Category: Corona Virus

Volunteers deliver meals to the homes of quarantined students who attend a school for children with significant disabilities on Chicago's north side. USA TODAY

CHICAGO By day fiveof her at-home quarantine, Emma Burkhalter lost it.

Shealready had done manicures and pedicures with her mom, readbooks and watched her favorite shows on Disney+. But the sudden halt to allnormal school and social activities since March 7 finally bubbled up to aphysical outburst, one of many her mom anticipates subduingwhile Burkhalter stays homefor two weeks because an aideat her school tested positive for the coronavirus.

"My daughter is combatant because she can't go out and play," said Erin Folan, the mother of Burkhalter, who is 20 and has an intellectual disability.

As the pace of virus-related school closures quickens nationwide,theshuttered Jacqueline B. Vaughn Occupational High School, which serves students with special needs in Chicago,has become an extraordinary test case for the restrictive new reality soon to be felt by millions of kids and familiesacross the country.

Before Friday, Vaughnwas the first and only Chicago Public School to close because of the virus. Staff and students were ordered to quarantine themselves at home and monitor their healthfrom March 7 to March 19.Now the school's more than 200 students and their families will be away from school even longer.

Emma Burkhalter, a 20-year-old student, poses in her Portage Park, Illinois home on March 11, 2020 while under quarantine from Vaughn Occupational High School. The Northwest Side special education school has shut down until March 18 and ordered its students into home-based quarantine after a school aide infected with coronavirus worked closely with students.(Photo: Camille C. Fine for USA TODAY)

Twenty-six states and counting, including Illinois,have ordered public schools to shut down for two weeks or more to contain the spread ofCOVID-19. Formany, that will start Monday, though Illinois' shutdown, which includes Chicago, will begin Tuesday.The state closures, alongwith those of individual districts, will affectat least 29.5million students nationwide more than half of American schoolchildren according to a tally kept by Education Week magazine. The unprecedented disruption will upendwork schedules, day care and social activitiesand challenge many familiesfinancially.

School closings: Growing number of states and large districts shut all K-12 schools

Most of Vaughn's students ordered to stay homecannot be left alone, which means parents are juggling schedules or missing work entirely to care for their children. Friends who usually come by to help are keeping their distance, increasing the pressure on families and adding to the social stigma of those whohave been near someone with the virus.

One of the most immediate effects: The families are in a bind financially and running low on supplies.Fundraising drives to raise money for Vaughn's parents, and to deliver food and cleaning suppliesto their homes, have been organized by both Chicago Public Schools and state Rep. Lindsey LaPointe, a Democrat, who lives near the school.

Pedestrians walk by Vaughn Occupational High School in Chicago, Illinois on March 11, 2020.(Photo: Camille C. Fine for USA TODAY)

The school's closure is also putting a halt to the students' academic progress.Vaughn's students require a lot of one-on-one help, which limits their ability to learn online the kind of programs some schoolsare planning to implement as their buildingsshut down.

Because Vaughn students have potentially been exposed to someone with the virus, they are not supposed to leave their homes or attend therapy sessions or regular group activities. That hasleftparents struggling to find ways to entertain their children.

"You can't Netflix them all day," said David Wisneski, whose daughter, a Vaughn student, has anintellectual disability.

"I wish we had more guidance on how to better engage our special-needs kids, since e-learning is not an option," Wisneski said. "How can we get help?"

How to talk to kids about coronavirus: Stay honest and simple to avoid anxiety

Folan, a bartending manager, had to take off all week to care for her daughter. Afterday five of the quarantine, she was still forgetting what activities wereoff-limits.

"I was going to take her to the library when she ran out of books, but then I thought, 'Nope, I can't do that either,' " she said.

Vaughn epitomizes how little is known about how thevirus spreads and infects people.

Unlike schools nationwidethat preemptively shut downor closed because of aconfirmedinfection in the community, Vaughn had an aide with theinfection working side-by-side with students and staff in the building.

Donations are left in the office of Illinois State Rep. Lindsey LaPointe, D-19th District, to be delivered to Vaughn Occupational High School students who were ordered into home-based quarantine.(Photo: Camille C. Fine for USA TODAY)

Cruise ship infections: Grand Princess produced sixth coronavirus case in Illinois

The aide, a woman in her 50s, had been on a Grand Princess cruise with confirmed cases of the virus, but she didn't show symptoms until muchlater. After that, two of her family members contracted the virus.

Anyone at Vaughn around the time the aide was in the buildingwas ordered to quarantine themselves at home, starting March 7.

Many worried that Vaughn kids might be more susceptible than other children to contracting the virus, as some students have respiratory issues.Yet as of Friday, no other students or staff showed symptoms. Staff and students on quarantine must take theirtemperature twice a day and send the readingsto the state health department.

Pull vulnerable kids out of school?As coronavirus sweeps country, parents worry about at-risk kids

"Currently, we're celebrating and also relieved that we have no other positive cases yet," said Noel McNally, Vaughn's principal.

While students muststay at home, their family members can come and go freely.

Folan said she's still surprised that Vaughn's students and staff are all healthy.

"It'sthe worst population for something like this to happen, because a lot of our kids don't knowhow to blow their noses or wash their hands properly, and theyre constantly touching each other. When they sneeze it goes everywhere," she said.

Are kids at risk?WHO report says no, but some doctors aren't so sure

Rose McDonough sorts through donations delivered to her door on March 11, 2020 in Chicago, Illinois. Her son Michael McDonough Jr. is a student at Vaughn Occupational.(Photo: Camille C. Fine for USA TODAY)

Schools in America serve as more than just education centers they feed more than 20 million children withfree or reduced-price meals.

About 75% of Vaughn's students come from low-income familieswho rely on those meals.Plus, the quarantine has put additional pressure on families: Some parents said that taking off work to care for their children is putting their job at risk.

Guadalupe Tafolla, a mother of a Vaughn student, had to take off from her job at McDonald's to care for her daughter. Friends she usually relies on for help, she said in an interview in Spanish, are afraid to come to the house.

Volunteer for Illinois State Rep. Lindsey LaPointe, D-19th District, Catherine Colombo leaves Lapointes office to deliver food and toiletries to Vaughn Occupational High School student Michael McDonough Jr. and his family.(Photo: Camille C. Fine for USA TODAY)

"It'shard because I'm a single mother and I have to care for my daughter," she said.

The district has hustled to funnel resources to Vaughn families. As of midweek, the district had packaged at least 500 boxes of food for pickup or delivery tostudents' families. That level of support will be hard to replicate at scale in low-income districts across the country as schools close.

McNally, who has been carrying out his principal duties from home during his own quarantine,said he's been contacted by parents who can't work and who are worried about losing their jobs. He said he and the district are offering to document the circumstances to employers so their parents can stay employed.

"This is beyond the scope of CPS," McNally said. "What's the federal support for businesses dropping staffing?"

Some districts across the countryare makingplans to offeronline instruction to students during the closures.

But many have instead ordered what amounts to an extended spring break. That's the plan for manyimpoverished districts,because it's difficult to guarantee equal access to instruction to low-income families who may not have the computers and high-speed internetenjoyed by higher-income households.

"There's no school district in thecountry that's prepared to offer online instruction that parallels what happens face to face in classrooms," said Aaron Pallas, a professor of sociology and education at Teachers College at Columbia University in New York City.

"There are tremendous inequalities among families when it comes to access and availability of technological tools," he added.

Some districts, such as Los Angeles Unified and Newark Public Schools in New Jersey, are sending students home with packets of material to work through.

Federal lawsays even in times of crisis, students with disabilitiesneed equal access to afree and appropriate public education. But the realities of doing that now are very difficult, school leaders say.

"I have to reiterate how different the Vaughn environment is," Janice Jackson, CEO of Chicago Public Schools, said in a news conference last week."Many require the assistance of special education teachers to do their work, so we cant expect the same thing we do in other schools with take-home assignments."

Bovena Stasiak, a Vaughn parent whose son isquarantined at home, will continue to look for ways to occupy him during the extended break. It's hard because even long walks are out, she said. He's bored. Heloves to talk to people and go places, Stasiak said, but that's off limits, too.

"I dont want him to put anyone in danger," she said.

Education coverage at USA TODAY is made possible in part by a grant from the Bill & Melinda Gates Foundation. The Gates Foundation does not provide editorial input.

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Coronavirus closed this school. The kids have special needs: 'You can't Netflix them all day.' - USA TODAY

When an infected person touches a surface, like a door handle, there's a risk they leave viruses stuck there that can live on for two to three days. Andrew Harrer/Bloomberg via Getty Images hide caption

When an infected person touches a surface, like a door handle, there's a risk they leave viruses stuck there that can live on for two to three days.

How long can the new coronavirus live on a surface, like say, a door handle, after someone infected touches it with dirty fingers? A study out this week finds that the virus can survive on hard surfaces such as plastic and stainless steel for up to 72 hours and on cardboard for up to 24 hours.

"This virus has the capability for remaining viable for days," says study author, James Lloyd-Smith, an assistant professor of ecology and evolutionary biology at the University of California, Los Angeles, who researches how pathogens emerge.

Although the World Health Organization had previously estimated the survival time on surfaces to be a "few hours to a few days" based on research on other coronaviruses, this is the first study by scientists at a federal laboratory to test the actual virus causing the current pandemic, SARS-CoV-2.

The study is out in preprint form and expected to be published.

Interestingly, some surfaces are less hospitable to SARS-CoV-2. For instance, the virus remained viable on copper for only about four hours.

It's useful to know how long it can stay alive of course, because the virus can contaminate surfaces when an infected person sneezes or coughs. Virus-laden respiratory droplets can land on doorknobs, elevator buttons, handrails or countertops and spread the virus to anyone who then touches these surfaces.

To test the survival time of the virus, scientists at the Rocky Mountain Laboratories in Montana, part of the National Institutes of Health, conducted a series of experiments comparing the novel coronavirus with the SARS virus (a similar coronavirus that led to an outbreak back in 2003).

In the lab, "they'd pick up the virus from the surfaces that had been contaminated and then put [the virus] into cell cultures," he explains. Then the researchers documented whether the virus could infect those cells in the dish. They did this multiple times, for both the viruses, at various time points.

"Big picture, the [two viruses] look very similar to each other in terms of their stability in these environments," Lloyd-Smith says.

Lloyd-Smith says these findings establish a good ballpark estimate for the survivability of the virus on these surfaces. "In a laboratory experiment, the conditions are pretty carefully controlled and constant," he says. By comparison, "in the real world, conditions fluctuate" conditions like temperature, humidity and light. So the survivability may vary, too.

For instance, if the virus contaminates a sunny windowsill or countertop, it may not last as long.

"Ultraviolet light can be a really powerful disinfectant and we get a lot of UVA light from the sun," says Daniel Kuritzkes an infectious disease expert at Brigham and Women's Hospital. "Direct sunlight can help rapidly diminish infectivity of viruses on surfaces," he says. He was not involved in the new research.

Much is still unknown about the virus's survivability on other types of surfaces like clothing, or carpeting. Kuritzkes says that based on prior research, it seems that "flat surfaces and hard surfaces are more friendly to viruses than cloth or rough surfaces."

And how about food? "Food is probably not a major risk factor here," Kuritzkes says. That's because most infection from the new coronavirus starts with the respiratory system, not the digestive tract. So infection comes from getting the virus on your hands and then touching your own eyes, nose and mouth. "Of more concern would be utensils, and plates and cups that might be handled by a large number of people in a cafeteria setting, for example," he says.

So, what can you do to protect yourself? Well, you've likely already heard this. Wash your hands. And wipe down shared surfaces.

Follow these tips for cleaning surfaces your own and public ones.

Wipe right: Use ammonia or alcohol-based products. Skip the baby wipes

Maintaining awareness of the many surfaces you touch during the day and cleaning them with approved products will help curb the spread of the coronavirus. Max Posner/NPR hide caption

"The good thing about COVID-19 is that it does not require any unique cleaning chemicals to disinfect hands and surfaces," says Andrew Janowski, an infectious disease expert at Washington University School of Medicine and St. Louis Children's Hospital. COVID-19 is the disease caused by the current coronavirus,

Good old-fashioned soap and water does the trick.

You can also use a wipe, but make sure you use an alcohol-based wipe, not baby wipes, which may not be effective, Janowski says.

And given that wipes are hard to come by at many stores at the moment, you can instead buy an EPA-registered disinfecting spray, such as one on this list from the Center for Biocide Chemistries, recommended by the Centers for Disease Control and Prevention and by Dr. David Warren, an infectious disease specialist at Washington University School of Medicine in St. Louis.

Or make a bleach-based spray yourself. You can make a DIY cleaning spray by mixing 4 teaspoons bleach per quart of water, according to the CDC.

Wash. Your. Hands. (Seriously!)

Yes, you've heard it a hundred times. So do it, already! Especially after you've been out in public, touching a lot of surfaces. Lather up with soap and scrub for 20 seconds. (Two times the "Happy Birthday" song, or sing "Baby Shark" you'll get midway through Daddy Shark).

And be thorough. Spend some time rubbing the backs of your hands as well as the front, interlace your fingers and pull them through, soap up each thumb with the opposite hand and, finally, to keep your fingernails virus-free, lightly scratch them against your palm. (For more detail, listen to NPR Short Wave's Maddie Sofia give a lesson here.)

Hand-washing is so important that if everyone followed good hand-washing hygiene, it could prevent an estimated 1 in 5 respiratory infections, according to the CDC that's the equivalent of about 6 million cases of the flu this year.

Hand sanitizer: DIY in a pinch?

Hand sanitizer is effective at killing viruses, too, although hand-washing is preferred, according to the CDC. If you can't get to a sink, hand sanitizer is a good backup plan just make sure it's at least 60% alcohol.

Given the shortage of hand sanitizers in some stores and reports of price-gouging online, there's lots of interest in DIY hand sanitizer. We've seen lots of recipes calling for a combination of rubbing alcohol and aloe vera gel, like this one from Wired.

"On paper, if a recipe can maintain the alcohol concentration above 60%, it should be effective against SARS-COV-2," says Andrew Janowski, but he says getting it just right might be trickier than you think. If in doubt when making these homemade sanitizers, soap and water are still effective against the virus.

Your smartphone is like a third hand. Wipe it down

One way to fend off germs: Clean your phone. Your phone is your "third hand"; one that harbors the multitude of germs and bacteria we come into contact with each day. Photo Illustration by Max Posner/NPR hide caption

One way to fend off germs: Clean your phone. Your phone is your "third hand"; one that harbors the multitude of germs and bacteria we come into contact with each day.

So you've just washed your hands and you're feeling squeaky clean. Then you pick up your cellphone, and guess what? It's covered with potential pathogens.

"Studies have shown that smartphones surfaces are covered in bacteria, including bacteria that can cause serious infections like Staphylococcus species," says Judy Guzman-Cottrill, an infectious disease expert at Oregon Health & Science University.

And phones are often held close to the eyes, nose and mouth, where germs can enter the body. So wipe it down often.

And you don't have to rub down your phone for long if you're using an alcohol-based sanitizer. "Just a few seconds should be sufficient to disinfect," says Janowski.

Try this stinky trick to stop touching your face

Having trouble remembering not to touch your face? Try rubbing a raw onion after hand-washing. Photo Illustration by Max Posner/NPR hide caption

Your face offers multiple entry points for the virus. So every time you touch your eyes, nose and mouth with grubby hands, you risk infection.

"If you have touched a table or a doorknob or some surface contaminated [with the virus] and then touch your eyes, nose or mouth, you have a chance of inoculating yourself with the virus," Kuritzkes says.

But, as a matter of habit, most of us touch our faces multiple times an hour without even realizing it.

So, here's an idea. "After you wash your hands really well, touch a piece of raw onion," says Catherine Belling of Northwestern University Feinberg School of Medicine. With this strong smell on your fingers, "you'll notice when you touch your face," she says. Sure, it may make you a tad antisocial, but it could be a good way to train yourself to touch less.

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How Long Can The Coronavirus Live On Surfaces? : Shots - Health News - NPR

A week ago, Mark Canliss restaurant in Seattle was offering a $135 tasting menu to a bustling dining room every night. Eileen Hornors inn on the Maine coast was booking rooms for the busy spring graduation season. And Kalena Masching, a real estate agent in California, was fielding multiple offers on a $1.2 million home.

Then the coronavirus outbreak changed everything.

Today, Mr. Canliss restaurant is preparing to become a drive-through operation serving burgers. Ms. Hornor is bleeding cash as she refunds deposits for scores of canceled reservations. And Ms. Masching is scrambling to save her sale after one offer after another fell through.

Last week, I would have told you nothing had changed, she said. This week, it has all gone to hell.

For weeks, forecasters have warned of the coronaviruss potential to disrupt the American economy. But there was little hard evidence beyond delayed shipments of goods from China and stomach-churning volatility in financial markets.

Now the effects are showing up in downtown nightspots and suburban shopping centers from coast to coast.

Not since the attacks of Sept. 11, 2001, has a crisis enveloped so much of the economy so quickly. Broadway is dark. The college basketball tournaments are canceled and professional sports are on indefinite hold. Conferences, concerts and St. Patricks Day parades have been called off or postponed. Even Disneyland which stayed open through a recession a decade ago that wiped out millions of American jobs and trillions of dollars in wealth is shuttered.

This hits the heart of the economy, and it hits the economy on all sides, said Diane Swonk, chief economist at Grant Thornton. Its not just that were slowing down things. Were actually hitting the pause button, and there is no precedent, there is no mold for that.

The effects are being felt even in places that the outbreak itself has not yet reached. Maine had not had a single diagnosed case of the virus when Ms. Hornor learned Wednesday that Bowdoin College, which accounts for 80 percent of her business, was calling off in-person classes and sending students home. Yet by midday the next day, she had lost 84 bookings, with more cancellations all but certain. At a somber staff meeting on Thursday, she told her 10 employees that she would try to avoid layoffs but that cuts in hours were inevitable.

I have people who rely on me to be able to pay their rent, she said. Not only do I have no money coming in, Im kind of hemorrhaging cash in terms of refunds for everyone.

Now that the outbreak is hitting the consumers, the damage is all but certain to spread. JPMorgan Chase said Thursday that it expected the U.S. economy to contract in the first two quarters of the year, which would meet a common definition of a recession. A survey of prominent academic economists, also released Thursday, found that a majority thought the outbreak was likely to cause a major recession.

For caterers, function halls and others whose business depends on large groups of people gathering together, business dried up nearly overnight.

It started Tuesday, said Elizabeth Perez, the co-owner and marketing director for the Pavilion Grille in Boca Raton, Fla. They were canceling Thursday night with a dinner for 47 people, and that was the first one. Then an Ultimate Chefs dinner for 120 scheduled for March 22 was postponed. A bar mitzvah for 150 on May 30 canceled. Thats at least $10,000, Ms. Perez said. She normally employs 20 people at an event to serve food and bus tables. Since they are hourly workers, if there is no event, there is no pay.

It isnt just the outbreak itself that is causing damage. The turmoil it has caused in the financial markets is also starting to spill over into the real economy.

Last weekend, Ms. Masching, a broker with Redfin in Silicon Valley, got three offers on a $1.2 million home she had listed in Mountain View. But by Monday, two people had rescinded their offers and the third tried to back out, citing stock market losses, after her client had accepted. At the same time, she said, prospective buyers are deciding to hold back offers on the belief that the carnage could eventually lead to lower home prices.

Most of our clients are using stock for their down payment, and they dont have the purchasing power they did even two weeks ago, she said.

In much of the country, offices remain open, restaurants remain full and day-to-day life remains relatively normal, albeit with fewer handshakes and more hand washing. But in places where the virus is already widespread, the downturn is well underway.

In Seattle, the place hit hardest so far by the outbreak in the United States, the normally bustling South Lake Union neighborhood has been eerily quiet since Amazon and other tech companies with headquarters in the area told their employees to work from home. That has been a disaster for Tom Douglas, a local chef with a dozen restaurants. Business is down 90 percent from usual.

On Wednesday, Mr. Douglas told his staff that dinner service on Sunday would be the last for two or three months. He was shuttering his restaurants and laying off almost all of the roughly 800 employees. He planned to apply for unemployment himself and research federal disaster or small business loans.

This is a serious natural disaster I dont think a lot of people are thinking about it that way just because theres no winds and theres no floods, he said. But this is a real natural disaster thats affecting people at the most basic level.

The pullback from public life is sending shock waves beyond the hospitality industry. When restaurants close their doors, they no longer need tablecloths delivered by linen services or beer from local brewers. When people stop flying, they no longer need taxis to the airport or $5 bottles of water from the airport newsstand.

Baden Sports, a sporting-goods manufacturer in the Seattle suburb of Renton, provides basketballs and baseballs for youth leagues and college tournaments, many of which are now being canceled. Jake Licht, who runs the company, has imposed a hiring freeze and is drawing up a budget in preparation for a recession.

This is moving so fast, Mr. Licht said. We had meetings and planning sessions three days ago that have already been invalidated. This is an hour-by-hour management challenge.

The speed of the crisis has outpaced economists ability to track it. As the stock market gyrated in recent days, economic data most of it from February, before the outbreak was widespread in the United States continued to look rosy. Even indicators that usually serve as early-warning systems have yet to catch up: New claims for unemployment insurance actually fell last week and remain near a multidecade low.

Still, there are early signs of a crisis that is still gaining steam. Measures of consumer sentiment fell sharply in early March, and indexes of business conditions have cratered. Airlines, ports, hotels and other directly affected industries have already announced layoffs or employee furloughs. Postings for restaurant jobs were down 26 percent last week compared with the same week a year ago, according to data from the job marketplace ZipRecruiter. Job listings in catering were down 39 percent and those in aviation down 44 percent.

The behavior changes that could set off an economic cascade that will eventually be seen in the labor market are really being put into motion now, said Julia Pollak, a labor economist at ZipRecruiter.

The workers who are feeling the effects of the pullback first are the ones least able to afford it: low-wage, hourly employees, many of whom arent paid if they miss work. Only one-third of leisure and hospitality workers have access to any paid time off, according to data from the Bureau of Labor Statistics.

Wallace McLeod has worked at TapWerks Ale House in Oklahoma Citys Bricktown district for five years, but he had never seen business as slow at the bar as it was on Thursday night. With 212 taps split between two stories, the pub would have been rocking with patrons heading to the Cher concert at the Chesapeake Energy Arena a few blocks away. I wouldnt be able to talk to you right now if the concert were going on, he said in an interview.

Instead, Chers event was postponed, the bar was largely empty and a night that should have brought in as much as $13,000 in sales would be lucky to reach $4,000 if the regulars toughed it out. Bartenders expecting to make over $200 for the night would be lucky to bring home $80, Mr. McLeod said which meant they, too, would rein in their spending.

You have less money, Mr. McLeod said, noting he would have to put off a birthday party for his daughter. You cant do as many things as youre used to doing.

The strength of the economy before the coronavirus hit may provide some protection. Companies that have spent recent years struggling to attract and retain workers may be reluctant to lay them off, especially if they expect a relatively rapid rebound.

Many businesses are doing whatever they can to hold on until then.

Canlis is one of Seattles highest-end restaurants, with a piano player who entertains customers at the bar and a four-course tasting menu that runs $135 a person. But when the outbreak began to spread in Seattle, business started to dry up. Mr. Canlis, one of the owners, realized that his business was one headline away from putting 100-plus employees out of a job.

So over a three-hour meeting in an apartment overlooking the city, the managers worked out a new plan. This week, the restaurant will start selling bagel sandwiches in the morning, running a drive-through serving burgers and veggie melts for lunch and delivering dinner to the doorsteps of Seattle residents.

Fine dining is not what Seattle needs right now, the restaurant said in an Instagram post announcing the change.

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Coronavirus Cost to Businesses and Workers: It Has All Gone to Hell - The New York Times

Senate Democrats on Thursday sought assurances from Kenneth T. Cuccinelli II, the deputy secretary of the Department of Homeland Security, that his department would not interfere with undocumented immigrants seeking medical attention.

This is a public health and safety issue that, if anything else, puts all of our communities at risk, Senator Jacky Rosen, Democrat of Nevada, said. Will the department refrain from apprehending individuals based solely on their immigration status while theyre seeking care?

Mr. Cuccinelli said ICE does not conduct enforcement at health care facilities absent single case exigent circumstances.

But immigrant advocates say that stepped-up enforcement could deter people from seeking medical care.

On Wednesday, nine Democratic senators wrote a letter to President Trump and members of his coronavirus task force urging the agency to halt civil immigration enforcement in or around health care facilities.

The senators also requested that Homeland Security publicly state that the administrations new wealth test, known as the public charge rule, would not penalize immigrants who receive treatment for coronavirus symptoms by labeling them public charges, thus barring their paths to green cards.

We cannot allow the fear this ill-considered rule creates to scare families away from getting the help that they may need if they come into contact with people, with the coronavirus, the Democrats said in the letter.

Reporting was contributed by Mike Baker, Rick Gladstone, Katie Robertson, Vindu Goel, Melissa Eddy, Michael Wolgelenter, Marc Santora, Niki Kitsantonis, Mitch Smith, Sarah Mervosh, Davey Alba, Tiffany May, Claire Fu, Elaine Yu, Farah Stockman, Ed Shanahan, Neil Vigdor, Lauretta Charlton, James Gorman, Zolan Kanno-Youngs, Matt Richtel, Mitch Smith, Amy Harmon, Michael Gold, Ben Dooley, Richard Prez-Pea, Azi Paybarah, Joseph Goldstein and Kirk Johnson.

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Coronavirus Cases Surge in U.S. and Europe - The New York Times

SEATTLE Two emergency medicine doctors, in New Jersey and Washington State, are in critical condition as a result of coronavirus, reinforcing concerns that the nations front-line medical workers are becoming especially vulnerable to the virus, the American College of Emergency Physicians said.

A lot of us think that despite everything we do, we will probably be exposed, said Dr. William Jaquis, the chair of the group. Still, he said, The first reported case certainly sends a shock wave through the community.

Emergency rooms represent a busy intake point for hospitals, where patients come in with symptoms but no diagnosis. As the coronavirus spreads during the typical flu season, emergency physicians are triaging large numbers of patients around the country with symptoms that could be the virus.

As compared to anyone else at a hospital, you are operating with the most incomplete information, said Dr. Angela Fusaro, an emergency doctor in Atlanta.

One of the ill physicians, a man in his 40s, is a doctor at EvergreenHealth Medical Center in Kirkland, Wash., a hospital near Seattle which has seen one of the largest concentrations of cases in the United States.

EvergreenHealth is providing care for one of our physicians who has a confirmed case of Covid-19. He is in critical condition but stable, the hospital said in a statement.

Dr. Jaquis said it appeared that the doctor had access to adequate protective equipment. This was an area with an outbreak, so they were expecting and prepared. That obviously makes us more nervous.

The other physician, a doctor in his 70s in Paterson, N.J., was also in isolation in intensive care. The doctor led his institutions emergency preparedness and was admitted to the hospital several days ago with upper respiratory problems, the physicians group said.

The nationwide shortage of N-95 protective masks has been concerning to doctors, who increasingly feel the need to use them in more situations to stay safe, Dr. Jaquis said.

Some emergency departments are adapting their facilities to minimize the risk to health care providers and other patients, opening tents to triage patients outside their buildings and creating separate entrances for patients and doctors, who do not typically wear protective gear as they come and go.

Emergency doctors at times must tend to patients before their virus risk is assessed, and may have a need, such as a major injury, that needs urgent attention, Dr. Fusaro said. Things that might be necessary to stabilize their life are pretty intimate, she said. If you have to put in a breathing tube, you are going to be right up against them. You cant practice that type of medicine from afar.

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Two Emergency Room Doctors Are in Critical Condition With Coronavirus - The New York Times

The US Health and Human Services Department was the victim of a cyberattack yesterday, the agency confirmed to Recode.

Bloomberg, which was first to report the attack on Monday morning, initially described it as a hack, but updates to its story removed the word hack, instead referring to it as multiple incidents of a cyber intrusion. A subsequent ABC News story said it was actually a distributed denial of service (DDoS) attack, which is a type of cyberattack but not a full breach. A DDoS attack is more consistent with Bloombergs description, which said the agencys servers were overwhelmed with millions of hits designed to slow or shut them down. Both reports said the attack was not successful and that no data was accessed.

Caitlin B. Oakley, a spokesperson for the HHS, told Recode that there was a significant increase in activity on HHS cyber infrastructure but that it remained fully operational.

Early on while preparing and responding to Covid-19, HHS put extra protections in place, Oakley said. HHS has an IT infrastructure with risk-based security controls continuously monitored in order to detect and address cybersecurity threats and vulnerabilities.

Meanwhile, the National Security Council confirmed to Bloomberg that there was an incident but downplayed its impact, adding that HHS and federal networks are functioning normally at this time.

We are aware of a cyber incident related to the Health and Human Services computer networks, and the federal government is investigating this incident thoroughly, John Ullyot, NSC spokesperson, said in a statement to Bloomberg. HHS and federal government cybersecurity professionals are continuously monitoring and taking appropriate actions to secure our federal networks.

In a Monday morning tweet, Washington Post reporter Ellen Nakashima said that a Department of Homeland Security source told her the attack has been overblown and that the site never crashed or seemingly was in any danger of doing so.

Details of the cyberattack at HHS emerged at the same time as a flurry of reports about a foreign disinformation campaign designed to spread fear during the coronavirus pandemic. Three anonymous federal officials told the Associated Press that such an effort was underway, though they did not specify which foreign entity was leading the effort. Bloomberg also reported that a recent tweet referencing a misinformation campaign from the National Security Council was related to the attack:

But its not entirely clear how the two incidents are related. The NSC tweet appears to be a reference to a viral text message that says President Trump is on the verge of declaring a nationwide mandatory quarantine a rumor that the White House has denied. It also seems as though such an action by the president would not be constitutional, since theres little evidence that a DDoS attack would result in the spread of misinformation.

An attack on the HHS during the coronavirus pandemic is probably not a coincidence, and now is obviously one of the worst possible times for an elevated level of uncertainty and fear. According to Bloomberg, officials dont yet know who is responsible but are assuming its a hostile foreign actor.

So far, its hard to know how seriously to consider the threat of further cyberattacks. DDoS attacks are common as cyberattacks go, because they are relatively easy. Where DDoS attacks that flood a server with messages can be performed with a single computer, a more powerful DDoS requires a network of computers or botnets. Over the course of the past decade, these types of attacks have become increasingly popular as tools of political protest or weapons of disruption. As long as the attacker has enough bots in their arsenal, they can temporarily devastate their victim websites, which may be forced offline for hours or even days an outcome that would have been particularly harmful in this case but, fortunately, appears to have been avoided.

While it doesnt look as though the HHS attack did more than spread fear, cybersecurity researchers have warned of several coronavirus-related phishing campaigns and malware posing as official emails or websites from health organizations. Those threats, along with the possibility of a foreign disinformation campaign, serve as additional evidence that were only just beginning to comprehend the scope of the coronavirus pandemic and its consequences.

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The Health Department website was attacked in the middle of the coronavirus pandemic - Vox.com

An office worker is screened with an infrared thermometer as he enters a building in New Delhi, India. Prashanth Vishwanathan/Bloomberg via Getty Images hide caption

An office worker is screened with an infrared thermometer as he enters a building in New Delhi, India.

Mild.

Moderate.

Serious.

Severe or extreme.

These are some of the adjectives being used to describe the symptoms displayed by patients with COVID-19. Vice President Pence used them in his remarks to the nation this week:

"Some some large percentage have mild flu symptoms; some have serious flu symptoms."

At this stage of the COVID-19 pandemic, there is not a standard definition of what symptoms are associated with these designations.

It can take years for such guidelines to be issued for a newly identified disease, according to Dr. Sandro Galea, an epidemiologist and dean of the Boston University School of Public Health.

Nonetheless, there are some preliminary definitions that can be helpful in understanding the range of symptoms.

Mild

In 80% of known cases, COVID-19 causes mild to moderate illness, according to a report of a joint World Health Organization-China mission of 25 infectious disease experts held in China late last month.

At a press conference on March 9, Maria Van Kerkhove, technical lead of the WHO Health Emergencies Program, had this to say about the symptoms for a so-called "mild" case: "This mild infection starts normally with a fever, although it may take a couple of days to get a fever. You will have some respiratory symptoms; you have some aches and pains. You'll have a dry cough. This is what the majority of individuals will have."

It is "nothing that will make you feel like you need to run to a hospital," says Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security.

A mild case of COVID-19 in and of itself is not dangerous. But in some cases more commonly in older people and in people with underlying health issues a mild case can progress to a moderate case that could require some supportive care such as fluids for dehydration, typically in an emergency room or urgent care center, especially if hospitals are overwhelmed by the most acute cases.

Moderate

Symptoms of being moderately ill with COVID-19 include coughing, fever above 100.4, chills and a feeling that you don't want to or can't get out of bed, says Adalja.

Some patients also experience shortness of breath, although that can occur in various ways. "Shortness of breath is a wide spectrum and whether we consider treatment will be based on how short of breath they are, their age and other health conditions," says Galea.

"Is it shortness of breath after climbing a flight of stairs or when there's no activity for example, when you're just sitting in a chair?" says Dr. Theresa Madaline, hospital epidemiologist at the Montefiore Health System in New York City.

In either case, there's cause for concern with a confirmed or suspected COVID-19 case. "Shortness of breath [with this virus] is a symptom to always check with a health care provider. Period," says Dr. Kenneth E. Lyn-Kew, a pulmonologist in the Section of Critical Care Medicine and Department of Medicine at National Jewish Health in Denver.

That's because shortness of breath can be caused by low oxygen levels in the blood. Blood carries oxygen to organs and tissues, and low levels can lead to organ shutdown or even death.

For patients with moderate symptoms, hospitalization is unlikely unless they are having difficulty drawing a breath or are dehydrated. Signs of dehydration can include increased thirst, dry mouth, decreased urine output, yellow urine, dry skin, a headache and dizziness.

But there's another possible development within the "mild to moderate" classification. "Some of those individuals will go on to develop a mild form of pneumonia," Van Kerkhove says. While pneumonia can often resolve on its own, especially in younger people, in older people and in those with underlying health conditions, pneumonia can be life-threatening or require hospitalization, especially if their immune system is weak.

In these instances, without supplemental oxygen or, if needed, a respirator to aid breathing, a patient's organs can shut down and the patient can die, says Galea. People with pneumonia can also get secondary bacterial infections, which can be life-threatening and require treatment with intravenous antibiotics.

A case that is "mild to moderate" will last about two weeks from the first signs of symptoms to recovery, WHO says.

Serious, severe, extreme

According to the report of the WHO-China joint mission, in about 1 in 5 patients, the infection gets worse. About 14% of cases can develop into severe disease, where patients may need supplemental oxygen. And 6% of cases become critical and may experience septic shock a significant drop in blood pressure that can lead to stroke, heart or respiratory failure, failure of other organs or death.

Theresa Madaline says that in some patients, symptoms can progress to severe in a few hours or over several days.

A different problem can occur if disease progresses. The virus can enter lung cells and start replicating, killing the cells. The immune system may take action to fight the virus, creating inflammation, destroying lung tissue and sometimes resulting in a more severe form of pneumonia.

This [immune system] response can impair your ability to get oxygen into your blood. Without enough oxygen, inflammation can become more severe and result in organ failure.

What to tell your doctor about symptoms

"Keep in mind that mild, moderate and severe are the inelegant terms we have right now," says Dr. Shira Doron, hospital epidemiologist at Tufts Medical Center in Boston. "Use symptoms rather than adjectives when you speak to a health care provider" and then they can determine whether you need to consider treatment.

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Defining Coronavirus Symptoms: From Mild To Moderate To Severe : Goats and Soda - NPR

As the coronavirus continues to spread across the globe, the news is coming at a fast and furious pace. But dont let the volume send you into a panic about your health and that of your loved ones.

The mantra is, Keep calm and carry on, said Dr. Marguerite Neill, an infectious disease expert at Brown University.

Heres a list of frequently asked questions about the coronavirus outbreak and its symptoms.

Common symptoms of this infection include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. The illness causes lung lesions and pneumonia. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common.

Patients may also exhibit gastrointestinal problems or diarrhea, and Dr. Neill said we are learning about different symptoms as we go. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

In some cases, people who had appeared stable rapidly deteriorate in the second week; anyone infected needs careful monitoring.

If you think youre sick as a result of the novel coronavirus, you can help safeguard your loved ones and community by staying at home, except to get medical care.

The current guidance from the Centers for Disease Control and Prevention recommends that you call a medical professional if you notice symptoms and

Live in or have traveled to an area with a known coronavirus outbreak

or

Have had close contact with someone who has traveled to an area with an outbreak

or

Have had close contact with anyone infected.

Call your doctor or health professional before you go. That will help him or her prepare for your visit and prevent the spread of the virus to other people in the office. Be sure to wear a mask when you go to the doctors office and when youre around other people. If you cannot find a mask, you can create a makeshift one from a scarf or T-shirt.

The C.D.C. also suggests that you avoid public transportation, ride-sharing services and taxis, and that you separate yourself from other people and animals in your home as soon as possible. That means not letting anyone enter your room and, ideally, not sharing bathrooms. Others should stay more than three feet away from you and avoid any surface you might have coughed on or touched, including doorknobs, plates, cups and towels. Disinfect the environment as much as possible.

Many state health departments have set up hotlines for people who want more information, but long wait times have been reported. Eventually, specific coronavirus testing centers may be set up.

Follow the same steps listed above if you think your children, or anyone else in your household, may be infected. Both the coronavirus and influenza are most dangerous to people who are over 65 or have chronic illnesses or a weak immune system. Children infected with the new coronavirus tend to have mild or no symptoms, and it is unclear how easily they transmit the disease to teenagers or adults.

The coronavirus seems to be more deadly than seasonal flu and quite contagious. Early estimates of the coronavirus death rate from Wuhan, China, the epicenter of the outbreak, have been around 2 percent, while the seasonal flu, on average, kills about 0.1 percent of people who become infected. But children appear to be more affected by the flu.

By contrast, the 1918 flu had an unusually high fatality rate, greater than 2 percent. Because it was so contagious, that flu killed tens of millions of people.

The new coronavirus seems to spread very easily, especially in confined spaces like homes, hospitals, churches and cruise ships. It appears to spread through droplets in the air and on surfaces from a cough or sneeze.

Whether a surface looks dirty or clean is irrelevant. If an infected person coughs and a droplet lands on a surface, a person who then touches that surface could pick it up.

A study of other coronaviruses found that they remained on metal, glass and plastic for two hours to nine days. But there is good news: The virus is relatively easy to destroy using any simple disinfectant or bleach.

Droplets can sit on the surfaces of latex gloves. Some experts suggest wearing cloth or leather gloves that absorb droplets and are bulky enough to discourage you from touching your face.

That is still unknown. This is a new virus, and everyone is believed to be susceptible.

Flu transmission decreases in hot weather every year, and the SARS coronavirus emerged in winter and was eliminated by the following June. But SARS was beaten by aggressive containment measures, not by the weather. The four mild coronaviruses that cause common colds still circulate in warm weather and cause summer colds.

In the 1918 and 2009 flu pandemics, there was a second wave in the fall.

There is no approved antiviral drug for the coronavirus, though several are being tested. For now, doctors can recommend only the usual remedies for any viral illness: rest, medicine to reduce pain and fever, and fluids to avoid dehydration.

Coronavirus patients with pneumonia may also need oxygen, and a ventilator if breathing trouble worsens. Some patients who appear to be doing well have a crash in the second week of their illness.

An experimental vaccine for the coronavirus may be ready for testing in humans within a few months. But even if it is approved, it will take much longer, at least a year, before it is available for widespread use. In the meantime, experts are urging people and their children to get a flu shot.

This virus can be deadly. Theres a reason government officials and medical experts across the world are issuing strong warnings.

About 80 percent of victims will recover without any need for hospitalization. Still, the cases categorized as mild by the Chinese C.D.C. included those with mild pneumonia, meaning there is fluid in the lungs but not seriously enough to require supplemental oxygen or intensive care. The other categories are severe, which means oxygen or ventilation is required, and critical, which means lung or organ failure.

It is important to keep these distinctions in mind, both to avoid unnecessary panic and to get a clear picture of the likelihood of transmission.

Many people are now panicking, and some actually are exaggerating the risks, said Dr. Jin Dong-Yan, a virology expert at the University of Hong Kong.

Unlike other, more mild coronaviruses, this one causes many deaths.

It is unclear how many completely symptom-free cases there are, because some people test positive a day or two before developing symptoms. The World Health Organization believes that only about 1 percent of cases never develop a fever or any other symptoms.

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What Are the Symptoms of a Coronavirus Infection? - The New York Times

Hotels have always been in the business of providing a good nights rest, but a growing number of brands are adding tools to help guests chill out and get to sleep.

And that was before the anxiety caused by the coronavirus.

Well-being is top of mind for everyone today, and we think thats going to continue in the future, said Mia Kyricos, senior vice president and global head of well-being at Hyatt Hotels. If you think about the world we live in now, its 24/7. We increasingly have demands in work and life.

Starting April 1, Hyatt is rolling out a partnership with the Headspace meditation app. Guests will be able to get content on relaxation and sleep-guided meditation through the Hyatt loyalty program mobile app. The chain will also offer content from Headspace via TVs at its hotels.

Were starting with 200 properties and rolling out from there, growing globally, Ms. Kyricos said. Theres a real interest for people to practice self-care.

Data from the National Institutes of Health bears this out. A survey found that the number of American adults who reported meditating in the previous year tripled from 2012 to 2017, jumping to 14 percent from roughly 4 percent.

The wellness offerings may also provide an opportunity for hotels to increase revenue, according to a study released in December by CBRE, a commercial real estate services and investment firm. With a glut of new rooms projected to cut into hotels profits, owners and managers were looking for alternatives to raising room rates even before Covid-19 curbed travel and dampened demand. A CBRE analysis of 159 hotels with on-site spas found that, in 2018, spa revenue rose at a higher rate than overall operating revenue.

Spas have really expanded beyond the four walls, said Jenna Finkelstein, a director at CBRE who focuses on the hotel industry. More and more, wellness is becoming a major decision factor when choosing a hotel.

Last fall, Calm, an app that delivers meditation and nature sounds, announced a partnership with Novotel, one of the brands of the French hotel conglomerate Accor, to give guests guided meditations for relaxation and sleep. Starting this year, in a phased rollout, guests at Novotel hotels around the world may sign up for a free two-month subscription to Calms premium tier of content.

Big brands in many industries, but specifically in travel, are listening to their customers and realizing that wellness is more important to them, said Alex Will, chief strategy officer at Calm.

I think people are just searching for help with sleep and relaxation in general, Mr. Will said. Its just tiring. We have this always-on lifestyle now. It just creates a huge amount of stress and strain on the body.

Travel is becoming increasingly more stressful, Mr. Will said.

The growing awareness that sleep is an important part of staying healthy has increased the interest in technology that can help people fall and stay asleep.

Broadly speaking, travel and sleep are major-use cases above and beyond our partnership with Novotel, Mr. Will added. The thing we hear a lot from our users is if you cant sleep, it makes everything else feel very hard in day-to-day life.

Although these initiatives predate the coronavirus pandemic, they are well-positioned to address travelers current fears, said Ms. Finkelstein of CBRE.

Especially with coronavirus and everything thats happening, you are starting to see people either pull back on travel or be a little more cautious when they travel, she said.

In-room relaxation offerings, she added, were particularly well-suited to dealing with the worries of fearful guests. Anything you can do to limit contact with other people but still have some sort of experience related to wellness is especially good in the immediate climate, Ms. Finkelstein said. Providing that safe space for relaxation thats one immediate way to solve some of these travel-related anxieties.

Ms. Finkelstein characterized the trend as an offshoot of the digitally enhanced in-room fitness offerings a number of hotel brands have started in recent years and connected it to the rising interest in wellness and self-care. A lot of these fitness brands have almost a cult following, if you will, she said. When people are traveling, what they dont want is for their routine to get disrupted.

Amenities promoting sleep also are an extension of the hotel industrys arms race in bedding goods like mattresses and pillows, said Phil Cordell, senior vice president of new brand development for Hilton Hotels & Resorts. The availability of meditation and sleep guides is the next logical step, he said. Its an extension-slash-evolution of how some of the thinking has been over the past few years.

Hilton is starting a new brand called Tempo that will offer in-room relaxation and sleep content via TV as well as printed literature when its hotels open starting next year. (Construction began earlier this month on the first one in Louisville, Ky.)

Mr. Cordell said that improving sleep hygiene was a major goal for the Tempo brand. We have a million demands on our time when we travel, he said. Its hard for us to disconnect the brain sometimes. Sleep shortfall is one of the biggest challenges we face today.

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Hotels Were Rolling Out Tools to Help Calm Travelers. Then Coronavirus Hit. - The New York Times

What if youre not in public health, but are thinking about your own personal chances and what your behavior should be?

If you imagine youve got a reproduction number of two, each persons infecting two others, on average. But some situations are more likely to spread infection than others. Weve found for things like Covid-19, its close-knit interactions that seem to be most important.

What we need to think about and what a lot of our modeling is certainly thinking about is not just how much transmission is happening, but where is that transmission happening. If youre going to change your behavior, think how to reduce those risky situations as much as possible.

If you were the average person, what would you pay attention to in terms of the news and the numbers?

One signal to watch out for is if the first case in an area is a death or a severe case, because that suggests you had a lot of community transmission already. As a back of the envelope calculation, suppose the fatality rate for cases is about 1 percent, which is plausible. If youve got a death, then that person probably became ill about three weeks ago. That means you probably had about 100 cases three weeks ago, in reality. In that subsequent three weeks, that number could well have doubled, then doubled, then doubled again. So youre currently looking at 500 cases, maybe a thousand cases.

I think the other thing that people do need to pay attention to is the risk of severe disease and fatality, particularly in older groups, in the over-70s, over-80s. Over all were seeing maybe 1 percent of symptomatic cases are fatal across all ages. Theres still some uncertainty on that, but whats also important is that 1 percent isnt evenly distributed. In younger groups, were talking perhaps 0.1 percent, which means that when you get into the older groups, youre potentially talking about 5 percent, 10 percent of cases being fatal.

In thinking about social behavior and thinking about your interactions, the question should be, How do we stop transmission getting into those groups where the impact could be really severe?

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The Coronavirus, by the Numbers - The New York Times