Coronavirus: what happens to people’s lungs when they get Covid-19? – The Guardian

The coronavirus is striking, and felling, more Italian men than women, and some experts are warning that being male may be a risk factor for the illness, just as older age is.

The Italian trend mirrors one seen in China, where men were more likely than women to die of Covid-19.

In Italy, more men than women have been infected, and a higher proportion of infected men have died. Some 8 percent of male patients died, compared with 5 percent of female patients, according to a Higher Health Institute of Rome analysis of 25,058 cases.

Being male is as much a risk factor for the coronavirus as being old, said Sabra Klein, a scientist who studies sex difference in viral infections at Johns Hopkins Bloomberg School of Public Health. People need to be aware that there is this pattern. Just like being old means youre at higher risk, so does being male. Its a risk factor.

She said the vulnerability could be biological or behavioral. Women have more robust immune systems, Dr. Klein said. And more men smoke in higher numbers, and they are less likely to wash their hands, studies show.

We dont always understand why something is a risk factor, and were probably not going to be able to pinpoint one thing, Dr. Klein said. But its remarkable that were seeing this across such socially and culturally distinct countries as Italy and China. More needs to be made of this fact.

On Friday, Dr. Deborah Birx, the coronavirus response coordinator for the White House, mentioned the gender disparity in deaths in Italy, but said the gender gap was twice as high in men at all ages. In fact, the report mentioned no deaths in people under 30 and very few deaths among men and women in their 40s and 50s. The heightened risk to men becomes apparent in their 50s, with the gender gap tapering off somewhat only at 90, probably because there are fewer men in this age group.

Over all, men represented 58 percent of 25,058 coronavirus cases in Italy, and 70 percent of the 1,697 deaths described in the report.

In China, the death rate for men was 2.8 percent, compared to 1.7 percent for women, according to the largest analysis of cases by the Chinese Center for Disease Control and Prevention.

Men also were disproportionately affected during the SARS and MERS outbreaks, which were caused by coronaviruses. More women than men were infected by SARS in Hong Kong in 2003, but the death rate among men was 50 percent higher, according to a study published in the Annals of Internal Medicine.

Some 32 percent of men infected with Middle East Respiratory Syndrome died, compared with 25.8 percent of women. Young adult men also died at higher rates than female peers during the influenza epidemic of 1918.

Women appear to have stronger immune systems than men. The female sex hormone estrogen appears to play a role in immunity, as does the X chromosome, which contains immune-related genes. Women carry two X chromosomes; men only one.

But women also develop more autoimmune diseases such as lupus and rheumatoid arthritis, in which the immune system attacks the bodys own organs and tissues.

Other health and behavioral factors may also be contributing to mens vulnerability. Men develop cardiovascular disease and hypertension at younger ages than women, and both of these conditions increase the potential for severe disease, said Kathryn Sandberg, director of the Center for the Study of Sex Differences in Health, Aging and Disease at Georgetown University.

Men also smoke at higher rates than women. In China, more than half of all men smoke, compared with less than 3 percent of women; in Italy nearly 30 percent of men smoke, compared with 19 percent of women. In the United States, the smoking gap is smaller, with 17.5 percent of men smoking compared with 13.5 percent of women.

After arguing for the importance of the care economy for years, I was delighted to see, after only one day of kids staying home, three different men tweet versions of the following: First day of home schooling and I now firmly believe that teachers should be paid like C.E.O.s. Indeed they should, and after this crisis subsides, we may finally be able to build support for higher teacher pay and prestige.

All these transitions take money, of course, and above all the basic security that allows people to see opportunity rather than devastation, to feel hope rather than fear. We must mitigate the rising panic as we contemplate the possibility that millions of Americans will simply not have a paycheck as local economies shut down.

Here, too, we are seeing a fast forward, to a rudimentary Universal Basic Income. Congress is considering various versions of that, including one proposal that would provide initial direct cash payments of $2,000 per person for every adult and child in families making up to $180,000, beginning in April.

Once again, however, we dont have to wait for Washington. The nonprofit group Give Directly, which has been testing universal basic income in Kenya, is raising money to provide $1,000 to families in need across the United States. The group is working with Propel, a company that made an app for managing food stamp benefits, to identify families in the federal Supplemental Nutrition Assistance Program, typically single mothers. Payments will be made through debit cards that can be loaded remotely, or by setting recipients up with online wallets. Communities can adapt versions of this system, creating an informal tax that could become a formal one.

Finally, all of this innovation will require universal access to fast, affordable broadband. Our government has an obligation to provide public education; it must now provide the broadband to make that education possible. It can certainly be done, but the government will have to better regulate private internet service providers and move to more accountable municipally owned internet service utilities, like the one that offers the nations fastest broadband, in Chattanooga, Tenn.

The future is here, whether we like it or not. Although a future dependent on the current federal government looks bleak, we can vote to change that in November. Right now, we can follow the lead of local and regional leaders and step up ourselves. Through the virus, we are rediscovering the dark side of the Rev. Dr. Martin Luther King Jr.s famous inescapable network of mutuality, tied in a single garment of destiny. But we can also rediscover what is possible and what we are capable of as a nation. We can use this crisis to create a better America.

Anne-Marie Slaughter, a former director of policy planning for the State Department, is the chief executive of New America.

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KIRKLAND, Wash. Loretta Rapp, 79, was easy to spot as she zipped through the Life Care Center nursing home in her electric wheelchair, dressed in one of her bright muumuus.

It had been hard for her to leave her apartment after she took a bad fall last year. But she was a no-nonsense woman who had raised three children, and she was trying to make the best of things. She went to physical therapy. She devoured detective novels. At the skilled-nursing facility tucked next to a row of Douglas firs in suburban Seattle, she was elected president of the residents council.

Life Care made an effort to keep things fun. There were shopping excursions to the Fred Meyer and lunch trips to Olive Garden, a recent afternoon with cute and cuddly animals. The Honky Tonk Sweethearts, a country group, came in for a show early in February. Ms. Rapp spent her days buzzing the hallways, visiting newcomers and cheering up bed-bound friends.

Then people started getting sick.

Not sick like what happens all the time in a nursing home, the bad flus and septic infections and old bones that will not heal. This was different. In the last few days of February, peoples temperatures started going off the charts. Some could not breathe. Then came word that the coronavirus, the one in China that was all over the news, was right there in Kirkland, population 89,000.

Two Life Care residents died on Feb. 26, though it would be days before tests confirmed they had the coronavirus. And 911 records showed that more people were failing. A 60-year-old man was not responding to liter after liter of oxygen. One patient was fading in and out of consciousness. Another was turning blue.

The staff put the facility on lockdown. The halls emptied. Bedroom doors were closed.

In Room 32W, Ms. Rapp lay straining to breathe as her fever spiked to 103 degrees.

At 1:52 p.m. on Feb. 29, a nurse called 911 to report Ms. Rapps failing health. Shes running a temp, he told the dispatcher. We think she, um

He stopped himself.

This is the place that has the coronavirus.

As confirmed cases of Covid-19, the disease caused by the virus, now surge across the country and overturn every facet of normal life, the troubled nursing home in Kirkland looks like a frightening preview of what could lie ahead.

Since the first positive tests at Life Care came back on Feb. 28, 129 people there including 81 residents, about two-thirds of its population have tested positive for the virus, and 35 people have died. Dozens of its workers have received coronavirus diagnoses, suggesting that the centers frantic efforts to sanitize the building, quarantine residents and shield staff members with gowns and visors may have come too late.

This caught them completely off guard, Jim Whitney, the medical services administrator for the nearby Redmond Fire Department, said. They just were not prepared for what was happening. None of us were.

Accounts from emergency responders, public health officials and those who had loved ones at Life Care show a cascading crisis marked by confusion and delays. A federal strike team of doctors and nurses did not arrive until more than a week after the first coronavirus cases were reported. Several crucial days ticked by before the facility was able to get tests for all its residents, making it impossible to tell which patients were already infected.

As a third of the centers workers fell sick or stayed home to avoid infection, the remaining nurses and aides strained to keep up as they worked 18-hour shifts. Patients were left in their beds, some of them scared and lonely.

Some of the health care employees at Life Care also worked at other nursing homes in the Puget Sound region. The ones who had been exposed to the virus at Life Care, investigators for the federal Centers for Disease Control and Prevention found, took it with them to other facilities, opening new pathways of infection.

Tim Killian, a spokesman for Life Care, said that as the crisis unfolded, administrators and nurses were left largely on their own, with little help from the county, state, and federal governments to confront the worst public-health crisis in a century.

Who do you see in the parking lot helping? he said last week. Wheres everyone else? Why is it falling to this one nursing home to solve it for everybody? Why was the entirety of government unwilling to come in and help?

Life Care is part of a Tennessee-based chain of 200 facilities across the country. The facility earned five stars out of five on its federal ratings for overall care last year, and families praised the workers and quality of care.

Many of the homes roughly 120 residents were in their 80s or 90s, suffered from dementia and were there for good. Others were there for rehabilitation after a fall or surgery, and hoped to be on their own again.

The 180 staff members included physicians, physical therapists, nurses and nursing assistants, many of them immigrants, who did the intimate work of bathing residents, getting them dressed and lifting them out of bed to use the bathroom.

In early February, the staff began to get concerned about what appeared to be a rash of seasonal influenza. Nineteen long-term care centers had reported similar infections, King County health officials said.

Some families received phone calls that now look like flashing warning signs.

On Feb. 18, Cami Neidigh said, Life Care called about her 90-year-old mother, Geneva Wood, whom she described as an independent and crotchety and strong Texan who was recovering from a stroke. She had pneumonia, the facility said. The next day, another patient suffering from a respiratory ailment had been sent to a hospital Life Cares first evacuation.

On Feb. 20, 86-year-old Chuck Sedlacek, who was recovering from a fall that had broken his ankle, was moved into a shared room at Life Care with a man suffering from what had been diagnosed as pneumonia.

Ms. Wood and Mr. Sedlacek later tested positive for the coronavirus.

The Mardi Gras party went ahead on Feb. 26 under purple and gold ribbons garlanding the entertainment room. Residents snacked on king cake and sausage and rice, clapping and singing to the tunes of a visiting Gatsby Jazz band.

In hindsight, once we heard the news about what was there, we thought that maybe there shouldnt have been a party, said Patricia McCauley, 79, who had visited, with her husband, more than half a dozen times in the previous two weeks to see a friend who subsequently tested positive for the coronavirus and died.

Around that time, Lt. Dick Hughes of the Kirkland Fire Department began to notice a troubling pattern in the 911 calls from Life Care: patient after patient suddenly overwhelmed by fever and cough. The center had made seven 911 calls in January. From Feb. 1 through March 5, there were 33.

We had one. Then we had another one, then we had another one, Mr. Hughes said. Patients were falling ill, and deteriorating with troubling speed. The nurses kept saying, They were not like this two hours ago.

Neither the paramedic crews nor the sick residents had been wearing masks or other protection. As they loaded up patient after patient, Lieutenant Hughes thought to himself: This is way too many.

The nursing home started to discourage visitors, but it did not forbid them, and family members said they did not think anything was seriously wrong.

I didnt see anything, said Amy Jou, who visited on Feb. 28 to do her 93-year-old mothers laundry.

Ms. Neidigh came that same morning to bring her mother coffee and discuss plans for moving her back into her own apartment. She said the staff warned her about what it still thought was a respiratory outbreak, and urged her to wear a mask. She slipped one on, but since several staff members were not wearing protection, she said, she figured there was little to worry about.

Mr. Killian, the spokesman, said that while some administrators or reception staff may not have been wearing protection at that point, the workers in contact with patients were all in masks. Of course we were geared up, he said. Of course we were.

The first coronavirus case would be confirmed later that night.

Two days later, on March 1, the first death of a Life Care resident was announced. It was described in the terse language of a government news release as a male in his 70s with underlying health conditions. Nearly every day since has brought news of more.

As news crews swarmed outside, residents were tucked behind closed doors and signs warning about droplet precautions were taped onto the walls.

The workers, you could see they were stressed and worried, said Curtis Luterman, who managed to move his mother out of Life Care. Worried about getting sick. Worried about if this place is going to close. Worried about the people they were taking care of.

A staff members voice was shaky as she called 911 in early March to help a 63-year-old man who was struggling to breathe.

Is the patient awake right now? the dispatcher asked.

Hes somewhat conscious. Hes turning blue. Hes having a hard time breathing.

The dispatcher asked whether the man had traveled to Asia, Iran or Italy in the last 14 days. No, said the caller, but she pointed out that the nursing home had already had two coronavirus cases.

OK, sure. So what were going to ask you to do is we are going to ask you if its possible to wheel him outside and place a mask on him? the dispatcher asked.

Ooh. OK. Ill try.

A nursing assistant who worked at the facility until she asked for leave during the first week of March said the work grew harder as the staff dwindled.

The woman, who spoke on condition of anonymity because Life Care did not give her permission to describe what she experienced inside, said it was agony to see stricken residents fitted with face masks and wheeled out to meet arriving ambulances, one after another. When she came home at the end of each shift, her husband met her at the front door and tossed her uniform into a garbage bag to launder.

It was scary, she said. I didnt want to be contaminated.

Time dragged on. People anxious to connect with parents they could no longer be in the same room with pulled up lawn chairs outside their bedroom windows. They shouted I love you into their cellphones as masked, gowned workers held a telephone up to their parents ears on the other side of the glass.

When Charlie Campbell came to the window to visit his 89-year-old father, Eugene, who has dementia and later tested positive for the virus, a staff member helped his father into a wheelchair and handed him his room phone.

We talked about the food, my mom and when he might be able to go back to living with her, Mr. Campbell said.

Some had to search for answers from a distance as their relatives deteriorated.

Carolyn Lockleys 65-year-old sister, Renee Gibbs, seemed incoherent and could barely remember what she had eaten for lunch when Ms. Lockley called her from her home outside of Philadelphia on March 2.

Ms. Gibbs, a longtime Life Care resident who was paralyzed because of multiple sclerosis, had received a pneumonia diagnosis weeks earlier. As they talked that afternoon, Ms. Lockley could hear her sisters roommate coughing in the background. Because there were not enough tests to go around, her sister still had not been tested for the coronavirus, but her sister feared she might have it. A nurse reported that her blood pressure was rising.

She promised to call with any updates but did not. When Ms. Lockley tried to get through to the center later, the phone rang and rang. She hung up and called 911.

I want them to take her to a hospital, she told the 911 dispatcher, her voice shaking. When I talked to her earlier today she was incoherent. Several people at the facility had already died, she told her.

I understand that, the dispatcher replied.

I am getting scared, Ms. Lockley said.

A team drove out from the Fire Department that evening, but the responders said Ms. Gibbs had told them she felt fine and did not want to go to a hospital.

Hours later, around 4 a.m., Ms. Gibbs developed a fever and was taken to the EvergreenHealth medical center, where she learned she had the coronavirus. She died five days later.

After her fall, Ms. Rapp, who had worked in the office of an elementary school, had struggled with moving into a nursing home. She was partial to the senior-living complex she had shared with her husband of more than 50 years before his death. But she had been doing better lately. Her room was decorated with family photos, and she made friends. When a new resident arrived, she would assure them with friendly bluntness: Dont worry, they cant kick you out.

Three times a day, she would show up at the bedside of Susan Hailey, 76, who had moved into Life Care for rehabilitation after a knee replacement, but had shattered her ankle in a fall and could no longer get out of bed. Ms. Rapp would chat with Ms. Haileys daughters and then buzz away in her wheelchair.

She loved to joke, said Ms. Hailey, who tested positive for the virus and is still at Life Care. If there were too many people in my room, shed leave. She didnt want to interrupt us. Ms. Hailey would tell her, Oh Loretta, youre not.

On Feb. 29, Ms. Rapp was transported to an isolated intensive-care room at the hospital. When she tested positive for the coronavirus, she ruefully called it the icing on the cake.

She was in such pain. On a conference call with her son and her doctor, days before she died on March 8, Ms. Rapp decided that she only wanted comfort care from there till the end.

Her son, Ken Rapp, said he and his mother spoke for a while longer on that final call; they exchanged I love yous, and he told her that he wished the family could be there with her. Eventually, they had to say goodbye.

Its the weirdest thing, Mr. Rapp said. Sitting there on the phone, hitting that red button and knowing youll never talk to her again.

But Mr. Rapp said his mother made it clear they should not try to come: She wouldnt wish this on anyone. Dont, she told him.

Mike Baker contributed reporting from Seattle and Matt Richtel from San Francisco. Susan Beachy, Jack Begg and Sheelagh McNeill contributed research.

While I didnt emerge as a postdoc epidemiologist, the lessons I took away, hidden in plain sight all these years, would be valuable to any member of the White House Coronavirus Task Force. Its all there, from Contagions advocacy for social distancing to Outbreaks and Hot Zones depictions of how interagency squabbling can slow responses. Even the epigraph of Outbreak, from the Nobel laureate and bacteriologist Joshua Lederberg, should have focused us on the gravity of a pandemic earlier: The single biggest threat to mans continued dominance on the planet is the virus.

But I also noticed something else: These films have perhaps numbed us to those very viruses that threaten us mostthe viruses that do not have a giant fatality rate or change our physical appearance. In Outbreak, Dustin Hoffmans Col. Sam Daniels, a virologist with the United States Army Medical Research Institute of Infectious Diseases, contends with Motaba, a fever-inducing virus that kills 100 percent of its patients in two to three days. In The Hot Zone, Ebola leaves its patients with a rash and kills them quickly. In Contagion, MEV-1 has a mortality rate around 20 percent. If Motaba had hit the U.S. the government would have been faster to quarantine cities and issue shelter-in-place orders, shutting down schools and non-essential businesses. Had Ebola been spreading around Indianapolis, I bet those revelers across the street would have stayed at home. But my neighbors seemed blind to COVID-19, which is more insidious and subtly dangerous than the diseases from the movies. Its mortality rate is in the single digits low enough so many think they have little to fearbut it is proving just as disabling to the economy and our way of life, if not more, than much more deadly outbreaks, which can be contained faster.

Earlier this week, I asked Dr. Ian Lipkin, a Columbia University epidemiologist, why all of these movies hadnt moved politicians and voters to take viral epidemics more seriously. I dont think movies change the way people feel about things, he told me, adding that he was working with the writer of Contagion, Scott Z. Burns, on a public awareness campaign ad on the novel coronavirus.

The fact that the United States has dodged the bullet with all of the latest infectious diseases, my perception of our government is that unless its screaming hot in the headlines, nothing will be done, says Tracey McNamara, a technical consultant on Contagion and a veterinary medicine professor at Western University of Health Services, told me.

Contagion, hints at our lackadaisical approach to any virus that isnt produced in a Hollywood studio: Theres a scene in which a reporter asks Centers of Disease Control and Prevention Administrator Dr. Ellis Cheever, played by Laurence Fishburne, whether the government is overreacting to a virus that would claim 26 million lives in 29 days.

Dr. Cheever, are you concerned that the CDC faces a credibility issue here, after the perceived overreaction to H1N1? the reporter asks.

Id rather the news story be that we overreacted than that many people lost their lives because we didnt do enough, Cheever replies.

Set pieces and dramatic press conference scenes like this one seemed a critical part of any disaster movie. Now, we see them almost everyday when the coronavirus task force briefs the nation. For decades, these films have thrilled theatergoers with an invisible enemy, the stark reality of an apocalyptic human-versus-nature, us-versus-it conflict. But the actual conflict in all of these films is actually something different: Its us versus the bureaucracy. These are not so much films about disasters as they are films about government.

Contagion is such a compelling filmlife is unfolding very much like the movie, says McNamara, who discovered West Nile Virus in the summer of 1999 while working as the chief pathologist at the Bronx Zoo, when crows started falling from the sky and into exhibits that August. The speed with which it spread. How it spread.

Turns out, Hollywood has been offering Washington clues about how a pandemic might transpire for decadesand what the government should do to fight it. Here are just a few:

Much of Outbreak revolves around the efforts of the protagonist (Col. Sam Daniels, played by Dustin Hoffman) to convince his boss, Brigadier General William Ford (played by Morgan Freeman) that the country faces a real threat from the fictional Motaba virus. Daniels spends much of the film battling with Army General Donald McClintock, played by Donald Sutherland, to get the word out about the dangers of the virus.

After Daniels ex-wife, CDC staffer Dr. Roberta Robby Keoughplayed by Rene Russotreats a dying and infected patient, she laments not getting a CDC advisory out about the virus faster. The CDC staffers efforts were blocked by her superiors. I shouldve forced the alert, the doctor says, explaining Motabas deadly effects. Christ, Sam. I opened this guy up, she tells her ex. Looked like a bomb went off inside. His pancreas, liver, kidney, spleenall the organs were liquified. Christ, I shouldve forced the alert.

In Contagion, weeks into the outbreak of MEV-1, Dr. Sanjay Gupta (played by himself) asks CDC Administrator Cheever how many people have died from the disease during a cable television appearance. The answer, Cheever admits, was very difficult to know exact numbers because reporting varied by state. There are 50 different states in this country, which means there are 50 different health departments. Followed by 50 different protocols.

And in the final episode of The Hot Zone, a dispute between an Ebola researcher and the head of the CDC almost derails efforts to get to the bottom of the Reston, Virginia, Ebola outbreak.

The guy hates my guts, Walter said of the CDC official Trevor Rhodes (James DArcy). Im never going to convince him to help.

You need to bury whatever happened between you two, Carter. You got no choice.

The messages of all these filmsinfighting and turf battles make things worsefelt apt for the ongoing feud between Health and Human Services Secretary Alex Azar and Seema Verma, administrator of the Centers for Medicare and Medicaid Services, which is a branch of HHS that operates independently. A series of incidents over the past 120 days suggest basic communication and coordination between CMS and HHS is lacking, thereby jeopardizing HHS mission and undermining public trust, HHS chief information officer Jose Arrieta wrote a recent memo.

The latest incident? On February 23, HHS email system crashed, causing vital messages about the emergency coronavirus funding package to be delayed for up to 11 hours. The cause: Vermas Centers for Medicare and Medicaid Services had failed to brief HHS leaders about a test that would send thousands of messages through the system. The outage slowed the administrations response to the deadly outbreak.

In the six-part National Geographic mini-series The Hot Zone, based on the 1994 non-fiction book by Richard Preston, Wade Carter, a fictionalized reclusive Ebola expert who studied the virus in the field, is frustrated that more senior officials arent taking the threat of Ebola on American soil more seriously. Carter tells Army Col. Nancy Jaax (played by Julianna Margulies), a veterinarian who helped contain Ebola-infected monkeys from the Philippines: Did I want this? Never. Now its here. Would it be good for the Oval Office to be pissing its pants about this now? You bet.

But by the end of the series, after the scientists ultimately contained an Ebola outbreak in Reston, Virginia, there seems to be little appetite from public policymakers to take the threat of an epidemic seriously. We see a flyover shot of Capitol Hill. In a nameless committee room, the deputy secretary of the National Institutes of Health asks Jaax: So no one died?

Thats correct, Mr. Chairman, Jaax says. But four people tested positive for the Ebola virus.

And 172 people were tested and came up negative, the deputy secretary responded, unperturbed.

The warning was clear: When scientists are worried, people should listen. And yet, not more than a week ago, President Donald Trump and some Republican members of Congress, along with conservative television hosts, were saying that journalists and Democrats were overplaying the threat of the coronavirus. Now some of those pols who thought it was no big deal are getting tested for COVID-19 themselves.

In The Hot Zone, Jaaxs husband, Noah Emmerichs Lt. Col. Jerry Jaax, makes a plea: Its no secret the CDC needs more funding for research and developmentmeaning that the CDC was caught somewhat flat-footed by the outbreak in Reston.

But back in real life, just last week, even as coronavirus was spreading in the United States, the acting director of the Office of Management and Budget Russ Vought defended the Trump administrations proposed $35 million cut to the Infectious Diseases Rapid Response Reserve Fund, designed for use by the CDC.

Rep. Matt Cartwright, the Democratic member from Pennsylvania, bristled at the cuts in a hearing with Vought. The question is today, as we sit here and we know about coronavirus and the impact its taking on the people of the world and the economies of the world and the stock market and everything, as you sit here today, are you ready to take that back?

In none of the virus movies I watched do we see the U.S. president. He or she is often one of the least important characters. In Contagion, hes moved underground. In Outbreak, we only see the chief of staff, talking White House officials through the ethics of bombing a California town, executing all of its citizens in order to contain Mataba. Instead, the most important charactersthe ones who do the talkingare the public health officials, virologists, researchers and frontline healthcare workers. In the movies, scientists always offer a clear explanation and as much information as they have to concerned citizens. Politicians would only get in the way.

President Donald Trump didnt get the memo. His statements about coronavirus have been perplexing and counterproductive. He said we have it under control. He compared it to the flu. He told people with the virus to go to work. He suggested the virus would disappear. Then he declared a national emergency.

In contrast, Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, and Dr. Deborah Birx, a global health official at the State Department who is now White House coronavirus response coordinator, are lucid, calm presenters of informationperhaps the administrations most credible spokespeople. If this were a Hollywood movie, those two would have been doing most of the talking from the beginning.

Bryan Cranston, who plays Rear Admiral Lyle Haggerty in Contagion, alludes to a congressman who is at risk of infecting his fellow members of Congress with MEV-1. Theres a sick congressman from Illinois in D.C., Haggerty says. He was in Chicago over the holiday. They are using the pod to fly him home, and then they are closing Midway and OHare. The governor there is calling out the national guard. They are setting up roadblocks. They are shutting down the board of trade, public transportation. Even the Teamsters are pulling their drivers off the road.

Any policymaker who watched that scene and connected the dots wouldnt have been able to escape the realization that in the event of a pandemic, it would be important for Congress to have a way of working remotely. This week, several representatives and senators directed some staffers to work from home. Still, members of Congress, many of whom are at risk of higher mortality rates given their average age57.8 years in the House and 61.8 years in the Senate dont have an established way to conduct their business remotely.

The Wolfgang Petersen film Outbreak is perhaps the least subtle of the group of films. A lab clinician infected with Motaba sees a movie with his girlfriend. As a result, the entire town of Cedar Creek, Californiapopulation 2,600is nearly bombed with the the most powerful non-nuclear weapon in our arsenal by the U.S. government to contain the spread of the virus.

When Daniels and Keough survey the infected at a makeshift hospital in Cedar Creek, Keough remarks: So manyso fast.

Apparently they all gathered at a movie theater, Daniels replies.

In Contagion, the CDC administrator urges social distancing and not shaking hands as the best advice for controlling the spread of MEV-1. We see empty gyms and open-floor plan offices. Right now, our best defense has been social distancing, Fishburnes Cheever, the CDC director, tells Dr. Sanjay Gutpa in a cable television studio. No handshaking. Staying home when you are sick. Washing your hands frequently.

The idea for the scene came from Lipkin, the Columbia University epidemiologist who told the films writer, Scott Z. Burns, that he would serve as a technical adviser on the movie if he agreed to make it as scientifically accurate a film as possible.

In the films emotional denouement, Cheever visits the home of one the CDCs janitors to deliver a vaccine, where he explains to the janitors son the origins of the handshake. (The scene was designed to disclose the history of the handshake, Lipkin told me in an interview earlier this week.)

Do you know where this comes from? Shaking hands? he asks the boy, after delivering the vaccine by pushing a swab up his nostril. It was a way of showing a stranger you werent carrying a weapon in the old days.

These days, we are all presumed to be armed and dangerous.

An epidemiologist answers the biggest questions she's getting about coronavirus. Wochit

As the coronavirus pandemic continues to shut down daily life across the globe, thousandsof our readers across the nation have asked us questions about COVID-19.

And we're answering them.

Forbasic facts about the virus what it is,how it spreads and where it's located you can get caught up by reading our in-depth explainer here.We've also debunked someviralcoronavirus myths.

But you're curious and continue to ask important questionsvia our newsletter, Coronavirus Watch. (Not a newsletter subscriber?Sign up for it here!)

So below, you can find answers to questions such as: Isit OK to be outside? How old are people who are dying in the U.S.? Is it safe to get carry-out food?

If you don't see an answer you're looking for, check outour first batch of answers, addressing things like:Can testing show if someone has had coronavirus and then recovered?Can someone get the coronavirus more than once?

What else would you like to know? Ask us by filling out the form you can find here.

Pamela from Wellsville, Pennsylvania

Acknowledging that older adults and persons with underlying health conditions are more susceptible to COVID-19, a growing number of stores are dedicating time or opening earlier for senior shoppers and other at-risk groups.

But Tania Elliott,clinical instructor of infectious diseases atNYU Langone, says she doesn't advise it. "That gives a false sense of security," she said. "By encouraging older people with chronic diseases to go out at a dedicated time, you're still exposing them to a bunch of other people, and if one person in that crowd is infected, then the virus will spread."

Elliott said she'd rather see storeslimiting the number of people who can enter during a given time period so that there are fewer people in the store. She also encourages healthy people to do the shopping.

Pam from Seven Lakes, North Carolina

The chances of transmission through your mail is very low, Elliott says. "Parts of the virus can fall on surfaces and survive on surfaces for up to 72 hours. But you have to have pretty good conditions for that to happen. So the likelihood would be very small, even with no precautions," she said.

Elliott advises people to put their mail down on a plastic plate instead of directly on a counter top or table, to use a letter opener, and to wash hands thoroughly after touching the mail.

Research on how long a virus may live on surfaces is evolving.The CDC has said there is likely very low risk of transmission of COVID-19 from products or packaging that are shipped over a period of days or weeks "because of poor survivability of these coronaviruses on surfaces."

But a recent studyfound that viable virus could be detected up to three hours later in the air, up to four hours on copper, up to 24 hours on cardboard and up to two to three days on plastic and stainless steel.

Alfrom Topeka, Kansas

Officials suggest self-quarantining for two weeks if you've had exposure to somebody with the virus and might be infected. It's a way to monitor if symptoms develop and, at the same time, avoid any possible spread to others. Since the incubation period for the virus is up to 14 days, you're "cleared" for the virus after two weeks, Elliott said.

After that, you still need to practice social distancing.

Danny from Sundance, Wyoming

No, for several reasons,saysPeter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine.

While a protective antibody is generated in those who are infected, scientists are not yet sure whether thatimmunity will last for a short period of time, for years or for life. Some say the possibility of reinfection is very likely.

Moreover, a new federal health report says Americans of all ages have faced serious health complications amid the outbreak. Data from the Centers for Disease Control and Prevention show that among the roughly 12% of COVID-19 cases in the U.S. known to need hospitalizations, about 1 in 5 were among people ages 20 to 44.Anywhere from 14% to 21% of adults ages 20 to 44 with COVID-19 have been hospitalized, the CDC data estimates. Two to 4% of cases led to ICU admissions, and less than 1% were fatal.

Finally, it's important to avoid getting and spreading the virus. While the young may not be the most at risk, they're carrying the disease to those who are more vulnerable, such as older people and those with underlying conditions.Dr. Deborah Birx, a member of the White House coronavirus task force, on Wednesday urged "the millennial generation"to take special precautions. "You have the potential to spread it," she said.

Linda from Hendersonville, Tennessee

Vaccines against pneumonia, such as pneumococcal vaccine and Haemophilus influenzae type Bvaccine, do not provide protection against the new coronavirus, according to the World Health Organization.The vaccines simplyguard against those specific bacterial infections.

The COVID-19 viruscan, in fact, cause pneumonia, but the vaccines cannot prevent this pneumonia.

Patti from Carmel, Indiana

Yes, that's OK! Just be sure to maintain distance from other people.The Centers for Disease Control and Preventionrecommenda distance of about 6 feet.

Even in some California counties where residents are being asked to stay home and"shelter in place," it's still fine to gofor a run, hike or do other outdoor activities, as long as proper social distancing is observed, according to local health officials.

Just remember: The White House recommends thatyou should avoid social gatherings involving more than 10 people, as well as all non-essential travel, shopping trips and social visits.

Social distancing: Why it's so important to stopping the spread of coronavirus

Social distancing matters. Here is how to do it and how it can help curb the COVID-19 pandemic. USA TODAY

Dennis from Las Vegas

Yes, there are many projections, but scientists say theyall hinge on how people behave. That's why it's essential to social distance and do what you can to prevent spread.

A conservativeUSA TODAY analysis based on data from the American Hospital Association, U.S. Census, CDC and WHOestimates that 23.8 million Americans could contract COVID-19, leavingalmost six seriously ill patients for every existing hospital bed. Another analysisfinds thatAmericastrajectory of community spread is trending toward Italys, where circumstances are dire.

One researcher at theGlobal Center for Health Securityestimated last month that as many as 96 million Americans could be infected.The Johns Hopkins Center for Health Securityestimatedthat 38 million Americans will need medical care for COVID-19. The CDC's worst-case-scenario is that about 160 million to 210 million Americans will be infected by December. Under this forecast, 21 million people would need hospitalization and 200,000 to 1.7 million could die by the end of the year.

Outside the U.S., leaked British documents projected thata coronavirus outbreakcould rage untilspring 2021.German Chancellor Angela Merkel said 60% to 70% of her country's population could eventually become infected.

USA TODAY analysis: America's coronavirus 'curve' may be at its most dangerous point

Debby from Omena, Michigan

The CDC and WHO have not issued formal guidance on carry-out food.

While the CDC says that there is no evidence to supporttransmission associated with food, aperson may get COVID-19 by touching a surface or object that has the virus on it and then touching their own face. The virus can, for example, survive on cardboard up to 24 hours, according to a recent study.

The issue of carry-out food also raises concerns about therisk couriers are facing by interacting with customers during their shifts. That's why some companiesare now offering"contactless" delivery options that help peoplemaintain social distancing by allowing couriers to ring the doorbell and leave the package outside.

Study finds: Coronavirus can live in the air for hours and on surfaces for days

It's vital to clean surfaces you touch every day amid the coronavirus outbreak. Here are mistakes to avoid. USA TODAY

Pam from Easton, Maryland

There's no specific data on this question yet, according to Gregory Poland, director of the Mayo Clinics Vaccine Research Group.

However, we do know that someone infected with the virus may begin showing symptoms anywhere between oneand 14 days after catching the virus,most commonly around five days, according to WHO.

"The peak viral shedding occurs during the first fivedays after the onset of symptoms.My guess is that within a few days of being exposed, these patients are beginning to shed virus," Poland said.

Carlos from Los Angeles

The most common symptoms are fever, tiredness and dry cough, according to WHO. Shortness of breath is also among the most common symptoms, according to the CDC.In most cases where symptoms present, those symptoms come together, Hotez said.

"Usually it presents with fever and cough,or fever, cough, and shortness of breath," he said."It might present with one of those symptoms first, but then it rapidly progresses to the others."

Some patients also have aches and pains, nasal congestion, runny nose, sore throat or diarrhea. Some people do not have symptoms at all.

ANew York neurosurgeonis warning people against looking out for fever as the first tell-tale symptom of the virus. Hissymptoms began with a little bit of congestion and only later progressed to afever, body aches and chills.

More on testing: Coronavirus test swabs aren't your standard Q-tips, and they're running out as testing ramps up

Catherine from Carson City, Nevada

In some cases, the virusultimately damages tiny air sacs in the lungs, restricting oxygen to the bloodstream and deprivingother major organs including the liver, kidney and brain of oxygen.

Severe cases of coronavirus: Some result in brain damage, inability to walk

In a small number of severe cases, that can develop into acute respiratory distress syndrome (ARDS), which requires a patient be placed on a ventilator to supply oxygen. However, if too much of the lung is damaged and not enough oxygen is supplied to the rest of the body, respiratory failure could lead to organ failure and death.

Here's what that looks likeinside the body.

Becky from Bentonville, Arkansas

In the U.S., ages range from people in their 50s to 90s, according to state and local health departments.

At least two people as young as 53 have died after contracting the virus. One was a Orleans Parish,Louisiana, resident who had underlying medical conditions, according to state health officials. Another patient was a53-year-old woman in New York City who had diabetes and heart disease, the mayor said.

However, this range is not conclusive becausehealth officials have not released the specific ages of several other patients,and new deaths are being reported eachday.

Antonio fromPatchogue, New York

No, the presence of the coronavirus would not turn a flu test positive.However, it's possible to have both the coronavirus and the flu at the same time. In that case, the flu test would be positive.

The opposite is also true: Presence of the flu would not result in a positive coronavirus test.It's important to note that, even if someone tests negative for the coronavirus,they still may be infected with the coronavirus.

We answer the often searched question: "What are the symptoms of coronavirus versus the flu?" USA TODAY

Ted from Scottsdale, Arizona

No. While shortness of breath is among the most common symptoms of the virus, according to the CDC, that diagnosis does not necessarily involve holding a large breath for 10 seconds. Medically known as dyspnea, shortness of breathis often describedas "an intense tightening in the chest, air hunger, difficulty breathing, breathlessness or a feeling of suffocation," according to the Mayo Clinic.

If you think you may be sick, call your doctor and follow CDC guidance.

Debra from Dayton, Ohio

The longer a mask is usedand the more damp it becomes, the less effective it is, Poland said. "Butit is definitely better than the alternative of no mask!"

Contributing: Adrianna Rodriguez, Dalvin Brown, Marco della Cava,Jayme Fraser and Matt Wynn

Follow Grace Hauck on Twitter @grace_hauck

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This is not true of infectious scourges such as influenza. The flu hits the elderly and chronically ill hard, too, but it also kills children. Trying to create herd immunity among those most likely to recover from infection while also isolating the young and the old is daunting, to say the least. How does one allow exposure and immunity to develop in parents, without exposing their young children?

The clustering of complications and death from Covid-19 among the elderly and chronically ill, but not children (there have been only very rare deaths in children), suggests that we could achieve the crucial goals of social distancing saving lives and not overwhelming our medical system by preferentially protecting the medically frail and those over age 60, and in particular those over 70 and 80, from exposure.

Why does this matter?

I am deeply concerned that the social, economic and public health consequences of this near total meltdown of normal life schools and businesses closed, gatherings banned will be long lasting and calamitous, possibly graver than the direct toll of the virus itself. The stock market will bounce back in time, but many businesses never will. The unemployment, impoverishment and despair likely to result will be public health scourges of the first order.

Worse, I fear our efforts will do little to contain the virus, because we have a resource-constrained, fragmented, perennially underfunded public health system. Distributing such limited resources so widely, so shallowly and so haphazardly is a formula for failure. How certain are you of the best ways to protect your most vulnerable loved ones? How readily can you get tested?

We have already failed to respond as decisively as China or South Korea, and lack the means to respond like Singapore. We are following in Italys wake, at risk of seeing our medical system overwhelmed twice: First when people rush to get tested for the coronavirus, and again when the especially vulnerable succumb to severe infection and require hospital beds.

Yes, in more and more places we are limiting gatherings uniformly, a tactic I call horizontal interdiction when containment policies are applied to the entire population without consideration of their risk for severe infection.

But as the work force is laid off en masse (our family has one adult child home for that reason already), and colleges close (we have another two young adults back home for this reason), young people of indeterminate infectious status are being sent home to huddle with their families nationwide. And because we lack widespread testing, they may be carrying the virus and transmitting it to their 50-something parents, and 70- or 80-something grandparents. If there are any clear guidelines for behavior within families what I call vertical interdiction I have not seen them.

New York City reports 5,683 cases and 43 deaths.

Late Friday, officials reported 5,683 confirmed coronavirus cases in New York City and 43 deaths. Earlier in the day, officials had put the number of cases at 5,151 and the number of deaths at 29.

As of late Friday, there were 736 confirmed cases in the Bronx (compared with 667 earlier in the day); 1,740 in Brooklyn (1,518); 1,402 in Manhattan (1,314); 1,514 in Queens (1,406); and 285 on Staten Island (242). Six cases were not linked to a specific borough.

Governor Cuomo ordered all nonessential businesses to keep all workers at home.

Gov. Andrew M. Cuomo on Friday issued a sweeping edict meant to compel New Yorkers to stay indoors as much as possible, ordering all nonessential businesses to keep their workers home as the number of confirmed coronavirus cases in the state raced toward 8,000.

New York State, with 6 percent of the U.S. population, now accounts for around half of all cases in the country.

Here are the highlights of Mr. Cuomos executive order, which takes effect Sunday at 8 p.m.:

Healthy people under 70 should limit outdoor activity to getting groceries and medicine, but they may exercise, walk outside and participate in other noncontact physical activities if they stay six feet away from others.

Mass transit will keep running, but people should not use it unless they absolutely must. Roads will remain open.

Nonessential gatherings of any size for any reason are banned.

There are stronger restrictions for people who are 70 and older, have compromised immune systems or have underlying illnesses. Those rules include wearing masks when in the company of others and not visiting households with multiple people.

Businesses considered nonessential must keep all of their workers at home.

Essential businesses that can stay open include: grocers and restaurants, health care providers, pharmacies, gas stations, convenience stores, banks, hardware stores, laundromats and cleaners, child-care providers, auto repair shops, utility companies, warehouses and distributors, delivery services, plumbers and other skilled contractors, animal-care providers, transportation providers, construction companies and many kinds of manufacturers.

Businesses that violate the order will be fined and forced to close. The state does not plan to fine people who violate the regulations, Mr. Cuomo said.

These provisions will be enforced, the governor said at a briefing in Albany. These are not helpful hints.

Gov. Ned Lamont of Connecticut issued an order similar to Mr. Cuomos on Friday, and Gov. Philip D. Murphy of New Jersey said he planned to order on Saturday that all nonessential businesses in that state shut down as well.

For weeks, as the coronavirus has spread across the globe, New York officials have warned that a surge of cases could overwhelm the states health care system, jeopardizing thousands of patients.

Now, it seems, the surge has arrived.

In a startlingly quick ascent, New York reported on Friday that the state was closing in on 8,000 positive tests, about half of the cases in the United States. The number was 10 times higher than what was reported earlier in the week.

The sharp increase is thrusting the medical system toward a crisis point, officials said.

In the Bronx, doctors at Lincoln Hospital and Health Center said they have only a few remaining ventilators for patients who needed them to breathe. In Brooklyn, doctors at Kings County Hospital Center say they are so low on supplies that they are reusing masks for up to a week, slathering them with hand sanitizer between shifts.

Some of the jump in New Yorks cases can be traced to ramped-up testing, which the state began this week. But the escalation, and the response, could offer other states a glimpse of what might be in store if the virus continues to spread. Gov. Andrew M. Cuomo on Friday urged residents to stay indoors and ordered nonessential businesses to keep workers home.

As it prepares for the worst-case projections, the state is asking retired health care workers to volunteer to help. The city is considering trying to turn the Jacob K. Javits Convention Center in Manhattan, the largest convention center in the country, into a makeshift hospital.

Case numbers continue their startling rise.

Friday afternoon, the number of confirmed coronavirus cases in New York State stood at 7,845, according to the most recent data from the city and state a jump of more than 2,000 from Thursday.

The state had performed 10,000 tests overnight, bringing the total number of people tested in New York to 32,427, officials said. Around 1,250 people were hospitalized, a hospitalization rate of 18 percent, the governor said.

Mr. Cuomo said New York was now testing more people per capita than China or South Korea.

As testing has ramped up rapidly in the state and the virus spreads, confirmed cases have grown at a breathtaking pace: When the week began, there were only about 700 cases in the state. Now there are about 10 times that.

Mr. Murphy said on Friday that 890 people in New Jersey had tested positive for the virus and that 11 had died, up from nine on Thursday. In Connecticut, officials reported 35 new confirmed cases on Friday, bringing the states total to 194. Four Connecticut residents have died of the virus.

Broadway producers have agreed to pay hundreds of actors, musicians, stagehands and others for the first few weeks of the industrys shutdown, and to cover their health insurance for at least a month.

The emergency relief agreement, which was announced late Friday, was negotiated by the Broadway League, a trade group, with 14 labor unions representing various workers, including ushers, makeup artists and publicists.

The Broadway shutdown, prompted by the coronavirus pandemic, has cost thousands of people their jobs, and is causing trickle-down damage to many Times Square businesses that depend on theater patrons.

The industry, which was idled on March 12, had initially said it hoped to resume performances on April 13, but a reopening is now expected more likely to be in May or June.

Under the agreement, all unionized employees will be paid for the week that was cut short by the shutdown, and the next two weeks.

The Army Corps of Engineers has sent service members to tour hotels in New York City to figure out how to convert up to 10,000 vacant rooms into temporary hospital rooms amid the coronavirus outbreak, Army officials said on Friday.

The Corps had not yet decided where the temporary hospitals would be, but General Todd Semonite, the Corps commander, said that candidates included empty hotels and the Javits Center on Manhattans Far West Side.

Mr. Cuomo wants the Corps to help build temporary hospitals, saying that he believes the state will have a disastrous shortage of hospital beds, particularly intensive-care beds.

General Semonite said that the Corps could turn empty hotels into intensive-care units, and could even convert hotel rooms into negative pressure rooms, which would prevent contamination from leaving the room and flowing into surrounding areas.

Crowds throng a new test center in Queens.

Early Friday, about 100 people lined up for coronavirus tests outside the emergency room at Elmhurst Hospital in Queens, one of several public hospitals that the city Health Department said on Thursday would begin testing people for the virus by appointment only.

The other public hospitals offering tests as of Friday included Bellevue, Harlem, Metropolitan, Kings County, Lincoln, Woodhull and Queens, officials said. Test centers are expected to open at Coney Island and Jacobi hospitals early next week. The city also plans to open several drive-through test sites at its hospitals.

Officials said they expected to test 150 people a day at each of the centers, which were created to ensure that New Yorkers with moderate to severe symptoms had access to tests without going to emergency rooms.

Those who have mild symptoms, are not over 50 or do not have underlying health conditions should continue to stay home, practice social distancing and consult their health care providers if their symptoms do not subside in three to four days.

Officials in New Jersey said that more than 600 people had been tested by Friday afternoon at the states first drive-through testing center, quickly exceeding its capacity and causing anyone not already in line to be turned away.

Governor Murphy said that people who were still hoping to be tested at the site, at Bergen Community College in Paramus, should try again Saturday morning. A second drive-through site, at the PNC Bank Arts Center in Holmdel, is expected to open on Monday.

To say there was pent-up demand would be the understatement of the century, Mr. Murphy said on Friday.

The site was scheduled to close for the day at 4 p.m., and state officials said that only those in line by around 1:50 p.m. would be eligible for testing.

In Connecticut, officials in Darien decided to move the first drive-through testing center proposed for in the town because of some logistics issues. The center, which was supposed to open at Darien Town Hall, will instead open on Monday at Darien High School.

Some Darien residents had objected to the Town Hall location.

Wow, this is maddening, Luke Bronin, the mayor of Hartford, wrote on Twitter. Public health needs to come before the convenience of homeowners offended by the location of the temporary test sites.

Holy Name Medical Center, a midsize community hospital in Teaneck, N.J., has been at the center of an outbreak in Bergen County, which has about a quarter of both the states confirmed cases and deaths from the virus.

The hospital has cleared its pediatric wing to make space for people infected with the virus, where 29 people are being held in isolation, and has carved its emergency room in two areas, creating a modified coronavirus wing.

On Friday, its chief executive, Mike Maron, said he had tested positive for the virus and was recovering at home.

As soon as I began developing symptoms, I self-quarantined and was tested, Mr. Maron said.

Holy Name has tested 453 people for the coronavirus in tents set up outside its emergency room and the hospital has treated 83 patients who tested positive.

All local and select bus services in New York City will effectively be free starting on Monday as the Metropolitan Transportation Authority, which oversees the subway and buses, works to keep its operations going while also protecting employees.

The authority is asking riders to begin boarding buses through the rear door, which will allow for more space between riders and drivers at the front of buses, the agency said in a statement.

The changes do not apply to authoritys express bus lines. Riders must still those buses from the front and pay, although they will not be allowed in the first three rows of seats.

Rear-door boarding will help ensure a safe social distance, said Sarah Feinberg, New York City Transits interim president. The safety of our employees and customers is Priority One.

Reporting was contributed by Helene Cooper, Kimiko de Freytas-Tamura, Luis Ferr-Sadurn, Michael Gold, Christina Goldbaum, Joseph Goldstein, J. David Goodman, Matthew Haag, Jeffery C. Mays, Jesse McKinley, Andy Newman, Azi Paybarah, Michael Paulson, Brian Rosenthal, Ed Shanahan, Jeffrey E. Singer, Liam Stack, Tracey Tully and Neil Vigdor.

Italy and Spain have both reported their biggest single-day death tolls from the coronavirus as Germanys 83 million citizens were warned they would be confined to their homes on Monday if they fail to behave responsibly this weekend.

As Europes governments ramp up already draconian restrictions to curb the coronavirus, authorities in Rome on Friday announced 5,986 new cases and a record 627 new deaths, raising the totals to 47,021 infections and 4,032 fatalities.

In Spain, the death toll rose to 1,002, a highest-ever increase of 235 in 24 hours. The latest statistics showed 19,980 confirmed cases across the country, more than a third in Madrid. Army specialists are to help disinfect care homes after the virus claimed more than 50 lives at elderly care facilities across the region.

The army, already deployed in northern Italy to help move bodies as funeral services are overwhelmed, will also be used to help police the lockdown in Lombardy, regional president Attilio Fontana said. The request to use the army is accepted and 114 soldiers will be on the ground, Fontana said. It is not enough, but its positive.

Helge Braun, Angela Merkels chief of staff, warned that a near-total lockdown as in force in Italy, Spain and France could soon be necessary in Germany. We will look at the behaviour of the people this weekend, Braun told Spiegel magazine.

Saturday is a decisive day, and we will keep a close eye on that. The chancellor would hold a conference call with state premiers on Sunday, he said.

The epidemic has infected more than 255,000 people worldwide and killed more than 10,400, according to the Johns Hopkins University tracker. Italy on Thursday overtook China as the centre of the biggest outbreak, with authorities in Beijing on Friday reporting no new cases of domestic transmission for the second day running.

Deborah Birx, the White House coronavirus task force response coordinator, said the virus appears to be less deadly for younger people but warned that data from Italy indicated the fatality rate is twice as high for men across all age groups. No one is immune, she said. We know its highly contagious to everyone. Mexico and the US announced plans to sharply limit travel over their busy shared border as part of efforts to control the outbreak.

As Spanish health authorities warned the peak of the crisis was still a few days away, frontline care workers described beleaguered hospitals operating near capacity and struggling with severe shortages of protective gear such as masks and gloves.

The current situation in hospitals in Madrid is critical, said ngela Hernndez of the Association of Doctors and Professionals in Madrid. The healthcare system is in a state of alarm. Spains health minister has promised reinforcements, including medical students and recently retired physicians.

In the UK all cafes, pubs, restaurants, gyms and other similar venues were ordered to close from Friday evening for the foreseeable future, and the government followed some other European countries in saying that it would pay a large proportion of workers wages.

Belgium, which entered lockdown on Wednesday, on Friday reported its biggest daily rise in number of deaths since the beginning of the epidemic. Sixteen more people had died from the virus, the health ministry said, bringing the total to 37, with more than 2,000 cases.

As in many European countries, schools, kindergartens, bars, nightclubs and non-essential shops have been closed in most parts of Germany and people urged to avoid unnecessary social contact in a bid to avoid a full-scale lockdown.

But people are still socialising outside, some even organising corona parties. The leaders of Germanys states warned mandatory confinement would be next. Unless everyone fundamentally changes their behaviour, we wont avoid tougher measures and sanctions, said the Baden-Wrttemberg premier, Winfried Kretschmann.

The countrys largest state, Bavaria, led the way on Friday, instituting a lockdown from midnight. We are not locking Bavarians in but we are winding down public life almost completely, the state premier, Markus Sder, said.

Beyond Europe, more than 1.2 million Iranians ignored pleas by the government, clerics and local authorities to stay at home, taking to the countrys roads at the start of Iranian new year. Iran on Friday reported 149 new deaths, making a total of 1,433 and 19,644 confirmed cases in all. South Africa said its confirmed cases had risen to 202, the most in the sub-Saharan region, while Tunisia announced a lockdown.

In the US, the New York governor, Andrew Cuomo, ordered all workers in non-essential businesses to stay home and banned gatherings statewide, while Californias population of 40 million experienced their first day under lockdown.

Gavin Newsom, the governor of the countrys most populous state, earlier wrote to Donald Trump to warn that 25.5 million Californians, roughly 56% of its population, could contract the virus.

President Trump said US authorities were aiming to fast-track the antimalarial drugs chloroquine and hydroxychloroquine synthetic forms of quinine, used to treat malaria for centuries for use as a coronavirus treatment.

Both Italy and France have said this week that they will extend their restrictions and may tighten them further as the number of deaths on the continent continues to rise.

In Austria, which has reported more than 2,200 coronavirus cases and six deaths, the chancellor, Sebastian Kurz, said on Friday that the signs were encouraging, but the country must continue to stick with the measures it had taken earlier. Hold tight, Kurz said. We must not slow down.

In France, which on Friday reported 12,612 cases 450 deaths, President Emmanuel Macron said the country was only at the beginning of the crisis. We are right at the start, Macron said. We have taken exceptional measures to absorb this first wave, but weve started a race against the virus. We must react strongly, and reorganise ourselves continually. We need to anticipate.

On Friday, authorities reminded people that exercise should be confined to 20-30 minutes in close proximity to home and alone, adding that they should only leave home once a day, choosing between, for example, shopping and exercise.

Police would step up security checks in Paris train stations from Friday, a spokesman said, as the country further escalated its lockdown measures. Like anyone else in France stopped by police without documentation to justify their presence outside their homes, rail passengers will face a fine of 135 (123). The mayor of Nice imposed a curfew starting from 8pm local time, going a step further than the national lockdown.

Revived trust in institutions.Michiko Kakutani is author of the 2018 bestseller The Death of Truth and former chief book critic of the New York Times.

The coronavirus pandemic, one hopes, will jolt Americans into a realization that the institutions and values Donald Trump has spent his presidency assailing are essential to the functioning of a democracyand to its ability to grapple effectively with a national crisis. A recognition that government institutionsincluding those entrusted with protecting our health, preserving our liberties and overseeing our national securityneed to be staffed with experts (not political loyalists), that decisions need to be made through a reasoned policy process and predicated on evidence-based science and historical and geopolitical knowledge (not on Trump-ian alternative facts, political expediency or what Thomas Pynchon called, in Gravitys Rainbow, a chaos of peeves, whims, hallucinations and all-round assholery). Instead of Trumps America First foreign policy, we need to return to multilateral diplomacy, and to the understanding that co-operation with alliesand adversaries, toois especially necessary when it comes to dealing with global problems like climate change and viral pandemics.

Most of all, we need to remember that public trust is crucial to governanceand that trust depends on telling the truth. As the historian John M. Barry wrote in his 2004 book The Great Influenzaa harrowing chronicle of the 1918 flu pandemic, which killed an estimated 50 million people worldwidethe main lesson from that catastrophe is that those in authority must retain the publics trust and the way to do that is to distort nothing, to put the best face on nothing, to try to manipulate no one.

Expect a political uprising.Cathy ONeil is founder and CEO of the algorithmic auditing company ORCAA and author of Weapons of Math Destruction: How Big Data Increases Inequality and Threatens Democracy.

The aftermath of the coronavirus is likely to include a new political uprisingan Occupy Wall Street 2.0, but this time much more massive and angrier. Once the health emergency is over, we will see the extent to which rich, well-connected and well-resourced communities will have been taken care of, while contingent, poor and stigmatized communities will have been thoroughly destroyed. Moreover, we will have seen how political action is possiblemultitrillion dollar bailouts and projects can be mobilized quicklybut only if the cause is considered urgent. This mismatch of long-disregarded populations finally getting the message that their needs are not only chronically unattended, but also chronically dismissed as politically required, will likely have drastic, pitchfork consequences.

Electronic voting goes mainstream.Joe Brotherton is chairman of Democracy Live, a startup that provides electronic ballots.

One victim of COVID-19 will be the old model of limiting voting to polling places where people must gather in close proximity for an extended period of time. We have been gradually moving away from this model since 2010, when Congress passed a law requiring electronic balloting for military and overseas voters, and some states now require accessible at-home voting for blind and disabled voters. Over the long term, as election officials grapple with how to allow for safe voting in the midst of a pandemic, the adoption of more advanced technologyincluding secure, transparent, cost-effective voting from our mobile devicesis more likely. In the near-term, a hybrid modelmobile-phone voting with paper ballots for tabulationis emerging in the 2020 election cycle in certain jurisdictions. We should expect that option to become more widespread. To be clear, proven technologies now exist that offer mobile, at-home voting while still generating paper ballots. This system is not an idea; it is a reality that has been used in more than 1,000 elections for nearly a decade by our overseas military and disabled voters. This should be the new normal.

Election Day will become Election Month.Lee Drutman is a senior fellow at New America and author of Breaking the Two-Party Doom Loop: The Case for Multiparty Democracy in America.

How do we hold an election in the time of coronavirus? By making it easier to vote when citizens want and where they want, so that Election Day doesnt become a health risk of big crowds and long lines. The change will come through expanded early voting and no-excuse mail-in balloting, effectively turning Election Day into Election Month (or maybe months, depending on the closeness of the election and the leniency for late-arriving ballots postmarked on Election Day). This transition requires considerable thought and planning to ensure that all communities are treated equally, and to prevent fraud. But facing the prospect of crowded polling places staffed by at-risk poll workers (who tend to be older), states will come under tremendous pressure to develop plans so that the election can go on regardless. This will mark a permanent change. Once citizens experience the convenience of early voting and/or voting by mail, they wont want to give it up. More convenience will generate higher voter turnout, potentially transforming partisan competition in America.

Voting by mail will become the norm.Kevin R. Kosar is vice president of research partnerships at the R Street Institute.

To date, five statesGeorgia, Kentucky, Louisiana, Maryland and Ohiohave postponed their presidential primaries. More states may well follow. But these elections cannot be put off indefinitely. Parties need to hold their conventions and select a presidential nominee before the autumn general election. The coronavirus might, according to some reports, continue to menace Americans through June or even the end of summer. In most states, this means elections policy is inviting an electoral train wreck. The clock is ticking.

Fortunately, there is a time-tested means for the country to escape the choice between protecting public health and allowing voters to exercise their right to vote: voting by mail. Military members overseas have voted by mail for decades. Some states, such as Washington, Oregon and Utah, already let everyone vote at home. They send every voter a ballot and then let them choose to cast it either via mail or at a polling place. Unfortunately, most states have set the toggle to voting in-person and requiring individuals to request to vote by mail. Voters already receive registration cards and elections guides by mail. Why not ballots? Given the risks that in-person voting poses, states now have urgent cause to move immediately to modernize their hidebound systemsand we should soon expect them to.

Dale Ho is director of the Voting Rights Project at the American Civil Liberties Union.

The COVID-19 pandemic poses an unprecedented threat to the way that most people vote: in person on Election Day. But there are several obvious steps we can take to ensure that no one has to choose between their health and their right to vote.

First, every eligible voter should be mailed a ballot and a self-sealing return envelope with prepaid postage. All ballots postmarked by Election Day should be accepted and counted. Ballots cast by mail should not be discarded based on errors or technicalities without first notifying voters of any defects and giving them an opportunity to correct them. At the same time, states can preserve in-person voting opportunities for people who need themsuch as voters with disabilities, with limited English proficiency, with limited postal access or who register after mail-in ballots have been sent out.

Elections administrators should receive extra resources to recruit younger poll workers, to ensure their and in-person voters health and safety, and to expand capacity to quickly and accurately process what will likely be an unprecedented volume of mail-in votes. Moreover, states should eliminate restrictions prohibiting elections officials from processing mail-in ballots until Election Day (15 states currently have such restrictions). And the media should help set public expectations that, in an environment with record levels of mail-in voting, tabulating results and forecasting winners may take longer than we have grown accustomed to.

If a state cannot do all of the above, it should take as many of these steps as possible. The current crisis makes these changes all the more necessaryand all the more likely to happen.

More restraints on mass consumption.Sonia Shah is author of Pandemic: Tracking Contagions From Cholera to Ebola and Beyond and the forthcoming The Next Great Migration: The Beauty and Terror of Life on the Move.

In the best-case scenario, the trauma of the pandemic will force society to accept restraints on mass consumer culture as a reasonable price to pay to defend ourselves against future contagions and climate disasters alike. For decades, weve sated our outsized appetites by encroaching on an ever-expanding swath of the planet with our industrial activities, forcing wild species to cram into remaining fragments of habitat in closer proximity to ours. Thats what has allowed animal microbes such as SARS-COV2not to mention hundreds of others from Ebola to Zikato cross over into human bodies, causing epidemics. In theory, we could decide to shrink our industrial footprint and conserve wildlife habitat, so that animal microbes stay in animals bodies, instead. More likely, well see less directly relevant transformations. Universal basic income and mandatory paid sick leave will move from the margins to the center of policy debates. The end of mass quarantine will unleash pent-up demand for intimacy and a mini baby-boom. The hype around online education will be abandoned, as a generation of young people forced into seclusion will reshape the culture around a contrarian appreciation for communal life.

Stronger domestic supply chains.Todd N. Tucker is director of Governance Studies at the Roosevelt Institute.

In the ancient days of 2018, the Trump administration was panned by experts for imposing tariffs on imported steel on a global basis for national security reasons. As the president tweeted at the time, IF YOU DONT HAVE STEEL, YOU DONT HAVE A COUNTRY! But to most economists, China was the real reason for disruptions in the metal market, and imposing tariffs additionally on U.S. allies was nonsensical, the argument went: After all, even if America lost its steel industry altogether, we would still be able to count on supplies from allies in North America and Europe.

Fast forward to 2020. Just this week, U.S. allies are considering substantial border restrictions, including shutting down ports and restricting exports. While theres no indication that the coronavirus per se is being transmitted through commerce, one can imagine a perfect storm in which deep recessions plus mounting geopolitical tensions limit Americas access to its normal supply chains and the lack of homegrown capacity in various product markets limits the governments ability to respond nimbly to threats. Reasonable people can differ over whether Trumps steel tariffs were the right response at the right time. In the years ahead, however, expect to see more support from Democrats, Republicans, academics and diplomats for the notion that government has a much bigger role to play in creating adequate redundancy in supply chainsresilient even to trade shocks from allies. This will be a substantial reorientation from even the very recent past.

Dambisa Moyo is an economist and author.

The coronavirus pandemic will create move pressure on corporations to weigh the efficiency and costs/benefits of a globalized supply chain system against the robustness of a domestic-based supply chain. Switching to a more robust domestic supply chain would reduce dependence on an increasingly fractured global supply system. But while this would better ensure that people get the goods they need, this shift would likely also increase costs to corporations and consumers.

The inequality gap will widen.Theda Skocpol is professor of government and sociology at Harvard.

Discussions of inequality in America often focus on the growing gap between the bottom 99 percent and the top 1 percent. But the other gap that has grown is between the top fifth and all the restand that gap will be exacerbated by this crisis.

The wealthiest fifth of Americans have made greater income gains than those below them in the income hierarchy in recent decades. They are more often members of married, highly educated couples. As high-salary professionals or managers, they live in Internet-ready homes that will accommodate telecommutingand where children have their own bedrooms and arent as disruptive to a work-from-home schedule. In this crisis, most will earn steady incomes while having necessities delivered to their front doors.

The other 80 percent of Americans lack that financial cushion. Some will be OK, but many will struggle with job losses and family burdens. They are more likely to be single parents or single-income households. Theyre less able to work from home, and more likely employed in the service or delivery sectors, in jobs that put them at greater danger of coming into contact with the coronavirus. In many cases, their children will not gain educationally at home, because parents will not be able to teach them, or their households might lack access to the high-speed Internet that enables remote instruction.

A hunger for diversion.Mary Frances Berry is professor of American social thought, history and Africana Studies at the University of Pennsylvania.

Some trends already underway will probably acceleratefor example, using voice technology to control entryways, security and the like. In the short term, universities will add courses on pandemics, and scientists will devise research projects to improve forecasting, treatment and diagnosis. But history suggests another outcome, as well. After the disastrous 1918-19 Spanish flu and the end of World War I, many Americans sought carefree entertainment, which the introduction of cars and the radio facilitated. Young women newly able to vote under the 19th Amendment bobbed their hair, frequented speakeasies and danced the Charleston. The economy quickly rebounded and flourished for about 10 years, until irrational investment tilted the United States and the world into the Great Depression. Probably, given past behavior, when this pandemic is over, human beings will respond with the same sense of relief and a search for community, relief from stress and pleasure.

Less communal diningbut maybe more cooking.Paul Freedman is a history professor at Yale and author, most recently, of American Cuisine: And How It Got This Way.

For the past few years, Americans have spent more money on food prepared outside the home than on buying and making their meals. But, now, with restaurants mostly closed and as isolation increases, many people will learn or relearn how to cook over the next weeks. Maybe they will fall back in love with cooking, though I wont hold my breath, or perhaps delivery will triumph over everything else. Sit-down restaurants also could close permanently as people frequent them less; it is likely there will be many fewer sit-down restaurants in Europe and the United States. We will be less communal at least for a while.

A revival of parks.Alexandra Lange is the architecture critic at Curbed.

People often see parks as a destination for something specific, like soccer fields, barbecues or playgrounds, and all of those functions must now be avoided. But that doesnt make the parks any less valuable. Im sheltering in place in Brooklyn with my family, and every day, the one time we go outside is to walk a loop north through Brooklyn Bridge Park and south down the Brooklyn Heights Promenade. Im seeing people asking Golden Gate Park to close the roads so theres even more space for people. In Britain, the National Trust is trying to open more gardens and parks for free. Urban parksin which most major cities have made significant investments over the past decadeare big enough to accommodate both crowds and social distancing. It helps that it is spring in the northern hemisphere.

Society might come out of the pandemic valuing these big spaces even more, not only as the backdrop to major events and active uses, but as an opportunity to be together visually. Ive been writing a book about shopping malls, and I would certainly not recommend a visit right now (all those virus-carrying surfaces). But, in suburban communities, malls have historically served the same function: somewhere to go, somewhere to be together. What we have right now is parks. After this is all over, I would love to see more public investment in open, accessible, all-weather places to gather, even after we no longer need to stay six feet apart.

A change in our understanding of change.Matthew Continetti is a resident fellow at the American Enterprise Institute.

Paradigm shift is among the most overused phrases in journalism. Yet the coronavirus pandemic may be one case where it applies. American society is familiar with a specific model of change, operating within the existing parameters of our liberal democratic institutions, mostly free market and society of expressive individualism. But the coronavirus doesnt just attack the immune system. Like the Civil War, Great Depression and World War II, it has the potential to infect the foundations of free society. State and local government are moving at varying and sometimes contrary speeds to address a crisis of profound dimensions. The global economy has entered the opening stages of a recession that has the potential to become a depression. Already, large parts of America have shut down entirely. Americans have said goodbye to a society of frivolity and ceaseless activity in a flash, and the federal government is taking steps more often seen during wartime. Our collective notions of the possible have changed already. If the danger the coronavirus poses both to individual health and to public health capacity persists, we will be forced to revise our very conception of change. The paradigm will shift.

The tyranny of habit no more.Virginia Heffernan is author of Magic and Loss: The Internet as Art.

Humans are not generally disposed to radical departures from their daily rounds. But the recent fantasy of optimizing a lifefor peak performance, productivity, efficiencyhas created a cottage industry that tries to make the dreariest possible lives sound heroic. Jordan Peterson has been commanding lost male souls to make their beds for years now. The Four-Hour Workweek, The Power of Habit and Atomic Habits urge readers to automate certain behaviors to keep them dutifully overworking and under-eating.

But COVID-19 suggests that Peterson (or any other habit-preaching martinet) is not the leader for our time. Instead, consider Albert Camus, who, in The Plague, blames the obliteration of a fictional Algerian town by an epidemic on one thing: consistency. The truth is, Camus writes of the crushingly dull port town, everyone is bored, and devotes himself to cultivating habits. The habit-bound townspeople lack imagination. It takes them far too long to take in that death is stalking them, and its past time to stop taking the streetcar, working for money, bowling and going to the movies.

Maybe, as in Camus time, it will take the dual specters of autocracy and disease to get us to listen to our common sense, our imaginations, our eccentricitiesand not our programming. A more expansive and braver approach to everyday existence is now crucial so that we dont fall in line with Trump-like tyrannies, cant and orthodoxy, and environmentally and physiologically devastating behaviors (including our favorites: driving cars, eating meat, burning electricity). This current plague time might see a recharged commitment to a closer-to-the-bone worldview that recognizes we have a short time on earth, the Doomsday Clock is a minute from midnight, and living peacefully and meaningfully together is going to take much more than bed-making and canny investments. The Power of No Habits.

The pop star announced Friday in an Instagram video that she'll pick three fans whom she'll help buy much-needed items as communities face home isolation, supply shortages and mounting unemployment.

"Our world is going through such hard times right now," Spears said in the video. "Whether it's with food or I'm getting your child diapers or whatever it is, DM me and I will help you out."

Her generosity is part of the #DoYourPartChallenge, an online movement in which people explain what they're doing to help others during the health crisis, then nominate three others to do the same.

Spears nominated Will Smith, Kate Hudson and her boyfriend, Sam Asghari.