot of time in terms of ramping up testing, Saad Omer, director of the Yale Institute for Global Health, says. Testing in an outbreak provides two functions. One is to diagnose those who are sick. The other is surveillance: to see where the virus may be lurking, especially in cases where symptoms are mild or dont manifest at all. The US has barely had enough testing capacity to test the sickest, let alone the capacity to do surveillance. Many doctors are telling patients with milder symptoms to just stay home and not get a test.
Social distancing is basically a sledgehammer, Konyndyk, who has worked on past outbreaks, like Ebola, says. Youre just stopping everything and hoping that in the process you will also slow transmission. What we need to do, he says, is turn that sledgehammer of social distancing into a scalpel: widespread testing and contact tracing.
The classic epidemiological approach to controlling disease is not to shut down society; its to target the people you know to have the disease and understand who theyre spreading it to, Konyndyk says. We cant do that right now because we dont have enough testing to know who has the disease.
Not only do we need more testing, we also need testing that can be completed within minutes. I would just be so happy if we had rapid diagnostics, Saskia Popescu, a hospital epidemiologist in Phoenix, Arizona, says. If youve ever been to an urgent care, when they do a flu test, in many cases it takes, like, 10 minutes. So if we can move to more of a rapid diagnostic where its a very, very quick turnaround, then we can make sure that those people go home and isolate themselves. Currently, it can take days to get a diagnostic test back, and people may not be sure of what to do while they wait.
These rapid tests are in the works. But were going to need other kinds of testing, too. Were also going to need serology testing of peoples blood. That way, we can figure out who has already had the disease and is now immune and can safely return to be in contact with others in society. (Though scientists still need to do more work in determining what immunity looks like in any given person.)
The first piece of the moonshot is what were doing now, and will hopefully sustain, which is mass social distancing to do the sledgehammer to bring down the numbers, Konyndyk says. Once you bring down the numbers back to a manageable level, he says, we need to go back to some textbook epidemiology.
Once theres widespread testing, there needs to be a huge team of public health workers in place to trace the contacts of those who test positive. Everyone who tests positive or who has come into contact with someone who tests positive then needs to be put into quarantine or isolation, to not spread the virus any further. This is how authorities routinely beat outbreaks even of incredibly infectious diseases like measles.
In South Korea, this work was aided by technology. Authorities used GPS data from peoples cellphones to figure out whom they may have been in contact with. The GPS data may prove more reliable than their memory. We need to take a good look at what South Korea has done, and what people here are willing to accept as far as some of those intrusions of public health into their normal lives, their privacy, Smith says. Also helpful would be a forecasting function for the ebb and flow of the disease at the community level, Konyndyk says. The country already has tools to forecast flu outbreaks. We could adapt them for Covid-19. With such a forecasting tool, we could see an upsurge in cases, and then dial the social distancing back up, he says.
Even aided by technology, this work would require an enormous number of workers. Its very labor-intensive to find contacts of people who are sick, Rivers says. A part of this part of what we do with contact tracing is to check on them every day to see if they have become sick. Keeping some measures of social distancing in place might make this work easier, too: If people have fewer places to go, fewer crowds to assemble in, there will be fewer contacts to track.
Konyndyk suggests this effort would take tens of thousands of people, maybe more.
So these are the questions our leaders need to be asking now: Who will do this work? Will it be the National Guard? Could we employ and train laid-off workers from the concurrent economic crisis to provide support? I think theres lots of options, but starting with the vision and the strategy is kind of where we should begin, Rivers says.
And right now these experts dont see that vision coming from the federal government. By and large, the response to this outbreak is in the hands of state and local leaders. But you want the federal government laying out, Heres the strategy, heres the path, and getting the ball rolling, Konyndyk says.
And even in this aggressive test-and-trace scenario, there could be many disruptions to our lives. It could mean a lot of people still under quarantine orders. Some level of general social distancing might also still need to be put in place. Perhaps, for example, schools could reopen but adults would still be encouraged to telework, and sporting events and other mass gatherings would be canceled. Its not the case that everything could go back to normal. Its the case that we could let some things go back to normal. Social distancing is a treatment wed need to gently taper off. (Wed also need to be vigilant about the possibility we still could import new cases from abroad.)
Researchers at the Imperial College of London suggested another way to taper off in a paper last week: pulsing. That is, we can relax social distancing policies when hospitals seem to be managing cases, and ramp them up when ICU beds are in short supply. But this isnt ideal. How would life look like if went on, and then we went off, and then on, and off, I think it would be hard to envision how life would unfold under that scenario, Rivers says. This likely wouldnt end the pandemic, but it would spread its pain over a longer period.
In any case, well probably have to take a step-wise approach off social distancing and see how we can best balance it with returning to some small slice of normal life. In time, well learn how to achieve that balance. For now and because there are just so many things about this virus that are still not known we need to stay put.
The ultimate goal in stopping a pandemic is a safe and effective vaccine that can prevent people from getting the virus. The good news is that these are already being tested. The bad news is that it could take a year or more to prove they are safe and effective. Honestly, I think the vaccine in 12 to 18 months is a moonshot, Smith says.
In the meantime, we might be able to find a treatment sooner. The World Health Organization is currently facilitating a multinational clinical trial, testing medicines and combinations of medicines to treat Covid-19. If scientists do discover drugs that decrease the ICU time by 20 to 30 percent, that would add up, Omer says, and ease the strain on hospitals. But even those drugs wouldnt necessarily stop the outbreak.
It would be really great, I think, for saving lives, Rivers says. But you wouldnt really expect it to slow transmission at all. People could still be getting sick and spreading the virus. And we would need to be vigilant, and patient, in this scenario, too. Even if we reduce the risk of severe disease and death, if we increase the number of cases, more people can still get sick and die.
The scientists I spoke to for this piece all understand the extreme weight and burden of social distancing. The economic concerns have real impact on health, Omer says. Its not that were being cavalier about this stuff. The economic ramifications of the pandemic are only adding to existing mental health strain. The scientists want it to end too.
But a balance is needed. I dont want to turn the economy back on in a way that just nukes our hospital system, and thats what we would do right now if we abruptly ended social distancing, Konyndyk says.
So whatever time we buy with social distancing we need to use wisely. We need to ramp up production of critical hospital supplies; we need to establish supply chains for the massive testing regime that will be needed. We need to train more people to help. And we can do this. Amazon was born in this country, UPS was created in this country, and we are teaching supply chain logistics in every management school, and we cant have a stable supply chain of personal protective equipment? Omer says. Clearly, we can and need to do better.
But all this requires leadership. President Trump is not using the full power of his office to make sure companies produce the needed supplies. If anything, he frequently uses his office to downplay the harms of the virus and hawk unproven cures.
Right now, we still have a chance to reduce the amount of harm this virus could cause. How? Lets figure out testing, lets get enough PPE [personal protective equipment] for first responders, Smith says. Lets get enough swabs. Lets buy more ventilators, build more ventilators to have this second chance at not messing things up.
We need to do this as a nation. While the pandemic is now hitting the New York region the hardest, it will in time likely hit other cities hard as well.
The greatest power we have right now is patience. Its not easy to muster in the face of such sacrifice. And at times, it can feel ineffective. But where you find it, drink it in. Currently, its likely our best chance at a cure.
Scientists warned that the United States someday would become the country hardest hit by the coronavirus pandemic. That moment arrived on Thursday.
In the United States, at least 81,321 people are known to have been infected with the coronavirus, including more than 1,000 deaths more cases than China, Italy or any other country has seen, according to data gathered by The New York Times.
The Times is engaged in a comprehensive effort to track the details of every confirmed case in the United States, collecting information from federal, state and local officials.
With 330 million residents, the United States is the worlds third most populous nation, meaning it provides a vast pool of people who can potentially get Covid-19, the disease caused by the virus.
And it is a sprawling, cacophonous democracy, where states set their own policies and President Trump has sent mixed messages about the scale of the danger and how to fight it, ensuring there was no coherent, unified response to a grave public health threat.
A series of missteps and lost opportunities dogged the nations response.
Among them: a failure to take the pandemic seriously even as it engulfed China, a deeply flawed effort to provide broad testing for the virus that left the country blind to the extent of the crisis, and a dire shortage of masks and protective gear to protect doctors and nurses on the front lines, as well as ventilators to keep the critically ill alive.
This could have been stopped by implementing testing and surveillance much earlier for example, when the first imported cases were identified, said Angela Rasmussen, a virologist at Columbia University in New York.
If these are the cases weve confirmed, how many cases are we still missing? she added.
Chinas leaders, stung by the SARS epidemic in 2003 and several bird flu scares since then, were slow to respond to the outbreak that began in the city of Wuhan, as local officials suppressed news of the outbreak.
But Chinas autocratic government acted with ferocious intensity after the belated start, eventually shutting down swaths of the country. Singapore, Taiwan, South Korea and Japan quickly began preparing for the worst.
The United States instead remained preoccupied with business as usual. Impeachment. Harvey Weinstein. Brexit and the Oscars.
Only a few virologists recognized the threat for what it was. The virus was not influenza, but it had the hallmarks of the 1918 Spanish flu: relatively low lethality, but relentlessly transmissible.
Cellphone videos leaking out of China showed what was happening as it spread in Wuhan: dead bodies on hospital floors, doctors crying in frustration, rows of unattended coffins outside the crematories.
What the cameras missed in part because Beijing made Western journalists lives difficult by withholding visas and imposing quarantines was the slow, relentless way Chinas public health system was hunting down the virus, case by case, cluster by cluster, city by city.
For now, at least, China has contained the coronavirus with draconian measures. But the pathogen had embarked on a Grand Tour of most countries on Earth, with devastating epidemics in Iran, Italy, France. More videos emerged of prostrate victims, exhausted nurses and lines of coffins.
The United States, which should have been ready, was not. This country has an unsurpassed medical system supported by trillions of dollars from insurers, Medicare and Medicaid. Armies of doctors transplant hearts and cure cancer.
The public health system, limping along on local tax receipts, kills mosquitoes and traces the contacts of people with sexually transmitted diseases. It has been outmatched by the pandemic.
There was no Pentagon ready to fight the war on this pandemic, no wartime draft law. There was eventually a White House Coronavirus Task Force, but it has been led by politicians, not medical experts.
The Centers for Disease Control and Prevention is one of the great disease-detective agencies in the world, and its doctors have contributed mightily in skirmishes against Ebola, Zika and any number of other health threats.
But the agency retreated into silence, its director, Dr. Robert Redfield, almost invisible humbled by a fiasco in the failure to produce basic diagnostic testing.
Now at least 160 million Americans have been ordered to stay home in states from California to New York. Schools are closed, often along with bars, restaurants and many other businesses. Hospitals are coping with soaring numbers of patients in New York City, even as supplies of essential protective gear and equipment dwindle.
Other hospitals, other communities fear what may be coming.
We are the new global epicenter of the disease, said Dr. Sara Keller, an infectious disease specialist at Johns Hopkins Medicine.
Now, all we can do is to slow the transmission as much as possible by hunkering down in our houses while, as a country, we ramp up production of personal protective equipment, materials needed for testing, and ventilators.
The world will be a different place when the pandemic is over. India may surpass the United States as the country with the most deaths. Like the United States, it, too, is a vast democracy with deep internal divisions. But its population, 1.3 billion, is far larger, and its people are crowded even more tightly into megacities.
China could still stumble into a new round of contagion as its economy restarts, and be forced to do it all again.
In the meantime, with the virus loose in the streets while millions of Americans huddle indoors, when will it be safe to come out and go back to work?
The virus will tell us, said Dr. William Schaffner, a preventive medicine specialist at Vanderbilt University Medical School.
When a baseline of daily testing is established across the country, a drop in the percentage of positive tests will signal that the virus has found as many hosts as it can for the moment, and is beginning to recede.
When hospital admissions have hit a clear peak and begun to plateau, we can feel optimistic, Dr. Schaffner said. And when they begin to drop, we can begin to smile.
That moment may arrive this summer. But as soon as the first of Americans begin venturing cautiously out, we will have to start planning for the second wave.
Reporting was contributed by Knvul Sheikh.
