Notes: Deaths are plotted on a log scale. Doubling times are based on growth rates averaged over the previous week. Other countries or areas with coronavirus deaths: Iraq (20), Canada (20), San Marino (20), Algeria (17), Austria (16), Greece (16), Malaysia (14), Portugal (14), Ecuador (14), Egypt (14), Norway (8), Luxembourg (8), India (8), Australia (7), Hungary (7), Poland (7), Pakistan (6), Albania (5), Peru (5), Hong Kong (4), Burkina Faso (4), Argentina (4), Morocco (4), Lebanon (4), Ireland (4), Romania (4), Bulgaria (3), Tunisia (3), Panama (3), Slovenia (3), Bangladesh (3), Dominican Rep. (3), Ukraine (3), Singapore (2), Costa Rica (2), Bahrain (2), U.A.E. (2), Colombia (2), Serbia (2), North Macedonia (2), Mauritius (2), Mexico (2), Taiwan (2), Guatemala (1), Nigeria (1), Moldova (1), Lithuania (1), Cayman Islands (1), Jamaica (1), Iceland (1), Paraguay (1), Afghanistan (1), Israel (1), Russia (1), Sudan (1), Croatia (1), Guyana (1), Montenegro (1), Gambia (1), Thailand (1), Ghana (1), Gabon (1), Finland (1), Czech Republic (1), Cyprus (1), Cuba (1), Andorra (1), Chile (1), Congo (1), Bosnia and Herzegovina (1), Azerbaijan (1), Curaao (1).
Donald Trump has signalled a potential change in his handling of the coronavirus pandemic, amid warnings of a record plunge in economic activity and unemployment potentially hitting 30%.
Writing in capital letters in a tweet late on Sunday, the US president said: We cannot let the cure be worse than the problem itself. At the end of the 15-day period of White House guidelines to enforce social distancing and other measures which began on 16 March we will make a decision as to which way we want to go.
Mike Pence, who heads the White House coronavirus task force, said earlier in the day the federal Centers for Disease Control and Prevention (CDC) would issue guidance on Monday meant to allow people already exposed to the coronavirus to return to work sooner.
The shift in tone could foreshadow a clash between a White House alarmed by economic paralysis in an election year and public health experts urging caution. The US now has more than 39,000 confirmed cases of coronavirus and more than 400 deaths.
After being criticised for a slow response to the crisis, Trump declared a national emergency and agreed to implement drastic measures. But the economic pain was swift. Last week the Wall Street Journal editorial board warned that federal and state officials need to start adjusting their anti-virus strategy now to avoid an economic recession that will dwarf the harm from 2008-2009.
Bret Stephens, a conservative columnist at the New York Times, which Trump monitors closely, wrote on Sunday that treating the virus as a threat comparable to the second world war needs to be questioned aggressively before we impose solutions possibly more destructive than the virus itself.
And Tom Fitton, a conservative commentator known to influence the president, tweeted: The consequences of this national shutdown, apart from any pandemic, are dire and will not be materially alleviated by any stimulus and [government] spending. The only stimulus that will work is opening America back up for business.
The change came as central bankers warned of unprecedented fallout. The St Louis Fed chief, James Bullard, said Americas GDP could shrink 50%, with unemployment rising to 30% in the second quarter. On Wall Street, Morgan Stanley saw a 30% contraction, driving unemployment to 12.8%.
The Federal Reserve said: Aggressive efforts must be taken across the public and private sectors to limit the losses to jobs and incomes and to promote a swift recovery once the disruptions abate.
The central bank said it was using its full range of authorities to provide powerful support for the flow of credit to American families and businesses.
In the Senate, attempts to pass a far-reaching stimulus package floundered and a Republican senator, Rand Paul of Kentucky, was revealed to have Covid-19.
Democrats said the $1.8tn proposals were weighted toward a corporate bailout at the expense of workers, hospitals and state and local governments. Republicans claimed Democrats were obstructing the bill in the middle of a national emergency. Both sides said they were confident a deal could still be agreed.
Trump warned that a rattled American public would take a dim view of an impasse. The only reason a deal couldnt get done is pure politics, he said on Sunday.
On Monday the likely Democratic presidential nominee, Joe Biden, said Trump should start acting like the the wartime president he has claimed to be.
The stalemate in the Senate was felt in the markets, where Dow Jones Industrial Average futures dropped more than 600 points.
In New York, which contributes close to half of the US tally, 15,168 cases, the governor, Andrew Cuomo, said an estimated 40% to 80% of residents could be infected but echoed the Trump administrations impatience to reboot the economy.
I take total responsibility for shutting off the economy in terms of essential workers but we also have to start to plan the pivot back to economic functionality, Cuomo told reporters in Albany. You cant stop the economy forever.
So we have to start to think about does everyone stay out of work, should young people go back to work sooner, can we test for those who had the virus, resolved and are now immune, and can they start to go back to work?
Cuomo, who has been praised for his handling of the crisis, added: We implemented New York pause, which stopped all the essential workers, etc. We have to start to think about New York forward How do you restart, or transition to, a restart of the economy?
Decisions to quarantine one in three Americans and shut down non-essential businesses in several large states, including New York, New Jersey, Illinois and California, have effectively frozen the service and manufacturing sectors of the US economy.
Measures being considered by legislators include financial aid for regular Americans, small businesses and critically affected industries including airlines, which have warned they may not survive without at least $50bn in government support.
Chuck Schumer of New York, the top Senate Democrat, has said more money is needed for community health centers, nursing homes, masks, ventilators, personal protective equipment and aid to state and local governments. The Republican majority leader, Mitch McConnell, of Kentucky, has urged Democrats to stop delaying aid and hurting financial markets.
Negotiations with the treasury secretary, Steven Mnuchin, continued on Monday. The House speaker, Nancy Pelosi, said that should the Senate fail, Democrats there would craft an alternative bill.
Meanwhile health officials warned of a dire shortage of protective masks and growing pressure to increase available ventilators. Trump has resisted pleas by governors to fully use his powers under the Defense Production Act, which can compel companies to produce vital equipment.
The surgeon general, Dr Jerome Adams, told NBC: I want America to understand this week its going to get bad. We really need to come together as a nation we really, really need everyone to stay at home.
The early signs in South Korea were alarming. In late February and early March, the number of new coronavirus infections exploded from a few dozen, to a few hundred, to several thousand.
At the peak, medical workers identified 909 new cases in a single day, Feb. 29, and the country of 50 million people appeared on the verge of being overwhelmed. But less than a week later, the number of new cases halved. Within four days, it halved again and again the next day.
On Sunday, the country reported only 64 new cases, the fewest in nearly a month. As new infections in wealthier countries like the United States and Germany soar to thousands daily, South Koreas have stabilized.
South Korea is one of only two countries with large outbreaks, alongside China, to flatten the curve of new infections. And it has done so without Chinas draconian restrictions on speech and movement, or lockdowns like those in Europe and the United States.
Italy, whose outbreak initially paralleled South Koreas, now reports thousands of new cases daily, and hundreds of deaths 793 on Saturday alone. In South Korea that day, Covid-19, the disease caused by the virus, killed two people. Some days, the toll is zero.
The head of the World Health Organization, Tedros Adhanom Ghebreyesus, has hailed South Korea as demonstrating that containing the virus, while difficult, can be done. He urged countries to apply the lessons learned in Korea and elsewhere.
South Korean officials caution that their successes are tentative. A risk of resurgence remains, particularly as epidemics continue raging beyond the countrys borders.
Still, as global deaths from the virus surge past 15,000, devastating health care systems and economies, officials and experts worldwide are scrutinizing South Korea for lessons. And those lessons, while hardly easy, appear relatively straightforward and affordable: swift action, widespread testing and contact tracing, and critical support from citizens.
President Emmanuel Macron of France and Prime Minister Stefan Lfven of Sweden have both called South Koreas president, Moon Jae-in, to request details on the countrys measures, according to Mr. Moons office.
Scott Gottlieb, a former commissioner of the Food and Drug Administration, has repeatedly raised South Korea as a model, writing on Twitter, South Korea is showing Covid-19 can be beat with smart, aggressive public health.
Just one week after the countrys first case was diagnosed in late January, government officials met with representatives from several medical companies. They urged the companies to begin immediately developing coronavirus test kits for mass production, promising emergency approval.
Within two weeks, though South Koreas confirmed cases remained in the double digits, thousands of test kits were shipping daily. The country now produces 100,000 kits per day, and officials say they are in talks with 17 foreign governments about exporting them.
Officials also swiftly imposed emergency measures in Daegu, a city of 2.5 million where contagion spread fast through a local church.
South Korea could deal with this without limiting the movement of people because we knew the main source of infection, the church congregation, pretty early on, said Ki Mo-ran, an epidemiologist advising the governments coronavirus response. If we learned about it later than we did, things could have been far worse.
South Koreans, unlike Europeans and Americans, were also primed to treat the coronavirus as a national emergency, after a 2015 outbreak of Middle East respiratory syndrome in the country killed 38.
The coronavirus is thought to have a five-day incubation period, often followed by a period of mild symptoms that could be mistaken for a cold, when the virus is highly communicable. This pattern creates a lag of a week or two before an outbreak becomes apparent. What looks like a handful of cases can be hundreds; what looks like hundreds can be thousands.
Such characteristics of the virus render the traditional response, which emphasizes lockdown and isolation, ineffective, said Kim Gang-lip, South Koreas vice health minister. Once it arrives, the old way is not effective in stopping the disease from spreading.
South Korea has tested far more people for the coronavirus than any other country, enabling it to isolate and treat many people soon after they are infected.
The country has conducted over 300,000 tests, for a per-capita rate more than 40 times that of the United States.
Testing is central because that leads to early detection, it minimizes further spread and it quickly treats those found with the virus, Kang Kyung-wha, South Koreas foreign minister, told the BBC, calling the tests the key behind our very low fatality rate as well.
Though South Korea is sometimes portrayed as having averted an epidemic, thousands of people were infected and the government was initially accused of complacency. Its approach to testing was designed to turn back an outbreak already underway.
To spare hospitals and clinics from being overwhelmed, officials opened 600 testing centers designed to screen as many people as possible, as quickly as possible and keep health workers safe by minimizing contact.
At 50 drive-through stations, patients are tested without leaving their cars. They are given a questionnaire, a remote temperature scan and a throat swab. The process takes about 10 minutes. Test results are usually back within hours.
At some walk-in centers, patients enter a chamber resembling a transparent phone booth. Health workers administer throat swabs using thick rubber gloves built into the chambers walls.
Relentless public messaging urges South Koreans to seek testing if they or someone they know develop symptoms. Visitors from abroad are required to download a smartphone app that guides them through self-checks for symptoms.
Offices, hotels and other large buildings often use thermal image cameras to identify people with fevers. Many restaurants check customers temperatures before accepting them.
When someone tests positive, health workers retrace the patients recent movements to find, test and, if necessary, isolate anyone the person may have had contact with,a process known as contact tracing.
This allows health workers to identify networks of possible transmission early, carving the virus out of society like a surgeon removing a cancer.
South Korea developed tools and practices for aggressive contact tracing during the MERS outbreak. Health officials would retrace patients movements using security camera footage, credit card records, even GPS data from their cars and cellphones.
We did our epidemiological investigations like police detectives, Dr. Ki said. Later, we had laws revised to prioritize social security over individual privacy at times of infectious disease crises.
As the coronavirus outbreak grew too big to track patients so intensively, officials relied more on mass messaging.
South Koreans cellphones vibrate with emergency alerts whenever new cases are discovered in their districts. Websites and smartphone apps detail hour-by-hour, sometimes minute-by-minute, timelines of infected peoples travel which buses they took, when and where they got on and off, even whether they were wearing masks.
People who believe they may have crossed paths with a patient are urged to report to testing centers.
South Koreans have broadly accepted the loss of privacy as a necessary trade-off.
People ordered into self-quarantine must download another app, which alerts officials if a patient ventures out of isolation. Fines for violations can reach $2,500.
By identifying and treating infections early, and segregating mild cases to special centers, South Korea has kept hospitals clear for the most serious patients. Its case fatality rate is just over one percent, among the lowest in the world.
There arent enough health workers or body-temperature scanners to track everybody, so everyday people must pitch in.
Leaders concluded that subduing the outbreak required keeping citizens fully informed and asking for their cooperation, said Mr. Kim, the vice health minister.
Television broadcasts, subway station announcements and smartphone alerts provide endless reminders to wear face masks, pointers on social distancing and the days transmission data.
The messaging instills a near-wartime sense of common purpose. Polls show majority approval for the governments efforts, with confidence high, panic low and scant hoarding.
This public trust has resulted in a very high level of civic awareness and voluntary cooperation that strengthens our collective effort, Lee Tae-ho, the vice minister of foreign affairs, told reporters earlier this month.
Officials also credit the countrys nationalized health care system, which guarantees most care, and special rules covering coronavirus-related costs, as giving even people with no symptoms greater incentive to get tested.
For all the attention to South Koreas successes, its methods and containment tools are not prohibitively complex or expensive.
Some of the technology the country has used is as simple as specialized rubber gloves and cotton swabs. Of the seven countries with worse outbreaks than South Koreas, five are richer.
Experts cite three major hurdles to following South Koreas lead, none related to cost or technology.
One is political will. Many governments have hesitated to impose onerous measures in the absence of a crisis-level outbreak.
Another is public will. Social trust is higher in South Korea than in many other countries, particularly Western democracies beset by polarization and populist backlash.
But time poses the greatest challenge. It may be too late, Dr. Ki said, for countries deep into epidemics to control outbreaks as quickly or efficiently as South Korea has.
China turned back the catastrophic first outbreak in Hubei, a province larger than most European countries, though at the cost of shutting down its economy.
South Koreas methods could help the United States, though we probably lost the chance to have an outcome like South Korea, Mr. Gottlieb, the former F.D.A. commissioner, wrote on Twitter. We must do everything to avert the tragic suffering being borne by Italy.
Max Fisher reported from New York, and Choe Sang-Hun from Seoul, South Korea.
After a week of Congress members and the Trump administration proposing various plans to get cash into the hands of Americans to help them weather the coronavirus crisis, Senate Republicans appear to have landed on a plan. While details are still being negotiated, it appears likely that what changes to the cash measures will be made will change how the cash is delivered, not how much and to whom.
The Coronavirus Aid, Relief, and Economic Security (CARES) Act, or the phase three coronavirus bill, includes, as of now, cash measures totaling $301 billion per the conservative Tax Foundation, the only think tank that has modeled the exact proposal as of this writing.
The plans provisions are very simple. Adults would get $1,200 each and children $500 each. At higher incomes, the checks would get smaller: The benefit would start decreasing at a rate of $5 for every additional $100 in income. The phaseout starts at $75,000 in adjusted gross income for singles, $112,500 for heads of household, and $150,000 for married couples filing jointly; it would phase out entirely by $99,000 for singles and $198,000 for couples (with no children).
For example, a single childless person with an AGI of $85,000 would get $700 because $500 of the benefit was phased out by their higher income.
Unlike some early Senate Republican proposals, there is no minimum income (which wouldve excluded very poor people), and the check amounts dont phase in, so the middle class doesnt get more than the poor.
Here is how that policy looks in graph form:
The check is a one-off. While Senate Democrats like Michael Bennet (CO), Cory Booker (NJ), and Sherrod Brown (OH) called for additional checks to be triggered by changes in the unemployment rate, and left-leaning members of Congress like Sen. Bernie Sanders (I-VT) and Reps. Maxine Waters (D-CA), Ilhan Omar (D-MN), and Rashida Tlaib (D-MI) called for monthly payments, the Senate bills cash portion wont re-up unless Congress explicitly authorizes additional cash assistance. Treasury Secretary Steve Mnuchin had signaled he wanted two installments but faced pushback from some Senate Republicans like Lindsey Graham (SC).
The Tax Foundation estimates that 93.6 percent of tax filers will get a check. Using a conventional measure (that is excluding dynamic effects), they find that the poorest fifth of Americans will see their income grow by 16.33 percent due to the bill while the top 1 percent wont see their incomes grow at all. One hundred percent of the poorest Americans would be eligible for a rebate, a huge change from the earlier Senate GOP proposal where as little as 80 percent of poor households were eligible.
The phase-out for top earners will be done using 2019 tax returns or 2018 returns if the taxpayer in question hasnt filed their 2019 taxes yet. The bill says that taxpayers relying on Social Security as part of retirement or through the Social Security Disability Insurance program can have their Social Security Administration data used directly; beneficiaries of Supplemental Security Income, which often benefits old or disabled people in poverty, are not included in the current version.
But its important to note that a large minority of Americans dont file taxes. The Tax Policy Center estimates that in 2019, about 43.8 percent of American tax units owed zero or negative income taxes. Most of those Americans will still file taxes to get refundable credits like the Earned Income Tax Credit or to retrieve taxes withheld by their employer that they dont actually owe. But millions of Americans 12 percent is a decent estimate will not file taxes, either because theres no reason to or because theyre among the millions eligible for the EITC who dont receive it.
The Senate bill as written would require these people to file 2019 returns to get their coronavirus checks. Thats a potentially significant burden, especially at a time when the IRSs volunteer tax prep centers for low-income people are largely shut down due to social distancing (I should know Ive been volunteering this tax season and havent gone in since March 14).
Senate Democrats have included among their demands a request that the bill be amended to allow cash to go more directly to these people. Some of them are addressed by the Social Security language already in the Senate GOP bill, but more could be included by allowing the benefits to be sent through EBT cards to people benefiting from welfare or food stamps, or by allowing it to be added the Supplemental Security Income checks for elderly or disabled poor people, or by allowing states to send the rebates to households whose information they have on file. The Center on Budget and Policy Priorities Robert Greenstein lays out some options here.
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Good morning.
(If you dont already get California Today delivered free to your inbox, heres the sign-up.)
Over the weekend, roughly 40 million Californians adjusted to life under a sweeping new order to stay at home, even as questions lingered about what, exactly, that means.
For small businesses, there was plenty of confusion over how it was determined whether they were essential.
[What does it mean to shelter in place?]
My colleagues Conor Dougherty and Thomas Fuller reported that even in the Bay Area, already several days into its massive containment experiment, there was plenty of room for interpretation.
Rather than get bogged down in questions, Matt Haney, a member of the San Francisco board of supervisors, said hes advising businesses to simply think of the common good.
On Wednesday, a gin distillery that had been deemed as nonessential asked him if it could convert into a factory that makes hand sanitizer.
In normal times, Mr. Haney said, that request would be met with various permitting requests and neighborhood and civic meetings that together would take months or years to satisfy, if it was possible at all. His advice: If youre able to make hand sanitizer, then do it.
[What does it mean to call in the National Guard?]
Theres no decision maker in an office somewhere stamping expedited permits, he said. Theres a wartime feel to it, where if you are doing something that is contributing to public health then thats the right thing to do.
Local leaders have been emphasizing that they dont want to punish people who violate the restrictions.
But theyve said that as theyve encountered residents or businesses not complying, enforcement is likely to ramp up.
The police chief of San Jose, Eddie Garcia, said Friday that his officers had already broken up gatherings in the city. The city also ordered a gun shop closed earlier this week. (Gun shops were declared nonessential by Mayor Sam Liccardo.)
Chief Garcia said he was incredulous at some of the businesses that tried to stay open.
A billiards hall. Are you kidding me? he said. I dont know how a billiards hall thought they could be open through this time.
[Heres what to know before you go to the grocery store.]
As the weekend wore on, big outdoor spaces explicitly exempted from new restrictions were crowded with people grasping for some sense of normalcy.
In the East Bay, The San Francisco Chronicle reported, parks and beaches were so packed that officials may be forced to close some of them.
San Diegans flocked to beaches and parks, according to The San Diego Union-Tribune, prompting county health officials to plead with residents to stay home.
In Malibu on Saturday, hikers on a wide trail mostly edged away from one another as they passed, even if their ecstatic dogs played together under a clear blue sky. Some, however, walked in larger groups down the center of the path.
A group of young roommates narrated their walk to a phone. An older woman wore a T-shirt that read, Stay Away, written in marker, accented by a hand-drawn heart.
[Read about how warmer weather may slow, but not stop, the spread of the coronavirus.]
Mayor Eric Garcetti of Los Angeles said on Sunday that after seeing the flood of people heading toward the water in Venice, hed be working with other leaders around the county to close beach parking lots, and if necessary, close off beaches altogether.
Your decision to not physically distance yourself may kill someone, he said. Dont take risks, dont mess around, dont be selfish.
[Check here for statistics and more information about the coronavirus outbreak in California.]
Heres more about which businesses are considered essential:
On Friday, after the statewide stay-at-home order went into effect, officials posted a longer document laying out which workers and businesses are considered essential and how theyd be allowed to operate.
Among the businesses that will be allowed to keep operating are convenience stores that sell food, liquor stores, cannabis dispensaries and laundromats.
You can read the list in full here, though state officials have said the directive could evolve in days and weeks to come.
[Read more about which industries and companies are hiring a lot.]
We often link to sites that limit access for nonsubscribers. We appreciate your reading Times coverage, but we also encourage you to support local news if you can.
President Trump approved a major disaster declaration that Mr. Newsom had requested earlier on Sunday. The move will bring more federal resources to help California fight the Covid-19 outbreak.
Pacific Gas & Electric reached a deal with the governor, clearing a major hurdle to exiting bankruptcy. (The plan needs a judges approval, but a signoff from the governor makes that more likely.) [The New York Times]
Firefighters are finding themselves squeezed from both sides amid the pandemic, which could make wildfire season much more difficult. [The New York Times]
And Hayward is set to open a coronavirus testing center that will prioritize emergency workers. [KQED]
As requested, the U.S. Navy is set to send a 1,000-bed hospital ship to the Port of Los Angeles this week. Its based in San Diego. [City News Service]
Want to understand how the coronavirus spread across the world? Heres a graphic explainer. [The New York Times]
Through this whole ordeal, we didnt want her to get lost in the story. Thousands of people have been dying from the coronavirus. Theyve been laid to rest without big gatherings. But the family of Loretta Mendoza Dionisio, outgoing and unstoppable, wanted her to be remembered as more than a statistic. [The New York Times]
[Read the latest updates on the coronavirus pandemic here.]
I dont know about you, but last week felt like a lifetime to me. And this week seems unlikely to be any less strange and anxiety-ridden.
Well have some more pet photos soon, but first, here are some tips for staying sane. They include setting small, achievable goals, finding joy and turning your panic into service. (Heres a list of organizations to get you started, if youre in a position to donate.)
And on the bright side, you can go to the hottest parties happening anywhere, and you can stay in your sweats; theyre all happening online.
California Today goes live at 6:30 a.m. Pacific time weekdays. Tell us what you want to see: CAtoday@nytimes.com. Were you forwarded this email? Sign up for California Today here and read every edition online here.
Jill Cowan grew up in Orange County, graduated from U.C. Berkeley and has reported all over the state, including the Bay Area, Bakersfield and Los Angeles but she always wants to see more. Follow along here or on Twitter, @jillcowan.
California Today is edited by Julie Bloom, who grew up in Los Angeles and graduated from U.C. Berkeley.
Italys reported coronavirus death toll grew to more than 4,000 on Friday, outpacing China, a country with more than 20 times its population. The Italian health care system is now buckling under the weight of the pandemic. Health care professionals are working day and night to keep critically ill Covid-19 patients alive, while wartime triage conditions have left doctorsto decide who lives and who dies. The crematorium in the hard-hit city of Bergamo is so overwhelmed that the army was brought in to deal with the corpses.
It could be a matter of weeks or even days before something similar happens here, Dr. Tom Frieden, the former director of the Centers for Disease Control and Prevention, told The Intercept.
Right now, the major concern that I have, and that other public health experts have, is the risk of outstripping health care capacity, said Frieden, who is currently a senior fellow for global health at the Council on Foreign Relations. This would be catastrophic. Its what were seeing in Italy now, and its what we could see in communities around the U.S. soon.
Frieden stressed the importance for healthy individuals of regular hand-washing and called for the medically vulnerable to self-isolate and stay 6 feet away from almost everyone. Weve seen terrible examples from Italy and Wuhan [in China] of thousands of health care workers getting infected, and we know that in the U.S. now, many health care workers have become infected.
New modeling and estimates point to a nightmare scenario in which there could be a tenfold greater need in the United States for intensive-care beds and ventilators than are available, Frieden said. What were hoping is that kind of peak that outstrips the health care system [as in Italy] does not come here, he told The Intercept. If it did, it could come in a matter of days to weeks.
Last week, Frieden published a worst-case but not implausible scenario in which he warned that Covid-19 could potentially cause 1 million deaths in the United States alone.
Whether the U.S. health care system buckles like Italys really depends on how vigorously and promptly we do social distancing, said Frieden, who was also a former commissioner of the New York City Health Department. The models suggest that you have about a week from where there is unlinked community transmission to have everyone hunker down and stay home, stop working, [and] stop interacting socially.
Many Americans have ignored these proscriptions, packing bars in Nashville and beaches in Miami. Others, like President Donald Trump, have likened Covid-19 to seasonal influenza. That comparison is flawed, according to Frieden. This is an unprecedented pandemic. Just to give you a sense of how unusual it is, it is the first time a new [respiratory] pathogen has been tracked to emerge, infect people in the lungs, and spread all around the world, he explained. It is also the most societally disruptive infectious disease event in more than 100 years, since the great influenza pandemic of 1918 to 1919.
In Italy, shops are shuttered, streets are deserted, and 60 million Italians are under what amounts to house arrest. An emergency law enacted last week banned civil and religious ceremonies, including funerals, to prevent the spread of Covid-19. But in some places like the Sicilian town of Porto Empedocle locals have attempted to defy the order, which carries a penalty of three months in jail.
The coronavirus spreads person to person, but much is still unknown about how infectious it is. Weve seen examples of about a 10 to 15 percent household attack rate, which means that not everyone in the same household as one patient who has the disease gets it, Frieden explained. He noted, however, that anecdotal evidence from cruise ships indicates that most crew members who shared rooms with someone with Covid-19 became infected themselves.
If Americans fail at social distancing, Frieden emphasized, the results could be disastrous and lead to what he calls an explosive transmission phase. This could be set off by super-spreading events, where a contaminated elevator button or doorknob leads to a large number of secondary transmissions. In earlier stages of the outbreak, that kind of transmission occurred, for example, when a person infected abroad returned home and transmitted the virus to their spouse or someone else in close contact.
Such a spike could overwhelm the capacity of Americas health care quickly. But even if the United States avoids catastrophe in the near term, the risk would go on for months, said Frieden, until we have a better sense of how to control this, and a better capacity to rapidly identify cases as they arise, shut down clusters before they become outbreaks, and tamp down outbreaks before they become epidemics.
The arc of coronavirus cases in Italy is frightening, continuing to jump by hundreds each day. But a public-health official looking at those numbers will see definite signs that the nationwide lockdown, imposed to keep individuals apart and the virus from spreading, is working.
The data look very different when plotted on what is called a logarithmic scale. In a typical graph, values on the (vertical) y-axis are plotted linearly: 1, 2, 3, and so on, or 10, 20, 30, or the like. By contrast, in a logarithmic plot, each tick on the y-axis represents a tenfold increase over the previous one: 1, then 10, then 100, then 1,000, then 10,000 and so on. (The interval doesnt have to be a factor of 10, it could be a factor of 2, or 5, or 27, or any other number, but humans seem to prefer factors of 10.)
Unconstrained, the coronavirus spreads exponentially, the caseload doubling at a steady rate. That curve, plotted linearly, is a skyrocketing curve. Plotted logarithmically, however, it transforms into a straight line which means that deviations from the exponential spread of the virus become much easier to discern.
Presented this way, the data for Italy clearly show that the infection rate is no longer exponential. The straight line is now a slight downward curve indicating that the rate of increase is slowing.
At a quick glance, the rate of spread in the United States looks similar to Italys, at least when plotted on a linear scale. But on a logarithmic scale, it is instantly apparent that the number of Americans becoming infected continues to double every three days or so. That indicates that the limited measures taken until recently did not sever social contact enough to slow the spreading. The U.S. curve has even bent upward in the last few days an even faster exponential growth perhaps reflecting more widespread testing.
Italys experience shows that more drastic containment measures work, so the U.S. curve may start bending downward in the coming days, as measures here go into effect. (John Burn-Murdoch at The Financial Times maintains a log chart for multiple countries.) The lag between the imposition of measures and their impact on the curve could take days to a week or two, because of the incubation time before symptoms arise. If the line does not begin to bend downward, more stringent actions are probably needed.
But when it finally does, it will herald a real change in the direction of the epidemic in the United States.
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COVID-19 is a disease caused by new respiratory virus first identified in China and is now spreading worldwide. This disease can lead to fever, cough and shortness of breath. There are thousands of confirmed cases in a growing number of countries internationally and the virus is now spreading in the United States.
The U.S. Office of Personnel Management (OPM) works closely with a number of federal agencies, including the Centers for Disease Control and Prevention (CDC), Federal Emergency Management Agency (FEMA), Department of State, Occupational Safety and Health Administration (OSHA) and Office of Workers' Compensation Programs (OWCP) at the Department of Labor to provide updated information to Federal agencies and employees as it becomes available.
The following guidance has been shared with Chief Human Capital Officers (CHCOs) on HR flexibilities and authorities related to Coronavirus Disease 2019 (COVID-19). Employees should contact the human resources office at their employing agency if they have further questions on specific authorities and flexibilities.
Three months into the novel coronavirus pandemic, its still unclear which drugs could combat the viral disease and which wont despite public figures like President Donald Trump extolling the unproven promise of some medications. With public health on the line, the scientific community is searching for answers faster than ever.
When the novel coronavirus tore through China in January and February, researchers and doctors quickly launched dozens of clinical trials to test existing medications against COVID-19, the disease caused by the novel coronavirus. But the research done so far in China hasnt generated enough data for conclusive answers.
We commend the researchers around the world who have come together to systemically evaluate experimental therapeutics, said Tedros Adhanom, director-general of the World Health Organization (WHO), in a press briefing. Multiple small trials with different methodologies may not give us the clear, strong evidence we need about which treatments help to save lives.
In their fight for clear, strong evidence, the WHO is launching a multicountry clinical trial to test four drug regimens as COIVD-19 therapies: an experimental antiviral drug called remdesivir, the antimalarial drug chloroquine (or the related hydroxychloroquine), a combination of two HIV drugs, and those same two HIV drugs along with the anti-inflammatory interferon beta.
The trial will be flexible and could add or drop additional treatment approaches or locations over time. In that way, it appears to be similar to the adaptive trial that the National Institute of Allergy and Infectious Diseases started in the US in February, which initially set out to test remdesivir but could expand to other drugs. The US is not currently involved in the WHO trial.
Hundreds of other clinical trials are underway, and other groups also continue to test the medications that the WHO selected heres a breakdown of some of the drugs that researchers are zeroing in on.
Studies found that hydroxychloroquine and the related chloroquine can stop the novel coronavirus from infecting in cells in the lab, and anecdotal evidence suggests that it may help patients with COVID-19. Because the drug has been around for decades as an antimalarial treatment, scientists have experience with it.
Its a known medicine, says Caleb Skipper, an infectious disease postdoctoral fellow at the University of Minnesota whos working on a smaller trial of the drug. Little blips of lab data over the last several years show this drug has activity against viruses.
Skippers trial is looking to see if hydroxychloroquine can prevent people who are exposed to the virus from developing severe disease. Theyre hoping to recruit health care workers, who are at a high risk of exposure to the virus, to participate in the trial.
The goal, Skipper says, is to get the drug in peoples systems early. Particularly with viruses, the earlier you inhibit their ability to replicate the better off youre going to be. If a drug is going to work, it is more likely to work early on in disease, he says. If you catch someone really early and provide treatment early virus will have replicated a lot less.
The existing evidence on hydroxychloroquine points in the right direction, Skipper says, but all of the research on the drug is still in very early stages. Its a long ways from being proven effective, he says.
Despite the limited evidence available, public figures, including Elon Musk and Trump, are pushing the message that hydroxychloroquine and chloroquine are the solutions to the outbreaks. I feel good about it. Thats all it is, just a feeling, you know, smart guy. I feel good about it, Trump said in a press conference on Friday.
As a result of the hype, demand for the drug has spiked, and manufacturers are increasing production. In Nigeria, two people overdosed on the medication after Trump said it could cure COVID-19. People who take it for other conditions, like lupus, are struggling to access their usual supply.
To be very clear, there is still no conclusive evidence that chloroquine will treat COVID-19. And treatments that appear promising based on anecdotal reports or feelings often dont end up working, which scientists know well: the majority of clinical trials fail, and theyre seeing that reinforced in coronavirus treatment efforts.
In February, doctors in Thailand said they saw their COVID-19 patients improve on the combination of two HIV drugs, lopinavirritonavir. The WHO is testing the drug combination in their trial, along with anti-inflammatory interferon beta, which the body produces naturally to ward off viruses. The drug combination was used in patients during the SARS and MERS outbreaks, and it appeared to help.
But a clinical trial of those two drugs in China just found that patients with COVID-19 who were given the drugs did not improve more quickly than patients who didnt receive it.
The study, which was published this week, focused on a group of 199 severely ill patients, which may be why the drug wasnt effective the patients were already too sick. But Timothy Sheahan, a coronavirus expert and assistant professor at the University of North Carolina Gillings School of Global Public Health, says he wasnt surprised the drug didnt work. Weve done work on that particular drug cocktail, he says. The fact it failed is totally in step with everything weve done in the past.
The antiviral drug remdesivir was first developed to treat Ebola, but research later showed that it could also block MERS and SARS in cells. Lab tests have shown that it can inhibit the novel coronavirus in cells as well.
Theres also anecdotal evidence that remdesivir helps treat COVID-19 patients, but thats also no guarantee that a clinical trial will show that it works better than a placebo. Thats why the data collected on the drug through the WHO trial, the US adaptive trial, and the other studies is so important: before giving it to sick people en mass, doctors have to be sure that it actually works.
Though not a part of the WHO trial, Chinese officials also reported that the Japanese anti-flu drug favipiravir, which it tested in clinical trials, was effective in treating COVID-19 patients. Japan is studying the drug more closely, though data from those trials on the drug has not yet been published. Based on the drugs antiviral activity in cells, Sheahan says hed be surprised if this drug ultimately ended up being effective. It doesnt work against MERS in cells, he says, and MERS is similar to the novel coronavirus.
In addition, some pharmaceutical companies are looking to repurpose anti-inflammatory drugs to try to calm lung inflammation in people with severe cases of COIVD-19; others are identifying the protective antibodies that people develop after theyre infected with the virus in an effort to manufacture a treatment.
Clinical trials take time to collect data properly, so there likely wont be concrete evidence until next month or later. Patients are already receiving these drugs through compassionate use programs, which allows doctors to order experimental medications in certain cases, and under off-label use, where doctors prescribe drugs outside of what theyre approved for. But ensuring the clinical trial process takes place alongside that, before jumping to conclusions about the best course of action, ensures patients can be treated based on evidence.
The sheer number of trials going on around the world for each particular treatment approach will give researchers more data to work with and data from different groups of people. The more populations you can show a particular intervention works or does not work for, the more valuable that is, Skipper says. The bigger amount of data available, the better.
