Category: Corona Virus

BEIJING China is pushing a new theory about the origins of the coronavirus: It is an American disease that might have been introduced by members of the United States Army who visited Wuhan in October.

There is not a shred of evidence to support that, but the notion received an official endorsement from Chinas Ministry of Foreign Affairs, whose spokesman accused American officials of not coming clean about what they know about the disease.

The intentional spreading of an unfounded conspiracy theory which recirculated on Chinas tightly controlled internet on Friday punctuated a downward spiral in relations between the two countries that has been fueled by the basest instincts of officials on both sides.

The insinuation came in a series of posts on Twitter by Zhao Lijian, a ministry spokesman who has made good use of the platform, which is blocked in China, to push a newly aggressive, and hawkish, diplomatic strategy. It is most likely intended to deflect attention from Chinas own missteps in the early weeks of the epidemic by sowing confusion or, at least, uncertainty at home and abroad.

Mr. Zhaos posts appeared to be a retort to similarly unsubstantiated theories about the origins of the outbreak that have spread in the United States. Senior officials there have called the epidemic the Wuhan virus, and at least one senator hinted darkly that the epidemic began with the leak of a Chinese biological weapon.

[Read: Two women fell sick from the coronavirus. One survived.]

The conspiracy theories are a new, low front in what they clearly perceive as a global competition over the narrative of this crisis, said Julian B. Gewirtz, a scholar at the Weatherhead Center for International Affairs at Harvard.

There are a few Chinese officials who appear to have gone to the Donald J. Trump School of Diplomacy, added Mr. Gewirtz, who recently published a paper on Chinas handling of the AIDS epidemic, after a similar disinformation campaign. This small cadre of high-volume Chinese officials dont seem to realize that peddling conspiracy theories is totally self-defeating for China, at a moment when it wants to be seen as a positive contributor around the world.

The circulation of disinformation is not a new tactic for the Communist Party state. The United States, in particular, is often a foil of Chinese propaganda efforts. Last year, Beijing explicitly accused the American government of supporting public protests in Hong Kong in an effort to weaken the partys rule.

The old tactic has been amplified by more combative public diplomacy and a new embrace of a social media platform that is blocked in China to spread a message abroad.

Victor Shih, an associate professor at the University of California at San Diego who studies Chinese politics, said that while the campaign was very likely an attempt to distract and deflect blame, a more worrisome possibility was that some officials fabricated the idea and persuaded top leaders to believe it.

If the leadership really believes in the culpability of the U.S. government, he warned, it may behave in a way that dramatically worsens the bilateral relationship.

Chinas leader, Xi Jinping, has faced sharp criticism for the governments initial handling of the outbreak, even at home. Public anger erupted in February when a doctor who was punished for warning his colleagues about the coronavirus died, prompting censors to redouble their efforts to stifle public criticism.

Chinese officials have repeatedly urged officials in other countries not to politicize what is a public health emergency. Conservatives in the United States, in particular, have latched on to loaded terms that have been criticized for stigmatizing the Chinese people. Secretary of State Mike Pompeo referred to the Wuhan virus, while Representative Kevin McCarthy, Republican of California, called it the Chinese coronavirus.

In response, Chinese officials and state news media have stepped up their criticism of American officials comments.

Only days before Mr. Zhaos latest post, the Xinhua news agency published a commentary denouncing Washingtons poisonous coronavirus politics and warning that spreading rumors simply encouraged fear, division and hate.

Their dangerously irresponsible statements are highly counterproductive at this drastic hour that demands solidarity and cooperation, the commentary, written by Gao Wencheng, said, and could be much more menacing than the virus itself.

The coronavirus, according to all evidence, emanated from Wuhan, China, in late December. Scientists have not yet identified a patient zero or a precise source of the virus, though preliminary studies have linked it to a virus in bats that passed through another mammal before infecting humans.

A senior official of Chinas National Health Commission, Liang Wannian, said at a briefing in Beijing last month that the likely carrier was a pangolin, an endangered species that is trafficked almost exclusively to China for its meat and for its scales, which are prized for use in traditional medicine.

The first cluster of patients was reported at the Huanan Seafood Wholesale Market, and studies have since suggested that the virus could have been introduced there by someone already infected. Wuhan and the surrounding province of Hubei account for the overwhelming amount of cases and deaths, so there is no scientific reason to believe the virus began elsewhere.

Mr. Zhaos assertion began with a post linking to a video of the director of the U.S. Centers for Disease Control and Prevention, Robert R. Redfield, testifying before the House on Wednesday and suggesting that some flu deaths might have been caused by the coronavirus.

When did patient zero begin in US? Mr. Zhao wrote on Twitter, first in English and separately in Chinese. How many people are infected. What are the names of the hospitals? It might be US army who brought the epidemic to Wuhan. Be transparent! Make public your date! US owe us an explanation.

Mr. Zhao appeared to refer to the Military World Games, which were held in Wuhan in October. The Pentagon sent 17 teams with more than 280 athletes and other staff members to the event, well before any reported outbreaks. The Pentagon has had confirmed cases in South Korea and Italy and is bracing for more to emerge, but no illnesses have been tied to American service members from October.

Mr. Zhaos remarks were spread on Chinas most prominent social media platform, Weibo, under a hashtag: #ZhaoLijianPostedFiveTweetsinaRowQuestioningAmerica. By late afternoon on Friday, that hashtag had been viewed more than 160 million times, along with screenshots of the original Twitter posts.

The State Department summoned the Chinese ambassador on Friday to protest Mr. Zhaos comments, officials in the Trump administration said.

At the regular briefing at the Ministry of Foreign Affairs on Friday, another spokesman, Geng Shuang, sidestepped three questions about whether Mr. Zhaos suggestion had politicized the crisis and reflected official Chinese policy.

He instead noted the statements made by American officials and lawmakers to smear and attack China.

We are firmly opposed to this, he said. In fact, the international community, including the United States at home, have different views on the source of the virus. What I have been saying in recent days is that the Chinese side always believed that this is a scientific issue and requires scientific and professional opinions.

Claire Fu contributed research.

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China Spins Tale That the U.S. Army Started the Coronavirus Epidemic - The New York Times

Mike Pence, commander of the U.S. coronavirus task force for some reason. Photo: ERIC BARADAT/AFP via Getty Images

Last month, the Centers for Disease Control and Prevention warned that the United States should brace for a domestic coronavirus outbreak, with the director of its National Center for Immunization and Respiratory Diseases explaining that its not so much of a question of if this will happen in this country any more, but a question of when this will happen. Globally, more than 167,400 cases of this pneumonia-like disease have been reported across every continent except Antarctica, with at least 6,329 deaths so far. Last week, the World Health Organization officially declared COVID-19 a pandemic, and President Trump declared a national state of emergency. So far, at least 66 American patients with the virus have died.

Heres everything we know about the spread of the virus in the U.S. so far.

As of March 16, there were at least 3,602 confirmed cases of COVID-19 the disease caused by the novel coronavirus in the U.S. In the past few days, the number of confirmed cases has accelerated dramatically, with over 1,100 new cases announced since Friday morning. However, officials have warned that due to delays in testing, the number of infected individuals is likely much higher. Most of the initial cases were people who recently traveled to China or were released from quarantine aboard the Diamond Princess cruise ship, which experienced an outbreak last month. Increasingly, though, new cases have cropped up in people who have no known association with outbreak epicenters, suggesting that the virus has been spreading undetected through person-to-person contact for weeks.

COVID-19 cases have been confirmed in 49 states and Washington, D.C., with the largest outbreaks in Washington State, New York, and California. As of Monday morning, in Washington State, 42 American patients with the virus had died. Twenty-seven of those deaths have been linked to an outbreak of COVID-19 at a long-term-care facility, the Life Care Center, in Kirkland, Washington.

As of Monday morning, the number of confirmed COVID-19 cases in New York rose to 732, with six confirmed deaths from the virus.

Over the weekend, officials in many states ramped up restrictions on large gatherings. On Sunday, the CDC recommended a ban on all gatherings of 50 people or more including weddings, festivals, parades, concerts, sporting events, and concerts for the next eight weeks. Restaurants and bars were ordered closed in New York City, Massachusetts, Ohio, Washington, Puerto Rico, and parts of California. (In some places, restaurants can remain open for takeout and delivery, or if they significantly reduce their occupancy. Other cities, including Los Angeles, have closed movie theaters and gyms as well.)

Officials in a growing number of cities and states have announced that schools will close this week, including in New York City, Massachusetts, Oregon, Ohio, Michigan, Maryland, and Kentucky. Some schools in California, Washington State, and Texas have closed as well. In New York City, the largest school district in the country, public schools will remain closed until at least April 20, though Mayor Bill de Blasio said there was a strong chance they would not reopen before the end of the school year. The mayor said that some schools will reopen as enrichment centers to provide services to vulnerable children, including homeless students and those with special needs, and that the city would open centers to provide child care for the children of health-care and emergency workers.

Officials in a number of states have encouraged companies to allow employees to telecommute if possible, and an increasing number of colleges and universities have suspended in-person classes, with some schools asking students not to return to campus after spring break. Many churches have canceled services, and the NBA has suspended its season after a player tested positive for the virus. Experts have called on nursing homes to limit nonessential social visits due to the high risk of transmission.

In a press conference last week, New York City mayor Bill de Blasio declared a state of emergency and said that coronavirus could impact daily life in the city for the next six months. De Blasio also cautioned New Yorkers about the spread of misinformation: Despite rumors to the contrary, as of Monday morning, elected officials had not called for shutting down mass transit or roadways, which are considered necessary to ensure that health-care systems continue to operate. New Yorkers can text COVID to 692692 for accurate updates.

An increasing number of New York City institutions have closed to the public, including Broadway theaters, the Metropolitan Museum of Art, and the Met Opera, and the citys annual St. Patricks Day Parade has been postponed. Many New York talk shows have begun taping without studio audiences, with some suspending production altogether.

Last week, New York governor Andrew Cuomo announced a containment zone in New Rochelle, a New York City suburb with one of the countrys largest outbreaks of COVID-19, where the National Guard has been deployed to clean facilities and deliver food to quarantined residents. Cuomo has also warned that the New York hospital system may soon be overwhelmed by the number of coronavirus cases, and has requested that the Army Corps of Engineers be deployed to New York to build more hospital beds.

On Friday afternoon, President Donald Trump declared a national emergency over the coronavirus. So what does that mean, exactly? Trump declared the emergency under the Stafford Act, which effectively frees up federal emergency management funds to be used for relief. On Friday, Trump said that the declaration would give him the authority to use up to $50 billion in federal funds to help states and territories fight the spread of coronavirus.

Trump also announced plans to accelerate and expand access to coronavirus testing, saying that millions of tests for the virus would be made available, though he added that he did not think that many would be necessary. He gave more authority to the Secretary of Health and Human Services, Alex Azar, who will now be able to lift restrictions on doctors and hospitals to give them more flexibility in fighting the virus, including the ability to treat patients remotely. The president urged states to set up emergency operations centers effective immediately, and also announced that he would waive interest on student loans.

Last month, President Donald Trump put Vice-President Mike Pence a man with a frankly dismal track record in public health in charge of the coronavirus response, assuring the public that the White House is very, very ready for this.

The Trump administration has since announced a number of travel restrictions. Last week, President Trump barred entry of all foreign nationals who have been in high-risk countries, including China, Iran, and much of Europe, within the last 14 days. As of March 13, American citizens and permanent residents who are returning to the U.S. from those areas are required to fly through one of 13 airports, listed here. The State Department has issued an advisory telling Americans to reconsider travel to all foreign countries, and has also advised Americans, especially those who are older or have existing medical conditions, to avoid cruises at this time.

There have been many issues with the availability and accuracy of the coronavirus test within U.S. borders. Some people say theyve been denied tests. Indeed, the criteria for getting tested were initially prohibitively narrow: Previous guidance stated it should be limited only to those who may have come into direct contact with the virus, whether by through a hot spot of contagion or an infected individual. Though Pence has since announced that anyone in the country can be tested for coronavirus, subject to doctors orders, theres still been widespread confusion, and government coronavirus hotlines have reportedly been inundated with calls.

The U.S. House and Senate recently reached a deal to provide $8.3 billion in emergency funding to stop the spread of the coronavirus, which has been approved by the Senate. According to the WashingtonPost, the money will go toward the development of a vaccine, public-health funding, medical supplies, and research of coronavirus in other countries. Meanwhile, the World Health Organization has said it will take up to 18 months to develop a vaccine for COVID-19.

Early Saturday morning, the House passed a sweeping aid package for people affected by the coronavirus, and the Senate is expected to vote on the measure this week. The package would establish paid emergency leave for some American workers, expand food assistance, and offer free coronavirus testing.

In most cases, COVID-19 is not fatal, but it appears to pose the greatest risk to elderly people and those with preexisting conditions that compromise their immune systems. The New York Times reports that among those who have died in the U.S., almost all have been in their 70s, 80s, and 90s. (Doctors and medical workers may also be at greater risk, due to their higher-than-average odds of exposure.) Because the CDC anticipates a sharp uptick in domestic transmission, though, it is urging people to prepare for the worst: Stock up on supplies medicine, non-perishable foods, toilet paper, etc. and fastidiously wash your hands. (Heres our guide to protecting yourself.)

Face masks have been selling out online and in stores, but the surgeon general has pleaded with people to stop buying them. Surgical masks dont do much to keep out disease-spreading particles, and the masks that do seem to help N95 facial respirators are recommended only for people who are already infected, or for health-care workers and caregivers. People wearing masks as a preventive measure may be taking valuable and limited resources away from those who actually need them. If you do find yourself in need of an N95 respirator, and you have creative facial hair, the CDC also has thoughts on which mustache styles will be safest in a pandemic.

If you have symptoms associated with coronavirus coughing, fever, respiratory issues call your doctor before simply showing up at their office: The virus is highly contagious and you want to limit the possibility of spreading it, bearing in mind that right now, the odds are better that you simply have a cold or the flu. (Which is also serious, and many health experts would advise you to get a flu shot.) If you are sick, the CDC recommends that you stay home and self-isolate, confining yourself to one room as much as possible and wearing a face mask when you have to interact with others. Wash your hands frequently soap and water and at least 20 seconds of scrubbing and avoid touching shared household items, cleaning high-touch surfaces (like your phone) regularly. Your health-care provider and even local health department will help you determine how long its appropriate for you to keep up these precautions.

Regardless of whether or not you have symptoms, though, keep your hands clean, and seriously, stop touching your face.

This post has been updated.

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Everything to Know About the Coronavirus in the United States - The Cut

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

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

A nurse administers a test at a drive-through COVID-19 coronavirus testing station, set up by the University of Washington Medical Center in Seattle. Ted S. Warren/AP hide caption

A nurse administers a test at a drive-through COVID-19 coronavirus testing station, set up by the University of Washington Medical Center in Seattle.

The other night, I had a patient in the ER where I work come in with fever, cough and shortness of breath. It would have been a routine visit, if not for the novel coronavirus currently sweeping the globe. The patient was concerned about the virus, and so were we. She had recently traveled to a conference in a country with known cases of COVID-19, as the disease caused by the coronavirus is called. She was middle-aged and had HIV, which we worried could increase her risk of serious illness from the virus. We contacted the department of health, where all testing in my state is currently performed, to request permission to test for the coronavirus.

The verdict? Denied.

Since the patient did not require hospital resources, like an oxygen mask or IV fluids, we discharged her home, urging her to self-quarantine and return if her symptoms worsened.

Every ER doctor that I work with already has several stories like this. This week, in Massachusetts, testing has been permitted only for patients with respiratory symptoms requiring hospitalization, or for patients with such symptoms who have traveled to endemic areas or had contact with confirmed coronavirus cases. Similar criteria apply in other states. The problem with this approach is that, according to all indicators, it is almost certainly missing a large number of cases.

Strong evidence suggests that the coronavirus is already spreading within the community and has been for weeks. After the first confirmed case appeared in the United States on Jan. 20, scientists in Seattle who had been collecting swabs to study influenza went rogue and, against the directive of the Food and Drug Administration and Centers for Disease Control and Prevention, developed a test and began looking for coronavirus in their flu samples. In late February, they quickly found their first positive a teenager with no recent travel and no sick contacts. Genetic sequencing of the virus by the same researchers suggested that the virus had likely been circulating in the community for as long as six weeks.

Now cases with no recent travel and no known contacts are emerging everywhere. Earlier this week, public health experts from Johns Hopkins confirmed that the virus is likely spreading undetected in the community. Put another way, this thing is probably out of the barn.

If that's the case, then why are we still facing such strict limitations on who we can test? There isn't a clear answer, but it seems to be a function of a woefully inadequate supply of test kits. In other words, what few tests we do have are being rationed for the people who need them most, like those requiring hospital admission. While South Korea has run nearly 250,000 tests and has capacity to test 10,000 people per day, current estimates suggest the United States has performed only about 19,000 tests. Here's another way to express just how far behind we are in terms of testing as of March 11, the United States had performed only 23 tests per million people, while the U.K had performed 347 per million, Italy 826 per million, and South Korea 3,692 per million, according to an analysis by multiple media outlets and the COVID Tracking Project.

Ashish Jha, director of the Harvard Global Health Institute, told NPR on Thursday that the United States' response has been "much, much worse than almost any other country that's been affected." He reached for words like "stunning," "fiasco" and "mind-blowing" to describe the situation.

This leads to a second, much more important question how were we so staggeringly unprepared to test for this virus? A number of hiccups have contributed. First, many test kits released by the CDC on Feb. 4 were defective. Designing and manufacturing these tests is challenging, and sometimes problems arise. There have been reports that early Chinese tests may have had a false negative rate as high as 50%. But rather than encourage university labs and private companies to help with test development, the FDA withheld permission for such work until Feb. 29. Contrast this with the response in South Korea, where a private biotechnology company began developing a test on Jan. 16, had a working version ready by Feb. 5t and had government approval for use one week later. That company is manufacturing enough kits to test a million people per week.

Private companies and academic labs are now developing their own tests. The Cleveland Clinic recently announced it had developed a rapid test for the virus. But concerns are mounting about a shortage of critical materials needed to run these tests.

The total failure to ensure that adequate testing would be available will likely prove to be the single most important factor in why the United States has been unable to contain the outbreak. As previously reported by NPR, Hong Kong, Singapore and South Korea all deployed an aggressive testing strategy very early on. This allowed them to find the first few cases and isolate them, preventing unchecked community spread. Because our government and public health authorities were unprepared, we have missed that precious opportunity in the United States, and it is going to cost people their lives.

This failure represents a profound abdication, at the highest levels of government, of responsibility to the health and security of the American population generally and of more vulnerable populations especially. Public health experts have known of the exceptional risk posed by novel coronaviruses for more than 20 years, but the current administration limited funding to the CDC and disbanded a White House unit expressly dedicated to preparing for a pandemic just like this one. Public statements from the top echelons of our government false comparisons to seasonal influenza, wildly misleading promises about access to testing, reassurances that everything is "perfect" continue to seed confusion and erode trust.

The most stunning illustration of this radical failure of leadership and responsibility occurred, for me, Thursday morning on C-SPAN. CDC Director Robert Redfield was testifying in front of Congress, and Rep. Debbie Wasserman Schultz was asking who was responsible for ensuring that those who needed to be tested could be tested. After several attempts to dodge the question, Redfield fell silent. He had no answer. He stared down at his desk, before slowly turning to a man seated next to him. It was Anthony Fauci, director of infectious diseases at the NIH. He had the courage to say what Redfield wouldn't.

"The system is not geared to what we need right now," he said. "And that is a failing."

What do we do now? We should still emphasize scaling up testing capacity in a massive way. Knowing exactly who has the disease will enable more effective quarantines, protect vulnerable populations and mitigate community spread. But the most critical measures occur at the individual level. Everyone should practice social distancing. That means curtailing all social interaction, canceling organized gatherings, working remotely, switching elbow bumps for handshakes and keeping a distance of several feet from others whenever possible. Everyone should also practice obsessive hand hygiene. That means washing your hands with soap and water for 20 seconds on a regular basis, and every time you come into contact with high-traffic areas, like a doorknob or subway pole. Avoid touching your face for any reason use a tissue to scratch an itch.

If you have any cold or flu-like symptoms, like fever, sore throat, cough, or muscle aches, you should wear a mask if you have access to one, isolate yourself, keep washing your hands and avoid contact with others as much as possible until at least two to three days after your symptoms have resolved. If you develop difficulty breathing, chest pain, profound weakness or confusion, then it's time to seek medical attention.

Community spread in the United States is already occurring, and the virus will likely reach a large number of people. But this is not the nightmare scenario. The nightmare scenario occurs if lots of people get sick at the same time. This could lead to a massive surge of ill patients arriving at hospitals all at once, which could easily overwhelm resources like oxygen tanks, ventilators and intensive care unit beds. If this happens, then people will die who otherwise might have recovered. Some European countries are already facing a situation like this. It is imperative that we spread out infections over time, or flatten the curve. This way hospitals will have adequate resources to treat everyone, and won't become overwhelmed. How do we flatten the curve? All of the individual actions I described above.

We're all in this together. If everyone does their part in limiting further spread, lives will be saved.

Clayton Dalton is a resident physician at Massachusetts General Hospital in Boston.

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Opinion: Early Coronavirus Testing Failures Will Cost Lives - NPR

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