How many cases of COVID-19 are there in Texas? It depends who you ask.
On Tuesday, the answers varied wildly.
Gov. Greg Abbott said at a press conference that 715 people have tested positive for the new coronavirus so far. At the same time, the Texas health services department which reports the states official count every day showed only 410 people. (Later in the evening, the number was revised to match Abbotts statements.)
Johns Hopkins University, which is tallying cases worldwide, reported 857 cases in Texas as Abbott gave his remarks. And the U.S. Centers for Disease Control and Preventions count tallied 507 cases in Texas in the morning but dropped the number to 352 by the afternoon.
Depending on which number you use, Texas is ranked either 10th in the nation for most cases or 21st.
The discrepancies have only been worse at the county level. Texas health officials reported 34 cases in Dallas County on Tuesday morning. Meanwhile, the county reported 169 cases among its residents. (The state updated the Dallas cases to 131 on Tuesday evening.)
Gov. Greg Abbott, in public addresses Tuesday and this weekend, had to reconcile that the states numbers were dramatically lower than those in other reports. In his update, he used numbers reported by the state and offered up a count from Johns Hopkins.
The Texas Department of State Health Services acknowledged the massive reporting discrepancies to The Texas Tribune this week and launched a new reporting system Tuesday evening that officials believe will close some of the gap. The updated page came with a note that more than 300 previously unaccounted-for cases were now being reflected in state data.
But public health experts have said that even the most generous accounting of positive cases in the state is a dramatic undercount given the rampant evidence of community spread, combined with the state health departments traditionally lengthy reporting process and limited testing capacity.
Experts have also emphasized the importance of ramping up testing in Texas and across the country, warning about the dangers of decision-making based on inconsistent numbers and incomplete data.
Abbott has signaled to Texans that the case numbers are informing some decisions. This weekend, he stopped short of calling for a statewide lockdown over the coronavirus, saying there are still many counties in Texas without any cases. As he made those statements Sunday, some counties were collectively reporting hundreds of cases that the state was not including in its official count.
I am governor of 254 counties in the state of Texas, Abbott said at a press conference Sunday. What may be right for places like the large, urban areas may not be right at this particular point in time for the counties that he said have no cases of COVID-19, the disease caused by the new coronavirus.
Cases reported by some rural counties show that its not just large, urban areas being hit by the virus. In small-town East Texas, local health authorities have reported one case apiece in Cass, Van Zandt and Morris counties as of Tuesday. The state reported none until Tuesday evening, when DSHS released its new reporting system.
One reason for the previous discrepancies between state and county numbers was that different methodologies were being used.
Until Tuesday evening, the state tracked cases by county of residence. This meant that if a University of Texas student who lived in Houston contracted the new coronavirus and was tested and treated in Austin, the tally appeared as a positive case in Harris County.
Many counties, on the other hand, have been reporting anyone who tested positive in their jurisdictions. DSHSs new method will use tallies directly from counties.
DSHS spokesperson Chris Van Deusen told The Texas Tribune that the new state reporting system will better reflect what local jurisdictions are reflecting and have a complete picture as possible.
In order to make sure were providing the most up-to-date information possible, were shifting to using the COVID-19 case counts that local jurisdictions are reporting publicly, Van Deusen said. Previously, we were relying on the official case forms we receive from local health departments and our regional offices. But those come in later than the public updates, so it created confusion about the numbers.
Other reasons for discrepancies center around who gets counted. Texas officials have made conflicting statements about whether the states count included so-called presumptive positive tests which are cases not confirmed by the CDC. The state also doesnt generally count coronavirus patients housed at the federal quarantine site in San Antonio.
Now that DSHS is including all cases reported publicly by local health departments, the agency says lingering discrepancies are possibly the result of other sources counting some cases more than once.
Dennis Perrotta, a former Texas state epidemiologist, said Texans should look to their local health authorities for the best data.
First of all, always, a local health department is the place where they know more about whats going on in their community, Perrotta said, adding that he was not surprised by the disparities between local and state numbers because of the complex reporting process.
With community spread of the virus happening in several Texas counties, more people who have contracted the virus likely havent been tested. And Texas is lagging behind other large states in testing capacity. According to a Washington Post report, New York has processed seven times as many tests as Texas, although Texas has over 9 million more residents.
Some experts say the virus has spread past the point when testing would have made a difference; sick people need to go to the hospital, and people not showing symptoms need to stay home.
While larger, urban counties may have the testing resources to understand the scope of the virus in their areas, small communities are not there yet, Perrotta said.
Theres still pressure on parts of Texas to try to understand whats going on in their community so they know whether or not they should just continue to work on identifying cases and tracking down their contacts or consider everybody as having it, Perrotta said. Some places are ready to move forward and not worry about testing, but others are trying to make sure their efforts match the threat.
Disclosure: The University of Texas has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.
Coronavirus testing capacity has begun to expand, with drive-through testing starting up in many places. But experts warn we still need to vastly expand testing to control the outbreak. John Moore/Getty Images hide caption
Coronavirus testing capacity has begun to expand, with drive-through testing starting up in many places. But experts warn we still need to vastly expand testing to control the outbreak.
Stay inside, don't meet with friends, don't go to work these are the messages coming from public health officials at every level of government. But increasingly, experts say they believe those stark warnings must be augmented with another message:
If you think you might be sick, even a little sick, get tested for coronavirus.
"Everyone staying home is just a very blunt measure. That's what you say when you've got really nothing else," says Emily Gurley, an associate scientist at the Johns Hopkins Bloomberg School of Public Health. "Being able to test folks is really the linchpin in getting beyond what we're doing now."
Testing "is absolutely essential to control the epidemic," agrees Robert Gallo, director of the Institute of Human Virology at the University of Maryland School of Medicine and a co-discoverer of HIV. Gallo says that testing was a major factor in bringing the AIDS epidemic under control, and it will be needed here as well: "You make it as cheap as you can and you make it as simple as you can," he says.
Currently, the federal government's official position is that the vast majority of Americans shouldn't even bother trying to get tested. "If you don't have symptoms, you don't need a test," Vice President Pence told reporters during a White House briefing on Sunday.
Pence's statement came on the same day that Sen. Rand Paul tested positive for the coronavirus, despite having no symptoms. And a growing body of research suggests that Paul is hardly alone asymptomatic or mildly symptomatic people are likely a key reason coronavirus continues to spread relentlessly across the globe.
Even when people become sick, the federal government only recommends testing in limited circumstances. According to official CDC guidance, testing should be prioritized to those admitted to hospitals, health care workers and those at risk for complications from the disease. Everyone else should be prepared to ride out their illness, COVID-19 or otherwise, at home.
Ashish Jha, director of the Harvard Global Health Institute, says he believes that the Trump administration has some reason to set those guidelines. Early missteps created a huge shortage of tests in the U.S. "They're dealing with a reality, which is we have far fewer tests than we need right now," he says.
In addition to the lack of tests themselves, there are also reported shortages in basic equipment such as personal protective gear and swabs. Given all that, Jha agrees that health care workers and the very ill should be getting tested most often.
But Jha and other experts say as soon as we can, we need to take the following measures:
Massively expand testing
As soon as possible, the criteria for who gets tested will need to be broadened, he says. First it should be extended to close contacts of the very ill, so that they can be quarantined and monitored. Then the tests should be given to mildly ill people to see whether they have the disease. And finally, a segment of the population should be tested at random, to look for asymptomatic spreaders. "That's the priority list, I think most experts agree," he says.
Getting there could require around 150,000 tests a day, he says. The total number of Americans tested since the crisis began in February is only 250,000, according to Pence on Sunday. Over the past week commercial labs have gone from completing around 8,000 to around 50,000 tests per day, according to data from the American Clinical Laboratory Association. That data does not include state public health departments and other institutions such as universities.
Isolate the sick and trace their contacts
Testing will be just the first step on the road to recovery, Gurley says. In South Korea, wide testing has been accompanied by isolating people who are infected and sending all of their contacts into 14-day self-quarantine. "It's that self-quarantine that will take care of people transmitting before they become ill," she says.
The South Korean effort has seen testing sites and quarantine centers spring up across the country. It has required the mobilization of industry, government and health care workers at every level. But it seems to have worked. For now, the small country has managed to hold the virus at bay and keep down deaths from the disease.
The U.S., with its large population and decentralized government, will require a far greater effort, but it's not impossible, says Jeffrey Shaman, a professor of environmental health sciences at Columbia University. "They were doing [tens of thousands] a day in South Korea," he says. "So why the hell can't we do 10 times that?"
Gradually loosen shelter in place
Shaman says that there is little alternative than to build up testing. The shelter-in-place orders can't go on forever. "There are enormous economic, psychological and emotional costs associated with everybody becoming a hermit in a cave," he says. And when they're lifted, the virus could surge back again, as it appears to be doing in Hong Kong, which was initially successful in stopping its spread.
The lack of testing is already having consequences. The disease is now spreading exponentially, and Shaman warns that New York City and other American municipalities will likely be slammed in the coming weeks as an influx of sick patients flood ERs and ICUs.
"Things are definitely going to get worse before they get better," Gurley agrees. But she adds, "the sooner that we can get testing up and running, the better off we're going to be."
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Jackson Browne has tested positive for coronavirus. The 71-year-old musician told Rolling Stone that he had mild symptoms including a small cough and a temperature and was recuperating at home in Los Angeles.
I feel lucky that Im not really badly affected, he said. I guess Ive got a really strong immune system. Theres so much we dont know.
He told the magazine that he assumed he had contracted the virus while in New York for the Love Rocks NYC benefit earlier this month. He said he now regretted making the trip.
There was already a question of being careful and saying, Ill bump elbows and not shake hands and wont hug anybody. I wont behave like that at this show. But still, youre in close quarters and youre breathing the same air. They are swabbing the mics, but somebody in the crew has it. For all I know, he got it from me. I could have got it from the crew member that has it or he could have got it from me. I dont know. I travelled on an airplane to get there.
Browne counselled young people to take the virus seriously. So many people that have it arent going to be tested, he said. They dont have symptoms, but they might have it and might be able to pass it on. Thats what younger readers need to understand: They need to take part in the global response to stop the spread. That means not going anywhere, not getting into contact with anybody, not seeing anybody.
Browne said he had been in quarantine for 10 days and was passing the time by calling friends, listening to music and reading the news. He said it was important for people with the virus to share their experiences.
I dont think my case is that important, but it might be helpful to know that some people dont get this really bad. The idea that we can contribute to the overall herd immunity. You get over this as quickly as you can and be available to help others.
Brownes last solo album was 2014s Standing in the Breach. Earlier this year, he released Let the Rhythm Lead: Haiti Song Summit Vol 1, an all-star charity album featuring musicians including Jenny Lewis, Jonathan Wilson, Malian musician Habib Koit and Spanish flamenco guitarist Ral Rodrguez.
Browne is due to tour the US with James Taylor in May: the dates are still scheduled to go ahead, but are subject to change.
Dr. Tom Frieden, former head of the Centers for Disease Control and Prevention, warns of 'catastrophic scenes' in New York. USA TODAY
The United States'response to the COVID-19 pandemic is haphazard, uncoordinated and sorely missing the guidance of the U.S. Centers for Disease Control and Prevention, that agency's former director told USA TODAY on Tuesday.
And the "extraordinary" absence of the nation's lead public health agency at the forefront of the coronavirus fightmakesTom Frieden feel "less safe."
Now president of the nonprofit Resolve to Save Lives, Frieden advises other nations on how toorganize against epidemics. He said global best practice is to designateone incident manager reporting to ahealth department official who then communicates to the head of state.
Same virus, different approach:These 5 maps show how states differ on protecting Americans against coronavirus
That's not how it's working in the U.S.
Weve heard that FEMAs in charge. Weve heard that the vice presidents in charge. Weve heard that (U.S. Ambassador-at-Large) Dr. (Deborah) Birx is the coordinator. Weve heard that (Health and Human Services Secretary Alex)Azar is in charge of the task force. Whos on first here? Frieden told USA TODAYs Editorial Board on a video call.
Former CDC director Dr. Tom Frieden(Photo: Jasper Colt)
The one agency that definitely isnt in charge is the CDC, which Frieden directed from 2009 to 2017.
It's a stark reversal fromthe past, when the CDC not only took the lead in the U.S. but globally against the threat of infectious disease. From the SARS epidemic in 2002, to the 2009 H1N1 flu, the beginning of the Ebola outbreak in 2014 and through the 2015Zika virus outbreak, the CDCheld frequent and sometimes daily briefings as the coordination center for the U.S. government and beyond.
This time, however, the agency that has led every major epidemic response in the nation for the past seven decades is just not there, Frieden said. Its 700 professionals specifically focused on infectious and lung disease appear sidelined.
Fighting an epidemic without CDC involved at the decision table and at the podium is like fighting with one hand tied behind your back, he said.
A visual guide: What does the coronavirus do to your body?
In previous outbreaks, the CDC had often daily calls with reporters.This time, the CDC has had multiple news conferences canceled because if the White House is having a press conference, they cant have one, Frieden said. The last one archived on the CDCs media page is from March 9.
Asked about Frieden's comments, the CDC responded that it is still actively engaged in the country's COVID-19 response and working with the entirety of the federal government.
Robert Redfield, the current director of the CDC, is a member of the White House Coronavirus Task Force buthas rarely appeared in its almost daily video briefings.
In a wide-ranging conversation with the editorial board, Frieden also said testing for the coronavirus is being mismanaged.
The drive to get everyone everywhere tested for COVID-19 is simply wrong from a public health perspective, he said.In areas with many cases, no one other than people who need to be hospitalized for the illness caused by the virus should be tested.
Theres every reason to not get tested, he said. "If youve got mild symptoms, stay home!" Trying to get tested just meansusing up protective equipment, staff time and scarce test kits and might infect others.
Is it alive?A coronavirus pandemic is sweeping the world, but what exactly is a virus?
If youre positive, its not going to make any difference. Youre going to be told to stay home unless youre having trouble breathing. Then you need to go to the hospital."
In places with relatively few COVID-19 cases, however, testing makes sense, Frieden said. In these areaspublic health officials can track contacts, call for self-isolation and slow the spread of the disease.
He also disagreed with the focus of the Trump administration's task force on "high-throughput" testing. Quick-turnaround is whats needed, Frieden said.
That may sound like a technical difference but its a big difference, he said.
High-throughput testing requires using centralized labs and can take between a day to four days to get results. Thats useless to front-line medical professionals seeing large numbers of people in emergency rooms, he said. They need to know within an hour whether someone has coronavirus and should be admitted and put into quarantine.
And that's going to be increasingly important if, as Frieden predicted, a big wave of infections comes crashing down on the United States.
The severely ill patients today were infected 10 to 12 days ago. It takes about 10 days to get sick and 5 fivedays to get very sick, he said. There will be an exponential increase in cases."
That worries the 35-year public health veteran. The decentralization of the U.S. health system only works if there is clear guidance from the top, Frieden said.
We can expect innovation and proactive action from states and local areas," he said. "But we really need to have clear guidance and coordination at the federal level."
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Read: How you should get food during the pandemic
The primary concern for shoppers is other people, not food. Though shoppers might worry about infecting themselves by handling the same apple or Cheerios box as someone else, health experts say transmission through food or its wrapping is largely avoidable. Research suggests that the virus can exist on cardboard food packaging for a day, and on plastic for several days, but it becomes less infectious over these periods. My recommendation is just to wash your hands after you handle external packaging, Angela Rasmussen, a virologist at Columbia University, says. High-touch objects such as shopping-cart handles are a bigger concern, but many stores have provided sanitizing wipes for those.
Coughing humans, meanwhile, can be harder to escape. This is a manageable risk for shoppers who can go to the store at odd hours and use the self-checkout. But at a high risk of infection are the cashiers themselves, who stand just a few feet from hundreds of customers a day. They might pick up the virus through food and money the customer touches. And if the customer coughs or sneezes near an employee while in line, the likelihood of transmitting the virus through respiratory droplets is also high, says Brandon Brown, a professor at UC Riverside who has studied infectious diseases.
In this way, the pandemic has put grocery-store stockers and cashiers in an impossible situation. The country cant simply shut down grocery stores. Along with pharmacies, theyre an important lifeline for homebound Americans. But even essential shopping can endanger low-paid workers who are not trained in pandemic preparedness and have little choice but to show up for work.
Read: Exclusive: Amazon confirms first known coronavirus case in an American warehouse
To try to mitigate this threat, workers at various grocery stores have asked for face masks, says Hilary Thesmar of the Food Industry Association, or FMI, a trade group of grocery stores. FMI requested masks for workers from the federal government, she says, but it hasnt been able to procure them, because theres a national shortage and the priority is health-care workers. Marc Perrone, the president of the UFCW, says the union is pushing for the government to consider grocery-store workers on par with first responders, which might give them access to masks and gloves.
Even then, wearing masks and gloves might violate a stores rules. A Trader Joes employee in New York, who requested anonymity, said workers at their store have been told they are not allowed to wear gloves at the registers. They dont want to alter the appearance of normalcy, the worker told me through a Twitter account associated with a Trader Joes workers collective. (A spokesperson for Trader Joes denied this, saying in an email, While the CDC does not recommend use of gloves in a retail setting, our Crew Members may choose to wear them.)
Winfrey kept a sense of humor as she revealed on Instagram that Graham is actually self-quarantined in their guest house in Santa Barbara, California. She joined Oprah Magazine's digital director Arianna Davis to talk about how she's getting through her days.
"He's at the guest house, because you all know I had pneumonia late last year," Winfrey explained. "I had just gotten off of antibiotics last week, because I had a bronchial infection."
Graham had been traveling for a speaking engagement and arrived home off a flight, so the couple is being extra cautious.
"Stedman did not arrive from Chicago until Thursday, he had been speaking in St. Louis. He'd been on planes," Winfrey said, adding, "Stedman is like, 'What's the procedure for coming home?' The procedure is, you ain't coming and sleeping in my bed."
Winfrey continued: "Literally, he goes, 'I'm not?' And I go,'Have you not been paying attention to the news?' Social distancing does not mean you go and sleep in the same bed with the person when you just got off American Airlines."
She even showed Graham hanging out in the window of the guest house, where he said, "The meals are dropped off at the door."
"It's not too bad," he laughed.
Besides delivering meals to Graham, Winfrey said she's perfectly content in her own company.
"I'm never bored, because I always have myself," she said. "I never feel alone, have never felt alone, because I just love being with myself."
MADRID Across Western Europe, health care professionals have used the language of war to describe the struggle against the coronavirus, which has left some hospitals on the brink of collapse.
And health care workers are the soldiers on the front lines.
Out of Spains 40,000 confirmed coronavirus cases, 5,400 nearly 14 percent are medical professionals, the health ministry said on Tuesday. No other country has reported health care staff accounting for a double-digit percentage of total infections.
But the problem is widespread throughout Europe. In Italy, France and Spain, more than 30 health care professionals have died of the coronavirus, and thousands of others have had to self-isolate.
In Brescia province, the center of Italys outbreak, 10 to 15 percent of doctors and nurses have been infected and put out of commission, according to a doctor there.
In France, the public hospital system in Paris has tallied 490 infected staff members, a small but growing proportion of the systems 100,000 or so employees.
The same dynamics are starting to take hold in Britain and the United States, where the contagion is bearing down but has yet to fully bite.
At the La Paz hospital in Madrid, one of the largest in Spains capital, 426 employees 6 percent of the medical staff are isolated at home, after testing positive or showing possible symptoms of the coronavirus, according to internal numbers provided by a labor union that represents doctors in Madrid.
At the smaller Igualada hospital in Catalonia, a third of the 1,000 hospital staff has been sent home.
The virus was already among us when we were really only testing those who came from Wuhan and then from Italy, said ngela Hernndez Puente, a doctor who is the deputy secretary general of the doctors union. Some of our doctors unfortunately worked without adequate protection and acted as vectors.
As doctors, nurses and other practitioners fall sick, the burdens increase on health care systems already groaning under the strain of an expanding epidemic. And infected workers and their hospitals are increasingly being recognized as vectors for the spread of the virus.
The number of cases in Spain has been doubling every four days, and the country is fast shaping up as Europes next epicenter of the contagion. On Tuesday, Spains coronavirus toll reached 2,700 dead, the second-highest in Europe after Italy.
In Madrid, the focus of Spains outbreak, so many are dying that bodies are being placed in an Olympic-sized ice skating rink that has been converted into an emergency morgue.
In some retirement homes, soldiers deployed to disinfect the premises found elderly people abandoned, or dead in their beds, prompting Spains public prosecutors to open an investigation.
It has not helped that Spains population, on average, is among the worlds oldest. But the government was also late to impose restrictions on the movement of people.
Even as a tragedy unfolded in northern Italy, mass events went ahead earlier this month in Madrid, and the government waited until March 14 to declare a state of emergency that has since forced people to stay indoors, barring exceptional circumstances.
Spain also did not shore up its stock of medical equipment early on. Doctors and nurses have had to work with a dangerous shortage of masks, gloves and other essential gear that has proved disastrous for them.
The grim situation has left many of Spains health care professionals overwhelmed and pleading for more equipment, doctors, nurses and ambulance crews have told The New York Times. For those who have been infected, a feeling of powerlessness has sunk in.
You are used to taking care of others and now youre being asked to stay home and take care of yourself, said Marc Arnaiz, a doctor in the internal medicine unit of the Igualada hospital, who tested positive earlier this month.
For most of us this job is a vocation, so its shocking and frustrating, he said.
Mr. Arnaiz, 31, said he had likely been infected by a patient. He noticed the first symptoms on March 9, the day his patient was confirmed positive, among the first in the hospital, which has since become one of the worst infection clusters in northeastern Spain.
While its impossible to know how many patients infected doctors and vice versa, the alarming spread within hospitals has forced the government to struggle with a shortage of both professionals and equipment.
Last week, the government launched an emergency recruitment plan to add 50,000 health care workers, ranging from medical students to retired doctors.
After employees began complaining openly about the stresses on the system, some Madrid hospitals told their staff not to speak out. Many of those interviewed by The New York Times were not authorized to comment publicly and asked that their full names not be used for fear of retribution.
One, Yolanda, has been a nurse for 30 years, working in a public hospital in Madrid. But earlier this month, as the outbreak worsened in Spain, she said she was moved instead to a makeshift emergency ward, where she had to learn new skills on the job while working without decent protective gear.
Weve been put on the front line not only without enough protection, but also sometimes with the stress of a very different work environment, she said, noting that she had never before handled intubated patients. The nurses in her unit wore face masks and gowns, but they had to reuse them because of a shortage.
Putting on a face mask again and again is as useless as sticking a piece of paper on your face, she said.
Last Thursday, Yolanda went home feeling feverish. On Sunday, she tested positive for coronavirus, along with about 30 colleagues. We have done our best, but some of us sadly became part of the contamination chain, she said.
Hospital workers unions were less hesitant to point fingers.
When we already knew that the virus was circulating in hospitals, we were still being told that the usage of protective gear should be limited to specific circumstances, said Juanjo Menndez, the communications director of SATSE Madrid, a nurses union. Its the kind of basic error that a student learns to avoid in the first year of medical school.
In Spain, France and Italy, officials and health care professionals said they were shocked by equipment shortages.
Giorgio Gori, the mayor of Bergamo, one of the hardest hit towns in Italy, said the doctors werent protected, and lacked the sufficient defenses, adding that he was still receiving requests for masks and gloves from doctors making home visits.
Jean-Paul Hamon, the president of one of Frances biggest doctor unions, told the LCI television broadcaster on Tuesday that he was particularly worried about workers who are not in hospitals but are still in close contact with patients, like general practitioners or retirement home employees.
Three of the five doctors who have died of Covid-19 so far in France were general practitioners, and one was a gynecologist. The state is absolutely unprepared, said Mr. Hamon, who is himself infected. The state is going to owe an explanation.
In Spain, doctors warned that hospitals were now paying the price of the loose measures announced in the early days of the outbreak.
The lack of protection is everywhere, the improvisation seems to be widespread, said Antonio Antela, a doctor who coordinates the infectious disease unit at the university hospital of Santiago de Compostela, in northwestern Spain. He has been hospitalized for a week after developing pneumonia and testing positive.
The lesson is: take care of your public health care system, because there will be other epidemics and we ought to be better prepared, he added in a telephone interview from his hospital bed.
At a medical center in the heart of Madrid, Mara, another nurse who is now isolated at home with coronavirus, said that she spent several days working without a face mask and gloves, handing out masks only to visitors who reported breathing problems or had recently been in Italy.
On March 11, the day she first felt fever, her medical center finally ordered all staff to wear masks. We probably didnt have enough face masks, but we also acted for far too long as if this was a limited problem, mostly imported from Italy, she said.
The Spanish government is now stepping up efforts to buy medical equipment, as well as distributing about 650,000 new test kits across the country. Two Chinese cargo planes filled with face masks and other gear landed in Madrid and Zaragoza on Tuesday.
We are a target like everybody else, but we are also a threat to other co-workers, said Juan, a 37-year-old doctor in a Madrid public hospital. Also, if you test everyone and theres no health care workers left in the hospitals, what can you do?
Raphael Minder reported from Madrid and Elian Peltier from Barcelona. Reporting was contributed by Jason Horowitz in Rome and Aurelien Breeden in Paris.
Mar 23rd 2020
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.
TWO WEEKS ago Xi Jinping, Chinas president, made a triumphal visit to Wuhan, capital of Hubei province, ravaged by covid-19, to declare that the virus had been basically curbed. His first stop was a hospital built at breakneck speed and run by the Peoples Liberation Army (PLA). Now armies across the world are temporarily putting down their guns and playing a frontline role in the war against the virus. That will ease the burden on overwhelmed civilians, but it may have far-reaching implications for the forces military proficiency.
In Italy and Spain, where death rates have spiralled upwards in recent weeks, thousands of soldiers have been deployed to quarantined cities to patrol the streets and enforce lockdowns. Turin seems to have conformed to the rules and camouflages, noted La Stampa, an Italian newspaper. In Bergamo rows of army trucks carried away bodies to ease the load on overflowing crematoriums. Hungary, Lebanon, Malaysia and Peru have all sent their armies to cajole recalcitrant citizens back into the safety of their homes.
Many countries are uncomfortable with state-mandated lockdowns, enforced by gun-toting soldiers. But they have found other uses for their soldiers. Armed forces are good at mounting big logistical operations at short notice. They have lots of pliant manpower and heavy vehicles, and expertise in moving large amounts of stuff from one place to another. In an average week, the Pentagons Transportation Command conducts more than 1,900 air missions and 10,000 ground shipments. The military has the capacity to plan while it is implementing in a way that most of the civil service does not, says Jack Watling of the Royal United Services Institute, a think-tank in London.
On March 19th Britain, which had thus far taken a laxer approach to the enforcement of social distancing than Italy or France, announced a new COVID support force, which will comprise over 20,000 personnel, bolstered with reservists. Military planners will be deployed to Regional Resilience Councils to identify and resolve bottlenecks in the provision of medical care for the most vulnerable, says Mr Watling. Other military personnel are being trained to drive oxygen tankers for the National Health Service. Other countries are doing much the same. On March 22nd National Guard (ie, reservist) units in three statesCalifornia, New York and Washingtonwere deployed to perform similar duties.
Armed forces are also well placed to help out overloaded health-care systems. For one thing, they often have large stockpiles of vital medical kit. The Pentagon has promised to hand over 5m respirator masks and 2,000 ventilators to civilian authorities. They tend to be good at rapid innovation, too. Israel's military-intelligence technology unit is not only producing low-tech masks, but also working on the conversion of simple breathing-support devices into more advanced ventilators, according to the Times of Israel. Britains Defence Science and Technology Laboratory at Porton Down, which has expertise in biological threats, is supporting the development and testing of vaccines, and the mapping of covid-19 cases. The US Army alone is working on 24 vaccine candidates, in collaboration with other agencies and companies.
Wartime experience can also yield useful insights for civilian medicine. The development of mechanical ventilators to ease Acute Respiratory Distress Syndrome (ARDS)a potentially fatal condition in which lungs cannot provide vital organs with enough oxygen, common in patients who die of covid-19emerged from work during the second world war. In recent decades military doctors have made important contributions to advances in ventilation and intensive care.
Military medics also train to operate amid chaos, with insufficient infrastructure and resources. Since January 25th China has sent over 10,000 military personnel into Hubei. In Wuhan, control of medical and essential supplies was handed entirely to the PLA. In Mulhouse in eastern France, where local hospitals have been overwhelmed, army medics are building a 30-bed field hospital for covid-19 cases. Mexicos president, who said last summer that he hoped to disband the army, has given control of ten new hospitals to the army and navy.
Elsewhere military doctors are taking on more routine cases to free up hospitals for the flood of more serious ones. America is sending a pair of naval hospital ships to Los Angeles and New York to release medical capacity for covid-19 patients; the army is preparing two mobile hospital units. Switzerlands citizen army has sent one of its four 600-strong hospital battalions to support civilian hospitals.
Military medical aid can also be a tool of diplomacy. On March 22nd Russias army, whose operatives are more accustomed to using toxic substances to poison foes around Europe than cleaning them up, began sending nine transport planes full of military disinfectant vehicles, eight brigades of medics, about 100 virologists and epidemiologists, and testing kits to the worst-affected parts of Italy. The lorries and planes bore the slogan From Russia with Love, in Russian and Italian.
It is understandable that overwhelmed states want to mobilise their armies for policing, logistics and medicine. But armed forces are designed first and foremost for killing people, rather than issuing fines on street corners or delivering food to supermarkets. And covid-19 will affect military preparedness, both directly and indirectly.
Military personnel are typically young and fita group that has been better able to shake off the effects of the virus. But they are not immune. Over half of coronavirus cases in New York state are aged 18 to 49. Troops often live in close quarters, increasing the likelihood and pace of transmission.
Irans Islamic Revolutionary Guard Corps, the countrys main armed force, is believed to have been hit badly by the epidemic; a veteran general died on March 13th. The army chiefs of Italy and Poland have both tested positive for covid-19. By March 23rd 133 American military personnel had been infected by the virus. On March 22nd a Pentagon contractor became the first American military fatality of the covid-19 pandemic. Many experts ridicule Chinas claim that not a single member of the PLA has been infected.
But even if armies do shrug off the immediate health effects of covid-19, the disruption to their work will have longer-lasting consequences. Self-isolating officers cannot gain access to classified networks from their homes, so many will have their productivity drastically limited. Meia Nouwens, of the International Institute for Strategic Studies, another think-tank in London, says that the crisis has disrupted the supply chains for Chinas defence industry.
Social distancing is also preventing armies from honing their fighting skills. Britain has halted almost all its basic training for new recruits. On March 11th Norway called off joint exercises with America and European allies in the Arctic, shortly after 23 American soldiers were quarantined after exposure to an infected Norwegian colleague. Two days later America scaled down Defender 2020, an exercise that would have involved the largest deployment of American troops to Europe since the cold war. Americas top general in Europe was forced to self-isolate after crossing paths with an infected Polish general at a planning meeting for the exercise.
Other European drills have been cancelled entirely; America and South Korea have postponed their annual joint exercises. But armies that stop exercising are liable to grow rusty. The challenge is when you have the next armoured battlegroup coming through and they havent done a stint in BATUS [the British Armys training area in Canada], for instance, do they still have a certification to deploy into NATO? asks Mr Watling. On March 23rd Russia offered at least a little respite, saying that it had called off war games on its western borders as a sign of good will.
Yet as armies grapple with the pandemic, geopolitical jostling goes on. On March 10th, as Mr Xi visited Wuhan, Americas navy conducted a so-called freedom of navigation operation near a Chinese-controlled island in the South China Sea. On March 19th at least 29 Malian soldiers were killed by suspected jihadists. A day later two Turkish soldiers were killed in a rocket attack in Syrias Idlib province, and two dozen policemen and soldiers were shot dead in Afghanistan. Troops may be distracted and diverted, but war does not pause for viruses.
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The Justice Department has also set up a task force to address hoarding and price gouging related to supplies urgently needed for the fight against the virus.
Attorney General Bill Barr said during a briefing at the White House on Monday that hoarding of supplies like masks would be prosecuted. However, memos issued by Barr and Rosen on Tuesday said the Department of Health and Human Services has yet to formally designate the health-related items the administration wants covered by the Defense Production Act.
The task force pursuing such issues will be headed by U.S. Attorney for New Jersey Craig Carpenito, and it will include someone from each U.S. Attorneys Office and other Justice Department units, Barr said.
