Category Archives: Wuhan, China

Coronavirus: Top scientist who battled COVID-19 says we will never live normally without vaccine! Nursing Homes, Packed Coffee Houses, and When will it Be Over?

As anyone else noticed the advertisements on television? They are mainly auto dealerships who will delivery your new car to your home and more attorney companies who will sue whomever you want and will not get charged unless they will your case. One of my former professors during my MBA program is a federal judge who warned me that judges are expecting to see many cases of malpractice cases coming to the courts secondary to the COVID-19 cases. Unbelievable!

 Ross McGuinness reported that a top scientist who fell ill with COVID-19 has said the world will never return to normal unless there is a coronavirus vaccine.

Peter Piot, director of the London School of Hygiene & Tropical Medicine, spent a week in hospital after contracting the virus in March. The Belgian virologist, who led the Joint United Nations Program on HIV/AIDS between 1995 and 2008, said climbing a flight of stairs still leaves him breathless.

Last week, a World Health Organization (WHO) official warned there may never be a coronavirus vaccine.

Prof Piot, one of the discoverers of the Ebola virus, is currently a coronavirus adviser to European Commission president Ursula von der Leyen. In an interview with Belgian magazine Knack, later translated by Science Magazine, he warned that a vaccine is needed for people to live normally again.

“The Commission is strongly committed to supporting the development of a vaccine,” he said. “Let’s be clear: Without a coronavirus vaccine, we will never be able to live normally again. “The only real exit strategy from this crisis is a vaccine that can be rolled out worldwide.

“That means producing billions of doses of it, which, in itself, is a huge challenge in terms of manufacturing logistics. And despite the efforts, it is still not even certain that developing a COVID-19 vaccine is possible.”

Prof Piot criticized anti-vaxxers, saying: “Today there’s also the paradox that some people who owe their lives to vaccines no longer want their children to be vaccinated. “That could become a problem if we want to roll out a vaccine against the coronavirus, because if too many people refuse to join, we will never get the pandemic under control.”

He said he hoped the coronavirus pandemic can help ease political tensions, citing how polio vaccination campaigns have led to truces between countries. He said he hoped the WHO could be “reformed to make it less bureaucratic”, saying it too often resembles a “political battleground”.

According to Johns Hopkins University, the US is the worst-hit country by coronavirus, with more than 79,500 deaths, followed by the UK with more than 31,900 and Italy with more than 30,500.

On Sunday, British prime minister Boris Johnson announced a range of new measures to ease the UK out of its COVID-19 lockdown. However, his announcement of the government’s measures was criticized by scientists, opposition politicians and workers’ unions, who called it confusing.

The government was left scrambling on Monday to bring some kind of clarity to the new measures. A 50-page document outlining the easing of restrictions was published on Monday. From Wednesday, people will be able to meet one person from another household in a park as long as they stay two meters apart.

Covid-19: nursing homes account for ‘staggering’ share of US deaths, data show

Reporter Jessica Glenza noted that residents of nursing homes have accounted for a staggering proportion of Covid-19 deaths in the US, according to incomplete data gathered by healthcare researchers.

Privately compiled data shows such deaths now account for more than half of all fatalities in 14 states, according to the Kaiser Family Foundation. Only 33 states report nursing home-related deaths.

“I was on a phone call last week, where four or five patients came into our hospital just in one day from nursing homes,” said infectious disease specialist Dr Sunil Parikh, of Yale School of Public Health in Connecticut. “It’s just a staggering number day to day.”

Despite early warnings that nursing homes were vulnerable to Covid-19, because of group living settings and the age of residents, the federal government is only beginning to gather national data.

In Connecticut, 194 of 216 nursing homes have had at least one Covid-19 case. Nearly half the Covid-19 deaths in the state – more than 1,200 people – have been of nursing home residents. The proportion is higher elsewhere. In New Hampshire, 72% of deaths have been nursing home residents.

Parikh said limited testing and a lack of personal protective equipment such as masks hampered efforts to curb the spread of Covid-19 in care homes. Due to limited testing capacity, most state nursing homes are still only able to test residents with symptoms, even though the disease is known to spread asymptomatically.

“What I would like to see is the ability to test the entire nursing homes,” Parikh said. “This symptomatic approach is just not cutting it. Many states, including Connecticut, are starting to move in that direction … but I hope it becomes a national effort.”

Nursing homes have been closed to the public for weeks but a bleak picture has nonetheless emerged. In New Jersey, Governor Phil Murphy called in 120 members of the state national guard to help long-term care facilities, after 17 bodies piled up in one nursing home.

In Maine, a 72-year-old woman who went into a home to recover from surgery died just a few months later, in the state’s largest outbreak.

“I feel like I failed my mom because I put her in the wrong nursing home,” the woman’s daughter, Andrea Donovan, told the Bangor Daily News. “This facility is responsible for so much sadness for this family for not protecting their residents.”

Fifteen states have moved to shield nursing homes from lawsuits, according to Modern Healthcare.

Nursing home residents were among the first known cases of Covid-19 in the US. In mid-February in suburban Kirkland, Washington, 80 of 130 residents in one facility were sickened by an unknown respiratory illness, later identified as Covid-19.

Statistics from Kirkland now appear to tell the national story. Of 129 staff members, visitors and residents who got sick, all but one of the 22 who died were older residents, according to the US Centers for Disease Control and Prevention (CDC).

By early March, most Covid-19 deaths in the US could still be traced to Kirkland.

“One thing stands out as the virus spreads throughout the United States: nursing homes and other long-term care facilities are ground zero,” wrote Dr Tom Frieden, the former head of the CDC, for CNN on 8 March.

That day, Frieden called on federal authorities to ban visitors from nursing homes. US authorities announced new measures to protect residents several days later.

The CDC investigation into Kirkland was released on 18 March. It contained another warning: “Substantial morbidity and mortality might be averted if all long-term care facilities take steps now to prevent exposure of their residents to Covid-19.”

It was not until 19 April that the head of the Centers for Medicare and Medicaid Services promised to track all deaths in nursing homes. That requirement went into effect this Friday, but there is still a two-week grace period for compliance. During the period from 19 April to 8 May, 13,000 people died, according to an NBC News analysis.

“This is really decimating state after state,” said Parikh. “We have to have a very rapid shift [of focus] to the nursing homes, the veteran homes … Covid will be with us for many months.”

Texas begins to reopen after Covid-19 quarantine – but political controversy and health risks await

Three reporters contributed to this article, Erum Salam, Nina Lakhani and Oliver Laughland, where they noted that Tim Handren, the chief executive of Santikos Entertainment, a small cinema chain in San Antonio, admits his business is not essential. But while the giants of the industry keep their screens closed, he has taken a different approach.

Since last weekend, three of nine Santikos cinemas have reopened to the public, among the first in America to do so during the coronavirus pandemic.

“Take your mask off and relax,” Handren said in a recorded message to customers. “Breathe in some great buttery popcorn smells, watch a great movie, and just enjoy some time with your family.”

The reopening is among the starker examples in Texas, where one of the quickest and most expansive efforts to reignite the economy has drawn significant controversy.

On the one hand, some civil liberty advocates have argued that their right to drink at bars, have their hair cut and dine at restaurants has been curtailed. On the other, many public health experts warn thousands will become infected as the state reopens.

Handren, who is also the mayor of the small town of Boerne, said that although his cinemas would keep patrons 6ft apart and offer a reduced menu there remained debate in the community about whether the shutdown had been necessary at all.

“Unfortunately, I still interact with people that believe Covid-19 is a hoax concocted by the media after all this time. That’s the extreme on that side of the equation … ‘We should have never shut down’. Even the lieutenant governor said that. And then there are others who want to hunker down and hibernate for the next six months. I’ve had to, as a mayor, balance health and economics.”

Abbott, a Republican, last week ended a stay-at-home order and allowed businesses including barber shops and retail outlets to open. The move followed decisions in other southern states including Florida and Georgia, and earned praise from Donald Trump.

The president told reporters: “Texas is opening up and a lot of places are opening up. And we want to do it, and I’m not sure that we even have a choice. I think we have to do it. You know, this country can’t stay closed and locked down for years.”

In private, Abbott has acknowledged that his decision to reopen is likely to cause an increase in coronavirus cases. Leaked audio obtained by the Daily Beast captured comments during a private call with state lawmakers.

Abbott, who has sought to downplay the increased risk to the public, said: “The more that you have people out there, the greater the possibility is for transmission. The goal never has been to get transmission down to zero.”

Infectious disease experts predict the average daily Covid-19 positive test rate in Texas could rise from 1,053 at the beginning of May to up to 1,800 by June.

As of this weekend, Texas had an estimated 16,670 active cases and 1,049 deaths. With the occasional dip, the number of cases continues to rise even while testing lags behind other states.

Harris county, which includes Houston, has 157 coronavirus cases per 100,000 people – 31% higher than the state average. Last month, officials said African Americans accounted for two-thirds of Covid-19 deaths in the city despite making up only 22.5% of the population.

Harris county judge Lina Hidalgo, a Democrat, has attempted to enforce a mandatory mask order. Abbott has publicly criticized her.

Dr Andrew Miller, a pediatric ophthalmologist in Harris county, reopened his clinic last week with social distancing in place. He told the Guardian that even after his decision to reopen, because of the pressing needs of patients, he was experiencing significant anger from those who refuse to wear masks.

He said: “We’ve had some pushback from families because we won’t let them in without a mask. They’ve been ugly to the staff. While I respect their civil liberties, I am entitled to not see them.”

Last week, Abbott took power away from officials who arrest Texans for certain Covid-19 violations. The move was prompted by a conservative backlash against the arrest of a salon owner in Dallas – another hotspot – who opened up against local rules. In an act that exacerbated the divisions on the case, Texas senator Ted Cruz appeared at the salon to receive a haircut from the recently released owner.

Houston lies in a sprawling industrial region with more than 500 petrochemical facilities, a busy shipping channel, large highways and commercial railroads, and one of the highest densities of polluting industries in the country, if not the world.

Air quality, specifically particulate matter, which increases the risk of multiple lung and heart conditions also associated with Covid-19 complications, has been worse in some parts of the city despite the lockdown, leading environmentalists to criticize the decision to reopen so quickly.

“It’s a blind, uninformed decision based on optimism that everything will be better, even though the evidence points to the contrary,” said Elena Craft, senior director at the Environmental Defense Fund (EDF), which coordinates a local project tracking air quality.

The meatpacking industry is also linked to several emerging hotspots in the Texas panhandle, a semi-rural region of 26 northern counties where Trump won 79.9% of the vote in 2016 and the Republican party dominates every level of government.

Moore county has the highest infection rate in Texas. Its death rate is 28 per 100,000 people, almost 10 times higher than Harris county and the state average.

Moore, where around 55% of residents identify as Latino or Hispanic, is home to the massive Brazilian-owned JSB meatpacking plant, which employs mostly Hispanic and migrant workers, many bussed in on company shuttles from towns including Amarillo. Nationwide, industrial meat plants have emerged as incubators for coronavirus spread.

Amarillo, the region’s largest city, situated across Potter and Randall counties, had 1,304 cases as of last Wednesday, including at least 18 deaths. The infection rate is rapidly rising. Potter county has the second worst rate in Texas, with infections doubling every seven or eight days.

Just to the south, in the city of Odessa, a group of armed militia men were arrested last week as they protested alongside bar owner Gabrielle Ellison, who attempted to reopen in violation of an executive order which mandates bars should remain closed.

The six men were members of a militia named Open Texas, which according to reports has operated across the state, offering armed support to business owners.

Ellison, who was also arrested, told local news from jail: “I think some rights were taken away from us, which one of them was like a right to survive. We have to survive and I think those rights were stripped from us.”

But looked what happened in Colorado!

Customers in Packed Colorado Coffee Shop Ignore Mask and Distancing Advice

 We have many stupid people as this next story proves. Customers in a Colorado coffee outlet on Sunday, May 10, resisted official calls for people to wear face masks and gloves – and to distance from one another – when in public.

This video shows the crowded scene inside a C&C Coffee and Kitchen store in Castle Rock on Mother’s Day morning. Few customers appear to be wearing face masks or distancing from one another to the extent suggested by federal and state officials.

Colorado Gov Jared Polis’s ‘Safer at Home’ order, which encourages six feet of distance between people, remains in effect until May 27.

As of May 10, Colorado had reported 19,703 confirmed cases of the coronavirus and 971 deaths.

Opinion: The coronavirus is accelerating America’s decline

Arvind Subramanian reported that the federal government’s response to the pandemic exposes incompetence and decay. The consequences will play out over years to come.

The COVID-19 crisis augurs three watersheds: the end of Europe’s integration project, the end of a united, functional America, and the end of the implicit social compact between the Chinese state and its citizens.                                                                                                                    As a result, all three powers will emerge from the pandemic internally weakened, undermining their ability to provide global leadership.                                                           Europe                                                                                                                                                Start with Europe. As with the 2010-12 eurozone crisis, the bloc’s fault line today runs through Italy. Drained over decades of dynamism and fiscally fragile, it is too big for Europe to save and too big to let fail. During the pandemic, Italians have felt abandoned by their European partners at a moment of existential crisis, creating fertile ground for populist politicians to exploit. The images of Bergamo’s COVID-19 victims being carried in body bags by military convoy to their anonymous, unaccompanied burials, will long remain etched in the Italian collective psyche.                                                                                    Meanwhile, when addressing how to help pandemic-stricken member states, the European Union’s technocratic, ostrich-like elites lapse into the institutional alphabet soup — ECB, ESM, OMT, MFF and PEPP — that has become their default language. The continent’s leaders have faltered and dithered, from European Central Bank President Christine Lagarde’s apparent gaffe in March — when she said that the ECB was “not here to close spreads” between member states’ borrowing costs — to the bickering over debt mutualization and COVID-19 rescue funds and the reluctant, grudging incrementalism of the latest agreement.                                                                                                                          Suppose, as seems likely, that the successful economies of the EU core recover from the crisis while those on the bloc’s periphery falter. No political integration project can survive a narrative featuring a permanent underclass of countries that do not share their neighbors’ prosperity in good times and are left to their own devices when calamity strikes.                             U.S.                                                                                                                                                      The United States’ decline, meanwhile, is over-predicted and under-believed. Even before the COVID-19 crisis, key U.S. institutions signaled decay: the incontinent presidency of Donald Trump, a gerrymandered Congress, a politicized Supreme Court, fractured federalism and captured regulatory institutions (with the U.S. Federal Reserve being an outstanding exception).                                                                                                                          Deep down, however, many of those Americans who see the decay reject the thesis of decline. They remain convinced that the country’s thick web of non-state institutions and underlying strengths — including its universities, media, entrepreneurial spirit, and technological prowess, as well as the global supremacy of the dollar — provide the resilience America needs to maintain its pre-eminence.

But so far, the world’s richest country has been by far the worst at coping with the pandemic. Although the US has less than 5% of the world’s population, it currently accounts for about 24% of total confirmed COVID-19 deaths and 32% of all cases.

In rapid succession, therefore, America’s credibility and global leadership have been buffeted by imperial overreach (the Iraq war), a rigged economic system (the global financial crisis), political dysfunction (the Trump presidency), and now staggering incompetence in tackling COVID-19. The cumulative blow is devastating, even if it is not yet fatal.                                                                                                                                                              Many of these pathologies in turn stem from the deep and poisonous polarization in US society. Indeed, Trump is now goading his supporters into insurrection. Come November, even the basic democratic criterion of holding free and fair elections could end up being flouted.                                                                                                                                         This is a critical moment. Prepare for the trading day with MarketWatch’s Need to Know newsletter. Our flagship email guides investors to the most important, insightful items required to chart the trading a day ahead.                                                      Of course, it would be alarmist and premature to see America’s far-reaching failures in the face of the COVID-19 crisis as threatening U.S. democracy or nationhood. But clinging adamantly to American exceptionalism at such a time seems like dangerous denialism.    China                                                                                                                                         Finally, there is China. Since the time of Deng Xiaoping, the country has thrived on a simple, implicit agreement: citizens remain politically quiescent, accepting curbs on freedom and liberties, and the state — firmly under the control of the Communist Party of China — guarantees order and rising prosperity. But the COVID-19 crisis threatens that grand bargain in two ways.                                                                                         First, the Chinese authorities’ terrible initial handling of the pandemic, and in particular their catastrophic suppression of the truth about the COVID-19 outbreak in Wuhan, has called the regime’s legitimacy and competence into question. After all, the social contract looks less attractive if the state cannot guarantee citizens’ basic well-being, including life itself. China’s true COVID-19 death toll, which is almost certainly higher than the authorities are admitting, will eventually come to light. So, too, will the stark contrast with the exemplary response to the pandemic by the freer societies of Taiwan and Hong Kong.  Second, the pandemic could lead to an external squeeze on trade, investment, and finance. If the world deglobalizes as a result of COVID-19, other countries will almost certainly look to reduce their reliance on China, thus shrinking the country’s trading opportunities. Similarly, more Chinese companies will be blocked from investing abroad, and not just on security grounds — as India has recently signaled, for example. And China’s Belt and Road Initiative — its laudable effort to boost its soft power by building trade and communications infrastructure from Asia to Europe — is at risk of unraveling as its pandemic-ravaged poorer participants start defaulting on onerous loans.                              The COVID-19 crisis will therefore probably hurt China’s long-term economic prospects. Widespread internal rumblings have begun, even if they are less evident externally. Domestic disorder is unlikely, because President Xi Jinping could ratchet up repression even more ruthlessly and effectively than he already has. But the current social contract will seem increasingly Faustian to the average Chinese citizen.

Command of resources is a prerequisite for power. But, as international-relations theory reminds us, projecting power beyond one’s borders requires a modicum of cohesion and solidarity within them. Weak, fractured societies, no matter how rich, cannot wield strategic influence or provide international leadership — nor can societies that cease to remain models worthy of emulation.                                                                                                     We have been living for some time in a G-minus-2 world of poor leadership by the U.S. and China. Both have been providing global public “bads” such as trade wars and erosion of international institutions, instead of public goods such as stability, open markets, and finance. By further weakening the internal cohesion of the world’s leading powers, the COVID-19 crisis threatens to leave the world even more rudderless, unstable, and conflict-prone. The sense of three endings in Europe, America, and China is pregnant with such grim geopolitical possibilities.                                                                                                            And Now Wuhan reported its first new coronavirus case in more than a month                                                                                                                      Aly Song from Reuters reported that Wuhan reported their first new COVID case.

  • The central Chinese city of Wuhan has reported its first new coronavirus case in more than a month.
  • The Wuhan Municipal Health Commission said Sunday that an 89-year-old man was confirmed to have the virus on Saturday. His wife, along with several members of the community, were recorded as asymptomatic cases, which are not included in official case tallies.
  • On Sunday, the National Health Commission revealed that 14 new symptomatic cases were reported on Saturday, marking the largest increase since April 28.

The central Chinese city of Wuhan, where the coronavirus first appeared last year, reported its first new case in more than a month on Sunday. The Wuhan Municipal Health Commission announced Sunday an 89-year-old male with a history of various health problems, tested positive for the virus on Saturday after showing symptoms.

His wife, who tested positive without symptoms, has been recorded as an asymptomatic case. Several other members of the community were also recorded as asymptomatic cases. The health commission said the elderly man, who resides in the Dongxihu district, lived in an area where 20 other people previously tested positive for the virus. The risk level for his district was raised to medium on Sunday. The new case is, according to multiple outlets, the first case reported in Wuhan since April 3.

Wuhan, the Chinese city hardest hit by the virus, has reported a total of 50,334 coronavirus cases and at least 3,869 deaths. In mid-April, the city revised its death toll, increasing it by 50%. The numbers coming out of China have repeatedly been called into question, especially by US officials, including the president.

China has argued that numbers are low because it took decisive action. The strict quarantine of Wuhan, a sprawling city of 11 million people, began on Jan. 23 and ended on April 8. Similar action was taken in cities across China.

On Sunday, China’s National Health Commission announced that there were 14 new coronavirus cases reported nationwide on Saturday, marking the largest single-day increase since April 28, according to Reuters. The majority of the new cases were reported in Shulan, a city in China’s northeastern Jilin province. Local officials raised the risk level to high in response.

China also reported 20 new asymptomatic cases, which are not included in the total tally. The country has reported 82,901 cases and 4,633 deaths.

How a COVID-19 Testing Model No One Is Talking About Could Save Thousands of Lives

Andrea Galeotti noted that with solid data in short supply relating to the characteristics and spread of COVID-19, many governments and health officials are struggling to formulate suitable health and economic policies. As a consequence, some although not all, countries are effectively waging a war against the coronavirus based on the dynamics of a game of chance. This in turn is producing considerable anxiety about when lockdowns might end and the first steps towards economic activity might begin to occur.

This absence of data and resultant lack of concrete purpose is perhaps best illustrated in the U.S. where the federal government has left individual states to decide when to reopen in phases, without clarity on how widespread COVID-19 actually is. What state governments should be doing is formulating a reopening procedure that is based on selecting and testing a representative sample of the population.

There is now abundant evidence that asymptomatic individuals are the key diffusers of COVID-19 and as such firmly locating those individuals is the only way to stop further waves of contagion. Testing has always been of paramount importance, but this should not be seen as a mandate to test on a massive scale. That option is clearly not practicable and should urgently be substituted for well-designed testing strategies that determine the rate of infection in the local communities of individuals being tested, as well offering a firmer bearing on the general prevalence and diffusion of the virus within the greater population. Based on this information, contact tracing and smart containment strategies can be designed in order to ensure that contagion curve is kept flat and the health system can operate within its capacity.

COVID-19 has shown it can infect people regardless of age, race, gender, and geography, and therefore has proved unpredictable and difficult to contain. This unpredictability has been mirrored by the divergent testing strategies of different governments around the world. Countries such as Italy, U.K., and the U.S. have principally been testing patients with severe symptoms and have largely withheld testing asymptomatic individuals. By contrast, in countries such as Germany, Iceland and South Korea, the testing regimen has quickly expanded to mildly symptomatic cases, and to asymptomatic individuals who work in jobs where, should the become infected, have a high chance of spreading the virus to many others. That includes, for example, medical staff and workers in transportation hubs.

These different approaches may have been dictated by different logistical constraints, yet it is clear those countries that have employed intelligent testing and contact tracing strategies have in turn been more successful in containing COVID-19. For example, Iceland, South Korea, Australia, and Singapore all have strong testing and contact tracing initiatives and their infection and mortality numbers are a fraction of the U.S.’s.

A key piece of the exit strategy for countries like the U.S., Italy, and the U.K., then, seems simple: develop a serological testing program on a representative sample of the population, while also gathering information on demographic characteristics such as age, gender, number of children, type of working sector, skills, social and working associations.

Serological tests detect the presence of antibodies for COVID-19 and make sense for this purpose for a few reasons. PCR tests, which detect RNA evidence of a virus, can only reveal a current or recent infection. Antibody tests, on the other hand, can, in theory, identify someone who was exposed to the virus months ago. By testing with this method, governments will be able to capture a clear picture to what extent the virus has already spread and identify trends across geographical regions as well as across individual characteristics such as age, gender, working sectors and skills.

Gathering this representative sample would be relatively easy and cost-effective to implement. It is also easy because countries can use representative samples of the population that are regularly used for socio-economic surveys. For example, the U.S. Bureau of Labor Statistics’ “Labor Force Statistics from the Current Population Survey” could be adapted to run such tests. Secondly, the data collected can be analyzed though standard statistical methods, which will help to infer a body of valuable analysis related to the spread across the wider population.

There are aspects of the design of such test programs that will need to be very carefully managed. For example, they could be vulnerable to outcomes that wrongly indicate the presence of COVID-19 in a given region, or, conversely, identify regions that notionally suggest low infection rates. In both examples, test validation is critical.

Through the collection and statistical analysis of such data, governments will be in a position to make an informed choice and evaluate the advantages and the disadvantages that are inherent in any policy that will relax social distancing before a vaccine is available. Formulating an exit strategy without this information amounts to flipping a coin—the proverbial game of chance and is the new cases of COVID-19 a signal of what we could see in this country as we ease self-quarantine and the “severe” lock-down in states and cities?

We need a comprehensive collection of data using contact as well as post infection patient tracing to get a handle on this pandemic and the possible recurrent waves!

American life has been transformed in a few short weeks and the Cost to Economies and the Ethics in Decision Making in a Pandemic

Italy a country at the heart of the Corona virus outbreak in Europe — watched its number of cases and deaths due to the novel Corona virus astronomically leap once again, up 793 deaths with 6,557 newly confirmed cases recorded in just 24 hours.

Saturday’s jump marks the worst day for fatalities since the crisis began just four months ago. The country now counts 53,578 diagnosed infections, up 13.9 percent, with 4,825 deaths — the highest in the world.

More than 60 percent of the most recent deaths occurred in the northern region of Lombardy. Hospitals in the area have been reeling under a staggering caseload that has left intensive care beds scarce and respirators in extremely limited supply.

According to the Financial Times, 2,857 people were in intensive care in Lombardy on Saturday, up from 2,655 on Friday. The new increases come almost two weeks into a nationwide lock down in an attempt to stop the COVID-19 virus in its tracks there.

There were also 943 full recoveries tallied yesterday — another record for the country.

On Thursday, Italy was witness to yet another grim milestone in its fight against the deadly disease by overtaking China to become the country with the highest number of deaths.

On Friday the government banned the last types of outdoor exercise Italians were able to participate in under the lock down measures by deciding that running and bicycle rides were no longer permitted. In addition, the Italian military has also been dispatched to Milan to ensure that citizens follow the new lock down measures.

The Italian interior ministry reported that more than 223,633 people were inspected by the Italian police nationwide on Friday, with 9,888 people reported for breaking the lock down measures and 260 for false declarations about why they were outside.

Across the Atlantic, the number of cases in the United States has now exceeded 22,000 with more than 270 deaths. New York tops the list with at least 10,000 confirmed cases; Washington state follows with just over 1,500 cases, and California is in tow with more than 1,200.

Thus far, the global pandemic has infected more than 287,000 people and killed over 11,900. More than 90,000 people have recovered so far, mostly in China.

The Associated Press and The Financial Times contributed to this report.

I found this article in the Economist discussing what the economic influence would be from the COVID-19 pandemic. The titular conceit of “28 Days Later”, as with many contagion-style horror films, is of a man waking up after a month-long coma only to find society upended by a rampaging virus. Many Americans are experiencing something similar. On March 3rd there were just 122 confirmed cases of COVID-19—the disease currently sweeping the world—and only seven deaths. By March 17th there were 7,786 confirmed cases (even these were a sure underestimate given the dearth of testing) and 118 deaths. Twenty-eight days later, on March 31st, what might America look like?

cap.gifp-a8GHW19EK4IzY.gif“We don’t know whether we’re going to look like Italy or the provinces outside Hubei” in China where the spread of COVID-19 was fairly effectively contained, says David Blumenthal, president of the Commonwealth Fund, a health-policy think-tank. “But the likelihood is—given the slowness with which we responded to the epidemic—that we look more like Italy,” he adds. Jerome Adams, the surgeon-general, has warned of the same.

Can America’s health system cope? The structural problems that make pandemic response more difficult—lack of paid sick pay, a large uninsured population and a significant number of insured people nonetheless worried about out-of-pocket medical bills—cannot be mended overnight. Instead, public-health experts and doctors are increasingly worried about sheer capacity constraints. In China, 5% of those diagnosed needed intensive care. There are roughly 97,000 beds in intensive care units (ICUs), of which one-third are empty. Though America has relatively few total hospital beds per person compared with other countries, it ranks among the highest for ICU beds per person, with nearly three times as many as Italy.

“The real limiting factors are likely to be the ventilators or the staff,” says Greg Martin, a professor of medicine at Emory University and president-elect of the Society of Critical Care Medicine. There are roughly 50,000 physicians trained in critical care and 34,000 similarly specialized nurses and assistants. This could be insufficient in the face of hundreds of thousands of cases at peak rates of infection.

Then there is the problem of kit. In China, half of those in critical care required the use of ventilators, machines that help people breathe. There are thought to be 62,000 full-featured mechanical ventilators in the country, many of which are already in use. Older stocks of perhaps 100,000 devices—including CPAP machines used for those with sleep apnea—could be called upon if needed, but would provide only basic functions. Ramp-ups in ventilator production are being pondered, including through emergency powers given to the president under the Defense Production Act of 1950, but there has been little actual action yet. On a phone call with state governors, President Donald Trump urged “respirators, ventilators, all of the equipment—try getting it yourselves”, which could spark an unhelpful competition between states for scarce resources.

“Under almost any basic scenario, things look tough. Hospital beds will be completely full many times over if we don’t substantially spread the load,” warns Ashish Jha, director of the Global Health Institute at Harvard. To head that off, Mr Jha has called for an Italy-style national quarantine, lasting for at least two weeks, in which all non-essential businesses are closed and gatherings of more than five people are barred to give time for testing to become widespread. After a dismally slow start to testing, the numbers are finally heading up—although the best estimates come not from public-health agencies, but volunteer trackers using a Google sheet—to an estimated 12,535 tests conducted on March 17th. Given the expected scope of the disease, and the reported obstacles to people with symptoms actually getting tested, much more will be needed.

Most hospitals are making contingency plans. There are plans to add physical beds by cancelling elective surgeries that can be postponed, converting recovery rooms into added beds and building tents to house some patients. The Cleveland Clinic, a prominent hospital, says it has plans in place to add 1,000 beds of capacity within 72 hours if needed. Teams of doctors and nurses with other specialties could be conscripted into critical-care work, supervised by critical-care doctors who handle the trickiest cases—like respiratory distress coupled with organ failure in the kidneys or heart. If this is insufficient, recently retired doctors could be drafted into service. Some teaching hospitals are using simulation centers to prepare medical staff for the inevitable surge in cases.

Testing? Testing?

Whether it will come to all this is still unclear. Testing capacity remains constrained, limiting the information epidemiologists have to feed both their models and their willingness to speculate. Their policy recommendations—social distancing, closure of schools and large gatherings—are nevertheless clear. One team of researchers has concluded that an epidemic resembling that of Wuhan, where the novel Corona virus first broke out, would overwhelm hospitals many times over, while one resembling Guangzhou, a city that locked down in the early days of the virus, could be dealt with.

On March 16th, however, a team of scientists based at Imperial College London, who have been advising the British government, also published forecasts of the epidemic’s trajectory in America. As with Britain, the figures look grim. Without any mitigation, America would experience 2.2m deaths, they predict. Even in the case of some mitigation—isolation of the sick, social distancing for the elderly, but an otherwise normal society—American hospital and ICU capacity would be exceeded eight times over, and the country would be on track for at least 1.1m deaths. Averting this through “suppression”—isolation of sick, closing of schools and universities, social distancing for everyone—would require months until therapeutics or vaccines can be developed.

America is therefore turning towards suppression of the virus. Millions of pupils and university students have been sent home and left to take classes online. Mr. Trump has advised that people not congregate in gatherings of more than ten people. San Francisco and surrounding counties have issued a “shelter-in-place” order that requires 7m to remain in their homes unless necessary. New York City is expected to do the same for its 8m residents. In 22 states, bars and restaurants have been ordered to close their seating and only serve takeaway. The state of New York is setting up drive-through testing centers, starting in New Rochelle, a commuter town in Westchester County that was one of the early sites of a COVID-19 cluster, and is urging federal troops to build emergency, temporary hospital facilities. New Rochelle’s mayor says he is surviving the lock down there on “adrenalin, coffee and M&Ms”.

The goal is to increase general hospital capacity by a factor of two and ICU capacity by a factor of ten within two months. Elections have been postponed in a few states for the Democratic primary, which now seems a dull, distant affair. America’s devolved system means that the shuttering will happen at different rates in different places, but the trajectory is clear. “You want a single national response. But when the federal government completely fails, as it has so far, then you can get states and cities to step up,” says Mr. Jha.

The question is how long this can go on for. Unmitigated, the epidemic would not peak for at least another three months. Suppression can reduce the spread of the disease, as China’s experiment with locking down most of its population showed, but relaxing these measures will inevitably bring another surge in cases. Mr. Trump, who a few weeks ago was suggesting the virus was the latest hoax invented to damage him, is now warning that this could be the start of a months-long reorientation in American life. And while these extraordinary actions should smother the disease, they will also smother the economy.

The dismal economic forecasts will require further action from Congress. It spent the last week haggling over a bill that would make testing for the disease free, increase the flow of safety-net benefits and grant paid sick leave to more workers (though this provision appears to be hollowing out with every iteration). Even before that bill was finalized, Washington’s attention had already turned to the even bigger economic stimulus package that must come next. Senators, both Democrats and Republicans, are tripping over themselves issuing plans to send cash directly to American families.          

The total package, which could be worth $1trn or more, dwarfs the $100bn-or-so bill recently signed into law and every other stimulus package in history. The Trump administration has proposed sending $500bn in direct cash to taxpayers, $300bn to keep firms afloat, and $200bn to bail out critical industries like airlines. The typical partisan bickering from Congress and even from Mr. Trump has been muted. Every politician seems to now realize that the country faces an unprecedented crisis, first of public health and then of the economy, that will last for months. Whether this action will look sufficient 28 days later is, as with seemingly every aspect of the Covid-19 pandemic, deeply uncertain. ■

Ethicists agree on who gets treated first when hospitals are overwhelmed by Corona virus 

As a member of our Ethics Committee I thought that the decisions that physicians and staff in other countries were facing regarding who gets the ventilators was an interesting conundrum. This article contributed by Oliva Goldhill in her article, The Aging Effect, is a great introduction into the decisions that we may have to make here in the US. Pandemics bring ethical dilemmas into sharp, terrible focus. Around the world, hospitals have been unable to cope with the millions who need treatment for Corona virus. China created makeshift hospitals and denied treatment to those who needed non-Corona virus care; Italians wait an hour on the phone to get through to emergency services. Few countries will fare better: The United States has fewer than 100,000 ICU beds, and is expected to need a minimum of 200,000 to cope with Corona virus; the UK has just 8,200 ventilators and is getting an extra 3,800.

As health care systems are overwhelmed with more patients than they can feasibly treat, medical personnel are forced to decide who should get the available ventilators and ICU beds. Quartz spoke with eight ethicists, all of whom agreed that in such dire situations, those who have the best chance of surviving get priority. Despite the unanimity, all agreed that this decision is far from easy and should not be taken lightly.

Different moral theories, same answer

The decision to prioritize those with good survival odds is reinforced by several moral theories. Utilitarianism, for example, argues that morality is determined by the consequences of actions, and so we should strive to create the maximum good for the maximum number of people. “If we give scarce treatments to those who don’t stand to benefit (and have a high chance of dying anyway), then not only will they die, but those with higher likelihood of survival (but require ventilator support) will also die,” says Lydia Dugdale, professor of medicine and director of the center for clinical medical ethics at Columbia University. “It’s not fair to distribute scarce resources in a way that minimizes lives saved.”

A contrarian theory, which bases ethics on the social contract we would agree to if we didn’t know our status in society, arrives at the same conclusion. Joshua Parker, a trainee general practitioner (primary care doctor) who co-wrote an article on the ethics of Corona virus care for the Journal of Medical Ethics, points to philosopher John Rawls’ concept of a “veil of ignorance” as a way to determine the just action: “Behind the veil of ignorance, I am stripped of any knowledge of my position. I don’t know if I’ll be old, young, rich, poor, well, unwell, male or female; and I don’t know if I will catch COVID-19 or if I do, what resources I will need,” he writes in an email to Quartz. This thought experiment makes it easier to judge what’s fair for society as a whole. Alex John London, director of the Center for Ethics and Policy at Carnegie Mellon University, agrees: “Such agents might agree that in a pandemic, when not everyone can be saved, health care systems should use their resources to save as many lives as possible—because that is the strategy that allows each person a fair chance of being able to pursue their life plan.”

Even typically diverging ethical theories are likely to point to this conclusion. Utilitarianism, which focuses on the consequences of an action, is typically opposed to deontology, which says morality is determined by the act itself. “The deontologist might well start with a justice argument: each person is individually valuable and should have an equal chance of health care,” says Anders Sandberg, a philosopher at the Future of Humanity Institute at the Oxford University. But if this is simply impossible, then the theory doesn’t hold. “As Kant said, “ought implies can,” and if one cannot do an action it cannot be obligatory.” A deontologist approach to treat everyone equally falls short when there simply isn’t enough medical equipment to treat everyone; if some will have access and some won’t, then we have to face the question of who gets preferential treatment. And so “even the most die-hard deontologist will usually agree” that it’s wrong to treat people who are unlikely to benefit while others are in need, agrees Brian D. Earp, associate director of the Yale-Hastings Program in Ethics and Health Policy at Yale University and The Hastings Center.

Doctors have reckoned with the need to allocate resources in the face of overwhelming demand long before Corona virus. Dugdale points out that the New York department of health’s ventilator allocation guidelines, published in November 2015 to address the issue amid a flu epidemic, states that first-come first-serve, lottery, physician clinical judgment, and prioritizing certain patients such as health care workers were explored but found to be either too subjective or failed to save the most lives. Age was rejected as a criterion as it discriminates against the elderly, and there are plenty of cases in which an older person has better odds of survival than someone younger.

So the decision was to “utilize clinical factors only to evaluate a patient’s likelihood of survival and to determine the patient’s access to ventilator therapy.” In tie-breaking circumstances, though, they did approve treating children 17 and younger over an adult where both have an equal odds of surviving. Dugdale adds that there’s talk of applying these guidelines to address Corona virus treatment in New York.

No good answer

The dire consequences of any decision made under such extreme circumstances means that, despite agreement, the best course of action is hardly favorable. “I would say that leaving some to die without treatment is NOT ethical, but it may be necessary as there are no good options,” David Chan, philosophy professor at the University of Alabama at Birmingham, writes. “Saying that it is ethical ignores the tragic element, and it is better that physicians feel bad about making the best of a bad situation rather than being convinced that they have done the right thing.”

Rather, it’s simply the least bad option. Alternatives, such as a lottery system or prioritizing the sickest, are likely to lead to more deaths. “There is a good chance that we invest resources into patients who don’t survive, and we have thus doomed not just the patient we tried to save, but also the patient who was passed over for care, because the resources have been used up,” says Vanessa Bentley, philosophy professor at the University of Alabama at Birmingham. “Lives that could have been saved were lost.”

Although there’s broad agreement on the best approach, the nuances of applying this decision will always be difficult. Not only must doctors accurately assess and prioritize those with the best chance of survival, but there could also be times when the hospital doesn’t have enough equipment to help even those with equal odds. Italy has prioritized treatment for those with “the best chance of success” but adds as a second criterion those “who have more potential years of life.” This secondary factor is not so easily agreed upon but, in the face of Corona virus, it’s an ethical question doctors will have to face.

Governments are spending big to keep the world economy from getting dangerously sick

The help is targeted at companies and individuals. More will be needed

In the recent edition of the Economist Today it was noted a character in a novel by Ernest Hemingway once described bankruptcy as an experience that occurs “two ways: gradually, then suddenly”. The economic response to the COVID-19 pandemic has followed this pattern. For weeks policymakers dithered, even as forecasts for the likely economic damage worsened. But in the space of just a few days the rich world has shifted decisively. Many governments are now on a war footing, promising massive state intervention and control over economic activity.

The new phrase on politicians’ lips is “whatever it takes”—a line borrowed from Mario Draghi, president of the European Central Bank (ECB) in 2011-19. He used it in 2012 to convince investors he was serious about solving the euro-zone crisis, and prompted an economic recovery. Mr Draghi’s promise was radical enough. Politicians are now proposing something of a different magnitude: sweeping, structural changes to how their economies work.

There are unprecedented promises. On March 16th President Emmanuel Macron of France declared that “no company, whatever its size, will face the risk of bankruptcy” because of the virus. Germany pledged unlimited cash to businesses hit by it. Japan passed a hastily compiled spending package in February, but on March 10th supplemented it with another one that included over ¥430bn ($4bn) in spending and almost four times as much in cheap lending. Britain has said it will lend over £300bn (15% of GDP) to firms. America may enact a fiscal package worth well over $1trn (5% of GDP). The most conservative estimates of the total extra fiscal stimulus announced thus far put it at 2% of global GDP, more than was shoveled out in response to the global financial crisis of 2007-09.

That sinking feeling

In part this radical action is motivated by the realization that the Corona virus, first and foremost a public-health emergency, is also an economic one. The jaw-dropping bad economic data coming out of China hint at what could be in store for the rest of the world. In the first two months of 2020 all major indicators were deeply negative: industrial production fell by 13.5% year-on-year, retail sales by 20.5% and fixed-asset investment by 24.5%. GDP may have declined by as much as 10% year-on-year in the first quarter of 2020. The last time China reported an economic contraction was more than four decades ago, at the end of the Cultural Revolution.

Grim numbers are starting to pile up elsewhere, not so much in the official statistics, which take time to be published, as in “real-time” economic data produced by the private sector. Across the world, attendance at restaurants has fallen by half, according to OpenTable, a booking platform. International-passenger arrivals at the five biggest American airports are down by at least 30%. Box-office receipts have crumpled (see chart 2).

The disruption to international travel will hurt trade, since over half of global air freight is carried in the bellies of passenger planes. The combination of disrupted supply chains and depressed demand from shoppers should hit trade far harder than overall GDP, if the experience of the last financial crisis is anything to go by. Already, the American Association of Port Authorities, an alliance of the ports of Canada, the Caribbean, Latin America and the United States, has warned that cargo volumes during the first quarter of 2020 could be down by 20% or more from a year earlier.

Official data are now starting to drip out. The Empire manufacturing index, a monthly survey covering New York state, in March saw its steepest drop on record, and the lowest level since 2009. In February Norway’s jobless rate was 2.3%; by March 17th it was 5.3%. State-level numbers from America suggest that unemployment there has been surging in recent days.

All this is fueling grim forecasts. In a report on March 17th Morgan Stanley, a bank, estimated that GDP in the euro area will fall by an astonishing 12% year-on-year in the second quarter of the year. The Japanese economy is forecast to contract by 2% this quarter and 2% next. Most analysts see global GDP shrinking in the first half of the year, with barely any growth over 2020 as a whole—the worst performance since the financial crisis of 2007-09.

Even that is likely to prove optimistic. On March 17th analysts at Goldman Sachs noted that they had “not yet built a full lock down scenario” into their forecasts for advanced economies outside Europe. Forecasts for America, which is at an earlier stage than Europe and Asia when it comes to the outbreak, remain Panglossian; very slow growth in China and a big recession in Europe could by itself be enough to send the world’s largest economy the same way. Steven Mnuchin, America’s treasury secretary, warned this week that the country’s unemployment rate could reach 20% unless Congress passes a stimulus package. A negotiating ploy? With shopping malls emptying, factories grinding to a halt and financial markets buckling, lawmakers may be loath to challenge the claim.

Despite stomach-churning declines in GDP in the first half of this year, and especially the second quarter, most forecasters assume that the situation will return to normal in the second half of the year, with growth accelerating in 2021 as people make up for lost time. That judgment is in part informed by China’s experience. More than 90% of its big industrial firms are officially back in business. Its stock market had been one of the world’s worst performers in early February but is now the best (or rather, least bad). There remains, however, a risk that global containment and suppression of the virus will need to continue for a year or longer. If so, global economic output could be dragged down for much longer than most people expect.

Perhaps the greatest lesson of the global financial crisis was that it paid to act decisively and to act big, convincing markets and households that policymakers were serious about countering the slump. If done right, central banks and governments can end up doing a lot less than they actually promised. A pledge to bail out banks makes it less likely savers will withdraw deposits and make a rescue necessary.

This time around, central banks sprang into action. Since February the Federal Reserve has cut interest rates by 1.5 percentage points. Other central banks have followed suit. Further deep rate cuts are not possible, though; interest rates were very low long before the virus began to spread.

Let’s get fiscal

Not all central banks are acting as boldly as they can. China has room to cut interest rates—its benchmark rate is 1.5%—but has held back in part because inflation is quite high (largely as a result of African swine fever, which hit pig stocks, raising prices). Central banks could try more creative policies. On March 19th the ECB’s governing council agreed to launch a €750bn bond-buying program, covering both sovereign and corporate debt. But the real action is now taking place on the fiscal front.

Governments are falling over each other to offer bigger and better stimulus packages. All countries are spending more on health care, both in an effort to find vaccines and cures and to increase hospital capacity. However, the bulk of the extra spending is on companies and people.

Take companies first. China, where the outbreak has slowed, is now trying to get people out and buying things. Foshan, a city in Guangdong province, has launched a subsidy program for people buying cars. Some cities have started giving out coupons that can be spent in local shops and restaurants. Nanjing this month gave out e-vouchers worth 318m yuan ($45m).

Most countries, however, are in or about to enter the worst part of the outbreak. As customers dry up, many firms will go bust without government help. Calculations by The Economist suggest that 40% of consumer spending in advanced economies is vulnerable to people shunning social situations. Firms in leisure and hospitality are especially rattled. The Moor of Rannoch hotel, in about as rural a part of Scotland as it is possible to find, says its insurer will not be paying out a penny for lost custom, since COVID-19 is a new disease and thus not covered under its policy.

One approach is to reduce firms’ fixed costs, largely rent and labor. China’s finance ministry will exempt companies from making social-security contributions for up to five months. The government has also temporarily cut the electricity price for most companies by 5% and enacted short-term value-added-tax cuts. The British government has extended a one-year business-rates holiday to all companies operating in the retail, hospitality and leisure sectors. Yet for many firms, no matter how much the government helps them reduce costs, revenues are likely to fall further.

So, measures may be needed to allow firms to maintain cash flow. Many banks are offering hefty overdrafts to tide corporate clients over. To encourage banks to keep lending, Britain has promised them cheap funding and state guarantees against losses. For very small firms, many of which do not borrow at all, it is offering non-repayable cash grants of up to £25,000.

Other countries are enacting similar plans. The Japanese government is helping small firms by mobilizing its state-owned lenders to provide up to ¥1.6trn of emergency loans, much of it free of interest and collateral requirements. Small firms qualify for help if their monthly sales fall at least 15% below a normal month’s takings. Bavaria, a rich state in Germany, announced on March 16th that small and medium-sized companies with up to 250 employees could receive an immediate cash injection of between €5,000 and €30,000. The European Commission has already relaxed state-aid rules so that governments can channel help to ailing companies.

The second part of the fiscal response is about helping people, and in particular protecting them from being made unemployed or suffering a drastic drop in income if that does happen. Ugo Gentilini of the World Bank counts more than 25 countries that are using cash transfers as part of their economic response to the virus. Brazil will give informal workers, who make up roughly 40% of the labor force, 200 Reais ($38) each. Small businesses will be allowed to delay tax payments and pensioners will get year-end benefits early. Australia is instituting a one-time cash payment of A$750 ($434) to pensioners, veterans and people on low incomes.

Northern Europe has led the way on implementing policies that make it less likely firms lay off workers. Germany has relaxed the criteria for Kurzarbeit (“short-time work”), under which the state pays 60-67% of the forgone wages of employees whose hours are reduced by struggling firms. Applications are going “through the roof”, according to the federal labor agency. The use of Kurzarbeit probably halved the rise in unemployment during the recession of 2008-09. More firms are now eligible to use it, temporary workers are covered, and the government will also reimburse the social-security contributions companies make on behalf of affected workers.

Bringing home, the Danish bacon

In Denmark firms that risk losing 30% or more of their workforce will see the government pay 75% of the wages of employees who would otherwise be laid off, until June. Norway’s government has beefed up unemployment benefits, guaranteeing laid-off workers the equivalent of their full salary for the first 20 days. Freelancers whose work vanishes for more than a fortnight will get payments equivalent to 80% of their previous average income. In Sweden the state will cover half of the income of workers who have been let go, with employers asked to cover most of the rest.

So far America has passed more modest legislation. Federal funding for Medicaid, which provides health care for the poor, is likely to boost spending by about $30bn, assuming it remains in place until the end of December, reckons Oxford Economics, a consultancy. America also has a new paid-sick-leave policy for some 30m workers, including 10m who are self-employed, worth just over $100bn. But in that regard America is merely catching up with other rich countries, which have far more generous sick-leave policies. America also has fewer automatic economic stabilizers, such as generous unemployment insurance, than most other rich countries. As a result, its discretionary fiscal boost needs to be especially large to make a difference.

It might be. The Trump administration’s plan to funnel money directly to households, if approved by Congress, is the most significant policy. It bears some resemblance to a scheme that was introduced in February in Hong Kong, in which the government offered HK$10,000 ($1,290) directly to every permanent resident. Mr. Mnuchin is thought to favor a check of $1,000 per American—roughly equal to one week’s average wages for a private-sector worker—with the possibility of a second check later. Some $500bn-worth of direct payments could soon be in the post.

Some economists are leery about such a policy. For one thing, it would do little to prevent employers from letting people go, unlike the plans in northern Europe. Another potential problem, judging by Hong Kong’s experience, is administration of the plan: the territory’s finance secretary hopes to make the first payments in “late summer”, far too far away for people who lost work last week. Mr. Mnuchin promises that payments will happen much sooner.

Checkered past

America has done something similar before, with results that were not entirely encouraging. The government sent out checks in both 2001 and 2008 to head off a slowdown. The evidence suggests that people saved a large chunk of it. The psychological reassurance of a bit of extra cash could be significant for many Americans, but the sums involved are not especially impressive. Bernie Sanders, a Democratic presidential contender, is not known for his smart economic policy making, but his suggestion of $2,000 per household per month until the crisis is over is probably closer to what is required.

Indeed, more fiscal stimulus will be needed across the world, especially if measures to contain the spread of the virus fall short. After the Japanese government passes the budget for next fiscal year at the end of this month, it can begin work on a supplementary budget that takes the virus into full account. Britain’s Parliament has given Rishi Sunak, the chancellor of the exchequer, carte blanche to offer whatever support he deems necessary, without limit.

How much further can fiscal policy realistically go? Last year the 35-odd rich countries tracked by the IMF ran combined fiscal deficits of $1.5trn (2.9% of GDP). On the not-unrealistic assumption that the average deficit rose by five percentage points of GDP, total rich-country borrowing would rise to over $4trn this year. Investors have to be willing to finance that splurge. The yield on ten-year Treasury bonds, which had fallen as low as 0.5% as fears of the virus took hold and traders sought havens, has recently risen above 1%. This is probably due to firms and investors selling even their safest assets to raise cash, but might reflect some anxiety over the scale of planned government borrowing.

Jesse Watters began “Waters’ World” on Saturday by delivering a message of positivity to his audience, saying he’s sure America can overcome the devastation from the coronovirus. “The United States of America is rolling into a recession or a depression. What we do now will determine which one it’ll be. First, we have to stop the spread. You know what to do. Wash your hands, stay clean and practice social distancing,” Watters said, reminding people of the guidelines given to keep people safe from exposure to the virus.

“If you can stay inside this week, work from home if you can. Don’t fly if you don’t have to. The virus is mostly in 10 large counties. A very high percentage in New York, California and Washington state,” he continued. “Some of these areas recognize the threat and are shutting down everything. All of them need to do that.”

Watters talked about where the country stands medically and scientifically, assuring people the “brightest” are on the case. “All the brightest scientists in America [are] working around the clock to find a vaccine. Our people are the most innovative in the world,” Watters said.

The host also addressed the president’s leadership, urging him and American industry leaders to do whatever they can. “The president should be invoking every possible law and power available to him. He should be mobilizing the military and declaring war on the coronavirus. Rally the country around the mantra ‘made in America,'” Watters said. “Every American industry should have all hands-on deck. This isn’t a time for weakness. This is a time for strength.”

“Our country’s fighting an invisible enemy within our borders,” Watters added. “We’ll dull the spike and kill it if we all work together.” Watters expressed his optimism toward an American rebound. “We’ve had to come together by staying apart. I know one thing for sure, we’ll stop it and we’ll kill it and we’ll be a better country for it. Tough times are ahead,” Watters said. “The American character shining bright, loving our families and our neighbors and working nonstop to save lives. It’s now in your hands. We have a great spirit and we shall overcome.”

Italy reported a second successive drop in daily deaths and infections from a coronavirus that has nevertheless claimed more than 6,000 lives in a month.The Mediterranean country has now seen its daily fatalities come down from a world record 793 on Saturday to 651 on Sunday and 601 on Monday.

The number of new declared infections fell from 6,557 on Saturday to 4,789 on Monday. The top medical officer for Milan’s devastated Lombardy region appeared on television smiling for the first time in many weeks. “We cannot declare victory just yet,” Giuglio Gallera said. “But there is light at the end of the tunnel.”

Coronavirus: why the US is in a mess, and How to Fix It and How Does the Virus Affect the Body? The Economy and Do We Have Enough Ventilators?

As this Coronavirus pandemic continues to spread, infect and kill more people we need to look the effects of this crisis. Peter Drobac reported that flattening the curve is the next goal to this new viral pandemic.

It’s always been a question of when, and not whether, humanity would face another challenge on the scale of the 1918 flu pandemic. 

The novel coronavirus is shaping up to be that challenge, with events moving at an unnerving pace. Since emerging in Wuhan, China in late 2019, more than 125,000 cases and 4,600 deaths have been reported worldwide. Officially a pandemic, the virus is shining a harsh spotlight on the strengths and weaknesses of the world’s health systems.

At first glance, the US should be well positioned to respond to a disease outbreak. It spends more than any other country on its health system, boasts a high concentration of specialists and laboratories, and has some of the world’s most respected public health experts. Yet with coronavirus, the US is courting catastrophe.

Because of serious problems with testing, coronavirus has been silently spreading in the US for nearly two months. A Harvard epidemiologist has cautioned that up to 60% of the adult population could become infected. With a health system already operating near its capacity in the height of flu season, this would spell disaster.

Hospitals would be overwhelmed. Shortages of intensive care beds and ventilators would cause death rates to rise. And people with other medical conditions, from complicated pregnancies to heart attacks, would find it more difficult to access the care they need. During the West African Ebola outbreak, health system collapse meant there were nearly as many deaths due to other diseases as from Ebola itself.

Before we all panic, there are some bright spots. Countries in Asia have shown that it is possible to bring the coronavirus epidemic under control, and they’ve had success in different ways.

But first, it’s important to understand what has gone wrong in the US.

Caught flat-footed

When the first coronavirus case was reported in the US on January 20, 2020, alarm bells were already sounding around the world. Unprecedented control measures in China, including the effective quarantine of nearly 100 million people, slowed the spread of the virus and bought the rest of the world time. But while other countries began preparing for the epidemic, the US was caught flat-footed.

Rather than use WHO-approved test kits, the US Centers for Disease Control and Prevention (CDC) developed its own coronavirus test. Regulations prohibited private and university labs from developing tests themselves. Problems with the CDC’s test, along with overly narrow testing criteria, created a massive testing bottleneck.

Fewer than 10,000 tests have been conducted in the US. Compare that with over 200,000 in South Korea. Case detection is the most fundamental part of a public health response to an outbreak. When we can’t do that, we’re operating in the dark.

Meanwhile, years of attempted budget cuts and the elimination of the federal Global Health Security office left America’s vaunted public health agencies less prepared to coordinate a response across the country’s fragmented and unequal health system. Unsteady presidential leadership has sowed confusion and misinformation.

So while 1,215 cases have been reported in 42 states, actually as of Sunday there was only the state of West Virginia that didn’t have a case of the virus, the real number is probably much higher. And with an epidemic that doubles every five days when unchecked, the US may not be far behind Italy.

Flattening the curve

So, what can the US learn from the Asian countries that have managed to blunt the spread of novel coronavirus? While no country has been able to stop the spread of the virus completely, several have managed to “flatten the curve.” What does this mean?

Flattening the epidemic curve means slowing the spread of new infections. This can ensure that not too many people are infected at the same time, giving health systems a better chance to cope. It also buys time, as researchers race to develop and test treatments and vaccines.

New cases in China have gone dropped from a flood to a trickle, at least for now, where they are only reporting 8-10 cases per day since Friday. But it required putting vast swaths of the country on total lockdown, exacting enormous economic and social pain. Italy is now following suit.

Singapore responded early, employing tried-and-tested public health measures: testing, enforced quarantine, and tracing contacts with surgical precision. The US is probably too late for this approach.

Taiwan also responded briskly, establishing a central command center, implementing targeted travel bans and proactive testing, and social distancing measures such as school closures.

South Korea may offer the best example of what could be possible in the US. Like the US, they had to play catch-up, facing a surge of infections tied to a secretive church in Daegu. The pillar of their response has been widespread, free testing, including drive-through test sites. Technology has aided the tracing of contacts, using GPS tracking. Rather than creating a total lockdown, they opted for social distancing measures targeting transmission hot spots. The number of daily new cases has dropped from a peak of 851 to fewer than 250.

Such measures would be workable in the US, but there is no time to waste. The testing bottleneck appears to be loosening, but it may be weeks before testing capacity can catch up to demand. Where possible, localities are taking matters into their own hands. 

In Seattle, one of the country’s transmission hot spots, the University of Washington launched a Korea-style drive-through test centre for its employees and students. In New Rochelle, New York, schools, churches and other gathering places in a “containment area” have been closed down. And mass gatherings are beginning to be cancelled across the country.

Efforts like this need to be scaled and spread dramatically—and quickly. Financial barriers to testing and medical care need to be eliminated, particularly for America’s large uninsured population. Hospitals and healthcare workers will need support to develop parallel care systems for coronavirus patients.

And as school closures, working from home, and transport restrictions are implemented more widely, efforts are needed to protect the most vulnerable.

The Trump administration needs to put the experts in charge and ask Congress for a blank cheque to give them the resources they need. It’s time for a war footing. 

Most importantly, everyone needs to understand that life in the time of coronavirus is different. 

A recession is unlikely but not impossible

Covid-19 infects the world economy?

As reported in Finance and Economics, if the final week of February saw financial markets jolted awake to the dangers of a COVID-19 pandemic, the first week of March has seen policymakers leaping into action. The realization that global GDP will probably shrink for part of this year, and the looming risk of a financial panic and credit-crunch, has led central banks to slash interest rates at a pace last seen in the financial crisis of 2007-09.

On March 3rd the Federal Reserve lowered its policy rate by 0.5 percentage points, two weeks before its scheduled monetary-policy meeting. Central banks in Australia, Canada and Indonesia have also cut rates. The European Central Bank and the Bank of England are expected to follow. If the money-markets are right, more Fed cuts are in store. A composite measure of the global monetary-policy rate, compiled by Morgan Stanley, a bank, is expected to fall to 0.73% by June, from 1% at the start of the year and 2% at the start of 2019.

Yet there is an uneasy feeling that a flurry of rate cuts may not be the solution to this downturn. In part that reflects the fact that they are already so low. A golden rule of crisis-fighting is that in order to be credible you should always have more ammunition available. In 2008-10 the global composite policy rate fell by three percentage points. Today, outside America, rich-world interest rates are close to, at, or below zero. Even the Fed has limited scope to cut much further—one reason, perhaps, why share prices failed to revive in the hours after its latest move.

The tension also stems from the peculiarity of the shock that the economy faces—one that involves demand, supply and confidence effects. The duration of the disruption mainly depends on the severity of the outbreak and the public-health measures undertaken to contain it. Given those uncertainties, policymakers know that while interest-rate cuts are an option, they also need fiscal and financial measures to help business and individuals withstand a temporary but excruciating cash crunch.

One way the virus hurts the economy is by disrupting the supply of labour, goods and services. People fall ill. Schools close, forcing parents to stay at home. Quarantines might force workplaces to shut entirely. This is accompanied by sizable demand effects. Some are unavoidable: sick people go out less and buy fewer goods. Public-health measures, too, restrict economic activity. Putting more money into consumers’ hands will do little to offset this drag, unlike your garden-variety downturn. Activity will resume only once the outbreak runs its course.

Then there are nasty spillovers. Both companies and households will face a cash crunch. Consider a sample of 2,000-odd listed American firms. Imagine that their revenues dried up for three months but that they had to continue to pay their fixed costs, because they expected a sharp recovery. A quarter would not have enough spare cash to tide them over, and would have to try to borrow or retrench. Some might go bust. Researchers at the Bank for International Settlements, a club of central banks, find that over 12% of firms in the rich world generate too little income to cover their interest payments.

Many workers do not have big safety buffers either. They risk losing their incomes and their jobs while still having to make mortgage repayments and buy essential goods. More than one in ten American adults would be unable to meet a $400 unexpected expense, equivalent to about two days’ work at average earnings, according to a survey by the Federal Reserve. Fearing a hit to their pockets, people could start to hoard cash rather than spend, further worsening firms’ positions.

Modeling the resulting hit to economic activity is no easy task. In China, which is a month ahead of the rest of the world in terms of the outbreak, a survey of purchasing managers shows that manufacturing output in February sank to its lowest levels since factory bosses were first surveyed in 2004. It seems likely that GDP will contract in the first quarter for the first time since the death of Mao Zedong in 1976.

Forecasters are penciling in sharp falls in output elsewhere (see chart 1). Goldman Sachs, a bank, reckons global GDP will shrink at an annualized rate of 2.5% in the first quarter. With luck the slump will end once the virus stops spreading. But even if that happens the speed and size of the economic bounce-back also depends on the extent to which those costly spillovers are avoided.

That is why central bankers and finance ministries are turning to more targeted interventions (see chart 2). These fall into three broad categories: policies to ensure that credit flows smoothly through banks and money markets; measures to help companies bear fixed costs, such as rent and tax bills; and measures to protect workers by subsidizing wage costs.

Start with credit flows. Central banks and financial regulators have tried to ensure that markets do not seize up, but instead continue to provide funds to those who need them. On March 2nd the Bank of Japan conducted ¥500bn ($4.6bn) of repo operations to ensure enough liquidity in the system. The People’s Bank of China has offered 800bn yuan ($115bn, or 0.8% of GDP) in credit to banks so long as they use it to make loans to companies badly hit by the virus. Banks have been asked to go easy on firms whose loans are coming due.

Governments are also helping firms with their costs, the second kind of intervention. Singapore plans corporate-tax breaks, and rental and tax rebates for commercial property. Korea will give cash to small firms struggling to pay wages. Italy will offer tax credits to firms that experience a 25% drop in turnover. In China the government has told state landlords to cut rents and given private-sector landlords subsidies to follow suit.

The final set of measures is meant to protect workers by preventing lay-offs and keeping incomes stable. China’s government has enacted a temporary cut to social-security contributions. Japan will subsidize wages of people who are forced to take time off to care for children or for sick relatives. Singapore has announced cash grants for employers of affected workers.

Today these policies are being sporadically announced, and their implementation is uncertain. As the virus spreads, expect more interest-rate cuts—but also the systematic deployment of a more complex cocktail of economic remedies. ■

As the Pandemic Spreads, Will There Be Enough Ventilators?

Patti Neighmond noted that as the coronavirus that causes COVID-19 spreads across the United States, there are continuing concerns among hospitals, public health experts and government leaders that hospital intensive care units would be hard-pressed to handle a surge in seriously ill patients.

A key limiting factor to being able to provide good care, they say, is the number of ventilation machines — ventilators — a hospital has on hand to help the most seriously ill patients breathe.

“The coronavirus, like many respiratory viruses, can cause inflammation in the lungs,” explains Dr. William Graham Carlos a pulmonary critical care specialist at Indiana University School of Medicine “And when the lungs become inflamed, the membranes that transfer oxygen from the air into the blood become blocked.”

When patients develop this type of viral pneumonia, they often require bedside ventilators which, Carlos says “can supply higher levels of oxygen and also help push air into the lungs to open them up, and afford more opportunity to get oxygen into the patient.”

Ventilators are generally a temporary bridge to recovery — many patients in critical care who need them do get better. These machines can be crucial to sustaining life in certain emergency situations. And if there is a surge in seriously ill patients, as COVID-19 spreads, ventilators could be in short supply, from hospital to hospital or nationally.

And if there’s an increase in very sick patients on a scale like what happened in China, Dr. Eric Toner says, the U.S. is not prepared. Toner studies hospital preparedness for pandemics at the Johns Hopkins Center for Health Security.

“We are not prepared, nor is any place prepared for a Wuhan-like outbreak,” Toner tells NPR, “and we would see the same sort of bad outcomes that they saw in Wuhan — with a very high case fatality rate, due largely to people not being able to access the needed intensive care.”

Toner says all hospitals have some lifesaving ventilators, but that number is proportional to the number of hospital beds in the institution. An average-sized hospital with 150 beds, for example, might have 20 ventilators. If more were needed, hospitals that need them could rent them, he says — at least for now. But if there’s a surge of need in a particular community — patients with serious pneumonia from COVID-19 or pneumonia related to flu, for example — all hospitals in the area would be competing to rent from the same place. “So that’s a very finite resource” he says.

The latest study available estimates there are about 62,000 ventilators in hospitals nationwide. That figure is seven years old — so the actual number could be higher.

There are also some machines in federally stockpiled emergency supplies, though the exact number isn’t public.

“There is a strategic national stockpile of ventilators, but the numbers are classified,” says Toner. It’s been “publicly stated,” he says, that there are about 10,000 ventilators in the national stockpile. “That number might be a bit outdated, but it’s probably about right,” he says. Other estimates range from 4,000 to somewhat less than 10,000.

You Have A Fever And A Dry Cough. Now What?

While any extra ventilators would be an important addition, Toner says it likely wouldn’t be enough to sustain the entire country through an experience like that seen in Wuhan, China.

If there’s not enough capacity at one hospital, it may be possible to transfer patients to another, he says.

“Not every community is going to be hit simultaneously; some cities will be badly affected while others are not so badly affected and then the wave of disease will move on.” So, in some cases, Toner says, it seems likely that patients could be transferred from an area where ventilators are scarce to an area where the supply is adequate.

But if hospitals continue to be overwhelmed, he says, at that point, “tough decisions would have to be made about who gets access to a ventilator and who does not.”

All health care providers and hospitals are now working overtime to try to prevent that sort of scenario.

Dr. Craig Coopersmith with Emory University School of Medicine, and a spokesperson for the Society of Critical Care Medicine, says he sees signs all across America that medical communities are working together to prepare.

Evergreen Hospital in Washington State, for example, which treated some of the first U.S. COVID-19 patients in late February, this week posted online its own “Lessons for Hospitals.” There has been a lot of ongoing communication, Coopersmith says, between hospitals, professional societies and individuals — in person, by phone and via shared Listservs and social media.

“In multiple ways, people are linking with each other to say ‘I’m not going to do this in isolation; tell me how you’re doing this, let me tell you how I’m doing this and let’s share lessons with each other,’ ” Coopersmith says.

The pandemic, he adds, is “remarkably challenging. But he sees the health care system’s response to it as remarkably heartening, “with everyone working together to ensure what’s best for patients, caregivers and the community.”

What does the coronavirus do to your body? Everything to know about the infection process

A visual guide of coronavirus infection, symptoms of COVID-19 and the effects of the virus inside the body, in graphics

Javier Zarracina and Adrianna Rodriquez reported that as the COVID-19 pandemic spreads across the U.S. – canceling major events, closing schools, upending the stock market and disrupting travel and normal life – Americans are taking precautions against the new coronavirus that causes the disease sickening and killing thousands worldwide.

The World Health Organization and U.S. Centers for Disease Control and Prevention advise the public be watchful for fever, dry cough and shortness of breath, symptoms that follow contraction of the new coronavirus known as SARS-CoV-2.

From infection, it takes approximately five to 12 days for symptoms to appear. Here’s a step-by-step look at what happens inside the body when it takes hold. 

Coronavirus infection

According to the CDC, the virus can spread person-to-person within 6 feet through respiratory droplets produced when an infected person coughs or sneezes. 

It’s also possible for the virus to remain on a surface or object, be transferred by touch and enter the body through the mouth, nose or eyes.

Dr. Martin S. Hirsch, senior physician in the Infectious Diseases Services at Massachusetts General Hospital, said there’s still a lot to learn but experts suspect the virus may act similarly to SARS-CoVfrom 13 years ago.

“It’s a respiratory virus and thus it enters through the respiratory tract, we think primarily through the nose,” he said. “But it might be able to get in through the eyes and mouth because that’s how other respiratory viruses behave.”

When the virus enters the body, it begins to attack.

Fever, cough and other COVID-19 symptoms 

It can take two to 14 days for a person to develop symptoms after initial exposure to the virus, Hirsch said. The average is about five days.

Once inside the body, it begins infecting epithelial cells in the lining of the lung. A protein on the receptors of the virus can attach to a host cell’s receptors and penetrate the cell. Inside the host cell, the virus begins to replicate until it kills the cell. 

This first takes place in the upper respiratory tract, which includes the nose, mouth, larynx and bronchi.

The patient begins to experience mild version of symptoms: dry cough, shortness of breath, fever and headache and muscle pain and tiredness, comparable to the flu.

Dr. Pragya Dhaubhadel and Dr. Amit Munshi Sharma, infectious disease specialists at Geisinger, say some patients have reported gastrointestinal symptoms such as nausea and diarrhea, however it’s relatively uncommon. 

Symptoms become more severe once the infection starts making its way to the lower respiratory tract.

Pneumonia and autoimmune disease

The WHO reported last month about 80% of patients have a mild to moderate disease from infection. A case of “mild” COVID-19 includes a fever and cough more severe than the seasonal flu but does not require hospitalization.

Those milder cases are because the body’s immune response is able to contain the virus in the upper respiratory tract, Hirsch says. Younger patients have a more vigorous immune response compared to older patients.

Dr. Pragya Dhaubhadel and Dr. Amit Munshi Sharma, infectious disease specialists at Geisinger, say some patients have reported gastrointestinal symptoms such as nausea and diarrhea, however it’s relatively uncommon. 

Symptoms become more severe once the infection starts making its way to the lower respiratory tract.

Pneumonia and autoimmune disease

The WHO reported last month about 80% of patients have a mild to moderate disease from infection. A case of “mild” COVID-19 includes a fever and cough more severe than the seasonal flu but does not require hospitalization.

Those milder cases are because the body’s immune response is able to contain the virus in the upper respiratory tract, Hirsch says. Younger patients have a more vigorous immune response compared to older patients.

The 13.8% of severe cases and 6.1% critical cases are due to the virus trekking down the windpipe and entering the lower respiratory tract, where it seems to prefer growing.

“The lungs are the major target,” Hirsch said.

As the virus continues to replicate and journeys further down the windpipe and into the lung, it can cause more respiratory problems like bronchitis and pneumonia, according to Dr. Raphael Viscidi, infectious disease specialist at Johns Hopkins Medicine.

Pneumonia is characterized by shortness of breath combined with a cough and affects tiny air sacs in the lungs, called alveoli, Viscidi said. The alveoli are where oxygen and carbon dioxide are exchanged.

When pneumonia occurs, the thin layer of alveolar cells is damaged by the virus. The body reacts by sending immune cells to the lung to fight it off. 

“And that results in the linings becoming thicker than normal,” he said. “As they thicken more and more, they essentially choke off the little air pocket, which is what you need to get the oxygen to your blood.” 

“So it’s basically a war between the host response and the virus,” Hirsch said. “Depending who wins this war we have either good outcomes where patients recover or bad outcomes where they don’t.”

Restricting oxygen to the bloodstream deprives other major organs of oxygen including the liver, kidney and brain. 

In a small number of severe cases that can develop into acute respiratory distress syndrome (ARDS), which requires a patient be placed on a ventilator to supply oxygen. 

However, if too much of the lung is damaged and not enough oxygen is supplied to the rest of the body, respiratory failure could lead to organ failure and death. 

Viscidi stresses that outcome is uncommon for the majority of patients infected with coronavirus. Those most at risk to severe developments are older than 70 and have weak immune responses. Others at risk include people with pulmonary abnormalities, chronic disease or compromised immune systems, such as cancer patients who have gone through chemotherapy treatment. 

Viscidi urges to public to think of the coronavirus like the flu because it goes through the same process within the body. Many people contract the flu and recover with no complications. 

“People should remember that they’re as healthy as they feel,” he said. “And shouldn’t go around feeling as unhealthy as they fear.” 

Coronavirus Disease 2019: Myth vs. Fact 

There’s a lot of information circulating about Coronavirus Disease 2019 (COVID), so it’s important to know what’s true and what’s not. Lisa Maragakis, M.D., M.P.H., senior director of infection prevention at Johns Hopkins, helps clarify information to help keep you and your family healthy and safe.

TRUE or FALSE? A vaccine to cure COVID-19 is available.

FALSE.

True: There is no vaccine for the new coronavirus right now. Scientists have already begun working on one, but developing a vaccine that is safe and effective in human beings will take many months.

TRUE or FALSE? You can protect yourself from COVID-19 by swallowing or gargling with bleach, taking acetic acid or steroids, or using essential oils, salt water, ethanol or other substances.

FALSE.

True: None of these recommendations protects you from getting COVID-19, and some of these practices may be dangerous. The best ways to protect yourself from this coronavirus (and other viruses) include:

Washing your hands frequently and thoroughly, using soap and hot water.

Avoiding close contact with people who are sick, sneezing or coughing.

In addition, you can avoid spreading your own germs by coughing into the crook of your elbow and staying home when you are sick.

TRUE or FALSE? The new coronavirus was deliberately created or released by people.

FALSE.

True: Viruses can change over time. Occasionally, a disease outbreak happens when a virus that is common in an animal such as a pig, bat or bird undergoes changes and passes to humans. This is likely how the new coronavirus came to be.

TRUE or FALSE? Ordering or buying products shipped from China will make a person sick.

FALSE.

True: Researchers are studying the new coronavirus to learn more about how it infects people. As of this writing, scientists note that most viruses like this one do not stay alive for very long on surfaces, so it is not likely you would get COVID-19 from a package that was in transit for days or weeks. The illness is most likely transmitted by droplets from an infected person’s sneeze or cough, but more information is emerging daily.

TRUE or FALSE? A face mask will protect you from COVID-19.

FALSE.

True: Certain models of professional, tight-fitting respirators (such as the N95) can protect health care workers as they care for infected patients.

For the general public without respiratory illness, wearing lightweight disposable surgical masks is not recommended. Because they don’t fit tightly, they may allow tiny infected droplets to get into the nose, mouth or eyes. Also, people with the virus on their hands who touch their face under a mask might become infected.

People with a respiratory illness can wear these masks to lessen their chance of infecting others. Bear in mind that stocking up on masks makes fewer available for sick patients and health care workers who need them.

We all have to utilize the best actions to get through this pandemic with good hygiene, cleaning surfaces and social distancing. Remember, we have no vaccines, not antiviral agents proven to work. Therefore, we need to our immune systems and the health care system to flatten the outbreak curve. We need to take the police out of the equation and decision making and support our health care, our workers who will lose their jobs due to this pandemic and the economy. Now!!