Tag Archives: Corona Virus

3 States See Record High in Daily Coronavirus Infections After Reopening; and What About the Rest of the World?

Many were waiting whether lockdowns were the answer to this pandemic, especially when we learned that Sweden didn’t mandate lockdowns or self-quarantines. But low and behold we learn of the spike in infections and deaths at the end of last week. In the article by Meghan Roos, 6/12/2020, In Sweden, Where No Lockdown was Ever Implemented, there was an increase one day spike of 1,474 on Thursday, 6/11/2020. Swedish health officials reported 49,684 infections and 4,854 deaths by Friday 6/12/2020. This country now has one of the highest per capita fatality rates in the world with an estimate 10 per cent of all COVID-19 cases resulting in death, accounting to date from John Hopkins University.

Now, as Nick Visser reported that Texas, Arizona and Florida all reported their highest daily increases in new coronavirus cases on Tuesday, even after all three states implemented and later lifted stay-at-home orders meant to stop the spread of infections.

State officials in Florida reported 2,783 new cases, in Texas, 2,622, and in Arizona, 2,392. All three states have seen social distancing regulations relaxed for weeks, and most businesses have been allowed to reopen in some capacity.

The figures come amid ongoing efforts by President Donald Trump and other Republican leaders to downplay the ongoing spread of the virus. At least 21 states have seen rates of new cases increase over the last two weeks as a majority of the country reopens.

At the same time, Trump has been pushing misleading claims that infections are only increasing because there’s more testing, going so far as to claim Monday, without evidence, that “if we stop testing right now, we’d have very few cases, if any.”

The president is also preparing to hold a massive rally in Oklahoma this weekend with 20,000 attendees at an indoor arena, despite pleas from local officials and health professionals that the event could quickly lead to a renewed outbreak in the state. Infection rates in Oklahoma rose 68% in the second week of June. 

“I’m extremely concerned,” Bruce Dart, the executive director of the Tulsa health department, told the Tulsa World. “I think we have the responsibility to stand up when things are happening that I think are going to be dangerous for our community, which it will be. It hurts my heart to think about the aftermath of what’s going to happen.”

Other state leaders have pushed back their own reopening efforts as cases have surged, including the governors of Utah and Oregon.

But in Florida, Gov. Ron DeSantis (R) said he was not considering another shutdown despite the surge in cases. He also rolled out the White House’s misleading talking point that cases were rising only because of increased testing.

“We’re not rolling back,” DeSantis said during a press briefing, according to the Miami Herald. “The reason we did the mitigation was to protect the hospital system.”

“You have to have society function,” he added. “To suppress a lot of working-age people at this point I don’t think would be very effective.”

In Arizona, some health officials were already reporting a strain on hospitals’ intensive care capacity due to a spike in coronavirus cases, even as Gov. Doug Ducey (R) said any concern was “misinformation” and said the facilities were prepared to handle an influx in patients.

And in Texas, Gov. Greg Abbott (R) said that, despite his own state’s figures, hospital capacity remained “abundant.”

“The more Texans protect their own health, the safer our state will be and the more we will be able to open up for business,” he said Tuesday.

Dr. Anthony Fauci, the country’s top infectious disease expert, said that, despite the attempts to alleviate any concern, some states jumped the gun on reopening before meeting White House criteria on case levels.

“There certainly were states that did not strictly follow the guidelines that we put out about opening America again,” Fauci said in an interview with NPR. “Clearly there were states that ― left to their own decision about that ― went ahead and opened to a varying degree … certainly before they got to the benchmarks that they needed to get.”

Recent news report is that multiple Florida hospitals have run out of ICU beds as the Coronavirus cases continue to spike.

In This State, the Virus Is ‘Spreading Like Wildfire’

Jenn Gidman noted that as states start to reopen, as well as the recent ongoing protests, amid the pandemic, there’s a red flag rising out of the Southwest. Business Insider reports the coronavirus outbreak “is going very badly” in Arizona, with more than 4,400 new cases over the weekend, bringing the total number of cases in the state to more than 37,500 as of Sunday, with nearly 1,200 deaths. Per Healthline, there’s been a 300% increase in reported cases since May 1. Tucson.com reports that in just one week (from May 31 to June 6), the state saw its biggest week-to-week increase yet: 7,121 new coronavirus patients, or about a 54% increase from the previous week. Meanwhile, the Arizona Republic reports that hospitalizations are on the rise as well, with two straight weeks of statewide hospitalizations surpassing 1,000 daily—the highest number since state reporting began in the beginning of April. Will Humble, a former director of the state’s Department of Health Services, says the spike is “definitely related” to the state’s stay-at-home order being dropped on May 15, per Newsweek. More on the Grand Canyon State:

Eyewitness to tragedy: CBS 5 talked to one doctor who works at two Phoenix hospitals, and he described what he’s been seeing in ERs and ICUs. “He asked if he could make a call in the hospital,” he says of one elderly patient. “It was very tragic to hear him say goodbye to his godkids and grandchildren, who you could really tell loved him.”

Texas Governor Says ‘No Reason Today to Be Alarmed’ As Coronavirus Cases Set Record

One question that I have is if states or cities declare a lockdown whether people will adhere to the lockdown?  Laurel Wamsley reported that Texas has seen a recent uptick in the number of COVID-19 cases, with a record level of new cases and hospitalizations announced Tuesday. People are seen here Monday along the San Antonio River Walk.

Texas Gov. Greg Abbott announced on Tuesday the state’s highest-ever number of new COVID-19 cases: 2,622.

He also reported a second record high: 2,518 people hospitalized with the virus in Texas, up from 2,326 a day earlier.

Despite the concerning uptick in people sick with the virus, Abbott said that the reason for his news conference was to let Texans know about the “abundant” hospital capacity for treating people with COVID-19. He and other officials spent much of the briefing touting the state’s hospital bed availability.

Disclosing the new record high number of hospitalizations related to COVID-19, Abbott emphasized that figure is “really a very small percentage of all the beds that are available.” Texas has so far been spared the high case numbers in other populous states. While it’s the second-largest state by population, Texas currently ranks sixth in terms of cumulative case numbers.

Before releasing the number of new cases, Abbott delved into what he said accounted for the previous daily high on June 10, which had 2,504 new cases. The governor said that spike could be largely attributed to 520 positive tests of inmates in Texas prisons being reported at once as well as a data error in a rural county.

He said there are also reasons for why Tuesday’s new case count was so high: tests results coming from an assisted living facility near Plano; a county south of Austin where positive cases seemed to be reported in batches; and 104 cases in one East Texas county that appear to be primarily from tests at a prison.

But he also pointed to uncareful behavior as a possible driver in some of the new cases. Abbott said there were a number of counties where a majority of those who tested positive for the coronavirus were under the age of 30, which he attributed to people going to “bar-type” settings or Memorial Day celebrations and not taking health precautions.

Abbott said that measures such as wearing masks, hand sanitizing and social distancing are what make it possible to reopen the state’s economy and Dr. John Hellerstedt, commissioner of the Texas Department of State Health Services, struck the same note.

“The message is we are seeing some increase in the number of COVID patients in the state. We expected this,” he said. “But we are seeing it occurring at a manageable level. I really want to stress that the continued success is up to the people of the state of Texas.”

Despite Abbott’s emphasis on the importance of masks, he has barred Texas cities from implementing any rules that would require face coverings. Abbott signed an executive order on April 27 that says while individuals are encouraged to wear face masks, “no jurisdiction can impose a civil or criminal penalty for failure to wear a face covering.”

On Tuesday, the mayors of nine Texas cities — including Houston, Dallas, San Antonio, Austin, Fort Worth and El Paso — sent a letter to the governor asking for the authority to set the rules and regulations on the use of face coverings.

“A one-size-fits-all approach is not the best option. We should trust local officials to make informed choices about health policy. And if mayors are given the opportunity to require face coverings, we believe our cities will be ready to help reduce the spread of this disease,” they wrote. “If you do not have plans to mandate face coverings statewide, we ask that you restore the ability for local authorities to enforce the wearing of face coverings in public venues where physical distancing cannot be practiced.”

Abbott said Tuesday that judges and local officials have other tools available for enforcement such as issuing fines for gatherings that don’t follow state protocols.

Austin Mayor Steve Adler extended a stay-at-home warning on Monday amid the news of rising cases – but that warning could only be advice to residents and not an order due to the state’s preemption.

“People are confused,” Adler told NPR’s Steve Inskeep on Tuesday. “They just don’t know at this point if it’s really important to wear face coverings or not, because I think they’re feeling like they’re getting mixed messaging — not only from state leadership but from national leadership. So, we’re just not getting the vigilance that we need on these efforts.”

And the Surges In COVID-19 Cases Cause Friction Between Local Leaders, Governors

In Austin, Adler said, you’ll see most everyone wearing a mask in grocery stores but not in restaurants or music clubs: “When we started opening up the economy and when the governor took away from cities the ability to make it mandatory, more and more people stopped wearing them.”

Adler said he agreed with Abbott that face coverings are key to reopening parts of the economy, even if they’re unpleasant for wearers.

“I know it’s inconvenient. I know it’s hot. I know it’s a nuisance,” Adler said. “And it’s hard to do, and people don’t like it. But at the same time, our community has to decide just how much we value the lives of folks in our community that are over 65 and older. We have to decide how much we value the lives of the communities of color that are suffering disproportionately because of this virus.”

Florida Officials Spar Over Rising COVID-19 Cases

Greg Allen reported that in Florida, where there’s a surge of new COVID-19 cases, officials are divided over what to do about it. The state saw 2,783 new cases Tuesday. It was the third time in the past seven days that Florida set a new daily record.

Florida Gov. Ron DeSantis and other Republican officials, including President Trump, say the rising number of new cases was expected and is mostly the result of increased testing. Florida is now testing more than 200,000 people a week, more than double the number tested weekly in mid-May.

But local officials and public health experts are concerned about other statistics that show that the coronavirus is still spreading in Florida. The state’s Department of Health reports that the number of people showing up in hospital emergency rooms with symptoms of the flu and COVID-19 is rising. Also, worrisome — the percentage of people who are testing positive for the virus is going up, total positive residents are 63,374 with 11,008 hospitalizations and 2,712 deaths.

In Palm Beach County, health director Alina Alonso says the rising positivity rate is a clear sign that the new cases can’t just be attributed to increased testing. Since Palm Beach County began allowing businesses to reopen, Alonso says, the percentage of people testing positive has jumped from 4.9% to 8.9%. “The fact that these are going up means there’s more community spread,” she says. “The virus now has food out there. It has people that are out there without masks, without maintaining distancing. So, it’s infecting more people.”

Alonso say the number of people hospitalized for the coronavirus has also gone up in Palm Beach County. “The numbers are very concerning to the hospitals,” she says. So far, the number of deaths from COVID-19 has remained low. But Alonso says deaths lag behind new recorded cases by about six weeks. She thinks the number of deaths will also rise. “We need to be cautious at this time. Wait a little bit until we see whether or not that happens,” she says. “If we go forward without waiting to see what is going on … by the time we get those deaths, it will be too late.”

Palm Beach County currently isn’t requiring residents to wear face coverings when in public places. County commissioners are now considering following the lead of Broward and Miami-Dade counties and making face masks mandatory.

In Tallahassee, DeSantis held a news conference where he responded to concerns about the rising positivity rate. Much of it, he said, is related to outbreaks among farmworkers and people in prison. Among the incidents he highlighted — a watermelon farm near Gainesville where, out of 100 workers tested, 90 were positive. DeSantis said, “When you have 90 out of 100 that test positive, what that does to positivity — that’s huge numbers.” Some of the other localized outbreaks among farmworkers, he noted, were in Palm Beach County.

DeSantis said there’s no reason to consider rolling back the rules allowing businesses to reopen at the moment. He has encouraged the resumption of sports events and attended a NASCAR race in Homestead, Fla., on Sunday with a few hundred other spectators. And he successfully lobbied for Florida to host President Trump’s acceptance speech at a Republican National Convention event in Jacksonville. That gathering is expected to draw thousands.

Democrats have become increasingly critical, saying DeSantis is ignoring important data that favor a more cautious response. Florida’s top elected Democrat, Agriculture Commissioner Nikki Fried, said, “Refusing to acknowledge the alarming patterns in cases, hospitalizations and positivity is not only arrogant but will cost lives, public health and our economy.”

Asymptomatic coronavirus transmission appears worse than SARS or influenza — a runner can leave a ‘slipstream’ of 30 feet

Quentin Fottrell reported that the WHO currently estimates that 16% of people are asymptomatic and can transmit the novel coronavirus, while other data show that 40% of coronavirus transmission is due to carriers not displaying symptoms of the illness. One study says that asymptomatic transmission “is the Achilles” heel of COVID-19 pandemic control. How worried should you be about asymptomatic transmission of COVID-19?

 hours earlier that transmission of the novel coronavirus in carriers who don’t show apparent symptoms happened in “very rare” cases.

Maria Van Kerkhove said it was a “misunderstanding to state that asymptomatic transmission globally is very rare,” and that her comments during a WHO news briefing had been based on “a very small subset of studies.” “I was just responding to a question; I wasn’t stating a policy of WHO,” she said.

The WHO currently estimates that 16% of people with COVID-19 are asymptomatic and can transmit the coronavirus, while other data show that 40% of coronavirus transmission is due to carriers not displaying symptoms of the illness.

Public-health officials have advised people to keep a distance of six feet from one another. Face masks are designed to prevent the wearer, who may be infected with COVID-19 but have very mild or no symptoms, from spreading invisible droplets to another person and thereby infecting them too. But “there’s nothing magic about six feet,” said Gregory Poland, who studies the immunogenetics of vaccine response in adults and children at the Mayo Clinic in Rochester, Minn., and is an expert with the Infectious Diseases Society of America.

“The virus can’t measure,” he told MarketWatch. “For example, the viral cloud while speaking will extend 27 feet and linger in the air for about 30 minutes. This is more like influenza in the sense that people transmit the virus prior to experiencing any symptoms and some people, of course, will not get sick.”

Asymptomatic transmission “is the Achilles’ heel of COVID-19 pandemic control through the public-health strategies we have currently deployed,” according to a study by researchers at the University of California, San Francisco published May 28 in the New England Journal of Medicine.

“Symptom-based screening has utility, but epidemiologic evaluations of COVID-19 outbreaks within skilled nursing facilities … strongly demonstrate that our current approaches are inadequate,” researchers Monica Gandhi, Deborah Yokoe and Diane Havlir wrote.

Brazil is on track to lead the world in coronavirus cases and deaths, and it still doesn’t have a plan for tackling the outbreak

Amanda Perobelli reported that Brazil could surpass the US in coronavirus cases and deaths by the end of July, according to estimates from the University of Washington.

The country recorded a daily record of 34,918 new coronavirus cases on Tuesday, according to Reuters. And despite the growing number of cases, the country has not created a plan to tackle the outbreak. Brazil could surpass the US in both coronavirus infections and deaths by the end of July, according to the main coronavirus tracking model from the University of Washington.

The country, which has yet to impose a national coronavirus lockdown, is on its way to registering more than 4,000 daily deaths, The Washington Post reported, citing the university. As of Tuesday, Brazil had more than 923,000 coronavirus infections and more than 45,000 deaths. Experts told Reuters the true number of cases was most likely higher.

As The Post noted, the country doesn’t have the same infrastructure to help it handle such a large outbreak as the US. But that hasn’t stopped President Jair Bolsonaro from largely dismissing the crisis the novel coronavirus is causing. In fact, he’s even attacked governors who chose to impose restrictions and threatened to host large barbecues in spite of public-health advice, The Post reported.

Brazil has not initiated a national testing campaign, has not implemented a national lockdown, and is dealing with insufficient healthcare expansion. Reuters reported that that country counted 34,918 new daily coronavirus cases on Tuesday.

In a report in early May, Carlos Machado, a senior scientist with Brazil’s Oswaldo Cruz Foundation, and his team warned that without a lockdown in Rio de Janeiro, the outcome would be “in a human catastrophe of unimaginable proportions.” He now says had his warnings been taken seriously, the outcome would not have been so bleak.

“From the point of view of public health, it’s incomprehensible that more-rigorous measures weren’t adopted,” Machado told The Post. “We could have avoided many of the deaths and cases and everything else that is happening in Rio de Janeiro. It was an opportunity lost.”

Scientists in the country told The Post that the country was veering into unknown territory. “We are doing something that no one else has done,” Pedro Hallal, an epidemiologist at the Federal University of Pelotas, told The Post. “We’re getting near the curve’s peak, and it’s like we are almost challenging the virus. ‘Let’s see how many people you can infect. We want to see how strong you are.’ Like this is a game of poker, and we’re all in.”

Bolsonaro’s approach has been to ignore the problem and sideline health experts

Reuters reported that senior officials leading Brazil’s coronavirus response had claimed the outbreak was under control.

“There is a crisis, we sympathize with bereaved families, but it is managed,” said Braga Netto, who spoke during a webinar held by the Commercial Association of Rio de Janeiro.

The World Health Organization’s regional director Carissa Etienne said Brazil was a major concern, Reuters reported. “We are not seeing transmission slowing down” in Brazil, Etienne said. Etienne said the country accounted for about 4 million coronavirus cases in the Americas and about 25% of the deaths.

The Post described Bolsonaro’s approach as being to ignore and sideline health experts. The Brazilian president fired Luiz Henrique Mandetta, his first health minister, after disagreements on social distancing, and then he fired his replacement, Nelson Teich, because he disagreed with the use of chloroquine as a treatment for coronavirus.

Similar to US President Donald Trump, Bolsonaro has boosted the use of hydroxychloroquine in the past. On Monday, the US Food and Drug Administration revoked the emergency-use authorization issued for the antimalarial drug.

One expert said even the public in Brazil did not heed public-health advice to limit the spread of the virus and continued to congregate without any safety measures implemented.

“It was a failure,” Ligia Bahia, a professor of public health at the Federal University of Rio de Janeiro, told The Post. “We didn’t have enough political force to impose another way. The scientists alone, we couldn’t do it. There’s a sense of profound sadness that this wasn’t realized.”

Presently there is only one country that has declared it COVID-19 cleared, that is Montenegro. New Zealand has declared their country COVID-19 free and then two cases turned up as two people from Europe who traveled to New Zealand tested positive and are now quarantined.

Look at the recent world numbers where the total cases are 8,174,327 with 443,500 deaths. Way too many!

When will it all be over?

People are Truly Stupid- People are furious over 2020 graduation ceremonies, the latest coronavirus political battleground

Lilly Altavena reported that people are furious about not being able to have their graduation ceremonies. How silly! Keiv Soliman doesn’t want to receive his diploma joined on-stage by a hologram of his principal. 

But as the coronavirus continues to cast a shadow on American traditions, making large gatherings like graduation ceremonies dangerous, a virtual ceremony might be the Highland High School senior’s only chance at pomp and circumstance. 

Soliman’s school, in Gilbert, Arizona, is staging an elaborate virtual graduation ceremony, where Highland seniors will be filmed walking across a stage to receive their diploma.

Their principal will read student names from a different room. Using “holographic technology,” video editors will then edit the ceremony to make it appear as if everyone was in the same room together.

But Soliman’s friends don’t want a studio-produced graduation, he said. They want a real ceremony. Soliman started a petition, which has more than 600 signatures so far, asking for an in-person ceremony — with masks and social distancing.

“You can’t really replace the real thing with anything but the real thing,” Soliman said. 

Graduation ceremonies have become a political battleground for schools, students and parents in the wake of school closures caused by the coronavirus. Some believe they can have a ceremony safely while others are accusing the high-schoolers and their parents of being selfish during a global pandemic.

“This is much bigger than a graduation ceremony,” said Reed Burris, a Gilbert resident opposed to in-person ceremonies. “You should be pushing for people to stay inside.” 

Soliman’s petition is one of more than 500 on Change.org, pleading for the preservation of in-person ceremonies across the U.S. 

Not the real thing, but… Students will cross the finish line to high school with a lap at the Daytona 500In Knoxville, Tennessee, district leaders backpedaled on a plan to hold graduation without guests when parents revolted. 

“There’s a lot more involved in these ceremonies than a student getting a paper diploma and turning their tassel,” Knox County Mayor Glenn Jacobs said.

The discourse shares similarities with the fervent demonstrations staged for and against reopening America’s businesses, as well as the debate over the use of masks in public places. The rancor underscores an increasingly fractured conversation around COVID-19. 

Uncertainty looms over ceremonies

Arizona’s stay-at-home order expires Friday. The governor isstill encouraging social distancing, but nothing in his new order appears to forbid gatherings.

The Arizona Department of Health Services recommended on Monday “that mass gatherings (such as graduations, concerts) are not held at this time.” 

Even still, the agency outlined steps for attendees and organizers to take if they planned to forge ahead with a ceremony: 

  • Anyone sick should stay home. 
  • Attendees should stay six feet away from each other.
  • Anyone in a high-risk group should not attend, including older adults and anyone with a serious underlying medical condition. 
  • Attendees should not touch their eyes, nose or mouth and should use hand sanitizer after leaving the event. They should also wash their hands with soap and water for at least 20 seconds upon returning home. 
  • Attendees should cover their faces at the event.
  • They should not borrow or rent graduation regalia.

Major Arizona school districts have either postponed ceremonies or have decided to hold virtual ceremonies.

Chandler Unified, the second-largest school district in the state, wrote to families on May 5 that the district is working on a plan to hold graduation ceremonies at each high school “while still adhering to the recommended CDC guidelines.”

At the ceremonies, students would be seated six feet apart and the audience would likely be limited. The ceremonies would be livestreamed for families to watch.

One superintendent in suburban Milwaukee, Wisconsin, initially resisted the idea of a virtual graduation because it made the emotional event seem so impersonal.

Back in early April, Wauwatosa School District Superintendent Phil Ertl said he hoped to just keep pushing back the date of an in-person ceremony for as long as it took to do it safely. But by early May, his district had gone the route of many others, with a planned video celebration set for June 7.

“We are also still hanging on to July 26 in hopes that we can do something in person,” Ertl said this week. “So much is changing. To cancel that date right now doesn’t make sense to me.”  

Pleas for the show to go on 

People in at least nine school districts across Arizona have started Change.org petitions to hold in-person graduation ceremonies. 

After Arizona Gov. DougDucey announced that businesses could start to reopen, a group of Arizona seniors made a video pleading for an in-person ceremony.

“There are ways we can make this happen,” one of the students in the video said. “We deserve a graduation.” 

The video was posted on Twitter and received nearly 100 retweets. But some who responded to the tweet scoffed at the idea.

“You’re asking to put your friends’ parents at risk of dying so you can feel accomplished for a completely normal and baseline accomplishment,” one Twitter user responded.

Others have tried to come up with alternatives to graduation. 

Beth Obermeyer, who works with high school students at New Foundation church in Goodyear, held driveway graduations for seniors. Using a megaphone, church staff surprised students by showing up on their driveway and holding impromptu celebrations, six feet apart. 

“We were trying to think of a way to make our high school seniors feel better because they’ve had such a rough spring,” Obermeyer said.

No prom, either: So, these families toasted a high school couple in their own backyard prom

In Great Falls, Montana, district officials said they did not want the coronavirus to end the tradition of graduating seniors’ ringing a school bell. Officials are leaving the bell in the school’s parking lot for students to ring. 

If students choose to ring the bell, they are asked to maintain social distancing, wear the supplied disposable gloves and sanitize hands before and after ringing the bell. The school is setting up a hand-sanitizing station.

‘We’re not taking this lightly’: Small Montana school to be among first in US to reopen

Some have said schools are being too cautious.

A group of Mountain View High parents in Mesa, Arizona, are throwing a senior salute parade for grads. Seniors on May 16 will line up six feet apart on the sidewalk of a Mesa street for cars to drive by in celebration.

Destinee Mack, a parent and one of the event’s organizers, initially asked the district if parents could drop their student off in the high school’s parking lot so the students could safely line up.

Mesa Public Schools denied that request, Mack said. Mesa did not respond to a request for comment. 

“I do think there’s a risk, but I do also think that if we follow the social distancing protocols . I think we can still do this in a socially responsible way,” Mack said. 

Harvard epidemiologist: Beware COVID-19’s second wave this fall

Len Strazewski writer for the AMA questioned whether sunshine and warm weather bring an end to face masks, physical distancing and other pandemic mitigation tactics? Several states may be easing stay-at-home orders, but the joy of the release of COVID-19 restrictions may be short-lived. And that is what we saw last weekend here in Ocean City, Maryland. The crowds were amazing!

People believe the talk of the second wave, which I became more aware when one of my cosmetic surgery patients, scheduled for her surgery rescheduled for September just cancelled her surgery due to her belief that there would be a second wave of the COVID-19 disease.

Featured updates: COVID-19

Track the evolving situation with the AMA’s library of the most up-to-date resources from JAMA, CDC and WHO.

Summer may slow the spread of the coronavirus a bit, but it will back by fall with a second wave that looks a lot like the first wave, said a leading epidemiology researcher. And the immunity that will bring a real end to the pandemic may be a long time coming.

Marc Lipsitch, DPhil, is professor of epidemiology at the Harvard T.H. Chan School of Public Health and director of the Center for Communicable Disease Dynamics. He discussed the prospects for mitigating a second wave of the COVID-19 pandemic and the potential approaches to faster development of a vaccine, with JAMA Editor-in-Chief Howard Bauchner, MD, on Dr. Bauchner’s podcast, “Conversations with Dr. Bauchner.”

“Almost every government is talking about lifting control measures. Not every government, but many, because of the economic burdens. Given the fairly high caseloads that we have in the United States, that’s a really risky thing to do right now,” Lipsitch said.

“I hope that the summer weather will help,” he added, but his research indicates that the warmer weather will only reduce transmission rates by about 20%. “That’s only enough to slow it down, but not enough to stop it.”

Jurisdictions may learn more about which tactics work best in mitigating transmission during this period and may learn whether some mitigation tactics such as school closings are valuable.

“But the downside,” Lipsitch warned, “is that many jurisdictions will have a plan to open up but not a plan to reclose, leading to more situations like New York, New Orleans and Detroit where there’s extreme strains on the heath care.”

Learn more with the AMA about the four signposts to safely reopen America. Also consult the AMA’s new physician practice guide to reopening.

Stay up to speed on the fast-moving pandemic with the AMA’s COVID-19 resource center, which offers a library of the most up-to-date resources from JAMA Network™, the Centers for Disease Control and Prevention, and the World Health Organization. Also check out the JAMA Network COVID-19 resource center.

Serological studies

Testing will be important, Lipsitch said, and medical researchers need to learn more about infection rates. Preliminary research indicates that rates may vary widely around the country and a real understanding may have to wait until comprehensive serological testing, he explained.

Local leaders will need to understand more about who gets infected before they can make good decisions about openings and staying open. Sociological factors such as poverty and transportation maybe important determinants in understanding infection and serological surveys may help in understanding who gets infected and which intervention and mitigation tactics are most valuable.

Fall will be difficult

Lipsitch said that despite hopes that summer will bring continued relief from the spread of the virus, “fall will be very much like the spring,” and the usual pattern of coronaviruses is likely continue with new transmission peaking in November and cases peaking in December.

“We will have a harder time controlling coronavirus in the fall … and we will all be very tired of social distancing and other tactics. The hard thing will be to keep enough of it to protect our ICUs and keep the number of cases from flaring up,” he said.

Controlling the virus may call for a return to the tactics that have worked in spring and a continued focus on maintaining resources such as personal protective equipment and increasing viral testing.

Illinois mandated ‘Stay-at-home’ orders, nearby Iowa didn’t: here’s what happened

Healthday reporter, Dennis Thompson noted that Statewide stay-at-home orders appear to help slow the spread of COVID-19 above and beyond other steps like banning large gatherings and closing non-essential businesses.

That’s the suggestion from a new cross-border study.

Certain counties in Iowa—one of five states that didn’t issue a stay-at-home order for its citizens—experienced a 30% greater increase in COVID-19 cases compared to counties right across the border in Illinois, which did issue such an order, the researchers reported.

“It does line up with a lot of other evidence that’s coming up from other national studies,” said senior researcher George Wehby, a professor of health management and policy with the University of Iowa College of Public Health. “Overall, there’s evidence the more restrictive measures were associated with greater declines in COVID case growth.”

For this study, Wehby and a colleague compared COVID-19 rates for counties on either side of the Iowa/Illinois border. “Border counties serve as nice controls because they tend to be somewhat similar,” Wehby said.

As the pandemic unfolded, Iowa issued a series of social distancing orders. The state banned gatherings and closed bars and restaurants, then closed non-essential businesses, and then closed all primary and secondary schools.

But Iowa did not issue a broad shelter-in-place order directing residents to stay home unless absolutely necessary, a step taken by Illinois on March 21.

The researchers found that the addition of a stay-at-home order was associated with a slower growth of cases in seven Illinois counties compared with eight neighboring counties in Iowa.

Within a month of the Illinois stay-at-home order, that state had nearly five fewer COVID-19 cases per 10,000 residents in border counties, compared with their neighbors across the line in Iowa, according to the report published online May 15 in JAMA Network Open.

Dr. Amesh Adalja, a senior scholar with the Johns Hopkins Center for Health Security, said, “It is not surprising that when a stay-at-home order is issued that you see a decrement in cases. The virus requires social interaction to transmit and a stay-at-home order delimits social interaction.” Adalja was not involved with the new study.

“However,” he continued, “the key metric is not necessarily the number of cases but the hospital stress load induced by the cases. Stay-at-home orders ideally should be issued with the primary aim of preserving hospital capacity.”

It’s important to know which social distancing measures work best as the world refines its response to COVID-19, Wehby said.

“Understanding what might be working more or less is a key question,” Wehby said. “This study only adds a little more information into the bucket of evidence that needs to be accumulated.”

For some unknown reason, stay-at-home orders appear to be associated with less transmission of the coronavirus, according to these results.

“These shelter-in-place or stay-at-home orders, there is something about them that seems to add above and beyond just closing restaurants,” Wehby said.

“Do people behave differently even when they go out under a stay-at-home order?” Wehby pondered. “Are you more cautious? Do you keep a larger distance? Are you more likely to wear a mask or avoid being close to people? People with more health risks, are they more likely to stay home following these orders?”

A COVID-19 survivor’s warning: Don’t rush back to normal. It doesn’t exist

The problem with recovery from COVID is that it may never be normal. Cortlynn Stark of the Kansas City Star reported that Stacy Jackson given birth five times. She’s not being dramatic. She could barely breathe.

“My body felt like someone had beat me and drugged me and then hung me up and beat and drugged me again,” Jackson said.

She had COVID-19.

Two of her uncles also later tested positive and were hospitalized. One of them, Marvin Jackson, died.

After nearly being placed on a ventilator, her kidneys beginning to fail, and spending five days unconscious, Jackson survived. Now she has a warning for Kansas City: Don’t rush to go back to normal. It doesn’t exist.

A positive test

Stacy Jackson started to feel sick on March 23. By the 26th, she tried to see her primary care physician. Staff asked Jackson, who also has Type 2 diabetes, over the phone if she was running a temperature. Jackson didn’t know, so staff came out with a thermometer to take her temperature. It was 104 degrees. Her doctor couldn’t see her.

From there, she went to the emergency room at Truman Medical Center. She was given a cocktail of drugs to help, what she called the “COVID super pack,” and a test for the coronavirus. Her test results would be ready in two days.

March 27 was her 21st wedding anniversary. Jackson and her husband had already taken the day off. She spent the day in bed, sick. She lost her senses of taste and smell. Her appetite was gone. Jackson spent the next day in bed as well.

Two days after her anniversary, she received her positive test result. Her condition continued to deteriorate and she went back to the hospital for a couple hours.

“I was scared to death,” Jackson said.

It was still in the early days of the virus in Kansas City. Fewer than 300 people had tested positive in the metro and no one in the city had died of it, according to statistics tracked by The Star.

By March 31, Jackson was struggling to breathe. Nearly 500 people across the metro had tested positive. “I just told myself, ‘you’re not gonna die,'” Jackson said. She told her husband he had to take her back to the hospital. He dropped her off outside. He couldn’t go in, of course. Health care facilities had already begun limiting visitors.

Jackson said she thinks the lack of oxygen took a toll on her brain as the disease took its toll on her mentally and physically. She was placed in the ICU and was in and out of consciousness from March 31 to April 4. Sometime during those five days, she became aware of two doctors in her room talking to each other: She may have to be put on a ventilator.

“I remember shaking my head no,” Jackson said. In a phone call a month later, she said she worried that if she was put on a ventilator, she wouldn’t survive. A study of patients in a New York placed on ventilators found that just 3% left the hospital alive. A quarter of them died. About 72% were still in the hospital.

On April 5, her fever broke and she started becoming more responsive. But every time she got up, “it was like running around Kansas City seven times,” Jackson said. By this time, more than 700 people tested positive in the metro.

For the first time since March 31st, she was able to call her husband. But talking was still painful. “He said ‘babe don’t talk, I’m just so glad I’m able to hear you,'” Jackson said. She left the hospital three days later.

A solitary battle

Jackson is used to being surrounded by family. But she hadn’t seen her mother since before Kansas City’s stay-at-home order went into effect on March 24. The month before, her mother, who lives at an assisted living facility in Overland Park, was in the hospital battling the flu and pneumonia. Jackson was by her side.

“We are a face to face family,” Jackson said. “When people are stricken with disease in our family, we pray together.” But no one could be by her side. Or the sides of her two sick uncles.

COVID-19 is isolating. Instead of family members by her hospital bed, she was surrounded by nurses and doctors—genuine and caring, she said—covered in personal protective equipment. One nurse, Jackson said, told her that if she left the hospital, she would be one of the first to leave the COVID-19 dedicated floor alive.

Her uncle Marvin Jackson died on April 23—one of three to die that day and one of 106 people to die across the metro since the outbreak began.

Never the same

When Jackson left the hospital on April 8, staff played the “Rocky” theme song for her. At home, four of her six children and her husband were waiting for her.

Her oldest two children have their own apartments in Kansas City. The middle two were home from college. Her youngest, twin boys, are seniors in high school. She was on oxygen support for two weeks. But she’s worried about reopening.

Beginning May 15, Kansas City businesses can reopen under a “10/10/10” rule. In Kansas, Gov. Laura Kelly’s phased reopening plan last week includes rules that businesses opening must maintain 6 feet of separation between customers and limit gatherings to less than 10. On the Missouri side, Gov. Mike Parson ordered businesses to maintain social distancing, but did not limit social gatherings.

“We’re risking millions of lives for comfortability,” Jackson said. “We need to stop the madness. I would rather have a light bill that I can’t pay than lose my life.”

She wants people to take the virus seriously and respect the severity. With most of her immediate and large family in the Kansas City area, they often have large gatherings of up to 45 people at her home.

Not anymore.

Jackson said her family would often rent out four tables at a Japanese steakhouse on the County Club Plaza.

Not anymore.

And even though she has cable, and a number of streaming services, she would still go to movie theaters.

Not anymore.

“We can’t go back to the way it was,” Jackson said. “I don’t know when I’ll be able to go back to a restaurant and feel safe.”

She couldn’t throw the usual Mother’s Day brunch for her aunts, cousins and sister-in-law either. By May 9, the day before Mother’s Day, 2,900 people tested positive and 146 people in the metro died of COVID-19. More than 1.3 million people across the country tested positive and more than 78,000 people have died.

“I value life a little bit more and how precious life is,” Jackson said. “We could be gone in the blink of an eye. We need to do everything in our power not to make it worse.”

Jackson is thankful to be alive.

74% of people are worried social distancing will not be followed as lockdown is eased

A University College London reported on a study that nearly eight in 10 people are worried about COVID-19 infections rising and people not adhering to social distancing as lockdown is eased, according to UCL’s COVID-19 study.

The study, launched in the week before the lockdown, is the UK’s largest on adult wellbeing and mental health during the coronavirus epidemic and has over 90,000 participants who report their feelings about the lockdown, government advice, along with wellbeing and mental health.

It is funded by the Nuffield Foundation with additional support from Wellcome and UK Research and Innovation (UKRI). Findings are broken down by age, gender, income, those living with children, those who are keyworkers and those living in rural areas and whether people live alone or not.

This week’s findings, which focus on how people have been feeling between 4-10 May, find that economic concerns about recession and unemployment levels rising also rank highly. Additionally, around one in three people express concern about pollution increasing, social cohesion decreasing, and crime levels rising.

Lead author, Dr. Daisy Fancourt (UCL Epidemiology & Health Care) said: “Our findings show that concern about increasing cases of COVID-19 are consistent across all ages, but concern about hospitals becoming overwhelmed is higher in younger adults, while concern about people not adhering to social distancing is higher in older adults.

“Concerns about unemployment and recession are consistent across ages, but concern about crime rising is higher in older adults, while concern about pollution increasing and social cohesion decreasing is slightly higher in adults under the age of 30.”

This week’s report also finds that half of people do not feel in control of their future plans with 23% of people and 39% of people feeling the same about their mental health and employment respectively.

Dr. Fancourt (UCL Epidemiology & Health Care) added: “This week we also found 50 % of our participants do not currently feel in control of their future plans, and many feel unable to manage their mental health and are worried about their future employment.

“However, in terms of physical health, eight out of ten people feel in control and the same can be said for their marriage or relationship. When we compare ‘sense of control’ across age groups, younger adults report feeling less in control across all domains. “The study team has also received support from Wellcome to launch an international network of longitudinal studies called the COVID-MINDS Network. Through the network, dozens of scientists and clinicians are coming together internationally to collate results from mental health studies running in countries around the world and compare findings. The initiative will support the launching of new mental health studies in other countries and show whether actions taken in specific countries are helping to protect mental health.

Unfortunately, I have to agree with this study, that is, as the lockdowns are eased, people will not take responsibility for their actions and ignore social distancing. As I mentioned from the beginning, people are stupid and are only concerned about what they want rather what is best for the general public and this disease. I do understand that many want to get back to work so that they can save their businesses and support themselves, their family and their employees.

And lastly, Happy Memorial Day Weekend and remember why we celebrate this day and those who gave their lives to protect us, our country and our freedoms!

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!

When This War Is Over, Many of Us Will Leave Medicine and the Stresses of Healthcare Workers on All Fronts

One ER physician recounts the stress of constant intubations and PPE shortages

Michele Harper reviews the stress of our frontline healthcare workers and here is a case.

I couldn’t see. My face shield was blurred by a streaky haze. I tilted my neck back and forth in an effort to peer beyond it, beneath it, through it, whatever might work. Was it condensation? I started to raise my hands to my face to wipe it away before I remembered and yanked them back down: I cannot touch my face, can’t ever touch my face — neither inside this room nor outside it.

As I stood at the head of the patient’s bed in ER Room 3, her nurse, Kate, secured a mask over the patient’s face to deliver additional oxygen. I checked to ensure the oxygen was cranked up to the maximum flow rate while we waited for the respiratory therapist. Even with that increased oxygen, the patient was saturating 85% at best, and her blood pressure was dropping.

Ninety minutes earlier, the patient — a woman of 68 years with significant impairment from a stroke — had been fine. The nurse at her nursing home called to inform us they were sending the patient to the ER for evaluation of “altered mental status” because she was less “perky” than usual. Her oxygen level on arrival was normal with no shortness of breath. Her blood pressure was a little low, but her blood glucose read high. Nothing a little IV fluid couldn’t fix, and initially, it did.

I had requested a rectal temperature; it read 103 degrees. The combination of her being a nursing home resident and running a fever was a red flag during these coronavirus times. I placed her on respiratory isolation and asked Kate to be extra vigilant for any decline. I ordered broad-spectrum antibiotics to kill any likely source of infection while I awaited her chest X-ray, urine, and blood tests. Her portable chest X-ray was done first and revealed what I had already anticipated: diffuse atypical infiltrates, a presumed telltale sign of Covid-19. Although our understanding of this viral infection is ever-evolving, it seems the only observation we can reliably conclude is that we have not yet identified anything pathognomonic about it.

Seventy-five minutes later, another nurse, Charlene, called, “They need you in Room 3.”

“Okay,” I replied as I entered orders on the next chest pain patient with shortness of breath.

“Dr. Harper, they need you in Room 3 now,” Charlene called again.

“Room 3? The nursing home patient? I’ll be right there. What happened?”

“Her oxygen is at 67%.”

I asked the clerk to call respiratory therapy for intubation. I then turned back to Charlene to ask her to help Kate prepare for the procedure.

Then the personal protective equipment (PPE) sequence. I grabbed gloves to remove my N95 mask from its paper bag and placed it over my face, checking it was snug over my nose and lower jaw. After removing those gloves, I donned my face shield, then walked to the cart for a new gown. Lastly, a fresh set of gloves before entering the patient’s room.

I was scared, and I don’t get scared. Other doctors do, but not ER doctors. We don’t scare easily.

Now I waited for the respiratory therapist. It was good that she needed extra time to get the ventilator and then don her PPE because I had to figure out why I couldn’t see without manually manipulating my face shield. My thoughts were pierced by the sound of panting. I checked the patient who was taking the oxygen quietly, rapidly, ineffectively at regular intervals that didn’t register a sound. Her eyes remained closed—no flip of an eyelash, no wince of her forehead, no twitch in a limb. Despite her instability, the patient was in no visible distress. No heaving breath there. The nurse to my left was concentrating on the patient’s oxygen. I heard only the crinkle of her gown as she adjusted her stance. The panting wasn’t hers. The nurse to my right prepared to administer the intubation medications. He read out my orders — the name and dose of the medication in each syringe and the order in which they were to be pushed. His voice was steady. It wasn’t him hyperventilating. The nurse just outside of the room kept documentation of the procedure on scrap paper she used to carefully transcribe each detail onto her laptop. She was too far away to be heard unless she yelled, so that audible breathing certainly wasn’t hers.

The panting was my own.

A hailstorm of thoughts ensued. Was my breath the fog on my face shield? If so, my N95 mask had a leak. Unsuspecting, had I already inhaled the virus? Would I be intubated next?

The respiratory therapist had arrived with the ventilator and put on her face shield. She was almost ready, so there was little time to pull myself together.

Breathe in, I commanded myself: One, two, three. Breathe out. I obeyed: One, two, three, four.

Was I already short of breath? Had I not noticed my symptoms when I drove to work this morning? Yesterday? Last night?

Breathe in. One two, three. Breathe out. One, two, three, four.

I was scared, and I don’t get scared. Other doctors do, but not ER doctors. We don’t scare easily. We’re a type of special forces who step in when everything else has failed. Typically, we do our job anonymously then leave when the mission is complete. Any injury to ourselves incurred in the line of duty is dealt with after we’re off the clock.

Once in a while, however, there are circumstances when the capacity to compartmentalize is overwhelmed, when the chronic stress breaks through so that the fear works on you. Now, as I stood at the patient’s bed with the video laryngoscope blade in one hand and the endotracheal tube in the other, panic pushed its way through me in involuntary. forceful. rapid. shallow. breaths.

Breathe in on one, two, three. Breathe out on one, two, three, four.

The respiratory therapist slapped on her gloves and in moments was at my side. It was time for intubation.

Breathe in on three and out on four.

At last, my breathing was smooth, measured, sound.

I looked through my mask again. It wasn’t condensation. It was streaks from the sanitizing wipes because we had to reuse our equipment.

I adjusted my eyes to the clear spaces. Finally, I could see. My N95 mask fit. I could breathe.

The room was relatively quiet, what I like to call “ER calm.” All was still, save for the bagging of respiratory therapy, save for the swoosh of oxygen jetting from its port aerosolizing everything.

I requested that the intubation medications be administered then checked for a response. After visualizing the vocal cords easily with the video laryngoscope, I slid in the endotracheal tube, and respiratory connected it to the vent. The patient’s oxygen increased to 100% on the monitor.

Those of us who survive will return each day to battle. But when this war is over, this is why many of us will leave.

Doffing my gown and gloves, I put on new gloves to remove and sanitize my face shield. I couldn’t imagine there was a way to effectively clean the foam band across the forehead. I hoped to remove the streaks. I also hoped the impossible: to remove the virus, because it was the same shield I had to use repeatedly during my shift. I took off the N95. We’re now told that we can reuse it, too, numerous times before getting a new one due to the PPE shortages, so I put the contaminated mask back in the bag until I would need to do it again for the next patient.

This is how we get infected. This is how we die.

Those of us who survive will return each day to battle because we do not walk away from war until it’s done. But when this war is over, this is why many of us will leave.

I walked to the back of the ER to use the restroom in the seven minutes before the patient was ready for CT and saw my ER director standing in the lounge. I waved hello.

“How did it go?” she asked, her eyes gentle, her smile sympathetic.

“It went,” I replied.

“How did you feel in the PPE? Did you feel protected?”

I paused to regulate my answer. Her intentions were good. She was an ER doctor who did her best to walk the fine line between the docs on the front lines and the administrators who notified me that “doctors don’t get paid sick leave” and “thank you for your service,” which were graciously sent out in two separate emails. Just another reminder that we health care providers are regarded as more disposable than our PPE. But this wasn’t her fault, so I felt responsible, in that moment, for her feelings too.

I pulled in my tone. “No. That equipment doesn’t protect us. There’s no way that we’re not all covered in Covid, but we’re following the ‘guidelines.’”

She nodded and frowned.

“Honestly,” I continued, “and I hate to say this, but my feeling is that the majority of people will have contracted this virus. Most people will get through it, and others won’t. Many will die. I don’t want any of us to die, but many health care providers will. The thing is, it’s impossible to know which camp we’re in until it happens.”

She nodded again.

We smiled at each other, and I continued to the bathroom. I washed my hands, turning them over each other, lathering the soap along each finger, under each nail. As I dried my hands, I looked up at the mirror, noting that my breath was now imperceptible when my phone rang.

A FaceTime request from my nine-year-old nephew, Eli.

My policy used to be to not answer the phone at work unless it was critical. But this is a different era. Eli is sheltering-in-place at a military base in California while his mother, my sister, is away for deployment.

I swiped the phone to answer. “Hi, Eli!”

“Hello, Aunt,” he announced more softly than usual. His eyelids hovered low, and his eyes weren’t their typical bright.

“How are you, Eli?” I inquired, masking my concern.

“I’m good.” He smiled with sleepy eyes. “I just woke up.” He yawned; his bushy eyebrows raised high. Years ago, he said his eyebrows were the indisputable evidence that Frida Kahlo was his great, great grandmother so he had to meet her forthwith. Upon being told that she had already passed away, he cried for the woman he had decided was his long-lost ancestor. Now, as he yawned again, his thick eyelashes shut tight. His head drifted back and his mouth reeled open expelling the strongest exhale of the bravest lion cub.

Smiling to myself, I sighed easily.

He breathed.

I breathed.

Today we are OK.

Anxiety on the Frontlines of COVID-19 

It’s not just healthcare workers’ physical health but also their mental health that’s suffering

Richard van Zyl-Smit, M.D./PhD described to a friend this week the current feeling of being in the hospital with COVID-19, as like sitting under a 1,000V high-tension electricity cable: there is a constant humming above your head, which is unnerving and just does not go away.

Two years ago, he published a book called They Don’t Award Nobel Prizes to Dead People about my experience as an academic clinician with a stress-induced anxiety disorder. The context is very different now, but the lessons I learned in that time might be of help to those of you feeling this intangible “humming” — a sense of anxiety that is neither defined nor visible even with no COVID patient contact — and for those of you who are caring daily for COVID-19 patients.

The first and most important aspect of this time is to recognize that anxiety is real. This is not something you might have experienced before. For those of us who have previously or currently suffer from anxiety, it is easily recognizable for what it is, but you may never have experienced it quite like this. You are not losing your mind or losing control, you are experiencing a loss of control of your environment. In many ways, the daily changing updates, the ever-changing schedules and call rosters are unsettling at best and can be completely unnerving as we can’t be certain from one day to the next. There is not a lot you can do about it, except to acknowledge it and talk about it.

The second aspect relates directly to that gnawing “hum.”

I learned previously the benefit of and strongly believe in “downtime.” Getting away from the humming, which is not so easy anymore as we don’t have rugby or soccer scores to get excited or depressed about, we don’t have news about politics or current affairs — except COVID, COVID, COVID. I used to play Candy Crush to get my mind off work and to get away from the “hum,” but recognized that did not accomplish much — it just kept my mind going, and the anxiety was still there. I now try to be creative, to garden, draw, write, crochet (see below), paint, anything that I can do that takes the focus off my work.

Exercise is great too — but now restricted to indoors! I don’t look at the hundreds of WhatsApp group messages unless I am at work; the latest medical publication of how I should treat my ventilated COVID-19 patient on my next week on call is not important when I am at home.

I am convinced that switching off the social media, medical media, and media media when you are not working is vital for your mental health. For some, it might mean no social media, for others less, but getting out from under the electricity cable when you can, is an important way to ensure your own sustainability over the next few months.

The last aspect relates to relationships: physical distance is key — but find, and seek out the people who can support you; keep talking to each other, be kind to each other and to yourself, and talk about the anxiety, fears, worries, or stress. Professional services are available to those feeling very out of control, but simply talking with someone is a fantastic way to get the humming out of your head.

As much as we need to care for our COVID-19 patients and protect ourselves with PPE, we also need to look after ourselves and protect our mental health. It is not a sign of weakness but requires courage and bravery to ask for help.

“Asking for help is not giving up, it is refusing to give up.” — Charlie Mackesy

We are all in this together — we need to be kind to each other and to ourselves.

India coronavirus doctors: Notes on hope, fear and longing Reporter Vikas Pandey shows us how the Corona virus is affecting doctors in India. Dr Milind Baldi was on duty in a Covid-19 ward when a 46-year-old man was wheeled in  with severe breathing difficulty.

The man was scared for his life and kept repeating one question: “Will I survive?”

The question was followed by a plea: “Please save me, I don’t want to die.” Dr Baldi assured the man that he was going to do “everything possible to save him”.

These were the last words spoken between the two men. The patient was put on a ventilator, and died two days later. The doctor, who works in a hospital in the central Indian city of Indore, vividly remembers the 30 “terrifying minutes” after the patient was brought to his hospital.

“He kept holding my hands. His eyes were full of fear and pain. I will never forget his face.”

His death deeply affected Dr Baldi. “It ate away my soul from inside and left a lacuna in my heart.” Seeing patients die in critical care wards is not uncommon for doctors like him. But, he says, nothing can compare to the psychological stress of working in a Covid-19 ward.

Most coronavirus patients are kept in isolation, which means, if they become critically ill, doctors and nurses are the only people they see in their final hours.

“No doctor ever wants to be in this scenario,” says Dr A Fathahudeen, who heads the critical care department at Ernakulam Medical College in southern India.

Doctors say they usually share the emotional burden of treating someone with that person’s family. But Covid-19 doesn’t allow that. Dr Fathahudeen says he will never forget “the blankness in the eyes” of a Covid-19 patient who died in his hospital.

“He wasn’t able to talk. But his eyes reflected the pain and the fear he was experiencing.” Dr Fathahudeen felt helpless because the patient was going to die alone. But there was a tiny sliver of hope: the man’s wife was being treated for coronavirus in the same hospital.

So, Dr Fathahudeen brought her to the ward. She stood still and kept looking at him and said her goodbye. She never thought her 40-year marriage would end so abruptly.

The experienced doctor says the incident left him “emotionally consumed”. But, he adds, there was “some satisfaction that he didn’t die without seeing his wife”. “But that won’t always happen. The harsh truth is that some patients will die without saying goodbye to their loved ones.”

The emotional toll is made much worse as many doctors are themselves in a form of isolation – most are staying away from their families to protect them. As a result, Dr Mir Shahnawaz, who works at the Government Chest Hospital in Srinagar, says it’s “not just the disease we are fighting with”.

“Imagine not knowing when you will see your family next, add that to the constant fear that you may get infected and you will begin to understand what we are going through.”

Adding to the stress, is the fact that they also have to constantly deal with the emotional outbursts of patients. “They are very scared and we have to keep them calm – be their friend and doctor at the same time.”

And doctors also have to make phone calls to the families of patients, and deal with their fears too. The whole process, Dr Shahnawaz says, is emotionally draining.

“It hits you when you go back to your room in the night. Then there is the fear of the unknown – we don’t know how bad the situation will get.”

Doctors are used to saving lives, he adds, and “we will continue to do that no matter what”. “But the truth is that we are also human beings and we are also scared.” He says that the first coronavirus death in his hospital made his colleagues break down: it was when they realized that Covid-19 doesn’t afford the family a final glimpse of their loved one.

“Family members want to remember the final moments of a patient – a faint smile, a few last words, anything really to hold on to. But they can’t even give a proper burial to the dead.”

Dr Fathahudeen says such psychological pressure needs to be addressed and each hospital needs to have a psychiatrist – both for doctors and patients. “This is something I have done in my hospital. It’s important because otherwise the emotional scars will be too deep to heal. We are staring at cases of PTSD among frontline workers.”

Doorstep doctors

It is not just those working in Covid-19 wards who are on the front line, but also the doctors, community health workers and officials who are involved in contact tracing and screening suspected patients by going door-to-door in virus hotspots.

Dr Varsha Saxena, who works in the badly affected northern city of Jaipur, says she walks into grave danger knowingly every day. Her job is to screen people for possible symptoms. “There is no other option. It’s the fight of our lifetime, but one can’t ignore the risks,” she says. “But it poses great risk because we don’t know who among the ones, we are screening is actually positive,” she adds.

She says doctors like her don’t always get proper medical-grade personal protective equipment. “The fear of getting infected is always there and we have to live with it. It does play on our mind and we have to fight hard to keep such negative thoughts away.”

But her biggest fear, she says, is getting infected and not showing any symptoms. “Then the risk is that we may end up infecting others. That is why field doctors also need PPE,” she adds. And the stress, sometimes, also comes home.

“It’s so draining. My husband is also a doctor, most nights we don’t even have energy to cook and our dinner involves just bread.”

Aqueel Khan, a bureaucrat and a colleague of Dr Saxena, acknowledges that psychological stress is a reality for all frontline workers, including officers like him who are embedded with medical teams. The fear really comes home for these workers when somebody close to them dies.

“I lost my uncle and a friend recently. It shook me, I can’t stop thinking about them. You can’t stop thinking that it can easily happen to you,” he says.

Mr. Khan is also staying away from his family: this year is the first time he will miss his daughter’s birthday. “My heart says to go home and see her from far, but the mind tells me otherwise. This constant struggle is very stressful.

“But we can’t turn our backs on the job. We just have to just keep at it, hoping that we come out alive on the other side of this fight.” ‘The risk is always there’

There is no respite for doctors and nurses even when they are not directly involved in the fight against coronavirus. People with other ailments are continuing to come to hospitals. And there has also been a surge in the number of people who are turning up at hospitals with coronavirus-like symptoms.

Dr Mohsin Bin Mushtaq, who works at the GMC Hospital in Indian-administered Kashmir, says coronavirus has “fundamentally changed our lives”. “We are seeing patients every day for other ailments. But the risk is always there that some of them could be infected,” he said.

And it worries him even more when he reads about doctors getting infected despite wearing PPE and dying. A number of doctors have died in India and dozens have tested positive. There is nothing we can do about it, he says, adding that “we just have to be mentally strong and do our jobs”.

Dr Mehnaz Bhat and Dr Sartaz Bhat also work in the same hospital, and they say that the “fear among patients is too much”. Dr Sartaz says people with a slight cold end up thinking they have coronavirus, and rush to the hospital. “So apart from treating them, we also have to deal with their fear,” Dr Sartaz adds.

He recently diagnosed Covid-19 symptoms in a patient and advised him to go for testing. But his family refused and took him away. The patient was brought back to the hospital after Dr Sartaz called the police. He says he had never imagined doing something like this in his medical career. “This is the new normal.”

The way patients are examined has also changed for some doctors. “We really have to try and limit close interactions with patients,” Dr Mehnaz Bhat says. “But it’s not what we have been trained for. So much has changed so quickly, it’s stressful,” she says.

And several attacks on doctors and nurses across the country have made them even more worried. She says it’s difficult to understand why anybody would attack doctors. “We are saving lives, risking our lives every day. We need love, not fear.” she adds.

And even worse:

E.R. doc on COVID-19 ‘front lines’ died by suicide                             To show how serious the stress is seen in this report by Cory Siemaszko reported that a New York City emergency room doctor who was on the “front lines” of the fight against the coronavirus has died by suicide, police said Monday. Dr. Lorna Breen, 49, who worked at New York-Presbyterian Allen Hospital, was in Virginia when she died on Sunday, said Tyler Hawn, a spokesman for the Charlottesville Police Department.

“The victim was taken to U.V.A. Hospital for treatment, but later succumbed to self-inflicted injuries,” Hawn said.

It was her father, Dr. Phillip Breen, who revealed the first details about his daughter’s tragic death. “She tried to do her job, and it killed her,” he told The New York Times. “She was truly in the trenches of the front line.”

He said his daughter seemed very detached of late and that she had described some of the horrors she had witnessed at the hospital while battling the virus. “Make sure she’s praised as a hero, because she was,” Phillip Breen said. “She’s a casualty just as much as anybody else who has died.”

The hospital confirmed Lorna Breen’s death in a statement released by chief spokesperson Lucky Tran, but gave few other details. “Words cannot convey the sense of loss we feel today,” the statement said. “Dr. Breen is a hero who brought the highest ideals of medicine to the challenging front lines of the emergency department. Our focus today is to provide support to her family, friends, and colleagues as they cope with this news during what is already an extraordinarily difficult time.”

NewYork-Presbyterian Allen Hospital has 200 beds, is in northern Manhattan and is one of the seven hospitals that make up NewYork-Presbyterian Hospital.

Infectious Disease Expert Makes Chilling Prediction for States Reopening Amid Pandemic                                                                 Reporter Lee Moran noted that infectious disease expert Michael Osterholm warned that the states starting to reopen amid the coronavirus pandemic “will pay a big price later on.”

Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota, told CNN’s Jake Tapper on Thursday that states like Georgia, Colorado and others that are easing social distancing restrictions were “putting gasoline on fire.”

“I think right now, this is one of the things we’ve learned, if we’re going to learn to live with this, then you just don’t walk in the face of it and spit in its eye, because it will hit you,” said Osterholm. “And I think that that’s a really important issue right now,” he continued. “When we have transmission increasing, when our hospitals are not able to take care of it and we don’t have enough testing to even know what’s going on, then that’s not the time to loosen up.”

Osterholm suggested it was “the worst example of how to start this discussion” about the “loosening” of society. “I wouldn’t do it,” he added. “I fear that these states will have to pay a big price later on because of what they’re doing.”

COVID-19: National Psychiatrist-Run Hotline Offers Docs Emotional PPE                                                                                              Emily Sohn reported that Mona Masood, DO, a Philadelphia-area psychiatrist and moderator of a Facebook forum called the COVID-19 Physicians Group, reviewed post after post about her colleagues’ fears, anxieties, and the crushing pressure to act like a hero, inspiration struck. Would it be possible, she wondered, to create a resource through which psychiatrists would be available to provide frontline physicians with some emotional personal protective equipment (PPE)?

She floated the idea in the Facebook forum, which has more than 30,000 members. The response was immediate. “All these psychiatrists just started contacting me, saying, ‘Please let me be a part of this. I want to volunteer,’ ” she told Medscape Medical News.

On March 30, Masood launched the Physician Support Line, a free mental health hotline exclusively for doctors. Within the first 3 weeks, the hotline logged more than 3000 minutes of call time. Some physicians have called repeatedly, and early feedback suggests the resource is meeting a vast need.

“Most of the cases have a lot of emotion from both sides. There are a lot of tears, a lot of relief,” said Masood.

“If Not Me, Then Who?”

Physicians have been facing mental health challenges long before the pandemic, and doctors have long struggled with stigma in seeking psychological help, says Katherine Gold, MD, a family medicine physician at the University of Michigan, Ann Arbor, who studies physician well-being, suicide, and mental health.

As a whole, physicians tend to be perfectionists and have high expectations of themselves. That combination can set them up for mental distress, Gold notes. Studies that have focused mainly on medical students and residents show that nearly 30% have experienced depression. Physicians are also at significant risk of dying by suicide.

Compounding the issue is the fact that physicians are also often reluctant to seek help, and institutional stigma is one persistent reason, Gold says. Many states require annual license renewal applications in which physicians are asked questions about mental health. Doctors fear they’ll lose their licenses if they seek psychological help, so they don’t pursue it.

A study conducted by Gold and colleagues that analyzed data from 2003 to 2008 showed that compared to the general public, physicians who died by suicide were less likely to have consulted mental health experts, less likely to have been diagnosed with mental health problems, and less likely to have antidepressants in their system at the time of death.

The COVID-19 pandemic may exacerbate these trends, suggests a recent study from China in which investigators surveyed 1257 healthcare workers in January and February.

Results revealed that a significant proportion of respondents had symptoms of depression, anxiety, insomnia, and distress. This was especially true among women, nurses, those in Wuhan, and frontline healthcare workers who were directly engaged in diagnosing, treating, or caring for patients with suspected or confirmed cases of COVID-19.

As Masood watched similar concerns accumulate on the COVID-19 Physicians Group Facebook forum, she decided to take action. She says her mentality was, “If not me, then who?”

Assisted by a team of experts, she created the hotline without any funding but with pro bono contributions of legal and ethical work, and she received a heavy discount from a company called Telzio, which developed the hotline app.

The hotline is open daily from 8:00 AM to midnight Eastern Time, and calls are free. Services are available only to physicians, in part because as a group, doctors tend to harbor guilt about asking for help that someone else might need more, Masood says.

When other types of healthcare workers call in, volunteers redirect them to hotlines set up for first responders and other healthcare providers.

So far, more than 600 psychiatrists have volunteered. They sign up for hour-long shifts, which they fit in between their own patients. Two or three psychiatrists are available each hour. Calls come directly through the app to their phones. There is no time limit on calls. If calls run long, psychiatrists either stay on past their shifts or pass the call to another volunteer.

Since its launch, the number of calls has steadily increased, Masood says. Callers include ICU doctors, anesthesiologists, surgeons, emergency department doctors, and some physicians in private practice who, Masood says, often express guilt for not being on the front lines.

Some physicians call in every week at a certain time as part of their self-care routine. Others call late at night after their families are in bed. If indicated, psychiatrists refer callers for follow-up care to a website that has compiled a list of psychiatrists across the United States who offer telehealth services.

There are no rules about what physicians can discuss when they call the hotline, and popular topics have evolved over time, says Masood. In the first week after the hotline’s launch, many callers were anxious about what the future held, and they saw other hospitals becoming overwhelmed. They worried about how they could prepare themselves and protect their families.

By the second week, when more doctors were in the thick of the pandemic and were working long hours, sometimes alone or covering shifts for infected colleagues, there were concerns about coworkers. Some were grieving the loss of patients and family members. The lack of personal protective equipment (PPE), says Masood, has been a common topic of conversation from the beginning.

Given the many unknowns about the virus, physicians have also grappled with the uncertainty around safety protocols for patients and for themselves.

On a deeper level, physicians have expressed a desire to run away, to stop going to work, or to quit medicine altogether. These escape fantasies are a normal part of the fight-or-flight response to stress, Masood says.

Doctors often feel they can’t share their fears, even with family members, in part because of societal pressures to act like heroes on the front lines of what has been framed as a war, she adds.

Heroes aren’t supposed to complain or show vulnerability, Masood says, and this can make it hard for physicians to get the support they need. Through the hotline, psychiatrists give doctors permission to feel what they are feeling, and that can help motivate them to go back to work.

“They don’t want to look like cowards, because that’s the opposite of a hero,” she said. “Saying it to another doctor feels much better because we get it, and we normalize that for them. It’s normal to feel that way.”

Each week, Masood conducts debriefing sessions with volunteers, who talk about conversations filled with raw emotion. When conversations wind down, most physicians express gratitude.

They tell volunteers that just knowing the hotline is there provides them with an emotional safety net. Masood says many physicians tell volunteers, “I know that if anything’s going wrong, I can just call and somebody will be there.” Volunteers, too, say they are benefiting from being involved.

“We are all really having this desperate need to be there for one another right now. We truly feel like no one gets it as much as we get one another,” said Masood.

Long-term Fallout

The need for psychiatric care is unlikely to end after the pandemic retreats, and Masood’s plan is to keep the hotline running as long as it’s needed. Like the rest of the world, physicians are in survival mode, but she expects a wave of grief to hit when the immediate danger ends. Some might blame themselves for patient deaths or question what they could have done differently. The long-term impact of trauma is definitely a concern, Gold says. Physicians in the ER and ICU are seeing many patients who decline quickly and die alone, and they witness young, previously healthy people succumb to the virus.

They’re seeing these kinds of cases over and over, and they’re often doing it in an environment where they don’t feel safe or supported while people in many places stage protests against the measures they feel are helping protect them.

Like veterans returning from war, they will need to reflect on what they’ve experienced after the adrenaline is gone and there is time to think.

“Even when things calm down, it will be great to have resources like this still functioning that can help folks think back through what they’ve been through and how to process that,” Gold said. “Things are going to remind them of experiences they had during COVID, and they can’t predict that right now. There will be a need for the support to go on.”

Masood is optimistic that the pandemic will bring the issue of physicians’ mental health out of the shadows.

“We have a really deep feeling of hope that that there’s going to be a lot more empathy for one another after this,” she said. “There’s going to be a willingness to not take mental health for granted. Doctors are people, too.”

We understand about those on the frontline of this pandemic. But do you all realize that many physicians and nurses are being furloughed during this pandemic due to elimination of elective surgery, many of which are necessary such as transplants and cancer treatments and surgery as well as limitation of their practice during this pandemic.

How do physicians pay their malpractice insurance and pay their staff and overhead and their huge education loans?

I fear that we may see a mass quitting/retirement of many nurses and physicians in our country and maybe world wide or many suffering from PTSD (Post Traumatic Stress Syndrome).

What then happens to our healthcare system? Will this pandemic force Congress to finally get serious regarding improving our healthcare system for All?

In isolation, worries and stress are magnified During the Coronavirus Pandemic. COVID-19 could lead to an epidemic of clinical depression!

Jonathan Kanter wrote in the Conversation that Isolation, social distancing and extreme changes in daily life are hard now, but the United States also needs to be prepared for what may be an epidemic of clinical depression because of COVID-19.

We are clinical psychological scientists at the University of Washington’s Center for the Science of Social Connection. We study human relationships, how to improve them, and how to help people with clinical depression, emphasizing evidence-based approaches for those who lack resources.

We do not wish to be the bearers of bad news. But this crisis, and our response to it, will have psychological consequences. Individuals, families and communities need to do what they can to prepare for a depression epidemic. Policymakers need to consider – and fund – a large-scale response to this coming crisis.

A perfect storm of depression risks

Most of us know the emotional components of depression: sadness, irritability, emptiness and exhaustion. Given certain conditions, these universal experiences take over the body and transform it, sapping motivation and disrupting sleep, appetite and attention. Depression lays waste to our capacity to problem-solve, set and achieve goals and function effectively.

The general public understands depression as a brain disease. Our genes do influence how easily we may fall into clinical depression, but depression is also, for most of us, substantially influenced by environmental stress. The unique environmental stressors of the COVID-19 crisis suggest that an unusually large proportion of the population may develop depression. This pain is likely to be distributed inequitably.

Stress and loss

Exacerbating the widespread stress of this crisis, many of us are suffering significant personal losses and grief reactions, which are robust predictors of depression. The ongoing and unpredictable course of these stressors adds an additional layer of risk.

As this crisis unfolds, death tolls will rise. For some, especially those on the front lines, acute experiences of grief, trauma and exhaustion will compound the stress and place them at even greater risk.

Interpersonal isolation

Prolonged social isolation – our primary strategy to reduce the spread of the virus – adds another layer of risk. Our bodies are not designed to handle social deprivation for long. Past studies suggest that people forced to “shelter in place” will experience more depression. Those living alone and lacking social opportunities are at risk. Loneliness breeds depression.

Families, who must navigate unusual amounts of time together in confined spaces, may experience more conflict, also increasing risk. China experienced an increase in divorce following their COVID-19 quarantine. Divorce predicts depression, especially for women, largely due to increased economic hardship over time.

Financial difficulties

The biggest stressor for many is financial. Unemployment and economic losses will be severe. Research on past recessions suggests that rising unemployment and financial insecurity lead to increased rates of depression and suicide. debt and financial deprivation during recessions are at significant risk for depression due to increased stress and difficult life circumstances. Minority-owned businesses may be at particular risk for buckling under the strain.

Recovery will be harder

Home foreclosures during the 2008 recession produced a 62% increased risk of depression among those foreclosed.

The mental health burden of economic recession will be distributed inequitably. When the stock market crashed in 2008, the rich experienced large wealth losses but not increased rates of depression. In contrast, those who experience unemployment,

While the COVID-19 crisis increases risk for depression, depression will make recovery from the crisis harder across a spectrum of needs.

Given depression’s impact on motivation and problem-solving, when our economy recovers, those who are depressed will have a harder time engaging in new goal pursuits and finding work. When the period of mandated social isolation ends, those who are depressed will have a harder time re-engaging in meaningful social activity and exercise.

When the threat of coronavirus infection recedes, those who are depressed will face increased immunological dysfunction, making it more likely they will suffer other infections. Depression amplifies symptoms of chronic illness. The inequitable distribution of the burden of the crisis will exacerbate existing racial health disparities, including disparities in access to depression treatment.

What to do?

Self-help suggestions are readily available. A good list, more evidence-based than most, is here. It is our experience, however, that such self-help encouragements for depression are not enough, and at times even insulting, for those who are truly struggling.

We need higher-level shifts in policy and how we approach the problem. Economic relief measures from the federal government are crucial responses both to economic recession and psychological depression. We call for a public health campaign to increase awareness of depression and treatment options, and for improvements in mental health sick-leave policies and insurance reimbursement to minimize barriers to treatment access.

How we talk about depression must change. The distress we feel is a normal human response to a severe crisis. Acknowledging and accepting these feelings prevents distress from turning into disorder. Describing depression solely as a brain disease increases helplessness and substance use among those who are depressed and decreases help-seeking. Emphasizing the causal role of our environmental context, in contrast, matches how depressed individuals across different ethnicities view the causes of their suffering, decreases stigma and increases help-seeking.

Finally, we recommend specific treatment options be prioritized. As we have discussed elsewhere, easy-to-train, cross-culturally applicable and effective treatment options exist. We wish for an army of practitioners to be trained and embedded in community and treatment centers across the country, and this army should represent the great diversity of our country.

Some specific suggestions to help us all:

Protect Your Family’s Mental Health During the COVID-19 Pandemic. 

Begin the Day with Gratitude

Before your feet hit the floor in the morning, think of something that you’re grateful for. Making this a focus for yourself, and teaching your kids to do the same, can have a significant impact on your emotional health. The heaviness of our current situation can quickly weigh us down, and if we begin our day with doom and gloom, then we have set the negative feeling pendulum into full swing.

A study published in the journal Psychotherapy Research found that writing a gratitude letter can improve a person’s outlook and emotional well-being. It even seems to change brain activity in a positive way, based on MRI scans of study participants.

Get into a Routine and Make a Daily Schedule

Depression and anxiety can keep you from feeling in control of your life. One way to counteract that feeling is by making a regular schedule and sticking with it. When you organize and structure your life, you know what to expect. Make sure you have a family routine.

Remember, kids are used to routine and structure in schools. Many thrive on having consistency in their lives, which consequently helps them feel in control, something kids need now more than ever.

Not only will having a plan can help you stay centered, it will keep you focused on the tasks at hand. A study published in the Annual Review of Psychology on psychological habits showed people rely on their routines and habits when they are stressed. That helps them get through difficult times, suggesting that establishing healthy routines could help with physical, emotional and mental health during difficult times like these.

So, go ahead and make a schedule. The first item on the list should be to make your bed. According to a survey by OnePoll and Sleepopolis, which provides mattress reviews, people who make their beds regularly tend to report feeling happier and more productive. Plus, if making your bed is on your to-do list, you can accomplish your first goal of the day.

How to Cope with Coronavirus Anxiety. 

Get a Good Night’s Sleep

According to the National Sleep Foundation, adults need between seven and nine hours of sleep each night. And research shows the amount and quality of sleep we get has a significant impact on mental health. The amount of sleep kids need varies considerably by their age. That ranges from newborns snoozing away most of the day (14 to 17 hours recommended), to preschoolers splitting time awake and asleep (11 to 13 hours in la la land recommended), to teens who are advised to get eight to 10 hours of sleep daily, though they rarely do.

Researchers have discovered that those suffering from mental health conditions, such as anxiety and depression, are at an increased risk of insomnia. And not getting adequate rest can raise one’s risk for mental health problems.

So, during times of high stress, sleep is of utmost importance. In addition to following a routine, another way that you can ensure a healthy night’s rest for you and your kids is by making sure the whole family is active during the day.

Go Outside

Research from Sweden suggests that being outside is associated with a lower risk of developing psychiatric disorders. In a separate study published in the International Journal of Environmental Health Research, researchers showed that spending about 20 minutes in the park can improve your overall well-being.

Even if you can’t get to a park, just getting some fresh air – while keeping 6 feet from others outside your household – can do you a world of good.

Eat Healthy

During this stressful time, it’s important to watch what you eat. That’s because what you put into your body will affect how you think and feel. Research has long documented the positive impact nutrition has on mood and that eating well is associated with lower levels of anxiety and stress.

Research has demonstrated the benefits of eating unprocessed food and having a diet that’s high in vegetables, fruits, unprocessed grains, with fish and only modest amounts of lean meats and dairy. Studies suggest that those who eat this way have depression rates 25% to 35% lower than those who consume a traditional Western diet characterized by processed foods, lots of red meat and high intake of unhealthy fats and carbs. The saying “you are what you eat” applies as much to mental health as it does to your physical health.

In a time of uncertainty, you need to take care of your mental health. Sure, you may be more confined than you usually are, but you don’t have to let anxiety and depression consume you. Make your mental health a priority by following the measures outlined above.

Also, if you need professional help, please reach out, as there are trained professionals who would like to assist you. Don’t forget, with COVID-19, you are not alone in how you are feeling. More importantly, remember this, too, shall pass.

Depression costs the U.S. economy US$210 billion yearly. That is under normal conditions. An epidemic of depression requires a multi-faceted, multi-level response.

Are We Only Going to See More Substance Abuse and Bad Behavior Including Gambling?

I was amazed that when our Governor of the great state of Maryland shut done businesses yesterday that the liquor stores were exempt, but not my medical offices. I also noticed that the substance abuse/methadone clinic next store to my office was still open for business and as usual, very busy. I continued to wonder when my oldest daughter asked how the pandemic will affect individuals suffering from substance use problems, particularly now that many of these individuals are in forced isolation.

Yale University professor Adrian Bonenberger noted that the coronavirus quarantine means different things to different people: A necessary inconvenience. A fusion of work and home life. A leap into social media, or virtual meetings once held face-to-face. For some, it’s possible to see a silver lining: more time with one’s family, and a change to the regular routine. But for people who suffer from substance use disorder, gambling addiction, or problematic video gaming—otherwise known as internet gaming disorder—the quarantine is fraught with danger.

“People will likely be practicing social distancing per the government’s recommendation,” said Marc Potenza, Ph.D., MD, HS, professor of psychiatry, who directs Yale’s Center of Excellence in Gambling Research, the Women and Addictive Disorders Core at Women’s Health Research at Yale, and the Yale Research Program on Impulsivity. “Oftentimes stress is linked to addictive behaviors, and there can be little question that the social distancing around coronavirus or COVID-19 has been a stressful interruption of routine for many.”

For people in treatment for substance use disorder, COVID-19 could lead to the type of stress and isolation most likely to result in risky behavior.

“Everyone is trying to protect the vulnerable from COVID-19, and the only way to make that happen is social distancing,” said Ellen Edens, MD, MPH, associate professor of psychiatry. “But social distancing can also be especially harmful for people with mental conditions or substance use disorder.”

According to Edens, there is a related concern: those who depend on medications to treat a substance use disorder may fall through the cracks. Like those with an opioid use disorder who take methadone or buprenorphine, both of which block cravings, treat opioid withdrawal and prevent opioid overdose; or those with a prescription for disulfiram, a medication that causes people to become sick if they drink alcohol and is most effective when taken under direct observation. Disulfiram is unavailable nationwide, according to Edens, though the intensively monitored in-person treatment often required for best outcomes, particularly early in treatment, is also unlikely in the current context.

Edens also notes that the most vulnerable moment for someone with substance use disorder is at the beginning of treatment, when they are deliberately and intensely plugged into group therapies and peer support groups like those popularized by Alcoholics Anonymous or AA. “With social distancing, one of the key components of addiction treatment—the reforging of family, social, or professional connections that may have been severed, exemplified by ‘network therapy’ or a ‘community reinforcement approach’—is lost,” she said. “The psychiatric community is doing what it can to make up for the sudden disruption of tested and effective in-person programs with things like old fashioned telephone calls. But between the technology gap with older patients and specific challenges faced by patients for whom disconnection is essentially the greatest danger, it’s difficult. Many AA groups that have closed their doors to comply with the injunction against gatherings of numerous people, and while it’s certainly prudent, it also leaves many attendees adrift.”

Another possible fallout from COVID-19 stems from the shutdown of casinos across the United States, coupled with the postponement or cancellation of professional sporting events including the NBA, NHL, MLS, and MLB (suspended), the Masters (postponed), the Boston Marathon (postponed), and the NCAA men’s and women’s basketball tournaments (canceled). Although gambling and sports gambling have been online and lightly regulated for years, there has never been an absolute vacuum of physical gambling locations. It’s likely that in the absence of a physical space in which to gamble, and without many of the typical outlets for gambling in place, some people with gambling addition will make their way to the internet.

The rise of e-sports is one possible place where online gambling and problematic video gaming could converge. A growing field with audiences for a single event in the millions, and over $1 billion in revenue as of 2019, e-sports, in which people play video games online competitively, requires no crowds, and can be accessed by anyone with a smartphone or laptop.

“A quarantine, particularly at home, may lead to bingeing on video games, alcohol, or drugs given the significant change to routine life. It could also lead to a relapse for those who had been doing well previously. Second, those who may have been considering coming to treatment now may suddenly be hesitant given possible exposure to the virus in a hospital or treatment setting and have decided to delay getting help,” said Brian Fuehrlein, MD, Ph.D., FW ’13, associate professor of psychiatry and director, Psychiatric Emergency Room, VA Connecticut Health Care System. Fuehrlein was careful to echo his colleagues in underlining the necessity of home quarantine and the importance of following it, and was unequivocal about the dangers posed to vulnerable populations like those who will be significantly economically impacted by social distancing.

There has already been an observable change in normal behavior at the VA, according to Fuehrlein—and the opposite of what one might expect, which is more cases. Fewer patients have been coming in for any reason, which does not bode well for long-term mental wellness. “Currently, we are seeing an uptick in those who were considering treatment for substance use disorder but have now decided to stay home instead (and thus are likely continuing to drink or use). Our census in the psych ER has actually been running lower than average,” said Fuehrlein.

In the long run, this will almost certainly turn into a large problem, or even a secondary epidemic for people already suffering from the various diseases of addiction. “I think in the long run we will see a sharp increase in depression, anxiety, and addictions of all types as a direct consequence of the current pandemic,” said Fuehrlein. “This may be due to the death of a loved one, a financial crisis, the loss of a job or housing, or some related tragedy. At the moment those consequences have yet to play out.”

Potenza echoes Fuehrlein and Edens’ concerns for people suffering from substance use or gambling problems at home, away from the usual forms of treatment. He brought up another population that will be at risk—in addition to the tens of millions of American workers (over 18% of the work force, according to an article published March 17, 2020 in the Los Angeles Times), millions of school children who have been cut loose with weeks of unstructured time. Without supervision, these groups will be especially vulnerable to what the DSM-5 defines as internet gaming disorder, on top of the better-known associated substance use disorder.

Said Potenza, “Oftentimes, it appears that people who are experiencing negative mood states or life stressors may turn to gambling, gaming, or use various substances including alcohol and drugs. COVID-19 is almost certainly creating more stress, and while health professionals and the government are mobilizing to address the threats posed by the virus, some of the recommended actions like social distancing and staying at home seem likely to lead to more gambling, more gaming, and more substance use.”

Almost 20 million American adults suffered from substance use disorder in 2017, while nearly 10 million American adults struggled with a gambling problem as of 2016. Both groups, in which there is almost certainly some overlap, rely on a therapeutic model that relies on person-to-person meetings. Potenza, Edens, and Fuehrlein all agreed that patients suffering from mental illness and substance use disorder could receive effective treatment via phone or computer, and that technology was racing to keep up with the changing demands of quarantine and the patient population. Any mechanism by which a connection could be forged, according to them, was preferable to isolation during the search for an effective vaccine and perhaps a cure.

“Ultimately,” said Potenza, “we don’t know what will happen. And that’s a source of stress for most if not all of us.”

It’s stockpiling, but not as you know it. Why coronavirus is making people hoard illegal drugs

Ms. Emma Reynolds of London (CNN) wrote that it’s not just toilet roll that people are panic buying. Some illegal drug users are reportedly stockpiling their substance of choice as restrictions intended to stop the spread of coronavirus disrupt the international supply chain.

And the consequences could be devastating, with experts concerned that people will adopt riskier habits, substitute unfamiliar drugs or enter withdrawal, which can be dangerous if unmanaged. Since heavy users often have other health problems, this could mean increased strain on services that are already near breaking point.

UK drug policy and crime experts told CNN they were worried over a growing number of reports of shortages and escalating prices for drugs, as international borders close and supply lines are cut off.

“There are reports coming through of people stockpiling their favorite drug or their drug of choice, and of course, that just creates a shortage, which has inevitably led to price increases,” Ian Hamilton, senior lecturer in addiction and mental health at the University of York, told CNN. He said he expected to see heroin “disappearing very, very quickly” in the UK.

Steve Rolles, senior policy analyst at the Transform Drug Policy Foundation, told CNN there was “anecdotal evidence of price rises… and that doesn’t seem surprising.”

“It does seem likely that the supply of drugs that these people are using, in particular heroin, is going to be restricted … it’s going to be more challenging to move drugs around.

“As weeks stretch into months, I think we’re likely to see a drought, a heroin drought.”

Alex Stevens, criminal justice professor at the University of Kent, told CNN that in areas including Birmingham and Bristol, users of heroin and synthetic cannabinoids “are reporting that they’re getting less in a £10 ($12) bag than they would have done four or five weeks ago.”

But this is an industry that operates on supply and demand. The dark web and sites including Craigslist are still active, with many users buying drugs through the mail at a time when police are not focused on monitoring post, according to several experts. “If the heroin isn’t available, they will probably find another route, whether it’s alcohol or inhalants, or benzodiazepines or something else,” said Rolles.

Rolles has even heard reports of dealers dressing in nurse’s uniforms and supermarket uniforms to make deliveries unnoticed.

What happens during a drought?

When the UK last experienced a heroin drought in 2010-11, the drug’s purity at “local dealer level” fell to 18%, according to the National Crime Agency. Street prices reportedly increased, and there was a reduction in the number of deaths involving heroin and a simultaneous (but smaller) increase in deaths involving methadone.

That may sound positive, but the experts say the effects could be different this time. Users may move from less dangerous drug-taking methods to injecting. They may use lethal combinations of drugs. They may use too much of their stockpile. And they may be more likely to overdose alone because of social distancing.

Women are using code words at pharmacies to escape domestic violence during lockdown

One vital difference between 2010 and 2020 that is causing anxiety among the experts is the proliferation of fentanyl, a synthetic opioid that is up to 50 times stronger than heroin and can therefore be transported in much smaller quantities. The drug has not yet become widespread in countries including Britain, but is wreaking havoc in the United States.

Fentanyl is the drug most often involved in overdoses in the US, according to the National Center for Health Statistics. The rate of overdoses involving the opioid skyrocketed by about 113% each year from 2013 through 2016. If you’re used to heroin and you take fentanyl, “the risk of overdose is extreme,” said Hamilton.

The drug is often manufactured in China, but little is moving out of the original coronavirus epicenter. It is also manufactured in Mexico and possibly Eastern Europe.

With many drug users dealing with mental health issues such as depression and anxiety, coronavirus isolation presents an unprecedented challenge.

“People who have an active disorder, addiction disorder, they’re going to look for ways to get a drug,” Cynthia Moreno Tuohy, executive director at NAADAC in the US (National Association for Alcoholism and Drug Abuse Counselors), told CNN.

Asking for help

The suicide rate in the United States has seen sharp increases in recent years. Studies have shown that the risk of suicide declines sharply when people call the national suicide hotline: 1-800-273-TALK.

There is also a crisis text line. For crisis support in Spanish, call 1-888-628-9454.

The lines are staffed by a mix of paid professionals and unpaid volunteers trained in crisis and suicide intervention. The confidential environment, the 24-hour accessibility, a caller’s ability to hang up at any time and the person-centered care have helped its success, advocates say.

The International Association for Suicide Prevention and Befrienders Worldwide also provide contact information for crisis centers around the world.

Tuohy expects more “poly-use” of readily available marijuana and alcohol, which is already seeing increased consumption worldwide.

It takes longer to build up data on illegal drug consumption, but analysts are watching closely.

Federal confidentiality laws in the US have been relaxed to allow people to access counseling and peer support faster. NAADAC is offering telehealth training, and resources to help clients find services available in their state.

“Whenever there’s a natural disaster, we know that relapse goes up, because of anxiety, the fear of the unknown,” said Tuohy. “Now we have an ongoing, natural disaster, if you will.

“The longer a crisis goes on, the less hope that people see … it doesn’t feel like there’s going to be a light at the end of the tunnel.

“Long term, we’re likely to see suicide go up as a result of depression. So I know that the suicide centers are gearing up and the suicide hotlines already are taking calls.”

A vulnerable population

Any disruption to the illicit drug supply will have the biggest effect on the most vulnerable populations. Heavy drug users are more likely to live with multiple people, have respiratory or other health issues or be homeless — and are therefore more at risk of contracting Covid-19.

“They are in a double tier of vulnerability in that they’re more likely to get the virus and they’re more likely to be affected negatively by it,” said Rolles. “So there’s a big responsibility, I think, on society to look after and protect those populations.”

If that doesn’t happen, hospitals and treatment facilities will face a huge additional strain, he warns.

Governments are conscious of the risks. The UK government has asked local authorities to house all homeless people. Low risk and pregnant prisoners are being released across the world.

Facilities in the US, UK and Canada are allowing stable users to pick up supplies of addiction treatment medications like methadone and buprenorphine once a week or every two weeks instead of daily, but this also presents risks.

Mat Southwell, a drug user and global advocate from Bath in southwest England, told CNN he was delivering a methadone prescription to a woman who cannot pick it up for herself, is suicidal and self-harms. She had gone three days without it.

Coronavirus is revealing how badly the UK has failed its most vulnerable

Will Haydock, from Public Health Dorset also in southwest England, told CNN that UK clinics were seeing an increase in people accessing treatment. He said this was encouraging but warned that for providers already making “significant changes to service design” this was adding to pressure. “It’s going to be a real challenge to deal with that influx of people who want support,” he said.

“This is a particularly vulnerable group of people, and you’re looking at services that are already really stretched.

“If we’re not able to offer the kind of level of support that we would like to, we will see more people die earlier than they need to.”

A spokesperson for the UK’s Home Office told CNN it is “monitoring the impacts of coronavirus” and law enforcement are “continuing to prevent drug trafficking and are successfully disrupting the drugs supply within the UK.”

The world was already facing a drug crisis before the coronavirus pandemic. The US is in the throes of an opioid epidemic. An estimated 10.3 million Americans ages 12 and older misused opioids in 2018. In 2017, there were more than 70,200 overdose deaths in the US and 47,600 of those deaths involved opioids.

The UK has seen near-record levels of drug-related deaths for six years in a row, and Scotland’s death rate is the highest in the European Union.

“I’m very apprehensive about what’s happening right now and what’s going to happen over the next few weeks to this group of our society who are extremely vulnerable, who’ve been exposed to adverse experiences, neglect and abuse from childhood onwards, and now risk being put at the back of the queue for support when in fact, they should be in front of it,” said Stevens, from the University of Kent.

The coming weeks and months will be crucial in identifying the effects of coronavirus on illegal drug use, alcoholism, suicide, domestic abuse, anxiety, and depression — and what it means for all of us as well as how we need to compromise, care and treat each other.