Category: Corona Virus

A man wearing a mask talks on the phone while walking on Capitol Hill in Washington, D. C. Mandel Ngan/AFP via Getty Images hide caption

A man wearing a mask talks on the phone while walking on Capitol Hill in Washington, D. C.

On this broadcast of The National Conversation, we answer your questions about the economy, face masks, pregnancy during the pandemic and the U.S. Census.

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Answering Your Coronavirus Questions: Face Masks, Pregnancy And The 2020 Census - NPR

One patient had lymphoma and heart failure. Another was 85 years old with metastatic cancer. A third was 83 and had dementia and lung disease. All were critically ill with the coronavirus, and, a doctor said, all were hooked up to ventilators in recent weeks at a major Manhattan hospital.

But soon, patients such as those might not receive similar aggressive treatment. As people with the virus overwhelm New York City hospitals, doctors have stepped up pressure on state health officials to give them a rare and unsettling power: the right to withhold care from patients who are not likely to recover.

Dwindling supplies mean there might not be enough ventilators or other items for everyone, and many doctors say they are growing increasingly uneasy with treating every patient equally. They believe medical workers soon might need to make difficult choices about treatment.

Usually, the standard is to intubate and do CPR and do all those things, said Dr. Angela Mills, the chief of emergency medicine services at NewYork-Presbyterian/Columbia University Medical Center. Theres no question about it; that will not most likely be sustainable.

New York is the epicenter of the coronavirus in the United States, but doctors have wrestled with questions over whether, and how, to ration care from the beginning of the global outbreak. In China, many patients with Covid-19 were initially turned away from hospitals, and in Italy, hospitals have given younger, healthier patients priority for ventilators over older, sicker adults.

The problem is a grim and wrenching one, and the experience of doctors in New York could signal what is to come for their colleagues in other states, which have begun dusting off triage plans.

As of Wednesday, there were 83,712 confirmed cases of the coronavirus in New York State, health officials said. More than 47,000 of those cases were in New York City, where, city officials said, 1,374 patients had died.

The New York chapter of the American College of Physicians, a national organization of internists, wrote to Gov. Andrew M. Cuomo last week, asking that he issue an executive order granting doctors immunity from liability for the decisions they make when the need for allocation of ventilators results in some patients being denied access.

Mr. Cuomo has repeatedly said he does not want to allow hospitals to ration care. No hospital has yet run out of ventilators, he has said. Some hospitals are experimenting with putting multiple people on one machine.

Theres no protocol, Mr. Cuomo said on Tuesday when asked if there would be a triage for patients if critical supplies run out.

Still, state health officials have had discussions with hospital representatives about how to quickly enact new rules if they are needed, according to people familiar with the matter. Two weeks ago, a draft was circulated, although nothing has been implemented.

A spokeswoman for the state Department of Health declined to answer questions about the discussions and instead referred to Mr. Cuomos stance that triage should not be necessary. She also pointed to a recent executive order by Mr. Cuomo that would protect doctors from lawsuits in Covid-related cases, but an American College of Physicians representative said on Wednesday that the order did not go far enough.

In the face of inaction from Albany, hospitals and physicians in New York have been talking among themselves in recent days to formalize common guidelines.

The goal is to have some kind of overarching concept of how to deal with a pandemic that weve never dealt with before how to deal with the level of illness weve never seen before, said Dr. Stuart Kessler, the emergency department director at Elmhurst Hospital Center, a particularly hard-hit public hospital in Queens.

The New York Times spoke to six doctors at five major city hospitals who said they worried they soon would have to decide on their own not to take the most aggressive lifesaving measures in every case. In addition to the moral anguish that may cause, some feared they would run the risk of lawsuits or even criminal charges if they went against the wishes of a patient or family.

Steven A. McDonald, an emergency room doctor at NewYork-Presbyterian, said he wrote to his supervisors on Tuesday asking for guidelines for making decisions about who should receive a ventilator and who should not.

The feedback I got from my department is that the hospital wants to wait for the governor to come down with their own guidelines, he said.

Hospitalizations and admissions to intensive care units are growing in New York, although at a slower pace than they were two weeks ago. Mr. Cuomo has said they are expected to peak in the next two weeks to a month, unnerving doctors.

We are on the battlefield. We are in the trenches and in the middle of a war, said Dr. Robert L. Klitzman, the director of the masters of bioethics programs at Columbia University. And we have not trained our medical staff to deal with military battlefield medicine and ethics.

At individual hospitals, there have been moments when a surge of patients has overwhelmed resources and staff.

We teeter on the brink of needing to ration ventilators, and then we back off for a little bit, said Dr. Tia Powell, the director of the Montefiore Einstein Center for Bioethics, part of Montefiore Medical Center in the Bronx.

Other equipment, such as intravenous pumps needed for delivering medicine to patients on ventilators, has also been in short supply in some places.

Dr. McDonald said that when he arrived to work at NewYork-Presbyterian/Allen hospital in Upper Manhattan on Monday, the hospital was redirecting ambulances to other facilities. When he asked why, he said he was told the hospital had run out of ventilators until a patients death freed one up.

He said he wondered what would happen if other hospitals were also at capacity.

At some point, were just going to have to take these patients and process them accordingly, he said. A spokeswoman for the hospital declined to comment.

A Connecticut man, John Schalhoub, said doctors seemed to be making decisions about rationing care when his mother- and father-in-law both were admitted to Elmhurst Hospital Center. Mr. Schalhoub said he learned through an insurance company that his mother-in-law had tested positive for the coronavirus, but he did not receive his father-in-laws results.

His in-laws, Rong-Hua Xie and Mei-Chun Huang, both 88, were given supplemental oxygen through face masks. But Mr. Schalhoub said doctors explained neither would be given a ventilator if they ultimately needed one.

Theyre basically saying that the use of ventilators is a last resort, but they have not had success with them with people of advanced age, Mr. Schalhoub said.

Dr. Mitchell Katz, the head of New York Citys public hospital system, said none of the facilities he oversees had yet had to prioritize who gets a ventilator. To my knowledge, no ethical system would ever use age as a sole criteria, Dr. Katz wrote in an email.

Ms. Huang died on Tuesday. She was not given a ventilator or other lifesaving measures, Mr. Schalhoub said.

Generally, hospitals follow the desires of patients or their families in how far doctors should go to save their lives. But soon those directives might not carry the same weight.

If you have an advance directive that says, I want everything done for me, in a pandemic that will not count, said Arthur L. Caplan, a professor of bioethics at the New York University School of Medicine. What will count is whether youre likely to benefit more than the next guy or next woman.

The state already had a plan for rationing ventilators in the event of a pandemic. In 2007, a state task force devised a formula, revised in 2015, to help hospitals decide who would get ventilators. It suggested hospitals form triage committees to weigh different factors, including likelihood of survival. It also envisioned a lottery system in some instances, and taking people off ventilators if they did not improve in a relatively short amount of time.

But the Department of Health has not instructed hospitals to use the guidelines, and they remain little more than a template for how hospitals might approach the problem. And some changes would be needed to adapt to what is known about Covid-19, such as that some patients need to be on ventilators for a week or two before improving, doctors said.

We know from the data coming in about Covid that they need more time, said Dr. Powell of Montefiore, who was a member of the task force that produced the 2015 report.

It is, however, receiving renewed interest. In mid-March, Dr. Powell and some other members of the task force participated in a conference call with the Department of Health and representatives of several major hospital systems, several participants said.

About two weeks ago, a five-page draft based on the 2015 guidelines was circulating, the participants said. In interviews, some said they had expected the state would authorize a plan soon after the call.

There was always the expectation they would implement crisis standards of care guidelines, and they have not issued a statement doing that, Dr. Powell said.

A participant in the process, who requested anonymity because the person was not authorized to speak about sensitive internal discussions, said guidelines were still being drafted.

One doctor at Weill Cornell Medical Center, on Manhattans Upper East Side, said that he had been wondering what to do in a hypothetical scenario: There are two Covid-19 patients in hospital rooms, but only one ventilator left. Without guidelines that authorize him to use his judgment, does he let a colleague help one patient while I walk slowly to the door with the 90-year-old? he asked.

Jesse McKinley contributed reporting.

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Should Doctors Have the Right to Withhold Care From the Sickest Coronavirus Patients? - The New York Times

Coffins of deceased people stored in a warehouse near Bergamo a city at the heart of Italy's coronavirus crisis before being transported to another region for cremation. Piero Cruciatti/AFP via Getty Images hide caption

Coffins of deceased people stored in a warehouse near Bergamo a city at the heart of Italy's coronavirus crisis before being transported to another region for cremation.

The coronavirus appears to be much more lethal in some countries than in others.

In Italy, about 10% of people known to be infected have died. In Iran and Spain, the case fatality rate is higher than 7%. But in South Korea and the U.S. it's less than 1.5%. And in Germany, the figure is close to 0.5%.

So what gives?

The answer involves how many people are tested, the age of an infected population and factors such as whether the health care system is overwhelmed, scientists say.

"Case fatality rates have been very confusing," says Dr. Steven Lawrence, an infectious disease expert and associate professor of medicine at Washington University School of Medicine in St. Louis. "The numbers may look different even if the actual situation is the same."

So it's likely that the seemingly stark difference between Germany and Italy is misleading and will diminish as scientists get more data, Lawrence says.

Also, because of the way countries monitor pandemics like the coronavirus, he says, the case fatality rate tends to decrease over time. The reason: When a new disease first shows up, testing usually focuses on severely ill people who are at high risk of dying. Later on, testing is more likely to include people with milder illness who are less likely to die.

That's what happened with West Nile virus, which appeared in the U.S. in 1999. At first, when scientists only knew of about a few dozen cases, it appeared the mortality rate was higher than 10%. But wider testing eventually found hundreds of thousands of people who'd been infected but never got sick enough to notice. Today, more than 3 million Americans have been infected and studies show that fewer than 1% become seriously ill.

If that pattern holds for coronavirus, countries such as Italy, which have been testing only the sickest patients, are likely to see their case fatality rates fall. But countries such as Germany, which has been testing both critically ill people and those with milder symptoms from the beginning, are less likely to see major changes in the case fatality rate.

The U.S. is somewhere in between. Testing was severely limited when cases started to appear. Since then labs have begun testing tens of thousands of people with less severe illness.

A country's case fatality rate is simply the number of deaths (the numerator) divided by the number of infections (the denominator). The problem is, both of these numbers may be unreliable.

For example, when an outbreak begins and health officials aren't looking for the virus, some people may die at home and never be diagnosed. That would lower the numerator and "might lead to an underestimate of the case fatality rate," Lawrence says.

But a much more likely scenario, he says, is that early in an outbreak, testing is limited to people who are so sick they wind up in the hospital. That means the only infections that get counted are in the people most likely to die. So the denominator is missing a huge number of infected people who survive, and that makes the virus appear much more deadly than it really is.

This is probably one reason that early death rates in China appeared so high, says Gerardo Chowell, a professor of epidemiology and biostatistics in the department of population health sciences at Georgia State University. Chowell is part of a team that has been using statistical modeling to study the outbreak in China and South Korea.

When cases started showing up in the city of Wuhan, Chinese health officials "were obviously caught by surprise" and lacked the ability to test many patients, Chowell says. So testing was restricted to the sickest people. That probably contributed to early evidence that the fatality rate in Wuhan was 4% or more.

A study published last week estimated that in Wuhan, the chance that someone who developed coronavirus symptoms would die was actually 1.4%.

In South Korea, though, "they have been doing massive testing" since the first cases were detected, Chowell says. As a result, that nation has been able to count infected people with mild symptoms as well as those who become severely ill. That may be one reason the case fatality rate in South Korea has remained below 2%.

Another factor affecting coronavirus fatality rates is the characteristics of the population that is infected at any given moment, says Mary Bushman, a postdoctoral researcher at Harvard's Center for Communicable Disease Dynamics and an author of the Wuhan study.

In Washington state, Bushman says, the first cases appeared in nursing home residents, who tend to be extremely vulnerable to the disease. That produced "an alarming number of deaths being reported," Bushman says. At one nursing home, 34 of 81 infected residents died, which is a case fatality rate of 42%.

But as Washington began testing for the virus outside the nursing home, it became clear the case fatality rate in the general population was vastly lower.

And across the U.S., as testing has expanded to include younger and healthier segments of the population, the fatality rate has decreased to levels similar to those in South Korea. "And I think we'll probably continue to see further decreases," Bushman says.

Differences in testing aren't the only reason that case fatality rates vary, though. In some countries, infected people have been more likely to die because the health care system has been overwhelmed, leaving critically ill coronavirus patients without access to lifesaving care, Chowell says.

In Wuhan, he says, high case fatality rates early on were probably caused in part by the inability of local hospitals to handle the huge influx of patients sick with the coronavirus.

An overburdened health care system may also be contributing to the high case fatality rate in Italy. "During those high peaks where the health care systems can be overwhelmed, there may not be enough people or ICU beds or ventilators to be able to provide the critical care that is needed," Lawrence says.

Ultimately, it will take a different sort of test to assess how lethal coronavirus has been, Lawrence says. Most current tests only detect active infections when the virus is still present in the body. But a different type of test now being developed but still probably months away from wide use can reveal whether a person has ever been infected. And that is what scientists need to know to establish the true denominator for coronavirus and to find the true case fatality rate.

In the U.S., it's likely that the case fatality rate from coronavirus will end up somewhere between 0.5% and 1%, once a broad cross-section of the population has been tested, Lawrence says.

But that's no reason for the nation to relax, he adds.

"To put it into perspective, that's 5 to 10 times more fatal than flu," Lawrence says, a disease that kills between 12,000 and 61,000 people a year.

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Why 'Death Rates' From Coronavirus Have Been 'Very Confusing' : Goats and Soda - NPR

The coronavirusdeath tollsurged past 3,800on Tuesday, eclipsing the total from the 9/11 terror attacks as New York City traded "Ground Zero" for "epicenter."

Near where the World Trade Center towers collapsed more than 18 years ago, Wall Street capped a debacle of its own Tuesday inthe month after reaching dizzying heights.

More than 900 people have died from COVID-19 in Manhattanalone, and the city was opening temporary hospitals in a convention center, a Navy ship and Central Park. Refrigeration trucks were serving as temporary morgues.

Still, the nation's top health expert found some reason for hope, saying social distancing was working and that the rate of increase ofNew York City cases might be starting to slow.

More than 500 deaths were reported nationwide Monday, the highest daily total since the first American died six weeks ago. The U.S. death tollhas now surpassed China, where the pandemic began late last year.

Cities and states tightened stay-at-home restrictions. Thousands of retailers across the nation, large and small, closed their doors, and many furloughed employees. Gunshops in Los Angeles won a reprieve, however, when authoritiesretracted an order to close them. Sheriff Alex Villanueva said hes heeding a federal Department of Homeland Security advisory issued that listed gun and ammunition dealers as essential critical infrastructure workers.

The United States hadmore than 186,000 confirmed casesTuesday afternoon, according to the Johns Hopkins University data dashboard. Worldwide, more than 855,000 peoplehave been infected with the virus and more than 42,000 have died.

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Estimates of between 100,000 and 240,000 Americans dying this year because of the coronavirus convinced President Donald Trump to extend social distancing guidelines, federal public officials said.

And that grim scenario would be worse without intervention, with a projection of as many as 2.2 million deaths,according toWhite House coronavirus response coordinator Deborah Birx.

Presented to the president over the weekend, the data explains why Trump backed down from an earlier notion of reopening the country by Easter, or potentially relaxing restrictions in parts of the nation that were not hit as hard, officials said. Trump announced Sunday he would extend social distancing guidelines through April 30.

Our country is in the midst of a great national trial, Trump said at Tuesday's briefing. Were going to go through a very tough two weeks.

The administration's top health officials, including Anthony Fauci, director of the director of the National Institute of Allergy and Infectious Diseases, warned that models are not always accurate and will be influenced by how seriously Americans take orders to avoid contact with others.Trump and others have said April could be a particularly deadly month in the ongoing battle with the virus.

-- John Fritze

In a briefing Tuesday, Secretary of State Mike Pompeo said that"Americans who wish to return home from abroad should (do) so immediately and make arrangements to accomplish that."

While Pompeo said his repatriation task force remains committed to bringing all Americans home, he said the window to do itis closing.

"We do not know how long the commercial flights in your countries may continue to operate," he said. "We can't guarantee the U.S. government's ability to arrange charter flights indefinitely where commercial options no longer exist."

In the meantime, he urged Americans to register with their nearest embassy or consulate or do so online via STEP, the State Department's Smart Traveler Enrollment Program, which provides citizens with safety alerts about local conditions and a communication link to their families back home.

Jayme Deerwester

U.S. stocks slumped Tuesday andthe Dow concluded its worst first quartereveras the coronavirus pandemic battered huge swaths of the global economy.

Stocks snapped the longest-ever bull market in history this month, swiftly retreating from records in mid-February after the outlook for the U.S. economy dimmed. The pandemic forcedlockdowns andtravelrestrictions, weighing on businesses across the world.

The Standard and Poors 500 fell 1.6% to close the month at 2,584.59, as broad lossesin the real estate and utility sectors, which are perceived as safer, offset mild gains in beaten-up energy shares. The broad index was off 20% this quarter, its worst such period since 2008.

The Dow Jones industrial average dropped 410.32 points to end at 21,917.16.The blue-chip average shed 23% in the first three months of the year, its worst-ever performance over that stretch. Both averages posted their worst monthlydeclines since 2008.

-- Jessica Menton

Struggling U.S. airlines must keep flying if they accept coronavirus aid, with proposed minimum service levels spelled out by aviation regulators.

The U.S. Department of Transportation said in a filing that participating airlines must maintain flights to all U.S. destinations they served before March 1 unless they are granted an exemption.

The requirement would be in effect through Sept. 30 but is subject to extension. International flights are exempt due to the State Department's March 19 advisory alert urging Americans to avoid all international travel.

Dawn Gilbertson

Dr. Anthony Fauci, the face of the national effort to curb the coronavirus crisis,offered a glimmer of hope Tuesday, saying social distancing was working and that the rate of increase of cases in New York City might be slowing.

"You are starting to see that the daily increases are not in that steep incline," Fauci said in an interview on CNN. "They are startingto be able to possibly flatten out."

Fauci,director of the National Institute of Allergy and Infectious Diseases, also said a recommendation that all Americans wear masks was "under very active consideration" by the federal task force on the crisis.

But it won't happen until the supply is sufficient to ensure that all health care workers are adequately equipped, he added. Faucialso stressed thatthe masks would do little to protect the wearerbut could help keep themfrom spreading the disease.

Chris Cuomo, a CNN journalist and brother of New York Gov. Andrew Cuomo, said he has tested positive for the virus. Cuomo said on Twitter that he had fever, chills and shortness of breath and is self-isolating in the basement of his home. "I just hope I didn't give it to the kids and (wife) Cristina," Cuomo said, adding that he will continue to appear on CNN from his basement.

"He's going to be fine," the governorsaid at his daily news conference."He's young, in good shape, strong. Not as strong as he thinks, but he will be fine."

A 68-bed emergency field hospital erected in Central Park wasset to receive patients infected with the coronavirus starting Tuesday.A team of 72 doctors, nurses and other health care workers from Samaritan's Purse, an evangelical Christian disaster-relief organization, have mobilized the facility, which is equipped with 10 ventilators.

The hospitalhas partnered with New Yorks Mount Sinai Health System and will prioritize moving overflow patients from the Brooklyn and Queens Mount Sinai branchesso they can resume respiratory care treatment.

The relief effort is not without some controversy, however.Because of anti-LGBTQ comments made in the past by Samaritan's Purse's founder,Franklin Graham, the group has faced backlash.

New York state senator Brad Hoylman posted a statement to his verified Twitter account in which he called onGraham "to publicly assure LGBTQ New Yorkers that they will receivethe same treatment as anyone else at the Central Park field hospital."

Lorenzo Reyes

A field stretcher in the field hospital being set up in Central Park.(Photo: Anthony Behar, SIPA USA)

New York Gov. Andrew Cuomo, comparing buying ventilators to online auctions, said the Federal Emergency Management Agency basically bigfooted individual states and drove up prices.Cuomosaid he believes FEMA shouldve been the purchasing agent for medical equipment before becoming the sole distributor to states in need.

Its like being on eBay with 50 other states, bidding on a ventilator, Cuomo said.You see the bid go up 'cause California bid. Illinois bid. Florida bid. New York bid. California rebids. Thats literally what were doing. I mean, how inefficient. And then, FEMA gets involved and FEMA starts bidding. And now FEMA is bidding on top of the 50, so FEMA is driving up the price. What sense does this make?

Cuomo released data indicating his statehad more than 75,000 positive cases including more than 9,000 new cases with a death toll of 1,550, as of Tuesday morning. He also said New York tests far more than any other state.

Lorenzo Reyes

The captain of an aircraft carrier is asking the U.S. Navy to step in to evacuate and isolate its crew as cases of thecoronavirushave broken out amongmembers.

In a four-page letter dated Monday and first obtained by theSan Francisco Chronicle, Navy CaptainBrett Crozier of the USS Theodore Roosevelt said"decisive action" was required to prevent deaths from the virus, and that the sailors on board were unable to comply with social-distancingguidelines because of the ship's close quarters.

Crozier wrote that"we are not at war, and therefore cannot allow a single Sailor to perish as a result of this pandemic unnecessarily."

The Navyreported March 24that three sailors had tested positive and been airlifted to a hospital in the Pacific. By Thursday, the number of infected sailors had jumped to 23.

-- Jeanine Santucci

Louisiana suffered its deadliest coronavirus day Tuesday with 54 deaths and 1,212 new cases, the state health department reported.

Tuesday'sstartling spike brings the total number of COVID-19-related deaths in Louisiana to 239 and cases to 5,237.

The state's Public Health department also reports that one-third of the ventilators across Louisianawont be suitable for coronavirus patients because they are of the emergency portable variety, whichdont work well for a long-term respiratory illnesslike COVID-19.

The health department also reported 12 new nursing homes with coronavirus "clusters" for a total of 40, almost 12% of the state's436 nursing homes or long-term care facilities.A cluster is identified as two or more cases that appear to be connected.

There are now confirmed cases in 60 of the state's 64 parishes.

Much of the world is locked in the same life-and-death struggle the U.S. faces. The number of worldwide, confirmed coronavirus cases surpassed 838,000 on Tuesday, while Italy's tally surpassed 105,000. The U.S. has more than any nation with more than 175,000, although availability of testing and national populations are factorsin the totals.

Italy has had the most deaths: more than 12,000. That includes 812 on Monday, up from 756 on Sunday. Spain has seen more than 8,200 deaths, including 849 on Monday, its highest total to date.

"We need every country to keep responding detecting, isolating, treating cases and tracing contacts, plus physical distancing," said Dr. Takeshi Kasai, the World Health Organizations regional director for the Western Pacific. "We know it works! And all countries need to keep preparing for large-scale community transmission."

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The World Health Organization is urging nations adopting strict stay-at-home orders to take care of their poor populations struggling to survive under the restrictions. Even the wealthiest nations have citizens who face dire consequences, warned Tedros Adhanom Ghebreyesus, the WHO's director general. Tedrossays he grew up poor in Ethiopia and knows what it means to have to worry about where the next meal will come from.

"I know that many people have to work every single day to win their daily bread," Tedros said. "If were limiting movement, what is going to happen to these people? Each and every country, based on their situation, must answer this question.

Macy's is furloughing a majorityof its 125,00 workers and Kohl's will do the same with 85,000 employees as the severe economic disruptions caused by the coronavirus stay-at-home drive roll through the retail industry. Gap Inc., which owns the Gap, Banana Republic and Old Navy, also announced that it would be "pausing pay" for the majority of store workers in the U.S. and Canada until stores are reopen.

"While the digital business remains open, we have lost the majority of our sales due to the store closures,"Macy's said in astatement.

Other sectors of the economy have already been hammered. Last week, Cheesecake Factory saidit would furlough 41,000 hourly workers and cut executive pay. And hotel giants Hilton, Hyatt and Marriott have all announcedfurloughs.

Brett Molina

Mexico has declareda national public health emergencybecause ofthe COVID-19 pandemic, ordering the suspension of nonessential activity until April 30. The country has reported 28 deaths and more than 1,000 confirmed cases. The emergency declarationissued byMexicos General Health Council requires a stop to nonessential public, private and social events and is intended to slow the spread of the virus.Schools inMexico hadalready closedand will now remain closed until at least April 30.

Daniel Borunda, El Paso Times

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The novel coronavirus has prompted social distancing measures around the world. One researcher believes what's being done isn't enough.

Lydia Bourouiba, an associate professor at MIT, has researched the dynamics of exhalations (coughs and sneezes, for instance) for years at The Fluid Dynamics of Disease Transmission Laboratory and found exhalations cause gaseous clouds that can travel up to 27 feet.

Her research could have implications for the global COVID-19 pandemic, though measures called for by the Centers for Disease Control and Prevention and the WHO call for six and three feet of space, respectively.

Theres an urgency in revising the guidelines currently being given by the WHO and the CDC on the needs for protective equipment, particularly for the front-line health care workers, Bourouiba told USA TODAY.

Jordan Culver

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Coronavirus live updates: More American deaths than on 9/11; US projections of 240,000; Dow's worst 1st quarter ever - USA TODAY

AboutCOVID-19

Coronavirus (COVID-19) is a new virus that causes respiratory illness in people and is extremely contagious. Symptoms include fever,cough, shortness of breath, and diarrhea.

ThePennsylvania COVID-19 guidewas created as a place for Pennsylvanians to quicklyfind theresources they need during the COVID-19 pandemic. Use this guide to learnabout statewide efforts to contain the spread of the disease, what Stay at Home Orders mean, guidance for businesses, unemployment help and more.

The guide is updated frequently with the latest efforts and announcements from government officials, so check back often for updates.

Use the map below to see the number of Pennsylvanians who have tested positive for COVID-19 in each county. These numbers are updated daily after being verified by the Department of Health.

You also can view the number of cases by countyin table format.

Map Key

fewer casesmorecases

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Coronavirus in Pennsylvania

This article was updated on March 23, 2020

Coronaviruses are types of viruses that typically affect the respiratory tracts of birds and mammals, including humans. Doctors associate them with the common cold, bronchitis, pneumonia, severe acute respiratory syndrome (SARS), and COVID-19. They can also affect the gut.

These viruses are typically responsible for common colds more than serious diseases. However, coronaviruses are also behind some more severe outbreaks.

Over the last 70 years, scientists have found that coronaviruses can infect mice, rats, dogs, cats, turkeys, horses, pigs, and cattle. Sometimes, these animals can transmit coronaviruses to humans.

Most recently, authorities identified a new coronavirus outbreak in China that has now reached other countries. It has the name coronavirus disease 2019, or COVID-19.

In this article, we explain the different types of human coronaviruses, their symptoms, and how people transmit them. We also focus on three particularly dangerous diseases that have spread due to coronaviruses: COVID-19, SARS, and MERS.

Stay informed with live updates on the current COVID-19 outbreak and visit our coronavirus hub for more advice on prevention and treatment.

Researchers first isolated a coronavirus in 1937. They found a coronavirus responsible for an infectious bronchitis virus in birds that had the ability to devastate poultry stocks.

Scientists first found evidence of human coronaviruses (HCoV) in the 1960s in the noses of people with the common cold. Two human coronaviruses are responsible for a large proportion of common colds: OC43 and 229E.

The name coronavirus comes from the crown-like projections on their surfaces. Corona in Latin means halo or crown.

Among humans, coronavirus infections most often occur during the winter months and early spring. People regularly become ill with a cold due to a coronavirus and may catch the same one about 4 months later.

This is because coronavirus antibodies do not last for a long time. Also, the antibodies for one strain of coronavirus may be ineffective against another one.

In 2019, the Centers for Disease Control and Prevention (CDC) started monitoring the outbreak of a new coronavirus, SARS-CoV-2, which causes the respiratory illness now known as COVID-19. Authorities first identified the virus in Wuhan, China.

Since then, the virus has spread to other countries, both in and outside Asia, leading the World Health Organization (WHO) to declare this as a pandemic.

As of March 23, more than 340,000 people have contracted the virus worldwide, causing over 14,000 deaths.

In the U.S., the virus has affected over 35,000 people, resulting in more than 450 deaths.

The first people with COVID-19 had links to an animal and seafood market. This fact suggested that animals initially transmitted the virus to humans. However, people with a more recent diagnosis had no connections with or exposure to the market, confirming that humans can pass the virus to each other.

Read more about how pangolins could be the source of COVID-19.

Information on the virus is scarce at present. In the past, respiratory conditions that develop from coronaviruses, such as SARS and MERS, have spread through close contacts.

On February 17, 2020, the Director-General of the WHO presented at a media briefing the following updates on how often the symptoms of COVID-19 are severe or fatal, using data from 44,000 people with a confirmed diagnosis:

The WHO reports that the two groups most at risk of experiencing severe illness due to a SARS-CoV-2 infection are older adults, defined as over 60 years old, and individuals who have other health conditions that compromise their immune system.

According to the CDC, children are not at higher risk for COVID-19 than adults.

While there are currently no published scientific reports about the susceptibility of pregnant women, the CDC notes that:

Pregnant women experience immunologic and physiologic changes which might make them more susceptible to viral respiratory infections, including COVID-19.

The CDC also recommend that infants born to mothers with suspected or confirmed COVID-19 are placed in isolation as a person under investigation.

Symptoms vary from person-to-person with COVID-19. It may produce few or no symptoms. However, it can also lead to severe illness and may be fatal. Common symptoms include:

It may take 214 days for a person to notice symptoms after infection.

No vaccine is currently available for COVID-19. However, scientists have now replicated the virus. This could allow for early detection and treatment in people who have the virus but are not yet showing symptoms.

The National Institutes of Health (NIH) suggest that several groups of people have the highest risk of developing complications due to COVID-19. These groups include:

The CDC advise that although there have been reports of complications in young children, these are rare. COVID-19 most commonly produces mild symptoms in children.

Cold- or flu-like symptoms usually set in from 24 days after a coronavirus infection and are typically mild. However, symptoms vary from person-to-person, and some forms of the virus can be fatal.

Symptoms may include:

Scientists cannot easily cultivate human coronaviruses in the laboratory unlike the rhinovirus, which is another cause of the common cold. This makes it difficult to gauge the impact of the coronavirus on national economies and public health.

There is no cure for coronaviruses that cause symptoms resembling the common cold. Treatments include self-care and over-the-counter (OTC) medication. People can take several steps, including:

A doctor can diagnose the virus responsible by taking a sample of respiratory fluids, such as mucus from the nose, or blood.

Coronaviruses belong to the subfamily Coronavirinae in the family Coronaviridae.

Different types of human coronaviruses vary in how severe the resulting disease becomes, and how far they can spread.

Doctors currently recognize seven types of coronavirus that can infect humans.

Common types include:

Rarer strains that cause more severe complications include MERS-CoV, which causes Middle East respiratory syndrome (MERS), and SARS-CoV, the virus responsible for severe acute respiratory syndrome (SARS).

In 2019, a new strain called SARS-CoV-2 started circulating, causing the disease COVID-19.

Limited research is available on how HCoV spreads from one person to the next.

However, researchers believe that the viruses transmit via fluids in the respiratory system, such as mucus.

Coronaviruses can spread in the following ways:

Coronaviruses will infect most people at some time during their lifetime.

Coronaviruses can mutate effectively, which makes them so contagious.

To prevent transmission, people should stay at home and rest while symptoms are active. They should also avoid close contact with other people.

Covering the mouth and nose with a tissue or handkerchief while coughing or sneezing can also help prevent transmission. It is important to dispose of any tissues after use and maintain hygiene around the home.

SARS is a contagious disease that develops after infection by the SARS-CoV coronavirus. Typically, it leads to a life threatening form of pneumonia.

During November 2002, the virus started in the Guangdong Province in southern China, eventually reaching Hong Kong. From there, it rapidly spread around the world, causing infections in more than 24 countries.

SARS-CoV can infect both the upper and lower respiratory tracts.

The symptoms of SARS develop over the course of a week and start with a fever. Early on in the condition, people develop flu-like symptoms, such as:

Pneumonia, a severe lung infection, usually develops. At its most advanced stage, SARS causes failure of the lungs, heart, or liver.

According to the CDC, authorities marked 8,098 people as having contracted SARS during its outbreak. Of these, 774 infections were fatal. This equates to a mortality rate of 9.6%.

Complications are more likely in older adults, and half of all people over 65 years of age who became ill did not survive. Authorities eventually controlled SARS in July 2003.

However, it can still occur after infection with SARS-CoV.

MERS spreads due to the coronavirus known as MERS-CoV. Scientists first recognized this severe respiratory illness in 2012 after it surfaced in Saudi Arabia. Since then, it has spread to other countries.

The virus has reached the U.S., while the largest outbreak outside the Arabian Peninsula occurred in South Korea in 2015.

Symptoms of MERS include fever, breathlessness, and coughing. The illness spreads through close contact with people who already have an infection. However, all cases of MERS have links to individuals recently returning from travel to the Arabian Peninsula.

A 2019 study on MERS found that the disease is fatal in 35.2% of people who contract it.

Keep up to date on the current COVID-19 outbreak. The Centers for Disease Control and Prevention have also a resource on reducing the risk of infection.

More:

Coronaviruses: Symptoms, treatments, and variants

Read: A letter from wartime France

The last time the world faced a pandemic of this scale, it was in the middle of an actual war. The Spanish flu appeared during the waning months of World War I, before quickly spreading around the world, infecting a third of the global population and killing tens of millions of people. Unlike with the current pandemic, invoking wartime imagery wasnt necessary to spur action against the Spanish flu. By that point in the war, everyone had already been making all these sacrifices, Mark Honigsbaum, a medical historian and the author of The Pandemic Century, told me, noting that many countries were already united against a common enemy, Germany, before this unseen enemy, the Spanish flu, came along.

There is a long history of world leaders framing fights against disease within the context of war. From Richard Nixons war on cancer to the Ebola wars, politicians have invoked battle analogies to communicate the seriousness of an issue and galvanize a national response. (The same can be said for matters that have nothing to do with disease, such as Lyndon B. Johnsons War on Poverty and the global War on Terror.)

In some ways, these wartime metaphors make sense. John Baugh, a linguist at Washington University in St. Louis, told me that when politicians and health officials invoke this language, its often because they feel that the public has not yet taken the problem seriously, an issue that, until very recently, was almost certainly the case with the coronavirus pandemic. Many countries were slow to figure out how best to respond to the crisis, while large swaths of their populations openly flouted social-distancing guidance. When the severity finally began to sink in, world leaders seized on terms such as battle plan, enemy, and frontline as a means of waking people up to the urgency of the situation and fostering a sense of solidarity.

But while wartime imagery can promote national cohesion, it can also breed fear, which can in turn drive anxiety and panic. The myriad changes being made to wage this warincluding enforced lockdowns, closures of schools and businesses, and the postponement of major events, such as electionsand the looming prospect of a global recession have not only created uncertainty, but stripped many people of any sense of control. One of the most visible ways this fear has manifested has been in the increasing prevalence of empty supermarketsa by-product of what appeared to be a surge in panic-buying that made newly precious commodities such as hand sanitizer, face masks, and toilet paper scarce or, in some cases, prohibitively expensive. (Other items, such as illicit drugs and firearms, experienced a similar increase in demand.) In this case, evoking war didnt just alert people to the severity of the situation. For some of the most vulnerable members of society, including the elderly and health-care workers, it made the crisis much, much worse.

See the article here:

The Case Against Waging War on the Coronavirus - The Atlantic

This article is part of David Leonhardts newsletter. You can sign up here to receive it each weekday.

China and South Korea have flattened their curves. Italy, Spain, Germany and the Netherlands have begun to flatten their curves.

The United States still has not.

More than half of all confirmed coronavirus cases in the United States have been diagnosed in the past five days. Depending on what data source you use, yesterday was either the worst day for new cases or one of the worst. And more than 3,000 Americans with the virus have died, meaning the death toll has now exceeded that of the 9/11 terrorist attacks.

As you can see in the chart above, the other three countries with the worlds largest number of confirmed cases Italy, China and Spain were all making significant progress at a similar point in their outbreaks. But the response in the United States has been slow and uneven.

President Trump spent almost two months denying that the virus was a serious problem and spreading incorrect information about it. Since then, he has oscillated between taking sensible measures and continuing to make false statements. (Yesterday, he said that hospital masks might be going out the back door suggesting that doctors or somebody else were stealing the masks rather than using them.)

Many state leaders both Democrats, like Gov. Jay Inslee in Washington State, and Republicans, like Gov. Larry Hogan, in Maryland have done a much better job. Altogether, the federal, state and local policies on social distancing may be starting to have an effect. The number of fevers recorded nationwide is falling, as Donald G. McNeil Jr. of The Times notes, which is an encouraging sign.

But the United States is badly behind. Both South Korea and the United States had their first confirmed case around the same day, in late January, as Neera Tanden of the Center for American Progress points out. South Korea has suffered only about 150 deaths, one-twentieth as many as the United States.

For more

John Burn-Murdoch, whos been creating some excellent charts for The Financial Times, explains that larger countries have not been suffering more rapid virus spread than smaller countries: Population does not affect pace of spread.

McKay Coppins, The Atlantic: Hundreds of people dying in a day, makeshift hospital tents popping up in Central Park, bodies being loaded into refrigerated trucks, a Navy hospital ship pulling into the harbor four weeks ago, this would have been dismissed as a wildly alarmist view of the coronavirus in NY.

Connor Harris of the Manhattan Institute writes that Sweden also appears to have responded poorly to the virus and is now suffering substantially more deaths than Denmark or Norway. Sweden took a laissez-faire approach to COVID-19 while their neighbors shut down public life and sealed the borders. It looks like were finally seeing the results, Harris writes.

If you are not a subscriber to this newsletter, you can subscribe here. You can also join me on Twitter (@DLeonhardt) and Facebook.

Follow The New York Times Opinion section on Facebook, Twitter (@NYTopinion) and Instagram.

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The U.S. Is Not Winning the Coronavirus Fight - The New York Times

Take a drive through the San Gabriel Valley, and it will look significantly different from many other cities in the U.S. under stay-at-home orders right now: Droves of people are out and about, going to the market, getting gas, stocking up on to-go orders but nearly everyone is wearing face masks and latex gloves.

The SGV is masked up and has been for weeks. In the month leading up to LA Mayor Eric Garcettis Safer at Home order, which was issued on March 15, Southern Californias most populated Asian-American community was already quietly preparing for the worst.

While cities around the country neglected to take the threat from the novel coronavirus seriously until it became a pandemic, many in the SGV are immigrants who can recall memories of the SARS/H1N1 outbreak and knew what was happening from news and social media networks, so they began wearing face masks, gloves, and stocking up on wipes and sanitizer in bulk.

The results of that preparation speak for themselves: Even as residents move somewhat freely through the area, according to the latest data from the LA County Department of Public Health, the number of confirmed COVID-19 cases in San Gabriel Valley cities have been significantly fewer than other municipalities such as Beverly Hills or Brentwood. For example, Alhambra and San Gabriel combined for 17 cases while Beverly Hills and Brentwood have a total of 62 as of March 30.

Steph Lu, who was visiting family from Canada for the Lunar New Year in January, spent her week-long vacation going to every drug store she could, searching for hand sanitizer, sterilizing hand wipes, and face masks. Hand sanitizer and face masks have been completely sold out at Target, Walgreens, Walmart, CVS, and all other major retailers in the SGV since late January; San Fernando Valley and West LA locations were almost fully stocked until mid-February.

Although the coronavirus has caused a number of San Gabriel Valley restaurants to shutter or temporarily halt services, many dine-in only restaurants have instead chosen to do a 180-degree turn in efforts to stay afloat and keep employees paid, shifting to a combination of takeout and grocery sales, or creating a special menu of dishes that would not typically be available for takeout or delivery. Business owners are trying to weather the storm and adapt quickly, or be left behind.

Alex Siu, a freelance digital producer from San Marino, has been observing whats been happening to SGVs usually bustling restaurant scene. Due to stay-at-home orders and xenophobia occurring in other areas, Siu has found himself sticking close to home and ordering take-out to support his favorite mom-and-pop restaurants for the time being. Big chain stores will be there tomorrow, but the local small businesses may not.

Uniboil, a hot pot restaurant in Monterey Park that previously experienced a 75 percent drop in business due to COVID-19 concerns, has since reopened to offer customers hygienically packaged cook at home hot pot. The new takeout option comes with a mini stove pot, two 24 ounce drinks (passionfruit green tea or milk tea), a pound of meat, soup base, dipping sauces, and platefuls of veggies. Theyve even added a vegetarian option. Orders over $50 include two complimentary face masks.

Henry Hsu, the son of the owners of Taipei Bistro, and its head manager, has modernized his familys restaurant to keep them in business, creating an online presence and signing up with delivery services like Ubereats, Doordash, Postmates, and GrubHub. We have to do all this to offset the huge rise in food costs and the limited availability of inventory everywhere, Hsu said. Our business is able to stay afloat because of our loyal customers so were lucky.

Hsu has implemented new sanitation rules for the restaurant: Customers are not allowed into the restaurant at all, and all pickups and money exchanges are done from 20 feet apart via a bench. The food and money is placed on a bench before the staff steps away for retrieval. The entire staff wears masks and gloves, and all surfaces, cooking utensils, and other restaurant instruments are sanitized multiple times a day. All cash must be sanitized upon receipt.

Go Cakes, a custom cakes company in San Marino, lost 100 percent of its wedding and event catering business since March. Although they did think of closing the store temporarily, they ended up switching to dessert delivery and pick up to provide something sweet in the community and hopefully stay in business. Owner Stephanie Fong has created a deliverable new series of cream puff series, which come in a box of six (with flavors like cereal milk and matcha). As with San Gabriel Valley custom, all contact is handled with gloves and face masks on and orders are placed on a table six feet apart.

San Gabriel Valley was hit first among LA communities due to coronavirus concerns, with many restaurants closing temporarily or seeing severely decreased sales in March. Some restaurants have adapted to the new reality with hygienic packaging and social distance protocols to encourage locals to continue getting takeout or delivery food. Despite the struggles, SGV restaurants will have to cope until life can return to normal, though with safer at home measures likely to extend to May 1 or beyond, its going to be a difficult time for restaurant owners and workers who rely on the business.

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The SGV Was Weeks Ahead of LA on Coronavirus, and Maybe Still Is - Eater LA

"We are not at war. Sailors do not need to die. If we do not act now, we are failing to properly take care of our most trusted asset our Sailors," Capt. Brett Crozier wrote in a memo to the Navy's Pacific Fleet, three US defense officials have confirmed to CNN.

"The spread of the disease is ongoing and accelerating," he added.

"Decisive action is required. Removing the majority of personnel from a deployed US nuclear aircraft carrier and isolating them for two weeks may seem like an extraordinary measure," he wrote in the memo. "This is a necessary risk. It will enable the carrier and air wing to get back underway as quickly as possible while ensuring the health and safety of our Sailors. Keeping over 4,000 young men and women on board the TR is an unnecessary risk and breaks faith with those Sailors entrusted to our care."

The commander of US Pacific Fleet declined to say how many sailors aboard the nuclear-powered aircraft carrier had tested positive for the coronavirus, but said that no one had been hospitalized.

"What I will tell you is I have no sailors hospitalized, I have no sailors on ventilators, I have no sailors in critical condition, no sailors in an ICU status on the Theodore Roosevelt," Adm. John Aquilino told reporters.

Asked about Crozier's letter, Aquilino said, "We're welcoming feedback. ... We want to make sure we understand exactly what the leader on the ground needs."

"We are on the same sheet of music and I am really trying to make it happen more quickly but there are some constraints we are operating around," Aquilino said, saying that the ship's captain wanted to see a faster pace than what was currently taking place.

One issue delaying the process is the lack of capacity to house, isolate and quarantine sailors in Guam where the ship is currently in port, something the admiral said the Navy was working to mitigate.

Asked about the letter, Secretary of Defense Mark Esper told CBS Tuesday, "Well, I have not had a chance to read that letter, read it in detail. Again I'm going to rely on the Navy chain of command to go out there to assess the situation and make sure they provide the captain and the crew all the support they need to get the sailors healthy and the ship back at sea."

"The commanding officer of the Theodore Roosevelt alerted leadership in the Pacific Fleet on Sunday evening of continuing challenges in isolating the virus," a US Navy official told CNN.

"The ship's commanding officer advocated for housing more members of the crew in facilities that allow for better isolation," the official added.

A second Navy official said that the number of coronavirus cases on board the aircraft carrier had surpassed 70 as of Tuesday morning, added that the Navy expected that figure to increase.

The outbreak seems to be escalating rapidly. A week ago the Pentagon confirmed three sailors on the Roosevelt had tested positive and that number had risen to 25 two days later. Since then the number of cases has almost tripled. On Monday, a US defense official told CNN that a second US aircraft carrier, the USS Ronald Reagan, is also facing a "handful" of positive cases.

Acting Navy Secretary Thomas Modly told CNN's John King Tuesday that he was aware of the letter and that the Navy was working to get the sailors off the ship.

"I heard about the letter from Capt. Crozier this morning, I know that our command organization has been aware or this for about 24 hours and we have been working actually the last seven days to move those sailors off the ship and get them into accommodations in Guam. The problem is that Guam doesn't have enough beds right now and were having to talk to the government there to see if we can get some hotel space, create tent-type facilities," Modly said.

"We don't disagree with the (Commanding Officer) on that ship and we're doing it in a very methodical way because it's not the same as a cruise ship, that ship has armaments on it, it has aircraft on it, we have to be able to fight fires if there are fires on board the ship, we have to run a nuclear power plant, so there's a lot of things that we have to do on that ship that make it a little bit different and unique but we're managing it and we're working through it," he added.

"We're very engaged in this, we're very concerned about it and we're taking all the appropriate steps," Modly said.

However, despite the large number of cases aboard, senior US military officials have insisted that the ship is capable of performing its missions.

"If that ship had to sail today for combat it's ready to sail right now if it was needed," Maj. Gen. Jeff Taliaferro, the vice director for operations for the Joint Staff, told reporters Monday.

"The appropriate measures are being taken for folks who have tested positive," he added.

The carrier is in port on a visit to Guam that the military has said was previously scheduled.

Crozier struck a more optimistic tone in a post on the ship's Facebook page on Monday, saying the "Sailors are in good spirits and are facing this new challenge with a level of professionalism that I have come to expect from such an amazing and resilient team."

CNN's Devan Cole and Michael Conte contributed to this report.

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Commander of aircraft carrier hit by coronavirus outbreak warns Navy 'decisive action' is needed - CNN