Category: Covid-19

COVID-19 Oklahoma Test ResultsPositive (In-State)565Positive (Out-of-State)2Negative*1229Hospitalized177Deaths23

*Negative testing results are only from the State Public Health Laboratory and do not include private laboratory negative results.

* Community spreadis defined as thespreadof an illness for which the source ofinfection is unknown. For purposes of our COVID-19 reporting, we are highlightingthe counties that contain a positive case.

Counties highlighted in yellow on the map above indicate a death in that county.

Data Source: Acute Disease Service, Oklahoma State Department of Health.*As of 2020-03-31 at 7:00 AM.

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COVID-19 | Oklahoma State Department of Health

Workers at Amazons Staten Island, New York, fulfillment center walked out today to protest the companys response to COVID-19 infections among its warehouse employees. Amazon has confirmed one case of COVID-19 at the New York facility, but workers say there have been at least 10 and that the company has failed to notify workers or properly clean the warehouse. Now, they are calling for Amazon to shut down the facility for two weeks for deep cleaning.

The goal is to get that building shut down, and they will shut it down, because no packages, nothing gets out the building without associates, says Derrick Palmer, who has worked at the facility, JFK8, for four and a half years. This is a pandemic. People are literally losing their lives because of this virus. And [Amazon is] not taking this seriously. Theyre not giving us our respect that we demand. Were not going to ask for it. Were going to demand it, because at the end of the day, were the heart and soul of that building, not the managers. Theyre back in the office. Were in the front lines working.

Workers at 19 US Amazon warehouses have tested positive for COVID-19, according to local news reports. So far, Amazon has closed facilities only when forced to do so by government order or worker protest. Last week, the company indefinitely closed a returns processing warehouse in Shepherdsville, Kentucky, after three workers tested positive and the governor ordered it shuttered. On March 18th, a sortation center in Queens, New York, was temporarily closed for cleaning after workers walked out upon learning of a positive COVID-19 case. Employees learned about the case from co-workers and say they had been expected to come to work.

The failure to notify workers when someone at a facility tests positive appears to be systemic. Last week, The Verge spoke with workers at several warehouses across the US who learned of COVID-19 cases from co-workers. At JFK8, Palmer says the first case was confirmed on March 12th, but workers were only told several days afterward when managers walked the floor and told employees in person. But the facility is staffed by more than 4,000 workers and is 855,000 square feet, so many learned of the incident through hearsay much later.

Amazon has a strong infrastructure for keeping its warehouse employees informed. For example, when the company announces mandatory overtime, Palmer points out, the company sends out texts and emails to every worker. With this incident, they have not sent out one text nothing at all, Palmer says.

Amazon says it has intensified the cleaning of its warehouses in response to the COVID-19 pandemic, but workers at JFK8 and elsewhere say the measures fall far short of whats needed. Palmer says shifts of about a dozen cleaners work at JFK8, too few to properly disinfect such an enormous building. (Workers in other warehouses in the US have expressed similar concerns about understaffing of cleaning crews.) While Amazon has stopped daily stand-up meetings and staggered schedules to minimize workers clustering together, certain roles in the warehouse, like the packing department, still require employees to stand in close proximity, and workers often pass items between each other.

The way that the department is set up, everyone is on top of each other, Palmer says. It is literally impossible to maintain the social distance within those departments, and they havent been practiced, they havent tried to adjust that at all because theres no way they can do it.

In Italy and Spain, where COVID-19 outbreaks have been spreading longer, Amazon refused to shut down facilities after workers became infected, prompting protests. Earlier this month, a group of senators wrote a letter to Amazon CEO Jeff Bezos expressing concern for the safety of Amazon workers and asking, among other things, whether the company would temporarily shut down facilities and provide paid leave for workers if someone tests positive for COVID-19. A petition among workers calling for a similar approach has garnered more than 1,500 signatures. The workers at JFK8 are also calling for paid leave while the facility is shut down for cleaning.

In a statement, Amazon called the workers claims unfounded and said its employees are heroes. The company is taking worker safety extremely seriously and has instituted several changes, the company said, including intensifying cleaning and screening worker temperatures. Regarding closing buildings, the company said it consults with health authorities and medical experts, and if a diagnosed worker hasnt been in the building for some time or if the area where they worked has already been cleaned during the regular course of business, the facility may not need to be closed.

The pandemic has shown a spotlight on the role of workers at Amazon, Instacart, and other goods-delivering tech companies. No longer laboring in the background of digital interfaces, theyre increasingly being recognized as frontline workers providing a vital service to millions of Americans who are being told to stay home. Both companies are trying to hire tens of thousands more people to meet surging demand. Amazon is giving its workers letters to carry saying they are essential employees, delivering critical supplies directly to the doorsteps of people who need them and should be allowed to continue their jobs amid shutdowns.

But the pandemic also exposes these workers to new risks, and workers say companies have been slow to adjust policies and protections. Instacart and Amazon now offer workers diagnosed with COVID-19 or placed into quarantine two weeks paid leave, but that doesnt help workers who have COVID-19 symptoms but cant get tested. Amazon warehouses have been optimized for speed and efficiency, and workers say the intense pace leaves them little time to use cleaning material that is often in short supply.

Today, Instacart workers are going on strike, calling for expanded sick leave, hazard pay, and protective equipment. Workers at Whole Foods, which is also owned by Amazon and faces unprecedented demand for delivery, are striking tomorrow. JFK8 marks the first major action at an Amazon fulfillment center, and workers at Amazon warehouses across the country have expressed similar concerns.

Shutting down a fulfillment center for a prolonged period would threaten Amazons ability to continue delivering products, but refusing to do so and failing to assure employees their safety is being taken seriously pose potentially greater threats to the company. Already, workers are staying home rather than venturing into crowded warehouses, choosing to forgo pay that Amazon recently increased rather than risk getting infected. Delivery times for some items now stretch to a month or more. Now, at JFK8, workers frustrated with the companys coronavirus response are trying to shut down the facility themselves.

Around 1PM on March 30th, workers filed out of the New York warehouse, many wearing masks and bandanas over their faces. Alexa, please shut down and sanitize the building, read one of the signs. On a live stream of the protest, workers expressed frustration with not being told about infections at the warehouse and said many were choosing to stay home without pay.

Were not done here. Today was a cry for help, said Chris Smalls, a worker at the facility and one of the walkout organizers, wearing a black bandana as he addressed protesters. Today was a win for us, but its a battle and the war is not over. Were going to go to City Hall possibly tomorrow morning. Weve got to get the governments attention. Just like in Kentucky, the government has to step in and close the building down.

Update March 30th, 8:00PM ET: After the protest, Amazon fired Chris Smalls, one of the organizers of the walkout. The company said Smalls was fired for violating safety regulations, including violating a 14-day quarantine after coming in contact with an employee diagnosed with COVID-19. Smalls disputed the companys claim and said he was fired for retaliation. I am outraged and disappointed, but Im not shocked, Smalls said in a statement. As usual, Amazon would rather sweep a problem under the rug than act to keep workers and working communities safe.

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Amazon warehouse workers walk out in rising tide of COVID-19 protests - The Verge

Aetna was the first insurer to announce its plan to help shield patients with COVID-19 from high medical bills. But out-of-network charges and other surprise bills remain a risk, say advocates for patients. Michael Nagle/Bloomberg via Getty Images hide caption

Aetna was the first insurer to announce its plan to help shield patients with COVID-19 from high medical bills. But out-of-network charges and other surprise bills remain a risk, say advocates for patients.

Three major health insurance providers have now pledged to shield patients from high medical bills if they need treatment for COVID-19. Insurers Cigna and Humana announced Monday that they would waive consumer costs associated with COVID-19 treatment. Last week, CVS Health announced a more limited change that Aetna would waive costs to patients for hospital admissions related to the coronavirus.

These announcements are a "big deal" says Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University. She notes that, on average, people's deductibles for health policies in the U.S. run between $1,800 and $6,500. "That's for most families a lot more cash than they have sitting in their bank account," she says. "So that's really scary."

All three insurers have now pledged to waive the patient's portion of a medical bill what's called a patient's "cost sharing." That means, if your plan qualifies, you won't have to pay your full deductible before insurance will take over, or have to pay the usual fixed amount for a medical service or treatment (the copayment), or a percentage of the total bill (coinsurance).

These insurers have also pledged to waive costs to patients for coronavirus testing and telemedicine visits related to COVID-19 and its symptoms.

So far, Aetna and Cigna are pledging to waive COVID-19 treatment costs through qualified medical bills that are incurred until June 1, 2020. Humana's policy does not yet have an end date.

In the scheme of things, says Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation, this move won't cost insurers much, since patient co-pays and deductibles usually account for only a fraction of expensive hospital stays.

"I think there's also a political element here," he says. "Insurers are likely going to be asking Congress for some kind of bailout, and they want to look like good community players when they make that ask."

Still, not every patient will be spared high medical bills if they get seriously ill with COVID-19. You have to have insurance 28 million people in the U.S. do not and, for now, your insurance provider needs to be one of these three companies, though others may follow their lead.

Levitt also notes that many people who are covered by an insurance company that has made a commitment like this might not be eligible to have their costs waived. "Most of the people who get insurance through employers are in what are called self-funded plans," he explains. For people in those plans, these announcements don't apply, since "it's the employers who are going to be deciding whether patients get cost relief here or not."

Levitt also warns that patients who can't get a test for the coronavirus, or whose test comes back as a false negative might still be on the hook for out-of-pocket costs. Until testing becomes more widely and readily available, he says, that hitch could be a substantial problem for patients hoping to have their medical bills covered.

There's also the issue of surprise bills. Even if you don't have to pay your health insurer, you could still be billed directly by the hospitals or doctors who provide your care if they are out of your insurance network. Nearly 1 in 5 inpatient admissions for pneumonia results in a surprise bill, according to a Kaiser Family Foundation analysis.

Loren Adler, associate director of USC-Brookings Schaeffer Initiative for Health Policy, says he's hopeful that Congress will act to protect patients from surprise bills in these situations, or that providers will refrain from balance billing, given the nature of the crisis.

"There is a very strong incentive on basically all actors not to let surprise bills happen here much stronger than in normal cases," Adler says. "I am hopeful folks will negotiate this without involving the patient, but the possibility is still there."

Overall, the insurer announcements on waiving patient cost sharing are good news, but there are caveats, and those caveats mean many people may still have to worry about their medical bills in the midst of this epidemic, says Levitt.

"On any normal day, the expense of a hospitalization for a patient even someone with insurance can be overwhelming," he says. "But now we're looking at these health care expenses coming on top of uncertainty about the economic future, people losing their jobs or getting their hours reduced it's a perfect storm."

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Aetna, Cigna and Humana Waive Most Costs To Patients For COVID-19 Treatment : Shots - Health News - NPR

Covid-19 in Critically Ill Patients in the Seattle Region Case Series | NEJM  nejm.org

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Covid-19 in Critically Ill Patients in the Seattle Region Case Series | NEJM - nejm.org

A domestic cat in Belgium has been infected with COVID-19, the disease caused by the new coronavirus that's spreading across the globe, the government's FPS Public Health, Food Chain Safety and Environment announced March 27, according to news reports.

This is the first human-to-cat transmission of the novel coronavirus (SARS-CoV-2). About a week after its owner got sick with COVID-19, after returning from a trip to Northern Italy, the cat developed coronavirus symptoms: diarrhea, vomiting and respiratory issues, Steven Van Gucht, virologist and federal spokesperson for the coronavirus epidemic in Belgium, told Live Science.

The owner sent samples of vomit and feces to Dr. Daniel Desmecht's lab at the Faculty of Veterinary Medicine of Lige. Genetic tests showed high levels of SARS-CoV-2 in those samples, he said. "The cat recovered after 9 days," Van Gucht said.

Related: 13 Coronavirus myths busted by science

Cats and humans appear to have a similar "doorknob" on the surfaces of respiratory cells that lets the SARS-CoV-2 virus get inside, according to Van Gucht.

In humans, scientists have figured out that the SARS-CoV-2 virus attaches to a receptor protein called ACE2 that's on the outside of respiratory cells. Once inside of these cells, the virus hijacks certain machinery so it can replicate.

"The feline ACE2 protein resembles the human ACE2 homologue, which is most likely the cellular receptor which is being used by Sars-CoV-2 for cell entry," Van Gucht said.

During the 2003 SARS outbreak, cats were infected with a coronavirus as well, Van Gucht said.

The only other pets thought to have "caught" the novel coronavirus from owners were two dogs in Hong Kong. The first dog, a 17-year-old Pomeranian, tested a weak positive for the virus at the end of February, Live Science reported. The dog died in mid-March, though the exact cause of death is not known, as the owner didn't allow an autopsy.A second dog, a German shepherd, tested positive but showed no symptoms of the disease, Bloomberg reported.

During the outbreak of another coronavirus, severe acute respiratory syndrome (SARS), dogs and cats contracted low levels of that virus, animal health expert Vanessa Barrs from City University told the South China Morning Post.

There have been no reports of pets passing the virus to their human owners, and Van Gucht stressed that even human-to-pet transmission is not a significant path of viral spread.

"We think the cat is a side victim of the ongoing epidemic in humans and does not play a significant role in the propagation of the virus," he said.

To prove definitively that the cat was infected with SARS-CoV-2, scientists will need a blood test to look for antibodies specific to this virus, Van Gucht said. Those tests will happen once the cat is no longer under quarantine.

Originally published on Live Science.

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Cat infected with COVID-19 from owner in Belgium - Livescience.com

An idea that has been doing the rounds on social media suggests that certain heart and kidney medications make people more susceptible to COVID-19. A new commentary strongly disputes this.

The commentary warns that discontinuing these hypertension and kidney medications would seriously endanger the health of those taking the drugs for high blood pressure, congestive heart failure, and chronic kidney disease.

A. H. Jan Danser, from the Department of Internal Medicine at the Erasmus Medical Centre in Rotterdam, The Netherlands, is the first author of the commentary, which appears in Hypertension, a journal of the American Heart Association (AHA).

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

Danser co-authored the paper with Dr. Murray Epstein, from the Division of Nephrology and Hypertension at the University of Miami Miller School of Medicine in Florida, and Daniel Battle, from the Division of Nephrology/Hypertension at the Northwestern University Feinberg School of Medicine in Chicago.

As Danser and colleagues explain in their paper, the idea that some heart and kidney medications may raise the risk of complications and death from a SARS-CoV-2 infection arose when it became known that the angiotensin-converting enzyme 2 (ACE2) receptor facilitates the entry of the virus into healthy cells.

Namely, some researchers that Danser and colleagues quote have suggested that taking the renin-angiotensin system (RAS) blockers specifically, angiotensin II type 1 receptor blockers (ARBs) might raise the risk of developing a severe and potentially fatal form of COVID-19.

RAS blockers are drugs doctors use to treat hypertension. ARBs also treat hypertension, congestive heart failure, and kidney disease, among other conditions.

In their commentary, the authors talk about studies that have raised the concern that such a preexisting hypertension treatment may elevate the risk of severe COVID-19. However, as Danser and colleagues find, there is insufficient evidence to sustain such a notion.

Amplified by social media and the mass circulation of inaccurate medical information, this idea led to some people not taking their medication.

Danser and associates say that at the crux of the [] prevailing confusion and panic that we are witnessing in the medical community is the question how do RAS blockers affect ACE2?

Firstly, they explain, Part of the confusion in social media and the public in general stands because, at times, ACE inhibitors are confused with ACE2 inhibitors.

The two are different enzymes with different active sites and the effect of ACE inhibitors on ACE2 activity is unlikely to affect the binding of the SARS-CoV-2 virus, explain Danser and colleagues.

Secondly, however, the authors do note some limited reports in animal models that suggest ARBs may affect ACE2 activity in the heart and kidney, but these results are diverse, they vary by ARB and organ, and required very high doses of the drug.

Even if the reported upregulation of tissue ACE2 by ARBs in animal studies and, generally, with high doses could be extrapolated to humans, this would not establish that it is sufficient to facilitate SARS-CoV-2 entry, they write.

Having reviewed more than 29 studies, the authors stress their conclusion: the findings are inconsistent.

People are making an unadvised leap, Dr. Epstein explains. The logic goes that, if [the drug] enhances penetrability, it enhances susceptibility to the disease, but thats a dangerous conclusion.

What investigators have found varies widely, depending on the organ studied, the experimental animal model, and the ARB being used in the study. In summary, there is a complete lack of consistency.

The only thing we can conclude definitively, based on all the known data, is that there is no credible evidence whatsoever that ARBs enhance susceptibility to COVID, says Dr. Epstein.

In fact, discontinuing treatment with ARBs and ACE inhibitors could cause a great deal of harm, particularly in these times where healthcare systems everywhere are under a lot of strain already.

This would be a double tragedy, because it would be happening precisely at a time when our hospital and ICU resources are stressed to the limit [] It will further tax our medical facilities and hospitals, and it will be truly tragic.

Dr. Murray Epstein

For live updates on the latest developments regarding the novel coronavirus and COVID-19, click here.

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COVID-19: No evidence that heart, kidney medications raise risk - Medical News Today

Patients that need hospital treatment for coronavirus may need a team of NHS staff to help them through.

Jessica Murray talks to the people who are key to such treatment from first responders to intensive care consultants to physiotherapists.

Were informed by the control centre whether the patient is query Covid-19, but were wearing protective equipment - mask and protective eyewear - for pretty much all jobs now. Were going into peoples houses and its an enclosed space so were not able to social distance.

Because people cant visit Covid patients in hospital, we facilitate the conversation so people can say their goodbyes, without being too explicit about it. We then advise them to take a phone with them if theyre able to, make sure theyve got a charger and if they dont know how to video call, we might quickly teach them how to use it before we set off.

We then take them to A&E but through a different door for Covid patients - although were finding the Covid side is busier than the normal side.

Then well deep clean the ambulance. We have to clean inside of our cab, around the steering wheel and all the stuff that we would touch, and its difficult because theres a lot of equipment and crevices in an ambulance.

What is Covid-19?

It is caused by a member of the coronavirus family that has never been encountered before. Like other coronaviruses, it has come from animals.

What are the symptoms this coronavirus causes?

The virus can cause pneumonia-like symptoms. Those who have fallen ill are reported to suffer coughs, fever and breathing difficulties.

In the UK, the National Heath Service has defined the symptoms as:

Should I go to the doctor if I have a cough?

Medical advice varies around the world - with many countries imposing travel bans and lockdowns to try and prevent the spread of the virus. In many place people are being told to stay at home rather than visit a doctor of hospital in person. Check with your local authorities.

In the UK, NHS advice is that anyone with symptoms should stay at home for at least 7 days. If you live with other people, they should stay at home for at least 14 days, to avoid spreading the infection outside the home.

How many people have been affected?

Chinas national health commission confirmed human-to-human transmission in January. As of 31 March, more than 780,000 people have been infected in more than 170 countries, according to the Johns Hopkins University Center for Systems Science and Engineering.

There have been over 37,800 deaths globally. Just over 3,200 of those deaths have occurred in mainland China. Italy has been worst affected, with over 11,500 fatalities, and there have been over 7,700 deaths in Spain. The US now has more confirmed cases than any other country - more than 164,000. Many of those who have died had underlying health conditions, which the coronavirus complicated.

More than 166,000 people are recorded as having recovered from the coronavirus.

We have the most patient contact out of any healthcare workers. [We] help the nurses with the really basic but essential tasks, such as washing and changing patients, helping them go to the toilet and helping them eat.

With the current coronavirus crisis, that role has expanded because we are so short-staffed - our ward is down 60% of staff at the moment. Were doing the Covid testing swabs and transferring positive patients around the hospital. I work on a trauma and orthopaedic ward, which is now on lockdown because we have so many confirmed cases.

With both suspected and confirmed patients, we are only wearing surgical masks, sleeveless, plastic aprons and gloves, so theres no eye protection and no arm protection. Today I worked a 13-hour shift with a patient who is confirmed positive, and Im still going in with basically nothing.

We also get a lot of the stress and abuse from patients who are scared and confused and dont know whats going on, because were the people they see most.

Were not classed as frontline workers even though we are very much on the frontline because every Covid-19 patient is coming to us. Medical staff dont know what theyre dealing with unless the patient comes through radiology.

You dont see Covid-19 in the lungs, so Im using the chest X-rays and CT scans to look for patches, mainly on the edges of the lungs, which suggest infectious changes. Were looking for pneumonia and fluid.

For ICU patients who are on a ventilator and not looking well, were likely to be down there at least daily, if not a couple of times a day, for chest X-rays. We have portable X-ray machines on wheels so we can go direct to the patients on the wards, but the CT scanner is a huge machine so they have to come to us for that one, which poses quite a logistical nightmare.

Were needed in A&E, across the wards and, in the ICU were used all the time. Weve also got a postmortem CT scanner so were anticipating Covid patients coming to us that way as well.

I care for some of the sickest patients in the hospital who have a chance of getting over their illness. If someone is in hospital with Covid-19 and their oxygen levels continue to deteriorate, they will often be transferred to intensive care as they might need a ventilator.

If that happens, a team of three or four of us will drift them off to sleep and put a breathing tube through their mouth into the airway. In some cases, we also turn them on to their front, for about 16-18 hours a day, because some Covid-19 studies suggest this can help with oxygenation. That takes at least five people.

We wear full PPE to go in and see patients, meaning a mask and either a visor and goggles or a full respirator helmet, as well as a gown, apron and three pairs of gloves. But we try to spend as little time in with them as possible to minimise our exposure.

I lead the ward rounds, and manage the whole patient - not just the lungs and the right amount of oxygen, but also the heart, the kidneys, and all the other organ systems. Covid-19 can affect the whole body, and many organs may need supporting.

Were seeing many patients stay on a ventilator for about seven to 10 days. After that, the hope is the oxygen levels have returned close enough to normal that patients can breath sufficiently on their own.

Its quite an invasive process coming to intensive care. You have quite a lot done to you. But thats because you need it.

In critical care theres a nurse by the bedside 24/7 - although obviously not the same nurse or we would burn out pretty fast. Other medical staff, like the consultants, physiotherapists and nutritionists, tend to go from patient to patient, so they rely an awful lot on the bedside nurses insight.

If someone is having breathing difficulties, we can reposition them, administer medicines, use oxygen masks, or maintain their ventilator. With breathing, you need to be pretty damn quick at reacting. If five or 10 minutes go by, bad stuff can happen.

We also do the things for the patients that they cannot do themselves. So well wipe their eyes, lubricate them, make sure their eyelids are shut, well brush their teeth, suction out any buildup of saliva and apply lip balm. Well use bedpans, well put in catheters and monitor those, well wash the patients, change their bedding and well regularly reposition them. Well also talk to them because were never quite sure what level of consciousness they have.

When the bedside nurse is in full protective equipment, they cant just nip away to pick up the medicine or a new set of linen. So you have someone who stays in the amber zone away from the patients, who can fetch stuff.

Another big part of my job is supporting family and friends, giving them updates and providing emotional support. In this current situation, were also exploring using FaceTime for patients to talk with their loved ones.

We help identify patients who need extra help breathing, and then help to maintain their chest and keep it clear of secretions. We are the people who are actually asking Covid patients to cough.

As theyre breathing out on the ventilator, we give their chest a really good shake with our hands. It just helps to clear the phlegm, because they cant cough as theyre paralysed and sedated. We do the cough for them, using our hands on their chest and tummy. Its a lot of very hands on treatment. Were then working with the nurses and medics to ultimately wean them off the ventilator.

We also do physical rehabilitation. It might be just sitting on the edge of the bed, but for somebody whos been tubed on intensive care, that is like running a marathon.

Covid-19 patients are probably going to be in intensive care for a little bit longer than were used to, so I think then we will also play a big role in rehabilitation. I think theres going to be a lot of post traumatic stress, and probably a lot of breathing pattern disorder.

*Name has been changed

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From ambulance to physio: what a Covid-19 NHS patient should expect - The Guardian

ByHub staff report

In recent weeks, the epicenter of the novel coronavirus pandemic has moved from China and East Asia to Italy and other Western nations including the U.S. The particularly severe outbreak in Italy has centered on the country's northern regions, including the city of Bologna, which is home to the Johns Hopkins School of Advanced International Studies in Europe. While the SAIS Europe campus has closed, classes, research, and collaboration have continued remotely and online.

To learn more about the situation in Bologna and across Europe, the Hub reached out to Filippo Taddei, a Johns Hopkins associate professor of international economics and a faculty member at SAIS Europe. He offered insights into the immediate and future impacts of the COVID-19 pandemic on European and American economies, political climates, and international relations. This is the first of a three-part series. The conversation has been edited for length and clarity.

Well, in reality, things have been changing very quickly during the past few weeks, which is similar to what you're now seeing in the U.S.

Image caption: Filippo Taddei

As the Italian government has introduced even stricter rules on people's movement and interactions, we accordingly decided, unfortunately, to close our building and campus. Now we are interacting with our community, with our colleagues, students, and administrators, purely online. It poses a lot of challenges, of course, but like any challenge it also poses an opportunity to do better. In the long run it will help us to be more effective with our online resources, especially using these online resources to teach and conduct a beneficial exchange of ideas. We have the right technology and the skills to adapt to this new setting, if a little bit by brute force because of the country's strict and rapid lockdown.

We need to understand that, in Europe, the impact of the epidemic is currently different in different countries, and at the moment some are more affected than others. But even for less affected countries, the outbreak needs to be dealt with quickly because we are so tightly integrated socially and economically. The outbreak in a single region or country quickly becomes a common problem. What we have to do in the face of this widespread and common shock to our economic and health systems is to implement an equally common and uniform response.

At the moment, the U.S. has one advantage in responding to the shock in comparison with Europe. Some states, like some European countries, will need more support than others, but the U.S. federal government is more readily available to pick up some of the state-specific costs due to the global shock. In the European Union, this is more complicated because we don't have a federal fiscal authority remotely resembling the United States Treasury. Each country has its own government with its own responses, which poses a problem for acting uniformly.

Thinking about our value chainor the way industries produce goodsEuropeans are far more integrated with one another than they often think. If one European country is severely affected, then the problem transfers very quickly to everybody else. It's just bad policy to leave public health responses at the state level in the U.S. or the member country level in the EU. Look at the consequences for the Italian economy, for example. Even though some countries are not as heavily affected by the virus now, they will suffer consequences from a complete disruption of another country's economy, like what has happened in Italy.

Image caption: The Spanish Steps, a popular tourist destination in Rome, is nearly abandoned in mid-March as a result of mandatory lockdowns throughout Italy.

Image credit: Getty Images

It's hard to say. We're still in the middle of it. The more countries that are affected by this shock, the more likely it is that they'll be able to join together. Recent crises were mostly asymmetric: some countries were more affected than others. Now we're facing something differenta shock that is far more uniform than those before. The effect of the epidemic could be more widespread, and as a result we might have a stronger push toward economic and political integration for the EU. If, as in past crises, the effects continue to be substantially more severe in some countries than in others, traditionally that has provided a strong force for disunity and disintegration across the European continent.

From an economic and policy point of view, we in Italy, and in Europe more broadly, were convinced that we stood on higher ground in terms of the standards of our health system. There was a general sense that our health system, throughout Europe, was superior and more robust, which would make the virus easier to contain here in comparison with Asia. The problem is we completely underestimated how contagious COVID-19 is and the implications for our demographic structure, with higher numbers of elders. Moreover, we underestimated how a health system geared to address conventional health needs might be very poorly placed to deal with an epidemic.

For example, if you go to the emergency room in North America it's a much quicker experience, but in European national health systems, like in Italy, the emergency room is often an admission gate to hospital care, even for less urgent cases. This system, built on patient-centered care like most Western health systems, allows the time to work through a patient's health problems. During a pandemic like this one, though, this practice might become an issue because it keeps patients around when they shouldn't be, possibly intensifying the outbreak. There is an extremely interesting and moving account of this issue recently published in the New England Journal of Medicine.

We did not understand quickly enough that this virus was an unconventional event that couldn't be dealt with by the conventional standards of our health system. By changing the triage procedure we've adaptedthe time an Italian emergency room takes to process patients now is different, faster, and oriented to COVID-19. Things would have likely been different if we had started sooner.

There is general lesson for Europe and the U.S.: if you use conventional responses to an unconventional scenario like this one, then you're very likely to fail. Rather than containing the virus, we ended up spreading it. We learned this the hard way. We were the victims of our own successful health system in a way. What's especially interesting is that, in Italy, the contagion has been particularly strong in the regionsLombardia and Emilia Romagnawhere the Italian health system is the strongest. They took thorough care of people longer but, in some cases, they were not ready to isolate them promptly. In the middle of an epidemic, even short delays can prove very important in failing to contain the outbreak.

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Understanding COVID-19's impact in Italy and Europe - The Hub at Johns Hopkins

INDIANAPOLIS, Ind. Governor Eric Holcomb provided the latest information about Indianas response to the COVID-19 pandemic Tuesday as the state continues to see cases spread across Indianas counties.

Among the updates, Governor Holcomb announced two new executive orders he would be signing.

The first executive order deals with the carryout-only order. The order would extend the policy through April 6.

The second executive order waives the statute to let e-notary rules take effect.

On Tuesday, state health officials say an additional 14 people died in Indiana from coronavirus-related illnesses. This brings the states total to 49.

Of the new COVID-19 deaths, five involved Indianapolis residents and four were from Lake County. Elkhart, Decatur, Hancock, Ripley and Warren Counties also reported a death.

Confirmed COVID-19 cases grew by 347 to 2,159. The virus has now been reported in 81 of Indianas 92 counties. Marion County continues to have the most new reported cases. The county now has 964 cases.

Dr. Kristina Box, State Health Commissioner for Indiana, says the numbers do not necessarily show the amount of new cases per day. IT is based on when the data is reported to them.

Dr. Box says the jump in deaths from March 14-March 21 is when tests were done through the state lab. She says it can take up to two weeks to get results, and that some patients may have died before their test result was available.

While the Indiana State Department of Health has been providing daily updates on the number of reported cases and deaths, Dr. Box says EMS needs more timely data to make real-time decisions.

The department will soon begin providing twice-daily updates to its coronavirus page, giving the latest information at peoples fingertips.

Another update provided in the briefing is that the Army Corps of Engineers has been called in for facility assessment and other planning help. This will help the state prepare to set up field hospitals in key areas of the state if it becomes necessary to address medical facility shortages.

The request was made through the state emergency operations center and FEMA.

Our hope is that we never need this, but we must prepare as if we will.

Governor Holcomb ended the main part of the address by thanking people for jumping in to help out with the COVID-19 response. He highlighted a COVID-19 Crisis Response Fund that will help those on the front lines.

Holcomb also mentioned sewing clubs from across the state that are producing masks for hospitals and other facilities in the state. An employer in Lebanon making a handheld disinfecting wand to send to food manufacturers and health care facilities. Holcomb said they are all examples of Hoosier hospitality at its finest.

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Gov. Holcomb to sign 2 executive orders on COVID-19 response - Fox 59

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LIVE UPDATES: Coronavirus in the Mid-South: Additional case of COVID-19 within SCSO - FOX13 Memphis