CORONAVIRUS TRACKING – Jonathan M. Metsch, Dr.P.H. PARTS 1-15 (and prequels). March 22, 2020

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Curated Contemporaneous Case Study Methodology

CORONAVIRUS TRACKING – Jonathan M. Metsch, Dr.P.H.

PARTS 1-15 (and prequels). March 22, 2020

PART 1. January 21, 2020. “The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.”

“The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.”

“Chinese researchers say they have identified a new virus behind an illness that has infected dozens of people across Asia, setting off fears in a region that was struck by a deadly epidemic 17 years ago.

There is no evidence that the new virus is readily spread by humans, which would make it particularly dangerous, and it has not been tied to any deaths. But health officials in China and elsewhere are watching it carefully to ensure that the outbreak does not develop into something more severe.

Researchers in China have “initially identified” the new virus, a coronavirus, as the pathogen behind a mysterious, pneumonialike illness that has sickened 59 people in the city of Wuhan and caused a panic in the central Chinese region, the state broadcaster, China Central Television, said on Thursday. They detected this virus in 15 of the people who fell ill, the report said.

The new coronavirus “is different from previous human coronaviruses that were previously discovered, and more scientific research is needed for further understanding,” the report said.” (A)

“China released the genetic sequence of a new coronavirus believed to be responsible for a cluster 0f unusual pneumonia cases in Wuhan. Phylogenetic analysis shows the coronavirus to be closely related to SARS CoV, the virus responsible for the SARS pandemic which began in China in 2003.

Further analysis is necessary, but this preliminary analysis shows the virus is also quite similar to other SARS-related coronaviruses which appear to be endemic to the area. Prior EcoHealth Alliance research has found evidence that these viruses are spilling into human populations. We are also conducting behavioral analysis with the goal of reducing risk for this spillover.

The virus responsible for the current outbreak in Wuhan has so far killed one person; fortunately it’s not currently believed that the virus has the ability to spread human-to-human. Our work has shown that there is a large diversity of coronaviruses that are endemic to China.” (B)

“Chinese officials confirmed Tuesday that six people have died from a pneumonialike coronavirus, while raising the number of confirmed cases of the illness to 300, sparking fears of an outbreak in the country. The virus, which was first confirmed on Dec. 31 in the city of Wuhan, is believed to have been transmitted from animals to humans, but Chinese health officials now say they have evidence that human-to-human transmission is also possible, potentially via saliva. The World Health Organization says the symptoms of the virus are fever, cough, and respiratory difficulties such as shortness of breath, all of which can, in serious cases, lead to pneumonia, kidney failure, and, in the most severe cases, death.” (C)

“Officials in China are racing to contain the spread of a new virus that has left at least six people dead and sickened more than 300, after it was confirmed the infection can spread between humans.

Wuhan, the central Chinese city where the coronavirus was first detected, announced a series of new measures Tuesday, including the cancellation of upcoming Lunar New Year celebrations, expected to attract hundreds of thousands of people.

Tour agencies have been banned from taking groups out of Wuhan and the number of thermal monitors and screening areas in public spaces will be increased. Traffic police will also conduct spot checks on private vehicles coming in and out of the city to look for live poultry or wild animals, after the virus was linked to a seafood and live animal market, according to a report by state media outlet the People’s Daily, citing Wuhan’s Municipal Health Commission.

The new measures come after Chinese President Xi Jinping ordered “resolute efforts to curb the spread” of the virus Monday.

There are now fears, however, that efforts to contain it are coming too late, hampered by a slow-moving Chinese bureaucracy which failed to put sufficient measures in place in time.

In the coming days, hundreds of millions of Chinese are expected to begin traveling across the country and overseas as the annual Lunar New Year break gets fully underway, compounding concerns of a further spike in cases.

Though infections were first detected in Wuhan in mid-December, infrared temperature screening areas were not installed in the city’s airports and stations until January 14, according to state media.

On Tuesday, China’s National Health Commission announced that it had received 291 confirmed cases of the Wuhan coronavirus, with 77 new cases reported on January 20.” (D)

“Earlier on Monday, Chinese authorities reported that the number of cases had tripled over the weekend to 218. The outbreak has spread to Beijing, Shanghai and Shenzen, hundreds of miles from Wuhan, where the virus first surfaced last month.” (E)

“Thailand and Japan each reported new cases of a coronavirus that has left two people dead and at least 40 sick in China, adding to concerns about the spread of the virus beyond Chinese borders ahead of a major holiday.

Health officials in Thailand on Friday said they had found a second case of the mysterious pneumonialike coronavirus in that country, in a 74-year-old Chinese woman. The woman is in good and stable condition, said a spokesman for Thailand’s public health ministry, Rungrueng Kitphati.

The woman entered Thailand through Bangkok via a flight from the central Chinese city of Wuhan, the epicenter of the outbreak. Investigators were still trying to gather information from the woman but have been hindered by a language barrier, Mr. Rungrueng said.

On Thursday, Japan’s Health Ministry said that a Chinese man in his 30s tested positive for the coronavirus. The man, a resident of Kanagawa Prefecture, just south of Tokyo, returned to Japan on Jan. 6 after traveling to Wuhan. The man, who came down with a fever on Jan. 3, was hospitalized on Friday but was discharged five days later because he had recovered, according to the Health Ministry.” (F)

“A British tourist is feared to have contracted the mysterious coronavirus that’s sweeping Asia after he was hospitalized on a trip to Thailand, according to a report.

Ash Shorley, 32, was admitted in critical condition to a Phuket hospital, where he’s being treated for pneumonia-like lung infections, the Sun reported.

Doctors believe his symptoms are consistent with the new Chinese coronavirus, which has killed three patients and infected hundreds of others.

“They think he is the first Western victim of the Chinese flu,” his father, Chris, told the outlet. “We are waiting on tests.”” (G)

 “Airports in New York, San Francisco and Los Angeles will begin screening passengers arriving from Wuhan, China, for infection with a mysterious respiratory virus that has killed two people and sickened at least 45 overseas, the Centers for Disease Control and Prevention announced on Friday.” (H)

“Officials this week also confirmed that the new coronavirus, which is linked to a seafood and animal market in Wuhan, is transmissible between humans. This ultimately sparked fears that a person infected with the virus and experiencing the most severe stage of infection could be a super-spreader —  someone who transmits the virus to a considerable more amount of people than the average infected person, the South China Morning Post reported…

In response to the outbreak, the World Health Organization (WHO) is holding an emergency meeting on Wednesday to determine whether or not it should be considered an international public health emergency, according to the South China Morning Post…

Australia is taking similar measures, with officials there announcing Tuesday that the country will also begin screening passengers who are arriving from Wuhan, according to The New York Times. Japan and South Korea also announced increased airport screenings.

But even with screening measures, “You cannot absolutely prevent entry into the country of a disease like this,” Brendan Murphy, the chief medical officer for the Australian government, said, according to the newspaper. Some people who are infected may not show symptoms, he explained.” (I)

“The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.

The CDC and Washington state officials said the man, in his 30s, was in good condition at Providence Regional Medical Center in Everett. The symptoms presented Sunday and the diagnosis was confirmed Monday.

Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases, called the news “concerning.”

“We’re still in the early days of this investigation,” Messonnier said.” (J)

A.China Identifies New Virus Causing Pneumonialike Illness, by Sui-Lee Wee and Donald G. McNeil Jr.,

B.Phylogenetic Analysis Shows Novel Wuhan Coronavirus Clusters with SARS,

C.Deadly Coronavirus in China Raises Fears of Outbreak as Human Transmission Confirmed, by ELLIOT HANNON,

D.6 people dead, 300 infected as China confirms Wuhan virus can be spread by humans, by James Griffiths and Nectar Gan,

E.China confirms new coronavirus can spread between humans, by Nectar Gan, Yong Xiong and Eliza Mackintosh,

F.Japan and Thailand Confirm New Cases of Chinese Coronavirus, by Sui-Lee Wee,

G.British tourist feared to be victim of deadly new Chinese coronavirus, by Jackie Salo,

H.Three U.S. Airports to Check Passengers for a Deadly Chinese Coronavirus, by Denise Grady,

I.Coronavirus outbreak in China sparks ‘super-spreader’ fears as pneumonia-like illness sickens hundreds, by Madeline Farber,

J.First US case of deadly coronavirus reported in Washington state, CDC says, by John Bacon,

PART 2. January 29, 2020. CORONAVIRUS. “If it’s not contained shortly, I think we are looking at a pandemic..”….. “With isolated cases of the dangerous new coronavirus cropping up in a number of states, public health officials say it is only a matter of time before the virus appears in New York City.”

CORONAVIRUS. “If it’s not contained shortly, I think we are looking at a pandemic..”….. “With isolated cases of the dangerous new coronavirus cropping up in a number of states, public health officials say it is only a matter of time before the virus appears in New York City.”

In July of 2009 the Mayor of Hoboken asked me to initiate a H1N1 “Swine Flu” Task Force. We started with a set of questions based on reports from communities that had already experienced a Swine Flu surge:

Health Officer: Where vaccination sites should be established? Is there a special plan to monitor restaurants and food shops where flu-related safety guidelines need to be strictly enforced? Who will start preparing a Community Education plan?

Hospital: What is the back-up plan if hospital becomes “contaminated” and is closed to admissions, or if nursing staff is depleted by flu-related absenteeism, etc.? ICU triage? Availability of respirators?

OEM:  off-site screening centers if hospital ER is on overload

Hoboken Volunteer Ambulance Corps:  “mutual assist” plan

Hoboken Police Department & Hoboken Fire Department: back-up plan if the ranks get depleted by the flu

BOE: criteria in deciding whether or not to close schools

Stevens Institute of Technology: surveillance and plan for (college) students

“Field Manual” for the Mayor

Interestingly Swine Flu never flourished in the Hoboken area probably due to herd immunity acquired from the Swine Flu in 2008 in New York City, where many Hobokenites work and visit.

Acute respiratory syndrome (SARS) is a viral respiratory illness caused by a coronavirus, called SARS-associated coronavirus (SARS-CoV). SARS was first reported in Asia in February 2003 and the illness spread to more than two dozen countries in North America, South America, Europe, and Asia before the SARS global outbreak was contained. According to the World Health Organization (WHO), a total of 8,098 people worldwide became sick with SARS during the 2003 outbreak. Of these, 774 died. In the United States, only eight people had laboratory evidence of SARS-CoV infection. All of these people had traveled to other parts of the world with SARS.” (A)

With SARS preparedness underway in NJ LibertyHealth/ Jersey City Medical Center, where I was President, proposed that our 100 bed community hospital with all single-bedded rooms, be immediately transformed into an EMERGENCY SARS ISOLATION Hospital.

The Hospital was in a small town at the intersection of many major highways. It could be easily secured since it had no immediately contiguous neighbors. It had a helicopter pad. Its patients could be easily transferred. And it could be managed by the Public Health Service or military medicine if necessary.

It didn’t happen!

“We understand that many people in the Unites States are worried about this virus,” said Dr. Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases (part of the Centers for Disease Control and Prevention).

“At this time, in the U.S., the virus is not spreading in the community,” she added. “For that reason we continue to believe that the immediate health risk from the new virus to the general public is low at this time.”

In the U.S., 110 individuals from 26 states are being investigated to determine whether they have coronavirus. Of those individuals, 32 have tested negative, five have tested positive, and the remaining test results are pending.

No new coronavirus cases have been diagnosed overnight, according to the CDC, and all five cases were in people who had traveled to China. Two of those five cases are in Southern California and Chicago, Washington state and Arizona have each reported one coronavirus case…

Five U.S. airports, in New York, San Francisco, Los Angeles, Chicago and Atlanta, continue to screen passengers from Wuhan for pneumonia-like symptoms, such as fever and respiratory problems. So far, airports have screened about 2,400 passengers, with screenings declining following strict travel bans and a quarantine in Wuhan…

The CDC is in the process of developing a real-time diagnostic test to identify the virus and is hoping to quickly roll that test out to states. For now, all samples are being sent to the CDC in Atlanta, a process which takes about a day, from the time clinicians and the CDC agree to test a patient for coronavirus until results come back from Atlanta. Other countries are doing similar centralized testing, Messonnier explained. While speed is important, accurate testing is the agency’s priority.

While a report in the Lancet, published Jan. 24, suggested that people who contract coronavirus might be able spread the disease before they develop symptoms, Messonnier maintained that the CDC has “no clear evidence” of patients’ being infectious before symptom onset. For now, the virus’ incubation period is believed to be between two and 14 days..

The World Health Organization did not declare a public health emergency of international concern last week, after deliberating for two days over the decision.” (C)

“It appears to be very well contained,” Mark Parrish, regional medical director of Northern Europe at International SOS, told CNBC Tuesday.

“The Chinese have done some extraordinary things, identifying the virus and its molecular structures and then instigating those quarantine measures in China where they have shut down these huge cities and stopped all movement. It’s come at a really bad time of the year … It’s likely to have moved around China.”

“It appears though that the death rate remains at about 2% to 3%, it seems to be very well contained at the moment,” he said.

“Putting it into perspective, 100 deaths or so, so far, all in elderly people and those that have other co-existing diseases unfortunately. And those are the ones that are most likely to be affected by this as their respiratory systems find it difficult to deal with these things.”..

Global media organizations have fixated on whether the outbreak will be declared a “global health emergency” by the World Health Organization (WHO). Currently, the WHO has the virus at a “high risk” level after admitting on Monday its error in initially stating (last week) that the global risk was “moderate.”

Christian Lindmeier, spokesperson for the WHO, told CNBC Tuesday that the assessment was done by a group of independent experts and that the situation would be re-evaluated “very soon.”

He said there was definitely a crisis in China “but declaring this a public health emergency of international concern is another step. It means that internationally this is spreading and is transmitting from human to human internationally.

“So not only a traveler carrying it from China into another country and it being contained there, but it spreading onward from there and this is something we’ve not yet seen, let’s be very clear about this,” he said.

Although it has not happened yet, Lindmeier said it would not be surprising if the virus spread further. He said health systems should closely monitor the situation and “be aware that this is what could come to their shores.”..

“The jury’s still out just how bad it will be, but when you think that the number of cases has doubled in one day, that’s very worrisome,” he said.” (D)

“With isolated cases of the dangerous new coronavirus cropping up in a number of states, public health officials say it is only a matter of time before the virus appears in New York City.

As a result, hospitals have been on the lookout for patients with recent travel involving Wuhan, the Chinese city where the coronavirus is believed to have originated. And they have urged those who recently traveled there — or who have been in contact with someone who has — to quickly seek medical care if they have any respiratory or flulike symptoms.

“It’s inevitable that we will have someone who is positive with coronavirus,” New York City’s health commissioner, Dr. Oxiris Barbot, said Sunday.

Some of the last passengers to arrive at Kennedy International Airport on the last direct flights from Wuhan before they were canceled were quarantining themselves at home. One man told of how he had confined himself to his house in Queens, as friends left special Lunar New Year meals on his doorstep.

So far, state officials have sought testing for nine patients who were deemed potential cases of the new coronavirus, sending samples to the Centers for Disease Control and Prevention for testing.

Four of those patients were found not to have the virus, and the tests involving the other five are still pending, Gov. Andrew M. Cuomo said Monday in a statement.

When the first case does arrive, health officials said, that patient may end up in a biocontainment unit in Bellevue Hospital or sent home to ride out the illness in his or her bedroom. That will depend largely on how sick they are, public health officials say…

By and large, the message to the public has been one of reassurance. “We are encouraging New Yorkers to go about their everyday lives and suggest practicing everyday precautions that we do through the flu season,” Dr. Barbot said.

But there is considerable anxiety and debate over the proper precautions within the city’s Chinatowns. That has only grown in the past few days as more alarming news has emerged out of Wuhan about the virus’s spread. So far more than 4,500 people have been sickened and more than 100 people have died.” (E)

“New York’s colleges, which enroll some 50,000 students from China, put out warnings to be on alert for symptoms of the deadly coronavirus as classes started up again for the spring semester.

Most of the Chinese students in the state are studying in the New York City area, according to the Institute for International Education’s most recent report.

New York University, which has upwards of 19,000 international students — more than any other college in the country — said it reached out to students from China’s Wuhan region, where the virus originated, and “provided them with information about the symptoms, instructed them to check in with us if they are experiencing those symptoms, reminded them about the availability of NYU health services.”

Spring semester classes begin Monday at NYU. A college spokesman would not say how many students come from the Wuhan area.” (F)

“The first U.S. patient, an unidentified man in his 30s, had traveled to the Wuhan area at the end of last year. He fell ill shortly after flying back to the U.S., where he lives north of Seattle.

In Washington state, health agencies have identified more than 60 people who came in close contact with the infected man before he was hospitalized in Everett, a city in Snohomish County outside Seattle.

The case quickly grabbed headlines, but it didn’t rattle local health clinic workers who had recently geared up to handle another infectious disease.

“The measles really kind of enlightened everybody about ‘Wow, there are a lot of things out there that can be really contagious and can get you really sick, really fast,’ ” says Tove Skaftun, the chief nursing officer for the Community Health Center of Snohomish County.

Skaftun says she’s glad that last year’s outbreak forced them to improve how they approach these situations.

“We’ve recently grown our infection-control program so it’s kind of at the forefront of a lot of what we do,” says Skaftun.

She says that effort focused on educating staff about the correct precautions to take when faced with different kinds of infectious diseases — including wearing protective air-purifying respirators when in contact with patients who may be infected…

The patient in Seattle first went to a local health clinic when he started showing symptoms. Once it became clear he was at risk for coronavirus, he was transported to Providence Regional Medical Center in Everett, a hospital north of Seattle, where he was treated in isolation. He remains in “satisfactory” condition, according to the Washington State Department of Health.

Dr. Amy Compton-Phillips, the chief clinical officer at Providence St. Joseph Health, which runs that hospital, says it was set up to handle high-level infectious pathogens during the Ebola scare of 2014.

“All types of infrastructure had been put in place to ensure that when something came around we’d be ready,” says Compton-Phillips.

Those include specialized gurneys to keep patients isolated while they’re wheeled around the hospital, robots that can listen to patients’ lungs and take blood pressure, and rooms with negative-pressure air flow so germs aren’t circulated throughout the rest of the hospital…

She says staff have practiced getting ready for an infectious outbreak pretty recently. Last year, Clark County, Wash., which is part of suburban Portland, Ore., had an alarming outbreak of 71 cases of measles, mostly among unvaccinated children…

“There are a lot of unknowns,” says Janet Baseman, professor of epidemiology at the University of Washington. “The best thing public health can do now is assume that it will be similar to other coronavirus outbreaks we have seen in recent years until proven otherwise.”

“Being overprepared is the name of the game,” she says.” (G)

“The emergency call was made to Hackensack University Medical Center late Thursday night.

A doctor’s office was sending a woman in her mid-20s to the emergency room, according to reports, with a suspected case of coronavirus, the deadly novel virus sweeping through China and much of Asia.

The alert turned out to be a false alarm: The patient did not have the coronavirus. Although a relief, it was a scenario hospitals across the state have been bracing for as fears mount that this new, mysterious virus will spread to New Jersey.

Emergency rooms throughout the Garden State are ramping up their procedures in preparation for the time when a patient does arrive with the deadly virus.

“The key is to recognize it early so you can isolate early, and that prevents the likelihood of spreading in our facility and to other patients and employees,” Dr. Jerry Zuckerman, vice president of infection prevention and control at Hackensack Meridian Health System, told NJ Advance Media…

Experts determined the patient who entered the Hackensack emergency room Thursday night was not infected with the virus after an evaluation, a spokeswoman for Hackensack Meridian Health said. Zuckerman declined to discuss the patient, but shed some light on how such a virus is contained in an emergency room.

The protocols are anything but high-tech. But they work, Zuckerman said.

Interview the patient. Mask the patient. Isolate the patient.

That’s it.

It may sound rudimentary, but that is all that stands between the virus spreading or being contained.

First, patients are interviewed to determine whether they’ve visited the outbreak’s place of origin. Then patients are masked and isolated, before being placed in an airborne infection isolation room — also called a negative pressure room. These rooms isolate pathogens.

If medical personnel must enter an isolation room, they have to wear respirator masks, gloves and goggles — think of the protective gear worn in the 1995 Dustin Hoffman film, “Outbreak.”..

 “Although this novel virus in understandably a cause for concern, it is important for New Jersey residents to know that the risk to the public remains low,” Health Commissioner Judith Persichilli said in the Department of Health statement.

“The New Jersey Department of Health works with hospitals and local health departments throughout respiratory virus and flu season on hundreds of disease outbreaks each year and we are prepared — along with our partners — to respond to potential novel coronavirus cases.”” (H)

“The Chinese city of Wuhan is rapidly building a new 1,000-bed hospital to treat victims of a new coronavirus, mobilising machinery to get it ready by early next week, state media said…

The new hospital is being built around a holiday complex originally intended for local workers, set in gardens by a lake on the outskirts of the city, the official Changjiang Daily reported on Friday. Prefabricated buildings which will have 1,000 beds will be put up, it said.

Building machinery, including 35 diggers and 10 bulldozers, arrived at the site on Thursday night, with the aim to get the new facility ready by Monday, the paper added.

“The construction of this project is to solve the shortage of existing medical resources” the report said.

“Because it will be prefabricated buildings, it will not only be built fast but it also won’t cost much.”” (I)

“How is China able to build a hospital in six days?

“China has a record of getting things done fast even for monumental projects like this,” says Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations.

He points out that the hospital in Beijing in 2003 was built in seven days so the construction team is probably attempting to beat that record. Just like the hospital in Beijing, the Wuhan centre will be made out of prefabricated buildings.

“This authoritarian country relies on this top down mobilisation approach. They can overcome bureaucratic nature and financial constraints and are able to mobilise all of the resources.”

Mr Huang said that engineers would be brought in from across the country in order to complete construction in time.

“The engineering work is what China is good at. They have records of building skyscrapers at speed. This is very hard for westerners to imagine. It can be done,” he added.

In terms of medical supplies, Wuhan can either take supplies from other hospitals or can easily order them from factories.

On Friday, the Global Times confirmed 150 medical personnel from the People’s Liberation Army had arrived in Wuhan. However it did not confirm if they would be working in the new hospital once it has been built.”  (J)

“Some infectious disease experts are warning that it may no longer be feasible to contain the new coronavirus circulating in China. Failure to stop it there could see the virus spread in a sustained way around the world and even perhaps join the ranks of respiratory viruses that regularly infect people.

“The more we learn about it, the greater the possibility is that transmission will not be able to be controlled with public health measures,” said Dr. Allison McGeer, a Toronto-based infectious disease specialist who contracted SARS in 2003 and who helped Saudi Arabia control several hospital-based outbreaks of MERS.

If that’s the case, she said, “we’re living with a new human virus, and we’re going to find out if it will spread around the globe.” McGeer cautioned that because the true severity of the outbreak isn’t yet known, it’s impossible to predict what the impact of that spread would be, though she noted it would likely pose significant challenges to health care facilities.

The pessimistic assessment comes from both researchers studying the dynamics of the outbreak—the rate at which cases are rising in and emerging from China—and infectious diseases experts who are parsing the first published studies describing cases to see if public health tools such as isolation and quarantine could as effective in this outbreak as they were in the 2003 SARS epidemic…

China’s health minister, Ma Xiaowei, warned Sunday that the virus seems to be becoming more transmissible and the country—which has taken unprecedentedly draconian steps to control the virus—was entering a “crucial stage.”..

Dr. Nancy Messonnier, director of National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention, said the agency knows transmission of the virus within the United States may be on the horizon.

“We’re leaning far forward. And we have been every step of the way with an aggressive stance to everything we can do in the U.S.,” she told STAT. “And yet those of us who have been around long enough know that everything we do might not be enough to stop this from spreading in the U.S.”

To date, at least 14 countries and territories outside of mainland China have reported nearly 60 cases. There have been no reports yet of unchecked spreading from those imported cases to others…

 “If it’s not contained shortly, I think we are looking at a pandemic,” Bedford said, though he cautioned that it’s impossible to know at this point how severe that type of event would be…

 “I’m not making a prediction that it’s going to happen,” Inglesby said, though he noted the mathematical modeling, the statements from Chinese authorities, and the sharply rising infection numbers make a case for this possible outcome. “I think just based on those pieces of limited information, it’s important for us to begin some planning around the possibility that this won’t be contained.”” (K)

“Laurie Garrett, a Pulitzer Prize-winning science writer, told Yahoo Finance that despite swelling panic over the spread of coronavirus, people should be “realistic” about the infection and the protections they employ against it.

“One of the smart ways to approach thinking about ‘how do you protect yourself,’ is to ask, well, when somebody here in the office has a common cold, and they’re sneezing all over the place, how do you make yourself not get the cold?” asked Garrett, the author of “The Coming Plague,” a book about emerging deadly diseases.

“Social distancing; that’s step number one. Keep your distance from other people” in order to avoid contracting or spreading an infection, Garrett told “The Final Round.” Cleanliness and personal hygiene is also of utmost concern, she added.

“For yourself, think of your hands as your number one problem: anything you touch that’s a common surface,” the author said, explaining that the same principle governs why people are discouraged from sharing utensils or cups.

“Here, in New York City, we think about the subways, we think about how we move around in the city; the answer, if you’re nervous, is wear gloves. Then take your gloves and wash them at night,” Garrett said. “If it’s socially required to shake hands, wash your hands afterwards.”…

Garrett said that “…unlike SARS, which only is contagious when you have a fever, this one seems to be contagious when you don’t even know that you’ve been infected, and the incubation time is much longer.”

While SARS only took three to five days to incubate, the coronavirus “is going out ten days. That means that, potentially, individuals are contagious to others for ten days, without knowing it, traveling about and doing whatever they do with their daily life and infecting so many other people.”

The author also argued that official numbers are “grossly underestimating” the true toll of infections.

“They have a lag time in testing people; they don’t have enough test kits; they have lines around the block, in Wuhan, of people trying to get tested,” says Garrett. “It’s wholly backed up.”” (L)

“A flight carrying about 200 American evacuees landed Wednesday at a US military base in Southern California after leaving the epicenter of the deadly coronavirus outbreak in China.

The flight — operated by Kalitta Air out of Ypsilanti Township, Michigan — was seen taxiing down the runway shortly after 8 a.m. (11 a.m. ET). Several law enforcement vehicles greeted it on the tarmac, their lights flashing…

The US Defense Department will work with the US Department of Health and Human Services, which includes the CDC, to provide housing and, if any individuals are ill, care at a local civilian hospital, Defense Department spokeswoman Alyssa Fara said.

In Alaska, officials conducted two health screenings after prior screenings in China. The CDC cleared all passengers to continue on to California, Alaska officials said.

Passengers were screened in an isolated area of the Anchorage airport’s north terminal, which handles international flights, and had no impact on general travel, airport manager Jim Szczesniak said.

The CDC will work with airport officials to clean the terminal, and there are no international flights scheduled at the airport until May, he said…

Precautions were taken to separate the crew on the plane’s upper level from the passengers on the plane’s lower level, she said, and the crew did not disembark in China.

“These individuals will be screened before they take off; monitored during the duration of the flight by medical personnel on board; screened again on landing to refuel in Anchorage, Alaska; monitored on the last leg of the flight by medical personnel on board; evaluated upon arrival at March Air Reserve Base … and then monitored for symptoms post-arrival,” the CDC said.

The passengers may be forced to stay in isolation between three days and two weeks, an official said.

Priority was given to US citizens at risk

The passengers include US diplomats and their families. The State Department said US citizens could board on a reimbursable basis if space was available.

While there are about 1,000 Americans living in Wuhan, priority was given to US citizens who are “most at risk for contracting coronavirus” if they stay in the city, the State Department said.” (M)

“How would you describe the rate of spread?

Honestly, we don’t know, and part of the reason that it’s continuing at this point in time is because testing is just becoming available. So, while we’re seeing a big bolus [large number] of diagnosed cases, we don’t yet know when they were actually infected.

What we’re waiting for from the World Health Organization is the “epi curve,” which is the graph that shows, by date, the number of new cases and the date of onset of their symptoms. It may be that we’ve been seeing 200 cases a day over 10 days, or it may be that we saw 3 cases, and then we saw 15 and then we saw 100 and then we saw 500 and now a thousand.

We just don’t understand yet whether the case count is due to accelerating spread, or is that just kind of an artificial understanding because of the way the tests are being deployed and the diagnoses are coming in…

How should health officials communicate with the public?

In any frightening new situation, trust is the most important thing. And when you don’t have all of the facts and you’re not sure about what’s going on, maintaining your credibility and your trust are of paramount importance. If you’re going to try to influence what people do or how they decide to manage themselves in a situation like this, you have a lot better chance of helping them decide to do the right thing if they trust you.

So that means first and foremost, telling them the truth. Tell them what you know is going on, tell them what you wish you knew but don’t. Then it’s important to tell them what you’re doing to get answers and, above all, that you promise that when you have new information, you will share it in a timely manner.

If you can keep that cadence going in an outbreak, people will trust you because you do what you say, and they will come to rely upon you as a credible source of updated information.” “(N)

Here are my main takeaways from that experience for ordinary people on the ground:

1. Wash your hands frequently.

2. Don’t go to the office when you are sick. Don’t send your kids to school or day care when they are ill, either.

Notice I didn’t say anything about masks. Having a mask with you as a precaution makes sense if you are in the midst of an outbreak, as I was when out reporting in the field during those months. But wearing it constantly is another matter. I donned a mask when visiting hospitals where SARS patients had been housed. I wore it in the markets where wild animals that were the suspected source of the outbreak were being butchered, blood droplets flying. I wore it in crowded enclosed spaces that I couldn’t avoid, like airplanes and trains, as I traveled to cities involved in the outbreak, like Guangzhou and Hong Kong. You never know if the guy coughing and sneezing two rows ahead of you is ill or just has an allergy.

But outdoors, infections don’t spread well through the air. Those photos of people walking down streets in China wearing masks are dramatic but uninformed. And remember if a mask has, perchance, intercepted viruses that would have otherwise ended up in your body, then the mask is contaminated. So, in theory, to be protected maybe you should use a new one for each outing.

The simple masks are better than nothing, but not all that effective, since they don’t seal well. For anyone tempted to go out and buy the gold standard, N95 respirators, note that they are uncomfortable. Breathing is more work. It’s hard to talk to people. On one long flight at the height of the outbreak, on which my few fellow passengers were mostly epidemiologists trying to solve the SARS puzzle, many of us (including me) wore our masks for the first couple of hours on the flight. Then the food and beverage carts came.”  (O)

“The spread of a fast-moving virus outside of China is of “grave concern” and has prompted the World Health Organization to reconvene an emergency meeting this week to decide whether it’s become a global health emergency, WHO officials said Wednesday.

The coronavirus has spread to a handful of people through human-to-human contact outside of China, Dr. Mike Ryan, executive director of the WHO’s health emergencies program, said at a news conference at the organization’s Geneva headquarters Wednesday.

“These developments in terms of the evolution of the outbreak and further development of transmission, these are of grave concern and has spurred countries into action,” Ryan said, adding that he just returned from China on Wednesday. “What we know at this stage, this is still obviously a very active outbreak and information is being updated and changing by the hour.”” (P)



C.New coronavirus ‘not spreading’ in the US, CDC says, by Erin Schumaker,

D.Health experts call for calm as coronavirus cases rise, by Holly Ellyatt,

E.New York Braces for Coronavirus: ‘It’s Inevitable’, by Joseph Goldstein and Jeffrey E. Singer,

F.New York colleges on coronavirus alert as classes begin, by Melissa Klein,

G.Response To 1st Coronavirus Case In Washington State Draws On Lessons From Measles, by WILL STONE,

H.After coronavirus false alarm, see how one N.J. hospital is preparing for the real thing, by Spencer Kent

I.Wuhan virus: China building 1,000-bed hospital over the weekend to treat coronavirus patients,

J.Coronavirus: How can China build a hospital so quickly?, by Sophie Williams,

K.Experts Warn of Possible Sustained Global, by Helen Branswell,

L.Author: Protect yourself against coronavirus infection with one simple step, by Olivia Balsamo,

M.US evacuees from China land at California military base as coronavirus outbreak grows, by Eliott C. McLaughlin and Faith Karimi, to look ‘pretty intense’:

N.Former CDC head who led U.S. SARS response speaks about coronavirus, by Erika Edwards,

O.How to Avoid the Coronavirus? Wash Your Hands, by Elisabeth Rosenthal,

P.WHO officials say coronavirus spread outside of China is of ‘grave concern’, Berkeley Lovelace Jr.,

(The old B.S. Pollak Hospital, part of the old Jersey City Medical Center, was constructed with federal funds during the Great Depression. The building is now privately owned.

“The Pollak Hospital facility was formerly the site of a three-story building constructed in 1918 for the Jersey City School for Crippled Children. It was taken over as the Infectious Disease Hospital and in 1934 received a loan of $2,996,000 by the Reconstruction Finance Corporation for a new county tuberculosis hospital. The 250-bed facility was eventually named for Dr. B.S. Pollak and became noted for the treatment of chest diseases. When completed in 1936, the 22-floor hospital, at 320 feet, was the tallest building in Jersey City until 1989 with the construction of Exchange Place Center at 490 feet.”) (B)

PART 3. February 3, 2020. “The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe…”..Trump appeared to downplay concerns about the flu-like virus …We’re gonna see what happens, but we did shut it down..” (D)

“The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe…”..Trump appeared to downplay concerns about the flu-like virus …We’re gonna see what happens, but we did shut it down..” (D)

The prospect is daunting. A pandemic — an ongoing epidemic on two or more continents — may well have global consequences, despite the extraordinary travel restrictions and quarantines now imposed by China and other countries, including the United States.

Scientists do not yet know how lethal the new coronavirus is, however, so there is uncertainty about how much damage a pandemic might cause. But there is growing consensus that the pathogen is readily transmitted between humans.

The Wuhan coronavirus is spreading more like influenza, which is highly transmissible, than like its slow-moving viral cousins, SARS and MERS, scientists have found.

“It’s very, very transmissible, and it almost certainly is going to be a pandemic,” said Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Disease.

“But will it be catastrophic? I don’t know.”

In the last three weeks, the number of lab-confirmed cases has soared from about 50 in China to more than 17,000 in at least 23 countries; there have been more than 360 deaths.

But various epidemiological models estimate that the real number of cases is 100,000 or even more. While that expansion is not as rapid as that of flu or measles, it is an enormous leap beyond what virologists saw when SARS and MERS emerged.” (A)

“The World Health Organization declared a global health emergency on Thursday as the coronavirus outbreak spread well beyond China, where it emerged last month.

The move reversed the organization’s decision just a week ago to hold off such a declaration. Since then, there have been thousands of new cases in China and clear evidence of human-to-human transmission in several other countries, including the United States.

All of which warranted a reconsideration by the W.H.O.’s emergency committee, officials said.

The declaration “is not a vote of no confidence in China,” said Tedros Adhanom Ghebreyesus, the W.H.O.’s director-general. “On the contrary, the W.H.O. continues to have confidence in China’s capacity to control the outbreak.”

The declaration comes now, he said, because of fears that the coronavirus may reach countries with weak health care systems, where it could run amok, potentially infecting millions of people and killing thousands.” (B)

“The Donald Trump administration declared the coronavirus outbreak to be a public health emergency in the United States on Friday, setting quarantines of Americans who have recently been to certain parts of China.

Centers for Disease Control and Prevention officials said it was the first quarantine order issued by the federal government in over 50 years. Marty Cetron, director of CDC’s Division of Global Migration and Quarantine, said the last time a quarantine was used was in the 1960s for smallpox…

U.S. citizens who have been in China’s Hubei province during the past 14 days and are returning to the U.S. States will undergo health screenings and be monitored during mandatory quarantines of up to 14 days, officials said.

Azar also announced a temporary suspension of entry into the United States of foreign nationals who pose a risk for the transmission of the coronavirus.

As a precaution, any U.S. citizen who has been anywhere else in mainland China beyond Hubei province will be screened when they return for evidence of coronavirus symptoms. They will also be subject to self-quarantines of up to 14 days and monitored by local health officials.

All flights from China to the U.S. will be funneled to one of seven airports that are designated ports of entry: New York, San Francisco, Seattle, Honolulu, Los Angeles, Chicago and Atlanta.” (C)

“The United States has taken decisive action to protect Americans from the threat of a fast-moving coronavirus while offering help to China, President Donald Trump said on Sunday, but a key adviser said Beijing had not accepted the offers of assistance.

Trump appeared to downplay concerns about the flu-like virus that has killed more than 300 people in China and spread to more than two dozen countries, telling Fox television in an interview, “We’re gonna see what happens, but we did shut it down, yes.” (D)

“People showing no symptoms appear to be able to spread the novel coronavirus that has caused an outbreak in China and led world health authorities to declare a global emergency, researchers reported Thursday in the New England Journal of Medicine. If confirmed, the finding will make it much harder to contain the virus.

The case described — from Germany — could help resolve one of the major unknowns about the virus, which as of Thursday night had infected nearly 9,700 people in China and killed 213. About 100 more infections have been reported in 18 other countries, but no deaths.

Some viruses, including SARS, which is another coronavirus, can only be passed when a person is showing symptoms. Others, like the flu, can be spread a day or two before the onset of symptoms. If people are contagious before they become sick, they can be unknowingly spreading the virus as they go shopping or to work or to the movies. Trying to snuff out the virus in that case is a much more difficult task.

What’s also concerning is that the spread from an asymptomatic person appeared to lead to two generations of cases, meaning the person who contracted the virus then passed it on to others.” (E)

“Close to 10,000 people have contracted the new coronavirus that originated in Wuhan, China—more cases than SARS in 2003. So far, 213 people have died. The preliminary fatality rate for 2019-nCoV hovers around 3%—which is low, but still concerning because of the number of cases accumulating.

But that fatality rate is likely to be higher in older adults. Unofficial open-source data from researchers based in the UK and China show that out of 41 deaths, 39 were in people over 50. Bloomberg reports similar figures. While that’s not unexpected, it indicates the need for effective therapies targeted at this population. And as the proportion of adults over 50 continues to increase globally, future pandemics could be deadlier than they’ve been in the past…

There are two reasons older adults are more susceptible to infections. First, seniors are more likely to have other chronic health conditions, like diabetes or chronic obstructive pulmonary disease, that make it harder for their bodies to cope with damage caused by a new pathogen. Every year, the majority of flu deaths are seen in people 65 or older.

Second, the immune system changes with age—particularly in its ability to respond to coronaviruses. Unlike the flu virus, which does most of the damage to your body on its own, most of the symptoms from coronavirus infections actually come from the body’s immune response, Menachery says. Although he and his lab team are still characterizing these reactions, it seems like coronaviruses encourage older immune systems to kick in with extra inflammation, which can have a cascading effect.” (F)

“Two more Americans, a husband and wife, were confirmed to have the coronavirus late Sunday in the second person-to-person transmission in the U.S. and the 10th and 11th cases in the country, respectively.

The husband, from San Benito County, California, recently traveled to Wuhan, China, the center of the virus’ outbreak, and apparently passed the disease to his wife, who did not go to China. Both 57, neither has been hospitalized, but they have also not left their home.

The couple’s diagnosis brings the total number of positive cases in the United States to 11. The ninth case in the country, in Santa Clara County, California, was announced Sunday afternoon. The other human-to-human transmission was also between a husband and wife and was announced last week in Illinois.” (G)

“Stopping the spread of a rapidly emerging disease takes masterful medical detective work, including tracing the people who have been infected and figuring out their web of contacts, steps that are vital to understanding how it’s being transmitted. US public health officials are following those trails to quickly detect new cases of the Wuhan coronavirus, including the report on Thursday of a sixth US infection—the husband of a woman who became ill after traveling from China back home to Chicago—which was followed by a seventh, in California, on Friday.

Yet there’s a potential wildcard, a deviation that throws off the most careful calculations. For reasons that are still unclear, some people, known as super-spreaders, transmit disease much more readily than others, and to many more people. Like an infectious grenade, they can set off a sudden cluster of illnesses. “These super-spreader events are very unique and fall out of the world of averages,” says Michael Osterholm, an infectious disease expert and director of the Center for Infectious Disease Research and Policy at the University of Minnesota. Yet super-spreading can shape the trajectory of an outbreak in unexpected ways, making it more difficult to control. Instead of infecting just a few people who are close to them, a super-spreader may inadvertently infect dozens—who go on to spread the disease elsewhere.” (H)

“Can wearing a medical face mask protect you against the new coronavirus? It’s a question many people, including pet owners who are putting canine face masks on their dogs, are asking.

If it’s a regular surgical face mask, the answer is “no,” Dr. William Schaffner, an infectious-disease specialist at Vanderbilt University in Tennessee, told Live Science.

A more specialized mask, known as an N95 respirator, can protect against the new coronavirus, also called 2019-nCoV. The respirator is thicker than a surgical mask, but Schaffner doesn’t recommend it for public use, at least not at this point.” (I)

“New York City health officials announced on Saturday that a patient at Bellevue Hospital Center might have the new coronavirus and that samples were being sent to the federal authorities for laboratory testing. If confirmed, it would be the first known instance of the virus in New York City.

Based on the patient’s symptoms and travel history from China, city officials were taking the potential case seriously. This was the first time city officials had sent a sample to the Centers for Disease Control and Prevention for testing.

Another reason the health authorities suspect it might be the new coronavirus: They had tested the patient for influenza and other common illnesses, and those tests came back negative, health officials said.

They said they did not expect to receive results from the C.D.C. for 36 to 48 hours, or possibly longer.

“An individual with a travel history to China felt unwell and sought help from a medical provider who promptly contacted the Health Department,” the health commissioner, Dr. Oxiris Barbot, said in a statement.” (J)

“China completed building on Sunday a massive, makeshift hospital in Wuhan that will serve as the frontline in battling the coronavirus epidemic, according to a report.

Huoshenshan Hospital was built in less than two weeks to treat patients at the epicenter of the virus that has killed more than 300 people, BBC reported.

The hospital, which has 1,000 beds, started construction Jan. 23 and will begin admitting patients on Monday, according to Chinese state media China Global Television Network.

Around 40 million people tuned into livestreams of the construction on YouTube and Periscope, while workers rushed to complete one of two hospitals that will specialize in treating the virus.

Chinese officials are still working to build the second emergency hospital, Leishenshan Hospital, which is expected to open Wednesday around 25 miles away from the newest site, CGTN reported.” (K)

“The 195 Americans who flew from China to California were first told they must clear medical tests that could take 72 hours or many days. Now they are all being quarantined for two weeks…

This makeshift community on a military base in Riverside, Calif., is made up of evacuees from Wuhan, the city in China that is the epicenter of the coronavirus outbreak. The 195 people, including diplomats, infants, a football player and a theme-park designer, are among Americans who have managed to leave Wuhan since a quarantine was imposed.

Now they find themselves stuck in place in the United States. The federal government on Friday imposed a 14-day quarantine, retroactive to when the plane left Wuhan. The patients were initially told they had to wait at least 72 hours for medical testing to be completed.” (L)

“The BlueDot algorithm scours news reports and airline ticketing data to predict the spread of diseases like those linked to the flu outbreak in China.

On January 9, the World Health Organization notified the public of a flu-like outbreak in China: a cluster of pneumonia cases had been reported in Wuhan, possibly from vendors’ exposure to live animals at the Huanan Seafood Market. The US Centers for Disease Control and Prevention had gotten the word out a few days earlier, on January 6. But a Canadian health monitoring platform had beaten them both to the punch, sending word of the outbreak to its customers on December 31.

BlueDot uses an AI-driven algorithm that scours foreign-language news reports, animal and plant disease networks, and official proclamations to give its clients advance warning to avoid danger zones like Wuhan.

Speed matters during an outbreak, and tight-lipped Chinese officials do not have a good track record of sharing information about diseases, air pollution, or natural disasters. But public health officials at WHO and the CDC have to rely on these very same health officials for their own disease monitoring. So maybe an AI can get there faster. “We know that governments may not be relied upon to provide information in a timely fashion,” says Kamran Khan, BlueDot’s founder and CEO. “We can pick up news of possible outbreaks, little murmurs or forums or blogs of indications of some kind of unusual events going on.” (M)

““The outbreak is probably a lot bigger than one the public health officials have confirmation of,” says James Lawler, an infectious disease specialist at the University of Nebraska Medical Center, who treated quarantined Ebola patients in 2017 and 2018. “Just using a back-of-the-envelope calculation on how many travelers there are from China in a given week, and percentage than might have been affected, it’s a lot.”

An area containing eight cities and 35 million people have now been quarantined in China, The New York Times reported Friday, while The Wall Street Journal reports that hospitals in the epicenter of Wuhan are turning away patients and medical supplies such as masks and sanitizers have run out.

Lawler and others say that the coronavirus outbreak will continue to spread as travelers from China to other nations exhibit symptoms of infection. He says we still don’t know how many people will get sick, and how many of those will die before the outbreak recedes.

To stop the spread of disease, public health officials will need to tell the truth and tell it quickly. But in the meantime, it might be worth deputizing an AI-driven epidemiologist.” (N)

As the coronavirus outbreak continues to spread across China, a flurry of early research is drawing a clearer picture of how the pathogen behaves and the key factors that will determine whether it can be contained.

How contagious is the virus?

It seems moderately infectious, similar to SARS.

How deadly is the virus?

It’s hard to know yet. But the fatality rate is probably less than 3 percent, much less than SARS.

How long does it take to show symptoms?

Possibly between 2 to 14 days, allowing the illness to go undetected.

How much have infected people traveled?

The virus spread quickly because it started in a transportation hub.

How effective will the response be?” (O)

“The World Health Organization has declared the growing coronavirus outbreak in China to be a global health emergency. It’s a recognition that the outbreak — now with nearly 10,000 cases — may continue to spread beyond China, and that the nations of the world should lend their assistance and be prepared.

Just a month ago, this virus, called 2019-nCoV, was unknown to science. Now, health officials are working furiously to understand it, trying to prevent a pandemic (a larger global spread of an infection).

These are still early days. Critical questions about the virus — namely how it spreads, and how deadly it is — remain to be firmly answered. But it’s not too soon to wonder: How does this outbreak end?

Right now, infectious disease experts are outlining three broad scenarios for the future of this outbreak. Keep in mind there’s a lot of uncertainty about how this will unfold.

1) The spread of the virus gets under control through public health interventions

This is the best-case scenario, and essentially what happened with the SARS (severe acute respiratory syndrome) outbreak in 2003…

2) The virus burns itself out after it infects all or most of the people most susceptible to it

Disease outbreaks are a bit like fires. The virus is the flame. Susceptible people are the fuel. Eventually, a fire burns itself out if it runs out of kindling. A virus outbreak will end when it stops finding susceptible people to infect.

3) Coronavirus becomes yet another common virus

There’s a third scenario about how this outbreak ends. That it doesn’t.

This has happened before. In 2009, a new strain of the H1N1 flu virus encircled the globe in a pandemic. But, “after a while it became a part of our normal repertoire of what might come up each flu season,” Mina says.” (P)

“Each new crisis follows a familiar playbook, as scientists, epidemiologists, health-care workers, and politicians race to characterize and contain the new threat. Each epidemic is also different, and each is a mirror that reflects the society it affects. In the new coronavirus, we see a world that is more connected than ever by international travel, but that has also succumbed to growing isolationism and xenophobia. We see a time when scientific research and the demand for news, the spread of misinformation and the spread of a virus, all happen at a relentless, blistering pace. The new crisis is very much the kind of epidemic we should expect, given the state of the world in 2020. “It’s almost as if the content is the same but the amplitude is different,” Bhadelia said. “There’s just a greater frenzy, and is that a function of the disease, or a function of the changed world? It’s unclear.”

And there will be a next epidemic. A new disease was always going to rear its head to test the world’s mettle, and more almost certainly will in the future. As I argued in 2018, the world isn’t ready. There has assuredly been progress—vaccines can be produced faster, global cooperation is tighter, basic research is nimbler—but supply chains are stretched, misinformation is rife, and investments in preparedness always fall into neglect once panic subsides. “Every year, things get more and more connected,” Inglesby says. “Epidemics like this show that all of it can be relatively quickly put at risk.” (Q)

A.Wuhan Coronavirus Looks Increasingly Like a Pandemic, Experts Say, by Donald G. McNeil Jr.,

B.W.H.O. Declares Global Emergency as Wuhan Coronavirus Spreads, by Sui-Lee Wee, Donald G. McNeil Jr. and Javier C. Hernández,

C.Trump administration declares coronavirus emergency, orders first quarantine in 50 years, by David Jackson,

D.Trump says U.S. has ‘shut down’ coronavirus threat; China shuns U.S. help, by Doina Chiacu, Andrea Shalal,

E.Study documents first case of coronavirus spread by a person showing no symptoms, by Andrew Joseph/

F.Coronaviruses hit seniors the hardest, by Katherine Ellen Foley,

G.2nd person-to-person transmission of coronavirus reported in US; 1st death confirmed outside China, by Christina Carrega,

H.Wuhan Coronavirus ‘Super-Spreaders’ Could Be Wildcards, by MICHELE COHEN MARILL,

I.Can wearing a face mask protect you from the new coronavirus?, by Laura Geggel,

J.New York City Eyes First Suspected Case of Coronavirus, by Joseph Goldstein,

K.China completes emergency coronavirus hospital in just days, by Jackie Salo,

L.Inside the California Military Base a Coronavirus Evacuee Tried to Flee, by Miriam Jordan,

M.An AI Epidemiologist Sent the First Warnings of the Wuhan Virus, by ERIC NIILER,

N.An AI Epidemiologist Sent the First Warnings of the Wuhan Virus, by ERIC NIILER,

O.How Bad Will the Coronavirus Outbreak Get? Here Are 6 Key Factors, by Knvul Sheikh, Derek Watkins, Jin Wu and Mika Gröndah,

P.Coronavirus: How does this outbreak end?, by Brian Resnick,

Q.The New Coronavirus Is a Truly Modern Epidemic, by ED YONG,

PART 4. February 9, 2020. “A study published Friday in JAMA found that 41% of the first 138 patients diagnosed at one hospital in Wuhan, China, were presumed to be infected in that hospital.…

 “A study published Friday in JAMA found that 41% of the first 138 patients diagnosed at one hospital in Wuhan, China, were presumed to be infected in that hospital.….

“Five health care workers at Good Samaritan Hospital in San Jose were exposed to the new coronavirus while treating a patient there and have been sent home and told to remain isolated until Feb. 11, according to Santa Clara County public health officials…

The workers are being kept at home “to protect the public’s health and limit any potential spread of the virus,” Santa Clara County public health officials said in a statement.” (A)

“During SARS, patients were sent to nine hospitals all over Hong Kong so that no one hospital had to bear the full burden of the outbreak. Despite this effort to spread the load, the outbreak overwhelmed the city’s health-care system. The Tuen Mun public hospital in the northwest of the city was one of the treatment facilities. The toll on the hospital was steep. Staff had to work long hours with the threat of a deadly virus looming over them. Non-emergency patients were turned away. Entire wards were turned into isolation zones. And the first of many casualties among health-care workers in Hong Kong occurred at Tuen Mun on April 26, 2003…

During SARS much of the spread was happening in hospitals. Once that became clear, public health officials put in place rigid infection control measures in medical settings; the outbreaks in Hong Kong, China, Toronto and elsewhere were brought under control. Cowling says transmission of this new coronavirus is quite different from SARS…

Public health officials don’t yet know what it will take to stop the new Wuhan coronavirus, but Seto says fanatically enforcing hand washing — at home and in hospitals — will probably be one of the keys.” (B)

“Most transmission appears to be occurring in the community,” he says. “We’ve seen a small number of infections of health-care workers, but nothing like SARS where one third of the cases were health-care workers. For the new coronavirus it’s a much smaller fraction in hospitals, and probably most transmission occurring in the general community. And that’s much, much more difficult for public health measures to deal with.”

Infectious disease specialists and scientists say the new coronavirus that’s shuttering companies across mainland China may be more contagious than current data shows.

Emerging in Wuhan, China, about a month ago, the virus has spread from about 300 people as of Jan. 21 to close to 21,000 and killed more than 420 — with the number of new cases growing by the thousands every day.

“The rapid acceleration of cases is of concern,” Dr. Mike Ryan, executive director of the World Health Organization’s emergencies program, said at a news conference last week before the agency declared a global health emergency.

Chinese scientists worry the respiratory illness, which world health officials say likely came from a fish market, has mutated to adapt to its new human hosts far more quickly than SARS. Data on the virus is changing by the day, and some infectious disease specialists say it will take weeks before they can see just how contagious it is. What they’re seeing so far is concerning and leading U.S. and international scientists to believe the virus is more contagious than the current data shows, according to interviews with epidemiologists, scientists and infectious disease specialists.” (C)

“The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe, according to many of the world’s leading infectious disease experts.

The prospect is daunting. A pandemic — an ongoing epidemic on two or more continents — may well have global consequences, despite the extraordinary travel restrictions and quarantines now imposed by China and other countries, including the United States.

Scientists do not yet know how lethal the new coronavirus is, however, so there is uncertainty about how much damage a pandemic might cause. But there is growing consensus that the pathogen is readily transmitted between humans.

The Wuhan coronavirus is spreading more like influenza, which is highly transmissible, than like its slow-moving viral cousins, SARS and MERS, scientists have found.

“It’s very, very transmissible, and it almost certainly is going to be a pandemic,” said Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Disease.” (D)

“When the H1N1 flu began spreading a decade ago, U.S. hospitals were flooded with patients. The pandemic, which was declared over in 2010, left nearly 275,000 hospitalized, as health officials fretted whether they would have enough beds, enough medical supplies, or enough protective gear…

Hospitals across the country are convening near-daily meetings to check in on their emergency preparedness plans. And they’ve called all hands on deck. Nearly everyone — from physicians and nurses to public affairs representatives and the employees responsible for ordering supplies and keeping the hospital clean — is involved in making sure a hospital’s existing emergency plans are up to date.

 “But as we project outward with the potential for this to be a much longer situation, one of the things that we’re actively working on is projecting the long-term needs for our health care system,” Dr. Nancy Messonnier, director of Center for Disease Control and Prevention’s National Center for Immunization and Respiratory Diseases, told reporters on Wednesday…

Much of that work revolves around hospitals planning for what Biddinger called the “four S’s” of a surge in patients amid an outbreak: supplies, staff, space, and the system that governs all of them.

They need to review their inventory of supplies, including ventilators, oxygen tanks, and the respirator masks that health workers might need to wear to care for infected patients. They need to plan for how to protect other patients in the hospital, particularly those with weak immune systems. They need to review screening procedures and the proper way to put on protective gear. And they need to educate everyone — from the front desk employees in the ER to the workers who take out the trash in patient rooms — in those protocols.” (E)

“Given the unknowns about 2019-nCoV, in the coming days and weeks, we’re in for some twists and turns. For now, many experts believe this outbreak could get a lot worse: burdening the Chinese health system, spreading in poorer countries with weaker health systems, and sickening and killing thousands more people along the way. Alternatively, it could get much better, with new cases and deaths steadily dropping. Here are the key factors that will determine which way it goes.

4 ways this outbreak could take a turn for the worse

1) China can’t contain the new coronavirus

2) The new coronavirus spreads in countries with weak health systems

3) The virus is actually deadlier than it seems right now

4) Travel bans isolate countries, spread xenophobia — and exacerbate outbreaks

4 things that could unfold that would prevent a pandemic

1) China contains the virus

2) Local clusters of the disease in other countries don’t grow

3) The virus can’t spread in poorer countries with hotter climates

4) We learn the virus is not as deadly as it seems (F)

“Princess Cruises late Tuesday said nine passengers and a crew member on one of its ships in Japan had tested positive for the new coronavirus from China, prompting local authorities to order a multiweek quarantine of the vessel.

The Santa Clarita, California-based line said more than 2,600 passengers and 1,044 crew on the Diamond Princess would remain quarantined on the ship for at least 14 days.

The 10 people who have tested positive for the virus are being taken off the ship, which is in the harbor of Yokohama, Japan — the port for Tokyo. They’ll be transferred to local hospitals…

Early Wednesday, another cruise vessel arriving in a major Asian port was quarantined until passengers could undergo screening for coronavirus. The quarantine of the 3,376-passenger World Dream, in Hong Kong, was ordered after three passengers from a previous sailing tested positive for the virus. World Dream is operated by Dream Cruises, an Asia-based cruise company that caters to Asian travelers.//

Princess said Diamond Princess would head out to sea to perform normal marine operations including, but not limited to, the production of fresh water and ballast operations, before returning to Yokohama and docking at the city’s port. Food and other supplies needed for the extended quarantine of the vessel will be brought onboard.

Passengers have been confined to their cabins for the duration of the quarantine, and many shipboard services have been shut down. Food is being delivered to cabins at regular intervals. Passengers have access to complimentary internet and telephone service to stay in contact with their families and other loved ones.”  (G)

“A southern New Jersey military installation is on a list of potential coronavirus quarantine locations should the need arise.

The Department of Health and Human Services has requested the support of the Department of Defense to provide space if primary and secondary facilities become full.

The Department of Defense identified 11 locations near major airports, including Joint Base McGuire-Dix-Lakehurst, which spans through portions of Burlington and Ocean counties, according to a news release issued Thursday.

The military involvement would be limited to providing housing support for up to 20 people as they undergo a period of quarantined observation, the Department of Defense release said. Military personnel will not be in direct contact with quarantined people and will minimize contact with personnel supporting the evacuees, officials said…

There are currently 12 confirmed cases in the United States, CNN reported Thursday. The news network report said that “planeloads” of Americans fleeing the outbreak in China are arriving at military bases across the United States.” (H)

“Current efforts to contain the coronavirus differ in many ways from those inflicted on lepers in the past century. Americans who may have been exposed to the virus in China are quarantined for 14 days and are not sentenced to life in isolation. The medical treatment is significantly improved and the chances of recovery are good. However, the corona virus is far more contagious than leprosy, against which 95% of people are naturally immune. Precautions are certainly useful.

But this recent outbreak raises questions similar to the health authorities that struggled with decades ago. Are quarantine and isolation the most effective way to contain a disease? Do you hesitate to identify yourself as a potential victim?

“It fails because people are headed for the hills,” said Wendy Parmet, a professor of health law at Northeastern University, Rob Stein from the NPR. “People don’t call and look for medical care … and medical care providers are afraid to treat patients because they don’t want to be quarantined.”

There are other questions as well.

Will the US decision to close its borders for foreigners who have recently visited China do more harm than good? The World Health Organization believes that such travel bans may and warns of panic and anxiety measures.

Perhaps more importantly, how are those who are believed to be potential carriers of the virus treated by those around them? NPR’s Maria Godoy reports that some Asian Americans are already experiencing a setback. A student was told to leave a cafe and “take the corona virus with her.”” (I)

“The Centers for Disease Control and Prevention has shipped the diagnostic test for the novel coronavirus to more than 100 public health labs nationwide, allowing states to test for coronavirus cases themselves and receive results quicker.

Why it matters: The FDA bypassed usual regulatory channels to distribute the test under an Emergency Use Authorization, which has been used in life-threatening situations like MERS, Ebola and the Zika virus.

Before, specimens from all over the country had to be shipped to Atlanta to have their suspected cases validated.

“This continues to be an evolving situation and the ability to distribute this diagnostic test to qualified labs is a critical step forward in protecting the public health,” FDA Commissioner Stephen Hahn said.” (J)

“CDC created this interim guidance to provide US public health authorities and other partners with a framework for assessing and managing risk of potential exposures to 2019-nCoV and implementing public health actions based on a person’s risk level and clinical presentation. Public health actions may include active monitoring or supervision of self-monitoring by public health authorities, or the application of movement restrictions, including isolation and quarantine, when needed to prevent the possible spread of 2019-nCoV in US communities. The recommendations in this guidance apply to US-bound travelers and people located in the United States who may have been exposed to 2019-nCoV. CDC acknowledges that state and local jurisdictions may make risk management decisions that differ from those recommended here. However, a harmonized national approach will facilitate smooth coordination and minimize confusion. The guidance may be updated based on the evolving circumstances of the outbreak.” (K)

“Infection control procedures including administrative rules and engineering controls, environmental hygiene, correct work practices, and appropriate use of personal protective equipment (PPE) are all necessary to prevent infections from spreading during healthcare delivery. Prompt detection and effective triage and isolation of potentially infectious patients are essential to prevent unnecessary exposures among patients, healthcare personnel, and visitors at the facility. All healthcare facilities must ensure that their personnel are correctly trained and capable of implementing infection control procedures; individual healthcare personnel should ensure they understand and can adhere to infection control requirements.

This guidance is based on the currently limited information available about 2019-nCoV related to disease severity, transmission efficiency, and shedding duration. This cautious approach will be refined and updated as more information becomes available and as response needs change in the United States. This guidance is applicable to all U.S. healthcare settings. This guidance is not intended for non-healthcare settings (e.g., schools) OR to persons outside of healthcare settings. For recommendations regarding clinical management, air or ground medical transport, or laboratory settings, refer to the main CDC 2019-nCoV website.” (L)

“Whether it’s an influx of coronavirus carriers or another Superstorm Sandy, a new nonprofit report finds New Jersey is in a relatively good position to handle the next public health emergency.

An annual survey released Wednesday by The Trust for America’s Health shows that New Jersey is among a top tier of 17 states considered to have the best health care and emergency response systems, along with the training and capacity to protect residents against communicable diseases, natural disasters and other calamities.

Officials at the Trust — a national research and advocacy group focused on public health and injury prevention — said the Garden State has ranked in the top third of states for the last several years, a significant improvement from 2013, when it came in as one of the seven lowest-scoring states.” (M)

“Gov. Phil Murphy on Monday launched a task force to make sure New Jersey is prepared for any threat from the surging coronavirus.

Murphy also noted that Newark Liberty International Airport is one of 11 major U.S. airports that receive flights from China requiring enhanced screening for the virus.

There are no confirmed cases of coronavirus in New Jersey, but Murphy said it’s “critical” the state has “strong preparedness protocols in place.”

“By establishing the Coronavirus Task Force, we are bringing together experts across state agencies, health officials, and federal partners to ensure that we are working collaboratively to protect the health and safety of all New Jerseyans,” the governor added.

According to an executive order Murphy signed Monday, the task force will coordinate all state efforts to “prepare for and respond to the public health hazard posed” by coronavirus.

The task force is chaired by state Health Commissioner Judith Persichilli and will include members of the state’s human services, law and public safety, education, and homeland security departments, as well as the State Police.” (N)

““I have to emphasize that the risk right now, certainly to the United States but definitely to the residents of New Jersey, is still low,” said state health commissioner Judith Persichilli, whom Murphy named as the chair of a new Coronavirus Task Force…

Authorities also said that Newark Liberty International Airport is one of 11 airports in the nation where flights from China will be allowed to land, and passengers on those flights will be screened and, if necessary, quarantined.

“We’ve been very proactive, we have teams in place ready to go,” Persichilli said. “There will be screening at the Newark Airport. We are prepared to handle quarantine of any person that comes in.”

Also represented on the task force are the State Police, the Office of Homeland Security, the attorney general and the Department of Education. The group will coordinate with hospitals and other health care facilities as well as federal authorities and the Port Authority, which runs Newark Airport.

Also Monday, Princeton University has told students who recently returned from China to “self-quarantine” for 14 days from the time they were last in China, a step the university said was being taken as a precaution. The number of students affected by the order is more than 100, according to various news reports.

The precaution matches a general advisory issued for travelers by state public health officials.

“If you’ve traveled to China and return from that travel, we would urge residents to monitor their symptoms for 14 days,” said Dr. Lisa McHugh, program coordinator for infectious disease epidemiology for the state health department. “If you develop symptoms, again we would urge you to contact your health care provider, and we’ll work through them to determine if the individual should be tested at the Centers for Disease Control.”” (O)

“China on Thursday finished building a second new hospital to isolate and treat patients of a virus that has killed more than 560 people and continues to spread, disrupting travel and people’s lives and fueling economic fears.

A first group of patients was expected to start testing a new antiviral drug, as China also moved people with milder symptoms into makeshift hospitals at sports centers, exhibition halls and other public spaces.

Other treatment centers had tight rows of simple cots lining cavernous rooms where patients with milder symptoms would be cared for. And Wuhan had another 132 quarantine sites with more than 12,500 beds, according to the official Xinhua News Agency.” (P)

“United States citizen died from the coronavirus in Wuhan, China, American officials said on Saturday. It was the first known American death from the illness, and was likely to add to diplomatic friction over Beijing’s response to the epidemic.” (Q)

“A study published Friday in the medical journal JAMA found that 41% of the first 138 patients diagnosed at one hospital in Wuhan, China, were presumed to be infected in that hospital.

This is big news. In plain English, it means that nearly half of the initial infections in this hospital appear to have been spread within the hospital itself. This is called nosocomial transmission. (Doctors use big words to hide bad things: Nosocomial means caught it in the hospital.)

What’s more, most spread doesn’t appear to have been the result of a so-called “super-spreader event,” in which a single patient transmits infection to many other people. In these events, a procedure such as bronchoscopy — where a doctor inserts a tube into the patient’s lungs — can result in many infections.

This would be a concern, but not nearly as much as what appears to have happened: Many health care workers and many patients got infected in many parts of the hospital. What’s more, since there’s a broad spectrum of infection and only patients who were sick were tested, it’s quite likely that there was even more transmission in the hospital.

So, like SARS and MERS — other coronaviruses — before it, the Wuhan coronavirus is spreading in hospitals.” (R)

“The World Health Organization’s director-general cautioned Saturday that transmission of the new coronavirus outside of China may increase and countries should prepare for that possibility.

 “It’s slow now, but it may accelerate,” Tedros Adhanom Ghebreyesus said during a press conference in Geneva. “So while it’s still slow there is a window of opportunity that we should use to the maximum in order to have a better outcome, and further decrease the progress and stop it.”

Tedros’s warning came after health authorities in Singapore announced they had diagnosed the infection in a man with no travel history to China and no known link to other cases in Singapore…

Infectious diseases expert Michael Osterholm warned that it is unwise to conclude that just because the world hasn’t yet seen outbreaks in other countries they won’t happen. It takes several generations of transmission — an imported case passed on to two others, who then infect two others and so on — before an outbreak takes off, he said.”

“What we’re watching is the public health community trying to catch up to the speed of the virus,” said Osterholm, who is the director of the University of Minnesota’s Center for Infectious Diseases Research and Policy.” (S)

“With an intense flu season in full swing, hundreds of thousands of coughing and feverish patients have already overwhelmed emergency rooms around the United States. Now, hospitals are bracing for the potential spread of coronavirus that could bring another surge of patients.

So far, only a dozen people in the United States have become infected with the novel coronavirus, but an outbreak could severely strain the nation’s hospitals.

“We’re talking about the possibility of a double flu pandemic,” where a second wave starts before the first is over, said Dr. Eric Toner, a senior scholar at the Johns Hopkins Center for Health Security.

Public health experts are also closely watching reserves of vital medical supplies and medications, many of which are made in China. Some hospitals in the United States are already “critically low” on respirator masks, according to Premier Inc., which secures medical supplies and equipment on behalf of hospitals and health systems. And China is the dominant supplier of the raw ingredients needed for penicillin, ibuprofen and even aspirin — drugs taken daily by millions of Americans and dispensed routinely to hospital patients.

“All the hospitals are taxed with a large flu season and other bugs,” said Dr. Mark Jarrett, the chief quality officer for Northwell Health, which operates 23 hospitals across Long Island and elsewhere in New York. About 400 patients are coming to its emergency rooms each day with flulike symptoms.

“Everybody is at maximum capacity,” Dr. Jarrett said…

“Many of us are holding our breath to see the downstream effect on pharmaceuticals and other medical supplies because of this outbreak in China,” said Dr. Paul Biddinger, who helps oversee emergency preparedness for Partners Healthcare, the Boston hospital group that includes Massachusetts General.

Experts like Dr. Toner say supplies could easily become depleted, especially at smaller hospitals that tend to have less inventory of basic items like masks, gowns and gloves. Hospitals have long struggled with shortages of injectable medications and staples like saline. In 2017, Hurricane Maria knocked out power to several pharmaceutical factories in Puerto Rico, leading to a shortage of saline bags…

Because the nature of the virus is still unknown, public health officials said it’s unclear what future challenges hospitals will face if the coronavirus spreads into an epidemic in the United States. While the current government guidelines call for patients to be treated in specialized isolation rooms, experts say it is unlikely that there will be enough isolation rooms at individual facilities.” (T)

“The number of deaths from novel coronavirus in mainland China increased to 811 Sunday, health officials with China’s National Health Commission said.

This exceeds the number of deaths reported from the SARS outbreak in 2003, which killed 774 people, according to the World Health Organization.

Outside of China, two people died from the disease in the last two week, one in the Philippines and one in Hong Kong, bringing total number of global deaths to at least 813.

As of Sunday, more than 37,198 confirmed cases have been reported on mainland China…

Six more people aboard a cruise ship quarantined in Japan have tested positive for novel coronavirus, bringing the total on the Diamond Princess to 70, Japan’s health ministry said Sunday.

The ministry said one of the six confirmed cases is a woman in her 70s who has Hong Kong residency, but is also a U.S. citizen. That brings the total number of American passengers who were confirmed to have the virus to 14.” (U)

“Four passengers on Friday were taken to a hospital after their cruise ship arrived in New Jersey for evaluation of coronavirus..

The CDC has confirmed just 12 cases in the United States, mostly in California; there have been no cases in New Jersey or New York

Four passengers traveling on a cruise ship that returned to New Jersey have tested negative for the new virus that has sickened tens of thousands in mainland China and killed more than 800.

Governor Phil Murphy said all passengers tested negative and “New Jersey currently has no confirmed cases of novel coronavirus and the risk to residents remains low.” (V)

(A)          Five San Jose hospital workers sent home after exposure to coronavirus, by  Deanne Fitzmauric,

(B)          How Hong Kong Beat SARS: Lessons Learned, by Jason Beaubien,

(C)          Wuhan Coronavirus Looks Increasingly Like a Pandemic, Experts Say, by Donald G. McNeil Jr.,

(D)          Researchers say the coronavirus may be more contagious than current data shows, by Berkeley Lovelace, Jr.,

(E)          ‘We need everyone for this’: U.S. hospitals harnessing resources to brace for any spike in coronavirus cases, by MEGAN THIELKING,

(F)          What happens next in the coronavirus outbreak? We mapped 8 scenarios, by Julia Belluz,

(G)         Nearly 4,000 people quarantined on cruise ship for 14 days after coronavirus confirmed onboard, by Gene Sloan,

(H)          N.J. military base is among potential coronavirus quarantine locations, by Justin Auciello,

(I)           Will Corona Virus Quarantines Help or Harm? A look back at leprosy, by Gwen Olson,

(J)           FDA allows states to test for coronavirus for faster results, by Marisa Fernandez,

(K)          Interim US Guidance for Risk Assessment and Public Health Management of Persons with Potential 2019 Novel Coronavirus (2019-nCoV) Exposure in Travel-associated or Community Settings,

(L)           Interim Infection Prevention and Control Recommendations for Patients with Confirmed 2019 Novel Coronavirus (2019-nCoV) or Persons Under Investigation for 2019-nCoV in Healthcare Settings,

(M)        How Ready Is NJ to Handle Public Health Emergencies? The Latest Results, by LILO H. STAINTON,

(N)         Gov. Murphy launches task force to protect N.J. from coronavirus, by Brent Johnson,

(O)         Murphy Sets Up Coronavirus Task Force, State Health Officials Say Risk in NJ ‘Is Still Low’, by Joanna Gagis,

(P)          China finishes second new hospital built for coronavirus patients,

(Q)         First American Dies of Coronavirus, Raising Questions About U.S. Response, by Raymond Zhong and Edward Wong,

(R)          New study an eye-opener on how coronavirus is spreading and how little we know, by Dr. Tom Frieden,

(S)          WHO cautions that transmission of the new coronavirus outside of China could increase, by HELEN BRANSWELL,

(T)          Hospitals are currently making preparations for a possible outbreak of the new coronavirus, by Reed Abelson and Katie Thomas,

(U)         Coronavirus updates: 14 Americans aboard quarantined cruise ship now confirmed to have coronavirus,

(V)          Royal Caribbean Passengers Test Negative for Coronavirus,

PART 5. CORONAVIRUS. February 18, 2020. “In short, shoe-leather public health and basic medical care—not miracle drugs—are generally what stop outbreaks of emerging infections..”

“Nearly six weeks after China announced the coronavirus outbreak, there’s still a surprising amount we don’t know about this newly discovered disease. But one thing is becoming clear: China’s silence in the earliest days of the crisis may have made it worse.

Chinese authorities delayed informing the world about the severity of a deadly disease spreading within the country’s borders — even trying to muzzle whistleblowers, like the late Dr. Li Wenliang. Now hailed as a national hero, Li was forced on January 3 by police to sign a letter saying he spread “untrue speech” for warning colleagues about the virus that eventually took his life.

With more than 40,500 people infected and 910 deaths, China’s missteps early on seem increasingly fateful. The fact that the international community has not acknowledged those missteps is also consequential…

But the reality is this: China’s mishandling and the ensuing silence from the international community is emblematic of how the global system governing the international response to pandemics fails to work, half a dozen global health experts told Vox.

Though we have global health laws — in particular, the International Health Regulations, or IHR — meant to guide countries dealing with outbreaks, they’re not actually enforceable. “You can’t penalize [countries that] don’t follow it,” said Devi Sridhar, the chair in global public health at the University of Edinburgh. Instead, the international community has to rely on “soft law and norms” — or “disease diplomacy.”..

The revised IHR asks countries to build out their disease surveillance capacities and report public health crises immediately. It also asks nations not yet affected by a new pathogen to avoid punishing those that are through travel and trade restrictions. “These revisions were all about trying to get countries to sacrifice their short-term interests for the long-term well-being of all countries,” said Sridhar…

 “The IHR operates on mutual trust largely, and it is a mutual trust,” said Eccleston-Turner. “That mutual trust has been eroded over a number of outbreaks where member states have ignored the recommendations from WHO.”” (A)

“Human intervention, or lack thereof, may also have been a factor. More than half a dozen doctors first discussed the threat of a potential coronavirus outbreak in early December only to be silenced by the local Communist Party, according to some critics of the government.

Yaxue Cao, founder and editor of the political pressure group, said a Wuhan doctor posted in a WeChat group to say there were seven cases of SARS connected to the seafood market. He was then scolded by the party disciplinary office, and forced to retract that, Cao said.

“From the same report, we learned that Wuhan health authorities were having overnight meetings about the new ‘SARS’ at end of December,” Cao posted on Jan. 27. “Earlier today. the Wuhan mayor said he was not ‘authorized’ to publicize the epidemic until Jan. 20.”…

The spread was likely helped by China’s Lunar New Year holiday last month. Wuhan mayor Zhou Xianwang said 5 million people had left the city before travel restrictions were imposed ahead of the Chinese New Year.

“People unfamiliar with China have trouble understanding the immense travel phenomenon that occurs during Lunar New Year, when, over a one-month period, some 3 billion people are on the move, many returning to their home towns and regions but others vacationing,” Tanner Brown, a Beijing-based journalist, wrote for MarketWatch last month. “Peak travel occurs this week.”..

People also may not know they’re carrying the virus. Symptoms of common human coronaviruses include a runny nose, headache, cough, sore throat, fever and a general feeling of being unwell, according to the CDC. Symptoms of the new coronavirus can include fever, cough and shortness of breath…

But it was weeks since the virus was first discovered before flights were curtailed, and the global travel industry is ideal for many viruses to travel long distances.

In an attempt to remain competitive, airlines have decreased their turnaround times in recent years. Many budget airlines have reduced turnaround times to 25 minutes by removing the seat pockets. Other airlines have managed to have long-haul turnaround times of 90 minutes. Not only do planes get a new plane load of passengers, they often get a completely different crew.

Deep cleans are not always possible during such turnarounds. Charles Gerba, a microbiologist at the University of Arizona, recommends using hand sanitizers or disinfectant wipes, particularly when traveling and/or at the office, where people may be reluctant to stay home if they’re sick.” (B)

“China’s new coronavirus may peter out. Or it might join the flu on the roster of the world’s winter illnesses — a bug that will be routinely vaccinated against. Or it might become a global pandemic, killing millions of people.

Experts don’t have enough information to predict which of these very different scenarios will come to pass. So for now, they are cautious.

“The issue is, we don’t know. And any sort of prediction would be ill-advised,” said the director of National Institute of Allergy And Infectious Disease, Anthony Fauci, at a Friday briefing by the presidential task force on coronavirus. “You really do prepare for the worst possible scenario.”

Scenario 1: The virus stays mostly in China

WHO officials this week still expressed hope that the Chinese government will largely contain the coronavirus through unprecedented travel restrictions and quarantine in Hubei province and elsewhere that most closely resemble martial law enacted over tens of millions of people. The quarantines began two weeks ago, and the coronavirus is thought to have an incubation period of up to 14 days, which is leading to questions about how well the measures have worked, especially after China locked down Guangzhou City, population 14 million, just this Friday…

Scenario 2: Another seasonal flu

If the coronavirus does manage to spread widely outside of China, it isn’t necessarily catastrophic. It could turn out to have seasonal behavior, flaring up in winter like the flu. That pattern has been seen in at least two of the common coronaviruses that affect people. If that’s the case for this new one, said Fauci, “when you start getting into the spring weather of April, May, and June, it almost certainly would start to turn around.”

On the downside, that means it would just come back next winter. That happened with the 1918 Spanish flu pandemic that hit the world in two seasonal waves.

Still, the extra time wouldn’t hurt, allowing for clinical trials to test the effectiveness of antiviral drugs used on an emergency basis in the outbreak. China has started two randomized clinical trials of a promising drug called remdesivir, overseen by respiratory disease expert Cao Bin at Beijing’s China–Japan Friendship Hospital. (One of the 12 US patients with the coronavirus tried the drug and recovered a day later.)..

Scenario 3: Deadly global pandemic

Then there’s the worst-case scenario: The relatively few cases popping up in dozens of countries flare up worldwide in the coming months with deadly consequences. It happened in 1957, when a flu pandemic killed 1.1 million people worldwide, and again in 1968, when another flu strain killed about 1 million people….

…That means the new coronavirus might have already skirted containment efforts and might be worse than reported in Hubei province, where some news reports have come of elderly people dying without ever being tested by hospitals. China’s nationwide travel ban, and reports of one province offering a $140 bounty to people who turn in recent arrivals from Wuhan, said Fisman, “are not things you do when you are winning against an outbreak.”…

The one caution about all predictions early in past outbreaks is that they don’t tend to match up with the outcome,” said Fisman, acknowledging his own expectations have worsened as the outbreak has continued. “We still don’t know a lot.”(C)

“As it continues to spread around the world, bringing panic with it, scientists are striving to develop ways of fighting this previously unknown threat. Sophisticated computer modelling is being used to track and predict its transmission, while virologists are attempting to engineer a vaccine. Others are seeking drug treatments that can help those who fall ill with the infection.

But this is not the first coronavirus scientists have encountered, and defeating them is harder than you might think. Even after decades of trying, coronaviruses are formidable foes…

In order to get a reliable model of how the disease spreads, Donnelly says, there are a few things we need to know about the virus. First, how long someone might be infected by it before developing symptoms. This is called the incubation period. Second, we need to know how long someone with the virus remains infectious for, and in cases where patients do not recover, how quickly the virus can cause death. “That helps us estimate the case fatality rate,” says Donnelly.

Super spreaders shed far larger numbers of the virus particles than other patients, increasing the chance they will infect someone else

Another important factor is the reproduction number, which is how many other people someone with the disease will infect. Donnelly and her colleagues have estimated the new coronavirus to have a reproduction number of about 2.6. “If that number is greater than one, then you expect there to be an outbreak,” she says….

Even if it can be diagnosed quickly, finding an effective treatment for a virus like this is famously difficult…

The speed at which coronaviruses mutate and so change their characteristics makes them hard to vaccinate against. Vaccines tend to train the immune system to target a particular feature, such as a protein structure on the shell of the virus. But by continually altering its appearance, our immune systems find it hard to recognise different infections. It is partly why the common cold has been so difficult to develop a vaccine against…

But it is still an open question as to whether a treatment or a vaccine will be found within a matter of months or if it will take years. Until then, says Donnelly, all that can be done is to continue to monitor the virus and try to stop it spreading.” (D)

“What do we most need to know next? For epidemiologists who track infectious diseases, the most pressing concerns are how to estimate the lethality of the disease and who is susceptible; getting detailed information on how it spreads; and evaluating the success of control measures so far.

No. 1 is the “clinical iceberg” question: How much of it is hidden below the surface? Because the outbreak is still evolving, we can’t yet see the totality of those infected. Out of view is some proportion of mildly infected people, with minor symptoms or no symptoms, who no one knows are infected…

In 2003, during the early days of the SARS outbreak, the medical community got the math wrong. At first, we believed that case fatality hovered between 2 percent and 3 percent. It took two pages of longhand algebra, written in Oxford, England, coded into a computer in London and then applied to data from Hong Kong, to get it right. The actual case fatality for Hong Kong was staggering: 17 percent…

Knowing the number of people likely to die, or who get seriously sick or have zero symptoms, will help health authorities determine the strength of the response required. They can better estimate how many isolation beds, heart-lung machines and medicines, among other things, are needed…

Along with getting a grasp on the level of severity is figuring out susceptibility, or who is most at risk for infection. The data so far indicates that this would include older adults, the obese and people with underlying medical conditions. There are few reports of children becoming infected. But are they not showing symptoms, or are they immune? And could they infect others as silent carriers?..

Returning to the big picture, we must also refine what we know about how the new coronavirus is passed between people. Even as the outbreak appears to keep escalating, we believe the rapid — sometimes necessarily draconian — response of governments and health authorities has made a dent in transmission. In another recent study, we estimated how many people could get infected if there were no drastic public health interventions. Our goal with this report was to sound the alarm over what could be, so that it wouldn’t be…

The goal is to stay at least a couple of steps ahead of the epidemic curve. Scientists must prepare health authorities to catch any subsequent waves of infections and prepare for the possibility that this particular virus could reappear seasonally — and maybe one day it could be only as bad as the common cold.

I’ve seen record-breaking outbreaks before and witnessed the world rally. If we all play our roles and remain on guard, then chances are we will defeat the new coronavirus, too…” (E)

“Even as U.S. authorities have taken the drastic steps of quarantining residents returning from China and temporarily banning foreign visitors who recently traveled to affected Chinese regions, they have urged the vast majority of U.S. residents to go about their regular activities.

But there are exceptions. People who returned from China on or after Feb. 3 have been formally quarantined or asked to stay home. And behind the scenes, local public health officials have launched painstaking efforts to reach “close contacts” of people with confirmed cases of the virus, dubbed 2019-nCoV, asking them to self-quarantine and submit to ongoing monitoring.

So what exactly is a ‘close contact’?..

For the new coronavirus, guidelines from the federal U.S. Centers for Disease Control and Prevention define “close contact” as anyone who has been within 6 feet of a person infected with the virus for a “prolonged period of time,” as well as those who have had direct contact with the infected person’s secretions. These guidelines are then interpreted by local public health departments…

In the US, health officials continue to stress low risk of coronavirus..

There is some case-by-case decision-making in assessing risk, Rudman said. Whether a health professional was wearing gloves, a mask or other protective equipment, and what kind of interaction they had with the patient, all factor in.

And because they work with people who are sick and may be at higher risk from infection, health care workers may be asked to take more extreme precautions. Santa Clara County’s public health department asked at least five people to go on two weeks of paid leave after a man who visited the hospital where they worked later tested positive for the virus.

Earlier cases were not so straightforward. One factor that has made the investigations particularly challenging is confusion over whether the virus can be spread by an infected person who is not showing symptoms. Health departments say that, given the uncertainty, they are taking a cautious approach and looking for any contacts going back three days before symptoms started. “Fortunately, we have so few cases, so we can do that,” Rudman said.

Rudman declined to say how many people are being monitored in Santa Clara but noted that having so few cases has meant she and her colleagues have had time to be methodical about who might be at risk. She hopes that will provide comfort to others in the community.” (F)

“A new report into the range of symptoms experienced by coronavirus patients suggests that around one in 10 suffer from diarrhea and nausea for a few days before developing breathing difficulties, leading to suggestions that the pathogen may be transmitted via feces. While this route of transmission has not been confirmed, the new data does raise the possibility that doctors may have missed some key early warning signs by focusing only on cases involving respiratory symptoms.

It has already been established that the virus is primarily passed on by droplets in an infected person’s cough, and the new study – which features in the Journal of the American Medical Association (JAMA) – found that the majority of coronavirus patients at a hospital in Wuhan, China, suffered from symptoms such as fever, muscle pain, and shortness of breath at the onset of the illness.

However, of the 138 patients observed by the study authors, 14 initially presented with diarrhea or nausea, developing more classic coronavirus symptoms a day or two later. According to Chinese media reports, doctors found traces of viral nucleic acids in the stool of patients who exhibited these atypical digestive symptoms.

The first US patient to be diagnosed with coronavirus is also said to have experienced diarrhea for a few days, and the virus was also found to be present in his feces.

While this doesn’t mean that fecal matter is responsible for the spread of the illness, it does provide evidence for another similarity between coronavirus and SARS, to which it is related. Back in 2003, hundreds of people in a Hong Kong housing estate became infected with SARS thanks to a plume of warm air emanating from a bathroom that had been used by an infected person…

Significantly, 41 percent of patients in the study became infected in hospital, with both healthcare workers and patients who had been hospitalized for other reasons catching coronavirus. Regardless of the transmission route, therefore, it seems that hospitals are a potential breeding ground for the virus, suggesting that improved hygiene may be necessary to prevent its spread.” (G)

“The coronavirus epidemic could grip about two-thirds of the world’s population if the deadly bug is not controlled, a top public health official said — as another expert predicted that cases in China could peak this month and fade away by April.

Professor Gabriel Leung, chair of public health medicine at Hong Kong University, told the Guardian he was examining the implications of the World Health Organization’s Monday warning that cases of coronavirus spreading outside China are the “tip of the iceberg.”

Most experts believe that each person infected can go on to transmit coronavirus to about 2.5 other people — creating an “attack rate” of 60 to 80 percent, Leung told the paper.

“Sixty percent of the world’s population is an awfully big number,” he said.

Even with a general fatality rate as low as 1 percent — a possibility once milder cases are taken into account — there could still be a massive global death toll, he added.

Meanwhile, experts are attempting to map out the likely course of the illness, Leung told the Guardian.

“Is 60 to 80 percent of the world’s population going to get infected?” he said. “Maybe not. Maybe this will come in waves. Maybe the virus is going to attenuate its lethality because it certainly doesn’t help it if it kills everybody in its path, because it will get killed as well.”

Health officials are also attempting to determine whether restrictions put in place in Wuhan — the epicenter of the outbreak — as well as other cities, have made a positive impact.

“Have these massive public health interventions, social distancing, and mobility restrictions worked in China?” Leung asked. “If so, how can we roll them out, or is it not possible?” “(H)

“The disease caused by the new coronavirus that’s sickened more than 42,000 people in China now has an official name: COVID-19. It stands for the coronavirus disease that was discovered in 2019.

The World Health Organization announced the name Tuesday, saying it was careful to find a name without stigma.

“We had to find a name that did not refer to a geographical location, an animal, or an individual or group of people,” WHO Director-General Tedros Adhanom Ghebreyesus said in a call with reporters.” (I)

“Time will tell if the new coronavirus ends up being less or more dangerous than the flu; we don’t fully know yet how bad it is. Usually, the diseases that stick around tend to become less lethal. Only live hosts can continue to make more viruses. Influenza is also pretty devious in how it mutates its surface molecules from year to year to evade immune system detection. If 2019-nCoV is not able to do that, people’s immunity to it could gradually improve.

But therein lies the paradox. The outcome that has public health officials really concerned is that 2019-nCoV will turn into something like a disease that we have a tough time making you worry about right now.

Every year physicians and public health officials try to get you to immunize yourselves against the flu, and far too many of you don’t. We beg you to practice proper precautions and hygiene — and, still, tens of thousands of people die, and too few worry enough.

Governments and employers could help by making it easier for sick people to stay home from work. Many Americans without paid sick leave go to work despite feeling ill, and many of those work at restaurants, schools and hospitals, where disease is easily spread.

The most significant defense the United States has to prevent pandemics is a solid public health infrastructure. The public has to trust it. The system also needs to be properly prepared and have the resources to handle a widespread infection. (The system is currently stretched thin and underfunded.) It’s critical to make sure there are enough medical supplies available, as well as necessities like food, to get a community through an outbreak.” (J)

“The Centers for Disease Control and Prevention is preparing for the coronavirus, named COVID-19, to “take a foothold in the U.S.,” Dr. Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, told reporters. “At some point, we are likely to see community spread in the U.S. or in other countries,” said Messonnier. “This will trigger a change in our response strategy.” (K)

“An apartment building in Hong Kong, its units linked by pipes. A department store in the eastern Chinese city of Tianjin, where more than 11,000 shoppers and employees mingled. A ski chalet in France, home base for a group of British citizens on vacation.

These sites, scattered around the world, have become linked by a grim commonality: They are places where pockets of new coronavirus cases have emerged in recent days, raising fears about the virus’s ability to spread quickly and far beyond its origins in central China.” (L)

“Right now scientists are trying to accomplish something that was inconceivable a decade ago: create a vaccine against a previously unknown virus rapidly enough to help end an outbreak of that virus. In this case, they’re trying to stop the spread of the new coronavirus that has already infected tens of thousands of people, mainly in China, and given rise to a respiratory condition now known as COVID-19.

Typically, making a new vaccine takes a decade or longer. But new genetic technologies and new strategies make researchers optimistic that they can shorten that timetable to months, and possibly weeks — and have a tool by the fall that can slow the spread of infection.” (M)

“As the new coronavirus continued to spread unabated within the city of Wuhan, China, government officials last week imposed draconian measures.

Workers in protective gear were instructed to go to every home in the city, removing infected residents to immense isolation wards built hastily in a sports stadium, an exhibition center and a building complex…

Many experts are skeptical that isolating thousands of patients in shelters can stanch the spread of the coronavirus. There are more than 40,000 cases in China now, in every province, although the wide majority are in Hubei Province.

“This is a bit like closing the barn door after the horses are already out,” said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center in Nashville…

Wuhan’s makeshift shelters may yet become breeding grounds for infection, especially if patients are not properly screened, Dr. Markel and other experts said.

The patients already are in a weakened state, and facilities like these make it easy for viruses and bacteria to travel — not just the coronavirus, but also any of the dozens of pathogens that may thrive when people gather in tight quarters.

“Whenever we put people in facilities together, even during a hurricane, we are concerned about them getting infectious diseases,” said Nicole A. Errett, a researcher at the University of Washington who is a co-director of the Collaborative on Extreme Event Resilience.” (N)

“CMS sent a memo to state survey agency directors urging them to double down on compliance with basic infection control practices.

The memo includes information and links to resources to combat the illness caused by the novel coronavirus. It also states that healthcare staff and surveyors, including federal, state and local contractors are expected to adhere to standard infection control practices, such as CDC recommendations on standard hand hygiene practices.

In 2020 surveys, CMS and accrediting organization acute care surveyors will be especially alert to hand hygiene practices, including the use of alcohol-based hand rub/hand sanitizer, the preferred method of hand hygiene in clinical settings, the memo says.

“We know that adherence to basic infection control and prevention practices such as hand hygiene can help reduce the risk of infectious disease spread in all healthcare settings,” the memo reads.” (O)

“Successful outbreak control works like this: Patients report their symptoms to health-care workers. Those health-care workers then report unusual cases to local public-health officials who investigate the illness. Those officials may isolate ailing patients, identify others with whom they have come into contact, and monitor those individuals. The results of these investigations are reported to government officials, who communicate reliable information about the outbreak and its causes to the public and the press. That information enables those who are not sick to take measures, such as hand washing and avoiding crowds, to prevent themselves from getting infected and spreading the outbreak. The promise of reliable information and competent, supportive medical care convinces others who are suffering symptoms to come forward so that new cases are identified, tracked, and treated. This cycle continues until the virus stops infecting new people, the people already infected get well or perish, and the outbreak burns out.  

In short, shoe-leather public health and basic medical care—not miracle drugs—are generally what stop outbreaks of emerging infections like severe-acute respiratory syndrome and the Ebola virus. However, in many countries without responsive governments, open press, and rudimentary health-care systems, controlling an infection becomes much harder. Officials in repressive societies are more apt to rely on counterproductive censorship and quarantine measures that unduly interfere with citizens’ rights and spread distrust.” (P)

“Further increasing the danger of outbreaks and epidemics is another by-product of better health: complacency. In 2013, less than 0.5 percent of international health aid was devoted to preventing infectious-disease outbreaks, and the portion of the World Health Organization budget funded by dues from 194 member countries had dwindled to less than the budget of the New York City Department of Health. Starved of funds, the international system intended to control outbreaks like Ebola failed miserably in West Africa.

After that episode, the Obama administration established a White House–based directorate to respond to outbreaks and dedicated $1 billion to help poor countries build the basic capabilities to prevent, detect, and respond to pandemic threats. The Trump administration has assisted in the international response to Ebola in Congo and offered China help in the current coronavirus crisis, but it also dismantled the White House directorate on pandemic preparedness and urged that U.S. funding for global health security return to pre-2014 levels.” (Q)

(A)          The tricky business of disease diplomacy, by Julia Bellu,

(B)          As coronavirus infections exceed 37,000, here’s how it spread so rapidly, by QUENTIN FOTTRELL,

(C)          Three Scenarios For The Coronavirus, by Dan Vergano,

(D)          In just a couple of months the new coronavirus that emerged from the Chinese city of Wuhan has spread around the world, sparking a race to find treatments and vaccines against it, by Abigail Beall,

(E)          The Urgent Questions Scientists Are Asking About Coronavirus, by  Gabriel Leung,

(F)          US health officials are seeking ‘close contacts’ of coronavirus. Here’s what that means, Anna Maria Barry,

(G)         Coronavirus May Be Transmitted Via Poop As Well As Coughing, Scientists Suggest, by Ben Taub,

(H)          Expert warns coronavirus could infect 60% of world’s population, by Amanda Woods,

(I)           Coronavirus gets official name from WHO: COVID-19, by Erika Edwards,

(J)           Lessons That Go Beyond the Coronavirus Outbreak, by Aaron E. Carroll,

(K)          CDC prepares for community outbreaks in US,

(L)           A Store, a Chalet, an Unsealed Pipe: Coronavirus Hot Spots Flare Far From Wuhan, by Viviann Wang, Austin Ramzy and Megan Specia,

(M)        Timetable For A Vaccine Against The New Coronavirus? Maybe This Fall, by JOE PALCA,

(N)         Huge Shelters for Coronavirus Patients Pose New Risks, Experts Fear, by Roni Caryn Rabin,

(O)         Don’t slip on infection control basics amid coronavirus outbreak, CMS warns, by Anuja Vaidya,

(P)          Coronavirus likely now ‘gathering steam’, by Alvin Powell,

(Q)         Coronavirus Is Spreading Because Humans Are Healthier, by Thomas J. Bollyky,

POST 6. February 17, 2020. Coronovirus. “Amid assurances that the (ocean liner) Westerdam was disease free, hundreds of people disembarked in Cambodia…” “ One was later found to be infected”…. “Over 1,000… passengers were in…transit home”…. “This could be a turning point””

“Confronting a viral epidemic with a scant supply of protective equipment, more than 1,700 Chinese medical workers have already been infected, and six have died.

In the hospital where Yu Yajie works, nurses, doctors and other medical professionals fighting the new coronavirus have also been fighting dire shortages. They have used tape to patch up battered protective masks, repeatedly reused goggles meant for one-time use, and wrapped their shoes in plastic bags for lack of specialized coverings.

Ms. Yu is now lying at home, feverish and fearful that she has been infected with the virus. She and other employees at the hospital said a lack of protective wear had left medical workers like her vulnerable in Wuhan, the central Chinese city at the heart of the epidemic that has engulfed this region.

“There are risks — there simply aren’t enough resources,” Ms. Yu, an administrator at Wuhan Central Hospital, said in a brief telephone interview, adding that she was too weak to speak at length.

Chinese medical workers at the forefront of the fight against the coronavirus epidemic are often becoming its victims, partly because of government missteps and logistical hurdles.

After the virus emerged in Wuhan late last year, city leaders played down its risks, so doctors didn’t take precautions…

On Friday, the Chinese government for the first time disclosed the toll the outbreak was taking on hospital employees: 1,716 medical workers had contracted the virus, including 1,502 in Wuhan, and six had died.” (A)

“Officials are also looking to see whether the medical workers were exposed to the virus unknowingly within a clinical environment and whether they were wearing protective equipment at the time, Ryan said. “There are a whole lot of factors we need to look at, and we will be doing that with Chinese authorities.”…

Dr. Sylvie Briand, head of WHO’s Global Infectious Hazard Preparedness division, told reporters that the health workers may have been fatigued at the time they were infected and weren’t taking proper protective measures because they were too tired. China has sent medical professionals from several regions to support those workers, she said….

WHO is asking suppliers of protective gear to prioritize sending the equipment to regions most affected by the virus.

Last week, WHO said it sent medical supplies such as masks, gloves, gowns and diagnostic tests around the world. It is discouraging stockpiling of protective gear, saying the limited number of items need to be saved for regions most affected by the virus. The price of protective gear has increased, while availability has decreased, WHO officials said…

On Thursday, world health officials said they were scrambling to determine just how widespread the new coronavirus is as Chinese authorities reported a surge in new cases after changing how they count confirmed infections.

“How big is the iceberg?” Ryan said. “We do know, and we all accept, that there is transmission occurring at some level in communities. We’ve all seen those clusters, we’ve all seen those super spreading events.”  (B)

“A sudden spike in new coronavirus cases in China this week shocked researchers. But the huge bump in numbers isn’t a sign that the epidemic is worsening, say researchers, it is instead the result of authorities changing how cases are confirmed.

On 12 February, Hubei province reported nearly 15,000 new cases of COVID-19, the disease caused by the coronavirus, representing a 33% jump in total infections worldwide in a single day. Total infections in China now number around 64,000, with more than 1,300 deaths.

But most of the Hubei cases — about 13,000 — are the result of a new policy in the province that means physicians can diagnose suspected cases of COVID-19 on the basis of chest images, rather than having to wait for genetic tests to confirm the presence of the virus, which can take days.

The policy is in response to pleas from clinicians who are overwhelmed by patients with respiratory diseases, and don’t have time to wait for lab results, says Wu Zunyou, chief epidemiologist at the Chinese Center for Disease Control and Prevention, who helped design and implementing the new policy. “The clinicians in Hubei made a very strong request to modify the criteria because of their heavy work load,” he says. Now they can care for people more quickly and ensure they are properly isolated to protect others, says Wu. “We need to save lives.”

The policy makes sense from a medical point of view, says Michael Mina, an infectious-disease immunologist and epidemiologist at the Harvard T. H. Chan School of Public Health in Boston, Massachusetts. “Triaging based on symptomatic evaluation and physical exam is the bed rock of hospital-based and clinical triage,” he says.” (C)

“Hospitals in Wuhan, China — the largest city in Hubei Province and the center of the epidemic — have struggled to diagnose infections with scarce and complicated tests that detect the virus’s genetic signature directly. Other countries, too, have had such issues.

Instead, officials in Hubei now seem to be including infections diagnosed by using lung scans of symptomatic patients. This shortcut will help get more patients into needed care, provincial officials said. Adding them to the count could make it easier for the authorities to decide how to allocate resources and assess treatment options.

But the change also shows the enormous number of people in Hubei who are sick and have not been counted in the outbreak’s official tally. It also raises the question whether the province, already struggling, is equipped to deal with the new patients.

The few experts to learn of the new numbers on Wednesday night were startled. Lung scans are an imperfect means to diagnose patients. Even patients with ordinary seasonal flu may develop pneumonia visible on a lung scan.” (D)

“Even before today’s news, experts complained that epidemiological information from China has been incomplete, threatening containment efforts.

The new coronavirus is highly transmissible and will be difficult to squelch. A single infected “super-spreader” can infect dozens of others. Outbreaks can seem to recede, only to rebound in short order, as the weather or conditions change.

Recent clusters of coronavirus cases suggest the new coronavirus not only spreads quickly, but also in ways that are not entirely understood.

In Hong Kong, people living 10 floors apart were infected, and an unsealed pipe was blamed. A British citizen apparently infected 10 people, including some at a ski chalet, before he even knew he was sick.

In Tianjin, China, at least 33 of 102 confirmed patients had a connection of some sort with a large department store.

“This outbreak could still go in any direction,” Dr. Tedros Adhanom Ghebreyesus, director general of the World Health Organization, said on Wednesday.

A change in diagnosis may make it still harder to track the virus, said Dr. Peter Rabinowitz, co-director of the University of Washington MetaCenter for Pandemic Preparedness and Global Health Security.” (E)

“The head of the U.S. Centers for Disease Control and Prevention said the new coronavirus, which has killed nearly 1,400 people and is still spreading in China, could be around for at least another year. The outbreak has affected almost 50,000 people worldwide. There are 15 confirmed cases in the U.S. but none are said to be suffering serious symptoms.

The agency is setting up five labs around the U.S. where people with flu-like symptoms can be tested for coronavirus if their flu results are negative. The virus, dubbed COVID-19, has spread to more than two dozen countries.

The CDC is ramping up its own response to the epidemic by setting up five labs around the U.S. where people with flu-like symptoms can now be tested for coronavirus if their flu results are negative. This comes as scientists around the world race to develop a vaccine.” (F)

“Another U.S. case of infection with the novel coronavirus was confirmed Thursday, bringing the total number of domestic cases to 15. Around the world, cases have reached nearly 60,000 to date.

But if something changes and large numbers of people get infected in the U.S., is the country’s health system prepared to cope with a surge of patients with this virus, or any future pathogen?

“Surge capacity in the health care system is something that we think a lot about and prepare for in the U.S., and not specifically to coronavirus per se, but for a whole host of events that could occur in the United States,” says Jonathan Greene, director of emergency management and medical operations at the Department of Health and Human Services…

“No one is ready for a worst case-scenario for a really bad, lethal, fast-moving pandemic,” says bioterrorism and biosafety expert Dr. Tara O’Toole, former undersecretary for science and technology at the Department of Homeland Security and now at In-Q-Tel, a nonprofit strategic investment firm that supports U.S. national security.

For instance, O’Toole thinks that hospitals would have a very hard time handling a lot of critically ill patients who need to be in isolation. “That’s why we want to make sure that the people we’re putting in hospitals and keeping isolated are really the ones who need that kind of care,” she says…

What’s needed is a strategic approach to rapidly deal with an epidemic, says O’Toole, but “we don’t have a strategy and we haven’t built the infrastructure” to do so….

On the other hand, HHS official Greene argues that the nation’s health care system is better prepared than it has been in the past. “We’ve gone through outbreaks of other diseases, other coronaviruses, SARS and MERS,” he says. And each one of those experiences has helped the system develop “tactics, capabilities, training and education to be able to deal with whatever comes down the road. This is just one more in a long history of disease outbreaks that we’re being asked to tackle.”

The strategic national stockpile, says Greene, holds “millions of face masks, and supplies of respirators, gloves and surgical gowns that could potentially be deployed if state and local supplies are diminished during this current outbreak.” Greene says that HHS is working with the health care sector and the supply chain to ensure that any disruptions that may occur or shortages are “short-lived and that the right amount of material can be provided” as soon as possible.” (G)

“Dr. Craig Spencer was the first patient in New York diagnosed with Ebola in 2014. After that experience, he wrote, “When we look back on this epidemic, I hope we’ll recognize that fear caused our initial hesitance to respond — and caused us to respond poorly when we finally did.” In terms of New York, what has changed since then?

Our overall preparedness in maintaining our readiness — that’s a key phrase we use — has exponentially increased since 2014 because we’re constantly collaborating, coordinating, and communicating at all levels — local, state, national, and even international. We’ve been given funding on a national scale to prepare for Ebola and special pathogens. It wasn’t just specifically for viral hemorrhagic fevers like Ebola; it gave us funding to prepare for coronavirus disease, for MERS, for SARS, the full gamut. From that funding we were able to do more drills, exercises, collaborative public health. The unfortunate part is that funding was only for five years, and it actually expires in a matter of months — in 2020. So this entire infrastructure that we’ve built across the nation is going to get dismantled in a couple of months, which is mind-boggling knowing we’re in a potential pandemic situation and we’re letting our guard down.

The other thing we’ve also done is, we want to make sure we’re giving patients the opportunity to tell us what they have. Before, it was you come in, come to the front desk, and they ask, “What are you here for.” By that time it’s basically too late. Because you’ve come in through the door, there are probably 50 people waiting in the waiting area, if you’re coming in with something respiratory and you’re coughing and sneezing, you’ve probably infected a number of folks around there. One of the strategies we’ve implemented is something very basic: respiratory stations, which basically have simple masks, hand sanitizer, a tissue, and a sign that says, “Do you have a fever? Do you have a cough? Do you have a rash? Yes? Please take a mask. If a mask is not there use a tissue and sanitize your hands.” And it tells you, “If you have travel history let us know immediately.” So now we’re letting patients self-identify. It helps expedite that triage process. Before this outbreak and the Ebola outbreak in 2014, we only had those stands during seasonal flu time, and once seasonal flu was done we would take out that stand. Now we know these infectious diseases are all around us, so it’s all season long…

What are you most concerned about right now sitting here? What’s going to keep you up tonight?

Based on everything that we’ve been seeing, reading, looking at what’s happening in China, it doesn’t seem like this virus is containable. It’s not the fault of the government itself or China itself, it’s the nature of the virus. You just can’t stop a respiratory virus, especially a respiratory one in nature where it’s the sheer form of breathing and having droplets develop — you just can’t control it. It’s one of those things we know we can’t contain, so we need to continue to prepare very aggressively for it. And that’s exactly what we’re doing. What’s keeping me up at night is knowing that these cases are going to continue to occur, and that’s what the CDC has stated, that we’re going to see an increased number of cases. We need to make sure that we’re able to identify every single one. It just takes one person coming into one of our facilities to start an outbreak.” (H)

““On December 27, Syra Madad published an op-ed in the Washington Post co-written with Ronald A. Klain. The piece warned lawmakers that vital funding needed to prepare hospitals for infectious-disease outbreaks would expire in May. “We do not know when the next dangerous pathogen will arrive in our country,” it read, “but we do know that it will happen — sooner or later.” Four days after the article was published, on December 31, the government in Wuhan, China, reported to the World Health Organization that it was treating dozens of patients for pneumonia of unknown cause.

That was the beginning of a busy January for Madad. As the senior director for the systemwide special-pathogens program for NYC Health and Hospitals, it was her job to prepare the city’s 11 hospitals for an outbreak. Madad also happened to be the star of Pandemic, a six part docuseries that premiered on Netflix on January 22 — a week after she gave birth to her third child…

We want more time to continue our trainings, so we can continue to prepare our front lines for the inevitable surge of cases that we may potentially see. We may not get a whole lot of cases or we may get a number of cases, but either way it’s best for us to prepare for the worst-case scenario. If we have a surge of cases present, we’re looking at it from a 4S standpoint or the emergency-management approach: staffing, stuff, space, and system. Based on those four high-level domains, we’re looking at how we can bulk up staffing. Because the No. 1 asset in the health-care system is our people, and without our people we can’t take care of patients. Do we get volunteers involved? Do we look at our memorandum of agreements with other agencies to bulk up our staffing? Things like that. (I)

“Doctors in five U.S. cities will begin testing patients with flu-like symptoms for the new coronavirus, the Centers for Disease Control and Prevention said Friday.

The coronavirus test will only be given to patients who test negative for the flu. So far, the testing protocol will be implemented in Chicago, Los Angeles, New York, San Francisco and Seattle, though more cities will be added.

It’s a sign that the U.S. is broadening its surveillance of the illness.

This is just the starting point,” Dr. Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, said during a press briefing Friday. “We plan to expand to more sites in the coming weeks.”

Messonnier said the increased testing is part of an effort to determine whether the virus is spreading in communities across the U.S. “The results would be an early warning signal to trigger a change in our response strategy,” she said.” (J)

“As an outbreak of a novel coronavirus has swept through Hubei province, China, the US Centers for Disease Control and Prevention has been preparing for its worst case scenario — a widespread outbreak of illnesses in the United States.

“Right now we’re in an aggressive containment mode,” CDC Director Dr. Robert Redfield told CNN’s Chief Medical Correspondent Dr. Sanjay Gupta in an interview on Thursday.

“We don’t know a lot about this virus,” he said. “This virus is probably with us beyond this season, beyond this year, and I think eventually the virus will find a foothold and we will get community-based transmission.”

As of Thursday, there have been 15 cases of the novel coronavirus confirmed in seven states: eight in California; two in Illinois; and one in Arizona, Washington, Massachusetts, Wisconsin and Texas.

While more research is needed to fully understand the virus, Redfield told Gupta that the CDC has focused on surveillance to track cases and containment strategies to slow possible progression of the virus in the United States. Slowing progression gives more time for researchers to work on developing and testing a vaccine and antiviral drugs for this novel coronavirus. Currently, there is no known cure for the virus.

“The containment phase is really to give us more time. This virus will become a community virus at some point in time, this year or next year,” Redfield said. “We don’t have any evidence that this coronavirus is really embedded in the community at this time, but with that said, we want to intensify our surveillance so that we’re basing those conclusions based on data.”

The containment strategy refers to efforts to prevent widespread transmission of the coronavirus in the United States, including having people with confirmed cases stay in isolation and placing restrictions on travel between affected areas in the world. Such containment measures were used widely during the SARS global outbreak of 2003, during which 8,098 people worldwide became sick and of those, 774 died, according to the CDC…

“What I’ve learned in the last two weeks is that the spectrum of this illness is much broader than was originally presented. There’s much more asymptomatic illness,” Redfield said. “A number of the confirmed cases that we confirmed actually just presented with a little sore throat.””  (K)

“When 195 Americans, including diplomats, were evacuated from Wuhan, China, last month, they were tested for the coronavirus on arrival at a California military base. Health officials swabbed the throats and noses of everyone in the group — the first to be evacuated from Wuhan — and they were relieved when all of their tests came back negative.

But as more government-arranged flights evacuated Americans from China in the days that followed, the federal health authorities adopted a new protocol: Only people who showed symptoms of illness during a 14-day quarantine period would be tested. For some among the more than 600 people who are still waiting to be cleared to go home from military bases in three states, the new rule has left them worried — and angry. Some are pleading with the Centers for Disease Control and Prevention to test them for the coronavirus.

“We are not asking for skateboards or toys,” said Jacob Wilson, 33, one of more than 30 people in quarantine on a base in San Diego who signed a petition this week calling for tests. “We are asking to get tested and make sure we are not passing anything to other people.” (L)

The concerns come as three people in quarantine on bases in San Diego and San Antonio, Texas, tested positive for the virus, which has killed more than a thousand people in China but so far has been found to have infected only 15 people in the United States.

In San Diego, where 232 people are waiting out a government-mandated two-week quarantine, some evacuees said they worried that they and their children had spent days mingling with people — in an eating area, on a playground and in a laundry room — and would like to know for sure whether or not they have the virus.

Fifteen cases of the coronavirus have been confirmed in the United States, including a 35-year-old man in Washington State, a couple in their 60s in Chicago and eight people in California.

One of the people evacuated from Wuhan last week to San Diego had coronavirus but was discharged because of a labeling error.

Some evacuees are wondering why they aren’t being tested on bases…

“We believe testing everyone at the facility would help identify potential suspects as early as possible, so the appropriate treatment could be put in place,” the evacuees wrote in the petition, which they called a “suggestion letter” and shared with one another over WeChat, a Chinese instant-messaging app.

The C.D.C., however, has declined to test every evacuee. Officials said that such tests are less accurate before people show symptoms, so a negative early result could be misleading rather than helpful. The agency tested everyone on the first evacuation flight, the officials said, because they were learning about the virus and because doing so allowed them to collect more data about it. Since then, they said, they have determined that swabbing hundreds of seemingly healthy people is not useful.

“Every test has a limit of detection,” said Dr. Joseph Bresee, a deputy incident manager for the C.D.C.’s response to the coronavirus. “Early on, the test may or may not be able to pick it up.”

Almost everyone who gets sick from the virus will show symptoms within 14 days of exposure, often early within that window, Dr. Bresee said. Evacuees on military bases are having their temperature checked at least twice a day and are asked to alert health officials if they feel sick or if their temperature rises.

Dr. Bresee said that he empathized with evacuees who want definitive answers about whether they are healthy.

“They’re concerned, they’re nervous, and they want to be assured of their safety,” he said, adding that the cost of testing was not a factor in the decision not to test everyone. “We don’t think testing would be helpful, and if we did, we would test them.””  ..

“At the San Diego base, Marine Corps Air Station Miramar, Mr. Wilson and others said that people had to leave their rooms to get breakfast, lunch and dinner from a small room, which is also where their temperatures were taken. People rummaged through boxes of fruit and snacks with their bare hands, he said, and they stood shoulder to shoulder in line waiting to check their temperatures despite being told to stay six feet away from one another.

After the petition was circulated, health officials agreed as of Thursday to deliver meals and take temperatures at the room doors of evacuees who preferred it that way.

“The reality is, it’s impossible for us to keep any distace from each other,” said Mr. Wilson, a tech entrepreneur in Wuhan. He and others also said officials had not required evacuees to wear masks.

Earlier in the week, a labeling error led the authorities to return an ill woman to the base from a San Diego hospital, though a test later showed that she had the coronavirus. The mistake raised new worries among some evacuees. The C.D.C. had erroneously informed the hospital that the woman had tested negative for the virus when, in fact, her samples had not been tested. Health officials have tried to calm concerns, saying the woman had been isolated from other evacuees before returning to the hospital.

Dr. Bresee said that health officials were learning more about the virus each day, but that there were no plans to change testing procedures for the hundreds in quarantine.

“As we learn more, we may pivot,” he said. “It doesn’t mean we were wrong once and are right now, it just means we’re learning.”” (M)

“To combat the spread of the coronavirus, Chinese officials are using a combination of technology and policing to track movements of citizens who may have visited Hubei Province.

Mobile phone owners in China get their service from one of three state-run telecommunications firms, which this week introduced a feature for subscribers to send text messages to a hotline that generates a list of provinces they have recently visited.

That has created a new way for the authorities to see where citizens have traveled.

At a high-speed rail station in the eastern city of Yiwu on Tuesday, officials in hazmat suits demanded that passengers send the text messages and then show their location information to the authorities before being permitted to leave the station. Those who had passed through Hubei were unlikely to be allowed entry.

Other cities were taking similar measures.

Companies in China generally shy away from sharing location data with the local authorities, over fears it could be leaked or sold. And there were some signs that the companies were uncomfortable with the new rule.

China Mobile cautioned that the data should be used cautiously, because it indicates where the phone has been, not its owner. It also doesn’t differentiate between people who briefly passed through a province and those who spent significant time there. (N)

“Coronavirus Test Kits Sent to States Are Flawed, C.D.C. Says

Some tests distributed by the agency deliver “inconclusive” readings. The C.D.C. will need to ship new ingredients, further delaying results.

Some of the coronavirus testing kits sent to state laboratories around the country have flaws and do not work properly, the Centers for Disease Control and Prevention said on Wednesday.

The kits were meant to enable states to conduct their own testing and have results faster than they would by shipping samples to the C.D.C. in Atlanta. But the failure of the kits means that states that encountered problems with the test should not use it, and would still have to depend on the C.D.C.’s central lab, which could cause several days’ delay in getting results.

“Obviously, a state wouldn’t want to be doing this test and using it to make clinical decisions if it isn’t working as well, as perfectly, at the state as it is at C.D.C.,” Dr. Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases, said at a news conference on Wednesday.

The C.D.C. recommends testing for some people who have symptoms like fever, cough or shortness of breath, and who, within the past 14 days, have traveled to China or have been in close contact with a patient known to be infected with the coronavirus. Doctors with patients in that category are supposed to consult their state health department about whether the patients should be tested for the virus…

Dr. Jeanne Marrazzo, director of the infectious diseases division at the University of Alabama at Birmingham, said accurate diagnostic tests were invaluable.

“The test is the only way you can definitely know you have the infection,” Dr. Marrazzo said. “You absolutely need it for case counting. It allows you to know who’s infected. You can treat those people, if a treatment is available, and you can isolate them.”..

The C.D.C. does not recommend testing for people who may have been exposed to the virus but have no symptoms. Even if they are infected, if they are still in the incubation period there may not be enough virus in their bodies for the test to detect.

The inability to detect very early infections is one reason for keeping planeloads of people from Wuhan in quarantine instead of just testing them and letting them go if the results are negative. A person could test negative and still be infected.

For the same reason, health authorities say there is no benefit to testing symptom-free people on cruise ships.

Because there is an unknown window of time between when a person becomes infected and when the test can find the virus, health officials have determined that a quarantine of two weeks — believed to be the incubation period of the illness — is the best way to make sure that people who may be infected do not transmit the virus to others.

Tests for other infectious diseases can also fail to detect some cases. A panel of tests used to screen for respiratory viruses when pneumonia is suspected can give negative results even if a patient is infected, Dr. Marrazzo said. So can rapid tests for flu and strep throat. Blood tests for H.I.V. can miss the diagnosis in people who were recently infected.”

“There is no perfect test for pretty much any infectious disease I can think of,” Dr. Marrazzo said. (O)

“The Diamond Princess cruise ship docked at Yokohama, Japan, on Friday. More than 200 coronavirus cases have been confirmed on the ship since it was quarantined last week.

The Diamond Princess cruise ship docked at Yokohama, Japan, on Friday. More than 200 coronavirus cases have been confirmed on the ship since it was quarantined last week.Credit…Jae C. Hong/Associated Press

The United States will evacuate Americans from the cruise ship that has been quarantined for more than a week in Japan because of coronavirus infections on board, the United States Embassy in Tokyo told Americans aboard the ship on Saturday.

American passengers and crew members were told in an email from the embassy that a chartered flight would arrive on Sunday for those who wanted to return to the United States.

The ship, the Diamond Princess, was placed under quarantine at the city of Yokohama early last week with about 3,700 passengers and crew members aboard, after a man who had disembarked in Hong Kong tested positive for the coronavirus. Since then, at least 218 cases have been confirmed aboard the ship.

There are about 400 Americans aboard, and at least 40 who were infected with the virus have been taken off the ship for treatment.

Americans will be subject to a 14-day federal quarantine and will be housed at two existing quarantine sites, in California and Texas, the Centers for Disease Control and Prevention said in a statement on Saturday.” (P)

“Errors by a hospital in San Diego and the US Centers for Disease Control and Prevention led to a woman with the novel coronavirus being sent back to Marine Corps Air Station Miramar instead of isolation at the hospital, according to a health official familiar with the situation.

The woman was among Americans in federal quarantine at the base, and is the first US evacuee from China known to be infected with the novel coronavirus.

She flew to the base on February 5 on a US Department of State flight evacuating Americans from Wuhan, China. The next day, she started experiencing symptoms of the novel coronavirus and was taken to UC San Diego Health. Three other people exhibiting symptoms were also transported to the hospital.

The hospital sent their specimens to a CDC lab in Atlanta for testing. According to the source, three of the four specimens were incorrectly labeled upon arrival and so they were not tested. The CDC lab did not realize the specimens were from the Miramar patients.

When no results were reported back, CDC staffers mistakenly gave UC San Diego Health the results of other patients who tested negative. That mistake led to the Miramar patients being transferred back to the base Sunday afternoon.

After they arrived back at the base, the mistake was discovered and the tests were run on the three Miramar patients.

The results for the woman came back positive, and she was transported back to UC San Diego Health on Monday morning, where she remains in isolation. The woman has had a very mild illness, according to the source, with no fever and a slight cough…

In a response Tuesday, the CDC said: “At all times, appropriate infection control precautions were taken around all of the persons quarantined at Miramar, including these three patients. From now on, a CDC laboratory staff member will form part of CDC quarantine field teams to ensure that specimens are correctly labeled/CLIA compliant to avoid delays in testing.””

During a press conference on Tuesday, Dr. Anne Schuchat, principal deputy director of the CDC, said “there was a little bit of a mix-up there” around the testing for the Miramar patient, but would not elaborate.” (Q)

“San Diego leaders declared a local emergency and public health emergency for seven days over the novel coronavirus, giving officials access to resources to address the virus.

CDC and county health officials cautioned that the declarations did not mean residents faced an increased risk of the virus.

Under the declarations, the county will be able to seek mutual aid, potentially be reimbursed for their response, and ensure resources to first responders and hospitals, stock pile medical supplies and gain access to hospital beds, and state and federal emergency funds if necessary.

“This action does not signify an increase in the risk to the residents in San Diego County to coronavirus,” Supervisor Nathan Fletcher told the media. “This is a step that positions us best to confront the challenges of this virus, this action best equips us to be in the strongest position to coordinate efforts, ensure access to available supplies, and best protect public health.”…

So far, San Diego has two confirmed cases of coronavirus. Those patients are under isolation at UC San Diego Medical Center.

According to Eric McDonald, medical director of the County’s Epidemiology and Immunization Branch, San Diego cases include:

Seven people are under investigation. Five of them have tested negative and two have tested positive;

Four non-San Diego residents who traveled to the region (but not Wuhan, China) monitored: Two tested negative and two have results still pending; Monitored 171 people returning from China with no symptoms: 48 have been cleared after self quarantine, 123 people are still being monitored. None are under investigation;

Thirteen San Diegans were on flights next to people confirmed for coronavirus. Eight people have been cleared after two weeks, four people are still self-quarantined, and one person was a person under investigation who has since tested negative.

MCAS Miramar has hosted two flights of passengers being evacuated from the coronavirus zone in Wuhan, China. Those passengers have been staying at the base under a 14-day quarantine. Once that quarantine ends next week, low to medium risk individuals will be asked to self-quarantine at home.” (R)

“Hundreds left a cruise ship in Cambodia. Then one tested positive for the coronavirus.

An American woman who disembarked from a cruise ship in Cambodia last week has tested positive twice for the coronavirus since flying on to Malaysia, officials in that country said on Sunday.

Cambodia allowed the ship, the Westerdam, to dock after five other ports  turned it away over concerns about the coronavirus.

Officials said more than 140  passengers from the ship had flown from Cambodia to Kuala Lumpur, Malaysia’s capital. All but the American woman and her husband had been allowed to continue to their destinations, including airports in the United States, the Netherlands and Australia. (S)

“A man who visited Hawaii was confirmed to have coronavirus when he returned home to Japan, Hawaii officials said Friday.

Health officials were tracking down details about his travel in the Aloha State, including his flight information and people with whom he had close contact.

The U.S. Centers for Disease Control and Prevention notified Hawaii about the man having the illness known as COVID-19 on Friday morning, Hawaii Health Director Bruce Anderson said.

The man was in Hawaii Jan. 28 to Feb. 7. He first visited the island of Maui, where he had no symptoms, Anderson said. He was on Oahu, the state’s most populated island, Feb. 3-7. While on Oahu, he had cold-like symptoms, but no fever, Anderson said.

He developed more serious symptoms when he returned to Japan, where he was tested and found to be positive for the illness, Anderson. He did not seek medical care in Hawaii, Anderson said.

Because of when his symptoms began, officials believe he became infected in Japan or while in transit to Hawaii, said state epidemiologist Dr. Sarah Park.” (T)

“The cruise ship had been shunned at port after port for fear it might carry the coronavirus, but when the Westerdam arrived in Cambodia on Thursday, the prime minister greeted its passengers with flowers.

Amid assurances that the ship was disease free, hundreds of elated passengers disembarked. Some went sightseeing, visiting beaches and restaurants and getting massages. Others traveled on to destinations around the world.

One, however, did not make it much farther than the thermal scanners at the Kuala Lumpur airport in Malaysia. The passenger, an American, was stopped on Saturday, and later tested positive for the coronavirus.

On Sunday, with passengers already headed for destinations on at least three continents, health officials were scrambling to determine how a big a problem they now have — and how to stop it from getting bigger.

“We anticipated glitches, but I have to tell you I didn’t anticipate one of this magnitude,” said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center.

With more than a thousand passengers from the Westerdam headed for home, Dr. Schaffner said, it may be harder than ever to keep the coronavirus outbreak contained to China.

“This could be a turning point,” he said.

It is unclear how well the passengers were screened before they were allowed off the ship. But the best approach to containing a broader spread of the virus from the Westerdam would be to track down all of the passengers and quarantine them for two weeks, experts said…

More than 140 passengers from the ship flew to Malaysia, and all but the American woman who tested positive and her husband were eventually allowed to continue on to their destinations, including the United States, the Netherlands and Australia, officials said. Over 1,000 other passengers took charter flights to Phnom Penh, the capital of Cambodia, and were in various stages of transit home, the cruise line said….

The global fight against the coronavirus is complicated by the fact that different countries may have different levels of disease surveillance and prevention measures. While the World Health Organization provides guidance, it is up to each country to enforce these standards, including whether to quarantine people who may have been exposed or to stop them from traveling.” (U)

(A)          China’s Doctors, Fighting the Coronavirus, Beg for Masks, Chris Buckley, Sui-Lee Wee and Amy Qin,

(B)          WHO is investigating 1,716 health workers in China infected with coronavirus, by Berkeley Lovelace Jr.,

(C)          Coronavirus latest: Chinese cases spike after changes to diagnosis method,

(D)          Coronavirus Cases Seemed to Be Leveling Off. Not Anymore, by Roni Caryn Rabin,

(E)          A worker cleans the floor of a temporary ward for patients with coronavirus in Wuhan, China, by Roni Caryn Rabin,

(F)          Coronavirus death toll mounts in China as U.S. braces for long fight, by CARTER EVANS,

(G)         Would The U.S. Health System Be Ready For A Surge In Coronavirus Cases?, by PATTI NEIGHMOND,

(H)          Is NYC Prepared for Coronavirus?, by James D. Walsh,


(J)           Doctor Who Survived Ebola Says He Was Unfairly Cast as a Hazard and a Hero, by Anemona Hartocollis,

(K)          5 U.S. cities to start testing patients with flu-like symptoms for coronavirus, by Erika Edwards,

(L)           CDC director: Novel coronavirus ‘is probably with us beyond this season, beyond this year’, by Jacqueline Howard,

(M)        Some Wuhan Evacuees Ask Why They Aren’t Being Tested for the Coronavirus, by Miriam Jordan and Nicholas Bogel-Burroughs,

(N)         China Is Tracking Travelers From Hubei,

(O)         Coronavirus Test Kits Sent to States Are Flawed, C.D.C. Says, by Denise Grady,

(P)          The U.S. says it will evacuate Americans from the cruise ship quarantined off Japan,

(Q)         “CDC and hospital errors led to US coronavirus patient being sent back to military base, health official says, by Elizabeth Cohen and Jon Passantino,

(R)          San Diego declares two emergencies over coronavirus to free up resources, by Mark Saunders,

(S)          Hundreds left a cruise ship in Cambodia. Then one tested positive for the coronavirus,

(T)          Japanese man who visited Hawaii confirmed with coronavirus. by JENNIFER SINCO KELLEHER,

(U)         Coronavirus Infection Found After Cruise Ship Passengers Disperse, by Richard C. Paddock, Sui-Lee Wee and Roni Caryn Rabin,

PART 7. CORONAVIRUS. February 20, 2020. With SARS preparedness underway in NJ LibertyHealth/ Jersey City Medical Center, where I was President, proposed that our 100 bed community hospital with all single-bedded rooms, be immediately transformed into an EMERGENCY SARS ISOLATION Hospital.

The Hospital was in a small town at the intersection of many major highways. It could be easily secured since it had no immediately contiguous neighbors. It had a helicopter pad. Its patients could be easily transferred. And it could be managed by the Public Health Service or military medicine if necessary.

It didn’t happen!

In 2014, I suggested several anchor principles for Ebola preparedness in New Jersey, as hospitals of all sizes and scope “marketed” their Ebola readiness, only to learn that it took well over 20/ 25 full time staff to care for one Ebola patient (and 50 in Dallas!).

These recommendations included that every hospital that certified its Emergency Room as ready for Ebola be subject to at least three separate drills using a standardized format, and then be subject to random “secret shopper” inspections;

that anyone with a confirmed or suspected Ebola diagnosis be immediately transferred to a regional center hospital designated by national standardized criteria which could demonstrate that it has sufficient nursing staff “volunteers” to care for a least five patients round the clock;

and that isolation hospitals be readied for instant activation, whether a closed hospital prepared for Ebola now and standing by, or a “virtual” hospital ready-to-go in military fashion.

Also there was a need to minimize Ebola patients walking into an ER unannounced, and suggested a statewide 800 number be established so patients can call ahead and be transported by a prepared ambulance team and taken to a regional center.

The Federal government, later than sooner, did exclusively designate three national bio containment facilities hospitals as Ebola Centers.

In 2016 I suggested that similar organizing principles were urgently need to be established for tiered Zika hospital preparedness by designating Zika Regional Referral Centers. More specifically:

1. There should not be an automatic default to just designating Ebola Centers as ZRRCs, although there is likely to be significant overlap.

2. Zika Centers should be academic medical centers with respected, comprehensive infectious disease diagnostic/ treatment and research capabilities, and rigorous infection control programs. They should also offer robust, comprehensive perinatology, neonatology, and pediatric neurology services, with the most sophisticated imaging capabilities (and Zika-related “reading” expertise).

3. National leadership in clinical trials.

4. A track record of successful, large scale clinical Rapid Response.

5. Organizational wherewithal to address intensive resource absorption.

6. Start preliminary planning for Zika care out of the initial designated ZRRCs.

7. Zika protocols will be templates for are other mosquito borne diseases lurking on the horizon, such as Chikungunya, MERS, and Dengue.

“The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe, according to many of the world’s leading infectious disease experts.

The prospect is daunting. A pandemic — an ongoing epidemic on two or more continents — may well have global consequences, despite the extraordinary travel restrictions and quarantines now imposed by China and other countries, including the United States.

Scientists do not yet know how lethal the new coronavirus is, however, so there is uncertainty about how much damage a pandemic might cause. But there is growing consensus that the pathogen is readily transmitted between humans.

The Wuhan coronavirus is spreading more like influenza, which is highly transmissible, than like its slow-moving viral cousins, SARS and MERS, scientists have found.

“It’s very, very transmissible, and it almost certainly is going to be a pandemic,” said Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Disease. But will it be catastrophic? I don’t know.”…

At the moment, it seems unlikely that the virus will spread widely in countries with vigorous, alert public health systems, said Dr. William Schaffner, a preventive medicine specialist at Vanderbilt University Medical Center.

“Every doctor in the U.S. has this top of mind,” he said. “Any patient with fever or respiratory problems will get two questions. ‘Have you been to China? Have you had contact with anyone who has?’ If the answer is yes, they’ll be put in isolation right away.”..

But even if an outbreak fades in June, there could be a second wave in the fall, as has occurred in every major flu pandemic, including those that began in 1918 and 2009….

“In God we trust,” Dr. Schaffner said. “All others must provide data.”” (A)

“A comprehensive study of more than 72,000 confirmed and suspected cases of the novel coronavirus by Chinese scientists has revealed new information about the deadly infection which has brought much of the country to a halt.

Carried out by a group of experts at the Chinese Center for Disease Control and Prevention and published in the Chinese Journal of Epidemiology on Monday, the study is the largest and most comprehensive examination of coronavirus cases so far.

It found that the novel coronavirus is more contagious than the related viruses which cause SARS and MERS. While the resulting disease, Covid-19, is not as fatal on a case-by-case basis, its greater spread has already led to more deaths than its related coronaviruses.” (B)

“Numbers have a certain mystique: They seem precise, exact, sometimes even beyond doubt. But outside the field of pure mathematics, this reputation rarely is deserved. And when it comes to the coronavirus epidemic, buying into that can be downright dangerous….

Constant on-the-nose reporting, however much it seems to serve transparency, has limitations, too.

It’s a short-term, and shortsighted, approach that’s difficult to resist, especially when people are afraid and the authorities are taking draconian actions. It’s only natural to compare and contrast whatever hard facts are available. And yet it’s especially dangerous to do that precisely because people are so anxious, and fear can trick the mind.

A view from a loftier perch — a month’s, or even just a week’s, perspective — would, and will, produce far more reliable information.” (C)

“One of the enduring images of the current coronavirus outbreak is a space-age looking thermometer pointed at an airplane passenger.

Eleven airports in the United States are using these temperature checks as part of expanded screening for novel coronavirus, and those measures might seem reassuring. If someone doesn’t have a fever, it seems like they’re fine — right?..

Earlier this month, British researchers published a study showing that temperature checks will fail to detect a coronavirus infection nearly half the time….

Since mid-January, the US Centers for Disease Control and Prevention has been employing temperature checks at selected airports, at first on people flying in from Wuhan, China, the epicenter of the outbreak, and now on all passengers who’ve been anywhere in mainland China in the past 14 days.

The temperature checks are part of an overall screening effort that includes giving passengers cards telling them to watch out for fever, cough and trouble breathing, all symptoms of the novel coronavirus disease, also called COVID-19.

“Finding sick people who are at risk for COVID-19, alerting asymptomatic travelers who may develop COVID-19 symptoms after arrival, and rapidly responding to any suspect COVID-19 illness, we can most effectively protect the health and safety of the American public,” said Dr. Martin Cetron, director of CDC’s Division of Global Migration and Quarantine.

Some experts say it’s that card — a simple card listing symptoms in English and Chinese — that holds the key to detecting coronavirus infection — not a thermometer.” (D)

“On Wednesday, the initial 14-day quarantine aboard a coronavirus-stricken cruise ship docked in Yokohama, Japan, officially ended. But the grueling saga seems far from for over for the ship’s 3,711 passengers and crew…

Japanese health officials are facing international criticism for their handling of the quarantine on the ship, the Diamond Princess. The quarantine was intended to curb the spread of disease by keeping people aboard, isolated from each other and from the public on land. But as cases mounted over the two weeks, it became clear that the control efforts only enabled the new coronavirus to spread. In fact, the 621 cases include at least three Japanese health officials, who were there to support the quarantine efforts but ended up becoming infected themselves….

Just before Dr. Hopland and his wife planned to board an evacuation plane chartered by the US State Department on Sunday, test results came back indicating his wife had contracted the virus. She was moved to a local hospital, and Dr. Hopland remains on the ship in an extended quarantine.

The chartered flights, meanwhile, repatriated over 300 other American cruise ship passengers, 14 of whom tested positive for the virus en route to the US.

“I was surprised I was negative because I knew the virus had swept through this boat like wildfire,” Dr. Hopland told the Journal. “My analogy is they put us in a petri dish to get infected.” (E)

“Nebraska’s specialized medical care has handled Ebola. Now it’s taking on the novel coronavirus

“They’re in the chicken soup stage right now,” Rupp said. “It’s really just watching them and giving them supportive care that you would probably get at home from a loving provider.”

The US Office of the Assistant Secretary for Preparedness Response asked UNMC early Monday morning to take in a total of 13 patients who had either tested positive, or had a high likelihood of testing positive, for the novel coronavirus.

The patients had been on a cruise ship docked off the cost of Japan for two weeks. The center said it was prepared.

“We’re having them under surveillance in quarantine until we know that they are not a danger to the public,” Rupp said, adding that most units have an exercise bike or a treadmill as well as a TV and WiFi so they’re able to communicate…

UNMC was commissioned by the US Centers for Disease Control and Prevention in 2005 to create the biocontainment unit where one patient currently is. The rest of the patients are in a separate federal quarantine center on the campus, that UNMC built through a private-public partnership.

In 2014, UNMC successfully treated three patients with Ebola, and the medical facility has the capacity to manage other highly infectious diseases like SARS, monkeypox and multidrug-resistant tuberculosis.” (F)

“In addition to the biocontainment unit, the hospital’s campus has the only federal quarantine unit in the country.

“We do a huge amount of research in these areas,” said Dr. Jeffrey P. Gold, chancellor of the University of Nebraska Medical Center, citing work on infectious diseases and research on countermeasures to weapons of mass destruction.

 “What — heaven forbid — happens if an employee or staff member gets exposed to one of these agents, or even worse than that, gets infected, where are you going to put them? You can’t just call up a local hospital and say, ‘I’ve got somebody who has anthrax, make up a bed,’” he said. “You need facilities that can do everything from air and water handling to the complexities of waste disposal.”” (G)

“The Center for Disease Control does not recognize surgical masks as a means of protection from viruses. Health professionals use N95 respirators that are formed tightly around the nose and mouth. Dr. Seery says N95s are expensive and not practical for the public.

“Surgical masks aren’t bad. If you’re stuck in something like a plane, I don’t think it’s going to do you much good,” Dr. Seery says. Unfortunately, it doesn’t stop all the air that you breathe in around the mask, but if you’re out and about in a community that has the flu, for example, it might reduce your chances of coming into contact with that flu virus while walking through someone’s sneeze cloud.”” (H)

“The director of a Chinese hospital at the epicenter of the coronavirus outbreak became one of its victims Tuesday despite “all-out” efforts to save his life, Chinese health officials said…

Liu Zhiming, president of Wuhan Wuchang Hospital in Hubei province, died of coronavirus-related pneumonia, China Daily reported. The hospital, one of the seven designated for the epidemic in Wuhan, treated thousands of people a day…

“Unfortunately he became infected and passed away at 10:54 Tuesday morning after all-out efforts to save him failed,” the commission said.” (I)

“An Oregon comedian who had been stranded on a Holland America cruise ship in Cambodia due to COVID-19 virus concerns managed to get a flight back home by breaking quarantine in a hotel where ship’s passengers were being held pending test results…

“There was no official ‘you can’t leave’ (at the hotel) but if you tried to go out the front door with your luggage, security would stop you,” King said. “But if you went out with your backpack and you were sightseeing, not a problem.”..

He says he chose to fly back on his own on a more full-service airline, even purchasing a full-price, upgraded ticket as not to raise suspicion that he was trying to quickly leave the country at the last minute as cheaply as possible.

King said he sailed through the airports on his three connecting flights, only being asked if he had been to China, and had a rental car reserved in Seattle to get home to Eugene if he couldn’t fly from here.

King said somebody asked him if it was “kind of selfish to self deport?” He said while the results of his virus test weren’t back, he’s confident he’s OK since he has not shown any symptoms, nor fever, and says he had been essentially in quarantine for 14 days.” (J)

“In one school district, families are pulling their kids out of school. In others, students show up in face masks.

Educators in another Southern California community agreed to suspend an exchange program to keep visiting Chinese students out of quarantine.

School districts across the U.S., particularly those with large Asian American populations, have scrambled to respond to the outbreak of the coronavirus, which has killed more than 1,500 people and sickened tens of thousands more, almost all in China.

At least 15 cases have been confirmed in the U.S., mostly in California, home to about one-third of the nation’s Chinese immigrants.

The districts find themselves in uncharted territory as they apply new federal travel rules to their student bodies. And in some cases, administrators are making decisions to address parental fears – not actual disease – with no official guidance. They’re weighing whether to allow students to work from home, even if they haven’t traveled abroad recently, or let them wear face masks in class.

Balancing these requests against broader public health needs often leads to different conclusions.

“We’re just doing our best to comply” as the rules and outbreak evolve, said Jenny Owen, spokesperson for the Duarte Unified School District, about 20 miles northeast of downtown Los Angeles. About 6% of the district’s students identify as Asian…

To prevent the virus’s spread in the U.S., the federal government has issued rules for returning travelers: U.S. citizens and legal permanent residents who visited the epicenter of the outbreak in China, Hubei province, in the previous 14 days must undergo a mandatory two-week quarantine at a government-run facility. Those who visited other parts of China must stay home and “self-quarantine” for two weeks.

The policies began Feb. 2, and as a result, an exchange program that brought children from China to Duarte schools has been temporarily halted to prevent the students from being quarantined, Owen said.

State public health departments are using the federal rules to draft guidelines for school districts.

The policies made a “night and day” difference in clearing up confusion, especially for families who had recently traveled from China and were wondering whether to send their kids to school, said Don Austin, superintendent of the nearly 12,000-student Palo Alto Unified School District in the Bay Area, where about 36% of students identify as Asian.

“When I first heard of the concept of self-quarantine, my first instinct was, this could be problematic if we’re alone on that and trying to create some of these policies and practices on the fly,” he said.

But school districts and local health departments still have to make quick decisions in cases that fall outside federal guidelines.”  (K)

“As the U.S. responds to a growing threat of the 2019 novel coronavirus, CMS and other organizations are clarifying how to code for testing and treatment of the disease.

Six things to know:

1. CMS created a new Healthcare Common Procedure Coding System code for providers and labs testing patients for SARS-CoV-2, or severe acute respiratory syndrome coronavirus 2.

2. Providers can use the HCPCS code U0001 to test patients for coronavirus using the CDC’s 2019 novel coronavirus real-time RT-PCR Diagnostic Test Panel.

3. Medicare’s claims processing system will start accepting the code April 1 for dates of services Feb. 4 onward.

4. Audrey Howard, senior outsource services consultant with 3M Health Information Systems, reviewed in a blog post the current ICD-10-CM codes providers could use to code for the virus.

5. For classifying coronavirus not associated with SARS, providers could use:

Pneumonia due to coronavirus: J12.89 and B97.29

Sepsis due to coronavirus: A41.89 and B97.29

Other infection caused by coronavirus: B34.2

Contact with and (suspected) exposure to other viral communicable diseases: Z20.828

6. For classifying the SARS-associated coronavirus, providers could use:

Pneumonia due to SARS-associated coronavirus: J12.81

Sepsis due to SARS-associated coronavirus: A41.89 and B97.21” (L)

“Staff at NYU Langone Health in New York City has designated the new virus as a “level 1” priority.

“A big part of this level is communication,” said Dr. Jennifer Lighter, hospital epidemiologist there.

“We are trying to communicate to NYU staff and patients in our medical center how to best protect themselves from the flu or COVID-19,” Lighter said. “That’s just general info like basic hand hygiene, sneezing into the end of your elbow and practicing safe distance from someone who is sick.”

NYU is also preparing for a level 2 or 3 scenario, she added, where there is transmission in the city and it begins to impact hospital operations. The health-care system has implemented a conservation plan and medical supplies, especially respirator masks, are only given to staff as needed, she said.

“If a team needed more, they would have to be infection-prevention approved or manager approved before someone would get more,” she said, adding staff is already feeling the brunt of the flu season.

The hospital is also recommending patients with more mild symptoms to stay at home, she said. The hospital has been ramping up its virtual urgent care, including training doctors and purchasing more iPads and other machines. “If you’re shortness of breath, obviously, please come in,” Lighter said.” (M)

(A)          Wuhan Coronavirus Looks Increasingly Like a Pandemic, Experts Say, by Donald G. McNeil Jr.,

(B)          Chinese CDC study finds Covid-19 virus to be more contagious than SARS or MERS, by James Griffiths and Nectar Gan,

(C)          Constant on-the-nose reporting, however much it seems to serve transparency, has limitations, too, by  John Allen Paulos,

(D)          No US coronavirus cases were caught by airport temperature checks. Here’s what has worked, by Elizabeth Cohen and John Bonifield,

(E)          Americans on coronavirus cruise ship barred from US after failed quarantine, by BETH MOLE,

(F)          Nebraska doctors are providing coronavirus patients with chicken soup and Tylenol, by Amir Vera and Nick Watt,

(G)         First Ebola, Now Coronavirus. Why an Omaha Hospital Gets the Toughest Cases, by Sarah Mervosh,

(H)          Do surgical masks protect against illness?, by Kristen Boxman,

(I)           Coronavirus 20 times more lethal than the flu? Death toll passes 2,000, by John Bacon,

(J)           Hotel getaway: Oregon comedian quarantined amid cruise ship virus sneaks flight to Seattle,

(K)          School districts grapple with coronavirus quarantines, face masks and fear, by Anna Almendrala,

(L)           Coding for coronavirus: 6 things to know, by Morgan Haefner,

(M)        Hospitals across the US prepare for coronavirus outbreak to become global pandemic, by Berkeley Lovelace Jr.,



PART 8. CORONAVIRUS. February 28, 2020. “…every country’s top priority should be to protect its health care workers. This is partly to ensure that hospitals themselves do not become sites where the coronavirus is spread more than it is contained.”

“Why this looks like the beginning of a pandemic

These outbreaks outside of China, along with the latest science on Covid-19, suggest we may soon see a rapid rise in infections — both in China and in more countries around the world. Here’s why.

1) The virus is very contagious and some people seem to be able to infect others before they know they’re sick: Researchers currently believe one infected person generally infects two to three others, which would make the new coronavirus more contagious than other coronaviruses, like SARS and MERS.


2) Countries are still mostly looking for the disease in people who’ve traveled from China: The main method of screening in many countries is still testing passengers coming from China, or from Hubei province only. But as we’ve seen, spread is happening beyond those people. And other cases may be undetected…

3) With flu season ongoing, it can take time to identify cases and outbreaks: “The challenge with this illness is that the clinical symptoms resemble other viral illnesses, like flu,” said Inglesby. So people with the flu, and doctors examining them, may not even be thinking of Covid-19 yet, especially in people who haven’t traveled to China.

4) China may also see another surge in cases soon as travel restrictions are gradually lifted: The country has taken extraordinarily draconian measures to stop this virus, quarantining millions, and shutting down transit and travel. But the business community is growing increasingly frustrated with the restrictions, and is pressuring government officials to ease some of the restrictions…

5) Many countries are only now getting testing up and running: Even the US — with one of the most highly-resourced health systems in the world — doesn’t have adequate diagnostic capacity right now:

Reminder: As of today (Feb 23), the US remains extremely limited in #COVID19 testing. Only 3 of ~100 public health labs have @CDC test kits working and CDC is not sharing what went wrong with the kits. How to know if COVID19 is spreading here if we are not looking for it.

6) Some people may have abdominal pain before respiratory symptoms — and that’s not something health officials are screening for: This coronavirus is still very new, and we don’t know its entire spectrum of illness yet, but we’re learning the disease may sometimes surface in surprising ways. Though it’s a respiratory infection, a recent JAMA article found some have abdominal symptoms such as discomfort first. This means “we may not be detecting cases that do not present in the classic way with fever and respiratory symptoms,” said William Schaffner, an infectious disease expert at Vanderbilt University….

We need to prepare for a pandemic…

For now, countries need to move from trying to contain the virus to mitigating its harm — reducing the spread, and caring for the very sick, said Jennifer Nuzzo, an infectious disease expert and senior scholar at the Johns Hopkins Center for Health Security. “It is beyond time,” she added.” (A)

“On Tuesday, Feb. 18, no coronavirus cases had been reported in Iran. On Sunday, the government announced 43 cases and eight deaths. Some 152 cases (and at least three deaths) were confirmed in Italy on Sunday, up from three cases on Thursday. The number of infected people in South Korea jumped to 763 (and six deaths) in just days.

As of Monday, Covid-19 was detected in at least 29 countries. In nations with few or no reported cases so far, particularly in South America and Africa, the absence of evidence shouldn’t be interpreted as evidence of absence. More likely, it reflects lack of testing.

Is the Covid-19 outbreak now a pandemic, whether or not the World Health Organization calls it that yet? If so, what’s next?

In a world ill-prepared for a potentially life-threatening, easily transmitted disease like Covid-19, the most effective way to mitigate the pandemic’s impact is to focus on supporting health care systems that already are overburdened…

This is the main reason every country’s top priority should be to protect its health care workers.

The United States and other countries in the Northern Hemisphere already are in the throes of a moderately severe flu season. Their inventories of protective equipment used by doctors, nurses and emergency medical workers — N-95 respirator masks, gloves, eye protection, disposable suits — are running low. These limited supplies must go to health care workers first, rather than the public. This is partly to ensure that hospitals themselves do not become sites where the coronavirus is spread more than it is contained: If infected health care workers die in large numbers, entire societies may be shaken to the point of panic.

Governments should also conduct Covid-19 preparedness drills in local hospitals and expand hospitals’ temporary capacity, for example, by setting up emergency tents in parking lots, as is already happening in some places in the United States. To minimize the strain on overstressed acute-care hospitals, supportive nursing care might have to be provided, in makeshift facilities and patients’ homes, as was done during severe pandemics in the past, such as the Great Influenza of 1918-19…

Ensuring all of this means facing the hard facts of this unfolding pandemic — and that requires thorough, transparent disclosures to the public. Past experiences, with the anthrax-laced letters in 2001 and the 2014 Ebola outbreak, suggest that people react more rationally and show greater resilience to a full-blown crisis if they are prepared intellectually and emotionally for it.” (B)

“The number of coronavirus cases in South Korea has soared to about 602, according to The New York Times. More than half of those cases involve members of, or those somehow linked to, the religious sect, the Shincheonji Church of Jesus, where a so-called superspreader infected at least 37 people last week.

A so-called superspreader infected at least 37 people at her church with the new coronavirus, and dozens of additional worshippers are also showing symptoms of the disease, called COVID-19, according to news reports.

The 61-year-old woman attends the Shincheonji Church of Jesus the Temple of the Tabernacle of the Testimony in Daegu, South Korea, according to the international news outlet AFP. The city, located in the southern part of the country, is home to about 2.5 million people. The woman, called “Patient 31” by Korea’s Centers for Disease Control and Prevention, developed a fever on Feb. 10 and attended four church services before being diagnosed with COVID-19. ..

Authorities described the outbreak as a “super-spreading event,” as the lone woman transmitted the infection to an unusually high number of people, according to Reuters. Current estimates suggest that a single person with the novel coronavirus spreads the infection to about 2.2 additional people, on average. The surge of infection at the church brings the total number of confirmed cases in South Korea to 104; one death associated with the virus has occurred in the country so far.” (C)

“Rain was falling on the night of Jan. 18, so the windows of the Tokyo party boat were shut. Inside were about 90 guests of a local taxi association who were celebrating the new year as the vessel floated down the Sumida River. Also on board, unbeknown to them, was a coronavirus capable of spreading ferociously.

It did just that. A driver in his 70s soon fell ill with fever; he later tested positive. The same day as his diagnosis, his mother-in-law died; she also was infected. Officials then discovered that 10 others from the boat were, too, including an employee who had served passengers from Wuhan, China. Still more who did not attend the party caught the virus after coming into contact with those who did.

As public health officials look for clues to one of the biggest uncertainties about the new coronavirus epidemic — whether it will eventually expand rapidly beyond its center in China — they are closely studying clusters of cases that have emerged recently in Japan.

The issue has taken on more urgency as passengers have begun walking off a contaminated cruise ship in Yokohama where 634 people have tested positive for the virus and two later died. Experts fear that some who were cleared to leave an onboard quarantine could later test positive, spreading infections on land in the same way that the party boat has done.

Alarmed officials are rushing to learn more about how the virus is transmitted, including how many of those infected experience mild symptoms or none at all, and whether it can be spread by people who are symptom-free.” (D)

“Most of the Americans who were being monitored at the University of Nebraska Medical Center for coronavirus after evacuating a cruise ship in Japan tested positive for the virus, the hospital says.

UNMC said in a statement Thursday that the US Centers for Disease Control and Prevention verified the Nebraska Public Health Lab results showing that 11 of the 13 patients have the novel coronavirus. The other two evacuees who were taken to the Omaha hospital tested negative, the statement said.

Bert Kelly, a CDC spokesman, told CNN that the agency has verified the results, bringing the total of confirmed cases in the United States to 26.

The hospital had said some of the patients had tested positive in Japan but some “came with a lack of clarity of what their test results were,” Shelly Schwedhelm told CNN. Schwedhelm is the UNMC/Nebraska Medical Executive Director of Emergency Management and Biopreparedness who has clinical oversight of the quarantine and biocontainment units.

Nine of the patients had tested positive for the virus in Japan and were positive again after being rested in the United States, another CDC spokesman, Joe Smith, told CNN on Friday.” (E)

“Preventing the spread of infectious disease is the essence of public health work, but the scale of efforts by state and local health departments across the country to contain the virus known as COVID-19, experts said, has rarely been seen. Since early February, thousands of people returning to the United States from mainland China, the center of the outbreak, have been asked to isolate themselves at home for 14 days…

Local health officials check in daily by email, phone or text. They arrange tests for people who come down with symptoms, and in some cases, groceries and isolated housing. There is no centralized tally in the United States of people being monitored or asked to remain in isolation, and they are scattered across the nation’s nearly 3,000 local health jurisdictions.

People arriving from mainland China are added each day, while those who have completed 14-day “self-quarantine” periods are released from oversight. In California alone, the department of public health has been monitoring more than 6,700 returning travelers from China, while health officials in Washington State have tracked about 800, and officials in Illinois more than 200.

At least 34 cases have been confirmed in the U.S. and more infections are expected…

 “All hands on deck are being pulled into this,’’ said Dr. Marcus Plescia, the chief medical officer for the Association of State and Territorial Health Officials, a nonprofit organization that represents public health agencies across the country. “If it really blows up, at some point, it could overwhelm state and local health departments.”…

In Washington, where the first coronavirus patient in the United States was confirmed on Jan. 21, health officials tracked down and monitored 69 individuals with whom the man had come in contact, including work colleagues, health workers and other patients present in a clinic he visited when he first felt sick. Still, there have been issues. One person the man had been in contact with and who had developed symptoms of illness flew on a plane to Wisconsin during the 14-day period when she was supposed to be isolated at home.

 “There is no way, with something this large, that you can make it seal-proof,’’ said Dr. Wiesman, who has started twice-weekly conference calls with the chief health officers in every state and territory to share tips and seek advice on how to manage the shifting challenges of the coronavirus response. While enforcing total compliance with isolation orders may not be possible, Dr. Wiesman said, “We have to try for 80 to 85 percent, and hopefully that will work.’’

Federal authorities are in charge of setting guidelines to manage the danger, such as deciding how much risk a returning traveler poses and who should be tested for the coronavirus. But the day-to-day work putting those policies in place and tracking thousands of people falls to the vast, decentralized network of local health departments across the country. Travelers’ data, culled from federal customs officials, is passed on to state health agencies, who farm out lists of people returning from China to local health departments.” (F)

Health experts sounded the alarm Friday over the worldwide threat of the coronavirus, with officials “warning of its “likely” community spread in the United States and the World Health Organization cautioning that “the window of opportunity is narrowing” for containing the outbreak worldwide.

The COVID-19 coronavirus, which erupted in China in December, has killed at least 2,360 people and sickened at least 77,900 worldwide, the majority of cases in mainland China.

Dr. Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, told reporters Friday that U.S. health officials are preparing for the coronavirus to become a pandemic.

“We’re not seeing community spread here in the United States, yet, but it’s very possible, even likely, that it may eventually happen,” she said. “Our goal continues to be slowing the introduction of the virus into the U.S. This buys us more time to prepare communities for more cases and possibly sustained spread.”

She said the CDC is working with state and local health departments “to ready our public health workforce to respond to local cases.” These measures include collaboration with supply chain partners, hospitals, pharmacies and manufacturers to determine what medical supplies are needed.

She said the “day may come” here where we have to shut down schools and businesses like China has done.” (G)

“In the U.S., the number of confirmed cases rose to at least 34, as a number of evacuated individuals from the Diamond Princess cruise ship have tested positive.

Several other Americans who were on board the ship have been diagnosed and hospitalized in Japan, according to the CDC. As of Friday afternoon, there were no plans to evacuate those patients. The U.S. Department of State said it will not rescue other Americans who choose to go on cruises in Asia.

“Such repatriation flights do not reflect our standard practice, and should not be relied upon as an option for U.S. citizens,” Ian Brownlee, an executive within the Department of State, said during a media briefing Friday.

On its website, the department has warned Americans to reconsider any planned cruises to or within Asia, saying such trips “may be impacted by travel restrictions affecting their itineraries or ability to disembark, or may be subject to quarantine procedures implemented by the local authorities.

How countries are able to contain the virus and prevent it from sustained person-to-person transmission will be important in determining the “ultimate end game” of the virus, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told NBC News.

“If infection control gets out of control in many of these countries throughout the world, then it’s going to be very difficult to prevent cases from then going, by travel, to all parts of the world,” Fauci said. “That’s how a pandemic starts.”

As part of a team of international scientists led by the World Health Organization, the National Institutes of Health and the CDC have staff members in China, observing containment and infection control efforts. They’re scheduled to travel into the epicenter of the outbreak, Wuhan, on Saturday.

“We still believe we can contain the virus,” WHO Director-General Dr. Tedros Adhanom Ghebreyesus said Friday during a media briefing. “But the window of opportunity is narrowing.”” (H)

“About 150 prescription drugs — including antibiotics, generics and some branded drugs without alternatives — are at risk of shortage if the coronavirus outbreak in China worsens, according to two sources familiar with a list of at-risk drugs compiled by the Food and Drug Administration.

Why it matters: China is a huge supplier of the ingredients used to make drugs that are sold in the U.S. If the virus decreases China’s production capability, Americans who rely on the drugs made from these ingredients could be in trouble.

What they’re saying: The FDA declined to comment on the list, but said in a statement that it’s “keenly aware that the outbreak could impact the medical product supply chain,” and has devoted additional resources toward identifying potential vulnerabilities to U.S. medical products stemming specifically from the outbreak.

The agency has been in contact with hundreds of drug and medical device manufacturers, and it’s also coordinating with global regulators like the European Medicines Agency.

It pointed out that there aren’t any vaccines, gene therapies or blood derivatives licensed by the FDA that are manufactured in China, although raw materials for many products do come from China and other southeastern Asian countries. The agency is in contact with biologics manufacturers to monitor supply concerns.

“If a potential shortage or disruption of medical products is identified by the FDA, we will use all available tools to react swiftly and mitigate the impact to U.S. patients and health care professionals,” said an FDA spokesperson.” (I)

“A group of 46 Congress members sent a letter to the Trump administration Feb. 20 urging the government not to give exclusive licenses to any drugmaker that develops a coronavirus vaccine using U.S. taxpayer funds.

The lawmakers expressed concern that if drugmakers are given excluisve licenses on coronavirus treatments or vaccines, they would raise the prices and make treatments inaccessible for many people affected by the virus.” (J)

“As the novel coronavirus, called COVID-19, continues to spread across the globe, Cleveland’s major hospitals are preparing for potential cases.

From screening patients for the virus to protecting medical providers, local health care systems are taking precautions to ensure that if they do get a case of COVID-19, it doesn’t spread, as it has in China.

“Part of preparedness is thinking ahead,” said Dr. Amy Ray, medical director of infection prevention at the MetroHealth System…

Early identification of patients who are at risk for COVID-19 infection is important, Ray said.

MetroHealth staff who schedule urgent appointments in doctors’ offices are trained to look for patients who are having fever and cough, or fever and shortness of breath, and have traveled in China or been in close contact with someone who traveled there, Ray said…

At the Cleveland Clinic, the electronic medical records vendor turned on a function that automatically prompts those who are checking in patients or taking calls to ask if patients have traveled to China and are experiencing symptoms such as cough and fever, said Dr. Tom Fraser, vice chairman of infectious disease at the Clinic…

At MetroHealth’s main campus in south Tremont area, officials have set aside a two-bed unit, called the Special Diseases Care Unit, for possible COVID-19 patients.

The unit has its own blood lab and an anteroom where health care workers can put on and take off their protective gear. The Infection Prevention Team is looking for other areas of MetroHealth with negative-pressure ventilation systems that could be used to care for COVID-19 patients, Ray said.

Portable X-ray and other equipment can be brought to the isolation rooms to minimize the need to move patients through the hospital, limiting the danger of transmission to others…

At each hospital system, medical personnel wear protective gear that covers their nose, mouth and eyes to examine patients suspected of having COVID-19. That means wearing fitted respirators, a face shield or goggles, gloves and a gown.

Keeping health care workers protected and healthy is a priority because they come in contact with so many others, Saade said.

“A big problem in these big epidemics — thankfully, we’re not there yet — is that you don’t have enough health care workers to help with people care,” he said…

While it’s ideal to isolate all patients in the hospital, if there were a COVID-19 outbreak, those with lesser symptoms would need to self-quarantine at home, Saade said.

“If we have just a few people, we can isolate them,” he said. “That’s not something that can happen if it’s widespread.”

Fraser said that a lot of the precautions that health systems are taking for COVID-19 are built on day-to-day infection-prevention practices.

In the end, it all comes down to the basics, he said.

“Everybody’s seen the Hazmat suits and stuff like that on TV. But if we don’t wash our hands well between patients, then you can have all kinds of fancy suits” but not be protected, Frazer said.

“Clean hands going in, and clean hands going out” is the “fail safe,” he said. “Because not everybody is going to come with a sign that says ‘I’ve got coronavirus.’ ”

The Clinic emphasizes daily basic infection-prevention practices, such as hand hygiene and proper cough etiquette.

“Those kind of basics, without those, everything else would fall apart,” Fraser said.” (K)

Labs in the US will start looking for the new coronavirus this week (L)

Specialized respirators are key to stopping spread of coronavirus to medical staff (M)

Flowchart to Identify and Assess 2019 Novel Coronavirus for the evaluation of patients who may be ill with or who may have been exposed to 2019 Novel Coronavirus (2019-nCoV)

For the evaluation of patients who may be ill with or who may have been exposed to 2019 Novel Coronavirus (2019-nCoV) (N)

Coronavirus: What it does to the body (O)

How the coronavirus can kill people (P)

Coronavirus Disease 2019 Information for Travel

This page includes information about Coronavirus Disease 2019 (COVID-19) for travelers and travel related industries. (Q)

Interim Guidance for Businesses and Employers to Plan and Respond to Coronavirus Disease 2019 (COVID-19), February 2020 (R)

(A)          “We are at a turning point”: The coronavirus outbreak is looking more like a pandemic, by Julia Belluz,

(B)          Is It a Pandemic Yet? It’s now clear that the coronavirus epidemic was never going to be contained. What’s next?, by Michael T. Osterholm and Mark Olshaker,

(C)          Superspreader’ in South Korea infects nearly 40 people with coronavirus, by Nicoletta Lanese,

(D)          What a Party in Japan May Tell Us About the Coronavirus’s Spread, by Sui-Lee Wee and Makiko Inoue,

(E)          11 cruise ship passengers test positive for coronavirus, Nebraska hospital says,  Nicole Chavez,

(F)          Local health officials check in daily by email, phone or text with the thousands of people returning to the United States from mainland China, where they may have encountered the virus, by Amy Harmon and Farah Stockman,

(G)         CDC is preparing for the ‘likely’ spread of coronavirus in the US, officials say, by Doug Stanglin,

(H)          U.S. takes steps to prepare for pandemic as global coronavirus cases rise, by Erika Edwards,

(I)           Scoop: Coronavirus threatens shortages of about 150 drugs, by Caitlin Owens,

(J)           Don’t allow monopoly of coronavirus drug rights, lawmakers urge Trump, by Maia Anderson,

(K)          Protecting patients, health care workers priorities as Cleveland Clinic, MetroHealth and UH prepare for coronavirus, by Ginger Christ,









PART 9. CORONAVIRUS. February 29, 2020.  Responding to a question about the likelihood of a U.S. outbreak, President Trump said, “I don’t think it’s inevitable…”It probably will. It possibly will,” he continued. “It could be at a very small level, or it could be at a larger level.”

 “A person in California who was not exposed to anyone infected with the coronavirus, and had not traveled to countries in which the virus is circulating, has tested positive for the infection in what may be the first case of community spread here in the United States, the Centers for Disease Control and Prevention said on Wednesday.

“At this point, the patient’s exposure is unknown,” the C.D.C. statement said. “The case was detected through the U.S. public health system and picked up by astute clinicians.”

The case was announced shortly after President Trump concluded a news briefing in which he said that aggressive public health containment measures and travel entry restrictions had successfully limited the spread of coronavirus in the United States.

It brings the number of cases in the country to 60, including the 45 cases among Americans who were repatriated from Wuhan, China — the epicenter of the outbreak — and the Diamond Princess cruise ship, which was overwhelmed by the virus after it docked in Japan.

Until now, public health officials have been able to trace all of the infections in the country to a recent trip abroad or a known patient.

This new case appears to be one of community spread — one in which the source of infection is unknown. It is possible the patient may have been exposed to a returning traveler who was infected, the C.D.C. said.” (A)

“The first suspected U.S. case of a patient getting the new coronavirus through “community spread” – with no history of travel to affected areas or exposure to someone known to have the COVID-19 illness — was left undiagnosed for days because a request for testing wasn’t initially granted, according to officials at UC Davis Medical Center in Sacramento, Calif.

The patient in Northern California is now the 60th confirmed case of the new coronavirus in the United States. The Centers for Disease Control and Prevention disclosed the latest case Wednesday evening, as President Trump assigned Vice President Pence to lead the administration’s response to the disease.

“This case was detected through the U.S. public health system — picked up by astute clinicians,” the CDC said in a brief statement about the new patient.

UC Davis included more details about the case in its own statement, drawing on an email sent to staff at its medical center. It said the CDC initially ruled out a test for the coronavirus because the patient’s case didn’t match its criteria.” (S)

“An American soldier in South Korea has tested positive for the new coronavirus, the U.S. military said on Wednesday.

The patient, a 23-year-old man, is based in Camp Carroll in Waegwan, only 12 miles from Daegu, the South Korean city at the center of  an outbreak in the country.

The soldier, the first U.S. service member to become infected, has been quarantined in his off-base residence, the military said.

The soldier visited Camp Walker, a military base in Daegu, on Monday and visited Camp Carroll from Friday to Tuesday.

South Korean and American “health professionals are actively conducting contact tracing to determine whether any others may have been exposed,” the military said.

The military added that it was “implementing all appropriate control measures to help control the spread of Covid-19 and remains at risk level ‘high’” for all its 28,500 soldiers stationed in South Korea “as a prudent measure to protect the force.” “(B)

“Why this looks like the beginning of a pandemic

These outbreaks outside of China, along with the latest science on Covid-19, suggest we may soon see a rapid rise in infections in more countries around the world. Here’s why.

1) The virus is very contagious, and some people seem to be able to infect others before they know they’re sick: Researchers currently believe one infected person generally infects two to three others, which would make the new coronavirus more contagious than other coronaviruses, like SARS and MERS…

2) Countries are still mostly looking for the disease in people who’ve traveled from China: The main method of screening in many countries is still testing passengers coming from China or from Hubei province only. But as we’ve seen, spread is happening beyond those people. And other cases may be undetected…

3) With flu season ongoing, it can take time to identify cases and outbreaks: “The challenge with this illness is that the clinical symptoms resemble other viral illnesses, like flu,” said Inglesby. So people with the flu, and doctors examining them, may not even be thinking of Covid-19 yet, especially in people who haven’t traveled to China.

4) China’s case toll is falling — but it may see another surge soon as travel restrictions are gradually lifted: The country has taken extraordinarily draconian measures to stop this virus, quarantining millions, and shutting down transit and travel. But the business community is growing increasingly frustrated with the restrictions and is pressuring government officials to ease some of them…

5) Many countries are only now getting testing up and running: Even the US, with one of the most highly resourced health systems in the world, doesn’t have adequate diagnostic capacity right now..

6) Some people may have abdominal pain before respiratory symptoms — and that’s not something health officials are screening for: This coronavirus is still very new, and we don’t know its entire spectrum of illness yet, but we’re learning the disease may sometimes surface in surprising ways. Though it’s a respiratory infection, a recent JAMA article found some have abdominal symptoms such as discomfort first. This means “we may not be detecting cases that do not present in the classic way with fever and respiratory symptoms,” said William Schaffner, an infectious disease expert at Vanderbilt University…”  (D)

“Outside China, there are now 2,790 cases in 37 countries, and 44 deaths,” WHO Director-General Tedros Adhanom Ghebreyesus said at a briefing in Geneva…

Tedros is urging the international community to have “hope, courage and confidence” that the new respiratory virus can be contained, citing 14 countries that haven’t reported a new case in more than a week.

Worldwide, there are currently 81,191 cases of the novel coronavirus, according to a dashboard created by the Johns Hopkins Whiting School of Engineering. That number includes 30,281 cases in which people recovered from COVID-19.

But Tedros also warned that the situation could get worse, saying, “At the same time, all countries, whether they have cases or not, must prepare for a potential pandemic.”..

On a broader scale, the WHO’s Tedros says every country should make it a top priority to protect workers who are dealing with the health crisis. And he says agencies should work with communities whose members are most at risk, “particularly the elderly and people with underlying health conditions.”

Despite the worrying rise of cases at the international level, Tedros again rejected calls Wednesday for the WHO to declare a pandemic, saying it’s not an accurate label for a virus he still views as containable. He has also recently noted that the virus’s fatality rate outside of Hubei province is less than 1%.

The WHO declared the coronavirus outbreak a global health emergency in January, as cases surged in China. The organization now says it believes the epidemic peaked and plateaued in China between the end of January and the early February.” (E)

“The World Health Organization (WHO) still avoided using the word “pandemic” to describe the burgeoning crisis today, instead talking about “epidemics in different parts of the world.” But many scientists say that regardless of what it’s called, the window for containment is now almost certainly shut. “It looks to me like this virus really has escaped from China and is being transmitted quite widely,” says Christopher Dye, an epidemiologist at the University of Oxford. “I’m now feeling much more pessimistic that it can be controlled.” In the United States, “disruption to everyday life might be severe,” Nancy Messonnier, who leads the coronavirus response for the U.S. Centers for Disease Control and Prevention, warned on 25 February. “We are asking the American public to work with us to prepare for the expectation that this is going to be bad.”

Dye and others say it’s time to rethink the public health response. So far, efforts have focused on containment: slowing the spread of the virus within China, keeping it from being exported to other countries, and, when patients do cross borders, aggressively tracing anyone they were in contact with and quarantining those people for 2 weeks. But if the virus, named SARS-CoV-2, has gone global, travel restrictions may become less effective than measures to limit outbreaks and reduce their impact, wherever they are—for instance, by closing schools, preparing hospitals, or even imposing the kind of draconian quarantine imposed on huge cities in China.” …

To prepare for what’s coming, hospitals can stockpile respiratory equipment and add beds. More intensive use of the vaccines against influenza and pneumococcal infections could help reduce the burden of those respiratory diseases on the health care system and make it easier to identify COVID-19 cases, which produce similar symptoms. Governments can issue messages about the importance of handwashing and staying home if you’re ill.

Whatever the rest of the world does, it’s essential that it take action soon, Aylward says, and he hopes other countries will learn from China. “The single biggest lesson is: Speed is everything,” he says. “And you know what worries me most? Has the rest of the world learned the lesson of speed?” (F)

“White House National Economic Council Director Larry Kudlow said Tuesday that the U.S. has “contained” the threat of a domestic coronavirus outbreak, breaking with the warnings of officials from the Centers for Disease Control and Prevention.

“We have contained this, I won’t say airtight but pretty close to airtight,” Kudlow told CNBC’s Kelly Evans on Tuesday afternoon…

Some of his comments stood in contrast to public pronouncements from CDC officials Tuesday that painted the coronavirus’ health threat to the U.S. as the most serious it‘s been.

Nancy Messonnier, who heads the National Center for Immunization and Respiratory Diseases, warned that American communities need to prepare now for the possibilities of remote work, teleschooling and other provisional measures when the disease starts spreading domestically.” (G)

“The Centers for Disease Control and Prevention on Tuesday warned that it expects the novel coronavirus that has sparked outbreaks around the world to begin spreading at a community level in the United States, as a top official said that disruptions to daily life could be “severe.”

“As we’ve seen from recent countries with community spread, when it has hit those countries, it has moved quite rapidly. We want to make sure the American public is prepared,” Nancy Messonnier, director of CDC’s National Center for Immunization and Respiratory Diseases, told reporters.

“As more and more countries experience community spread, successful containment at our borders becomes harder and harder,” she said.

There have been 14 cases of the virus diagnosed in the U.S., all in people who traveled recently to China or their close contacts. Another 39 U.S. residents have been infected in other parts of the world before being repatriated and quarantined. But CDC officials say the country could soon see more cases as the virus starts to spread through communities in areas outside China, including Iran, South Korea, and Italy.

The CDC urged American businesses and families to start preparing for the possibility of a bigger outbreak. Messonnier said that parents should ask their children’s schools about plans for closures. Businesses should consider whether they can offer telecommuting options to their employees, while hospitals might need to look into expanding telehealth services, she said.

“Disruption to everyday life might be severe,” Messonnier said, adding that she talked to her children about the issue Tuesday morning. “While I didn’t think they were at risk right now, we as a family ought to be preparing for significant disruption to our lives.”

The CDC’s messaging seemed to be at odds with the position of the World Health Organization, which reiterated Tuesday that countries could stop transmission chains if they acted swiftly and aggressively…

Messonnier said the CDC is evaluating data on measures that could be used to stem the spread of the virus, including school closures and other social distancing strategies, voluntary home quarantines, and surface cleaning methods. The CDC is using data from past flu outbreaks to study those strategies, but will tailor its recommendations for the new virus.

In a press briefing Tuesday afternoon, other top health officials pushed back on the perception that the public needs to take direct action now to prepare for community spread of the virus. They also doubled down on the message that the U.S. has successfully contained the spread of the virus thus far…

Messonnier said the CDC is also in conversation about whether to change the case definition that triggers a sick patient to be tested for the virus. Currently, health officials recommend testing only for people who have respiratory symptoms and have recently traveled to China, or those who have been in close contact with someone who was infected. But as community spread picks up in other countries, the case definition could change.” (H)

“President Donald Trump on Wednesday tried to ease growing fears over the spreading coronavirus, saying at the White House that his administration has the situation under control and is “ready to adapt” if the virus spreads.

“Because of all we’ve done, the risk to the American people remains very low,” Trump said. “We’re ready to adapt and ready to do whatever we have to as the disease spreads, if it spreads.

“We’re very, very ready for this,” Trump said, adding that only 15 people had contracted the virus in the U.S. and that all were expected to recover.

Trump, speaking from the Brady Briefing Room, said he was putting Vice President Mike Pence in charge of his administration’s response to the potential pandemic. Trump, however, rejected that he had made Pence a “czar” for the response to the virus.

Pence, speaking after Trump, reiterated that the “threat to the American public remains low” and said, “We will continue to bring the full resources of the federal government … to see to the health and well-being and to the effective response to the coronavirus in the United States of America.”

Trump — who this week announced a $2.5 billion plan to help combat the illness — said at the briefing, “We’re going to spend whatever is appropriate.”

Following the remarks of Trump and Pence, several senior officials from the National Institutes of Health and the Centers for Disease Control and Prevention spoke — and many didn’t paint quite as rosy a picture. One NIH official said a potential coronavirus vaccine was still at least a year away.

The president’s address came amid a tumbling stock market and grave criticism from Democrats who say his handling of the outbreak has been inadequate. It also came just a day after the CDC warned that it was only a matter of time before the illness, known as COVID-19, will spread across communities in the United States…

Measures to contain the virus in the U.S. so far have involved restricting travel to and from China — the center of the outbreak — and isolating identified cases.

Trump on Wednesday called those efforts “some very good early decisions” and indicated that he would consider restricting travel to South Korea and other countries “at the right time.”…

Federal health officials added Tuesday that they are preparing for a potential pandemic. CDC officials said the virus could disrupt daily lives, including closing schools, forcing people to work from home and delaying elective medical procedures.

Trump, asked Wednesday whether schools should prepare for a spread of the virus, replied that “every aspect of our society” should be prepared. He added that he doesn’t think it would come to that but that people should be prepared “just in case.”

But he also vacillated at various points during his news conference between agreeing with and rejecting the stark warnings of a broader potential outbreak issued by government public health experts.

Responding to a question about the likelihood of a U.S. outbreak, he said, “I don’t think it’s inevitable.

“It probably will. It possibly will,” he continued. “It could be at a very small level, or it could be at a larger level.”

At another point, Trump said, “Nothing is inevitable.” “ (I)

“Mike Ryan, head of the WHO’s health emergencies program, suggested countries need to be working full bore to be ready to deal with the virus.

“It is time to prepare. It is time to do everything you would do in preparing for a pandemic,” he insisted…

Mike Ryan, head of the WHO’s health emergencies program, suggested countries need to be working full bore to be ready to deal with the virus.

“It is time to prepare. It is time to do everything you would do in preparing for a pandemic,” he insisted.

Continuing to focus on trying to contain the virus — a goal many infectious diseases experts are skeptical can be met — buys time, Ryan said, noting if the illness can be prevented from spreading in Europe until flu season ends, hospitals won’t face a double blow.

“Even slowing down the virus by a month or six weeks has a massive positive benefit to the system,’’ he said.

But people need to be realistic about the limits of containment. “We cannot shut down the world,” Ryan said. “That’s not going to work.”

Countries should be working on trying to reduce the risk of imported cases, reduce the risk of spread from cases that get in, and increase the chance that people who get sick survive the infection. “But I think we have to be very, very careful in trying to suggest that we could absolutely stop the virus from spreading from one country to the next,” he said. “I don’t think that’s possible.”” (J)

“A federal health official warned Tuesday that the deadly coronavirus could cause “severe” disruptions in the USA as global experts struggled to fend off the outbreak and avoid a pandemic.

Is it too late?

“Disruption to everyday life may be severe,” Nancy Messonnier, director of the Centers for Disease Control and Prevention’s National Center for Immunization and Respiratory Diseases, warned at a news conference Tuesday. Schools could be closed, mass public gatherings suspended and businesses forced to have employees work remotely, she said.

Messonnier said the coronavirus has caused sickness and death and sustained person-to-person transmission. That’s two of the three factors for a pandemic, she said.

“As community spread is detected in more and more countries, the world moves closer to meeting the third criteria – worldwide spread of the new virus,” Messonnier said.

Although the World Health Organization determined Monday that the term pandemic “did not fit the facts,” experts said it very soon could…..

Melissa Nolan, a medical doctor and professor of epidemiology at the University of South Carolina’s Arnold School of Public Health, cited new clusters in Iran, which faces at least 95 cases and has had 16 deaths, and Italy, which is dealing with 322 cases.

“If we continue to see focalized local transmission in areas outside of China, the WHO will need to reconvene,” Nolan told USA TODAY on Tuesday. “We are very close to seeing this virus becoming a pandemic.”

Nolan said responses to the outbreaks in Iran and Italy could help health officials in other countries prepare their own medical and quarantine policies before an outbreak. That is crucial, said Robert Glatter, an emergency physician at New York’s Lenox Hill Hospital who fears the world is on the “cusp” of a pandemic.

“Trying to contain a disease which spreads like influenza, in this case COVID-19, is almost impossible,” he said. “We are talking about rapid-fire and sustained transmission.”…

Ogbonnaya Omenka, an assistant professor and public health specialist at Butler University’s College of Pharmacy and Health Sciences, said he understands the concerns. The main implication of declaring a pandemic is requiring, or at least further urging, national governments to prepare facilities and health workers to treat a lot of patients, Omenka told USA TODAY.

“Not only is this costly, it may also trigger panic,” he warned. “Countries may as well put in place these plans without the official announcement.”

Tedros stressed that a pandemic declaration would not eliminate the need for health authorities to continue testing, limiting contact with the sick and encouraging frequent hand washing – the front-line defense….

Messonnier acknowledged the CDC struck a more urgent tone in warnings about the virus in the USA. The proliferation of coronavirus in countries outside China raised the agency’s expectations the virus will spread here.

“People are concerned about this situation –  I would say rightfully so,” Messonnier said. “But we are putting our concerns to work preparing. Now is the time for businesses, hospitals, communities, schools and everyday people to begin preparing as well.”

“It’s not so much a question of if this will happen anymore but rather more a question of exactly when,” an official said.” (K)

“When you start to see sustained transmission in other countries throughout the world, it’s inevitable that it will come to the United States,” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told NBC News.

In the U.S., 57 people have been diagnosed with COVID-19, the illness caused by the new coronavirus. The majority are among repatriated residents who were passengers of the Diamond Princess cruise ship, docked in Japan.

The CDC said Americans should prepare for the possibility of disruptions to their daily lives if the virus were to start spreading in the U.S. That could include closing schools, working from home and delaying elective medical procedures.

“We should all be dusting off our pandemic preparedness plans and rehearse them very quickly,” said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University. “The core concept is social distancing.”

Business leaders, Schaffner said, should start considering which employees could work from home. Perhaps the time will come, he and other experts said, to observe religious practices and ceremonies at home, rather than attend larger community gatherings at places of worship. And families should start asking themselves how they would handle a week or two at home, without traveling even short distances for food, medicine or entertainment.”  (L)

“Gown, gloves, goggles, mask — deposit in biohazard container and wash hands for 20 seconds. That’s how to take it off safely. 

It’s a drill that’s becoming muscle memory for health care workers these days as hospitals and medical facilities prepare for the anticipated spread of the new coronavirus from China. Blanchard wants it to feel as routine for the Teaneck hospital’s staff as tying their shoes or fastening a seat belt.

Practice in donning and doffing personal protective equipment — or PPE, as it is called — has gained new urgency as the United States braces for a possible surge in infections. Health care workers are on the front lines…  

There has been no community transmission in the United States, Messonnier said. New Jersey has no cases.   

But the near certainty that the virus will arrive — whether in small, localized outbreaks or as a widespread epidemic — has state and local health officials and hospital leaders on the alert and concerned. 

In New Jersey, a governor’s task force meets weekly and has updated a preparedness plan. Hospital infection-control practitioners, chief medical officers and executives met with state health officials earlier this month. A conference call with 250 hospital executives — the second since the COVID epidemic began in China — is planned for later this week.

At individual hospitals, staff members are scanning for updates and new information on the virus, taking inventory of supplies, drawing up plans and reviewing infection-control procedures. One large system — RWJBarnabas Health — has a daily meeting of its emergency response team and a secure communication line systemwide.

“We don’t know who we may encounter in the Emergency Department,” said Jesson Yeh, an emergency physician at Holy Name who was part of that hospital’s training this week. “We need to be prepared for any possible situation, which may include people with viruses like the coronavirus, flu — Ebola, even.”

“Sometimes we do need a brush-up on how to prepare,” said Jennifer Temple, an Emergency Department nurse taking Blanchard’s review program. “Not that we forget. But it’s an emergency room; we want to work so fast. This is a great way to remind us.” 

Health care workers are the front lines of defense against the coronavirus’s spread as they diagnose and treat the sick. Their close proximity, exposure to the spray of coughs and sneezes and high touch contact as they do everything from take temperatures to insert breathing tubes vastly increases their risk of infection… 

For hospitals, that means two things, said Dr. Adam Jarrett, Holy Name’s chief medical officer: “The first thing we’re doing is reinforcing the training our staff has.” Then, “we’re making sure we have appropriate supplies.” 

Previous exercises involving government agencies across the nation “did show us that if we had a pandemic, there were going to be supply issues,” said Messonnier, of the CDC. “We are now thinking through and working on those supply issues,” to ensure there’s protection for health care workers. 

“There’s absolutely a shortage of masks and gowns,” said Jarrett, of Holy Name. “There hasn’t been a problem because there haven’t been any patients yet,” he said. “If there’s a significant outbreak in the tri-state area, I think there could be.”

CDC guidelines call for workers to wear N95 masks, which are also used in some construction or industrial settings. They form hard domes over the mouth and nose, with material like a HEPA filter filtering all air in and out. Hospitals are carefully controlling their use. Washable gowns might be used and thrown away, Jarrett said, if there aren’t enough disposable gowns. 

Another concern, depending on how the spread of the virus evolves, could be high rates of absentees among health care workers and other essential workers. New Jersey’s earlier pandemic flu preparedness plan, drafted in the wake of the 2009 swine flu epidemic, told hospitals to prepare for absences of 30% to 50%. 

CDC guidelines say health care institutions should err on the side of caution when workers may have been exposed to COVID-19 and show symptoms of fever or illness. They should stay home from work and self-quarantine, the agency suggested. 

Hospitals could manage those shortages by shifting the workers to concentrate on critical needs, employing temporary agency nurses, or canceling elective procedures, a spokeswoman for the state Health Department said. 

During Superstorm Sandy, for example, hard-hit facilities were able to waive standard credentialing procedures to make it faster to bring in personnel from other areas or out of state. “ (M)

“In New Jersey, Gov. Phil Murphy said preparations are ramping up. He noted that there are currently no confirmed cases in the state, but said it was prudent to anticipate that there would be.

“It’s pretty clear from financial markets the past couple of days, it’s pretty clear when you look at South Korea, Iran, Italy, that this is not going away anytime soon,” he said.

“We had a whole-of-government meeting this morning in Newark, just going over, once again, protocols, pre-emptive action — what do we do if X or Y happens,” he said, during remarks Wednesday at an unrelated news event at William Paterson University. “We’re doing everything to get out ahead of this and also be prepared as possible if something hits us.”

Murphy also said Health Commissioner Judith Persichilli on Wednesday was to convene a conference call with all hospitals in the state about preparations, noting that the state’s designated center for handling cases, University Hospital in Newark, “has a capacity of only so much.”.. (N)

“Against a backdrop of educated guesses — the state epidemiologist predicted it could be like a bad flu season with 500 deaths, but with no vaccine — Connecticut hospital officials said they have been drilling for weeks, got practice from the Ebola scare in 2014 and with the flu in 2009 and this year, and are ready for a coronoavirus outbreak if it comes to that.

In anticipation, as the virus spread in China, Hartford Hospital activated its emergency preparedness plan in early January, involving more than 300 units of the hospital, Dr. Ajay Kumor, chief medical officer, said at a news briefing Wednesday afternoon.

Gov. Ned Lamont outlines steps Connecticut has taken to prepare for coronavirus, urges residents to follow CDC guidelines to prevent spread of the disease »

For Dr. Mike Ivy of Yale-New Haven Hospital, the process is worn smooth on his lips: You have flu-like symptoms. You come into the emergency room. At the registration desk, you’ll be asked if you’ve traveled abroad to an area with there has been transmission of the virus — China, Iran, South Korea, Japan, northern Italy.

If the answer is yes, you’d be taken to an isolation room with negative air pressure, evaluated by a doctor and nurse and tested for coronavirus. You’ll be admitted if you’re sick enough, sent home if you’re not.

“People can isolate themselves at home so they do not infect anyone else,” said Ivy, deputy chief medical officer.

If you stay at the hospital, your treatment team will be wearing gowns, gloves and masks when they come in.

“And then, hopefully, you get better,” Ivy said, “as the majority of the patients do.”…  (N)

“Health organizations in Rhode Island said Tuesday that they are taking their coronavirus preparedness efforts to a higher level.

The United States said officials are warning Americans to prepare for the spread of coronavirus in communities across the country.

Doctors with Lifespan said they have created an emergency task force, so each facility can work together to combat the virus should it spread into Rhode Island…

The Rhode Island Department of Health said they’ve been having frequent talks with schools here, too.

A spokesperson for the University of Rhode Island said they have 50 students and one faculty member in Italy.

“The University remains in frequent contact with its study-abroad host partners, who have been communicating regularly with the students about the COVID-19 situation in Italy,” said the spokesperson.

Rhode Island Hospital Disaster Medicine and Emergency Preparedness Director, Dr. Selim Suner, said a concern is how exactly it’s spreading.

“We don’t know if it’s airborne yet because those studies have not been done,” said Suner…

The best preparation he said we know well.

“Hand-washing and keeping a distance from ill people is the best prevention,” said Suner.” (P)

“Reacting to concerns about the quickening spread of coronavirus, Gov. Andrew M. Cuomo said on Wednesday that the state would set aside some $40 million to fight the virus, as well as plan for possible quarantines at homes, hotels and hospitals.

In a briefing in the Capitol, the governor and his health commissioner, Dr. Howard Zucker, stressed that New York still had no confirmed cases of the virus, but warned that its spread to the state was inevitable.

The scope of the virus’s spread and the importance of New York as a center of global commerce and transportation led Mr. Cuomo, a third-term Democrat, to ask for additional funding for fighting the disease.

“It is highly probable that we will have people in New York State who test positive,” said Mr. Cuomo, noting that New York City is “the front door internationally” for many travelers. “No one should be surprised when we have positive cases.”

In addition to the $40 million from the Legislature, Mr. Cuomo said he would ask federal authorities permission to test patient samples in a laboratory in New York, rather than waiting several days for results from the C.D.C. in Atlanta….

State officials have already been taking precautions against the disease, asking some 700 recent visitors to China to voluntarily quarantine themselves, even as Customs and Border Protection agents continue to screen passengers at area airports. Individuals who have visited mainland China are judged to be of “medium risk,” according to the State Health Department, though it said none of those self-isolating individuals had exhibited symptoms of coronavirus.

In New York City, where officials say seven potential patients have been tested and cleared, Mayor Bill de Blasio has expressed confidence that the city is prepared, citing previous scares involving even more deadly diseases like Ebola in 2014…

 “We are in a state of high vigilance, high readiness, all elements of the city government, to address this crisis,” he said at a news conference on Wednesday. “We have the greatest public health capacity of anywhere in this country.”

The city has made 1,200 hospital beds available for anyone suspected of having coronavirus and has distributed 1.5 million face masks to health care workers.

But the mayor warned that the city needed help from the federal government in obtaining more protective gear — at least 300,000 more masks, he said — and stressed the importance of giving local health departments the ability to test for the virus on their own.

Other major cities were also taking precautions, including San Francisco, which declared a local state of emergency on Tuesday, despite no confirmed cases, saying “the global picture is changing rapidly.”

On Wednesday, officials at the Metropolitan Transportation Authority said they were working with state and federal health officials to assess potential contingency plans.

Those measures could include limiting or staggering public transit ridership, according to a document prepared by City Hall and the New York City’s Emergency Management Department in 2014 that focused on how the city might respond to a flu pandemic…

Similarly, state health officials were regularly consulting with the C.D.C. as well as county officials, and studying federal recommendations for mitigation in case of a large outbreak, including basic precautions such as covering one’s face when sneezing or coughing, to more expansive measures such as school closures and cancellation of public events.

“If you prepare correctly, you’ll have less of an issue when a situation develops into something that is more problematic,” Mr. Cuomo said. “The threat you don’t take seriously is the one that becomes serious.” (Q)

“A man in Miami went to the hospital to receive a test for the coronavirus after developing flu-like symptoms, only to receive the news that he didn’t have it — and a $3,270 medical bill, the Miami Herald reports.

Why it matters: The man had just returned from a work trip to China, so took his symptoms more seriously than normal, which is exactly what public health experts want people to do.

Our thought bubble: The episode would be a great parody of the health care system, if it wasn’t real.

The man has a short-term health insurance plan, which usually have skimpy benefits in exchange for lower premiums, and don’t have to cover pre-existing conditions. The Trump administration has expanded them.

The hospital told the Herald that the patient is only on the hook for $1,400 based on his insurance, but his insurer told him that first, he must provide three years of medical records to prove that his flu didn’t relate to pre-existing conditions.

And more bills are probably coming.” (R)

(A)          C.D.C. Confirms First Possible Community Transmission of Coronavirus in U.S., by Roni Caryn Rabin,

(B)          U.S. Soldier Tests Positive for Virus in South Korea,

(C)          Last 48 hours,

(D)          “We are at a turning point”: The coronavirus outbreak is looking more like a pandemic, by Julia Belluz

(E)          Coronavirus: More New Cases Are Now Reported Outside China Than Inside, by Bill CHAPPELL,

(F)          The coronavirus seems unstoppable. What should the world do now?, by Jon Cohen, Kai Kupferschmidt,

(G)         Kudlow breaks with CDC on coronavirus: ‘We have contained this’, by ELI OKUN,

(H)          CDC expects ‘community spread’ of coronavirus, as top official warns disruptions could be ‘severe’, by  MEGAN THIELKING,

(I)           Trump says coronavirus risk to Americans ‘very low,’ puts Pence in charge of gov’t response, by Adam Edelman,

(J)           WHO tells countries to prepare for coronavirus pandemic, but insists it’s too soon to make that call, by HELEN BRANSWELL,

(K)          Could a coronavirus pandemic be stopped? US warns of ‘severe’ disruptions, by John Bacon, Ken Alltucker,

(L)           CDC warns Americans of coronavirus outbreak, by Erika Edwards,

(M)        ‘Not a question of if … but when’: How NJ hospitals are preparing for coronavirus spread, by Lindy Washburn,

(N)         Officials Urge Preparations for Coronavirus in U.S., Noting Global Spread, by DAVID CRUZ,

(O)         Connecticut hospitals say they are ready for the coronavirus, but with no vaccine, ‘inevitable’ challenges lie ahead, by Josh Kovner,

(P)          Lifespan creates emergency task force as coronavirus fears heighten,

(Q)         Coronavirus in New York: $40 Million to Combat Spread, by Jesse McKinley, Luis Ferré-Sadurní and Christina Goldbaum,


(S)          Diagnosis Of Coronavirus Patient In California Was Delayed For Days, by Bill Chappell,

Part 10. CORONAVIRUS. March 2, 2020.Stop Surprise Medical Bills for Coronavirus care. (&) Lessons Learned (or not) In California and Washington State from community acquired cases.

“A man in Miami went to the hospital to receive a test for the coronavirus after developing flu-like symptoms, only to receive the news that he didn’t have it — and a $3,270 medical bill, the Miami Herald reports.

Why it matters: The man had just returned from a work trip to China, so took his symptoms more seriously than normal, which is exactly what public health experts want people to do.

Our thought bubble: The episode would be a great parody of the health care system, if it wasn’t real.

The man has a short-term health insurance plan, which usually have skimpy benefits in exchange for lower premiums, and don’t have to cover pre-existing conditions. The Trump administration has expanded them.

The hospital told the Herald that the patient is only on the hook for $1,400 based on his insurance, but his insurer told him that first, he must provide three years of medical records to prove that his flu didn’t relate to pre-existing conditions.

And more bills are probably coming.”  (A)

“Frank Wucinski and his 3-year-old daughter, Annabel, are among the dozens of Americans the government has flown back to the country from Wuhan, China, and put under quarantine to check for signs of coronavirus.

Now they are among what could become a growing number of families hit with surprise medical bills related to government-mandated actions.

Mr. Wucinski, a Pennsylvania native who has lived in China for years, accepted the U.S. government’s offer to evacuate from Wuhan with Annabel in early February as the new coronavirus spread. His wife, who is not an American citizen and remains in China, developed pneumonia that doctors think resulted from Covid-19, the disease caused by the respiratory virus. Her father, whom she helped care for, was infected and recently died.

The first stop for Mr. Wucinski and Annabel was a two-week quarantine at Marine Corps Station Miramar near San Diego. During that time, they had two mandatory stays in an isolation unit at a nearby children’s hospital. The first started upon arrival in the United States, and the second was a few days later, after an official heard Annabel coughing…

After their release from quarantine, Mr. Wucinski and his daughter went to stay with his mother in Harrisburg, Pa. That’s where they found a pile of medical bills waiting: $3,918 in charges from hospital doctors, radiologists and an ambulance company.

“I assumed it was all being paid for,” Mr. Wucinski said. “We didn’t have a choice. When the bills showed up, it was just a pit in my stomach, like, ‘How do I pay for this?’”

The federal government has the authority to quarantine and isolate patients if officials believe them to be a public health threat. These powers, which date back to cholera outbreaks among ship passengers in the late 19th century, are rarely used. They don’t say anything about who pays when the isolation happens in a nongovernmental medical facility — or when they’re brought there by a private ambulance company…

A Centers for Disease Control and Prevention spokesman declined to comment on whether it would pay the bills of patients kept in mandatory isolation…

“My question is why are we being charged for these stays, if they were mandatory and we had no choice in the matter?” Mr. Wucinski wrote in his message.

…. hen contacted by The New York Times, a Rady Children’s Hospital spokesman said the physicians’ bill had been sent in error and that the family would not be held responsible for the charges.

“We’re in the process of assessing how the error occurred,” the spokesman, Benjamin Metcalf, said. “We are working with government agencies regarding billing for these cases.”

The ambulance company that transported the Wucinskis, American Medical Response, charged the family $2,598 for taking them to the hospital. A company representative declined to comment on the bill “due to patient privacy concerns,” but said the company would look into the case.

An additional $90 in charges came from radiologists who read the patients’ X-ray scans and do not work for the hospital. Having such doctors, who may be outside a patient’s insurance networks, provide services to hospital patients is one of the major causes of surprise medical bills.” (W)

“Health officials in Washington state said on Saturday a coronavirus patient has died, marking the first death in the U.S. from COVID-19, the illness associated with the virus.

The person who died was a man in his 50s who had underlying health conditions, and there was no evidence he contracted the virus through travel, health officials said.

Shortly after announcement of the death, President Donald Trump at a White House press conference said the United States is issuing more travel restrictions and warnings to help prevent spread of the virus. He also said he is meeting with pharmaceutical executives to discuss work toward a coronavirus vaccine.

Washington Gov. Jay Inslee meanwhile declared a state of emergency in response to new cases of COVID-19, directing state agencies to use all resources necessary to prepare for and respond to the outbreak.

“This will allow us to get the resources we need,” Inslee said. “This is a time to take commonsense, proactive measures to ensure the health and safety of those who live in Washington state.”” (B)

“A patient infected with the novel coronavirus in Washington state has died, a state health official said Saturday, marking the first death due to the virus in the United States…

Three new presumptive positive cases were announced in Washington state on Saturday, meaning a test given by a state or local lab came back positive, but has yet to be confirmed by the CDC’s lab in Atlanta.

Among those three cases was the patient who died, health officials said.

The person-to-person cases include several of unknown origin, including:

• A woman in Washington County, Oregon, who is presumptive positive. She is in isolation.

• A high school boy in Snohomish County, Washington, who is presumptive positive. He’s doing well, according to Dr. Chris Spitters, interim health officer for the Snohomish Health District.

• An older woman in Santa Clara County, California, who tested positive.

• A Solano County, California, woman who is in serious condition at UC Davis Medical Center.” (C)

“The U.S. Centers for Disease Control and Prevention and Washington state health officials have launched an investigation into two cases of coronavirus at a nursing home in a suburb of Seattle, the same town where the nation’s first coronavirus fatality occurred.

An outbreak in such a facility is particularly troubling because of the close quarters and the vulnerability of the elderly residents to disease.

A health care worker at the Life Care Center in Kirkland and a female resident in her 70s have tested positive for the disease, state and federal officials revealed in a media call Saturday.

Around 27 of 108 residents and 25 of 180 staff members also have some symptoms of COVID-19, and are being tested, officials said.

Authorities are “very concerned about an outbreak in this setting, where there are many older people,” said county health official Jeff Duchin.” (D)

“Researchers who have examined the genomes of two coronavirus infections in Washington State say the similarities between the cases suggest that the virus may have been spreading in the state for weeks.

Washington had the United States’ first confirmed case of coronavirus, announced by the Centers for Disease Control and Prevention on Jan. 20. Based on an analysis of the virus’s genetic sequence, another case that surfaced in the state and was announced on Friday probably was descended from that first case.

The two people live in the same county, but are not known to have had contact with one another, and the second case occurred well after the first would no longer be expected to be contagious. So the genetic findings suggest that the virus has been spreading through other people in the community for close to six weeks, according to one of the scientists who compared the sequences, Trevor Bedford, an associate professor at the Fred Hutchinson Cancer Research Center and the University of Washington.

Dr. Bedford said it was possible that the two cases could be unrelated, and had been introduced separately into the United States. But he said that was unlikely, however, because in both cases the virus contained a genetic variation that appears to be rare — it was found in only two of the 59 samples whose sequences have been shared from China, where the virus originated.” (E)

“The first suspected U.S. case of a patient getting the new coronavirus through “community spread” — with no history of travel to affected areas or exposure to someone known to have the COVID-19 illness — was left undiagnosed for days because a request for testing wasn’t initially granted, according to officials at UC Davis Medical Center in Sacramento, Calif.

The patient in Northern California is now the 60th confirmed case of the coronavirus in the United States. The Centers for Disease Control and Prevention disclosed the latest case Wednesday evening, as President Trump assigned Vice President Pence to lead the administration’s response to the disease.

“This case was detected through the U.S. public health system — picked up by astute clinicians,” the CDC said in a brief statement about the new patient.

UC Davis included more details about the case in its own statement, drawing on an email sent to staff at its medical center. It said the officials initially ruled out a test for the coronavirus because the patient’s case didn’t match the CDC’s criteria.

The new patient, who lives in Solano County and has not been identified, was transferred to UC Davis Medical in Sacramento County from another hospital this month. Staff at UC Davis then suspected the patient might be infected with the coronavirus that has caused more than 2,800 deaths.

“Upon admission, our team asked public health officials if this case could be COVID-19,” the hospital said. “We requested COVID-19 testing by the CDC, since neither Sacramento County nor CDPH [California Department of Public Health] is doing testing for coronavirus at this time. Since the patient did not fit the existing CDC criteria for COVID-19, a test was not immediately administered. UC Davis Health does not control the testing process.”

Health and Human Services Secretary Alex Azar said Thursday morning that the CDC is streamlining the process it uses to test for the coronavirus across the country, saying it will spread the new process to all of its labs.

Azar said all of the CDC’s network of nearly 100 public labs will soon be using the modified process. The next step, he said, is to develop a “bedside diagnostic” that doctors and hospitals could use. He did not give details about when that might occur.” (F)

“About 124 health care workers — including at least 36 nurses — are under self-quarantine after possible exposure to the coronavirus patient admitted to UC Davis Medical Center last week, a nurse union said.

“Despite University of California medical facilities being generally better prepared and equipped to treat challenging medical cases, the recent UC Davis Medical Center COVID-19 case highlights the vulnerability of the nation’s hospitals to this virus and the insufficiency of current Centers for Disease Control guidelines,” the National Nurses United said in a news release Friday.

“We know that we can be successful in getting all our hospitals prepared to control the spread of this virus. We are committed to working with hospitals and state and federal agencies to be ready,” Bonnie Castillo, the union’s executive director, said in a statement. “But nurses and health care workers need optimal staffing, equipment, and supplies to do so.”

The patient was transferred to UC Davis on February 19 from a Northern California hospital. Officials from both hospitals said the patient wasn’t initially tested for the virus because she didn’t meet the existing CDC criteria.

The patient didn’t have any relevant travel history or exposure to another known patient, said Dr. Sara Cody, director of the county’s public health department.

Confirmation that the Solano County woman had contracted the virus came Sunday, after UC Davis doctors insisted on testing.

Since then, CDC officials say they’ve updated their testing guidelines.

“As soon as that case was recognized, we met and we revised our case definition for persons under investigation,” CDC Director Dr. Robert Redfield said earlier this week. “Today, that has been posted (to the CDC website) along with a new health advisory that the recommendation should be when a clinician or individual suspects coronavirus, then we should be able to get a test for coronavirus.”” (G)

“Sacramento County’s top health official says he expects a few of the UC Medical Center employees exposed to the coronavirus last week to test positive themselves in the coming days.

That’s not as alarming as it may sound, Peter Beilenson, county health services director, said on Friday. Those employees, if infected, stand a good likelihood that they will not become sick or will only be mildly ill, and may not need to be treated.

“I expect there will be a few positives, probably asymptomatic,” Beilenson said. He said he bases that prediction on early data indicating 80 percent of people infected by the new virus have mild symptoms or none at all…

“I think there will be more cases. That is not a horrible thing,” he said. “Once the disease gets into the population, with so many mild symptoms, common cold-like symptoms, people will be spreading it unbeknownst to them. It gets it to be more a common variety.”

In total, more than 100 employees of three Northern California hospitals are believed to have been exposed. In addition to those at the Vacaville hospital and UC Davis Medical Center, another three employees recently were sent home from Kaiser Permanente-South in Sacramento after potential exposure to the virus, according to Rep. John Garamendi…

“The best guess is that there are people who are not showing symptoms, but, are, nevertheless, infected. That’s a very normal way for diseases to spread,” Matyas said. “To public health officials, this is what disease does. The issue is that it’s not alarming, but we have to move to the next phase.”

That not only means testing and screening, but also being more rigorous at the hospital level, as Matyas said, to “universally assume the possibility” that a patient seeking care and has flu- or cold-like symptoms may carry the virus.

The mystery patient at UC Davis Medical Center has been the center of national attention and politicized debate since officials at the center announced on Wednesday that they had what was believed to be the first coronavirus patient in the U.S. with no known provenance for the illness.” (H)

California Gov. Gavin Newsom said Thursday that 33 people have tested positive for COVID-19 and the state is currently monitoring at least 8,400 others —a day after U.S. health officials confirmed the first possible community transmission of the coronavirus in a Solano County resident.

“This is a fluid situation right now and I want to emphaize the risk to the American public remains low,” said Dr. Sonia Y. Angell, California Department of Public Health Director and State Health Officer during a press conference. “There have been a limited number of confirmed cases to date.”..

“We are currently in deep partnership with CDC on one overriding protocol that drives our principle focus right now and that’s testing, and the importance to increase our testing protocols and to have point of contact diagnostic testing as our top priority not just in the state of California but I imagine all across the United States,” Newsom said at a press conference.

Newsom said five of the 33 patients who tested positive for the virus have since left the state. It wasn’t immediately clear whether the 33 positive cases were part of the group of Diamond Princess passengers who were evacuated from the cruise ship that was quarantined off the coast of Japan. The U.S. had 60 cases as of Wednesday night, 42 of which are people who were on the ship, according to the CDC.

California health officials have 200 testing kits on hand and will be receiving more over the next few days, Newsom said.

“We have just a few hundred testing kits and that’s surveillance testing as well as diagnostic testing. That’s simply inadequate to do justice to the kind of testing that is required to address this issue head on,” he said.

Newsom said that the CDC has made “firm commitments” to improve the state’s testing capacity, but did not provide details, such as how many testing kits the agency has agreed to send to the state.” (I)

“It was the nation’s first infection that had unknown origins. The director of California’s Public Health Department last week called her case a “turning point” that could signal widespread infection is increasingly difficult to stop.

The woman’s case unleashed a deluge of questions and concerns about how local, state and federal officials responded to the mounting public health concern after the evacuees arrived at Travis Air Force Base — and what future responses might look like. A U.S. government whistleblower now says federal workers did not have the necessary protective gear or training when they were deployed to help quarantined people, including those at Travis.

Since the Solano County woman’s illness became known, teams of health care investigators have fanned out across Northern California trying to understand exactly how — and how widely — the virus has spread.

“We have deployed there,” Secretary of Health and Human Services Alex Azar told McClatchy this week. “We’ll send whatever we need to assist the state and local public health authorities with the contact tracing and getting to the bottom of her case.”” (J)

“For weeks, public health experts have been watching to see whether factory shutdowns and shipping problems in China caused by the coronavirus epidemic will cause drug shortages in the United States.

Late Thursday, the Food and Drug Administration issued a statement noting that one drug is now in short supply because of problems related to the coronavirus outbreak. But it refused to disclose the name of the drug and its manufacturer — as well as where the product or its ingredients were made — saying that it could not reveal “confidential commercial information.”

The agency’s vague announcement angered public health advocates and those who track drug shortages, who said the lack of information would only create more confusion as the virus has spread around the globe to at least 56 countries from the original epidemic in China.

The F.D.A. has long been criticized by public interest groups for refusing to reveal company information that could affect public safety. Federal law protects companies from having trade secrets and confidential proprietary information disclosed, which the agency has cited to withhold details, like naming countries where raw ingredients come from….”

The F.D.A. has said it is closely monitoring about 20 products where the manufacturers rely solely on China for their finished products or active pharmaceutical ingredients. Dr. Hahn said Thursday that the drugs being monitored are considered “noncritical drugs.”

Hospitals have struggled for years with shortages of hundreds of critical drugs, many of them staples of medical care that have been on the market for decades. In 2017, Hurricane Maria damaged many pharmaceutical factories in Puerto Rico, closing them for weeks and leading to supply problems, including a shortage of saline bags made by Baxter. Problems with manufacturing quality have caused other shortages, including a global shortfall of valsartan, a widely used blood pressure drug.

Erin Fox, a drug shortage expert at the University of Utah, said, “When the F.D.A. tells the American public that there is a shortage without disclosing the specific drug, this only creates fear and panic, which is unacceptable in the current situation.”

The F.D.A. frequently cites companies’ proprietary reasons for why it does not disclose certain information, including the names of specific drugs when companies are cited for manufacturing problems, or details about clinical trials, Dr. Carome said. “Those are examples where I think it’s an overuse,” he said.” (K)

“The surgeon general on Saturday urged the public to stop buying masks, warning that it won’t help against the spread of the coronavirus but will take away important resources from health care professionals.

“Seriously people — STOP BUYING MASKS!” the surgeon general, Jerome M. Adams, said in a tweet on Saturday morning. “They are NOT effective in preventing general public from catching #Coronavirus, but if health care providers can’t get them to care for sick patients, it puts them and our communities at risk!”

The plea comes as panicked consumers rush to buy masks online, including so-called N95s, a surge that has led to price gouging and counterfeit products.

In another tweet, Mr. Adams said the best way to protect against the virus is to wash hands regularly, and for those who are feeling ill to stay home.

Health officials around the world have been imploring the public to stop buying masks if they are healthy or not caring for someone who is ill. Medical professionals need a large supply of the masks because they are in direct contact with infected patients and must change their masks repeatedly.

“There are severe strains on protective equipment around the world,” said Dr. Michael J. Ryan, executive director of the health emergency program at the World Health Organization, during a briefing on Friday. “Our primary concern is to ensure that our front line health workers are protected and that they have the equipment they need to do their jobs.”

Dr. Ryan said masks primarily prevent a person from giving the disease to someone else.

“There are limits to how a mask can protect you from being infected,” he said. “The most important thing everyone can do is wash your hands, keep your hands away from your face and observe very precise hygiene.”

The W.H.O.’s guidelines recommend that health workers use surgical masks to cover their mouths and noses but the Centers for Disease Control and Prevention has instructed them to wear masks known as N95s, which are thicker, fit more tightly around the mouth and nose, and block out much smaller particles than surgical masks do.

Both masks help prevent the spread of droplets from a person’s cough or sneeze, but medical specialists have said that for average members of the public, they are generally not effective.

A person is more likely to get infected by touching contaminated surfaces than from a droplet traveling through the air.

Air can also get in around the edges of the masks, particularly flat surgical masks. Health care workers who wear N95 masks as part of their jobs are required to undergo a fit test at least once a year to ensure that there are no gaps around their mouths.

Most people are unlikely to know how to wear these masks and could accidentally contaminate themselves if they touch the outside of the mask when they remove it and then touch their face.

“Not having a mask does not necessarily put you at any increased risk of contracting this disease,” Dr. Ryan said…

Robert Redfield, director of the Centers for Disease Control and Prevention, told the House Foreign Affairs Committee on Thursday that it was critical that masks remain available for doctors and nurses who were caring for those affected by the virus and for people tending to loved ones with the illness.

“There is no role for these masks in the community,” he said. “These masks need to be prioritized for health care professionals that as part of their job are taking care of individuals.”” (L)

It has been nearly three months since the first cases of a new coronavirus pneumonia appeared in Wuhan, China, and it is now a global outbreak. And yet, despite over 80,000 infections worldwide (most of them in China), the world still doesn’t have a clear picture of some of the most basic information about this outbreak…

In recent days the W.H.O. has complained that China has not been sharing data on infections in health care workers. Earlier this month, the editors of the journal Nature called on researchers to “ensure that their work on this outbreak is shared rapidly and openly.”..

Lest Americans feel that it could never happen here, Dr. Lipkin points out that it took many months for health officials in the United States to acknowledge and recognize H.I.V. as a new virus, despite the fact that gay men were turning up at alarming rates with unusual pneumonias and skin cancers.

Scientific competition has also slowed reaction and response, experts fear — leading to the extraordinary editors’ plea in Nature. For a young researcher, a paper in Nature or the New England Journal of Medicine is gold in career currency. Scientific prestige may encourage perfecting data for peer review, but preparedness requires rapid dissemination of information.

While federal officials in the United States warn Americans to be ready for the virus, there are some important aspects of its spread about which we have little information — even though they have likely already been studied by scientists and officials, in China, in Japan and elsewhere. Scientists in various countries are presumably gathering large amounts of data day by day and the world deserves to see more of it.

“Were there patterns around infections, places, procedures? Maybe that is being collected and readied for the medical literature. But it would be hugely important to know,” said Dr. Tom Inglesby, director of the Center for Health Security of the Johns Hopkins Bloomberg School of Public Health, which studies epidemics.

For example: Of the more than 1,700 health workers who were infected in China, did those infections occur before they knew to wear protective equipment? Were they doing procedures that might lead to exposure? Those answers would quell fears about how the virus spreads and how to protect front line workers.

Likewise, there were hundreds of people who tested positive aboard the Diamond Princess cruise ship and were transferred to the hospital. But there has been little public information released about what shape they were in. How many in the cohort were really sick, how many just had minor symptoms and how many just needed isolation? Does the pattern of infection suggest a role for transmission via plumbing on the ship?” (M)

“The federal government is “ramping up testing” in the United States for the coronavirus and is looking to vastly increase its screening efforts as global cases of the virus continue to rise, said Health and Human Services Secretary Alex Azar on Sunday.

Azar and Vice President Mike Pence made the rounds of the Sunday morning political talk shows looking to assure the public that risk to most Americans remains low despite the inevitability of more cases arising in the near future.

“I think it’s very important that we treat the American people like adults and explain to them that we don’t know where this will go, that we will see more cases, that we will see continued community spreading in the United States, as we’re seeing around the world,” Azar said during an appearance on ABC’s “This Week.” “How big that gets, we do not know. But we have the most advanced public health system and surveillance system in the world. We are actively working on a vaccine. We are actively working on therapeutics. The diagnostic is out in the field, and we’re going to work to protect the American people with every tool that we’ve got.”..

Pence, appearing on NBC’s “Meet the Press” said “there’s no question” there will be more cases of the virus formally known as COVID-19, but said the risk “remains low” to Americans.

“We’re going to bring the best scientific minds, experts together … we’re going to work every day … to contain this disease, to treat those that are contracted, and I’m very confident we’re ready, and I know … that we’ll get through this,” said Pence who was tapped by Trump to lead the federal government’s response to the disease.

Pence told “Meet the Press” host Chuck Todd that the administration would “respect any decisions that are made at the state and local level” to address the virus. Gov. Andrew M. Cuomo on Saturday announced that New York had received approval by federal health officials to begin its testing, the approval coming after the governor pressed Pence to fast track the decision.” (N)

“The Trump administration may use a 70-year-old law to speed up the manufacturing of medical supplies before a coronavirus outbreak, Alex M. Azar II, the health secretary, said on Friday, a seeming acknowledgment that the virus poses a threat beyond the reassurances of President Trump.

The Defense Production Act, passed by Congress in 1950 during the Korean War, allows the president to expand production of the materials for national security purposes. Mr. Azar said that the federal government could move to expedite certain contracts, including for supplies like face masks, gowns and gloves. Mr. Azar has said that 300 million of a type of mask known as N95 are needed for the emergency medical stockpile for health care workers.

“I don’t have any procurements I need it for now, but if I need it, we’ll use it,” Mr. Azar told reporters at a White House briefing on the administration’s request to Congress for emergency funds to respond to the virus…

Mr. Azar said that “the situation may worsen, and we may need to mitigate its spread in the United States.” If cases of the coronavirus began spreading widely, he said, those showing mild symptoms should stay home rather than seek help at hospitals, to avoid the risk of overcrowding health facilities.

“The advice is going to be: Stay home, manage your symptoms, and we’ll provide guidance of at what point would you seek high-level medical attention,” Mr. Azar said.

Mr. Azar’s remarks appeared to reflect a recognition that the outbreak may reach a newer and more dangerous phase. In addition to his comments about the government stockpiling protective equipment and about how people should seek medical care in the case of a wider outbreak, he also raised the possibility of school closures.

“It might make sense to close a school or certain schools or take other measures like that,” Mr. Azar said. “Every option needs to be on the table as we assess the situation, but it depends on the circumstances.”” (O)

“Hospitals and public health officials on the leading edge of the U.S. mitigation strategy have been getting ready for weeks…

At the sprawling NYU Langone Health system in New York, which has nearly 1,700 inpatient beds at six facilities, doctors are working to prevent patients from swamping hospitals with minor respiratory complaints and crowding out patients who may need more intensive care.

They are ramping up messaging that tells people how to arrange online appointments with providers and other alternatives, said Michael S. Phillips, chief hospital epidemiologist for the system…

NYU is already working to conserve “personal protective equipment” — full-body “moon suits,” masks, face shields and other gear — for a shortage that Phillips considers inevitable. Many masks used in U.S. hospitals come from Hubei province in China, where the outbreak began. And when production in China resumes, equipment surely will be reserved for use in that country, he said. About 65 percent of N95 respirators are manufactured outside the continental United States, in China and Mexico, according to HHS data.

NYU is urging health care personnel to re-use moon suits now to help preserve inventory for later. That is appropriate, for example, in treating patients with tuberculosis, he said. Face masks can be used again by the same person, especially after practice sessions, he said.

“We are really looking carefully at how we’re utilizing

[protective equipment]

, and I think every hospital in the United States is girding for these kind of shortages,” Phillips said.

While some hospitals have as many as 14 weeks worth of masks on hand, the overall situation is grim. India, Taiwan and Thailand also have halted or limited exports as they brace for spikes in demand in their own countries.

Anticipating a surge in need, California’s state officials have ordered 300,000 masks to distribute to hospitals and clinics on an emergency basis, hoping to add to the 20,000 currently in state stockpiles. Officials would not say where they hope to find that many masks.

Health care systems nationally have about two weeks of supply left on hand, said Soumi Saha, senior director of advocacy at Premier Inc., a large group purchasing organization that serves 4,000 hospitals.

Normally, an average of 2 million masks per month are used in the United States, Premier said. That rises to 4 million per month during a typical flu season.

Two domestic manufacturers that use raw material from the United States — 3M and Prestige Ameritech — are ramping up production but are not expected to be able to satisfy demand of 4­ million masks a month until April, Saha said.

“I don’t think hospitals can sort of buy their way out of this problem. It is not a bidding war for N95s,” said Amy Ray, director of infection prevention for the MetroHealth System in Cleveland. “The supply is the supply, and prudence is necessary to preserve the stock that we have.’’” (P)

“The World Health Organization on Friday raised its assessment of the global coronavirus risk from “high” to “very high,” the most serious assessment in its new four-stage alert system.

“This is a reality check for every government on the planet,” said Dr. Michael J. Ryan, deputy director of W.H.O.’s health emergency program. “Wake up. Get ready. This virus may be on its way.”

The assessment addresses the risks of both uncontrolled spread of the virus and the resulting impacts.

United States health officials have given similarly alarming assessments, though President Trump has played down the threat.

The W.H.O. does not officially use the word “pandemic,” often defined as the worldwide spread of a new disease, but many health experts say the coronavirus epidemic is one, or soon will be.” (Q)

“President Trump complained on Friday that Democrats and the news media were trying to scare Americans about the coronavirus to score political points against him but asserted that the outbreak had been relatively limited because of his action to stem infections…

Mr. Trump spoke hours after Mick Mulvaney, the acting White House chief of staff, likewise blamed the news media for exaggerating the seriousness of coronavirus because “they think this will bring down the president, that’s what this is all about.”..

Mr. Mulvaney said the administration took “extraordinary steps four or five weeks ago,” to prevent the spread of the virus when it declared a rare public health emergency and barred entry by most foreign citizens who had recently visited China.

“Why didn’t you hear about it?” Mr. Mulvaney said of travel restrictions that were widely covered in the news media. “What was still going on four or five weeks ago? Impeachment, that’s all the press wanted to talk about.”

The news media has been covering the global spread of coronavirus for months.

But Mr. Mulvaney claimed that the news media was too preoccupied covering impeachment, he said, “because they thought it would bring down the president.”

The media’s focus switched to the coronavirus for the same reason, he continued.

“The reason you’re seeing so much attention to it today is that they think this is going to be the thing that brings down the president,” he added. “That’s what this is all about it.”

Following the president’s lead, Mr. Mulvaney also brushed off concerns over the virus; there have been 60 cases identified in the United States.

“The flu kills people,” he said. “This is not Ebola. It’s not SARS, it’s not MERS. It’s not a death sentence, it’s not the same as the Ebola crisis.” (R)

“If the next few weeks or months bring calm — and scientists increasingly worry that they will not — the world would do well to remember this time what it seems to have forgotten again and again. Another pathogen will emerge soon enough, and another after that. Eventually, one of them will be far worse than all its predecessors. If we are very unlucky, it could be worse than anything in living memory. Imagine something as contagious as measles (which any given infected person passes to 90 percent of the people he or she encounters) only many times more deadly, and you’ll have a good sense of what keeps global health officials up at night.

Here’s what is certain: Despite many warnings over many years, we are still not ready. Not in China, where nearly two decades after that SARS outbreak food markets that sell live animals still thrive and authoritarianism still undermines honest and accurate communication about infectious diseases. Not in Africa, where basic public health capacity remains hobbled by a lack of investment and, in some cases, by political unrest and violence. Not in the United States, where shortsighted budget cuts and growing nationalism have shrunk commitments to pandemic preparedness, both at home and abroad.

To be sure, some broad progress has been made in the past few years. Vaccine development and deployment now proceed faster than at any point in history. The World Health Organization has corrected many of the institutional shortcomings that thwarted its responses to previous outbreaks. Other countries, in both Europe and Africa, have stepped up to fill the global health leadership position that America appears to have vacated.”

But, as Covid-19 makes clear, much more is still needed.” (S)

“Today, as the country faces the possibility of a widespread outbreak of a new respiratory infection caused by the coronavirus, there are nowhere near that many ventilators, and most are already in use. Only about 62,000 full-featured ventilators were in hospitals across the country, a 2010 study found. More than 10,000 others are stored in the Strategic National Stockpile, a federal cache of supplies and medicines held in case of emergencies, according to Dr. Thomas R. Frieden, a former director of the Centers for Disease Control and Prevention.

Tens of thousands of other respiratory devices could be repurposed in an emergency, experts say, but the shortfall could be stark, potentially forcing doctors to make excruciating life-or-death decisions about who would get such help should hospitals become flooded with the desperately sick…

Across the country, educators, businesses and local officials are beginning to confront the logistics of enduring a possible pandemic: school closings that could force millions of children to remain at home, emergency plans that would require employees to work remotely, communities scrambling to build up supplies.

In plausible worst-case-scenarios given the pattern of the outbreak thus far, the country could experience acute shortages not just in ventilators but also health workers to operate them and care for patients; hospital beds; and masks and other protective equipment.

“Even during mild flu pandemics, most of our I.C.U.s are filled to the brim with severely ill patients on mechanical ventilation,” said Dr. Eric Toner, a senior scholar at the Johns Hopkins Center for Health Security and an expert on health care preparedness. “I hope and pray Covid-19 turns out to be a moderate pandemic, but if not, we’re in serious trouble,” he said, referring to the name given the disease caused by the virus.

Resources are concentrated in the most populous and wealthiest cities, leaving rural areas and other neglected communities exposed to greater risk. And public health experts worry that efforts to contain an outbreak could be hamstrung by budget cuts that have weakened state health departments.

In an extreme situation, some hospitals’ plans include provisions for rationing, even removing some patients from ventilators without requiring their consent to make way for others presumed to have a better chance of survival. Some plans would also limit the access of certain categories of patients from critical care or even hospitalization during a peak pandemic based on criteria such as their age or an underlying chronic disease.

The concept of imposing such measures makes physicians dedicated to saving every life uncomfortable, and there is evidence that many people who could be removed from life support or refused care under such protocols would otherwise survive.” (T)

“Leading health experts from around the world have been meeting at the World Health Organization’s Geneva headquarters to assess the current level of knowledge about the new COVID-19 disease, identify gaps and work together to accelerate and fund priority research needed to help stop this outbreak and prepare for any future outbreaks…

The meeting, hosted in collaboration with GloPID-R (the Global Research Collaboration for Infectious Disease Preparedness) brought together major research funders and over 300 scientists and researchers from a large variety of disciplines. They discussed all aspects of the outbreak and ways to control it including:

the natural history of the virus, its transmission and diagnosis;

animal and environmental research on the origin of the virus, including management measures at the human-animal interface;

epidemiological studies;

clinical characterization and management of disease caused by the virus;

infection prevention and control, including best ways to protect health care workers;

research and development for candidate therapeutics and vaccines;

ethical considerations for research;

and integration of social sciences into the outbreak response. (U)

“The first confirmed case of novel coronavirus in New York State — a woman in her 30s who recently traveled to Iran — was announced Sunday night by Governor Cuomo.

“There is no reason for undue anxiety — the general risk remains low in New York,” Cuomo said in a statement. “We are diligently managing this situation and will continue to provide information as it becomes available.”

Cuomo said the woman who contracted the virus is currently isolated in her home.

“The patient has respiratory symptoms, but is not in serious condition and has been in a controlled situation since arriving to New York,” Cuomo said. “This was expected. As I said from the beginning, it was a matter of when, not if there would be a positive case of novel coronavirus in New York.” (V)

(A)          How a coronavirus scare can lead to surprise medical bills, by Caitlin Owens,,

(B)          First coronavirus death in the U.S. happens in Washington state, by Nicole Acevedo and Minyvonne Burke,

(C)          First death from coronavirus in the United States confirmed in Washington state, by Dakin Andone, Jamie Gumbrecht and Michael Nedelman,

(D)          Washington State Probing Troubling Coronavirus Outbreak In Nursing Home, by Mary Papenfuss,

(E)          Coronavirus May Have Spread in U.S. for Weeks, Gene Sequencing Suggests, by Sheri Fink and Mike Baker,

(F)          Diagnosis Of Coronavirus Patient In California Was Delayed For Days, by BILL CHAPPELL,

(G)         More than 120 UC Davis health care staff in self-quarantine after possible exposure to coronavirus, by Christina Maxouris and Alexandra Meeks,

(H)          Expect more Sacramento coronavirus cases in the next few days, county health chief warns, by TONY BIZJAK AND DARRELL SMITH,

(I)           California is monitoring at least 8,400 people for the coronavirus, by Berkeley Lovelace Jr.,

(J)           Coronavirus evacuees passed through California military base. Did safety plan break down?, by JASON POHL, FRANCESCA CHAMBERS, DARRELL SMITH, AND CATHIE ANDERSON,

(K)          First Drug Shortage Caused by Coronavirus, F.D.A. Says. But It Won’t Disclose What Drug or Where It’s Made, by Katie Thomas,

(L)           Surgeon General Urges the Public to Stop Buying Face Masks, by Maria Cramer and Knvul Sheikh,

(M)        We Don’t Really Know How Many People Have Coronavirus, by Elisabeth Rosenthal,

(N)         Testing for coronavirus to vastly increase, federal officials say, by Laura Figueroa Hernandez,

(O)         Government Eyes War Powers to Speed Medical Manufacturing Ahead of Virus, by Noah Weiland and Emily Cochrane,

(P)          Shortages, confusion and poor communication complicate coronavirus preparations, by Lena H. Sun, Christopher Rowland and Lenny Bernstein,

(Q)         The World Health Organization on Friday raised its assessment of the global coronavirus risk from “high” to “very high,” the most serious assessment in its new four-stage alert system.

(R)          “The flu kills people,” Mick Mulvaney, the acting White House chief of staff, said. “This is not Ebola.”, by Annie Karni,

(S)          Here Comes the Coronavirus Pandemic,

(T)          How Prepared Is the U.S. for a Coronavirus Outbreak?,

(U)         World experts and funders set priorities for COVID-19 research,

(V)          Officials: First confirmed case of novel coronavirus in New York State, by  David M. Schwartz and Lisa L. Colangelo,

(W)        Kept at the Hospital on Coronavirus Fears, Now Facing Large Medical Bills, by Sarah Kliff,



PART 11. CORONAVIRUS. March 5, 2020. “Gov. Andrew Cuomo… would require employers to pay workers and protect their jobs if they are quarantined because of the coronavirus.”

“This epidemic is a wake-up call for companies to carefully review the strategies, policies, and procedures they have in place to protect employees, customers, and operations in this and future epidemics. Here are eight questions that companies should ask as they prepare for — and respond to — the spread of the virus.

1. How can we best protect our employees from exposure in the workplace?

2. When should we exclude workers or visitors from the workspace?

3. Should we revise our benefits policies in cases where employees are barred from the worksite or we close it?

4. Have we maximized employees’ ability to work remotely?

5. Do we have reliable systems for real-time public health communication with employees?

6. Should we revise our policies around international and domestic business travel?

7. Should we postpone or cancel scheduled conferences or meetings?

8. Are supervisors adequately trained?

Diligent planning for global health emergencies can help protect employees, customers, and the business.  But plans are only as good as their execution. Companies should use the current situation to optimize and battle-test their plans. Whether or not Covid-19 becomes a full-blown pandemic, these capabilities will prove invaluable as the emergence of a global pandemic, caused by this coronavirus or another agent in the future, is not a matter of “if” but “when.” “(A)

“Some companies have already taken precautions like limiting travel to affected countries or big international conferences. Others have asked employees to stay home because they visited a country with a more serious outbreak.

But with new unexplained cases being reported in the United States — and the first domestic death from the illness reported on Saturday — a growing number of American workers could soon be asked to alter their routines, or just stay home.

Exactly how that affects you will depend on many factors, including the generosity of your employer’s benefits and where you live. Here’s what labor lawyers and business groups say could potentially unfold in your workplace — and what rights workers have.

The situation is ever-evolving as the virus continues to spread — and policies are being revised daily as employers monitor public health notices.

Nobody wants employees to come to work if they are sick or have been exposed to the virus, but U.S. workers are less likely to be covered by a paid sick leave policy than those in other developed countries.

“This can put hourly workers in a bind, and make employees in the U.S. more likely to show up for work when they are sick,” said Joseph Deng, who specializes in employment and compensation law at Baker & McKenzie in Los Angeles.

The Centers for Disease Control and Prevention has recommended that employers establish “nonpunitive” policies, encouraging employees who are sick or exhibiting symptoms to stay at home.

“We may see companies develop more flexible and generous sick leave policies,” Mr. Deng said. That could reduce the hard choices that employees have to make…

What can my employer ask me to do?

Will I be paid if I’m told to stay home?

What happens if I or a family member get sick?

What are my rights if I’m worried about going to work?

Can my employer ask me to wear a mask?

Will my employer tell me if a colleague is infected?” (B)

“Amber Clayton, who directs the Society for Human Resource Management’s Knowledge Center, which fields calls from HR professionals seeking guidance, said many employers have business continuity plans in place for atypical situations, and some even have infectious disease management plans, but still it has been getting questions from companies, some about employees coming back from China: “Do they have to come back into the office right away? Can we require them to stay at home?”..

Even though technology can help facilitate some workplace decisions, Clayton said employers can find themselves in “unknown territory” with labor law implications, especially if the coronavirus outbreak in the U.S. gets much worse and forces more widespread business impacts…

The issues are more complicated for workers who are not on salary, and whose employers do not offer paid time off for leave, since often these hourly-wage employees have no legal protection for any nonworking hours, based on the Fair Labor Standards Act, which in other cases does protect them, such as in cases of overtime-pay claims.

Clayton said firms should consider paying employees for time they will be out, even if not covered by medical-leave laws or other company policies, but without a legal requirement this could hit hourly workers hard in sectors where there is no remote work option, such as restaurants and hospitality; or furloughed factory workers without specific protections in an existing collective-bargaining agreement…

“The idea that if you’re not coming in, staying home sick, that you will not get put on the next big project or not get the next promotion, this is the time to combat that … to change the norms,” he said. “At the majority of companies, that is still not the case. Employees are still worried in normal flu season about this, even though it saves a company money when people stay at home, and in this environment it’s a whole different ball game.”

SHRM’s Clayton said she is less sure about permanent changes to workplace culture resulting from the current outbreak, but she said that, in the least, for companies that don’t have business continuity plans and infectious disease management plans in place, it is time to implement them.” (C)

“The authorities confirmed on Tuesday a second case of coronavirus in New York, a man in his 50s who lives in Westchester County, just outside New York City, touching off an intense search by health investigators across the region to determine whether he had infected others.

The inquiry stretched from a hospital in Bronxville, N.Y., to a nearby high school, to both a law office and a college campus in Manhattan. The effort provided one of the first glimpses in New York of the kind of comprehensive efforts that health officials in countries across the world have mounted to stem to spread of the coronavirus.

New York health officials were tracking down doctors and nurses who treated the man in a hospital for days before he was confirmed to have the illness — and placing some in quarantine. And they were growing concerned that his son, a college student who officials believe lives in university housing, might be showing symptoms of the illness, too, raising fears of further transmission.

“I think we have to assume this contagion will grow,” George Latimer, the Westchester County executive, said at a news conference on Tuesday.

The man became ill on Feb. 22 and was admitted to a hospital in Westchester on Feb. 27., according to Dr. Demetre C. Daskalakis, the deputy commissioner for disease control at New York City’s Department of Health and Mental Hygiene. Officials acknowledged that the patient might have exposed doctors, nurses and others to the illness.

“We believe that a couple of the medical professionals have been quarantined,” Mr. Latimer said, adding that state health officials were examining “what exposure might exist” to the staff at that medical facility, the NewYork-Presbyterian Lawrence Hospital in Bronxville.

The patient has since been transferred to a Manhattan hospital. He is a lawyer who lives in New Rochelle, N.Y., and works in Manhattan.

Two of the man’s children have links to New York City. One child attends a Jewish high school in the Bronx’s Riverdale neighborhood, and the school was closed on Tuesday as a precaution. The other, the college student, attends Yeshiva University but had not been on campus since Feb. 27, according to a statement released by the school. Additionally, the statement said, a student at the university’s law school was in self-quarantine after having contact with the law firm where the Westchester man works.

City officials said the stricken man’s son, the Yeshiva student, exhibited light symptoms that could be the coronavirus, or perhaps nothing at all.

The city’s disease detectives were trying to recreate the son’s movements to learn whom he had close contact with. They have also been in touch with the small Midtown law firm where the Westchester man works and they have spoken with the man’s close colleagues to evaluate their level of exposure, officials said.”  (D)

“New Jersey has yet to see any cases and state officials insist the public health system is ready to respond, but it is now a question of when — not if — coronavirus will be discovered in the Garden State…

 “My Administration is actively engaged in a multi-level, whole-of-government approach — from our hospitals, to our schools, to our ports — to implement a preparedness and response plan for the potential spread of the coronavirus in New Jersey,” Murphy said. “Together, we are prepared to respond properly and swiftly to any future individuals who meet the (CDC) guidelines for coronavirus testing.”

The DOH has also launched a webpage with a host of resources for communities, businesses and schools. Persichilli said she is working with other government officials, local health departments and hospital leaders to ensure they are planning properly for a potential outbreak.

“As you know, hospitals are on the front line of this response,” Persichilli said. “We are actively working with the (New Jersey Hospital Association) and hospitals directly to ensure they have sufficient plans in place to prepare for and respond to a surge in ill patients or a (medical goods) supply chain disruption.”

The CDC also issued new guidance for hospitals designed to help them maintain proper stocks of medical supplies, including very limited re-use of certain respirators used by clinical staff. NJHA president and CEO Cathy Bennett, who previously served as state health commissioner, said this input allows facilities to help plan how best to protect staff and patients.

“The updated testing criteria can be helpful in improving disease surveillance,” Bennett added. “The more insight the better in honing our preparations and response.”

State Department of Education Commissioner Lamont O. Repollet, who joined Murphy’s briefing, said his department has been working to update school districts on the outbreak and urged local leaders to remain in contact with county school officials, who are serving as a conduit to the state. He reminded districts they should already have in place a policy for home instruction, consider rescheduling group events, and properly report any communicable diseases identified at school.

Repollet also reminded school officials not to allow concern about coronavirus to evolve into fear, stigma or racism against individuals of Chinese or other Asian descent. “Let’s make sure we are better than that. Stigma hurts everyone. Bullying and harassment hurt everyone,” he said.” (E)

“As confirmed cases of the COVID-19 coronavirus spread in the U.S. this week, school leaders nationwide are preparing for their worst-case scenario emergency plans. Some are already shutting down schools or considering online learning if the health threat persists.

And some are simply saying: Wash your hands.

So, who’s right? Perhaps everyone.

District leaders are right to emphasize hand washing, staying home if you’re sick and covering your cough with a sleeve or tissue, school and health leaders said. But they should also disclose their emergency plans to parents about what will happen if the virus becomes more widespread – even if it unnerves families, leaders said this week…

So far, the response from schools and health officials has varied depending on whether a locality has confirmed cases – and experts’ views on how much action is appropriate is rapidly evolving. But the uncertainty of how far the virus will spread has put school leaders in a difficult spot of projecting a sense of calm while also acting with an abundance of caution for student safety…

The Centers for Disease Control and Prevention late last week offered different guidance to schools and daycare centers depending on whether they have a locally identified case of COVID-19.

For institutions that don’t have a confirmed case, the CDC said schools should review and update their emergency plans, emphasize hand-washing, communicate with local health departments and review attendance policies – including dropping rewards for perfect attendance.

For institutions located in areas with COVID-19 cases, the CDC recommends schools  talk with their local health officials before canceling classes. Together, they can determine how long schools should be closed. And schools can also determine options for distance or online learning so kids don’t fall behind…

In the event of a school closure, he said, “there’s also a huge cost to not doing anything.”” (F)

“As state and local public health offices scramble to respond to the coronavirus outbreak, they do so against a backdrop of years long budget cuts, leaving them without the trained employees or updated equipment to adequately address the virus’ growing threat, former public health officials say.

In the past 15 years, public health, the country’s front-line defense in epidemics, lost 45% of its inflation-adjusted funding for staff, training, equipment and supplies. The Public Health Emergency Fund, created for such disease or disaster relief, is long depleted. And much of the money the federal government is racing to come up with now to combat the COVID-19 outbreak will be pulled from other often-dire health needs and probably will arrive too late to hire the needed personnel. 

Florida, with two cases so far, and Washington, where six deaths have been reported, have declared states of emergency, and state and local officials there and elsewhere assure they have staff, equipment and procedures ready. But early testing glitches in California, the failure to protect federal health officials from the virus in cruise ship patients and a climbing number of U.S. cases raise questions about that confidence.

Health and Human Services Secretary Alex Azar told a Senate panel last week that only about 30 million of the 300 million face masks needed for health care workers are available.

“Once again, we’re not that prepared,” said Dr. Boris Lushniak, a former deputy and acting U.S. surgeon general who spent 13 years at the Centers for Disease Control and Prevention and is now dean of University of Maryland’s School of Public Health.  “When those (basic public health efforts) aren’t supported well, in the time of emergency you don’t have the infrastructure to shift gears and go into emergency mode.”

The prospect of contending with an epidemic hits often-ignored public health departments already taxed by at least 70 homegrown threats, including a host of sexually transmitted diseases and tuberculosis.

It has been 16 months since President Donald Trump declared opioid abuse a public health emergency and less than a year since Kentucky warned it might have to close 42 of its county health departments amid the country’s worst outbreak of Hepatitis A. In New York City, an explosion of measles among unvaccinated children that ended just six months ago cost the city more than $2 million to fight and involved 400 public health employees, according to the Big Cities Health Coalition…

Time is also a problem, said Oscar Alleyne, program director at the National Council of County and Local Health Officials. State and local health departments have lost about 30,000 people over the past seven years, he said, and now have to find or wait for money to hire recent public health graduates and train them for these new, often short-term jobs.

It takes six to nine months to find and hire the people capable of doing the testing and other surveillance work needed, said Dr. Lamar Hasbrouck, a former CDC medical epidemiologist, who was Illinois’ health secretary from 2012 to 2015.

“The time lag is so significant, by time the people get hired, the whole thing can be over,” he said.

Dr. Nirav Shah, who was New York’s state health commissioner from 2011 to 2014, said that in addition to supplies and other department resources, funding will be needed for staff to trace the contacts of infected people. He worries most about cuts to the Epidemiological Intelligence Service, which can go straight to the source of the virus…

The health care system relies on public health agencies.

In a full-blown outbreak, coronavirus patients will be spread across many hospitals that are usually competitors, so public health agencies have to be the connective tissue that coordinates the response, said Dr. Tom Talbot, chief hospital epidemiologist at Vanderbilt University Medical Center.

“They are my heroes,” said Talbot, “because they are drastically under funded and still on the front lines helping to fight this thing.”” (G)

“Looser regulations on who can develop tests for the virus will allow for a significant increase in the number of Americans likely to be screened, the F.D.A. commissioner said.

The Trump administration said on Monday that it could have the capacity for nearly a million tests for the coronavirus by the end of this week, as the government prepares to escalate screening as the American death toll reached six and U.S. infections topped 100.

Private companies and academic laboratories have been pulled in to develop and validate their own coronavirus tests, a move to get around a government bottleneck after a halting start, and to widen the range and number of Americans screened for the virus, Dr. Stephen Hahn, the commissioner of the Food and Drug Administration, said Monday at a White House briefing…

 “We expect to have a substantial increase in the number of tests this week, next week and throughout the month,” Dr. Hahn said, flanked by Vice President Mike Pence and top federal health officials.

Dr. Hahn’s initial comments caused some confusion about the number of tests that would be administered by the end of the week, but the administration clarified that he was speaking of the capacity for increased testing, not the number of Americans that would be tested. That number is still unknown…

Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases, said in an interview with NBC on Monday that the virus had “reached outbreak proportions and likely pandemic proportions.”..

Earlier in the day, Mr. Pence discussed the virus with the nation’s governors, and later joined the president in the meeting with pharmaceutical companies where Mr. Trump said he heard that a vaccine would be ready in three to four months. Dr. Fauci, who was in the room, clarified that deploying a vaccine was at least a year away…

Restrictions on testing have severely constrained local health departments, which were desperate to catch up with and contain the spread. Dow Constantine, the executive of King County, Wash., said the county was preparing to buy a motel in the Seattle area where people who were infected with the coronavirus could stay to remain isolated.

On Saturday, the F.D.A. said that hundreds of academic medical centers that have developed and validated diagnostic materials for the virus could begin testing patients immediately, even before the F.D.A. completes an emergency authorization review, which laboratories run by states and private companies have also applied for.” (H)

“Vice President Mike Pence said the Centers for Disease Control and Prevention was lifting all restrictions on testing for coronavirus, and would be releasing new guidelines to fast-track testing for people who fear they have the virus, even if they are displaying mild symptoms.

“Today we will issue new guidance from the C.D.C. that will make it clear that any American can be tested, no restrictions, subject to doctor’s orders,” Mr. Pence told reporters at the White House.

The federal government has promised to significantly ramp up testing, after drawing criticism for strictly limiting testing in the first weeks of the outbreak. But health care supply companies and public health officials have cast doubt on the government’s assurances, as complaints continue that the need for testing remains far greater than the capacity.

“The estimates we’re getting from industry right now — by the end of this week, close to a million tests will be able to be performed,” the head of the Food and Drug Administration, Dr. Stephen Hahn, said at a White House briefing on Monday.

But some companies developing tests say their products are still weeks away from approval.

And even if a million test kits were available, public health laboratories say they would not be able to process nearly that many within a week. A spokesman for the Department of Health and Human Services said on Monday that public health labs currently can test 15,000 people daily, though that figure is expected to grow.” (I)

“An outbreak of coronavirus disease in a nursing home near Seattle is prompting urgent calls for precautionary tactics at America’s elder care facilities, where residents are at heightened risk of serious complications from the illness because of the dual threat of age and close living conditions.

As of Monday afternoon, the emergence of the novel contagious illness at the Life Care Center of Kirkland, Washington, had left four residents dead and others hospitalized, local health officials said. A health care worker also has been hospitalized. In total, Washington state has reported six deaths, officials said.

Officials previously said that of the nursing home’s 108 residents and 180 staff members, more than 50 have shown signs of possible COVID-19 infections, the name given the illness caused by a novel coronavirus that emerged from Wuhan, China, late last year. Visits from families, volunteers and vendors have been halted and new admissions placed on hold, according to a statement from Ellie Basham, the center’s executive director…

The situation may be akin to the spread of coronavirus on cruise ships, such as the Diamond Princess that was quarantined off the coast of Japan, with one key exception, Steinberg said. People on cruise ships can be confined to their rooms with minimal interaction with staff and fellow residents. People in nursing centers are there because they need help with activities of daily living, he noted…

In the Washington state center, Duchin said, officials are advising health workers to separate cohorts of sick patients from those who remain well and to don personal protective gear, including eye protection, to avoid infection. “It’s a very challenging environment with so many vulnerable patients to manage an outbreak,” he said.” (J)

“New York is among the first states in the country to waive some fees and expenses for people who undergo testing for the coronavirus, as public health officials are increasingly worried that medical bills will discourage the poor and uninsured from getting medical care.

The federal government is also considering paying for care for those affected, possibly based on funds available through federal disaster relief programs. There are “initial conversations,” Dr. Robert Kadlec, a senior official at the U.S. Department of Health and Human Services, told Congress on Wednesday.

In addition to the nation’s 27.5 million uninsured, some lawmakers are concerned that the tens of millions who are underinsured — Americans with high deductibles or limited insurance — may also be at risk of unexpected expenses as more and more people are exposed to the virus.

The health insurance system “is designed to make you think twice to seek care every time you get a runny nose, fever and cough,” said John Graves, a health policy expert at Vanderbilt University. Even though identifying people with the virus in the early stages is critical to preventing a spread of the disease, Dr. Graves said, many people are likely to wait out any symptoms to avoid expensive care.

New York said it would require some health insurance companies to waive any cost sharing for coronavirus testing, including the cost of going to the emergency room, doctor’s office or urgent care center if within a plan’s network.

“Containing this virus depends on us having the facts about who has it — and these measures will break down any barriers that could prevent New Yorkers from getting tested,” Gov. Andrew M. Cuomo said in a statement on Monday.” (K)

Bergen New Bridge Medical Center said March 3 that it has expanded its Telehealth service Bergen New Bridge Cares to screen patients for COVID-19.

Along with partner Air Visits, Bergen New Bridge Cares offers urgent-care screening and assessment by a licensed physician of patients who have medical complaints and symptoms. Telehealth consultations with an infectious disease physician are available if necessary. Patients can access Bergen New Bridge Cares at 201-204-0712.

The COVID-19 screenings are based on the most current CDC Evaluating and Reporting Persons Under Investigation (PUI) guidelines. If further evaluation is necessary, a physician will evaluate each patient and coordinate additional care.

“With the rapidly evolving health crisis, we felt extending the reach of our services into the home was crucial in identifying patients and expediting care while also limiting community exposure,” said Deborah Visconi, president and CEO at Bergen New Bridge Medical Center.

“It is our hope that by putting our experts at the fingertips of the community, people’s fears will be eased and they will be more willing to seek early evaluation and treatment,” Visconi added.”  (L)

“In early February, Royal Caribbean’s Anthem of the Seas docked in Bayonne, New Jersey, in need of a hospital. The cruise ship was carrying patients who had traveled from China, where an outbreak of COVID-19 had taken root. Four passengers needed to go somewhere for further medical observation.

The obvious next step was University Hospital in Newark, a major academic medical center equipped with isolation rooms. “The hospital is following proper infection control protocols while evaluating these individuals,” Gov. Phil Murphy said in a statement. The patients tested negative, but the governor was clear. The state’s first coronavirus cases would go to University…

But infection control has been a recurring problem at some of the very hospitals that would likely be called upon to treat COVID-19 patients, a ProPublica review of hundreds of hospital inspection reports found. This raises concerns that they could become hotbeds for disease, putting patients at risk and rendering infected workers unable to care for others.

“Health care workers are my top worry,” said Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston. He noted that in China, so far, about 15% of infected hospital workers have become severely ill. “If this takes place in the U.S., and we see those numbers of workers sent home or in the ICU, being taken care of by their colleagues, things will start to unravel. This is the soft underbelly of our preparedness system right now.”

At least two health care workers in Northern California had preliminary positive tests for COVID-19 at NorthBay VacaValley Hospital, pending CDC confirmation. The hospital had treated a patient who later tested positive for the disease. Other health care workers who came into contact with the patient are also in quarantine.

There is no list of designated centers to handle the most critical COVID-19 patients, experts said. But the Centers for Disease Control and Prevention, during the 2014-16 Ebola outbreak, named 55 hospitals it considered to be in the first tier of treatment centers to handle that kind of crisis — mostly large, urban teaching hospitals capable of complex care like blood transfusions and ventilation.

ProPublica analyzed five years of federal hospital inspection reports for these facilities and found violations for infection control failures or other factors that could hamper the response to an outbreak at more than half of them. About 1 in 5 of the facilities had four or more violations; the analysis found more than a hundred overall. It’s not clear by looking at the reports how many of the violations led to patient infections. Problems that get cited on the inspection reports are required to be corrected as part of the regulation process.

But it’s also true that inspections only flag a small number of the actual problems in hospitals. American hospitals, overall, are so bad at preventing infections that hospital-acquired infections are considered a leading cause of death in the United States. The hope would be that the sites designated as specialized infection-control centers would do better…

Medical experts say they wonder: if hospitals can’t control the spread of pathogens under normal conditions, what happens if they face a rush of patients with a disease as contagious and serious as the one caused by COVID-19?

During the SARS outbreak in the greater Toronto area, 44% of the total cases were among health care workers. A retrospective study, published in the journal Emerging Infectious Diseases in 2004, hypothesized that “lapses in infection control measures may be responsible,” noting that caregivers were particularly at risk during procedures like intubation…” (M)

“Gov. Andrew Cuomo said he would amend his budget proposal on paid sick leave to include a provision that would require employers to pay workers and protect their jobs if they are quarantined because of the coronavirus. The announcement of the change came at a press conference Tuesday morning at the state Capitol where Cuomo signed a controversial new law expanding his gubernatorial powers in the event of such an emergency.

“I’m going to amend the paid sick leave bill that I sent to the Legislature to where there is a specific provision that says people, who because of this situation with coronavirus, have to be quarantine should be protected,” the governor said. “Their employer should pay them for the period of quarantine and their job should be protected. And I’m going to make that available to be paid sick leave, bill that I sent up.”” (N)

“A cruise ship was being held off the coast of San Francisco on Thursday amid fears that more than 3,500 passengers and crew may have been exposed to the coronavirus blamed for almost 3,300 deaths worldwide.

California Gov. Gavin Newsom said the Grand Princess was sailing with 62 passengers who company officials say had been on the ship’s previous voyage with a 71-year-old man who eventually died from the virus. The current cruise was scheduled to arrive in San Francisco on Wednesday but will not return to port until testing can take place, Newsom said. Test kits were being flown onto the ship, he said.

More than 20 passengers and crew members have developed symptoms consistent with COVID-19, Newsom said.

“We will be able to test very quickly… to determine if these individuals that are symptomatic just have traditional colds or the flu or may have contracted the COVID-19 virus,” Newsom said.” (O)

“In the wake of a series of avoidable mistakes, Donald Trump and his team have confronted quite a bit of criticism over their handling on the coronavirus outbreak. For the most part, the president has responded by arguing that the unflattering assessments are part of a “hoax” cooked up by his political enemies.

Yesterday, however, during a White House event, Trump switched gears a bit, implicitly acknowledging the missteps, but insisting that Barack Obama deserves the blame. From the official transcript:

“[T]he Obama administration made a decision on testing that turned out to be very detrimental to what we’re doing. And we undid that decision a few days ago so that the testing can take place in a much more accurate and rapid fashion. That was a decision we disagreed with. I don’t think we would have made it, but for some reason it was made. But we’ve undone that decision.”” (P)

“The House voted to approve a roughly $8 billion emergency funding deal to address the coronavirus on Wednesday, the latest step in a race to contain the outbreak that has killed nearly a dozen in the US.

It included more than $3 billion for the research and development of vaccines and diagnostics, roughly $2.2 billion to fund public health programs, and $1 billion for medical supplies and other preparedness measures.” (Q)

(A)          8 Questions Employers Should Ask About Coronavirus, by Jeff Levin-Scherz and Deana Allen,

(B)          Coronavirus and the Workplace: What if the Boss Says to Stay Home?, by Tara Siegel Bernard,

(C)          The ‘stranded employee’ is a coronavirus problem the work world has never seen, by Eric Rosenbaum,

(D)          Coronavirus in N.Y.: Second Case Sets Off Search for Others Exposed, by Joseph Goldstein and Jesse McKinley,

(E)          Preparing for Coronavirus in NJ: Not if But When, Say Murphy Officials, by LILO H. STAINTON,

(F)          US schools are in a ‘state of alert’ amid coronavirus outbreak. Are they overreacting – or not doing enough?, by Erin Richards,

(G)         ‘This is not sustainable’: Public health departments, decimated by funding cuts, scramble against coronavirus. By Jayne O’Donnell,

(H)          Vice President Mike Pence’s reassurances contrasted with warnings delivered on Monday by top officials across the federal government, by Noah WeilandEmily Cochrane,

(I)           Coronavirus Updates: U.S. Will Drop Limits on Testing, Pence Says.

(J)           Coronavirus Risk In Elder Care Facilities, by JoNel Aleccia,

(K)          Waive Fees for Coronavirus Tests and Treatment, Health Experts Urge, by Reed Abelson and Sarah Kliff,

(L)           Bergen New Bridge expands telehealth service for COVID-19, by Anthony Vecchione,

(M)        U.S. Hospitals Say They’re Ready for Coronavirus. Their Infection Control Violations Say Otherwise, by Marshall Allen, Caroline Chen, J. David McSwane and Lexi Churchill,

(N)         A new paid sick leave plan for coronavirus, Cuomo expands his proposal in response to the public health threat, by ZACH WILLIAMS,

(O)         Coronavirus updates: Cruise ship kept off West Coast; California, LA declare emergencies, by John Bacon,

(P)          With bogus claim, Trump tries to blame coronavirus missteps on Obama, by Steve Benen,

(Q)         House passes $8 billion emergency package in scramble to fight coronavirus outbreak in US, by Gina Heeb,


Part 12. CORONAVIRUS. March 9, 2020. “Tom Bossert, Donald Trump’s former homeland security advisor…(said) that due to the coronavirus outbreak, “We are 10 days from the hospitals getting creamed.”

“On Friday night, the Uber driver from Queens tested positive, and the case prompted more than 40 doctors, nurses and other workers at a hospital there to go into voluntary self-isolation over fears that they might have been exposed to the coronavirus, officials said on Saturday.” (A)

“Employees of the University of Washington’s UW Medicine system can now get tested for coronavirus without leaving their cars.

The system’s medical center in northwest Seattle has turned a hospital garage lot into a drive-through clinic that can test a person every five minutes. They typically get results within a day or so.

But the idea involves more than convenience. It’s also about safety.

“Because of the way this virus could be spread, we want to make sure there’s good ventilation,” says Dr. Seth Cohen, who runs the infectious disease clinic at UW Medical Center Northwest.

Coronavirus has already caused at least 17 deaths in the Seattle area and infected at least 83 people.

So staff have placed three medical tents on the first floor of the center’s multilevel garage, which is not enclosed. Signs and orange cones funnel vehicles to the testing site…

“We want to make sure that if our staff test negative we get them back to work as soon as we can,” Cohen says. “But if they test positive we want to keep them out of the workforce to make sure they’re not going on to infect other staff or patients.”” (B)

“ “We’re past the point of containment,” Dr. Scott Gottlieb, commissioner of the Food and Drug Administration during the first two years of President Trump’s administration, said on CBS’ “Face the Nation.”

“We have to implement broad mitigation strategies. The next two weeks are really going to change the complexion in this country. We’ll get through this, but it’s going to be a hard period. We’re looking at two months, probably, of difficulty,” Gottlieb said.

U.S. Surgeon General Jerome Adams said that shifting to a mitigation phase means that communities will see more cases and need to start thinking about whether it makes sense to cancel large gatherings, close schools and make it more feasible for employees to work from home.

That’s what happened Sunday, with more reported school closings, warnings against group gatherings and cancellation of big events, such as the BNP Paribas Open, an Indian Wells tennis tournament scheduled to start this week.

“And that’s going to be different in Seattle than what it’s going to be in Jackson, Miss.,” Adams said on CNN’s “State of the Union.” “But communities need to have that conversation and prepare for more cases so we can prevent more deaths.”…

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said that people who are older or have underlying health conditions should also consider avoiding large crowds and travel.

“If you are an elderly person with an underlying condition, if you get infected, the risk of getting into trouble is considerable,” Fauci said on NBC’s “Meet the Press.”

“So it’s our responsibility to protect the vulnerable. When I say protect, I mean right now. Not wait until things get worse. Say no large crowds, no long trips. And above all, don’t get on a cruise ship.”

The comments from current and former officials marked a big shift, acknowledging that the country is past the point of being able to contain the outbreak and needs to pivot to aggressive efforts to mitigate the virus’ spread.” (C)

“Tom Bossert, Donald Trump’s former homeland security advisor, told NBC News on Tuesday that due to the coronavirus outbreak, “We are 10 days from the hospitals getting creamed.”

In an op-ed published by The Washington Post on Monday, Bossert also stated, “officials must pull the trigger on aggressive interventions,” later adding, “Aggressive interventions put off and ease the peak burden on hospitals and other health-care infrastructure.”

Bossert specifically suggesting that “School closures, isolation of the sick, home quarantines of those who have come into contact with the sick, social distancing, telework and large-gathering cancellations must be implemented before the spread of the disease in any community reaches 1 percent.”

“If we fail to take action, we will watch our health-care system be overwhelmed,” he warned, “Starting now, public health messaging should be framed in light of this clear objective.”” (D)

““They’re coming in so intensely now that being able to give you a detailed case breakdown, we’re not in that position to do that at this moment because there are so many coming forward,” de Blasio said, speaking at Bellevue Hospital in Manhattan. “As of 12 noon … the number of confirmed cases in New York City is 36. That’s 16 new since yesterday and 11 new even since this morning at 7 a.m. when I last spoke about this.”

Almost 2,000 New York City residents are in voluntary isolation while 30 people are in mandatory quarantine, he said.

Dr. Mitchell Katz, CEO of NYC Health + Hospitals, said local hospitals are bracing for an onslaught of COVID-19 cases, adding that local hospitals are preparing to discharge current patients to handle incoming coronavirus patients.

 “We are prepared at Bellevue and all of our hospitals that were we to have many patients with respiratory distress, we would rapidly discharge those patients who are in the hospital now and do not need to be in the hospital because they can be safely cared for at home,”  Katz said.” (E)

“Schools, temples, churches and other large gathering places within much of the New York City suburb of New Rochelle will be shut down for two weeks as the state battles to contain of one of the nation’s worst coronavirus clusters.

The National Guard will be called in to help clean facilities and deliver food, Gov. Andrew Cuomo said Tuesday.

Cuomo announced plans to enforce a “containment area” for a 1-mile radius around the center of the cluster, an area of Westchester County that includes much of the city of New Rochelle and stretches into the town of Eastchester. As of Tuesday afternoon, the state had 174 confirmed cases of the coronavirus, second only to Washington state.

“This is literally a matter of life and death,” Cuomo said.” (F)

“California’s Sacramento County is calling off automatic 14-day quarantines that have been implemented for the coronavirus, saying it will focus instead on mitigating the impact of COVID-19.

The change is an acknowledgement that the county cannot effectively manage the quarantines while its health system copes with coronavirus cases. It also reflects problems with the U.S. government’s coronavirus testing program — issues that slowed efforts to identify people with the deadly virus and to contain COVID-19.

“With the shift from containment to mitigation, it is no longer necessary for someone who has been in contact with someone with COVID-19 to quarantine for 14 days,” the county says.

Effective immediately, people in Sacramento County should not quarantine themselves if they’ve been exposed to the COVID-19. Instead, they should go into isolation only if they begin to show symptoms of the respiratory virus, the county’s health department says.

Sacramento County has at least 10 coronavirus cases, including one person who recovered.

Decisions on how to try to contain and control the coronavirus have largely been left to state and local officials, rather than those at the federal level.” (G)

“Nursing homes and assisted living centers should take unprecedented action to curtail most social visits, and should even take steps to keep some employees away, to slow the spread of the new coronavirus, the industry said on Tuesday.

The recommendation follows an outbreak of the virus in the region around Seattle, where five long-term care facilities have been hit with cases, including a facility in Kirkland, Wash., where 18 residents have died. There have now been more than 950 cases of coronavirus in the United States, including 29 deaths.

“The mortality rate is shocking,” said Mark Parkinson, president and chief executive officer of the American Health Care Association. He said that the death rate might well exceed the 15 percent reported in China for people aged 80 and older who were infected.

The challenge of the virus “is one of the most significant, if not the most significant” issues the industry has ever faced, he said.

Industry officials said they are recommending that nursing homes should allow people to enter only if it is essential.

Staff members, contractors and government officials should be asked, “Do you need to be in-building to operate?” said Dr. David Gifford, the health care association’s chief medical officer.

As for family members, he said, “Our recommendation is they should not be visiting.”

Anyone who does visit, he said, should be screened carefully at reception and anyone who has signs of illness should be turned away.” (H)

“N95 masks are essential for protecting health care workers and controlling the epidemic, but some hospitals have been unable to get new shipments as supplies dwindle.

As hospitals around the country prepare for an influx of highly infectious coronavirus cases, their supplies of a crucial type of respirator mask are dwindling fast.

“We’re not willing to run out of N95 masks,” Dr. Susan Ray, an infectious disease specialist at Grady Memorial Hospital in Atlanta, said in a phone interview, referring to the masks by their technical name. “That’s not O.K. at my hospital.”” (I)

“It’s bad enough in ordinary times for a doctor or nurse to work while sick. But as Covid-19 hits hospitals, as it almost certainly will, the tendency of health care professionals to work through illness will present a serious threat to both patient safety and the public’s health…

It is tempting to point the finger at health care professionals who come to work when sick. After all, if their illness is contagious, they pose a threat — in some cases a potentially life-threatening one — to vulnerable patients. But that would be a mistake.

As patient safety expert Paul Batalden has said, “every system is perfectly designed to get the results it gets.” In the case of presenteeism in health care, it is precisely that system — or, more precisely, the lack of a system — that deserves the lion’s share of the blame.” (J)

“As the U.S. battles to limit the spread of the contagious new coronavirus, the number of health care workers ordered to self-quarantine because of potential exposure to an infected patient is rising at a rapid pace. In Vacaville, Calif., alone, one case — the first documented instance of community transmission in the U.S. — left more than 200 hospital workers under quarantine and unable to work for weeks.

Across California, dozens more health care workers have been ordered home because of possible contagion in response to more than 80 confirmed cases as of Sunday morning. In Kirkland, Wash., more than a quarter of the city’s fire department was quarantined after exposure to a handful of infected patients at the Life Care Center nursing home.

With the number of confirmed COVID-19 cases growing by the day, a continued quarantine response of this magnitude would quickly leave the health care system short-staffed and overwhelmed. The situation has prompted debate in the health care community about just what standards medical facilities should use before ordering workers quarantined — and what safety protocols need to become commonplace in clinics and emergency rooms.

“It’s just not sustainable to think that every time a health care worker is exposed they have to be quarantined for 14 days. We’d run out of health care workers,” Nuzzo says. Anyone showing signs of infection should stay home, she adds, but providers who may have been exposed but are not symptomatic should not necessarily be excluded from work.

The correct response, she and others say, comes down to a careful balance of the evolving science with the need to maintain a functioning health care system…

As the virus continues to spread, hospitals should be stockpiling such equipment, figuring out how to add beds and planning for staffing shortages, says Dr. Richard Waldhorn, a professor of medicine at Georgetown University and contributing scholar at Johns Hopkins who recently co-authored recommendations for hospitals on how to prepare for a COVID-19 pandemic.

Hospitals should already be training providers to take on expanded duties, Waldhorn says. If a hospital becomes overwhelmed, the Medical Reserve Corps can be mobilized, as can networks of providers who have volunteered to aid in emergency situations. Once workers have been infected and recover, it might make sense to have them treat other coronavirus patients since they likely will have immunity.

Eventually, as a disease becomes widespread, quarantine simply stops being a priority, says Nina Fefferman, a mathematician and epidemiologist at the University of Tennessee-Knoxville.

“There’s a point where we stop trying to quarantine anyone and we just say, OK, we’re going to have more deaths from the fire department not being able to fight fire than from everyone getting the disease.”” (K)

“At the University of Utah Hospital in Salt Lake City, patients who are worried that they may have the coronavirus no longer enter the hospital itself. Instead, they are treated just outside in big tents, where physicians donning protective gear test them and a special air filter whisks germs away.

Two 20-foot-wide tents were put up on Saturday as a way to limit the exposure between individuals suspected of having the coronavirus and patients in other areas of the hospital. A third, smaller tent was erected on Sunday.

As of Monday afternoon, only two Utahns were confirmed to have the coronavirus, including one evacuated from the stricken Diamond Princess cruise ship — but the University of Utah Health, which includes the Salt Lake City hospital, is not taking any chances.

“It’s an all-hands-on-deck situation right now.”

“We’re spending almost all of our time right now at the hospital system educating our staff, educating the public. It’s an all-hands-on-deck situation right now,” Kathy Wilets, spokeswoman for University of Utah Health, said.

Through social media and news conferences, the health care system is urging people to call first if they believe they may have COVID-19, the illness caused by the coronavirus.

Over the phone, the patients will be directed to the tents outside of the hospital, Wilets said, or be told to drive to an urgent care center, where a doctor in personal protective equipment will walk over to their car and test them without them having to get out of the driver’s seat. They will then be instructed to drive home, where they are to remain while they wait for the test results.” (L)

“At the very beginning [of an outbreak] this will happen because you don’t know patients are infected and you only realize later that people were exposed,” said Grzegorz Rempala, a mathematician at the College of Public Health at Ohio State University who models the spread of infectious diseases.

Now that the disease has started to spread through the community, any patient with respiratory symptoms potentially could be infected, though health officials note the likelihood remains low. As providers start routinely wearing protective gear and employing strict safety protocols, accidental exposure should decline…

 “We’re not used to being concerned, before we even do the triage assessment, [about] whether the patient is infectious and could infect hospital workers,” said Dr. Kristi Koenig, the EMS medical director of San Diego County. She said that thinking started to evolve during the 2014 Ebola outbreak. Hospitals should routinely mask patients who come in with respiratory symptoms, she said, given any such patient could have an infectious disease such as tuberculosis.

Yet providers don’t often think in those terms. “In many ways we’re spoiled because we’ve gone from a society 50 or 100 years ago where the major killers were infectious disease,” said Dr. Michael Wilkes, a professor at UC Davis School of Medicine. “Now we’ve become complacent because the major killers are heart disease and diabetes.”

Faced with this new infection risk, many hospitals are scrambling to retrain workers in safety precautions, such as how to correctly don and doff personal protective equipment.

Sutter Health, which has 24 hospitals in Northern California, started ramping up its emergency management system five weeks ago in preparation for COVID-19. Before coming to the emergency room, Sutter patients are asked to call a hotline to be assessed by a nurse or an automated system designed to screen for symptoms of the virus. Those with likely symptoms are guided to a telemedicine appointment unless they need to be admitted to a hospital…

As the virus continues to spread, hospitals should be stockpiling such equipment, figuring out how to add beds and planning for staffing shortages, said Dr. Richard Waldhorn, a professor of medicine at Georgetown University and contributing scholar at Johns Hopkins who recently co-authored recommendations for hospitals on how to prepare for a COVID-19 pandemic.

Hospitals should already be training providers to take on expanded duties, Waldhorn said. If a hospital becomes overwhelmed, the Medical Reserve Corps can be mobilized, as can networks of providers who have volunteered to aid in emergency situations. Once workers have been infected and recover, it might make sense to have them treat other coronavirus patients since they will have immunity.”  (M)

“In this California epicenter of the coronavirus outbreak, officials say they are trying to be as transparent as possible. They’re keeping a cruise ship out at sea, updating citizens on new cases and providing emergency resources to battle the epidemic.

But on one matter there remains absolute silence: the names of those who have died after being exposed to COVID-19. One California patient and at least 13  Seattle-area residents have died from the illness.

Experts in public health and bioethics say that far from helping society, a decision to reveal the identities of people – dead or alive – who have contracted the coronavirus would be a disaster with far-reaching ramifications.

“Doctors don’t out people,” says Jeffrey Kahn, director of the Johns Hopkins Berman Institute of Bioethics in Maryland, which focuses on the ethical implications of scientific advancement. “Whether it’s HIV, syphilis, coronavirus or anything else, people simply won’t show up to their doctor if they feel they might be outed for a condition.”

Kahn pointed to the Hippocratic Oath, which explicitly states that a physician will “respect the privacy of my patients, for their problems are not disclosed to me that the world may know.”

What’s more, laws laid down in 1996 by the Health Insurance Portability and Accountability Act (HIPAA) ensure that a person’s  health records remain undisclosed to the general public long after their death. That means releasing names of anyone with COVID-19 would violate HIPAA. There have been 51 confirmed COVID-19 cases in California…

What officials are duty-bound to do in any sort of infectious case – whether it’s a sexually transmitted disease or tuberculosis – is referred to as “contact tracing” investigation. This piece of detective work involves finding out anyone who has been in contact with the infected patient and advising them of best next steps…

 “HIPAA requires us to protect confidentiality, and we are only releasing as much information as is necessary to protect public health,” says Combs Prichard, adding that officials did disclose that the one COVID-19 victim in the county – described as an older adult with underlying conditions – was from the city of Rocklin.

“We are absolutely 100% doing a thorough contact investigation, that’s why we don’t feel there is a public health reason to release more identifying information,” she says. “We’ve been able to develop a thorough list of close contacts and are contacting them directly and placing them in quarantine.”

Placer County’s approach represents “a constant discussion in public health, as we’re walking a fine line between causing harm and getting people unnecessarily frightened versus making sure they adopt the right precautions,” says Claire Wheeler, professor of Public Health at Portland State University.

Wheeler points out that while medical officials may be following protocol by not releasing the names of COVID-19 victims or those who have the virus, that doesn’t stop those contacted by health workers from sharing details, including a name, with friends or through social media.

Should such personal information be leaked to the media or online, “it could be very bad for those individuals,” Wheeler says. “What if they lost their jobs? In these situations, people become hysterical. That’s the most dangerous piece of this.”” (N)

“Bridgeport Hospital President Anne Diamond addressed the media Saturday afternoon. Diamond said the doctor who tested positive for coronavirus did not expose patients to the illness because he was exhibiting no symptoms when he made rounds at the hospital.

A doctor who works in Connecticut and recently made rounds at Bridgeport Hospital has tested positive for the coronavirus, the governor announced Saturday.

This is the second New York state resident who works in a Connecticut hospital to test positive for the virus, also known as COVID-19. State officials announced Friday night that an employee who works at both Danbury and Norwalk hospitals has tested positive for the coronavirus.

The doctor in Bridgeport did not shows symptoms of coronavirus while working with patients, the governor’s office said, and “stayed home to self monitor.” Officials said he was not an employee of the hospital, but rather a community doctor who made rounds there.

“This physician saw a limited number of patients at Bridgeport Hospital. At that time, the physician displayed no symptoms associated with COVID-19,” said Anne Diamond, president of the hospital. “As a result, the physician contact here during that time does not constitute an exposure.”

Hospital staff were notified and the “very small number of patients” who came into contact with the doctor were isolated, she said. The Centers for Disease Control and Prevention has since told them that isolation is not necessary.

“The CDC has advised us that our staff will not require isolation or furlough given the nature of the encounter, but we are asking that all staff self monitor for symptoms in the future,” Diamond said.” (O)

(A)          Coronavirus in N.Y.: Cuomo Declares State of Emergency,

(B)          Seattle Health Care System Offers Drive-Through Coronavirus Testing For Workers, by JON HAMILTON,

(C)          ‘We’re past the point of containment’: Coronavirus fight enters new phase, by ANITA CHABRIA, LAURA KING, ANDREW J. CAMPA, ALEX WIGGLESWORTH,

(D)          Trump’s Former Homeland Security Advisor Tells NBC: ‘We Are 10 Days Away From Our Hospitals Getting Creamed’, by Leia Idliby,

(E)          NYC coronavirus cases are ‘coming in so intensely now,’ Mayor de Blasio says, by William Feuer,

(F)          Coronavirus updates: Suburban New York community to enact ‘containment’ area, close schools, by John Bacon,

(G)         Coronavirus: Sacramento County Gives Up On Automatic 14-Day Quarantines, by BILL CHAPPELL,

(H)          Nursing homes should bar most family and friend visits, the industry says,

(I)           Some Hospitals Are Close to Running Out of Crucial Masks for Coronavirus,by Abby Goodnough,

(J)           Doctors working while sick is bad enough in ordinary times. During the Covid-19 outbreak it could be catastrophic, by Steven Joffe,

(K)          Scarcity Of Health Workers A New Concern As Self-Quarantining Spreads With Virus, by JENNY GOLD,

(L)           Amid growing coronavirus cases, hospitals have shared goal: Prevent the spread within their walls, by Elizabeth Chuck,

(M)        Surging Health Care Worker Quarantines Raise Concerns As Coronavirus Spreads, by Jenny Gold,

(N)         Keeping coronavirus patients anonymous is crucial to battling the outbreak, by Marco della Cava,

(O)         Doctor who made rounds at Bridgeport Hospital has tested positive for COVID-19,  by JENNA CARLESSO,

Part 13. CORONAVIRUS. March 14, 2020. “If I’m buying real estate in New York, I’ll listen to the President….If I’m asking about infectious diseases, I’m going to listen to Tony Fauci,” *

 * Rep. Tom Cole (R-Okla.)  (A)

“Very plainly, Trump needs Fauci more than Fauci needs Trump.”

“You’ve heard of Dr. Phil and Dr. Oz, but before the novel coronavirus outbreak, you might never have heard of Dr. Fauci. Today, he’s everywhere.

“You should never destroy your own credibility. And you don’t want to go to war with a president,” Fauci, who has served under six presidents, told Politico. “But you got to walk the fine balance of making sure you continue to tell the truth.”

He’s had decades of practice since he was appointed in 1984 and guided the response for the HIV/AIDS, SARS and Ebola outbreaks, among others. His service has been awarded with the Presidential Medal of Freedom and numerous other honors, including 45 honorary doctoral degrees from universities in the United States and abroad.” (B)

“A virus that is deadly and little understood. An administration in deep denial. Anthony S. Fauci has been here before.

As the coronavirus epidemic escalates, the director of the National Institute of Allergy and Infectious Diseases (NIAID) has become a familiar media presence.

Fauci’s expertise and credibility shine against the contradictory and false messages coming from President Trump. The administration has at times sounded more concerned with protecting the president politically than stopping the spread of a potentially lethal disease.

While Trump tries to play down the severity of a public health crisis that might affect his reelection prospects, Fauci has laid out the best assessment of the true danger in stark terms.” (C)

Dr. Anthony Fauci, the nation’s leading expert on infectious diseases, is widely respected for his ability to explain science without talking down to his audience — and lately, for managing to correct the president’s pronouncements without saying he is wrong.

President Trump said that drug companies would make a coronavirus vaccine ready “soon.” Dr. Fauci has repeatedly stepped up after the president to the lectern during televised briefings or at White House round tables to amend that timetable, giving a more accurate estimate of at least a year or 18 months.

Mr. Trump said a “cure” might be possible. Dr. Fauci explained that antiviral drugs were being studied to see if they might make the illness less severe. The president also said the disease would go away in the spring. Dr. Fauci said maybe so, but because it was caused by a new virus, there was no way to tell.

Experts like Dr. Fauci should be the ones who speak to the public during epidemics, said Representative Donna E. Shalala of Florida, who was his boss during the Clinton administration, when she led the Department of Health and Human Services.

“I think Tony is playing the same exact role that he has in the past — to make sure the science is accurate and clear,” Ms. Shalala said. “During a health emergency, it’s the scientists and physicians that are the credible people to the American public, not politicians.”..

If Dr. Fauci has become the explainer-in-chief of the coronavirus epidemic, it is in part because other government scientists have left a vacuum, avoiding the news media spotlight or being reined in by the Trump administration and accused of exaggerating the threat from the virus. When reporters call Dr. Fauci, he calls them back…

 “There are a lot of world class scientists, but Tony has a special set of skills,” Ms. Shalala said. “An ability to communicate, high integrity and an understanding of politics — and to know to stay out of politics in order to protect scientists.” (D)

“On Wednesday, March 11, top public health officials including Dr. Anthony Fauci, the director of the National Institute for Allergy and Infectious Diseases, testified before the House Committee on Oversight and Government Reform about the government response to the novel coronavirus, COVID-19…

His testimony laid out a stark, sobering picture of what the United States faces in the coming weeks and months. Here are the important exchanges, with bolding to highlight key points:

“Getting it into phase one in a matter of months is the quickest that anyone has ever done literally in the history of vaccinology. But the process of developing a vaccine is one that is not that quick. It will bring us three or four months down the pike and then you go into an important phase called phase two to determine if it works,” he continued. “That will take at least another eight months or so.”…

“Whenever you look at the history of outbreaks, what you see now in an uncontained way, and although we are containing it in some respects, we keep getting people coming in from the country that are travel-related. we’ve seen that in many of the states that are now involved. and then when you get community spread, it makes the challenge much greater. So I can say we will see more cases and things will get worse than they are right now. How much worse we’ll get will depend on our ability to do two things, to contain the influx of people who are infected coming from the outside, and the ability to contain and mitigate within our own country. Bottom line, it’s going to get worse.”…

“I appreciate your comments, but I can tell you absolutely that I tell the president, the vice president and everyone on the task force what exactly the scientific data is and what the evidence is.”…”I have never, ever held back telling exactly what is going on from a public health standpoint….

“If we don’t do very serious mitigation now, that what’s going to happen is that we’re going to be weeks behind and the horse is going to be out of the barn. And that’s the reason we’ve been saying, even in areas of the country where there are no or few cases, we’ve got to change our behavior. We have to essentially assume that we are going to get hit. And that’s why we talk about making mitigation and containment in a much more vigorous way. People ask, why would you want to make any mitigation? We don’t have any cases. That’s when you do it. Because we want this curve to be this, and it’s not going to do that unless we act now.” (E)

America has failed to meet the capacity for coronavirus testing that it needs, a top public health official acknowledged Thursday.

“The system is not really geared to what we need right now,” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said in a House hearing about coronavirus test kits in the United States, which were initially dogged by technical glitches. “That is a failing. Let’s admit it.”..

When the virus first started appearing in America, the Centers for Disease Control and Prevention had narrow criteria for who could be tested for it, further limiting the number of tests performed on top of the technical problems. Those guidelines have since been expanded. Dr. Robert Redfield, director of the CDC, who was also testifying in the hearing, directed Wasserman Schultz’s question to Fauci.

“The idea of anybody getting it easily the way people in other countries are doing it, we’re not set up for that,” …”Do I think we should be? Yes. But we’re not.”..

The blunt acknowledgment came as the CDC reported it had tested just over 11,000 specimens for the virus so far, far fewer than other nations, especially given that multiple specimens are needed for each patient. Meanwhile, South Korea is testing nearly 20,000 patients per day, according to the BBC.” (F)

“But now that the public-health response is underway, is the president’s 2018 decision having a practical effect? Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, was unexpectedly candid on this point today.

In fact, Dr. Fauci took some of his most direct swipes at the White House since the outbreak began. When [Democratic Rep. Gerald Connolly] asked him about the 2018 eradication of the global health unit on the White House’s National Security Council, he answered, “It would be nice if the office was still there.”

The NIH leader added, “We worked very well with that office.”

Remember, Trump has struggled to explain why, exactly, he disbanded the global health security unit. As we talked about the other day, the president originally argued, “I’m a businessperson. I don’t like having thousands of people around when you don’t need them. When we need them, we can get them back very quickly.”

As it turns out, the administration cannot actually reassemble such a team “very quickly,” though Trump, still unfamiliar with how much of the executive branch works, may not have known that.

His second explanation was even less persuasive. “You can never really think is going to happen,” the president said on Friday, adding, “Who would have thought? Look, how long ago is it? Six, seven, eight weeks ago — who would have thought we would even be having the subject? … You never really know when something like this is going to strike and what it’s going to be.”…

And now it sounds as if Anthony Fauci would’ve preferred if Team Trump had left Team Obama’s model intact.” (G)

“As of today, March 13, 2020—three-plus years into the current administration, three months into public awareness of the coronavirus spread, seven-plus months until before the next election—Anthony Fauci is playing a role in which no previous Trump-era figure has survived.

One other person has been in the spot Fauci now occupies. That is, of course, James Mattis, the retired four-star Marine Corps general and former secretary of defense for Trump. Former is the key word here, and the question is whether the change in circumstances between Mattis’s time and Fauci’s—the public nature of this emergency, the greater proximity of upcoming elections, the apparent verdict from financial markets and both international and domestic leaders that Donald Trump is in deep over his head—will give Fauci the greater leverage he needs, not just to stay at work but also to steer policy away from the abyss.

Why is Anthony Fauci now, even more than James Mattis before him, in a different position from any other publicly visible associate of Trump’s?

Pre-Trump credibility, connections, and respect. Fauci has been head of the National Institute of Allergy and Infectious Diseases, at the National Institutes of Health, since Ronald Reagan’s first term, in 1984. (How can he have held the post so long? Although nothing in his look or bearing would suggest it, Fauci is older than either Bernie Sanders or Joe Biden. He recently turned 79.)

Through his long tenure at NIH, which spanned the early days of the HIV/AIDS devastation and later experience with the SARS and H1N1 epidemics, Fauci has become a very familiar “public face of science,” explaining at congressional hearings and in TV and radio interviews how Americans should think about the latest threat. He has managed to stay apart from any era’s partisan-political death struggles. He has received a raft of scientific and civic honors, from the Lasker Award for health leadership, to the Presidential Medal of Freedom, awarded by George W. Bush.

Thus, in contrast to virtually all the other figures with whom Trump has surrounded himself, Fauci is by any objective standard the best person for the job — and is universally seen as such. This distinguishes him from people Trump has favored in his own coterie, from longtime consigliere Michael Cohen to longtime ally Roger Stone to longtime personal physician Harold Bornstein; and from past and present members of his White House staff, like the departed Michael Flynn and the returned Hope Hicks and the sempiternal Jared Kushner; and fish-out-of-water Cabinet appointees, like (to pick one) the neurosurgeon Ben Carson as Secretary of Housing and Urban Development.

Put another way: Very plainly, Trump needs Fauci more than Fauci needs Trump. This is not a position Donald Trump has ever felt comfortable in— witness the denouement with Mattis.” (H)

“Now that President Trump has made Vice President Pence the US’ coronavirus czar, Fauci has to run interviews by Pence’s office for clearance.

Some of Fauci’s statements about the virus have been at odds with claims from President Trump.

US public-health experts and politicians have been angry that Fauci appeared to be sidelined. One said his silence “is a threat to public health and safety.”…

But after President Donald Trump made Vice President Mike Pence the US’ coronavirus czar, Fauci and other top health officials were reportedly told “not to say anything else without clearance” from the White House, according to The New York Times.

Fauci told Politico Friday that he has not been muzzled, but that he does have to clear interviews with Pence’s office…

US health experts and politicians were angry about the possibility that the White House would restrict Fauci’s speech, the Times reported.

“Presidents Reagan, Bush, Clinton, Bush and Obama trusted Tony Fauci to be their top adviser on infectious disease, and the nation’s most trusted communicator to the public,” Ronald Klain, who led the Obama administration’s response to the 2014 Ebola crisis, tweeted on Thursday.” (I)

The disruption to everyday life in America caused by the coronavirus pandemic is the most severe Dr. Anthony Fauci has seen in the 36 years he’s been the director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health. While there have been “an awful lot of challenges,” this situation is different because of all the “unknowns” surrounding the virus, he said.

“With regard to disruption of everyday life, we have not seen that before, but we’ve not had this kind of a situation before,” he said on “CBS This Morning” Friday. “I mean, we’ve had pandemics. The 2009 H1N1 swine flu was a pandemic, but it was influenza. We were familiar with what influenza does, familiar with its seasonal capability. Right now, there are a lot of unknowns.”…

Fauci also said even without widespread testing, mitigation measures should be taken to slow the spread of coronavirus.

“The kinds of things you’re hearing about which we call social distancing, which means staying away from crowds, doing teleworking, where appropriate, closing schools, canceling events that bring many, many people together. You can do that right now,” he said. “Obviously we want to and will have considerably more testing in the future, but you don’t wait for testing to do the mitigation. You can do it right now.” (J)

Dr. Anthony Fauci, one of the lead scientists behind the Trump administration’s coronavirus response, said Friday that disruptions to everyday life in the U.S. could last up to eight weeks…

 “I mean it’s unpredictable but if you look at historically, how these things work, it’ll likely be anywhere from a few weeks up to eight weeks or more,” he said, adding that he hopes it’s going to be only two, three or four weeks.

“It’s really impossible to make an accurate prediction,” he said.

But there have been barriers for doctors to conduct coronavirus tests. The current system in place is “failing,” Fauci said at a Congressional committee hearing Thursday. It “is not really geared to what we need right now,” he said.

“That is being rapidly corrected,” he said on “CBS This Morning.” “We had a task force meeting yesterday, and we heard that the kinds of tests from the commercial sector that would be readily available is really very, very close right now. Very close.”

Fauci said restrictions on who can be tested “have been lifted” by the Food and Drug Administration, and he hopes by next week, “If you go in, there’s a good reason for you to get it, you’re going to get a test.”

“It’s going to be graded. It’s not going to all happen tomorrow or the next day,” he cautioned.

Fauci also said even without widespread testing, mitigation measures should be taken to slow the spread of coronavirus.

So-called social distancing measures are crucial to slowing the spread of COVID-19 and ensuring that hospitals are not overwhelmed by an influx of patients.

By spreading the outbreak out over a longer period of time, public health officials can have more time to prepare, get more resources and equipment, and ensure that everyone who needs medical care is able to get it….

Asked if the U.S. is heading toward a gradual shutdown, Fauci replied: “I’m not sure we’re going to get to that. I think that would be really rather dramatic, but I can tell you that all things are on the table. We just have to respond as things evolve over the days and over the weeks.” (K)

(A)          “You don’t want to go to war with a president”: Top NIH doctor talks coronavirus response, by Rashaan Ayesh,

(B)          Who is Dr. Anthony Fauci, America’s top coronavirus fighter? By Anagha Srikanth,

(C)          Anthony Fauci fights outbreaks with the sledgehammer of truth, by Karen Tumulty,

(D)          Not His First Epidemic: Dr. Anthony Fauci Sticks to the Facts, by Denise Grady,

(E)          8 key exchanges from the testimony of the nation’s top infectious disease expert who warned the US outbreak is going to ‘get worse’, by Grace Panetta,

(F)          ‘It is a failing. Let’s admit it,’ Fauci says of coronavirus testing capacity, by Elizabeth Chuck,

(G)         NIH’s Fauci wishes Trump hadn’t disbanded global health unit, by Steve Benen,

(H)          2020 Time Capsule #2: The Exceptional Dr. Fauci, by James Fallow,

(I)           Anthony Fauci, whose stark warnings about the coronavirus have contradicted Trump’s optimism, is a public-health hero, by Aylin Woodward,

(J)           Coronavirus “unknowns” put U.S. in unprecedented situation, top infectious disease expert says,

(K)          Top health official Fauci: Coronavirus crisis could last 8 weeks, by JESSIE HELLMANN,

PART 14. CORONAVIRUS. March 17, 2020. “ “Most physicians have never seen this level of angst and anxiety in their careers”…. One said “I am sort of a pariah in my family.”

(From PART 2. CORONAVIRUS. January 29, 2020)

With SARS preparedness underway in NJ, LibertyHealth/ Jersey City Medical Center, where I was President, proposed that our 100 bed community hospital with all single-bedded rooms, be immediately transformed into an EMERGENCY SARS ISOLATION Hospital.

The Hospital was in a small town at the intersection of many major highways. It could be easily secured since it had no immediately contiguous neighbors. It had a helicopter pad. Its patients could be easily transferred. And it could be managed by the Public Health Service or military medicine if necessary.

It didn’t happen!

In July of 2009 I encouraged the Mayor of Hoboken initiate a H1N1 “Swine Flu” Task Force. I was appointed co-chairman with the Health Officer.

We started with a set of questions based on reports from communities that had already experienced a Swine Flu surge:

Health Officer: Where vaccination sites should be established? Is there a special plan to monitor restaurants and food shops where flu-related safety guidelines need to be strictly enforced? Who will start preparing a Community Education plan?

Hospital: What is the back-up plan if hospital becomes “contaminated” and is closed to admissions, or if nursing staff is depleted by flu-related absenteeism, etc.? ICU triage? Availability of respirators?

OEM:  off-site screening centers if hospital ER is on overload

Hoboken Volunteer Ambulance Corps:  “mutual assist” plan

Hoboken Police Department & Hoboken Fire Department: back-up plan if the ranks get depleted by the flu

BOE: criteria in deciding whether or not to close schools

Stevens Institute of Technology: surveillance and plan for (college) students

“Field Manual” for the Mayor

Interestingly Swine Flu never flourished in the Hoboken area probably due to herd immunity acquired from the Swine Flu in 2008 in New York City, where many Hobokenites work and visit.

“One Seattle-area hospital has already seen patient care delayed by the stringent infection-control practices that the government recommended for suspected coronavirus cases. Another in Chicago switched Thursday morning into “surge” mode, setting up triage tents in its ambulance bay and dedicating an entire floor to coronavirus patients. At least one is already receiving emergency supplies from the federal government’s stockpile.

With the bow wave of coronavirus infections still to come, hospitals across the country are trying to prepare for a flood of critically ill patients who will strain their capacities like nothing they have seen in at least a generation. Even with some time to prepare, administrators fear they will not be ready.

Staffing shortages could hinder care if doctors and nurses become infected. There may not be enough ventilators or bed space for a crush of seriously ill patients.

“Our hospitals are already stretched to capacity,” said C. Ryan Keay, the medical director of the emergency department at Providence Regional Medical Center in Everett, Wash., near Seattle, which is dealing with the largest outbreak in the country. “We’re a hospital that is always full, so it doesn’t take much to tip us over the edge.”…

The strain is already playing out in unexpected ways. Since admitting the first known case in the United States, Dr. Keay’s hospital has followed Centers for Disease Control and Prevention protocols for sanitizing facilities used by multiple patients with suspected coronavirus infection, which resulted in slower treatment.

“If somebody had to go in for a chest X-ray, as most of these patients do, the X-ray room would need to be down for 30 minutes afterward to reverse the airflow and sanitize,” Dr. Keay said. “If you have lots of patients, that becomes a huge issue and delay.”

Another unanticipated development: More moderate forms of breathing support, such as nebulizers and Bipap machines, should spare ventilators for the worse cases, but those technologies cannot be used on coronavirus patients because they risk releasing particles into the air.

Hospitals can take steps to increase their capacity, for instance by canceling some elective procedures or repurposing facilities meant to care for psychiatric patients. The most critical action, however, is outside hospitals’ control: slowing the spread of the virus through hygiene and social distancing, so cases spread out and the health system can treat patients who need care.

Most hospitals maintain disaster preparedness plans for multiple situations, such as mass casualties and novel infectious diseases. Those contingency plans are typically for a surge in capacity of up to 20 percent, hospital executives said. Some experts believe that hospitals could increase their capacity by resorting to more extreme measures, such as sending patients home earlier than planned or renting space at nearby facilities to set up makeshift hospital rooms…

Rush University Medical Center, the largest hospital in Chicago, put its surge protocols into effect Thursday morning for the first time in its 183-year history. The hospital has treated four confirmed cases of coronavirus and expects an onslaught in the coming weeks.

“We made the decision to surge because of the concern we’re seeing nationally and internationally,” said Omar B. Lateef, the hospital’s chief executive. “The W.H.O. is making statements about the risks of inaction, so we felt a responsibility to do something.”

Rush officials estimate that new triage tents outside — with chairs spaced 6 feet apart, the distance the World Health Organization recommends for separating infected individuals — and additional beds inside will increase the hospital’s emergency department capacity by 40 percent.

“We have to accept that this is a tremendous challenge for the health care system,” Dr. Lateef said. “If we allow uncontrolled spread, we will be overwhelmed. But if we practice mitigation, then hospitals can handle it.”  (A)

“As the coronavirus has swept across New York, officials have become increasingly alarmed about a bleak reality: The state may not have enough ventilators for everybody who could need one.

It is still possible that the state could slow down the spread of the virus enough to curb the demand for ventilators, the machines that help the sickest patients to breathe. But a panel convened a few years ago by the state found that in the worst-case scenario of a flulike pandemic, New York could be short by as many as 15,783 ventilators a week at the peak of the crisis.

The panel, the New York State Task Force on Life and the Law, studied ventilators for years before issuing a 2015 report offering guidance for hospitals on how to decide who to ventilate and who to effectively let die during an emergency. The advice is now frighteningly relevant…

Most of the New York’s major health systems have declined to provide details about their ventilators or what they will do if they run out. Some hospital administrators have said they believe new measures, such as closures of schools and restaurants, can slow the spread of the virus and keep the number of critically ill people below levels that could overwhelm hospitals.

But officials have repeatedly said that a ventilator shortage is one of their top concerns…

In interviews, ventilator manufacturers warned that, amid the pandemic, they do not have the ability to provide New York more ventilators — which can cost at least $25,000 apiece and require significant training to use…

New York’s hospitals are considered to be among the best in the world. But the state has slightly fewer ventilators per capita than the national average, according to a New York Times comparison of the 2015 state task force report and a study by the Johns Hopkins Center for Health Security.

The task force found that in 2015, there were about 7,250 ventilators in New York hospitals and about 1,900 in nursing homes. But the vast majority of them were already being used. Even with the state’s own emergency stockpile, the group found there were only 2,800 available.

The New York State Department of Health has declined to provide updated numbers…

Part of the problem is that the shortage goes far beyond the nuts and bolts of a machine. Ventilators must be operated around the clock by trained employees…

Only a few hospital systems have so far been willing to say publicly what they would do if they have more patients in need of ventilation than machines.

Northwell Health, which has 23 hospitals, and Montefiore Medical Center, with 11 hospitals, both said that if supplies ran out, they would adopt the task force guidelines.

Generally, when patients are mechanically ventilated, a flexible tube is placed into their windpipe, and a finely calibrated pump sends oxygen-rich air into the lungs.  Managing everything — from air flow to medicines — is labor intensive. Intensive care nurses are typically assigned just a few such patients at a time.” (B)

‘Two prominent emergency medicine physicians are calling for hospitals and other health care organizations to be vigilant and proactive in protecting health care workers during the coronavirus crisis…

“The first is the potentially overwhelming burden of illnesses that stresses health system capacity,” they write, “and the second is the adverse effects on health care workers, including the risk of infection.”..

Personal protective equipment (PPE) is one of the best defenses of health care workers, Adams and Hall note. However, they say the primary concern is surfaces that become contaminated via droplet and contact, rather than by airborne transmission.

“Therefore, ensuring routine droplet barrier precautions, environmental hygiene, and overall sound infection prevention practice is indicated,” the co-authors say, noting that US Centers for Disease Control and Prevention guidelines suggest health care workers working with such patients wear gowns, gloves, and either N95 respirators with face shields or goggles, or powered air-purifying respirators…

 “In a study of outpatient health care personnel in diverse ambulatory practices, medical masks applied to both patient and caregiver provided effectively similar protection as N95 masks in the incidence of laboratory-confirmed influenza among caregivers who were routinely exposed to patients with respiratory viruses,” they note…

Unfortunately, health care facilities can be chaotic places at times, particularly in the emergency department, where healthcare workers face the potential of a large number of unannounced and undiagnosed patients arriving at once. Hall and Adams say health care workers must be quick and vigilant about isolating anyone who seems to be experiencing a respiratory illness. Such measures include putting face masks on patients upon arrival, promoting coughing etiquette, and providing for hand hygiene…

Ultimately, Adams and Hall say, health care workers ought to consider themselves at elevated risk of exposure, and act accordingly. One way to address that reality is to ameliorate concerns health care workers might have about the safety of their own families. Addressing such concerns could include things like providing priority access to testing, treatment, and vaccination if and when it becomes available. It can also mean providing employees with adequate time off to care for loved ones who become ill. (C)

“The American Red Cross is urging healthy residents to make an appointment and donate blood as the country faces a “severe blood shortage” due to the coronavirus outbreak.

Nearly 2,700 Red Cross blood drives have been canceled, resulting in about 86,000 fewer donations and more cancellations are expected.

“I am looking at the refrigerator that contains only one day’s supply of blood for the hospital,” said Dr. Robertson Davenport, director of Transfusion Medicine at Michigan Medicine in Ann Arbor. “The hospital is full. There are patients who need blood and cannot wait.”…

Eduardo Nunes, Vice President of Quality, Standards, and Accreditation at AABB, said most hospitals are down to a blood supply of two to three days…,

Nunes said the best cure for the national blood shortage is for young, healthy people to make an appointment with their local blood bank and donate.” (D)

“Hospitals in Michigan are preparing disaster plans to free up beds that could be used to handle a possible surge of hundreds or thousands of patients with COVID-19, the disease caused by coronavirus, after the federal government declared a national emergency Friday.

While the number of people with the disease would have to drastically increase for these plans to go into effect, hospitals are planning for worsening scenarios that would include canceling elective surgeries, creating additional inpatient space set up for infectious patients, and sending patients home earlier or to doctor’s offices instead of the hospital for less urgent cases…

Ruthanne Sudderth, the hospital association’s senior vice president for public affairs, said each hospital has a worst-case scenario based on its capacity and level of care it provides. But the association has advised hospitals to shore up their patient care, facilities and staff during the national emergency caused by the coronavirus outbreak, which has killed more than 5,400 people worldwide, including 41 in the U.S.

“We have told them try to prepare for surge capacity. Look at elective procedures and whether to continue to do so. Use virtual visits (telemedicine) wherever possible, to free up physical capacity for COVID-19 or any other issue,” Sudderth said.

Hospitals generally have 25 percent to 35 percent of their beds filled by elective patients. There are approximately 23,000 staffed hospital beds in Michigan, according to the American Hospital Association. That would be enough for about 1 in 500 Michiganians who need hospital-level care.

“When patients are ready to be discharged, open those beds. Provide additional medication to take home, if possible, or offer mail order, so they don’t have to return to free up capacity,” she said. “If someone doesn’t need to be in the hospital, they don’t need to be there.”

Sudderth said hospitals also are considering transferring patients who don’t need inpatient settings to ambulatory care centers to free up additional beds.

Under emergency conditions, tents or temporary structures can be set up in parking lots to screen patients before they enter the hospital to avoid having them come into contact with vulnerable patients inside, Sudderth said.

“Emergency planning for infection disease outbreaks allows them to set up facilities outside,” she said. “This can increase inpatient capacity and also protect patients and staff.”

Bob Riney, president of health care operations and COO of Henry Ford Health System, said the six-hospital system with more than 40 medical centers has discussed and planned for a worst-case scenario. Every day, more than 200 managers discuss plans in conference calls.

“We have very high occupancy” at Henry Ford already because of flu patients and the health system’s advanced specialty care programs, Riney said. “We have scenarios and plans to invoke … deferral of elective procedures” and other actions to expand the number of available beds for sicker patients…

Henry Ford also has more than 150 negative pressure rooms for coronavirus patients or those with other contagious diseases such as tuberculosis. It also has 19,000 N95 respirator masks — a high-quality disposable device that covers the nose and mouth — that medical staff wear in caring for patients.”  (E)

“Holy Name Medical Center in Teaneck is grappling with the coronavirus outbreak, CEO Mike Maron said.

Eleven cases. Six of which are in the ICU. And 40 more patients under observation…

It’s why Holy Name CEO Mike Maron thinks all the attention the coronavirus has been getting in New Jersey — from the school closings, banning of public gatherings, suspensions of pro sports leagues and even the fights over toilet paper and bottled water — is not enough. Not even close…

Maron and his staff are working around the clock under the most trying of conditions. The vitally important single-use N95 masks that are needed to care for patients who have been identified — you know, the ones the state is running out of? Holy Name went through 795 of them. Just on Friday. By 7 p.m.

“They say we are getting more,” he said. “And we’ve asked (Gov. Phil Murphy) to get into the stockpile. We need them.”

The same goes for test results.

Maron said he has given up on the Centers for Disease Control and Prevention.

“They haven’t even confirmed our first case,” he said.

He knows the state lab is overloaded. And, while Maron praised the efforts of LabCorp — “they’ve really been great to work with” — he has seen firsthand, every day for a week, how quickly the disease can spread.

“The labs are very, very slow,” he said. “I’m still waiting to hear back on two of my cases that are in ICU. We’ve seen enough patients that our team feels it can make a diagnosis. We’re not taking any chances. We’re isolating people…

“Holy Name is at the epicenter of the outbreak in New Jersey,” he said.

Maron said the past week has been unlike any other in his more than four-decade career.

“I can fall back on my cholera experiences in Haiti, which was devastating, considering the lack of basic medical supplies after the earthquake — and then the other things that came here, everything from MERS and SARS, and even when we ramped up for Ebola — this is unprecedented,” he said…

Holy Name sits in an area with a large Asian population. Considering the virus began in China, one would assume …

Don’t, Maron said.

“Not one of my patients is Asian,” he said. “Not one. And, even though the outbreak in New Rochelle (New York) started in a Jewish community, only two of the 51 are Jewish.”

Maron said this point needs to be emphasized.

“We were on a call with all the rabbis here in Teaneck, and I said, ‘Let me be very clear: This is not a Jewish disease, this not an Asian disease.’”…

“If you call, we do a video conference with a physician — and, depending on your condition, we may tell you (to) self-quarantine at home,” he said. “We’ll have someone come and drop off a home monitoring system, which can take your temperature and take your oxygen saturation rate, your sb02. It gets automatically reported to us and we’ll monitor you.”

If it gets bad, Maron said, hospital personnel will come get you and bring you in — and isolate you. The hope is that treatment will help you recover enough to go home. He knows that’s not always the case. And he’s not taking any chances…

“One of my employees, who is a beloved guy here, got it in the community and came in,” he said. “We had him in our ER in isolation. We were monitoring him, and the decision was: ‘He seems to be doing a little bit better. We think we’re going to discharge him home under self-isolation and monitor him from there.’ But we wanted to wait another hour or two because we were just seeing a little indication that something’s not right.

“In that two hours, he decompensated so fast. He is one of the ones in the ICU on a ventilator. He’s fighting for his life. It goes that quick.”” (F)

“The announcement came one week after President Trump signed an $8.3 billion funding bill to combat the coronavirus crisis.

President Donald Trump declared a national emergency over the ongoing coronavirus disease 2019 (COVID-19) outbreak Friday afternoon.

The declaration makes $50 billion available to fight the spread of COVID-19.

“In furtherance of the order, I’m asking every state to set up emergency operations centers effective immediately,” Trump said. “I’m also asking every hospital in this country to activate its emergency preparedness plan so that they can meet the needs of Americans everywhere.”

Trump said the declaration will allow Department of Human Services (HHS) Secretary Alex Azar to “waive provisions of applicable laws and regulations to give doctors, hospitals—all hospitals—and healthcare providers maximum flexibility to respond to the virus.”

Among the regulations waived under the declaration are restrictions on telehealth usage, the requirement that critical access hospitals have a 25-available-bed limit for patients, and a maximum length of stay of 96 hours for inpatients.

Additionally, nursing homes will be able to waive the requirement that patients have a three-day hospital stay prior to admittance; and hospitals will have restrictions lifted for hiring new physicians, obtaining available office space, and caring for patients within the facility itself in order to “ensure that the emergency care can be quickly established.”

Trump also said the administration has been in discussions with pharmacies and retailers to make drive-through tests available at critical locations identified by public health professionals. “The goal is for individuals to be able to drive up and be swabbed without having to leave your car,” he said.

Trump announced several initiatives designed to stimulate innovation around solutions to the pandemic. Ten days ago, he brought together the CEOs of commercial labs and directed them to “immediately begin working on a solution to dramatically increase the availability of tests.” (G)

“ “Most physicians have never seen this level of angst and anxiety in their careers,” said Dr. Stephen Anderson, a 35-year veteran of emergency rooms in a suburb south of Seattle. “I am sort of a pariah in my family. I am dipping myself into the swamp every day.”

As the coronavirus expands around the country, doctors and nurses working in emergency rooms are suddenly wary of everyone walking in the door with a cough, forced to make quick, harrowing decisions to help save not only their patients’ lives, but their own.

The stress only grew on Sunday, when the American College of Emergency Physicians revealed that two emergency medicine doctors, in New Jersey and Washington State, were hospitalized in critical condition as a result of the coronavirus. Though the virus is spreading in the community and there was no way of ascertaining whether they were exposed at work or somewhere else, the two cases prompted urgent new questions among doctors about how many precautions are enough…

In emergency departments, the danger comes from the unknown.

Patients arrive with symptoms but no diagnosis, and staff members must sometimes tend to urgent needs, such as gaping wounds, before they have time to screen a patient for Covid-19, the disease caused by the virus. At times, the protocols they must follow are changing every few hours.” (H)

“Nearly 50 employees of Life Care Center of Kirkland, the Seattle-area nursing home that has been an epicenter of the coronavirus outbreak in the U.S., have tested positive for the virus, according to a report.

The results from Public Health – Seattle & King County, the health agency that serves the nation’s 15th largest metropolitan area, were reported in a Twitter post by a reporter from Seattle’s KIRO-TV.

The figures showed 47 employees tested positive, 24 tested negative, one test was inconclusive and five test results were still pending. In addition, 18 more employees were to be tested Saturday.

The 47 positive tests of employees, coupled with 63 positive tests for the home’s patients, means the nursing home accounts for about one-third of the state’s 328 confirmed cases of coronavirus, KIRO reported.” (I)

COVID-19 (Coronavirus) Outbreak Preparedness Center – Infection control and outbreak preparedness resources for hospitals and healthcare providers (J)

Coronavirus Disease 2019 (COVID-19) – Hospital Preparedness Assessment Tool (K)

“Proactive planning, in which leaders anticipate and take steps to address worst-case scenarios, is the first link in the chain to reducing morbidity, mortality, and other undesirable effects of an emerging disaster. It is vital that the principles and practices of crisis care planning guide public health and health care system preparations. This discussion paper summarizes some key areas in which CSC principles should be applied to COVID- 19 planning, with an emphasis on health care for a large number of patients. Hospitals routinely utilize selected principles of CSC to deal with seasonal outbreaks, lack of bed availability, and drug shortages, but a potential pandemic requires a deeper understanding and application of CSC.

Reduced to its fundamental elements, CSC describe a planning framework based on strong ethical principles, the rule of law, the importance of provider and community engagement, and steps that permit the equitable and fair delivery of medical services to those who need them under resource-constrained conditions. CSC are based on the following key principles [1]: (L)


Duty to Care

Duty to Steward Resources





A.            U.S. Hospitals Prepare for Coronavirus, With the Worst Still to Come, by Sarah Kliff,

B.            N.Y. May Need 18,000 Ventilators Very Soon. It Is Far Short of That,By Brian M. Rosenthal and Joseph Goldstein,

C.            Coronavirus: For Health Care Workers, Risk of Infection, But Also Burnout, by JARED KALTWASSER,

D.            The US faces ‘severe blood shortage’ as coronavirus outbreak cancels blood drives and regular donations, by Adrianna Rodriguez,

E.            Hospitals prepare for potential surge of patients from coronavirus, by JAY GREENE,

F.            Life at the epicenter of N.J.’s coronavirus outbreak, by Tom Bergeron,


H.            Doctors Fear Bringing Coronavirus Home: ‘I Am Sort of a Pariah in My Family’, by Karen Weise,

I.             Washington state nursing home sees nearly 50 employees test positive for coronavirus, by Dom Calicchio,



L.             Duty to Plan: Health Care, Crisis Standards of Care, and Novel Coronavirus SARS-CoV-2, by John L. Hick, Dan Hanfling, Matthew K. Wynia, and Andrew T. Pavia,


PART 15. CORONAVIRUS. March 22, 2020. “…Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration….in a series of exercises that ran from last January to August.

(Hoboken, New Jersey; September 2001)

“Military helicopters and jets were overhead, as President Bush was getting ready to leave. The plumes of smoke from the World Trade Center were still billowing skyward.

Suddenly a huge white military hospital ship with four Red Crosses steamed by and docked right across river. I thought how this hospital ship brought the war even closer to home but mostly about how the hospitals in Hudson County had responded and performed so magnificently.”

“A U.S. Navy hospital ship is expected to head to the Seattle region next week, with the intention of helping to alleviate the strain on the city’s hospital system due to the influx of patients infected by the novel coronavirus.

The USNS Mercy — one of the Navy’s two 1,000-bed hospital ships — will likely leave its homeport of San Diego sometime next week. Meanwhile, the Mercy’s sister ship, the USNS Comfort, will not head to New York harbor from its homeport of Norfolk until early April,due to scheduled maintenance, officials said.” (A)

 “State and healthcare officials in Washington state have begun drafting plans for their worst-case scenario: denying patients complete medical care if the coronavirus overwhelms the health system in coming weeks.

Approximately 280 people were on a three-hour conference call Wednesday, including CMOs and nursing leaders for most of the state’s hospitals and health systems and representatives from the Washington State Hospital Association and state chapter of the American College of Emergency Physicians, the New York TImes reported.

The triage plan, still in progress, will assess factors such as age, health and likelihood of survival in determining who will get access to full care and who will merely be provided comfort care, with the expectation that they will die.

Other considerations leaders shared with the New York Times:

The goal in developing criteria for prioritizing care is to provide fair and evenly applied practices across the region, reducing the likelihood of variation in care depending on which hospital a patient goes to.

Another goal of drafting the plan is to avoid putting responsibility on individual physicians and nurses to make such decisions and reduce the anguish they would experience in denying care.

One leader noted the crisis strategies are not something anyone wants to anticipate, but it would be worse to be unprepared in the event they are needed.” (B)

“We are doing everything we can at the City level to prevent the spread of COVID-19 in all ways possible, including any people unnecessarily coming into Hoboken for a trip that we can’t track and to locations we can’t determine. As of last night, there were surprisingly several dozens of rentals available on Airbnb. All short-term rentals, including Airbnb are now prohibited until further notice in Hoboken, with a new order issued by the Office of Emergency Management. We have informed Airbnb and ask all hosts to remove their listings without delay.”

“Only one retailer, CVS, has opened a drive-through coronavirus testing site so far, but it is limited to only first responders who are referred by government and public health officials.

Walmart and Walgreens said they plan to open test sites in the Chicago area in the next few days.” (C)

“Patients can see a pharmacist at a Kroger Health pharmacy for rapid strep throat and flu testing – effective immediately – according to the company.

A pharmacist will evaluate symptoms of flu-like illness or sore throat, medical history, and conduct an examination. As part of the service, the pharmacist may perform a nasal swab or throat swab collection for a diagnostic test screening for influenza or Streptococcus bacteria (strep throat).

If indicated, pharmacists can also prescribe and supply the appropriate treatment during that same visit, helping decrease the length, severity and spread of illness…

104 Michigan Kroger Health pharmacies will be joining providers at The Little Clinic with the ability to provide this service.

In preparation of this service, about 250 Kroger Health pharmacists received specialized training that allows them to provide strep throat and flu testing at their pharmacies and prescribe medication, if needed.” (D)

“While the novel coronavirus continues to spread in the U.S. — and in Florida — the Florida Legislature voted Wednesday to expand the roles of pharmacists and some nurses to test and treat certain conditions and perform certain acts without the supervision of a physician…

After debate that weighed access with quality of care, the Senate passed two expanded practice bills that have been a top priority of House Speaker José Oliva.

HB 389 allows pharmacists to test and treat patients for the flu and strep throat and also give them authority to treat chronic medical conditions. HB 607, a scaled-back version of Oliva’s wish, allows highly trained advanced practice registered nurses to provide primary care and practice independently of doctors.” (E)

“A temporary field hospital for use by people unable to isolate and recover from COVID-19 in their own homes will be located at a soccer field in Shoreline, a city spokesman said.

The Shoreline Temporary Field Hospital, at 19030 First Ave. N.E., will provide up to 200 beds, according to the city website. It will house “people exposed to, at risk of exposure, or becoming ill with the novel coronavirus.”

“It’s basically to relieve pressure on the hospitals and to free up beds for critical patients,” said Eric Bratton, a city spokesman. The hospital will be on a turf soccer field that is on school district property but is leased by the city, Bratton said.

“My understanding is they’re setting it up now, but they’re not anticipating using it or occupying it for another week or so,” Bratton said.

King County is creating field hospitals at several locations for people who cannot remain in their own homes or do not have a home.” (F)

“The FDA on Feb. 29 loosened diagnostic test restrictions, opening the door for health systems to use their own COVID-19 tests, instead of relying on public health labs or the CDC for testing.

Developing a new diagnostic test usually takes about six months to a year, but microbiologists and other scientists at top health systems have been working around the clock to create new tests for COVID-19 in just about a month.

Here are six health systems that developed their own tests for COVID-19:

1. Rochester, Minn.-based Mayo Clinic developed and validated a COVID-19 test in under a month, Matthew Binnicker, PhD, a clinical microbiologist and director of the system’s Clinical Virology Laboratory, said March 12. The health system submitted its data to the FDA seeking emergency use authorization. Initially, Mayo’s lab will process up to 300 tests a day. The lab said it plans to double that number over the next few weeks after it obtains additional equipment.” (G)

“New Jersey Health Commissioner Judy Persichilli said Thursday the state had a two-part plan to reopen Inspira Medical Center Woodbury in the wake of the coronavirus pandemic, which could happen in 3-4 weeks.

“I told him his task is to empty out the facility and our task as a team is to bring it back up,” Persichilli said, referring to Inspira CEO John DiAngelo. “The first part is for Mr. DiAngelo and his team to move out the existing individuals who are inhabiting that location.”

The hospital closed in December after Inspira opened a newer facility in the Mullica Hill section of Harrison in Gloucester County. The facility currently houses only a satellite emergency department, behavioral health services, and outpatient services including imaging and lab work. It will be able to provide 300 new beds, the commissioner said…

Persichilli said the hospital would not be just for COVID-19 patients but would provide all types of medical services to “absorb the surge” as more patients need to be treated for the virus.” (H)

“Facing a dire shortage of protective face masks for health care workers, administrators at the University of Nebraska Medical Center decided they had no choice.

Masks are certified for one-time use only. But on Thursday, the center began an experimental procedure to decontaminate its masks with ultraviolet light and reuse them. Administrators plan to use each mask for a week or longer.

To the knowledge of the program’s administrators, the medical center is the first to disinfect and reuse masks.

“We have talked with a lot of others around the country who are going after a similar approach,” said John Lowe, the medical center’s assistant vice chancellor for health security training and education, who designed the program.

When administrators made the decision, they knew the procedure violated regulations promulgated by the Centers for Disease Control and Prevention, which said that if masks were decontaminated they could no longer be certified for use.

But late Thursday night, the agency issued new guidance, saying that “as a last resort, it may be necessary” for hospitals to use masks that were not approved by the National Institute for Occupational Safety and Health.

That change would seem to mean it is now acceptable for hospitals to decontaminate and reuse masks during the coronavirus pandemic, said Shawn Gibbs, a professor of environmental health at Indiana University.

If that were not the case, he added, then many hospitals would find themselves in a tightening bind as gear shortages spread: “What is preferred — not using respirator protection equipment, or using a decontaminated respirator whose certification is voided?”” (I)

“Here are 14 notes from hospitals, health systems and physicians on their responses to the coronavirus pandemic.” (J)

“CMS is urging all hospitals to comply with the American College of Surgeons’ recommendation to cancel non-urgent elective procedures amid the COVID-19 pandemic.

However, some hospitals and health systems nationwide have opted to continue some surgeries based on their patients’ needs.

Here’s their thinking:

UC Davis Medical Center (Sacramento)

The major academic medical center cares for a large volume of patients with complex health conditions and surgical needs. The hospital said it is continuing to offer scheduled surgeries for select patients, as the hospital is not yet seeing any surges related to COVID-19. About half of the hospital’s surgical cases for March 19 are oncology- or injury-related. A spokesperson for UC Davis said the hospital is evaluating surgical cases daily to determine which can be rescheduled.

“Although we are the largest hospital in the area, we are not encouraging surgeries, but we are saying to surgeons and their patients that we can accommodate patients’ needs,” the spokesperson told Becker’s. “These surgeries, especially pain-relieving, trauma and cancer-related procedures, are not seen as ‘elective’ by patients. Moreover, we are able to make changes in less than 24 hours, should demands change.” (K)

“These hospitals and physicians aren’t stopping elective surgeries: Here’s their thinking” (L)

“A bipartisan effort is underway to include legislation in the Senate’s $1 trillion coronavirus package that would protect patients from surprise medical bills, The Hill confirmed Wednesday.

A last-minute push from Sen. Lamar Alexander (R-Tenn.) and Rep. Frank Pallone Jr. (D-N.J.) seeks to include language that is favored by insurers, rather than doctors and hospitals, according to sources familiar with the effort.

The provision, similar to what was included in separate bills from the House Energy and Commerce Committee and the Senate Health Committee, would let the government set provider rates based on the average price for in-network services offered in a geographical area, a practice known as “benchmarking.”

Protecting patients from receiving medical bills for thousands of dollars after receiving care from an out-of-network doctor had been seen as a rare area of possible bipartisan agreement this year.

But the effort has been slowed by an array of competing proposals and intense lobbying from doctors and hospitals, who worry it would lead to damaging cuts to their payments. Some conservative groups and lawmakers also argue the approach is akin to government price-setting.” (M)

“Last-minute fighting among lawmakers over the details of a more than $1 trillion economic stabilization package to aid families and businesses devastated by the coronavirus pandemic left the sweeping legislation teetering on the brink on Sunday, with the Republican-controlled Senate pushing ahead toward a vote on the package without a formal compromise with Democrats.

The top four congressional leaders met with Steven Mnuchin, the Treasury secretary, to hash out differences over the package, which remains unfinished after days of rapid closed-door negotiations with administration officials and bipartisan groups of senators.

They emerged without news of an agreement, but indicated that talks would continue even as Senator Mitch McConnell of Kentucky, the majority leader, planned to move forward with an initial procedural vote on the package during a rare Sunday session in the Senate…

But Mr. McConnell said that the leaders “were very close” and “were still talking” after the meeting in his office, which included Senator Chuck Schumer, Democrat of New York, and Representative Kevin McCarthy, Republican of California, the two minority leaders…

Democrats, for their part, continued to push for stronger protections for workers and raised alarms about the scope of some funding levels and programs. Among the concerns, according to Democratic aides, was the size of a Treasury Department fund and the discretion Mr. Mnuchin and his lieutenants would have to decide who would receive those funds, as well as how quickly the administration would have to disclose loans or loan guarantees made to companies and industries.

Democrats have also voiced concerns that the bill does not contain enough barriers to prevent industries from laying off their work forces after receiving federal funds, and are pushing for giving grants instead of loans to airlines.” (N)

“Speaker Nancy Pelosi is hitting pause on bipartisan negotiations on a $1.6 trillion-plus emergency package in the Senate, saying the House will forge ahead with its own bill to address coronavirus after congressional leaders failed to reach a deal earlier Sunday.

Pelosi’s comments come just hours before the Senate is scheduled to take a critical procedural vote on the package aimed at trying to stymie an economic collapse as the coronavirus continues to disrupt massive sectors of the U.S. economy.

“From my standpoint, we’re apart,” Pelosi told reporters as she entered Senate Majority Leader Mitch McConnell’s (R-Ky.) office Sunday morning…

Senior House Democrats have been working on dual tracks for days — simultaneously drafting language for their own bill while also conferring with Senate Democrats on what they’d like to see in the McConnell-Schumer proposal.

The various House panels involved, from Financial Services to Ways and Means, Energy and Commerce and Education and Labor, were told to wrap up their portions of the bill Saturday night. The House Appropriations Committee is now compiling all of the language and legislative text could be expected as soon as Monday, according to multiple sources.

Democratic leadership also huddled on a conference call on Friday night, where Pelosi reiterated her plans to release a legislative framework that lets Democrats lay a marker in the talks.

It’s unclear what exactly will be in the final House Democratic package. The caucus held several hours of conference calls this week for members to promote their ideas, including a significant expansion of unemployment insurance, direct cash payments to Americans under a certain income threshold, funding for hospitals and medical supplies, and grants to keep small businesses from folding. Hundreds of proposals were submitted from all corners of the caucus.

“I’m anxious to see what Speaker Pelosi would put on the table. She needs to be part of this conversation,” said Senate Minority Whip Dick Durbin (D-Ill.) when asked about Pelosi’s plans. “We do have a bicameral Congress and the House of Representatives will ultimately consider whatever is sent to them. And I hope we can have a bipartisan agreement when that’s sent.”

Many of those same provisions are also being negotiated in the Senate bill but some House Democrats wanted to go even further, using the urgency of the herculean package to achieve broader, long term policy goals like a massive infrastructure deal.” (O)

“Restaurants say they need $325 billion in federal assistance. Boeing wants $60 billion. The travel industry has requested $250 billion and manufacturers are seeking $1.4 trillion in loans to deal with the economic devastation being wrought by the coronavirus.

And that’s to say nothing of the casinos, airlines and franchise owners, all of whom have signaled that they, too, will need relief from the federal government to survive.

Then there are the industries and companies that do not immediately come to mind as front-line casualties but are nonetheless lobbying for their causes to be addressed as Congress prepares to allocate $1 trillion or more in response to the crisis.

The prospect of a bailout of a scale without precedent has set off a rush to the fiscal trough, with businesses enduring undeniable dislocation jostling with more opportunistic interests to ensure they get a share.

The sportswear company Adidas is seeking support for a long-sought provision allowing people to use pretax money to pay for gym memberships and fitness equipment — despite the mandatory closure of fitness facilities in many jurisdictions during the outbreak.

Drone makers are urging the Trump administration to grant waivers they have been seeking that would allow them to be used more widely — including to deliver medical supplies or food without risking human contact that could spread the virus.

Movers are requesting $187 million in assistance to make up for revenue lost as a result of a Defense Department order halting moves, while Airbnb is asking Congress to give tax breaks and access to small business loans to people who lost income from a decline in home rentals.

Then there are the pig farmers. They are citing coronavirus in renewing their call for the federal government to expedite foreign worker visas, with an executive at the National Pork Producers Council noting in an email “many Americans have experienced empty meat cases in recent days, as we adapt to the surge in demand.”

While the halls of the Capitol are eerily quiet, lobbyists are burning up the phone lines and flooding email inboxes trying to capitalize on the stimulus bills moving quickly through Congress. President Trump has already signed into law a coronavirus relief package including funds to provide sick leave, unemployment benefits, free coronavirus testing and food and medical aid to people affected by the pandemic.” (P)

“Yet there are lessons to be learned from two places that saw the new coronavirus before we did and that have had success in controlling its spread. Hong Kong and Singapore—both the size of my state—detected their first cases in late January, and the number of cases escalated rapidly. Officials banned large gatherings, directed people to work from home, and encouraged social distancing. Testing was ramped up as quickly as possible. But even these measures were never going to be enough if the virus kept propagating among health-care workers and facilities. Primary-care clinics and hospitals in the two countries, like in the U.S., didn’t have enough gowns and N95 masks, and, at first, tests weren’t widely available. After six weeks, though, they had a handle on the outbreak. Hospitals weren’t overrun with patients. By now, businesses and government offices have even begun reopening, and focus has shifted to controlling the cases coming into the country…

The fact that these measures have succeeded in flattening the covid-19 curve carries some hopeful implications. One is that this coronavirus, even though it appears to be more contagious than the flu, can still be managed by the standard public-health playbook: social distancing, basic hand hygiene and cleaning, targeted isolation and quarantine of the ill and those with high-risk exposure, a surge in health-care capacity (supplies, testing, personnel, wards), and coördinated, unified public communications with clear, transparent, up-to-date guidelines and data. Our government officials have been unforgivably slow to get these in place. We’ve been playing from behind. But we now seem to be moving in the right direction, and the experience in Asia suggests that extraordinary precautions don’t seem to be required to stop it. Those of us who must go out into the world and have contact with people don’t have to panic if we find out that someone with the coronavirus has been in the same room or stood closer than we wanted for a moment. Transmission seems to occur primarily through sustained exposure in the absence of basic protection or through the lack of hand hygiene after contact with secretions.” (Q)

“President Trump on Thursday exaggerated the potential of drugs available to treat the new coronavirus, including an experimental antiviral treatment and decades-old malaria remedies that hint of promise but so far show limited evidence of healing the sick.

No drug has been approved to treat the new coronavirus, and doctors around the world have been desperately administering an array of medicines in search of something to help patients, especially those who are severely ill.

The malaria drugs, chloroquine and hydroxychloroquine, are among the remedies that have been tried in several countries as the virus has spread around the world, killing at least 9,800.

Both drugs have gone into short supply in the United States this month, as word has spread of their potential benefit to coronavirus patients. Manufacturers of the generic products have said they are ramping up production. One company, Teva, said it would donate millions of pills of hydroxychloroquine to hospitals, and another company, Mylan, said it would restart production of the drug.

In a White House briefing Thursday, Mr. Trump said the anti-malaria drugs had shown “tremendous promise.”

“I think it’s going to be very exciting,” he said. “I think it could be a game changer, and maybe not.”” (R)

“The outbreak of the respiratory virus began in China and was quickly spread around the world by air travelers, who ran high fevers. In the United States, it was first detected in Chicago, and 47 days later, the World Health Organization declared a pandemic. By then it was too late: 110 million Americans were expected to become ill, leading to 7.7 million hospitalized and 586,000 dead.

That scenario, code-named “Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration’s Department of Health and Human Services in a series of exercises that ran from last January to August.

The simulation’s sobering results — contained in a draft report dated October 2019 that has not previously been reported — drove home just how underfunded, underprepared and uncoordinated the federal government would be for a life-or-death battle with a virus for which no treatment existed.

The draft report, marked “not to be disclosed,” laid out in stark detail repeated cases of “confusion” in the exercise. Federal agencies jockeyed over who was in charge. State officials and hospitals struggled to figure out what kind of equipment was stockpiled or available. Cities and states went their own ways on school closings.

Many of the potentially deadly consequences of a failure to address the shortcomings are now playing out in all-too-real fashion across the country. And it was hardly the first warning for the nation’s leaders. Three times over the past four years the U.S. government, across two administrations, had grappled in depth with what a pandemic would look like, identifying likely shortcomings and in some cases recommending specific action.

In 2016, the Obama administration produced a comprehensive report on the lessons learned by the government from battling Ebola. In January 2017, outgoing Obama administration officials ran an extensive exercise on responding to a pandemic for incoming senior officials of the Trump administration.

The full story of the Trump administration’s response to the coronavirus is still playing out. Government officials, health professionals, journalists and historians will spend years looking back on the muddled messages and missed opportunities of the past three months, as President Trump moved from dismissing the coronavirus as a few cases that would soon be “under control” to his revisionist announcement on Monday that he had known all along that a pandemic was on the way.” (S)

“Senator Richard M. Burr sold hundreds of thousands of dollars’ worth of stock in major companies last month, as President Trump and others in his party were still playing down the threat presented by the coronavirus outbreak and before the stock market’s precipitous plunge.

The stocks were sold in mid-February, days after Mr. Burr, Republican of North Carolina and the chairman of the Intelligence Committee, wrote an opinion article for Fox News suggesting that the United States was “better prepared than ever before” to confront the virus. At least three other senators sold major stock holdings around the same time, disclosure records show.” (T)

“President Trump said “The FDA Commissioner — Stephen Hahn, who is with us — he’s fantastic.  And he has been working 24 hours a day.  He’s been — he’s worked like, probably as hard or harder than anybody in this — in the group, other than maybe Mike Pence or me.” (U)

ITALY “Our small city has been on lockdown for nearly two weeks. The streets are silent. Many factories are closed. The only people allowed outside are those walking their dogs, heading to the grocery store or those who have permission from the government. A few of our friends are hospitalized from the coronavirus, with many more in quarantine at home. Hundreds of people have died here.

In mid March, we heard that doctors from a nearby hospital didn’t have enough valves for their lifesaving ventilator machines. And the company that produced the valves couldn’t meet the growing demand.

Our company is five years old. We make earthquake sensors, silicone bandages, bicycles — practical stuff. We had never made valves before, but we wanted to help.

We visited the hospital to see the valve, which connects the patient to the breathing machine, mixing pure oxygen with air that enters through a rectangular window. It looks like a chess piece waving one arm and it needs to be replaced for each patient.

We came back to our office and started working, fueled by adrenaline. Our first few attempts didn’t succeed, but eventually we made four copies of the prototype on a small 3-D printing machine that we have in our office.

While the valve might look like a simple piece of plastic, it’s pretty complex; the hole that diffuses the oxygen is less than a millimeter in diameter.

The day after, we returned to the hospital and gave our valves to a doctor who tested them. They worked and he asked for 100 more. So we went back to the office, and returned to the hospital with 100 more. We hoped that this would last them for a few days. Still, the coronavirus rages on. A few hospitals in northern Italy asked us to make copies of the same piece. We are printing them now…

This sparked a second idea: to modify a snorkeling mask already on the market to create a ventilation-assisted mask for hospitals in need of additional equipment, which was successful when the hospital tested it on a patient in need.” (V)

(A)          US Navy hospital ship expected to depart for Seattle next week amid coronavirus pandemic, by Elizabeth McLaughlin,

(B)          Washington healthcare leaders draft statewide plan for care rationing, by Molly Gamble,

(C)          As demand for coronavirus testing grows, Walmart and Walgreens will soon open drive-through sites for first responders, Melissa Repko,

(D)          Kroger Health pharmacies to offer flu, strep throat testing services in Michigan,

(E)          Amid coronavirus, FL Legislature votes to expand roles of pharmacists, some nurses, by SAMANTHA J. GROSS,

(F)          King County to put 200-bed field hospital on Shoreline soccer field amid coronavirus outbreak,

(G)         6 health systems with in-house COVID-19 testing, by Mackenzie Bean,

(H)          Closed N.J. hospital could re-open in a month for coronavirus patients. But it won’t be easy, By Bill Duhart,

(I)           Surgical masks are supposed to be used just once. But doctors in Nebraska are attempting a novel experiment as gear shortages arise, by Gina Kolata,

(J)           Coronavirus, March 20: 14 notes directly from physicians, hospitals, by Kelly Gooch and Mackenzie Garrity,

(K)          Coronavirus, March 20: 14 notes directly from physicians, hospitals, by Kelly Gooch and Mackenzie Garrity,

(L)           “These hospitals and physicians aren’t stopping elective surgeries: Here’s their thinking”, by Mackenzie Bean, Laura Miller and Anuja Vaidya,

(M)        Lawmakers pushing to include surprise medical billing in coronavirus package, by NATHANIEL WEIXEL,

(N)         Coronavirus Live Updates: Trillion-Dollar Stimulus in Doubt as Democrats Press for Changes; Senator Rand Paul Is Infected,

(O)         Pelosi pushes forward with her own emergency coronavirus package, by HEATHER CAYGLE, SARAH FERRIS and MARIANNE LEVINE,

(P)          Coronavirus Stimulus Package Spurs a Lobbying Gold Rush, by Kenneth P. Vogel, Catie Edmondson and Jesse Drucker,

(Q)         Keeping the Coronavirus from Infecting Health-Care Workers, by Atul Gawande,

(R)          With Minimal Evidence, Trump Asks F.D.A. to Study Malaria Drugs for Coronavirus, by Denise Grady and Katie Thomas,

(S)          Before Virus Outbreak, a Cascade of Warnings Went Unheeded, by David E. Sanger,Eric Lipton, Eileen Sullivan, Michael Crowley,

(T)          Senator Richard Burr Sold a Fortune in Stocks as G.O.P. Played Down Coronavirus Threat, by Eric Lipton and Nicholas Fandos,

(U)         Remarks by President Trump, Vice President Pence, and Members of the Coronavirus Task Force in Press Briefing,

(V)          We Made Copies of Ventilator Parts to Help Hospitals Fight Coronavirus, by Cristian Fracassi and Alessandro Romaioli,




“A SEVERE FLU PANDEMIC… could kill more than 33 million people worldwide in just 250 days.” – “Boy, do we not have our act together.” — Bill Gates”. (J)

EBOLA. PART 13. Ebola Treatment Centers are having difficulty maintaining their ability to respond to Ebola cases that may come again to the U.S.

PART 4. CANDIDA AURIS. “.. nursing facilities, and long-term hospitals, are…continuously cycling infected patients, or those who carry the germ, into hospitals and back again.”

Tomorrow morning’s Emergency Preparedness meeting (just scheduled for 8AM,

“we are not finished with Zika… It very well could come back.” Are we ready?

Hospitals are developing their own Zika preparedness models. Compare the Central Florida and Johns Hopkins approaches! Which template makes more sense?

We don’t know what we don’t know” (1) The challenge to emergency preparedness…..,

You are Chief Preparedness Officer at Chiang Rai Region General Hospital in Thailand waiting for the twelve boys and their coach trapped in a cave

Doctor, Did You Wash Your Hands?® There is a sign in my primary care provider’s examination room:

“Raw” Curated Contemporaneous Case Study Methodology by Jonathan M. Metsch, DR.P.H.



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