As the coronavirus crisis deepens and the advice is to stay at home, people are becoming increasingly creative about how to cope. Here are just some of the ways people are trying to deal with social distancing.
The Houseparty video messaging app, which basically allows you to throw parties with your friends, is becoming hugely popular again.
Launched in 2016 downloads are rocketing. The app allows you to video call up to eight people and do something important, like play Pictionary. Or have a virtual dinner party where everyone does the cooking.
You cant go to your local for the pub quiz, so Edinburgh-based Gooses Quizzes are staging nightly pub quizzes at 7pm. Just form a virtual team, download the form, answer the questions and the winner will be announced the next day. Why not have a drink too?
Organisers have asked teams to be be inventive with names. Theres too much QuaranTinaTurner and Quizteam Aguilera, they say. And obviously dont cheat give Google a break!
The lockdown is allowing us to get closer to celebrities than ever before. The rich and famous too are staying at home and giving us a glimpse in to their world.
Broadway diva Patti Lupone for example has given a tour of her surprising basement, showing off her juke box, one-armed bandit and pinball machine. Ellen DeGeneres complains her table isnt big enough for a 4,000 piece jigsaw. Arnold Schwarzenegger feeds his miniature horses indoors.
Over at Patrick Stewarts house the actor is, wonderfully, reading Shakespeares sonnets. On Twitter he explains: When I was a child in the 1940s, my mother would cut up slices of fruit for me (there wasnt much) and as she put it in front of me she would say: An apple a day keeps the doctor away. How about: A sonnet a day keeps the doctor away? So...here we go: Sonnet 1.
Just 153 to go.
The Chinese-American writer Yiyun Li, winner of the Guardian First Book Award, has started a free virtual book club in which she invites everyone to read and discuss Tolstoys War and Peace together.
It started last week but, given the idea is only to read 12 pages a day, there is still time to catch up. On Monday the club was up to Vol 1, Part 1, xviii-xx and the sixth anglaise is being danced in the Rostovs ballroom.
What is the point of watching a movie if youre not dressed up as a character? The Irish comedian Alison Spittle is hosting covideo parties where everyone watches the same film on Netflix at 9pm. The dress code for Groundhog Day was forever winter.
For Hook it was a more challenging child killing sea captain but make it fashion.
Its not weird but it could well be wonderful. Londons Institute of Contemporary Arts is encouraging people to listen to some of the 900 talks and discussions which were staged at the ICA between 1982 and 1993.
They are available on the British Librarys Sounds website and include Ken Campbell (fondly described in his Guardian obituary as one of the strangest people in Britain) interviewing Derek Jarman; a rare chance to hear the playwright Caryl Phillips in conversation, notably with Graham Swift; and the surprising opportunity to hear Jonathan Aitken and Enoch Powell give their views on secrecy and the state.
Learn to salsa, cha cha cha or waltz. Step by Step dance school in Northampton began live streaming nightly virtual dance classes on Saturday night and they soon proved a hit.
On the first night dance director Andrzej Mialkowski was joined by 376 online viewers. Two hours later, after the video had been uploaded on to Facebook, it had been viewed 6,000 times.
Small businesses across America are already feeling the financial crunch from coronavirus restrictions that have millions of people taking refuge from the virus outbreak by staying at home and avoiding unnecessary shopping trips.
One analyst predicted that the disruption to businesses from coronavirus could lead to 15,000 permanent retail store closures in 2020, with the Economic Policy Institute predicting that the disease outbreak could potentially wipe out three million jobs from the U.S. economy before this summer.
Those concerns are certainly setting in for small business owners across the country, as a recent Goldman Sachs survey of more than 1,500 small business owners found that more than 50% of them said they didn't think they could continue operating their businesses for more than three months amid the current conditions caused by the coronavirus outbreak.
Several U.S. states have already begun mandating that non-essential businesses basically anything beyond supermarkets and pharmacies close their doors to customers. But, even in states where that isn't the case, scores of small businesses have already made the move to close up shop totally or reduce their hours of business dramatically.
"I never could have imagined being closed for days and days," says Barb Skupien, the 51-year-old owner of Embellish, a jewelry boutique in Asheville, North Carolina that she first opened in 2015 after previously running a similar store in Chicago for roughly seven years.
Skupien closed the doors of her store on March 16 after a particularly busy day on Sunday, March 15 left her concerned that people weren't taking the coronavirus threat seriously enough. Her shop typically sees anywhere from 15 to 20 people come through on an average day, but despite Sunday's typically being slower, Skupien says she still had about 25 customers throughout the day that Sunday.
"I felt like it was my civic duty to be a part of the solution and not part of the problem," Skupien tells CNBC Make It about her decision to close the store rather than be seen to be encouraging more people to ignore government officials' social distancing recommendations. (North Carolina has not yet mandated that non-essential businesses close their doors, though the state has ordered restaurants and bars to only offer takeout or delivery services.)
Now, with retailers across the country preparing for closures that could last months, Skupien isn't sure when she'll be able to reopen. "Now, it feels like it's going to be weeks, and I guess it could be months," she says.
With the business's cash flow abruptly cut off, Skupien is left to wonder how long she'll be able to cover her storefront's rent, which is $3,800 per month. She adds that her landlord will allow her to defer that expense for two months, with the potential to re-evaluate her position down the road.
Without that break from her landlord, Skupien says she could have been forced to permanently close up shop after about a month. As it stands, she believes she has enough money saved to "string it along for a couple of months," she says.
Still, Skupien quickly gets choked up when asked about her plans for continuing to pay her store's lone other employee (aside from herself) should money get even tighter.
"I have not had that conversation with her," Skupien says, adding that she's continued paying the employee as the two of them work on building a website that would allow them to sell items from the store online in the hopes of creating a new revenue stream.
"Once we're done doing that, I will have to have that conversation (with her)," she says.
Since closing her doors, Skupien says, she's had a few friends and loyal customers reach out to pay her upfront to buy jewelry from her store that they'll pick up once she reopens.
She's also participating in an Asheville-based website, called Asheville Strong, that aims to support local businesses affected by the coronavirus by creating a directory where consumers can buy gift cards for those businesses that can be used at a later date (once the coronavirus outbreak has subsided), giving business owners a temporary influx of cash without asking customers to physically patronize their stores.
Catherine Campbell, who runs an Asheville-based marketing and public relations firm called Bright Planning, started the Asheville Strong website last weekend in the hopes of helping struggling local businesses create a temporary revenue stream. "We were brainstorming all kinds of ways for them to figuratively keep their doors open if they literally couldn't," Campbell tells CNBC Make It.
As of Thursday, Skupien had only sold two gift cards totaling $125, but she says "it meant the world" to know that those customers were intent on helping her business through a tough time.
Indeed, the financial crunch facing Skupien is familiar to hundreds of her fellow small business owners in Asheville and surrounding areas (Campbell's website already had more than 300 listings for local businesses as of Wednesday), and it's an issue affecting millions of small businesses across the country.
"Cash flow, even in a good economy is often a struggle for small businesses," says Holly Wade, the director of research and policy analysis for the National Federation of Independent Business (NFIB), the country's largest small business association. "But, now it has turned into one of the most, if not the most, important obstacle that they face."
With so many businesses closing their doors temporarily or reducing opening hours, Wade is adamant that it's important for consumers to adjust along with their local businesses in order to help them survive.
"To support small businesses during this massive disruption in consumer spending will require all hands on deck," Wade says. Some ways to support local businesses, whether they remain open or not, include buying gift cards or even making a point of ordering carry-out or delivery food from local restaurants, Wade says.
Restaurants, in particular, have faced a massive disruption to their income streams and business models. Many have had to stop allowing sit-down customers, pivoting to offer only takeout or delivery services.
Economists are already forecasting that the U.S. restaurant industry could lose $225 billion in revenue from closures resulting from the coronavirus outbreak, and that the industry could shed up to seven million jobs over the next three months, according to the National Restaurant Association.
In Baltimore, Stephanie Hershkovitz and her brother, Joshua Hershkovitz, run the italian restaurant Hersh's, which closed its doors on March 15. The following day, Maryland Gov. Larry Hogan ordered the closure of the state's restaurants except for delivery, carry-out and drive-thru orders.
Before closing, Hersh's business had actually been pretty good despite government officials warning people to avoid large public gatherings. The restaurant, which features two full stories of dining space, plus a bar with a popular cocktail program, was packed the previous week.
"It was like people were having an End of Days celebration, which is actually the reason that we ended up closing because my brother and I were concerned about how packed it was," Hershkovitz tells CNBC Make It.
On Thursday, she says, the restaurant kicked off a takeout service that she hoped would create a sustainable revenue stream. However, Hershkovitz notes that takeout orders typically only accounted for no more than 10% of their restaurant's overall business. Plus, the restaurant will only be offering takeout service four hours a day, from 4 p.m. to 8 p.m. each evening.
"It's not that much, but we do have a big neighborhood following," she says. "So, we expect that, hopefully, this takeout will take off, so to speak."
Their hope is that carry-out orders of pizza and pasta will generate enough income to help support the restaurant's staff of roughly 20 employees, who have already had to endure a drastic reduction in work hours.
"One of our big motivators in doing this is to keep our employees employed," Hershkovitz says. However, the sibling restaurant owners have also taken steps to obtain government assistance for their employees.
"We've already filed a bulk unemployment claim for them, because you can do that not just for complete temporary layoffs but also for a reduction of hours, which there have certainly been a reduction in hours," Hershkovitz says.
Meanwhile, small business owners are also awaiting further government assistance in the form of a potential emergency financial aid package that has been proposed by the federal government and could include over $300 billion for loans to keep small businesses afloat.
At the same time, small businesses that are affected by the coronavirus can apply for low-interest loans of up to $2 million from the U.S. Small Business Administration, CNBC Make It previously reported. And, the Treasury Department also announced it will defer the deadline for annual tax payments by 90 days.
Skupien tells CNBC Make It that she's considering applying for a loan through the SBA to help keep her business afloat.
"Small business owners are having to navigate a very, very uncertain future right now and it's not a one size fits all impact on small firms," the NFIB's Wade tells CNBC Make It. "It depends on the industry, where they're located, what the degree of the impact is on them."
Max Morey, 69, runs the Crescent Theater, an independent movie theater in Mobile, Alabama, which he decided to close on Thursday, March 12, without any idea when it will be safe to start welcoming moviegoers once again.
Much like Skupien, Morey made his own decision to close his doors, not because business had slowed down (in fact, he had roughly 60 customers for one of his final showings of the movie "Emma" on Thursday), but because he felt remaining open was not in the best interest of public safety and the health of his customers or two employees.
Morey paid his two employees for an extra week of work despite the theater remaining shuttered this week and he tells CNBC Make It he also offered to help them out with rent or money for food if it comes to that.
"I told them that I would be there for them and, we're going to make it through [this]," says Morey, who personally lives off of a combination of Social Security checks and his own savings.
He actually put $28,000 of his own money into the theater to keep it afloat three years ago. "I'll never get it back," he says. "But, hey, life is short. Have fun."
Business has "never been healthy" for the theater, which boasts only a single movie screen with 90 seats that offers three showtimes per day, seven days a week. Morey tries to show a mix of independent films and blockbusters (Paramount Pictures' "A Quiet Place 2" had been set to start showing on Friday).
He typically pulls in between $15,000 and $20,000 for each film that he shows at the theater over the course of a two- to three-week run.
"It's always been fragile [and] on thin ice," Morey tells CNBC Make It, pointing out that the movie theater business has generally struggled in recent years due, in part, to the rise of streaming entertainment. In addition to Morey's own savings, in recent years the theater has relied on Kickstarter campaigns to keep the lights on. One such crowdfunding campaign raised $84,000 in 2012 to keep the Crescent running while another raised $72,000 in 2017.
Still, Morey isn't overly concerned about his prospects of reopening the theater eventually, once the coronavirus threat has subsided. He's already hoping to reopen at some point this summer, though he admits that a movie theater where moviegoers sit together in close confines for hours at a time is "the perfect petri dish" to spread disease. In other words, he doesn't want to rush to reopen.
For now, Morey wants his theater to remain a vocal piece of the local community. He plans to write inspiring messages on the theater's marquee, located in downtown Mobile. "I'm going to put 'We love you, Mobile, stay safe' on my marquee," he says. He wants it to be "a little soundboard for the community, and I'll change it every few days."
Check out: The best credit cards of 2020 could earn you over $1,000 in 5 years
Don't miss:
'Are we going to be left behind?' Where small business owners can go for help during the coronavirus shutdowns
If you lose your job due to the coronavirus pandemic, here's how to navigate filing for unemployment
Like this story?Subscribe to CNBC Make It on YouTube!
Coronavirus cases continue to surge throughout the United States and experts say some portions of the country are beyond containment.
The wide-spread virus has a high person-to-person transmission rate and is beginning to seriously affect younger adults, not just older generations.
According to a reportby the Centers for Disease Control and Prevention that tracked the first 2,500 cases in the U.S., nearly 40% of COVID-19 patients who were hospitalized were between the ages of 20 and 54.
Those who are infected and dont require hospitalization are instructed to stay home, but that still leaves families androommates vulnerable.
So, what can one do to keep loved ones safe while recovering at home from COVID-19? And what can caregivers do to stay healthy?
Dr. Raphael Viscidi, an infectious disease specialist at Johns Hopkins Medicine, said respiratory viruses are commonly transmitted between people with the closest and prolonged contact.
Reports that are coming out of China suggest that many, if not most, of (coronavirus)transmissions are coming from family units, he said.
The goal is to reduce social contact, the duration of contact and the environmental space shared with a sick person on a day-to-day basis.
That starts in the bedroom.
Its a very small shared environment with a high probability the virus is present, Viscidi said. The bed itself is a surface where a sick person is depositing the coronavirus with just a cough or sneeze.
Harvard Medical School recommends caregivers use aseparate bedroom while the infected person issick. Viscidi said the recommended self-quarantine time is at least 14 days.
In addition to their own bedroom, Harvard is also recommending the sick person have their own designated bathroom so no one else in the house is exposed to contaminated surfaces.
You spend time in the bathroom, Viscidi said. Theyre trying to identify places where someone whos sick is more likely to be spreading the virus.
Bathrooms have surfaces touched on a daily basis, such as faucets, doorknobs, toilets and sink counters. Theyre also relatively small, increasing the risk ofexposure.
When a person is sick with coronavirus, they release the virus into the environment through coughing or just breathing.
The virus may remain infectious in the air for hours. A study published Tuesday in the New England Journal of Medicine found viable virus could be detected in the air for up to three hours.
Were not by any way saying there is aerosolized transmission of the virus but this work shows the virus stays viable for long periods in certainconditions, so its theoretically possible, study leader Neeltje van Doremalen at the National Institute of Allergy and Infectious Diseases told the Associated Press.
The virus is transmitted through droplets that fallquickly and can exist on surfaces as well, perhaps for as long as three days depending on conditions. Although, Viscidi noted that transmitting the virus through a surface is very low unless an individual is constantly touching the surface for a long time.
In order to minimize that risk, the CDCrecommends having good airflow or ventilationin the form ofair conditioning or a simple open window.
Dr. Joseph Khabbaza, a pulmonary and critical care physician at the Cleveland Clinic, said all standard rules apply when it comes to food preparation.
Washing hands and disinfecting kitchen surfaces are common practices in the kitchen, even if no one is sick in the house.
The frequent cleaning of surfaces is really the key in those settings, he said.
Khabbaza also said its important to maintain the recommended distance of six feet away from a person in all rooms but especially in the kitchen.
There are a number of ways to serve an infected person food, Khabbaza said. It can be left by the door to be retrievedor leftin the kitchen for the sick person to comeout and eat.
Caregivers can enter theroom as long as the patient is wearing a mask. The caregiver alsocouldwear a mask if more are available.
Although there is no specific diet for coronavirus patients, Khabbaza said they may not have an appetite and may only want soup or crackers.
Harvard Medical School advises family members not to share household items such as dishes, drinking glasses, cups or eating utensils with the sick. After use, they should be washed thoroughly.
Keeping the sick person's bedroom and bathroom door closed can provide an extra layer of precaution.
Its an extra physical barrier that no droplets are leaving that space, Khabbaza.
However, he points out its not likely a particle is able to travel far, surviveoutside the bodyand infect a healthy person.
Wiping surfaces, frequenthand-washing and avoiding the face are more crucial to minimize transmission of the virus even in settings that arent contained.
Limiting contact is the name of the game, and in our modern world, its become much easier with the use of technology.
Family members can limit contact by using computers, cellphones and tablets to message and call loved ones while they are sealed safely inside their designated bedrooms.
Khabbaza stresses the importance of comforting sick people in their time of need.
Its almost impossible not to feel that anxiety just with this climate and environment, he said. Theres a big benefit of minimizing that anxiety, making sure that youre relaxed around your loved one is important.
Hesuggested using FaceTime or Skype to communicate with people who are sick instead of just messages and calls.
Thats one way you can have lots of conversation and laugh together and see each other smile while still being at very low risk of transmission, Khabbaza said.
The CDC and Harvard Medical School advise caretakers to place all used disposable gloves, facemasks and other contaminated items in a lined container before disposing of them with other household waste.
While Viscidi said its not necessary to double-bag garbage, Khabbaza said extra bags couldnt hurt and its never a bad idea to use gloves while handling waste.
Tissues shouldnt be harmful after theyve already made it to the bottom of a wastebasket.
"Particles and droplets shouldnt just be aerosolized as a tissue in the wastebasket," he said."Once it'sin there, it won't go anywhere."
However,he said it could behelpful if the sick person tiesup the garbage bag before the caregiver comes in and takes it out. This could minimize anxiety when entering the room.
"Youwon't be able to take care of your lovedone as well if your nerves are taking over," he said.
Although there havent been reports of pets or other animals becoming sick, the CDC recommends restricting contact with them while sick with COVID-19 until more is known about the virus. This includes petting, snuggling, being kissed or lickedand sharing food.
If possible, have another person in the house whos not sick to care for the animals. If thats not possible, make sure the sick person washes their hands before and after interacting with pets and wear a face mask.
Viscidi said limiting pet interaction benefits people in the house more than the pet itself.
If youre having severe symptoms and youre petting them constantly, theres going to be some virus on the dog, he said. And then somebody else comes by and pets the dog.
The dog isnt going to get infected, but it can act like a contaminatedsurface for other people to get sick.
As many public health experts have reiterated, the key to keeping people healthy is hygiene.
The CDC defines cleaning as the removal of germs, dirt and impurities of surfaces, and defines disinfecting as using chemicals to kill germs on surfaces. The agency recommends disinfecting surfaces after cleaning to further lower the risk of spreading infection.
The CDC recommends taking the following precautions when disinfecting the house while a family member is sick with COVID-19:
Be aware that there can be contaminated residue on used tissues, masks and gloves from someone sick with the coronavirus that can be dangerous to others that live in the home. Here are some ways to correctly dispose of the contaminated items.
SOURCE USA TODAY reporting; Stanford University; World Health Organization; Centers for Disease Control and Prevention
A woman wears a mask as a preventive measure inside a minibus taxi in Johannesburg. Michele Spatari/AFP via Getty Images hide caption
A woman wears a mask as a preventive measure inside a minibus taxi in Johannesburg.
Earlier this year, when the first reports of the coronavirus started to come out of China, global health officials said they were very worried about what would happen if the virus started spreading in Africa, where many health systems are already struggling.
Well, now the coronavirus is spreading in Africa.
So far the number of reported cases remains low. As of Saturday, more than half the nations on the continent 36 of the 54 countries had reported cases. South Africa, with 150 cases, is the only one with more than 100.
Nonetheless, many countries in Africa are responding aggressively to the pandemic.
Schools were ordered closed in the Nigerian capital of Lagos after only eight cases were confirmed nationwide. Last week South Africa banned visitors from high-risk countries, closed down schools and quickly opened drive-through testing centers in Johannesburg.
Regional experts say a widespread pandemic in Africa could cripple the continent's fragile health-care systems and be devastating economically. It also could be difficult to contain while foreign donor nations that traditionally assist the continent in such crises are overwhelmed with their own outbreaks.
The head of the World Health Organization's Africa region, Dr. Matshidiso Moeti, said on Thursday that most of the cases have been imported from Europe and so far there is relatively limited community transmission of the virus on the continent.
"Although there may be some undetected infections, we don't think these are very large in number," Moeti said.
Given Africa's close ties to China and the explosive outbreaks happening elsewhere in the world, it's unclear why that is. Researchers are questioning whether Africa is somehow less vulnerable to the virus or if it is still just in an early phase of the epidemic.
Moeti speculated that the low number of cases may be because the Southern Hemisphere is just coming out of summer.
"In southern American countries there's also been spread but it has not been the same as we've seen in the Global North. So we are trying to understand if this could be related to temperature or to weather," she said in a video conference call with reporters. "We have a distinct flu season in the southern part of continent and some Eastern African countries. We may from this infer that we should expect ... perhaps in a couple of months when the winter sets in in the South ... to see an increase in the rate of transmission of this virus."
One question in Africa is whether the number of confirmed cases is so low simply because the virus isn't being detected.
At the beginning of February only two countries in sub-Saharan Africa Senegal and South Africa had the ability to test for the novel coronavirus. WHO has helped 43 more countries set up or augment their national laboratories so that they can also test for this pathogen.
The overall capacity of those labs is low, and the tests will have to be done in capital cities. But getting even a basic level of domestic testing capacity running could be crucial as borders close and international air transport grinds to a halt.
Managing a major outbreak on the continent could be difficult, Moeti said, and two of WHO's recommended interventions social distancing and hand-washing may not always be possible.
"Sometimes families live in houses where you don't have a bedroom for every family member," Moeti said. "Quite a few people in the family have to sit in the same space, sleep in the same space.
"In addition they may be in houses that do not have running water so the possibilities of hand-washing in the ways that it's recommended with soap is a challenge under those circumstances."
Tom Achoki, who's studied health care in Africa extensively, says the medical systems have improved significantly in many countries since the 2014 Ebola outbreak. "But still the health-care systems are very weak."
Achoki, the co-founder of Mass Sciences and a lecturer at the University of Pretoria, says by "very weak" he doesn't mean just a shortage of emergency room beds. "They're dealing with access to things like disinfectant," he says. There's a need to train workers on using masks and gowns to protect themselves when treating COVID-19 patients, he says. Achoki also points out that the data is still collected on paper forms rather than digitally in many African countries.
"So the transmission of data is not as effective," he says. "This is an epidemic which is moving very quickly." He says improving information systems is something that needs to be addressed and could hamper the ability of some countries to respond to this outbreak effectively.
Gyude Moore, who served as part of Liberian President Ellen Johnson-Sirleaf's administration during the Ebola outbreak, says African nations are already innovating to fight COVID-19.
Moore, who's now a visiting fellow at the Center for Global Development, says countries saw the devastation of the Ebola crisis and are taking steps to get ready for this virus.
"For example, Nigeria, they've applied the lessons from Ebola and they are doing their best to separate the response to the [coronavirus] pandemic from the provision of regular health care," he says.
"The people [in Nigeria] presenting symptoms of the disease are ushered into a specialized clinic, specialized areas separate from the regular health system," Moore says. "It allows the health system to continue to function and not be overwhelmed quickly. What we saw in West Africa [during Ebola] was how very fast and how easily the health system was overwhelmed as the case load increased."
To prevent that during this pandemic, countries across the continent are trying to get ready for COVID-19. Uganda hasn't yet confirmed a single case but it's already banned weddings and large religious gatherings. Kenya, Moore notes, has shut down schools.
But most African nations can't order nationwide or citywide lockdowns as Italy and China have. Moore says it's just not possible. "In an informal economy," he says. "People literally have to go out every day as a means of being able to feed themselves."
One of the other big concerns in Africa is how the coronavirus may affect places that are also battling other diseases such as malaria, cholera and HIV.
"HIV-positive individuals who are on medications are probably fine," says Karen Hofman, a professor of public health at the University of the Witwatersrand in Johannesburg. "The people that are most vulnerable ... and there are a lot of them ... are HIV-positive individuals who are not on medications." Roughly a third of the 7.7 million South Africans with HIV are not on treatment.
COVID-19 has been particularly deadly to people with compromised immune systems. Hofman says the expectation is that the disease would be quite bad if it starts spreading among people who are HIV-positive and not on medication.
South Africa also has a large number of people with tuberculosis. It's not known exactly how COVID-19 would play out in TB patients but piling a second respiratory disease on top of TB could be devastating.
Hofman says she hopes the arrival of coronavirus in South Africa will spur people who are HIV-positive to enroll in the government's free treatment program. She also says there might be a silver lining in getting more people to wash their hands, which could stop the spread of other diseases too.
"This is a big natural experiment that's going on right now. We don't really know exactly how it's going to play out," she says. But Hofman says South Africans and people in many low- and middle-income countries are accustomed to adversity.
"So possibly we will handle this a little bit better," she says. "But the fact is that this is going to have a huge economic consequence aside from the health issues. In a country where there is already a 30 to 35 percent unemployment, this is of grave concern to us."
During two of this weeks White House briefings, President Trump referred specifically to two potential treatments that have been identified by medical researchers and clinicians, and that have undergone various degrees of investigation and testing in the ongoing fight against the global coronavirus pandemic. Its important to note upfront that regardless of what you may have heard, from Trump or any other sources, no drugs or treatments have been proven as effective for either the prevention of contracting COVID-19 or for its treatment.
That said, a number of different clinical studies are currently in progress all over the world, and in the U.S., the National Institutes of Health is looking to fill a 400-volunteer study that will provide clinical results related to use of remdesivir, an antiviral drug developed by Gilead originally as a treatment for Ebola, but its still only in clinical trials even for treatment of that disease. This study could also add other drug candidates as additional test therapies. Meanwhile, studies in China and France have examined the effectiveness of anti-malarial drugs, including chloroquine and hydroxychloroquine including one small-scale study that suggests the positive effects of hydroxycholoroquine in reducing both the duration and symptoms of COVID-19 in combination with an antibiotic called azithromycin.
The important thing to keep in mind when considering these or any other potential treatments for the novel coronavirus, which is still relatively young, is that a lot of what we know about them so far is effectively anecdotal, and based not on the kind of scientifically rigorous controlled clinical studies that are normally used in the years-long development and certification of drugs. Instead, treatments like remdesivir and chloroquine/hydroxychloroquine are being deployed in the field by healthcare practitioners based on their approved use in similar (but crucially not the same) situations, like the Ebola and SARS outbreaks.
Often, theyre being used under whats called compassionate grounds in the U.S. This effectively amounts to employing a drug thats not yet certified for general use in treatment of a patient whose condition is so severe that a doctor is willing to go to desperate lengths to try to alleviate their symptoms. This has the advantage of sidestepping typical testing and approval procedures, and requiring that the results of its use are documented, which contributes to the overall body of clinical knowledge in terms of its effects and interactions with patients and with COVID-19.
Its not a clinical study, however, and that means there are still a lot of unknowns when it comes to its use that just cant be learned or asserted based on scattered, individual instances of compassionate care treatment.
As the Commissioner of FDA and the president mentioned yesterday, were trying to strike a balance between making something with the potential of an effect available to the American people, 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, explained National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci during a press conference on Friday. But the information that youre referring to specifically is anecdotal, it was not done in a controlled clinical trial. So you really cant make any definitive statement about it.
During Thursdays White House coronavirus pandemic task force briefing, Trump made false claims that chloroquine was already approved by the FDA as a treatment for COVID-19 under an emergency authorization. FDA Director Dr. Stephen Hahn clarified that this and remdesivir were being considered and studied by the FDA, as was an approach that would use plasma extracted from patients whod recovered from COVID-19, as a potential source of antibodies for others. Still, all of these are still quite far away from clinical deployment in any generally approved way.
Meanwhile, Faucis cautions should be taken for what they are: Warnings that are primarily meant to emphasize that the reason the FDA requires clinical studies, even for drugs already tentatively approved for use in other cases, is because it has patient health and safety in mind. While chloroquine has been used for decades to treat malaria, and chronic rheumatoid arthritis, it can have dangerous side effects, including death, if taken incorrectly. Even when taken correctly, it can cause things like stomach distress, and even permanent damage to a persons vision.
Faucis comments Friday explain the risks of putting too much stock in any potential treatment at this stage, even if they are showing promising results among small or even medium-sized deployments.
Youve got to be careful when you say fairly effective, it was never done in a clinical trial that compared it to anything, he said in answer to a reporters question about chloroquines efficacy in treating SARS. It was given to individuals and felt that maybe it worked [] Whenever you do a clinical trial, you do standard of care, versus standard of care plus the agent youre evaluating. Thats the reason why we showed back in Ebola why particular interventions worked.
A summary survey of various prospective treatments and their current status was published today In Medscape, and this includes the current state of remdesivir and chloroquine investigations, as well as a number of other drugs being studied by researchers. As has been reported here and elsewhere, there are promising signs that they could prove effective in either treatment, or treatment and even preventative use (in the case of remedesivir), but these are, as Dr. Fauci puts it, only the first step that should lead to more sophisticated clinical studies, which themselves will then need competing peer studies to eventually prove out.
CORTLAND COUNTY (WBNG) -- Cortland County confirmed its first two positive cases of the coronavirus on Saturday.
The New York State Health Department confirmed the two cases as unrelated; one being a child under 5-years-old and the other person in their 50s. The New York State Health Department and the Cortland County Health Department are in the process of identifying the people who may have been in contact with the individuals who tested positive.
All cases that are confirmed as positive will be isolated under a Public Health order. The individuals who have been in close contact with the positive cases will be quarantined and monitored by the health department.
There are 12 members of the Cortland County community who are not symptomatic, but are self-quarantining for 14 days. This group of people is not connected to the confirmed cases.
If you develop symptoms of illness including fever, cough, or trouble breathing, contact your healthcare provider. Call ahead to explain your symptoms.
NYSDOH has a hotline and a website for members of the public who have questions: 1-888- 364-3065 and https://www.health.ny.gov/diseases/communicable/coronavirus/ For general Inquiries: Cortland County Hotline: 607-756-3415 New York State Hotline for COVID-19: 1-888-364-3065
For more coverage of the coronavirus,click here.
WASHINGTON President Donald Trump has pressed the Food and Drug Administration to eliminate barriers to the availability of drugs that may treat COVID-19, an illness with no known cure.
But theres no guarantee these drugs will kill the virus and it may take weeks or even months before they are on the market.
Trump said an antimalarial drug called hydroxychloroquine thats also used to fight arthritis would be made available almost immediately to treat coronavirus.
Its been around for a long time, so we know if things dont go as planned, its not going to kill anybody, Trump told reporters at the White House.
The president said other drugs would be soon available, too.
But Food and Drug Administration Commissioner Stephen Hahn said it would some time to run the clinical trial on these drugs.
In the meantime, people whove tested positive for the coronavirus, or think they may have COVID-19, can only try to treat the symptoms which include fever, sore throat, dry cough and shortness of breath. Some COVID-19 patients also experience diarrhea, nausea, or vomiting, sometimes before respiratory symptoms begin.
There are different opinions on the best way to do make a COVID- 19 patient more comfortable while the disease runs its course, which, depending on the severity of the contagion, could take weeks. But theres consensus that people who have tested positive for COVID-19 or think they may have the disease, should isolate themselves at home as far as possible from other family members and contact a doctor by phone instead of visiting the physicians office.
That doctor may order a coronavirus test, although many with those prescription have found it difficult to get a test in Connecticut and elsewhere.
For those with health care coverage through Medicare, HUSKY, or most private health insurance companies, coronavirus tests are free. Trump signed a new bill this week that will make coronavirus testing free to the uninsured, too.
Medicare, HUSKY and many private insurers who did not do so before are also covering the costs of a telemedicine visit with your doctor.
The Centers for Disease Control and Prevention says to get medical attention immediately if you have difficulty breathing, persistent pain or pressure in the chest, confusion or the inability to arouse from sleep, a temperature thats over 104 degrees Fahrenheit or bluish lips or face.
People who think they have COVID-19 are treating it like a cold or flu.
Over-the-counter medications, like cough suppressants, can help minimize coughing episodes, and expectorants can help people bring up mucus. A humidifier can also help. Pain relievers and fever reducers can help treat aches and reduce fevers. And doctors say COVID-19 patients should remain hydrated, drinking plenty of fluids.
Theres a debate, however, over which pain and fever reducing medicine should be used.
The World Health Organization this week warned against the use of ibuprofen, aspirin and other anti-inflammatory drugs to fight the fever and aches of COVID-19 after a leading French health official warned against it.
Frances health minister, Olivier Vran, said aspirin and ibuprofen worsened the symptoms of the disease. Vran said certain drugs, including ibuprofen, increase the number of so-called ACE2 receptors on the surfaces of cells. The coronavirus uses these receptors to infect cells, so, in theory at least, taking these drugs might make one more vulnerable to the virus.
The WHO recommends take acetaminophen (Tylenol) instead.
However, Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said there is no proof that ibuprofen should be avoided.
I think it was a conflating of some medical issues may be true, may not, but theres no good scientific evidence that says ibuprofen can make coronavirus worse, Fauci said.
There are also differing opinions about how to deal with a fever.
Some doctors say there may not be a good reason to lower a temperature, unless its very high, because dozens of medical studies show fever helps fight infection.
Others warn that even a slight fever increases the metabolic rate, burning up calories. Coupled with a decrease in food intake, an increase in the metabolic rate can weaken a patient. It is estimated that for every degree Fahrenheit of rise in body temperature, the metabolic rate increases by 7 percent.
The CDC also has these recommendations for those who are sick:
The CDC also says the decision to end home isolation should be made on a case- by- case basis by a physician.
When a new virus like the novel coronavirus appears and starts infecting people, one critical asset in the fight against it is blood from people who were sick and then recovered. These blood samples can help scientists understand how the immune system responds to it, and can help in the search for therapies to treat the disease.
Thats why, this week, the Vaccine Research Center at the National Institutes of Health put out a call looking for blood donations from people who had COVID-19 and are now healthy.
Analysis of blood samples can give researchers information about if and how people develop protective antibodies after an infection. The immune system usually produces antibodies, which can bind to and deactivate viruses, during and after a viral infection. Those antibodies provide an infected person a level of protection from the virus in the future theyre unlikely to be infected again because their bodys new antibodies will stop the virus.
The initial steps are to follow individuals who have recovered and have a way to measure their antibody response, says Darrell Triulzi, director of the Division of Transfusion Medicine at the University of Pittsburgh Medical Center.
Scientists want to understand how strong the immune response to a novel coronavirus infection is, and how well that response protects people against the virus in the future. They also need to know how long the protection lasts. Long-term research on SARS patients, for example, shows that the protective immune cells were no longer present in some people six years after they were sick.
Preliminary research (that hasnt yet been published) on COVID-19 patients shows that they do produce high levels of antibodies, which virologists say is a sign people wouldnt get sick from the virus a second time. Another still unpublished study on monkeys found that they developed antibodies after they were infected with the novel coronavirus, and they didnt get sick a second time if they were exposed to the virus again. It indicates that infection results in protective immunity against SARS-CoV, at least in the short term, Angela Rasmussen, a research scientist at the Center for Infection and Immunity at the Columbia University Mailman School of Public Health, wrote in an email to The Scientist.
But more research is still needed to understand if the antibodies actually provide therapeutic benefit, Triulzi says.
Scientists also turn to the blood of patients who have recovered from COVID-19 as a possible stopgap treatment for the most at-risk people. Because their blood plasma is presumably full of protective substances like antibodies, if its injected into sick people, it may help them fight off disease. Its an old strategy and dates back as far as the 1918 Spanish flu outbreak in the United States, when doctors reported that it helped reduce the number of deaths in seriously ill patients. Recently, its been used on an experimental basis to treat people with MERS, H1N1, and Ebola.
In Ebola it seemed effective, and all we have are case reports right now for COVID-19, Triulzi says. At a press briefing, Stephen Hahn, commissioner of the Food and Drug Administration, said that the agency was evaluating it. Its a possible treatment, he said.
The treatment is risky, though, and there are always concerns that the use of plasma could make any subsequent infection with the virus in question worse. It would likely only be a temporary measure until more refined treatments became available. But the benefits may outweigh the risks for health care workers or older people who are more likely to become seriously ill if they were infected with the virus.
Just because blood can help researchers study COVID-19, though, doesnt mean that the blood of people who are or have been infected is generally dangerous, Triulzi noted. An infectious virus wouldnt linger in someones blood for a long time after theyre sick, so its not a concern for blood banks or people receiving blood transfusions. Transmission by blood has not been reported and is unlikely, he says.
And during a pandemic like this one, its more important than ever for healthy people to donate blood if theyre able. Donation drives have been cancelled left and right. Yet the need for blood continues, he says. There isnt a risk of getting the coronavirus from the donation process. And we still need the blood.
If you have a cough, fever, or shortness of breath, how can you tell if youve got Covid-19, a common cold, the ordinary flu, or a bad case of the worries? Should you get tested? When should you seek medical care and when should you just stay home?
Two of us (M.H. and M.W.) are primary care doctors who have received numerous calls from concerned patients with symptoms such as cough, fevers, or shortness of breath. Those calls prompted us with the help of several colleagues to develop a simple self-triage tool to help individuals decide when to treat their symptoms safely at home and when to seek medical help. One of the most important things each of us can do during the ongoing pandemic is to free up medical providers to concentrate on the seriously ill.
First the good news: The vast majority perhaps 80% or more of people who come down with Covid-19, especially those under 50, will suffer symptoms that are no more serious than a bad cold or a mild flu and will be better within two weeks. There is no need to seek testing or go to a doctors office. A test result wont change your medical care because there is no treatment at this time other than the usual recommendations for any cold or flu: drink plenty of liquids, rest, stay home, and try over-the-counter remedies. (A test will, however, alert you to be extra careful not to infect others.)
advertisement
In some people, though, Covid-19 is a more serious illness, particularly among the elderly and those with chronic conditions. Thats why the current outbreak must be taken so seriously.
Our team at the Gehr Family Center for Health Systems Science and Innovation at the Keck School of Medicine of USC, in partnership with Akido Labs, developed a triage tool to help guide patients. Its available online for anyone to use. This tool will help most people effectively manage mild and moderate symptoms of Covid-19 at home.
advertisement
We have also compiled the general advice and tips for self-care at home below.
Although the news reports about Covid-19 are alarming, reports from China, Italy, the U.S., and elsewhere indicate that for most people, infection with the novel coronavirus is on par with getting the flu. These steps can help you know if you need formal medical care and, if not, how to care for yourself safely at home.
Know when to seek medical care. The reasons to seek immediate care today are no different than they were before the Covid-19 outbreak. The severe symptoms listed in the table below suggest that you need medical attention. Otherwise, if you have a fever and cough or other cold or flu symptoms, but are otherwise healthy, are under age 60, arent having difficulty breathing, and dont feel seriously ill, youre better off caring for yourself at home.
Severe symptoms that suggest the need for medical attention (please note that this is not intended to be a comprehensive list, but provides general guidance)
Dont go straight to a doctors office or urgent care. Start by calling a medical advice line or a telemedicine option instead. Its wise these days to stay away from crowded places, and that includes emergency departments, hospitals, doctors offices, urgent care centers, and clinics unless you are seriously ill. These are places where you could pick up the coronavirus if you dont have it, or spread your batch to other people.
Many health plans have 800 numbers with nurses or doctors on call to answer questions by phone, as do some doctors offices. Look at your insurance card and make the call. Some clinics are conducting video visits, also known as telemedicine. If you call an advice line first, you can often get the guidance you need without spreading infection or unnecessarily exhausting yourself.
Save testing for those sick enough to need hospitalization. Testing for Covid-19 will not change your medical care because there is no treatment available or necessary for mild symptoms. (People with serious symptoms, such as difficulty breathing, should get supportive care in the hospital.) Tests are currently in short supply and are being prioritized for those who have severe symptoms or who have been exposed to someone diagnosed with Covid-19. If you do not fall into one of those two categories, resist the urge to request testing unless public health officials encourage you to get tested for tracking purposes. (We know as we write this that the indications for testing may loosen in the days ahead as testing supplies increase.)
Practice self-care. Viral infections are dehydrating. Drink plenty of liquids. Pedialyte and soups that contain salt are helpful, as are plain water, tea, juice, and soda. Drink enough so your urine is its normal pale color and you produce as much urine as you usually put out. Note: Not urinating normally is a sign you may need medical attention. If you have special dietary restrictions due to diabetes, kidney disease, heart failure, or other condition, get medical advice by phone or email about the fluids that are best for you.
Some over-the-counter medications may help. As anyone who has experienced a cold knows, over-the-counter remedies tend to provide only limited relief, and some may have side effects such as dry mouth, drowsiness, and raised blood pressure. Try flushing out your nose and sinuses with saline solution. Fever-reducers and pain medications such as Tylenol (acetaminophen) can help, and honey can be an effective cough remedy. There is anecdotal evidence that non-steroidal anti-inflammatory medications like ibuprofen or naproxen may make Covid-19 worse, though more research is needed.
If you have one or more chronic medical conditions, seek telephone advice from an expert to make sure you choose a treatment that is safe for you.
Dont ask for antibiotics. Antibiotics do not work for viral illnesses like Covid-19. They also often cause side effects such as nausea, diarrhea, and rashes.
Get plenty of rest. Infections stress the body. Lots of rest including sleep will help keep your immune system strong so it can devote itself to ridding your body of the virus.
Separate yourself from others to prevent the virus from spreading. If you have the symptoms of a cold or the flu, play it safe and act as if you have Covid-19. Wear a face mask when in a room with others and if you must leave the house. Avoid close interactions with others for 14 days.
Follow the advice of public health authorities. Even for those who arent ill, social distancing will avoid fueling this pandemic. Please heed the advice of your local officials.
This is a scary moment in history. No one should be faulted for feeling anxious. Most people with viral illnesses including Covid-19 can be cared for effectively in their own homes without seeking formal medical care and will recover within two weeks. But its also important to know when to seek expert care.
We hope that our simple tool for self-triage and general advice and tips for self-care at home can ease some of the anxiety. and help you take the best care of yourself and your loved ones without putting yourself or others at unnecessary risk.
Michael Hochman, M.D., is a primary care physician, associate professor of clinical medicine at the Keck School of Medicine of USC, and director of the Gehr Family Center for Health Systems Science and Innovation at Keck. Michael D. Wang, M.D., is a professor of clinical medicine at Keck and director of inpatient programs for the schools Department of Medicine. Katy Butler is a journalist, essayist, and author who writes extensively about health topics. The authors acknowledge the essential contributions of Arek Jibilian, M.D., Carolyn Kaloostian, M.D., Anjali Mahoney, M.D., Rishi Mehta, M.D., Pieter Cohen, M.D., and Chris Hendel for reviewing this material and helping develop the triage tool.
There's "currently no scientific evidence establishing a link between ibuprofen and worsening of COVID19," the European Medicines Agency advised Wednesday. REKINC1980/Getty Images hide caption
There's "currently no scientific evidence establishing a link between ibuprofen and worsening of COVID19," the European Medicines Agency advised Wednesday.
Updated March 19 at 12:08 p.m. ET
Over the past few days, social media has lit up with reports, picked up by some media outlets, that taking drugs like ibuprofen to ease COVID-19 symptoms could actually worsen the progress of the illness.
But most infectious disease experts say there's no good scientific evidence at this point to support that claim.
The furor was sparked by a tweet by the French health minister, Olivier Vran, over the weekend. He warned people not to take nonsteroidal anti-inflammatory drugs, or NSAIDS a category of pain relievers and fever reducers that includes ibuprofen because some French COVID-19 patients had experienced serious side effects. The warning was also included in a bulletin from the French health ministry, which counseled that patients should instead use acetaminophen, the generic name for Tylenol.
But the European Medicines Agency issued a statement Wednesday saying that while it is monitoring the situation, there's "currently no scientific evidence establishing a link between ibuprofen and worsening of COVID19."
Dr. Carlos del Rio, a professor of infectious diseases and global health at Emory University's Department of Medicine, agrees. "I think the minister of health of France is wrong [in] prohibiting the use of ibuprofen based on limited data," he says.
The World Health Organization is looking into the matter, says spokesperson Christian Lindmeier, "but after a rapid review of the literature, [the WHO] is not aware of published clinical or population-based data on this topic." A few media outlets have reported that WHO is now advising against using ibuprofen to treat fevers in patients with COVID-19 symptoms, but Lindmeier tells NPR that's not true.
"Based on currently available information, WHO does not recommend against the use of of ibuprofen," the WHO stated on its official Twitter account, adding, "'We are also consulting with physicians treating COVID-19 patients and are not aware of reports of any negative effects of ibuprofen, beyond the usual known side effects that limit its use in certain populations."
The questions about ibuprofen's safety for COVID-19 patients seem to have stemmed, in part, from a letter published in The Lancet last week hypothesizing the ways various medications could, perhaps, increase the risk of infection with the coronavirus. Research has shown that the virus attaches itself to cells in the lungs by way of an enzyme angiotensin-converting enzyme 2 (ACE2). The Lancet commentary suggested that taking ibuprofen might increase the number of ACE2 receptors on a cell, which could make someone taking the drug more vulnerable to infection.
But just because you have more ACE2 receptors doesn't mean you're more susceptible to infection, says Rachel Graham, a virologist at the University of North Carolina Gillings School of Global Public Health. She's one of the researchers who discovered how the coronavirus binds to cells.
"You can have low levels of ACE2 and still be susceptible," Graham says. What's more, she adds, the evidence that taking ibuprofen increases these receptors is almost nonexistent.
"This is why we have clinical trials to inform our medical decision-making," rather than relying on a few anecdotal cases, says Dr. Krutika Kuppalli, an infectious disease physician and fellow with the Johns Hopkins University Center for Health Security. Kuppalli says she doesn't see the Lancet letter as a reason to avoid ibuprofen for COVID-19, though she always tells her patients to use Tylenol for fever "because its mechanism is thought to affect the temperature regulating center of the brain."
Dr. Angela Rogers, a pulmonologist at the Stanford University Medical Center and chair of its intensive care unit's COVID-19 task force, notes that Tylenol is the go-to medication for patients who are sick enough to be hospitalized for any infection. That's because these patients are at higher risk of damage to internal organs, including kidneys. And kidney damage can be a side effect of ibuprofen for some patients who use it long-term in higher doses, says Rogers, whose research focuses on the kind of acute respiratory distress experienced by the most severe COVID-19 cases.
Of course Tylenol, like any medicine, isn't risk-free either; Rogers notes that acetaminophen can cause serious liver damage in high doses. In low doses, though, she says, Tylenol is "very effective" for reducing fever and "very safe."
As for what Rogers would advise for patients who are treating symptoms of COVID-19 at home?
"We don't have a lot of evidence in this disease in general," she says. Like the other physicians and scientists NPR spoke with, Rogers emphasizes that any evidence that ibuprofen exacerbates the coronavirus disease is faint at best. That said, "If people have no liver disease and it makes them feel a little bit more secure to start with Tylenol first, that might be a reasonable way to do it."
