Category: Covid-19

While many people with COVID-19 get over it relatively quickly, Marjorie Roberts has been living with symptoms for months. Marjorie Roberts hide caption

While many people with COVID-19 get over it relatively quickly, Marjorie Roberts has been living with symptoms for months.

For Marjorie Roberts, it started on March 26.

The healthy, 59-year-old life coach in Atlanta says it started as a normal day. She went out to get the mail. As she walked back to her apartment, she lost her balance. Odd for her, but she didn't think much of it.

By evening, "everything came down on me like a ton of bricks," she says. Extreme fatigue was the first symptom among several. Her long ordeal was just beginning. "I had no idea what I was in for."

On April 23, Natalie Nowell, 34, had a similar experience. A mom of three in Memphis, Tenn., she spent most of her time running around after her children. Her family had been quarantined for over a month.

Natalie Nowell with her husband and three children. She's been suffering from COVID-19 symptoms for months and still has trouble breathing. Ashley Veneman/Javen Photography hide caption

Natalie Nowell with her husband and three children. She's been suffering from COVID-19 symptoms for months and still has trouble breathing.

Then, seemingly out of nowhere came a heaviness in her chest and a feeling of deep unease. She told her husband she needed to rest. It was worse when she woke up. Awful chest pains "like there was a ton of bricks sitting on my chest," she says.

According to reports earlier this year from the World Health Organization, about 80% of coronavirus infections are "mild or asymptomatic" and patients typically recover after just two weeks.

That hasn't been the case for Roberts or Nowell. Months later, both women are still experiencing symptoms of COVID-19: shortness of breath, chest pains, vomiting, and neurological symptoms that range from headaches and fatigue to hallucinations and jumbled words.

Support groups on Facebook include thousands of people who say they have been wrestling with serious COVID-19 symptoms for at least a month, if not two or three. The groups have coined a name for themselves: "long-haulers."

While both Nowell and Roberts visited the emergency room early in the course of their illnesses, neither was admitted to an ICU. Doctors determined neither of them needed a ventilator; their cases technically counted as "mild."

But their lives have been irrevocably changed by the onslaught of symptoms relentless and rolling waves of fever, headache, nausea, and the terrifying inability to catch their breath. For Roberts, it's robbed her of time. "I was so good. This COVID-19 has stolen my life," she says.

Weeks after her initial symptoms, Nowell could barely walk from room to room in her house. Roberts, too, struggled to breathe.

Long-haulers are often left out of the COVID-19 narrative. Data sheets count cases, hospitalizations, recoveries and deaths, but Roberts and Nowell don't fit neatly into any of these categories. Neither woman initially tested positive for the disease. They both went to the hospital for a test when their symptoms became too much to bear, both tested negative, both were told to go home and just rest. Both women dealt with doctors who didn't believe them until finally both got confirmation they did have the virus.

Many long-haulers say their doctors doubted their symptoms were as severe as they were saying. Roberts says her original primary care physician insisted it was just stress and suggested she watch Lifetime movies and do puzzles to calm down. "I know stress," Roberts says. "This was not stress."

Nowell, who at that point couldn't form words to read bedtime stories to her children, begged her doctor to help. "He said, 'Well, maybe you have a UTI. Or maybe it's a stomach infection. Let's call it a sinus infection.' "

Both women eventually found doctors who believed them, and that made a huge difference.

"I was relieved because I felt like I was going to get taken seriously for how sick I felt," Nowell says. "And then the other part of me was terrified. Because the whole world is dealing with this, and now all of a sudden it's in my home, it's in my body and that was scary."

That was a few months ago. More than a hundred days from their first symptoms, Roberts and Nowell still struggle to breathe through constant congestion. The headaches come and go, and so does the nausea. Roberts' lungs are so scarred she had a biopsy in early August to get a better picture of her prognosis. She's still waiting for the results.

Nowell says she's doing better, but it's been slow going.

The heartbreaking loneliness of the pandemic has been difficult enough for healthy people. But it's been a terrifying challenge for those like Roberts and Nowell who also must live with foggy minds, intense fatigue and continual fear of erratic symptoms. Roberts says she's still afraid to go anywhere because the worst symptoms still come on so fast.

They both get through the day with a mixture of hope and prayer. Nowell has Bible verses she relies on. And Roberts says, "I pray they find a cure."

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What It's Like When COVID-19 Lasts For Months - NPR

Vaping is linked to a substantially increased risk of COVID-19 among teenagers and young adults, according to a new study led by researchers at the Stanford University School of Medicine.

The study, which was published online Aug. 11 in the Journal of Adolescent Health, is the first to examine connections between youth vaping and COVID-19 using U.S. population-based data collected during the pandemic.

Among young people who were tested for the virus that causes COVID-19, the research found that those who vaped were five to seven times more likely to be infected than those who did not use e-cigarettes.

Teens and young adults need to know that if you use e-cigarettes, you are likely at immediate risk of COVID-19 because you are damaging your lungs, said the studys senior author, Bonnie Halpern-Felsher, PhD, professor of pediatrics.

Young people may believe their age protects them from contracting the virus or that they will not experience symptoms of COVID-19, but the data show this isnt true among those who vape, said the studys lead author, postdoctoral scholar Shivani Mathur Gaiha, PhD.

This study tells us pretty clearly that youth who are using vapes or are dual-using [e-cigarettes and cigarettes] are at elevated risk, and its not just a small increase in risk; its a big one, Gaiha said.

Data were collected via online surveys conducted in May. Surveys were completed by 4,351 participants ages 13 to 24 who lived in all 50 U.S. states, the District of Columbia and three U.S. territories. The researchers recruited a sample of participants that was evenly divided between those who had used e-cigarettes and those who had never used nicotine products. The sample also included approximately equal numbers of people in different age groups (adolescent, young adult and adult), races and genders.

Participants answered questions about whether they had ever used vaping devices or combustible cigarettes, as well as whether they had vaped or smoked in the past 30 days. They were asked if they had experienced COVID-19 symptoms, received a test for COVID-19 or received a positive diagnosis of COVID-19 after being tested.

The results were adjusted for confounding factors such as age, sex, LGBTQ status, race/ethnicity, mothers level of education, body mass index, compliance with shelter-in-place orders, rate of COVID-19 diagnosis in the states where the participants were residing, and state and regional trends in e-cigarette use.

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Vaping linked to COVID-19 risk in teens and young adults - Stanford Medical Center Report

Applications of predictive modelling early in the COVID-19 epidemic  The Lancet

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Applications of predictive modelling early in the COVID-19 epidemic - The Lancet

The good news: The United States has a window of opportunity to beat back Covid-19 before things get much, much worse.

The bad news: That window is rapidly closing. And the country seems unwilling or unable to seize the moment.

Winter is coming. Winter means cold and flu season, which is all but sure to complicate the task of figuring out who is sick with Covid-19 and who is suffering from a less threatening respiratory tract infection. It also means that cherished outdoor freedoms that link us to pre-Covid life pop-up restaurant patios, picnics in parks, trips to the beach will soon be out of reach, at least in northern parts of the country.

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Unless Americans use the dwindling weeks between now and the onset of indoor weather to tamp down transmission in the country, this winter could be Dickensianly bleak, public health experts warn.

I think November, December, January, February are going to be tough months in this country without a vaccine, said Michael Osterholm, director of the Center for Infectious Diseases Research and Policy at the University of Minnesota.

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It is possible, of course, that some vaccines could be approved by then, thanks to historically rapid scientific work. But there is little prospect that vast numbers of Americans will be vaccinated in time to forestall the grim winter Osterholm and others foresee.

Human coronaviruses, the distant cold-causing cousins of the virus that causes Covid-19, circulate year-round. Now is typically the low season for transmission. But in this summer of Americas failed Covid-19 response, the SARS-CoV-2 virus is widespread across the country, and pandemic-weary Americans seem more interested in resuming pre-Covid lifestyles than in suppressing the virus to the point where schools can be reopened, and stay open, and restaurants, movie theaters, and gyms can function with some restrictions.

We should be aiming for no transmission before we open the schools and we put kids in harms way kids and teachers and their caregivers. And so, if that means no gym, no movie theaters, so be it, said Caroline Buckee, associate director of theCenter for Communicable Disease Dynamics at Harvards T.H. Chan School of Public Health.

We seem to be choosing leisure activities now over childrens safety in a months time. And I cannot understand that tradeoff.

While many countries managed to suppress spread of SARS-CoV-2, the United States has failed miserably. Countries in Europe and Asia are worrying about a second wave. Here, the first wave rages on, engulfing rural as well as urban parts of the country. Though theres been a slight decline in cases in the past couple of weeks, more than 50,000 Americans a day are being diagnosed with Covid-19. And those are just the confirmed cases.

To put that in perspective, at this rate the U.S. is racking up more cases in a week than Britain has accumulated since the start of the pandemic.

Public health officials had hoped transmission of the virus would abate with the warm temperatures of summer and the tendency heightened this year of people to take their recreational activities outdoors. Experts do believe people are less likely to transmit the virus outside, especially if they are wearing face coverings and keeping a safe distance apart.

But in some places, people have been throwing Covid cautions to the wind, flouting public health orders in the process. Kristen Ehresmann, director of infectious disease epidemiology, prevention, and control for the Minnesota Department of Health, points to a large, three-day rodeo that was held recently in her state. Organizers knew they were supposed to limit the number of attendees to 250 but refused; thousands attended. In Sturgis, S.D., an estimated quarter of a million motorcyclists were expected to descend on the city this past weekend for an annual rally that spans 10 days.

Even on smaller scales, public health authorities know some people are letting down their guard. Others have never embraced the need to try to prevent spread of the virus. Ehresmanns father was recently invited to visit some friends; he went, she said, but wore his mask, elbow bumping instead of shaking proffered hands. And the people kind of acted like, Oh, you drank that Kool-Aid, rather than, We all need to be doing this.'

Ehresmann and others in public health are flummoxed by the phenomenon of people refusing to acknowledge the risk the virus poses.

Just this idea of, I just dont want to believe it so therefore its not going to be true honestly, I have not really dealt with that as it relates to disease before, she said.

Buckee, the Harvard expert, wonders if the magical thinking that seems to have infected swaths of the country is due to the fact many of the people who have died were elderly. For many Americans, she said, the disease has not yet touched their lives but the movement restrictions and other response measures have.

I think if children were dying, this would be a different situation, quite honestly, she said.

Epidemiologist Michael Mina despairs that an important chance to wrestle the virus under control is being lost, as Americans ignore the realities of the pandemic in favor of trying to resume pre-Covid life.

We just continue to squander every bit of opportunity we get with this epidemic to get it under control, said Mina, an assistant professor in Harvards T.H. Chan School of Public Health and associate medical director of clinical microbiology at Bostons Brigham and Womens Hospital.

The best time to squash a pandemic is when the environmental characteristics slow transmission. Its your one opportunity in the year, really, to leverage that extra assistance and get transmission under control, he said, his frustration audible.

Driving back transmission would require people to continue to make sacrifices, to accept the fact that life post-Covid cannot proceed as normal, not while so many people remain vulnerable to the virus. Instead, people are giddily throwing off the shackles of coronavirus suppression efforts, seemingly convinced that a few weeks of sacrifice during the spring was a one-time solution.

Osterholm has for months warned that people were being misled about how long the restrictions on daily life would need to be in place. He now thinks the time has come for another lockdown. What we did before and more, he said.

The country has fallen into a dangerous pattern, Osterholm said, where a spike in cases in a location leads to some temporary restraint from people who eventually become alarmed enough to start to take precautions. But as soon as cases start to plateau or decline a little, victory over the virus is declared and people think its safe to resume normal life.

Its like an all or nothing phenomenon, right? said Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases. You all locked down or you get so discouraged with being in lockdown that you decide youre going to be in crowded bars you can have indoor parties with no masks. You can do all the things that are going to get you in trouble.

Osterholm said with the K-12 school year resuming in some parts of the country or set to start along with universities in a few weeks, transmission will take off and cases will start to climb again. He predicted the next peaks will exceed by far the peak we have just experienced. Winter is only going to reinforce that. Indoor air, he said.

Buckee thinks that if the country doesnt alter the trajectory it is on, more shutdowns are inevitable. I cant see a way that were going to have restaurants and bars open in the winter, frankly. Well have resurgence. Everything will get shut down again.

Fauci favors a reset of the reopening measures, with a strong messaging component aimed at explaining to people why driving down transmission now will pay off later. Young people in particular need to understand that even if they are less likely to die from Covid-19, statistically speaking, transmission among 20-somethings will eventually lead to infections among their parents and grandparents, where the risk of severe infections and fatal outcomes is higher. (Young people can also develop long-term health problems as a result of the virus.)

Its not them alone in a vacuum, Fauci said. They are spreading it to the people who are going to wind up in the hospital.

Everyone has to work together to get cases down to more manageable levels, if the country hopes to avoid a disastrous winter, he said.

I think we can get it under much better control, between now and the mid-to-late fall when we get influenza or we get whatever it is we get in the fall and the winter. Im not giving up, said Fauci.

But without an all-in effort the cases are not going to come down, he warned. Theyre not. Theyre just not.

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America's window of opportunity to beat back Covid-19 is closing - STAT

I thought our advocacy would result in more in-person learning, at least K-5, Infurna said. In the end, it may have prevented us from only having remote learning. ... I think of my kids and it breaks my heart.

Across Massachusetts, heated debates over school reopenings have dominated the summer and often are unfolding in communities where active COVID-19 cases are nearly nonexistent. The rate of residents testing positive for COVID-19 over the past two weeks was less than 1 percent in more than half of the states cities and towns. Yet very few districts have indicated they will reopen schools to all students full time, five days a week.

Instead, districts are gravitating toward part-time in-person schooling or starting the year remotely for all or the vast majority of students, including communities with low infection rates, such as Dedham, Somerville, and Wayland.

The Winchester School Committee on Thursday decided in a 4-to-1 vote to give students two options learning from home full time or doing two days of in-person classroom instruction and the rest of the week remotely.

The increasing reality that most students will spend more time out of the classroom than in one appeared to iritate Governor Charlie Baker at a press conference last Friday.

To say everybody should go remote, I mean first of all, the facts dont support it, the data doesnt support it, and the science doesnt support it, said Baker, who has urged districts to bring back as many students as possible.

But Baker is facing massive opposition from the Massachusetts Teachers Association and the American Federation of Teachers Massachusetts, which are pushing for remote learning and instructing members not to enter buildings until state and local officials prove they are safe.

State officials, citing a smattering of studies and advice from medical experts, have insisted students and staff should be safe in school. Younger students tend to contract and transmit the virus at lower rates than adults, although those rates can increase for students closer to adulthood.

Winchester Superintendent Judith Evans said she would like to reopen schools full time once its safe but other factors complicate the decision. For instance, social distancing rules are slashing classroom capacity. Meanwhile, 30 percent of teachers have indicated they are at high risk for a severe coronavirus infection.

Consequently, the district would need to hire even more teachers to add socially-distant classrooms. That comes at a time when the district is running budget shortfalls.

I understand and empathize with our families and staff members, Evans said. Many face extreme challenges balancing child care, work, and home responsibilities and are deeply worried about their familys health and their childrens academic progress. If this were a matter of will or being more creative or thinking outside the box to bring more students back safely, we would do it.

The state, acknowledging space is tight at many schools statewide, relaxed social distancing standards to 3 feet. Many districts have been reluctant to adopt the lower standard. Evans said many of her teachers indicated they would not be able to return to fully-enrolled classrooms at 3-feet social distancing, citing health concerns.

Unlike New York, Maine, and other states, Massachusetts did not establish reopening criteria that were tied to COVID-19 infection rates in local communities or regions. A state education spokesperson on Monday did not offer any explanation for the absence of such criteria.

The Department continues to work with school superintendents and health officials to develop additional school opening guidelines and recommendations, she said in a statement.

The World Health Organization recommends reopening schools after two-week infection rates drop below 5 percent. Only about a dozen Massachusetts communities are at or above 5 percent.

On Wednesday, a group of parents called Bring Kids Back MA is planning a State House rally to advocate for a transparent, metrics-based approach for reopening classrooms.

The lack of public health criteria irks Jena Howard, a mother of three in Woburn, where the two-week COVID infection rate is below 2 percent. She pushed for a full return, but school officials plan to offer only two days of in-person instruction and three days of remote learning a week.

On Friday, Howard decided to enroll all her children in a Catholic school. She blames teacher unions for the reluctance of school systems to reopen full time.

They are a powerful entity that is pushing for remote learning only, she said. The number of parents outweighs the union members yet we just dont have the bargaining power that the unions have and our voices are being overshadowed by the angry mob.

Advocates for a full return tend to be parents of young children, who require much attention navigating Zoom classes, completing online assignments, or doing hands-on projects. State guidelines for reopening schools urged districts to make in-person instruction a top priority for elementary-school students because they are not independent learners yet.

But some parents say districts arent doing enough to accommodate them.

We are very fearful for the fall, said Erika Hoffman, of Winchester, who had to put aside her grant-writing job to oversee her two young childrens education. Her youngest son, a kindergartner in the spring, lost his love for school and the social isolation took a toll.

We struggled to get him to do worksheets, she said. When they had Zoom classes three times a week, he didnt want to participate. He would cry and run to his room and hide. He was struggling emotionally, and he became really depressed.

Many Winchester parents say school officials are not thinking creatively. Parents suggested using churches, other community spaces, and a former elementary school that houses the superintendents office for additional classrooms.

But school officials shot down the ideas. Evans said she would need to add 110 classrooms to the towns five elementary schools, costing more than $6 million. Two elementary schools already have modular classrooms. The former elementary school cannot be used because it is not fully handicap accessible.

And, of course, not all parents share the same outlook. Pamela Cort, a parent of two high school students, was leaning toward allowing her children attend school part time, but as the states COVID-19 rate increased and more research into the negative effects of the virus on children emerged, she decided remote-only was the safer option.

She wished the entire school system would start remotely, but added she understood why school officials decided to give parents a choice.

When the time is right for a full return, Evans emphasized she will rely on data and medical expertise. But she cautioned that the unpredictable course of the pandemic could prompt full-scale remote learning.

Winchester parents urging a full return havent given up. They intend to write letters to the governor and pitch in with other statewide efforts.

If we dont use data, Infurna said, its just politics and its going to impact the academic, social, and emotional progress of our children and no one is hearing their voices.

James Vaznis can be reached at james.vaznis@globe.com. Follow him on Twitter @globevaznis.

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With COVID-19 infection rates below 1% in most Massachusetts towns, many parents wonder why schools cant fully reopen - The Boston Globe

Heres what to know:

Group gathering sizes

The new order reduced the limit on outdoor gatherings from a maximum of 100 people to 50 people in a single space. For smaller areas, a limit of 25 percent of the areas legal maximum occupancy, or eight people per 1,000 square feet, may also apply.

The new order also states that at any indoor or outdoor gathering where individuals cannot maintain 6 feet of social distance will be in violation of the new rules, no matter the number of participants.

But there are some exemptions to the order. It does not set capacity limits on public spaces like parks and beaches, or political rallies and religious activities. The provision does apply to programs, celebrations, social outings, and any other events that draw people together, according to the order.

The maximum occupancy for indoor gatherings remains unchanged at 25 people in a single enclosed area.

Face mask protocols

Masks are still required, indoors or outdoors, when individuals cannot maintain at least 6 feet of physical distancing. But under the new provisions, for any gathering of more than 10 people from more than a single household, all individuals over the age of 2 are required to wear a face covering, and could be fined for not doing so (see enforceable fines).

The new face-covering rule applies to gatherings in all venues and locations, public or private, including in homes, backyards, parks, athletic fields, and parking lots.

Individuals are exempt from the rule if they have a medical condition or a disability that prevents them from wearing a mask.

Restaurant operations

The state is doubling down on its efforts to make sure as Baker put it bars arent masquerading as restaurants. Starting today, alcoholic beverages can only be served at restaurants if accompanied by food prepared on-site.

According to the order, prepared food does not include potato chips, pretzels, and other pre-packaged or manufactured food.

For customers, an item of food must be ordered at the same time as an alcoholic beverage. Shared items may be ordered as long as they sufficiently serve the number of people at the table.

Enforceable fines

The Department of Public health, local boards of health, and now state and municipal police are authorized to enforce the new order. Violations can result in a fine up to $500 per violation, or a cease and desist order.

According to Baker, the new rules will remain in effect until rescinded, or when the state of emergency ends whichever comes first.

Massachusetts is in Phase 3, step one, of the statewide coronavirus reopening plan. Governor Baker said he is postponing entering Phase 3, step two, due to concern over weakening metrics the state has been monitoring for reopening.

Brittany Bowker can be reached at brittany.bowker@globe.com. Follower her on Twitter @brittbowker.

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New COVID-19 restrictions went into effect today in Mass. Heres what to know - The Boston Globe

Dr. Jos Gabriel Lpez-Plascencia spent over 60 years providing health care for low-income families in Phoenix. Courtesy of Valle del Sol Community Health hide caption

Dr. Jos Gabriel Lpez-Plascencia spent over 60 years providing health care for low-income families in Phoenix.

In June, Marcel Lopez and his cousins set up a Zoom video call to say goodbye to their grandfather. Retired physician, Jos Gabriel Lpez-Plascencia Dr. Lpez for short was near death at his home in Phoenix. He was unable to speak, but he let his grandchildren know he was listening.

"Every time we talked to him, he'd kick his leg and move his arms to let us know he was hearing us," Marcel says. As they sang his favorite song "Por Un Amor," he noticed over the video call that his grandfather started crying. "I would've loved to have been there holding his hand, just to see him one last time."

A few hours later, Dr. Lpez died from complications due to the coronavirus. He had just turned 99. Dr. Lpez is one of the more than 163,000 people who have died from COVID-19 in the United States, a disease that has hit the country's Latino population especially hard.

His work in medicine helped generations.

"I remember him with that smile," says Blanca Fernndez. She's in her quiet living room in Phoenix looking at a faded photo of a young Dr. Lpez and his wife from their anniversary party. "They were always having fiestas and we were always there, singing and dancing," she says. "We were compadres."

Her photo is proof that Dr. Lpez was a sharp dresser. He's wearing a black tuxedo with ruffles and a big bow tie. For Fernndez, that outfit is actually a reminder of the time he saved her husband's life. On a hot Arizona day in 1974, her husband, Jess Fernndez, came home from his construction job with severe symptoms of heat stroke. Instead of dialing 911, Fernndez called Dr. Lpez.

"[Dr. Lpez] was on his way to a doctors' banquet and he came to my house right away," Blanca Fernndez says. "He came with his tuxedo on and he took care of my husband because my husband was dying. So we are very grateful to him because he really saved my husband."

Dr. Lpez arrived in the U.S. in 1947 after a Catholic priest in Arizona invited him to help provide health care for low-income families. Courtesy of the Lpez family hide caption

Dr. Lpez arrived in the U.S. in 1947 after a Catholic priest in Arizona invited him to help provide health care for low-income families.

The older generation remembers Dr. Lpez as one of the few Spanish-speaking doctors in all of South Phoenix. Born in Guadalajara, Mexico in 1921, he arrived in the U.S. in 1947 after a Catholic priest in Phoenix invited him to help care for low-income families in Arizona. Dr. Lpez practiced medicine and surgery for over 60 years even enlisting in the Arizona Army National Guard as a medical officer. He served neighborhoods in South Phoenix that once faced decades of segregation and poverty.

"People knew where they could go for help, and that was Dr. Lpez," says former patient Abe Arvizu Jr. He can still picture the crowded waiting room inside Dr. Lpez's office. "It was wall-to-wall no room and people out in the hallway waiting. And they were mostly undocumented, or farm workers, or just the poor people from the surrounding areas."

"People didn't have to make appointments, they would just walk in and he would see them," says Olivia Rosales-Murrieta, 83, who was Dr. Lpez's receptionist in the early 1960s. "He never asked me, 'How many more patients do I have to see?' I never never heard him complain."

Dr. Lpez (left) enlisted in the Arizona Army National Guard as a medical officer. He retired in 1977 as a Lt. Col., and continued to practice medicine until he was 89. Courtesy of the Lpez family hide caption

Dr. Lpez (left) enlisted in the Arizona Army National Guard as a medical officer. He retired in 1977 as a Lt. Col., and continued to practice medicine until he was 89.

Rosales-Murrieta was with Dr. Lpez at the start, back when he saw patients out of his house in Tolleson a small farming community west of Phoenix. "Most of his patients didn't have medical insurance," Rosales-Murrieta says. "They paid in cash." And if his patients didn't have enough money for an appointment, they would find other ways to pay.

"They would exchange," says Arvizu Jr. "For a lot of people in the barrios, that's how you survived. Whether you did lawns, whether you did cement work, brick work, or whether you had a bakery or made food [The Lpez's] always had food at their house."

In communities left out of the healthcare system, Dr. Lpez was their trusted caregiver. He looked after multiple generations of family members and stayed with patients until his retirement at 89. He had a saying: "It's not how hold you are; it's how long you've been living."

His family is holding onto those words now, as they're confronted by the devastating tragedies of this pandemic. Shortly after Dr. Lpez's death, his daughter Barbara Ann Sordia and her cousin Humberto "Junior" Trujillo also died from COVID-19.

Like many of his loved ones, 88-year-old Blanca Fernndez (with her photo of Dr. Lpez in his tuxedo) decided not to attend his funeral Mass due to rising coronavirus cases in Arizona. She's been home thinking about the last phone call she had with her old friend.

"Oh yes," she says. "Two weeks before he died." Dr. Lpez called to check-in on her family, and to remind her that it was almost his 99th birthday. "We talked for the last time; I'm very sorry about his loss," she says with a pause. "And also, I'm glad. Because pretty soon, I'll be over there with him. I'll be there with Dr. Lpez, singing and dancing."

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'I Remember Him With That Smile': Beloved Phoenix Doctor Dies Of COVID-19 At 99 - NPR

Patient-reported outcomes: central to the management of COVID-19  The Lancet

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Patient-reported outcomes: central to the management of COVID-19 - The Lancet

The Trump administration is reportedly considering a measure to block US citizens and permanent residents from returning home if they are suspected of being infected with coronavirus.

A senior US official told Reuters that draft regulation, which has not been finalized and could change, would give the government authorization to block individuals who could reasonably be believed to have contracted Covid-19 or other diseases.

Donald Trump has instituted a series of sweeping immigration restrictions since the start of the coronavirus pandemic, suspending some legal immigration and allowing US border authorities to rapidly deport migrants caught at the border without standard legal processes.

Reuters reported in May that US government officials were concerned that dual US-Mexico citizens might flee to the United States if the coronavirus outbreak in Mexico worsened, putting more stress on US hospitals.

The draft regulation, which was first reported by the New York Times on Monday, would be issued by the US Centers for Disease Control and Prevention, which has played a lead role in the pandemic response, the senior official told Reuters.

Federal agencies have been asked to submit feedback on the proposal to the White House by Tuesday, though it is unclear when it might be approved or announced, the Times reported.

A Trump pandemic task force was not expected to act on the proposal this week, although that timeline could change, the official said.

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Trump considers blocking Americans who may have Covid-19 from coming home - The Guardian

Coronial autopsies identify the indirect effects of COVID-19  The Lancet

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Coronial autopsies identify the indirect effects of COVID-19 - The Lancet