As the virus tears through New York, it’s spreading through rural America, too.
Credit…The New York Times
The head of the World Health Organization warned that politicizing the pandemic would result in “many more body bags.”
New York State alone now has more confirmed coronavirus cases than Italy.
Don’t count on the coronavirus fading in hot weather the way some other viruses do, the National Academy of Sciences said.
Why N.Y. has so many cases: ‘Everything was slow’
The coronavirus struck the U.S. first on the West Coast, but hardest in New York, where at least 6,268 people have died since the state’s first positive test on March 1. “The bad news isn’t just bad,” Gov. Andrew M. Cuomo said Wednesday. “The bad news is actually terrible.”
It’s likely that nothing could have completely prevented America’s biggest and densest metropolis from being walloped. But early on, when swift action might have made a big difference, the official response was hampered by confused guidance, unheeded warnings, delayed decisions and political infighting, a team of Times reporters found.
The virus “was spreading widely in New York City before anyone knew it,” said Dr. Thomas R. Frieden, a former head of both the Centers for Disease Control and Prevention and the New York City Health Department.
Dr. Frieden said that if the state and city had acted a week or two earlier to order social distancing, close businesses and tell people to stay home, the outbreak might have claimed half as many lives, or even fewer. But New York was days behind California and Washington State in taking those measures.
Rural populations tend to be older, poorer and less healthy than the national average. Health care systems in rural areas often lack resources and are short on doctors and nurses.
“A lot of communities are an hour’s drive or more from an I.C.U. bed, and some of them don’t have hospitals,” said Jack Healy, who covers rural places for The Times. “While the numbers are smaller, they could be overwhelmed easier. If a couple of nurses get sick, that may be a huge portion of the staff at a smaller clinic.”
Rural areas are also concerned that they may not have enough clout to compete for scarce resources against places like New York and Seattle, Jack said. The financial burden from the virus outbreak is also squeezing smaller hospitals, and some are closing.
“It’s akin to taking heavy artillery off the field during a battle,” Jack said. “It’s astonishing.”
What we know about chloroquine
As doctors and researchers scramble to find treatments for Covid-19, one drug has attracted outsize attention: hydroxychloroquine, a prescription medicine frequently used to treat malaria, rheumatoid arthritis and lupus.
President Trump has promoted the drug repeatedly in televised briefings, despite warnings from his own health officials that there is little data to support its widespread use.
Here’s where the science currently stands.
One lab study found that it may block the virus from invading cells. Drugs that conquer viruses in petri dishes do not necessarily work in people, though: In earlier studies, hydroxychloroquine failed to prevent or treat other viral illnesses in humans, including influenza.
Is it being given to coronavirus patients now?
Yes. Clinical trials with control groups have begun around the world, including one in the United States involving 510 patients at 44 medical centers.
Early studies suggested some benefit in patients with mild cases, but much of that research was done without proper controls; scientists agree that more rigorous testing is needed.
If I can get hydroxychloroquine on my own, should I take it?
No. There is no evidence yet that the drug can keep healthy people from getting infected, and it can have significant side effects. There are concerns that it may not be safe for people whose organs have been damaged by the virus.
And if you are buying it on the street or the internet, what you get may be fake or unsafe. An Arizona man in his 60s died last month after swallowing an aquarium cleaning product that had chloroquine on its label.
The Cook County jail in Chicago has emerged as the largest-known source of U.S. coronavirus infections: As of Wednesday, at least 238 inmates and 115 staff members had tested positive.
New York, the hardest-hit state in America, reported its highest number of coronavirus-related deaths in a single day on Wednesday, announcing that another 779 people had died.
There have been 1,440 cases in and 27 deaths in Washington, D.C., amid growing concern that residents are not complying with social distancing guidelines.
More than six weeks after Saudi Arabia reported its first case, as many as 150 members of the royal family are believed to have contracted the coronavirus.
What you can do
Stay safe when running errands. The C.D.C. has a guide on how to safely gas up the car, shop for groceries, receive a delivery or visit the doctor.
Find moments of solace away from the children. Crying in your car counts as self-care. The same goes for meditation. Our parenting column offers other ways to find headroom, or even joy.
Look good on your computer camera. Tom Ford gave us some staging tips, including putting a white cloth or sheet of paper on the table between you and your computer, to bounce up a little extra fill light.
Is your takeout order saving the restaurant or risking lives? It’s complicated. Our California critic, Tejal Rao, says the answer may lie in how well the restaurant protects its workers.
What else we’re following
Democrats are pressing for an expansion of voting access measures, like voting by mail, as the pandemic threatens to upend elections through November. Republicans are resisting the changes; President Trump has said they could harm his party’s election prospects.
Some experts think too many Covid-19 patients are being put on ventilators and could survive with less invasive aid, the health and science news site STAT reports.
One out of three recovered coronavirus patients studied in Shanghai had low levels of antibodies, which may signify a greater risk of reinfection.
With so few cars on the road and so many factories shuttered in New Delhi, “the air is so clean that for once, you can’t taste it,” our correspondent writes.
Don’t expect a quarantine baby boom: Disasters have little effect on birthrates, experts say, and if anything, the pandemic will probably discourage some couples from having children.
Jigsaw puzzles are hotter than ever. Ever wonder how they make them? The process takes weeks.
What you’re doing
My daughter and I live half an hour’s drive away from each other. We used to get together for “Sunday Fun-day” each week. Now we have “Sunday Trunk-day.” I fill the trunk of my car with goodies: fresh baked lasagna and cookies, assorted groceries and snacks, games. When I arrive she unloads the goodies, and then we chat through the window with her standing at least six feet back. I miss my hugs, but we make do.
— Adelle Bishop, Whittier, N.C.
Let us know how you’re dealing with the outbreak. Send us a response here, and we may feature it in an upcoming newsletter.
Jonathan Wolfe and Tom Wright-Piersanti helped write today’s newsletter.
Updated April 11, 2020
When will this end?
This is a difficult question, because a lot depends on how well the virus is contained. A better question might be: “How will we know when to reopen the country?” In an American Enterprise Institute report, Scott Gottlieb, Caitlin Rivers, Mark B. McClellan, Lauren Silvis and Crystal Watson staked out four goal posts for recovery: Hospitals in the state must be able to safely treat all patients requiring hospitalization, without resorting to crisis standards of care; the state needs to be able to at least test everyone who has symptoms; the state is able to conduct monitoring of confirmed cases and contacts; and there must be a sustained reduction in cases for at least 14 days.
How can I help?
Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities. More than 30,000 coronavirus-related GoFundMe fund-raisers have started in the past few weeks. (The sheer number of fund-raisers means more of them are likely to fail to meet their goal, though.)
What should I do if I feel sick?
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
Should I wear a mask?
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
How do I get tested?
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
How does coronavirus spread?
It seems to spread very easily from person to person, especially in homes, hospitals and other confined spaces. The pathogen can be carried on tiny respiratory droplets that fall as they are coughed or sneezed out. It may also be transmitted when we touch a contaminated surface and then touch our face.
Is there a vaccine yet?
No. Clinical trials are underway in the United States, China and Europe. But American officials and pharmaceutical executives have said that a vaccine remains at least 12 to 18 months away.
What makes this outbreak so different?
Unlike the flu, there is no known treatment or vaccine, and little is known about this particular virus so far. It seems to be more lethal than the flu, but the numbers are still uncertain. And it hits the elderly and those with underlying conditions — not just those with respiratory diseases — particularly hard.
What if somebody in my family gets sick?
If the family member doesn’t need hospitalization and can be cared for at home, you should help him or her with basic needs and monitor the symptoms, while also keeping as much distance as possible, according to guidelines issued by the C.D.C. If there’s space, the sick family member should stay in a separate room and use a separate bathroom. If masks are available, both the sick person and the caregiver should wear them when the caregiver enters the room. Make sure not to share any dishes or other household items and to regularly clean surfaces like counters, doorknobs, toilets and tables. Don’t forget to wash your hands frequently.
Should I stock up on groceries?
Plan two weeks of meals if possible. But people should not hoard food or supplies. Despite the empty shelves, the supply chain remains strong. And remember to wipe the handle of the grocery cart with a disinfecting wipe and wash your hands as soon as you get home.
Can I go to the park?
Yes, but make sure you keep six feet of distance between you and people who don’t live in your home. Even if you just hang out in a park, rather than go for a jog or a walk, getting some fresh air, and hopefully sunshine, is a good idea.
Should I pull my money from the markets?
That’s not a good idea. Even if you’re retired, having a balanced portfolio of stocks and bonds so that your money keeps up with inflation, or even grows, makes sense. But retirees may want to think about having enough cash set aside for a year’s worth of living expenses and big payments needed over the next five years.
What should I do with my 401(k)?
Watching your balance go up and down can be scary. You may be wondering if you should decrease your contributions — don’t! If your employer matches any part of your contributions, make sure you’re at least saving as much as you can to get that “free money.”
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