Fact-checking organization Snopes has been forced to scale back its routine content production and special projects, as the amount of misinformation caused by the COVID-19 pandemic has overwhelmed its fact-checkers.
In a blog post that was later published as a series of tweets, the organization said the pandemic is overwhelming its small team and that it cant ask them to ramp up productivity at a time when everyones personal lives are being placed under such strain. Yes, publishing less may seem counterintuitive, the organization wrote, but exhausting our staff in this crisis is not the cure for what is ailing our industry. Going forward, it said it intends to focus its efforts only where we think we can have a significant impact.
Snopes isnt the only organization struggling to handle the amount of misinformation thats being spread about the novel coronavirus pandemic. Facebook, which until last year had partnered with Snopes to combat misinformation, pledged to remove coronavirus misinformation, only for a software bug to start marking legitimate news articles as spam. Twitter, meanwhile, has been inconsistent in its approach. It removed misinformation posted by several high-profile accounts but later refused to remove a misleading tweet from Tesla CEO Elon Musk.
In its announcement, Snopes offered some advice on how people could help to combat the spread of misinformation. It directed people toward official information sources like the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) and asked people to support local news publications and businesses. It also called for people to support Snopes directly with donations and to lobby big tech platforms to do more to combat misinformation themselves.
As well as scaling back production on its regular content, Snopes says that its offering all of its employees a $750 cash bonus to help with any costs they may be facing, and it has said it will offer paid time off for people as they look after themselves and their families.
In the meantime, if youd like to check out the COVID-19 fact-checking Snopes has already done, you can do so here.
As we try to predict what will happen here in the US with COVID-19, its natural to look at the experience in China, where the epidemic began. In a study published in the journal Pediatrics, we learn about how the pandemic affected children.
The study looked at information about 2,143 children with COVID-19 infections that were reported to Chinas Centers for Disease Control from January 16 to February 8 of this year. Of the infections, about a third were confirmed with a laboratory test for COVID-19. The others were diagnosed based on symptoms and the results of other tests, such as x-rays.
The best news in this study is that 90% of the children had illness that was asymptomatic, mild, or moderate as opposed to severe or critical. While 4.4% were reported as asymptomatic, given that only a third had laboratory testing, its very likely that the actual number of asymptomatic infections in children during that time period was higher. Only one child died.
In adults, it appears that more like 80% have mild to moderate infections. We dont know why children appear to have milder disease overall. Its likely a combination of factors related to body chemistry, immune function, and even social factors such as how children are cared for and spend their days. But whatever the reason, its good news.
However, there is a part of the study we need to pay attention to: younger children are at higher risk of running into trouble. Among children less than a year old, 10.6% had severe or critical disease. For children ages 1 to 5, that number was still high at 7.3%. It dropped to 4.2% for 6-to-10-year-olds, 4.1% for 11-to-15-year-olds, and 3% for those 16 and older. Interestingly, the only child who died was 14 years old.
Its not really surprising that the youngest children, especially infants, are more vulnerable. In most epidemics, such as influenza, its the very young and the very old that have the highest risk.
How can we use this information? Aside from all the advice already given to parents about hand washing, social distancing, and maintaining healthy habits, parents of young children should take extra care.
Be especially careful about who has contact with your young children
Be particularly watchful should young children get sick
Call your doctor for advice rather than bringing your child in for mild or moderate illness (theres nothing your doctor can do at the office, and you are just adding the risk of more exposures). However, you should absolutely seek medical care if your child has
Follow me on Twitter @drClaireMD
For more information on coronavirus and COVID-19, see the Harvard Health Publishing Coronavirus Resource Center.
Minnesota Timberwolves star Karl-Anthony Towns has become the latest public face in the fight against the coronavirus after revealing in an emotional video late Tuesday night that his mother has been hospitalized for the past week and is dealing with health complications from what he believes to be COVID-19.
Towns said his mother, Jacqueline Cruz, is in a medically induced coma and had to be put on a ventilator.
"I think it's important that everyone understands the severity of what's happening in the world right now with the coronavirus, and I think where my life is right now could help, so I decided to do this video and give you an update of where I'm at," Towns said during a nearly six-minute video posted to Instagram. "I was told early last week my parents weren't feeling well. My first reaction to her was to go seek medical attention immediately. There's no reason to wait, just go to the nearest hospital. And after a couple days of not showing any signs of improvement, I was very adamant on the first day to go to a hospital and seek further evaluation.
"Specifically, my sister told her she needs to get checked for corona. I don't think anyone really understood what it was, with deteriorating condition. She kept getting worse, she kept getting worse, and the hospital was doing everything they can."
"She just wasn't getting better," Towns continued. "Her fever was never cutting from 103, maybe go down to 101.9 with the meds, and then immediately spike back up during the night. She was very uncomfortable. Her lungs were getting worse, her cough was getting worse. She was deteriorating. She was deteriorating -- and we always felt that the next medicine would help. This is the one that's going to get it done. This mixture is going to get it done."
Towns, who was born and raised in New Jersey, said both of his parents were not feeling well over the past week and that both were tested for COVID-19. Towns noted that his father, Karl Sr., was released from the hospital and had been told to self-quarantine as they awaited the results of the test.
Towns said the family assumed his mother had COVID-19 because of the symptoms she was showing, but she started to feel better in recent days before taking a turn for the worse.
"She was feeling great," Towns said in the video. "We talked, and she felt she turned the corner; I felt she was turning the corner. I knew there was more days to come, but I felt that we were heading in the right direction. They said that she went sideways and things had went sideways quick. And her lungs were extremely getting worse and she was having trouble breathing, and they were just explaining to me that she had to be put on a ventilator. And she was getting worse and she was confused by everything, and I'm trying to talk to her about everything and encourage and stay positive, just talk through everything with her."
Utah Jazz guard Donovan Mitchell, who was diagnosed with the virus two weeks ago but has said he was asymptomatic, offered good words to Towns on Twitter.
Towns, who had to pause at times during the video to compose himself, said he was in constant contact with his mom before she was put into the medically induced coma.
"I talked to her when she went there and told her I loved her," he said. "Every day I always told her how much I love her. She was telling me things I didn't want to hear so -- I dismissed some things she was saying because it wasn't something I want to hear. It came to a point where it's difficult. It's been very difficult for me and my family, to say the least. She's the head of our household. She's the boss.
"She's been in a medically induced coma. Since that day, I haven't talked to her, haven't been able to obviously communicate with her. I've just been getting updates on her condition. It's rough, and day by day we're just seeing how it goes. We're being positive; I'm being very positive. So I'm just keeping the strength up for everybody and my family."
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In a 2017 interview with ESPN, Towns said his mother had worked in the Rutgers University medical department for more than 20 years. He shares a close relationship with his parents and is hopeful that by speaking out about his mother he can affect how other people view the seriousness of the virus.
"[My family] told me to make this video so that people understand that the severity of this disease is real," Towns said. "This disease needs to not be taken lightly. Please protect your families, your loved ones, your friends, yourself. Practice social distancing. Please don't be in places with a lot of people; it just heightens your chances of getting this disease, and this disease ... it's deadly. It's deadly. And we're going to keep fighting on my side, me and my family, we're going to keep fighting this. We're going to beat it. We're going to win."
Towns, who had not played in an NBA game since Feb. 10 because of a fractured left wrist, remained hopeful about his mother's prognosis and sent warm wishes out to anyone dealing with the virus.
"I hope my story helps," Towns said. "I hope my story gives you the correct information. Send my love to all your families. I'm praying for every single one of you guys. Give everyone my thoughts and my prayers, and life may keep throwing punches at me, but I'll keep getting back up. And I ain't going to quit at any time, and neither will my whole family, neither will my mother. Dominican women are strong, I know they are. My mother is the strongest women I know, and I know she'll beat this, and we're going to rejoice when she does. Love you guys, and I'll talk to you later."
The coronavirus has infected more than 435,000 people worldwide and killed more than 19,000. The COVID-19 illness causes mild or moderate symptoms in most people, but severe symptoms are more likely in the elderly or those with existing health problems. More than 111,000 people have recovered so far, mostly in China.
Information from The Associated Press was used in this report.
Brazils far-right president, Jair Bolsonaro, has claimed he wouldnt feel anything if infected with coronavirus and rubbished efforts to contain the illness with large-scale quarantines as his countrys two biggest cities went into shutdown in a desperate bid to save lives.
In a televised address to the nation on Tuesday night, Bolsonaro slammed what he branded the economically damaging scorched earth tactics being used to slow the advance of an illness that has now claimed about 15,000 lives around the world.
The virus has arrived and we are fighting it and soon it will pass, claimed Bolsonaro, who is facing a growing backlash in Brazil for repeatedly dismissing coronavirus as a media fantasy and trick.
Bolsonaros incendiary remarks came as both Rio de Janeiro and So Paulo were placed under partial lockdown by municipal and state authorities who fear an explosion of cases in the coming days.
Joo Doria, the governor of So Paulo, Brazils most economically important and populous state, has declared a 15-day quarantine period affecting about 46 million of Brazils 210 million citizens.
Meanwhile Rios mayor, Marcello Crivella, has ordered an indefinite shutdown of that citys commerce and schools with Rios state governor, Wilson Witzel, also introducing drastic measures to counter coronavirus.
But in his five-minute address which sparked loud protests in both Rio and So Paulo - Bolsonaro railed against such steps and attacked the media for spreading a feeling of dread among the population by reporting on the death toll in Italy.
Our lives have to go on. Jobs must be kept we must, yes, get back to normal, Bolsonaro said as his governments health officials announced that the number of deaths in Brazil had risen to 46 with more than 2,200 cases.
A small number of state and municipal authorities must abandon their scorched-earth ideas: the banning of public transport, the closing of commerce and mass confinement, Bolsonaro said.
What is happening around the world has shown that the at-risk group are those over 60 years old. So why close schools? Ninety per cent of us will show no sign [of infection] if we are infected.
There was growing speculation on Tuesday that Bolsonaro himself may have been infected with coronavirus amid reports that a military hospital where Brazils president had been tested had withheld two names from a list of positive cases for reasons of secrecy.
Those reports had set off rumours that Bolsonaro would use his address to confirm a positive diagnosis. Instead he told citizens: In my particular case, because of my background as an athlete, I wouldnt need to worry if I was infected by the virus. I wouldnt feel anything or at the very worst it would be like a little flu or a bit of a cold.
The address went down badly with many Bolsonaro critics who believe his response to coronavirus will be the end of his political career.
The first political suicide broadcast live on national radio and television, tweeted Ricardo Noblat, a prominent Brazilian journalist.
Brian Winter, the editor-in-chief of Americas Quarterly, tweeted: Pray for Brazil.
EL CENTRO, CA - MARCH 1: (NEWSWEEK AND US NEWS AND WORLD REPORT OUT) A man sleeps in a dormitory for ... [+] Mexican and foreign nationals convicted of a felony or deportable offense at a federal detention center on March 1, 2006 in El Centro, California. The federal issue of not having enough beds or detention centers is scheduled to be rectified in 2006 with increased Department of Homeland Security (DHS) funding. Mexican nationals caught illegally crossing the border by Customs and Border Protection (CBP) officers are sent back immediately if there is no outstanding criminal case on record. Those detained by Immigration and Customs Enforcement (ICE) following a criminal conviction are sent to detention centers like El Centro prior to their federal immigration court hearing. Many appeal the judgement to deport and stay at the El Centro facility until they win or lose. California was the first state in 1987 to implement a program where foreign nationals convicted of a crime were eligible for deportation. Many violators of immigration laws flee before their cases come to trial. It is estimated that some 6.3 million illegal Mexican immigrants live in the U.S. and some 485,000 undocumented Mexican immigrants enter the U.S. annually. The U.S. government estimates 11 million illegal immigrants reside in the U.S. In 2005, San Diego and Imperial counties of southern California deported 40,335 Mexican and Central American immigrants. (Photo by Robert Nickelsberg/Getty Images)
Immigrant detainees, prisoners, and the homeless are at huge risk for coronavirus (COVID-19) infections. Sadly, scant attention has been paid to them as some seem to feel that they deserve their plight and dehumanize them, calling them illegals.
The immigrant detainees live in closed spaces, much like the cruise shipswhere COVID-19 spread so rapidly, Eunice Cho, senior staff attorney for ACLU, described. They are not readily able to practice the level of good hygiene and social distancing that are recommended.
Now, just as predicted, the first detainee has tested positivefor coronavirus infection. He was being held at the Bergen County Jail, and was tested after becoming ill. This is the same center where an officer tested positive last week.
Conditions in an ICE facility in the Hudson County Correctional Facility in New Jersey have gotten so bad that inmates are going on a hunger strike over access to soap and toilet paper.
At the nearby privately operated Elizabeth Detention Center, inmates complained of not having even hand sanitizer in their close quarters, and that guards were not using masks or gloves. One medical worker there had a positive test last week.
Most of the almost 40,000 detainees in ICE (U.S. Immigration and Customs Enforcement) custody are refugees seeking asylumsomething which is perfectly legal. Yet they have been separated from family and held in crowded, unsanitary conditions. Many have never been convicted of any criminal offense.
As I wrote last fall, U.S. Customs and Border Patrol (CBP) is responsible for the deaths of at least eight children, several from influenza. Nonetheless, not only have they refused to provide flu vaccinations to those in their custody, but they have refused to allow volunteer physicians and nurses to administer them either.
As Dr. Mark Travassos, of the University of Marylands Center for Vaccine Development and Global Health, observed, Under the present administration, detainment centers have become a black box what happens in them has not been open for review byeven elected officials.
We have an urgency with COVID-19 to have people practice social distancing, which actually means being physically separated from others by at least six feetpreferably more.
Coronavirus can also be spread by touching contaminated surfaces. This is why frequent, careful hand washing is recommended. Yet last fall, the US government went to court arguing that children in detention are not entitled to basic sanitation, clean clothes, bathing, and toothbrushes.
This is why detainees are at huge risk and feel like they are sitting on a time bomb. Silky Shah, executive director of Detention Watch Network, described them as sitting ducks.
She emphasized to me that despite the ruling that those incarcerated need to be provided supplies for hygiene, that is still not happening. Many are malnourished; some are given rotting food. Private prisons, where most are held, are profit-driven.
ICE has a history of responding poorly to public health threats. For example, unvaccinated employees were responsible for fueling a measles outbreak at Eloy detention center.
ProPublica reports that ICE has repeatedly failed to follow rules meant to contain communicable diseases. For example, the detention center in Aurora, Colorado, had multiple outbreaks, including mumps and chickenpox, which they failed to report. They also refused to vaccinate detainees to try to protect them until forced to after the fact. A private contractor for ICE, the GEO Group, runs this facility. During an inspection of the center in February, 68 people were found to be quarantined with the flu and 70 others hadmumps. Ten inmates are under observation for COVID-19 after an exposure though none are reportedly ill.
Cho told me that conditions at the centers have deteriorated from their baseline, which the Office of Inspector General (OIG) reported as being unsafe. She also stressed the ACLUs similar report, Code Red, which exposed the failure of the camps to provide adequate care in a timely manner, and how that has led to inmate deaths. In fact, over one-third of deaths that have happened under the Trump administration are suicides in ICE custody and there is a mental health crisis happening in ICE detention.
Last week, the ACLU (national andWashington State), and the Northwest Immigrant Rights Project (NWIRP) sued ICE to release the vulnerable detainees at Tacoma Northwest Detention Centerwho are at risk of death or serious illness from COVID-19. That center is near Seattle, the first city to be hard-hit by the virus.
Physicians Scott Allen and Josiah Rich gave urgent recommendations to Congress that there be a process in place to identify potentially infected detainees, test them, then isolate or quarantine; limit transfers of detainees; and have alternatives to detaining them. He warned that the current situation was a tinderbox scenario.
Physicians for Human Rights, Human Rights First, and Amnesty International USA are among other groups calling for the release of detainees. More than 3000 doctors also wrote a letter, stressing the devastating risks infection posed, particularly to vulnerable individuals.
John Sandweg, former acting director of ICE, has warned about the danger of COVID-19 in detention, saying it would spread like wildfire. He noted that the close quarters in which detainees are held is the opposite of the social distancing that is being recommended. He therefore called last week for the release the thousands of nonviolent, low-flight-risk detainees currently in ICE custody.
Importantly, Sandweg stressed that infected detainees also pose a significant risk to the hundreds of people who work at each ICE facility, and that this will enhance community spread, as the workers take the infection home to their families. What happens then? Local communities that house the mostly private detention centers will have their hospitals overwhelmed by the sudden influx of COVID-19 patients.
Given that more than 90% of the immigrants who are released to their communities pending court proceedings return for their hearing dates, one might ask why the administration has not heeded the warnings of so many medical specialists about how devastating and uncontrollable outbreaks of coronavirus will be in detentions centers.
Perhaps one reason detainees are not being released is that over70 percentof detainees are held in private, for-profit facilities. Two of the largest of those,GEO Group and CoreCivic (Corrections Corporation of America). Despite their failure to provide safe conditions for detainees, the GEOearned $2.3 billion in 2018, mostly from U.S. government contracts, which is more than any other ICE contractor.
With infections now in a detainee and more in ICE employees, the crisis of COVID-19 infections clearly has arrived in our detention centers.The urgency to address the safety of immigrants in our detention camps and of prisoners in our jails grows exponentially every day along with the coronavirus epidemic.
PETALING JAYA: JP Morgan believes that Malaysia has entered the acceleration phase pertaining to the increase in Covid-19 infections and that this could peak by the middle of next month.
The research house is pricing in expectations that the acceleration phase of the curve will last for only the next 1 to two weeks before moving into the accumulation stage, when the overall infection growth rate slows to between 100 and 250.
We expect the peak infection to be by the middle of April, at approximately 6,300 cases, it said based on its assumptions on three factors: sample population, secondary infection rate (RO) and mortality assumptions.
We believe the governments actions are proving effective in curbing the spread and intensity of the epidemic. Mortality rates in Malaysia are low, it added.
It said that Malaysias virus test per million is 482 which is four to 81 times higher compared with the other Asean countries at six to 109 tests per million population and even higher than several European Union countries.
And this suggested that the country has relatively better positioning to contain the virus diffusion process, it said.
JP Morgan said the strategy could result in higher reported infection numbers, but it was confident of milder development and mortality.
It also noted that the movement control order that started last week should also help to slow the spread and along with border controls should be able to subdue the secondary spread of the epidemic.
Based on the restrictions put upon the people in Malaysia, JP Morgan said it assumed that the countrys size of community spread level would be relatively small moving forward compared with European countries.
Also, we rate the countrys efforts on infection curve control highly. Therefore, we assume that the potential size of the group that initially interacts with the infected group (the group that needs to get the virus test) is to be around 0.2% of the total population, the research house said.
Given the total size of the test group in Hubei, China and South Korea is about 0.1% to 0.7% of the total population. We view that initial setting on the sample population looks reasonable, it added.
JP Morgan said Malaysias RO is estimated to be at 1.7 at present and these are similar infection parameters used in China and South Korea.
This suggests Malaysia would face a doubling of infection process in every five to seven days in the early acceleration stage, it said.
However, considering several containment measures and lower population density, in our opinion, an initial setting of RO at 1.7 (vs China: two; South Korea: 1.9) looks reasonable, JP Morgan said.
It also said Malaysias reported mortality ratio is 0.77% which appeared too low compared with the global average of 4.4%.
We initially set the mortality assumption at around 2% in the epidemiology modelling in Malaysia and use the same mortality assumption for South Korea and China, it said.
Nobodys risk is zero when it comes to the Covid-19 coronavirus.
Anybody can get sick in this pandemic. But different people have different risks of getting severe symptoms that require hospitalization or intensive care and the chances of dying from Covid-19 vary widely across age groups.
The conventional wisdom says kids and young people may be fine even if they get infected, with the risk of a case being more severe increasing with age. Its the older folks, we need to worry about, this thinking says, given death rates reach 20 percent or more among people 80 and older. Public health experts have seemed exasperated by the social media images of younger Americans who continue to socialize or even take a spring break vacation, worried that the perception a young person has little to fear from the coronavirus has given them a false sense of security.
To be clear, nobody should feel invulnerable to the coronavirus. Young people are going to contract the disease, a not-insignificant percentage of them are going to get very sick, and a smaller number will die. The rates of severe and deadly cases might not be nearly as high as the older generations that we are worried about, but the data already show that age alone does not make you invincible.
There are two other things about risk to keep in mind about whos at higher risk. One, there is some indication that men could be at a higher risk of severe symptoms and death than women. In the initial Wuhan, China, outbreak, for example, men were dying at a notably higher rate than women. Weve seen the same trend in Italy. But we will need more research and data to be sure about the effect of gender on a patients prognosis.
Second, we know that people who have underlying medical conditions face higher odds of getting really sick or dying from Covid-19, particularly those with heart disease, diabetes, high blood pressure, lung disease, and cancer. Having one or more of those conditions increases a persons risk of severe symptoms beyond what their age alone would suggest.
To review everything we know on age and the Covid-19 risk, Im going to draw from a few sources that well keep coming back to: the World Health Organization report on the initial Wuhan outbreak, the Centers for Disease Control and Preventions new report on the early cases in the US, Spains breakdown of its pandemic by age group, and two Vox articles on the risks to children and older people.
One caveat: Overall infection rates increase with age (kids seeing lower infection rates, seniors higher). But its hard to know if thats because young people actually get infected less or simply because they are less likely to develop serious symptoms and seek medical attention, and so their cases are being underreported. A second caveat: The data we have so far are preliminary, and what we know will change as more information from different countries outbreaks come in.
Well therefore stick to the data we have both good numerators and denominators for to answer an important question: What are your risks if you do get infected with the coronavirus?
Now lets run through the different age groups and what we know about their risks.
The important stats on our youngest:
So far, the data does bear out the idea that kids are not uniquely at risk of Covid-19, which is both surprising (because they usually are more vulnerable to the flu) and a relief.
But this age group obviously covers everybody from infants to kids approaching middle school. And we do have evidence that the youngest of these can see more severe cases than their older brothers and sisters in elementary school, as Voxs Umair Irfan reported:
A study published March 16 in the journal Pediatrics of more than 2,100 children in China found that children of all ages were vulnerable to Covid-19, though the vast majority experienced mild symptoms, and some experienced none at all. A caveat for this study is that only one-third of the children in the sample were tested and confirmed to have the Covid-19 virus, SARS-CoV-2. The rest were presumptive Covid-19 cases, which means theres a possibility that another pathogen could have caused the observed symptoms.
Zeichner, who co-authored a commentary article about the findings, noted that the worst outcomes in children were often among infants. The study showed that about 30 percent of childhood Covid-19 cases deemed severe and more than half of Covid-19 cases deemed critical were among children less than 1 year old. Though the overall numbers were small 7 infants had critical illness and 33 suffered severe illness it did show that younger children faced a higher likelihood of more dangerous outcomes.
The other complication is that these younger people could still spread the disease to older generations, who are more at risk of critical illness.
Bottom line: Infants appear more vulnerable than toddlers and elementary school kids. Overall, though, only a small number of children under 10 years old are requiring hospitalization because of Covid-19 and, as of March 21, nobody in this age group has died.
The important stats on adolescents and just-turned-adults:
With the younger generations, same as the older generations, underlying medical conditions add to a persons vulnerability. But the absence of health problems does not mean the absence of risk: CNN reported Sunday on a 12-year-old girl in Atlanta with Covid-19 who has no known health conditions and who is nevertheless on a ventilator.
Bottom line: Older kids and teenagers may be more resilient than their younger peers in some ways (lower hospitalization and ICU rates in Spain, the only country we have data to separate the 0-9 and 10-19 cohorts), but there is still a small risk of serious complications or death.
The important stats on young adults:
Bottom line: We are seeing a higher hospitalization rate among young adults compared to the teens directly behind them in age, and comparatively more of them wind up in the ICU. Fatality rates are still low, but deaths do happen. The trends that will carry through the rest of this article the older you get, the higher the risk are starting to show up.
The important stats on this working-age population:
To prevent these numbers from becoming too abstract, the story of Jeffrey Ghazarian is a sad warning for this population. Ghazarian, a 34-year-old who lived near Los Angeles, died Thursday from Covid-19 after five days on a ventilator. He was a cancer survivor, which fits with what we know about the disease: People with past health problems and compromised immune systems are more at risk.
Bottom line: For this demographic, a significant number of people are being hospitalized, upward of one in five cases. And those final numbers from the CDC are a good example of how risk can vary within these age groups: Odds of hospitalization, intensive care, and death seem to increase from ones early 40s to late 40s. Weve seen the same trend in Spain: The rates of hospitalization jumped from 17 percent for ages 30 to 39 to 23 percent for ages 40 to 49.
The important stats on the people entering their golden years:
For folks over 50, the risks steadily grow, both due to their age and because they are more likely to have a preexisting medical condition that exacerbates their risk. Almost half of Americans ages 55 to 64 have at least one preexisting condition, according to the Kaiser Family Foundation.
Thats a problem when an unknown pathogen strikes. More from Voxs Brian Resnick:
The longer we live, the more likely our cells are to replicate in dangerous ways, the more damage they accumulate, and the more likely our organs are to stop functioning normally. This puts us at a heightened risk of chronic health conditions, like cancer or diabetes. Along with already weakened immune systems, these underlying diseases can make it harder for the body to ward off infections. The takeaway: Its not just age alone that endangers people; its being older with one or more chronic diseases.
Among the 105 patients who had died in Italy as of March 4, two-thirds had three or more preexisting conditions. The most common was hypertension, followed by ischemic heart disease and diabetes mellitus. These chronic illnesses can leave organs degraded and more vulnerable to infection. Additionally, the treatments for these conditions can suppress the immune system, leaving the body susceptible to pathogens.
Bottom line: All of these folks are in the high-risk category. A substantial minority are being hospitalized, and a handful of people out of every 100 have died. The dangers increase if they have heart or lung problems, or if they have diabetes or a cancer diagnosis.
The important stats on older individuals:
One note: The ICU stays could be lower for the oldest people if the disease progresses so quickly that they dont even have an opportunity for intensive care.
Bottom line: There is no need to belabor the point, as I think one thing most people know about Covid-19 is it hurts older people the most. The data bears this out: People in this age group are the most likely to be hospitalized and to ultimately die during this pandemic.
For the rest of us, the risk is less severe but far from zero, and every person should be mindful of how their current health might make them more susceptible. And all of us, no matter our age or health status, should do our part to protect the most vulnerable through social distancing.
One of the most wrenching questions in medicine has been playing out to garish effect in White House press conferences.
The question is this: In an emergency, like the exploding pandemic of the coronavirus that causes Covid-19, how much data should doctors require before they use a medicine? President Donald Trump has made clear that he thinks two old malaria drugs, hydroxychloroquine and chloroquine, should be deployed quickly against the coronavirus, SARS-CoV-2. But his own lieutenants, the heads of the Food and Drug Administration and the National Institute of Allergy and Infectious Diseases, have been hesitant.
Theres no question the need for effective treatments is urgent. Cases of Covid-19 are exploding, with more than 24,000 reported nationally and more than 10,000 in New York State alone. Actual numbers may be far higher. Reports say that New York hospitals are full with patients on ventilators who need treatment now.
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Hope has emerged around two anti-malaria drugs: chloroquine, discovered in 1934, and a derivative of it called hydroxychloroquine that is thought to have less severe side effects. Both have shown promise in preventing SARS-CoV-2 from infecting cells in the laboratory. And a small and preliminary clinical trial of hydroxychloroquine in France circulated widely and stirred excitement on social media (including from the president) though its findings were hardly definitive about whether the drug would benefit coronavirus patients. New York Governor Andrew Cuomo said Sunday that a study of the drug will start Tuesday.
The fact that these drugs have already been cleared by the FDA for use against other diseases theyre prescribed by doctors not just for malaria but also rheumatoid arthritis and lupus has added momentum to the argument they should be quickly made available for Covid-19; their side effects, which include heart and nerve damage and suicidal thoughts, are well-understood and, given the current circumstances, manageable, supporters argue. Doctors can already prescribe them off-label.
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At a Thursday news briefing, Trump trumpeted that chloroquine had shown very, very encouraging early results and said were going to be able to make that drug available almost immediately. Minutes later, FDA Commissioner Stephen Hahn, an oncologist, clarified that the drug would be available in the setting of a clinical trial a large, pragmatic clinical trial to actually gather that information and answer the question that needs to be answered and asked and answered.
On Friday, the president said, It may work, it may not work. I feel good about it. Thats all it is. Just a feeling. At the same press conference, Anthony Fauci, a physician who heads the NIAID and a veteran of outbreaks going back to HIV, emphasized the need for a methodical clinical trial.
Were trying to strike a balance, Fauci said, between making something with a potential of an effect to the American people available, at the same time that we do it under the auspices of a protocol that would give us information to determine if its truly safe and truly effective.
On Saturday morning, Trump tweeted: HYDROXYCHLOROQUINE & AZITHROMYCIN, taken together, have a real chance to be one of the biggest game changers in the history of medicine, referencing a scientific journal article about the small clinical trial of 36 patients in France. Several other small studies of other antiviral drugs have also shown glimmers of hope. So what should doctors do?
How likely is it that the possible benefits shown in a small study will turn out to be a mirage? One way of understanding this is to look at what happens with medicines in clinical trials. Experimental drugs are usually studied in three stages of progressively larger studies. The first, called Phase 1 trials, are small studies used to get an early read on efficacy and rule out obvious safety issues. These are then refined in larger Phase 2 studies and then in the large Phase 3 studies used by the FDA to decide whether to approve a drug.
The study referenced by Trump, and other studies done so far of potential treatments for Covid-19, are small and hastily designed even by the standards of Phase 1 studies. So how often do infectious-disease drugs that enter Phase 2 studies reach the market? An analysis by the Biotechnology Industry Organization says they worked out only 27.5% of the time between 2009 and 2015. That means that three-quarters of the time, medicines against infectious disease that looked promising in small studies either were ineffective or had side effects that made them unusable. Even for medicines that reached Phase 3 trials, just 63% succeeded.
But the issues with these studies go beyond their small size or the fact that early promises, in research, often dont pan out. It goes to one of the big truths about how doctors, eager to see a new drug succeed, can subconsciously lie to themselves with clinical studies: To be trustworthy, these studies often need to be randomized. This means that not only are some patients assigned to a control group that doesnt get the promising medicine, but that who gets what treatment is decided, essentially, by a coin flip. (The most rigorous of these randomized trials are also blinded, meaning the doctors running the studies dont know which patients are in which group.)
The use of randomization as the standard way to design a medical study goes back to another deadly infectious disease: tuberculosis. In the early part of the 20th century, it was a scourge, and many doctors turned to gold-based treatments, to try and control it. They turned out to be toxic and ineffective. In 1946, researchers in the United Kingdoms Medical Research Council decided to conduct a randomized trial of another treatment, the antibiotic streptomycin, in 107 patients. The results were clear: 7% of those who received streptomycin died, compared to 27% of those in the control group.
That study, published in the British Medical Journal in 1948, became the basis for most modern medical research. The sacrifice made by the 52 people in the control group meant that there was no doubt the streptomycin worked _ and that a situation like gold treatment, where many patients get a therapy that harms, instead of helping, wouldnt repeat itself.
The study Trump and others have touted was anything but randomized. Instead, Covid-19 patients were treated with either hydroxychloroquine or the combination of hydroxychloroquine and azithromycin, an antibiotic also known as Zithromax, at a hospital in Marseille, France. They were compared to coronavirus patients at hospitals in Marseille, Nice, Avignon, and Brianon who didnt receive these drugs.
The study doesnt show that patients lived longer or were more likely to recover, but instead shows that the amount of virus in the blood was reduced much faster in the patients who took hydroxychloroquine and even faster in the six patients who took the combination of hydroxychloroquine and azithromycin.
That result is encouraging, but for patients who are not gravely ill, it doesnt tell how to weigh the side effects of hydroxychloroquine against the potential benefits. Thats the reason for a clinical study like the one starting in New York.
But for doctors on the front lines, particularly in New York City, where hospitals are becoming overwhelmed and where there are many patients on ventilators, the drugs could be an immediate option. As Cuomo put it in a press conference Friday, where a person is in dire circumstance, [you] try what you can.
Reports about the potential of hydroxychloroquine as a potential treatment for Covid-19 have been circulating among New York City emergency physicians for more than a week, and some patients are reportedly getting the hydroxychloroquine/azithromycin combination. (Perhaps as a result, there are shortages cropping up for patients with lupus and other diseases who need the drug.) The University of California, San Francisco, and the University of Washington both recommend hydroxycholoroquine for very sick Covid-19 patients.
The qualms about the French study extend to two other studies of antiviral drugs as potential Covid-19 treatments. A study of 80 patients given the Japanese flu drug favipriavir, which is not approved in the U.S., was not randomized; it found a shorter clearance time for the drug. A small randomized trial of HIV medicines, published in the New England Journal of Medicine, found no overall benefit, but hints that it helped some subgroups of coronavirus patients.
Taken together, some stock analysts have forecast that these results could improve the odds that another antiviral drug, Gileads remdesivir, could prove effective in two Phase 3 studies in China that are expected to read out in April.
For drug development, getting results so soon is blindingly fast. For doctors on the ground and patients who are struggling to breathe, it is agonizingly slow.
Billionaire philanthropist Bill Gates maintained today that nationwide total, sustained isolation is ... [+] the best way to beat coronavirus with minimal lives lost and economic damage.
Topline: Bill Gates said that total isolation for six to ten weeks is the only viable option to minimize lives lost and economic damage for the United States to recover from the COVID-19 crisis.
Background: Microsoft founder Bill Gates is the second-richest person in the world, with a $97.4 billion net worth. He has donated 25% of his wealth to charitable causes through his philanthropic organization, the Bill & Melinda Gates Foundation, which has given $50 million to COVID-19 therapies so far.
Editors note: The Economist is making some of its most important coverage of the covid-19 pandemic freely available to readers of The Economist Today, our daily newsletter. To receive it, register here.
CHILDREN USUALLY rejoice in a break from school, assuming it will be a chance to slack off. Not Ryu, a nine-year-old in Tokyo. As the new coronavirus spread across Japan, schools throughout the country closed on March 2nd. His parents have enforced a strict schedule every day. It includes Japanese, science and physical education. He does mathematics on his abacus every morning. On weekdays he is allowed to play in a park for 90 minutes. I wish I could take him to the park more, but we have limited time as we work from home, frets his mother, Fujimaki Natsuko.
Ryu is one of almost 1bn students around the world whose schooling has been interrupted as a result of covid-19 (see map). As The Economist went to press, just over 100 countries including China, Italy and South Korea had closed their schools, as had 43 states in America, as part of efforts to contain covid-19. Britain will close all schools on March 20th. Schools, where sticky-fingered children gather every day, sharing toys and sucking on pencils, are an obvious place for diseases to flourish. In 2013 Britains Health Protection Agency looked at flu outbreaks that coincided with school closures. It found that shutting them slowed the transmission of the virus, even if it also slowed the transmission of knowledge.
The data on whether school closures will curb covid-19 are limited. Children may not be the main routes of transmission, says Michael Head, who studies global health at the University of Southampton. And the economic, social and educational costs are heavy. On March 12th Bill de Blasio, the mayor of New York, said there were many, many reasons not to close the citys 1,800 schools (though on March 16th it did just that, shuttering Americas largest school system for at least four weeks). For all governments, deciding whether or not to close schools is a choice between two bad options.
A study in 2009 modelling the effects of closing all schools and formal day-care centres in America for a month put the cost at 0.1-0.3% of GDP. Some countries seem better prepared to deal with the economic impact. In China the nationwide closures came with government-mandated work-from-home policies and subsidies for companies to enable their employees to do so. But in Japan not all parents are entitled to work from home or to take paid sick leave. In Italy one-fifth of workers are self-employed and so do not qualify for sick pay. People in precarious work may lose their jobs altogether if they have to stay at home to look after children.
For poor children, schools may provide the most nutritious meal of the day. Around 26m children in American schoolsroughly half of all studentsqualify for free or reduced-price lunches. In New York City 22,000 children sleep in municipal shelters. Some school districts in New York are setting up pickup points so that the hard-up can still get free meals. Britain has said it will continue to provide those children who ordinarily get free school meals with food.
Officials must always take such costs into account. But in the middle of a pandemic there is an extra consideration. The study in 2009 estimated that, if schools are closed for a month, between 6% and 19% of key health-care workers would have to stay at home to take care of their offspring. Britain will keep schools running for vulnerable children and those whose parents are key workers.
For most parents, however, the immediate worry is how prolonged school closures will affect their childrens education. Those preparing to take crucial exams are particularly jittery. The gaokao, Chinas single university-entrance exam, is usually held in June. This year it will probably be delayed, says Xu Liangdi of China Policy, a think-tank, although the government has so far made no announcement.
Around 245,000 students in Britain were expecting in May and June to sit their A-levels, the exams that determine which universityif anywill grant them a place. On March 18th the government announced that those exams would be cancelled. Boris Johnson, the prime minister, said that the government would make sure that children still got the qualifications they need and deserve for their academic career. That may go some way to assuaging fears that children whose parents lack the cash or knowledge to compensate for schools closing would be worst affected.
For American students the stakes are lower, in part because their transcriptbased on their academic performance throughout the yearis the most important part of their university application, but also because they can take SATs, the exams used in college admissions, all year round. Most sit them in the spring. For those hoping to start university in 2021, the March and May tests have been cancelled. They will be rescheduled, however, and students may be able to take them at home.
Nonetheless universities may have to be more accommodating. Covid-19 will absolutely affect the admissions procedure for Miami University in Ohio, says Bethany Perkins, the director of admissionsparticularly the deadlines. Students with offers from American universities have to choose which to accept by May 1st. But students worry that they will have to make an important decision without being able to visit any campuses. Along with their parents, some are calling for the date to be pushed back to June 1st. Colleges have yet to react. Harvard says it is not changing its application process.
The disruption has lent ammunition to those who disapprove of high-stakes exams, which some education theorists want to scrap. Some institutions have already made SATs optional. Others, including Miami University, were considering doing so. The upheaval caused by covid-19 might accelerate that process, says Ms Perkins. But the flaws of other kinds of assessment may become clear in the coming months, bolstering those who believe that SATs and other high-stakes exams, which offer a relatively objective and transparent measure of ability, are the least unfair way to decide who gets into university.
The pandemic wont change this. But it will highlight the strengths and weaknesses of teaching online. Online resources are increasingly popular but few countries boast a developed digital infrastructure for all students. A survey by Teacher Tapp, an app, of over 6,000 teachers in Britain found that only 40% of those in state schools would be able to broadcast a video lesson, compared with 69% of teachers at independent schools. Elena Silva of New America, a think-tank, says that few American states have adequate kit for teaching online. Most states are not that prepared. This is a moment of forced opportunity.
Teachers have little choice but to seize it. Since Italy closed its schools and universities on March 5th, teachers forums have filled with discussions on the relative merits of Zoom, Moodle and virtual classrooms. Some teachers had been trained to use such technology, but many have faced a steep learning curve. Carla Crosato, a teacher in Treviso, in northern Italy, has been uploading videos in which she explains the novels of Italo Svevo and Luigi Pirandello to her students. I never thought Id become a YouTuber at 56, she says.
Even if teachers manage to broadcast their lessons, students may struggle to join them. Not everyone can get online (see chart). In America 7m school-age children cannot access the internet at home. Lin Kengying of 21st Century Education Research Institute, a think-tank in China, says that the closure of schools since the Lunar new year holiday, which began at the end of January, has led his organisation to reconsider the potential of e-learning. It hasnt been smooth, he says, citing problems such as internet access, scheduling classes, teachers unfamiliar with online tuition, and subjects such as physical education being awkward to teach remotely. In China teachers have to submit lesson plans for review by censors, which has led to delays. Students have been spamming the main online teaching app with one-star reviews in an effort to get it removed from the app store. And Xue Hua, a mother of two in Jiangxi province, has been printing out all the learning materials for her 16-year-old son, Guo Guo, because she worries about too much screen-time.
Even done properly, online learning is a poor substitute for the kind that happens in a classroom. On average, students fare worse working online, especially those with less strong academic backgrounds, says Susanna Loeb of Brown University. Online courses can be an asset when students cannot be in school, but she reckons that they are suboptimal for most and argues that long periods of time spent away from actual schools will probably lead to childrens education suffering.
Online learning has clear potential. Educational technology powered by artificial intelligence can help children in poor countries with iffy schoolssupposing they have internet access. In 2018 researchers found that after four and a half months of using an Indian app called Mindspark, which tests basic language and maths skills, children made more progress in these areas than those in the control group. But the success of such initiatives relies on preparation and organisation, not sudden scrambles to teach existing curriculums to entire populations of students in the midst of a pandemic.
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This article appeared in the International section of the print edition under the headline "Mid-term break"
