From Health and Fitness

Policías usan balas de goma que pueden matar, cegar o mutilar de por vida

En ciudades de todo el país, los departamentos de policía han tratado de frenar los disturbios provocados por la muerte de George Floyd disparando balas de goma a las multitudes, a pesar de que cinco décadas de evidencia muestran que estas armas pueden incapacitar, desfigurar e incluso matar.

Además de las balas de goma, que generalmente tienen un núcleo de metal, la policía ha usado gases lacrimógenos, granadas explosivas, gas pimienta y proyectiles para controlar a las multitudes de manifestantes que demandan justicia para George Floyd, de 46 años, quien murió después que un oficial de policía de Minneapolis se arrodillara sobre su cuello, mientras otros oficiales lo sostenían.

Algunas manifestaciones pacíficas se han vuelto violentas, con personas rompiendo ventanas, incendiando edificios y saqueando tiendas.

El uso de balas de goma por parte de la policía ha provocado indignación, con imágenes gráficas en las redes sociales mostrando a personas que perdieron un ojo o sufrieron otras lesiones después de recibir el impacto.

Un estudio publicado en 2017 en el British Medical Journal encontró que el 3% de las personas impactadas por balas de goma murieron a causa de la lesión. El 15% de las 1,984 personas analizadas sufrieron lesiones permanentes por estas, también conocidas como “proyectiles de impacto cinético”.

Las balas de goma deben usarse solo para controlar “una multitud extremadamente peligrosa”, dijo Brian Higgins, ex jefe de policía del condado de Bergen, Nueva Jersey.

“Dispararlas en multitudes abiertas es imprudente y peligroso”, dijo el doctor Douglas Lazzaro, profesor y experto en trauma ocular en la NYU Langone Health.

La última semana de mayo, una abuela en La Mesa, California, fue hospitalizada en una unidad de terapia intensiva después de recibir el impacto de una bala de goma entre los ojos. El actor Kendrick Sampson dijo que sufrió el impacto de siete balas de goma en una protesta en Los Ángeles.

En Washington, DC, la Guardia Nacional supuestamente disparó balas de goma el lunes 1 de junio para dispersar a los manifestantes pacíficos cerca de una iglesia histórica donde el presidente Donald Trump después se sacó una foto.

En una declaración, el Fiscal General William Barr defendió las acciones de los agentes de la ley locales y federales en Washington, diciendo que habían “hecho un progreso significativo restaurando el orden en la capital de la nación”.

Barr no mencionó el uso de gas lacrimógeno o balas de goma.

La fotógrafa independiente Linda Tirado dijo que fue cegada por una bala de goma en una protesta en Minneapolis.

En un correo electrónico, el vocero del Departamento de Policía de Minneapolis, John Elder, dijo: “Utilizamos balas de espuma menos letales, de 40 mm. No usamos balas de goma”.

Elder no mencionó la marca de estas balas de espuma. Pero un sitio web las describe como proyectiles que son “una solución excelente si necesita incapacitar a un solo sujeto o controlar una multitud”.

Nadie sabe con qué frecuencia la policía usa balas de goma, o cuántas personas sufren daños cada año, dijo el doctor Rohini Haar, profesor de la Escuela de Salud Pública de la Universidad de California-Berkeley y experto médico de Physicians for Human Rights. Muchas víctimas no van al hospital.

La policía no está obligada a documentar su uso, por lo que no hay datos nacionales que muestren con qué frecuencia se usan, dijo Higgins, ahora profesor adjunto en el John Jay College of Criminal Justice en Nueva York. No existen estándares nacionales para su uso.

Cuando apuntan a las piernas, las balas de goma pueden evitar que una persona peligrosa o una multitud se acerque a un oficial de policía, dijo Lazzaro.

Pero cuando se dispara a corta distancia, pueden penetrar en la piel, romper huesos, fracturar el cráneo y hacer explotar el globo ocular, dijo. Las balas de goma pueden causar lesiones cerebrales traumáticas y “heridas abdominales graves, incluidas lesiones en el bazo y el intestino junto con los principales vasos sanguíneos”, dijo el doctor Robert Glatter, médico de emergencias en la ciudad de Nueva York y vocero del Colegio Estadounidense de Médicos de Emergencia.

Disparar balas de goma a distancia disminuye tanto su fuerza como su precisión, lo que aumenta el riesgo de disparar a las personas en la cara o impactar en los transeúntes, dijo Lazzaro.

Physicians for Human Rights, un grupo de defensa sin fines de lucro con sede en Nueva York, ha pedido que se prohíban las balas de goma.

El ejército británico desarrolló balas de goma hace 50 años para controlar a los manifestantes nacionalistas en Irlanda del Norte, aunque el Reino Unido dejó de usarlas hace décadas.

Las fuerzas de seguridad israelíes utilizan balas de goma contra manifestantes palestinos. La policía francesa fue criticada por usar balas de goma el año pasado después que docenas de manifestantes resultaran heridos.

“Las balas de goma se usan casi todos los días en algún lugar del mundo”, dijo Haar. “Usarlas contra civiles desarmados es una gran violación de los derechos humanos”.

Según Physicians for Human Rights, muchas armas policiales consideradas “menos que letales” pueden causar graves daños.

  • Las armas acústicas, como los cañones que hacen ruidos muy fuertes, pueden dañar la audición.
  • El gas lacrimógeno puede dificultar la visión y la respiración.
  • El spray de pimienta, aunque es doloroso e irritante, no causa daños permanentes, dijo Lazzaro.
  • Las bolas de spray de pimienta, que se han utilizado para sofocar protestas recientes, pueden ser mortales cuando se usan incorrectamente. En 2004, una mujer de Boston de 21 años fue golpeada en el ojo y asesinada por un gránulo de gas pimienta disparado por la policía para dispersar a las multitudes que celebraban la victoria de la Serie Mundial de la ciudad.
  • Los dispositivos de desorientación que crean ruidos fuertes y luces brillantes, conocidos como granadas de conmoción cerebral o explosiones repentinas, pueden causar quemaduras graves y lesiones, incluido daño al tímpano. Las multitudes que corren por pánico pueden causar lesiones por aplastamiento.
  • Los cañones de agua pueden causar lesiones internas, caídas e incluso congelación si el clima es frío.
  • La fuerza física, como golpear a alguien para controlarlo, hace que aproximadamente 1 de cada 3 personas sean hospitalizadas, dijo el doctor Howie Mell, vocero del Colegio Americano de Médicos de Emergencia y ex médico táctico, que trabajó con los equipos SWAT.

Las balas de goma son menos dañinas que someter a las personas por “fuerza física o balas normales”, dijo Mell. “Pero en estos días se están disparando mucho más de lo que se suelen disparar”.

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Noticias En Español Public Health States

Contact Tracing Could Be Much Easier — but There Are Tradeoffs

The handshake came first. Then the high-five, fist bump and more recently, the elbow touch. Canadian researchers are now working on a new greeting, the CanShake.

It is not a mere salutation. The CanShake — which involves people shaking their phones at each other upon meeting to transmit contact information — is one of many emerging concepts seeking to use smartphones to do mass contact tracing to track and contain the spread of Covid-19. All involve harnessing common consumer technology to log people’s location or movements and match it against the location of people known to be sick.

There are dozens of versions, many already in practice around the world, including in South Korea, Singapore, China, Italy and Israel. But in the United States, privacy concerns and absence of national policy have made the approach slower to catch on.

Efforts are piecemeal. Google and Apple have a partnership underway to develop software for smartphones that would enable them to continuously log information from other devices. The MIT Media Lab has built contact tracing technology too. Three states — Alabama, North Dakota and South Dakota — have said they have deployed or are developing apps for tracking the virus.

The experimentation is happening as states, counties and cities are working to train people for the traditional, more arduous approach to contact tracing.

“There’s an army of contact tracers being hired. Technology can make this much more efficient,” said Dr. Gunther Eysenbach, editor of the Journal of Medical Internet Research, who is developing the CanShake.

George Rutherford, an epidemiologist at the University of California, San Francisco who is leading training of 10,000 California contact tracers, said digital ideas are bubbling up. “We’ve gotten several hundred people who want to show us their stuff,” he said.

But he said, they rely on smartphones, and some lower-income people most at risk from Covid-19 don’t have them.

ImageA contact tracing app being pushed by the governors of North and South Dakota was found to violate its own privacy policy
A contact tracing app being pushed by the governors of North and South Dakota was found to violate its own privacy policyCredit…Stephen Groves/Associated Press

The traditional method of contact tracing is time consuming and labor-intensive. It takes about 90 minutes for each case, Dr. Rutherford said — 60 minutes to interview the person who tests positive and 30 minutes to call or send texts to all the people the sick person remembers being in contact with.

Whatever the technology, there are trade-offs among the major ways that the information can be shared, stored and communicated: geolocation, Bluetooth and QR codes.

Geolocation

This software typically runs in the background on phones to help with location services like Google Maps. It can track people to within about 10 meters of their location, and be turned on and off voluntarily.

However, in other countries this technology has worked partly because it has been used automatically, with governments taking the data without asking permission.

After 3,000 people from the Diamond Princess cruise ship disembarked in Taiwan in late January — some of whom were later found to be infected — the Taiwanese government tapped into geolocation data of individual cellphone users to look for contacts between its citizens and the passengers.

The technology found 627,386 residents of Taiwan who had been in the vicinity of the passengers, whose own location data was also taken using other surveillance methods: the busses they took, the locations where they used credit cards, security-camera footage and their phone data.

Image
German soldiers in Berlin in April tried out an app that promised to show if someone nearby had tested positive for coronavirus.Credit…/EPA, via Shutterstock

Those residents all received text messages and were offered tests if they exhibited symptoms. Of 67 people tested, none were positive. Dr. Eysenbach, who is an author of a paper on the test, said it was effective but “did not require informed consent” and “would in the Western world be perceived as very privacy invasive.”

A report called “Apps Gone Rogue,” published in April by the MIT Media Lab, found that many international versions of contact-tracing technology “expand mass surveillance, limit individual freedoms and expose the most private details about individuals.”

That said, use of geolocation software doesn’t have to invade privacy, partly because it can be turned off by a user who knows he or she might be monitored. It also is possible to build applications that do not allow movement history to be accessed by outside sources, said Ramesh Raskar, an associate professor at the MIT Media Lab.

Bluetooth

Bluetooth, the technology that your phone uses to communicate with other devices, can connect people to within one meter of one another and thus is more precise than geolocation technology. But it potentially creates privacy risk given that very precision.

The MIT Media lab has developed a contact-tracing concept that could use Bluetooth or geolocation technology in ways its developers say would not compromise individual liberties.

Safe Paths runs in the background of a person’s phone — with his or her permission — creating and storing a history of movements. If a person tested positive, that individual’s history would be downloaded to a database. After that, other people who used the service could run checks to see if their own movements had intersected with someone who tested positive — “completely private,” Mr. Raskar said, likening the idea to someone checking for rain without having to reveal his or her location.

The project is being developed with input from the Department of Health and Human Services, Harvard University and the Mayo Clinic. Mr. Raskar said several countries and 15 cities and states had expressed interest to MIT in the technology, but declined to identify them.

Image
Singapore’s contact-tracing app, TraceTogether, uses Bluetooth to supplement the country’s efforts to track and monitor coronavirus cases.Credit…Catherine Lai/Agence France-Presse — Getty Images

Apple and Google also use Bluetooth to let jurisdictions develop contact-tracing apps.

The companies’ technology offers privacy protections and is “a good-faith effort,” said Gaurav Laroia, a lawyer for Free Press, a nonprofit that is part of a consortium that includes the American Civil Liberties Union. The larger issue, though, he said, is whether people will choose to download these apps.

Bluetooth is also the technology behind the CanShake, an app in early development. When two people were near each other, they would shake their phones at each other to trigger a passing of their contact information through a Bluetooth connection. The data would be logged in each phone. Then, if either person got sick, the information could be downloaded by the authorities, who would — with the user’s permission — warn those in the contact log.

  • Frequently Asked Questions and Advice

    Updated June 2, 2020

    • Will protests set off a second viral wave of coronavirus?

      Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.

    • How do we start exercising again without hurting ourselves after months of lockdown?

      Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.

    • My state is reopening. Is it safe to go out?

      States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.

    • What’s the risk of catching coronavirus from a surface?

      Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

    • What are the symptoms of coronavirus?

      Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

    • How can I protect myself while flying?

      If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

    • How many people have lost their jobs due to coronavirus in the U.S.?

      More than 40 million people — the equivalent of 1 in 4 U.S. workers — have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.

    • Should I wear a mask?

      The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.

    • What should I do if I feel sick?

      If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.


“The idea is to replace the handshake with the CanShake. It alludes to the idea that you ‘can shake’ again — not your hands but with your phone,” Mr. Eysenbac said.

QR codes

When coronavirus cases surged in South Korea this winter, hospitals there asked people seeking tests or treatment to answer questions on their phones before arriving, including whether they had a fever or cough. After completing the responses, each person was sent a QR code to their phone.

When the person arrived at the hospital, a scanner captured the code and the individual’s information and the person was directed to get a Covid-19 test or not.

Initially, this was seen as a way to process people without paperwork, said Dr. Ki Mo-ran, a professor at the National Cancer Center Graduate School of Cancer Science and Policy.

Image
QR technology in Mudanjiang, northeastern China, in April.Credit…Agence France-Presse — Getty Images

Now, the country is considering expanding the use of QR codes. In May, Dr. Ki met with Prime Minister Chung Sye-kyun to recommend expansive use of the technology for contact tracing. In an interview, Dr. Ki said she described how it would scan visits by people to larger gatherings at restaurants, churches and night clubs, for example.

The proposed expansion of this technology was prompted, she said, by an outbreak that began in a nightclub. The government’s policy at the time was that visitors to such gatherings were required to sign in and leave their contact information.

But she said that 30 percent of the visitors to the nightclub could not be found because there was such a rush of people that not everyone gave information or partial data that could not be traced.

Under the new rules, she said, “people would generate a QR code, rather than writing down” their information. That code would be scanned when they entered and the information “would be connected to the government,” which, in the event of outbreak, could look for intersections between the sick and those nearby.

The government is exploring this idea of a “digital visitors list,” for a six-month test at nightclubs, restaurants and bars. The government would collect the data but would delete it after four weeks if it was not needed to trace an outbreak.

The report from MIT Media Lab noted that one source of abuse from all three technologies was that governments broadcast the location of people who were infected. Singapore published maps designating whereabouts of infected citizens while Korea sent text messages about their locations. It didn’t identify people by name, the report said, but it noted that divulging locations was still “making these places, and the businesses occupying them, susceptible to boycott, harassment, and other punitive measures.”

Dr. Ki acknowledged that privacy was a critical concern, but cautioned that protecting public health may be worth trade-offs. “Privacy is a very important issue,” she said, “but nowadays even though we try to protect personal privacy, it’s very critical to save the community, so we have to find the very appropriate balance.”

How to Normalize the College Search Process for Juniors

Carly Ross, an 11th-grader at Evanston Township High School outside of Chicago, had planned to take the ACT for the first time in April after completing a 10-week prep course over the winter. When the April test date was canceled because of the coronavirus pandemic, she signed up for one in June.

Last week, the ACT canceled the June administration at two-thirds of testing locations nationwide, including at Carly’s school. She’s holding out hope to take the test in July.

“It’s adding so much stress to the process because now the ACT is talking about an online test, which is something I haven’t prepared for,” she said. “This isn’t how I expected my college search to unfold at all.”

She’s certainly not alone. The college search process, challenging even under normal circumstances, looks more daunting than ever to today’s high school juniors, thanks to Covid-19.

After spending a year inside three admissions offices to research a forthcoming book on the selection system at top-ranked schools, here are some things I found that the Class of 2021 can do to bring a sense of normalcy to their college search in the months ahead.

Control what you can.

“Students can’t do anything this year about canceled tests, or how their high school is treating grades, or a missed track season,” said Hannah Wolff, the college and career-center specialist at Langley High School in Northern Virginia. “But they can get started on writing essays or compiling information for their applications. Students should concentrate on what they can still do.”

Ms. Wolff suggested juniors whose summer plans fell through because of the coronavirus shutdowns instead use their time to broaden their college list beyond the narrow set of eight to 10 schools at a similar level that students typically settle on. One reason to expand your list to include a wider mix of colleges is that many schools are only now considering revisions to their admissions policies and deadlines, given the uncertainty over ACT/SAT testing dates. In a year when the admissions process is especially unpredictable, a student considering selective schools should also look at three or four lower in the rankings that might be more flexible on academic requirements and give more financial aid because they need to fill seats.

Also, concerns over a possible second wave of the virus causing future shutdowns may make it more appealing to some families to look at colleges closer to home. And with the widespread economic impact of the coronavirus, students’ financial circumstances might change, resulting in more applicants to less expensive state schools or those colleges that offer a boatload of merit aid.

Applying to a broader mix gives you more options when you need to choose a school after decisions start rolling in.

Consider skipping the ACT/SAT.

The College Board added a test date in September, in addition to its August and October dates, and gave priority registration for all three to juniors who never had the chance to take the SAT. But whether the ACT/SAT will be able to administer their tests this fall or offer the usual capacity in an era of social distancing remains unclear. On Tuesday, the College Board announced it was postponing plans to offer a remote SAT this year, saying it “would require three hours of uninterrupted, video-quality internet for each student, which can’t be guaranteed for all.”

So, what should juniors do who still haven’t taken a test? “Normally, I’d suggest students prepare for the tests, unless they’re not a good test taker,” said Brennan Barnard, director of college counseling at the Derryfield School in New Hampshire and co-author of “The Truth About College Admission.” “But this year, students should definitely question whether it’s worth it with the number of schools that have gone test optional.”

Test-optional means that applicants can submit test scores if they want to, but it won’t hurt their chances of admission if they don’t. A handful of selective colleges enacted test-optional polices in the wake of the coronavirus pandemic — some temporarily for the Class of 2021, such as Columbia University, the University of Washington and Boston University; others as part of a three-year experiment, including Davidson College and Tufts University. The University of California also suspended testing requirements for the Class of 2021, and last month agreed to phase out the ACT/SAT altogether for in-state residents over the next few years (the system will decide on out-of-state applicants later on).

You might not have an ACT/SAT score, but you probably have a PSAT score that gives you a sense of how you perform on a standardized test. If you have solid grades from taking a strong curriculum in high school, but a subpar PSAT score for the set of schools you’re considering, you might consider looking to the growing number of test-optional schools rather than wait on in-person ACT/SAT tests that might never happen.

Go beyond the virtual campus tour.

When you go on a campus tour in person, “you hear the great stuff, and the not-so-great stuff just by being there,” said Mark Butt, director of undergraduate selection at Emory University. “Now you have to actively seek that experience in virtual tours.”

Online information sessions and phone calls with admissions counselors are useful, but students should go beyond the channels that the colleges control. Scroll through topic pages on Reddit, such as r/applyingtocollege, or watch YouTube videos recorded by students talking about how they applied to college or “day in the life” videos showing you what life is really like on their campuses.

Don’t just sit around this summer.

Summer jobs have disappeared for many teenagers, as have many summer activities and sports. But that shouldn’t be an excuse to play video games in your bedroom or make TikTok videos all day.

In a sea of applications that often look numbingly similar, admissions officers often look for something that stands out — an eclectic combination of classes, for instance, or an activity that has meaning rather than just another sign-up club.

“Use this time to do something that you haven’t had a chance to do before,” Ms. Wolff said. “Some of my students have learned how to play the guitar online or took up knitting during the pandemic.”

Such activities show admissions officers that students see the challenge of the pandemic as an opportunity to broaden their skills or create something new — such as making masks for front-line workers or organizing a food drive — rather than see learning as something fixed by their schools.

  • Frequently Asked Questions and Advice

    Updated June 2, 2020

    • Will protests set off a second viral wave of coronavirus?

      Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.

    • How do we start exercising again without hurting ourselves after months of lockdown?

      Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.

    • My state is reopening. Is it safe to go out?

      States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.

    • What’s the risk of catching coronavirus from a surface?

      Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

    • What are the symptoms of coronavirus?

      Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

    • How can I protect myself while flying?

      If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

    • How many people have lost their jobs due to coronavirus in the U.S.?

      More than 40 million people — the equivalent of 1 in 4 U.S. workers — have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.

    • Should I wear a mask?

      The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.

    • What should I do if I feel sick?

      If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.


Make senior year relevant.

With many high schools offering classes pass/fail this spring, colleges don’t have the usual grades to consider. They might look more closely at senior year schedules to see how applicants challenged themselves. If students feel they aren’t ready to move on to the next level of a subject because their spring was upended, they should use the summer to brush up with online courses.

“Schools might be more flexible, but that doesn’t mean it will be suddenly easier to get into a selective school,” Ms. Wolff said. “They’ll still have high expectations.”

Write about the coronavirus, maybe.

The Common Application, which is used by nearly 900 colleges, has added a question that allows students to explain how Covid-19 affected their education or personal lives. But should students also write their personal essays about the crisis? In other words, how much Covid-19 is too much?

If the pandemic had a far-reaching impact on your life, writing about it is a “a great way to glean what you missed, did not miss, made time for, or found ways to continue to pursue, even when it was taken away in the traditional sense,” said Rick Clark, director of undergraduate admission at Georgia Tech.

But be sure to bring to the essay the same level of details and specifics that admissions officers expect when an applicant writes about anything that has shaped their life. And remember, the essay is very rarely the thing that helps get an applicant in anyway.

Over all, “juniors should think about what they miss most about high school right now,” said Mr. Barnard. “What do you miss about the relationships with teachers, the classes, the activities, and then translate that into what you’re looking for ultimately in a college.”

Jeffrey Selingo is the author of the forthcoming book “Who Gets In and Why: A Year Inside College Admissions.”


A Beacon of Possibility for Your Time Indoors

Welcome. I was talking to my colleague Kim Severson a few days ago about the strange rhythms of our lives before the coronavirus came, weeks cut up by work trips, a lot of nights away from home.

“Do you miss hotel life?” she asked.

I thought about it for a minute before responding, “I do, actually.”

And I do. I miss the empty neatness of the rooms in the business-travel hotels in which I usually stay, the views over parking lots with mountains in the distance, or a working river, a shimmery desert highway, a shadowed street. I miss the scratchy sheets and thin pillows and slowpoke internet access and the taste of lobby coffee I get on the way to the car. I miss learning things in new places. I miss going.

[Like this newsletter? Sign up to receive it in your inbox.]

Increasingly, that work is happening again, albeit with an abiding sadness, as some of my colleagues bear personal witness to the unrest that is gripping the nation even as the pandemic still swirls. And they are not alone. A lot of people are not at home any longer, not all the time. Some are in the streets, marching, kneeling, gathering close. Others are working, or heading out to trailheads, or eating in restaurants, or swimming hard at the local pool. Some are doing both. The specter of Covid-19 has changed a great deal for all of us, but not that: the enduring desire to connect, in public, with those we love and with those with whom we disagree.

But At Home remains: a beacon of possibility for those hours when you’re sheltered alone or with family, socially-distanced, keeping safe with clean hands. And there are still a lot of those hours. There will be for some time to come. Our best ideas for how to live a full and cultured life in a pandemic appear below. We publish more every day on At Home. Please visit.


How to deal.

ImageYuval Ben-Ami and Elisha Baskin, standing in the rear, at their home in the Luberon region of France. Ms. Baskin gave her husband a birthday party in mid-May, and told the guests that it would be held outdoors. As the festivities became more relaxed, party-goers moved inside.
Yuval Ben-Ami and Elisha Baskin, standing in the rear, at their home in the Luberon region of France. Ms. Baskin gave her husband a birthday party in mid-May, and told the guests that it would be held outdoors. As the festivities became more relaxed, party-goers moved inside.Credit…Avikam Perry

What to eat.

Image
Credit…Linda Xiao for The New York Times
  • Samantha Seneviratne has a strawberry pie, above, that stays out of the way of its peak season fruit, with an end result that will remind you of strawberry shortcake.

  • With all of the talk about sourdough starter and intricate desserts, you may be surprised to find out that the hapless cooks among us are struggling with rising to the challenge of cooking their own meals.

  • And Melissa Clark continues to find solutions where other people only see problems. She perfected grilled salmon, and raided her pantry to plan recipes for banana scones, an Irish colcannon and a farro bean salad.


How to pass the time.

Image
Credit…The New York Times
  • You can get absolutely lost in “The Gross Clinic” by Thomas Eakins, above, but Jason Farago provided a road map.

  • In a time filled with difficult conversations, few directors can tap into emotion better than Spike Lee, which makes A.O. Scott’s starter guide to Lee’s films a must read.

  • And there are few better resources for tips, distractions and advice than our reporters, many of whom have added to our growing collection of Google Docs.


Like what you see?

You can always find much more to read, watch and do every day on At Home. And you can email us: athome@nytimes.com.

What’s the Future of Group Exercise Classes?

During 24 days in February and March, 112 people were infected with the Covid-19 virus in South Korea after participating in or associating with participants in Zumba classes, according to a sobering new epidemiological study published in Emerging Infectious Diseases.

The study, which traces the start of the illness cluster back to a one-day instructor workshop held in mid-February, raises crucial questions about the risks of infection during group exercise classes and whether and how such workouts might be made safer.

Across the country, fitness facilities are reopening now after lengthy closures because of the coronavirus, prompting some predictable concerns among members about safety. Recently, I wrote about ways to minimize infection risks at gyms if you are weight training or using exercise machines, like treadmills.

But, by their nature, group exercise classes could present unique and daunting challenges to infection control, as the new South Korean investigation suggests. In that study, epidemiologists affiliated with Dankook University College of Medicine in Cheonan report that they became aware in late February of a new, confirmed coronavirus case in Cheonan, a populous city about 50 miles south of Seoul, the nation’s capital.

By tracing that person’s contacts and following up on other newly confirmed cases in the city, the researchers discovered that the common thread connecting the infections was Zumba. Popular in South Korea, these fast-paced dance classes are prolonged — lasting for close to an hour — often crowded and punctuated by instructors’ shouts and participants’ heavy breathing.

Digging farther, the scientists tracked the earliest, precipitating coronavirus cases to a Zumba instructor-training course held on Feb. 15 in Cheonan. Of the 27 newly minted Zumba teachers attending, eight later tested positive. But in the meantime, they taught classes, without wearing masks and, in a few instances, while coughing.

Within about a week of participating, 54 of their 217 students tested positive, for an “attack rate” of about 25 percent. (An attack rate represents the percentage of people exposed who become infected.) Soon afterward, more than a dozen of the students’ and teachers’ family, friends and acquaintances also tested positive. All told, 112 cases were traced to indoor dance classes at 12 different gyms. Most of the resulting illnesses were not severe, but some led to pneumonia.

“It is thought that hyperventilation caused by severe exercise in a confined space may be the reason for the extremely high attack rate,” says Dr. Ji-Young Rhee, a professor at Dankook University College of Medicine and senior author of the new study.

But if those findings sound concerning, the data did contain some bright spots. The epidemiologists uncovered zero cases resulting from classes with fewer than five students per session or from low-intensity yoga or Pilates classes, even if they were taught by an infected instructor.

Over all, the study offers both cautions and guidance for anyone considering an in-person return to dance, yoga, boot-camp or similar group exercise classes, both the authors and other experts agree. “Exercising in a gym will make you vulnerable to infectious disease,” Dr. Rhee says. But limiting class sizes and sticking with low-intensity exercise, which entails little heavy respiration, might help to lessen viral transmission.

Proper air circulation also is essential, says Linsey Marr, a professor of civil and environmental engineering at Virginia Tech University, who studies airflow. She was not involved with the South Korean study but read it at my request. “I have actually thought about this issue a lot,” she says, “because I’m an avid CrossFitter and I want to get back to my routine. But I think indoor exercise classes can be conducted safely only if there is sufficient ventilation with outdoor air, not recirculated air.”

  • Frequently Asked Questions and Advice

    Updated June 2, 2020

    • Will protests set off a second viral wave of coronavirus?

      Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.

    • How do we start exercising again without hurting ourselves after months of lockdown?

      Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.

    • My state is reopening. Is it safe to go out?

      States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.

    • What’s the risk of catching coronavirus from a surface?

      Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

    • What are the symptoms of coronavirus?

      Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

    • How can I protect myself while flying?

      If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

    • How many people have lost their jobs due to coronavirus in the U.S.?

      More than 40 million people — the equivalent of 1 in 4 U.S. workers — have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.

    • Should I wear a mask?

      The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.

    • What should I do if I feel sick?

      If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.


To reduce infection risks from airborne virus particles, she says, the current recommendation for airflow calls for about 10 liters of outdoor air per second, per person in the room. In practice, the more people in an exercise class, the more outside air needs to be flowing in and out. If you are returning to the gym or workout studio, ask your facility’s manager about their ventilation system. If the air-conditioning system does not draw in air from outside, request that the staff open all available windows and doors.

Social distancing remains necessary, too, which means class sizes almost certainly will need to be smaller than they might have been in the past. “Relatively large numbers of participants, all breathing heavily in a small space, provides ideal conditions for viral spread,” says Alexandro Andrade, a professor of exercise science at the State University of Santa Catarina in Brazil, who studies the effects of air quality on health and physical performance.

Masks or other facial coverings are likely to be required during classes, depending on local regulations or facility rules, and should be encouraged everywhere, Dr. Andrade says.

Moving group classes outside, too, if possible and practical, could bolster natural air flow, widen interpersonal spacing and drench the class in sunlight, he says. But avoid outdoor classes if they are conducted between high walls or buildings, since those bulwarks prevent the breeze from dispersing people’s expired breaths.

Hype Collides With Science As FDA Tries To Rein In ‘Wild West’ of COVID Blood Tests

“Save your business while saving lives,” reads the website of Because Health, a Seattle tech startup selling two types of tests to employers willing to pay $350 a pop to learn whether their workers have been infected with COVID-19.

The “Workplace Health” plan includes not only nasal swab tests to detect infection, but also blood tests aimed at indicating whether workers have developed antibodies to the virus — and, possibly, future protection.

“There’s a tremendous consumer demand,” said Dr. Lars Boman, the Boston-based medical director for the firm. “Can they return to work? Can they return to life?”

What the website does not make clear, however, is that public health officials have explicitly warned that antibody tests should not be used to make decisions about workplace staffing.

“This is a personal choice of the business, of the consumer,” Boman said.

Across America, untold numbers of employers, employees and ordinary citizens are turning to a slew of sometimes pricey new COVID-19 blood tests. Knowing who’s already been infected could have important implications for understanding the spread of the disease, scientists say. But serious questions about the accuracy of some of the serology tests — and the usefulness of the results they provide — have prompted the federal Food and Drug Administration to try to rein in what several infectious disease experts described as “the wild, wild West” of antibody testing.

“It does look as if companies sprang up overnight both importing these tests and distributing them,” said Dr. Michael Busch, director of the nonprofit Vitalant Research Institute in San Francisco. “It’s outrageous that people were trying to make money off of this fear.”

More than 200 tests have flooded the market in a matter of weeks, promising to detect antibodies, which are proteins that develop in the blood as part of the body’s immune response to an invading virus. These are different from the molecular tests, typically done with nasal swabs, used to diagnose infection.

As of June 1, only 15 antibody tests had received FDA “emergency-use authorizations,” which allow tests that haven’t been fully vetted to be used in a crisis. Even that standard has become a selling point for some large companies, such as LabCorp and Quest Diagnostics, which emphasize that they rely on tests that have received the FDA nod.

In late May, the FDA removed more than 30 serology tests from a list of commercially available kits, saying they “should not be distributed” for sale. Removal could result from a manufacturer not submitting an emergency-use authorization request within a “reasonable period of time,” or if the test shows “significant problems” that cannot be or have not been addressed in a timely manner, the agency said. The manner of enforcement remains unclear.

Last month, the CDC issued new guidelines warning that, given the low prevalence of the virus in the general population, even the most accurate tests could be wrong half of the time.

“Serologic test results should not be used to make decisions about grouping persons residing in or being admitted to congregate settings, such as schools, dormitories, or correctional facilities,” the guidelines state. “Serologic test results should not be used to make decisions about returning persons to the workplace.”

Such tests are most useful for understanding the epidemiology of the virus, not for making individual decisions, said Dr. Mary Hayden, director of the division of clinical microbiology at Rush Medical Laboratories in Chicago. Even the best tests can’t yet answer the crucial question about whether antibodies confer immunity from future COVID infections, Hayden said.

“The best possible scenario is that people get infected and they have protective immunity for a long time,” she said. “That would be awesome. But we just don’t have that right now.”

But a plethora of tests being pitched to consumers explicitly promise results aimed at allowing a return to work, school and other social arenas.

The tests offered by Because Health are among hundreds churned out since March, ranging from those offered by commercial labs and academic research centers to small developers seeking a toehold in the lucrative market spurred by a global pandemic. Because Health is using two antibody tests in tandem, one of which received emergency-use authorization on May 29; the other is still pending.

Anders Boman, the son of the medical director and co-founder of Because Health, said that until the COVID crisis occurred, the company, which launched in Seattle last year, was focused on “a niche of integrative care and sexual health,” including hormone treatments for men and women.

“Consumers are not concerned about sexual health right now,” Boman said, explaining the change in focus. “They’re concerned about how to get back to work, how to return to normal and are they safe?”

The FDA normally follows a stringent approval process for tests to detect diseases, often a costly effort that can take months or years. That typically requires independent validation of the accuracy of the tests. But after being criticized for the fumbled rollout of diagnostic tests during the start of a global pandemic, the FDA swung hard in the other direction, waiving its usual requirements and letting firms rush self-validated tests into the market.

“They sort of relaxed all regulatory oversight,” Hayden said.

Several experts interviewed by Kaiser Health News said the FDA faced tremendous political pressure to make antibody tests available.

“It was really a single pressure — and that was the fact that the original inability to get a [diagnostic] test on the market in the U.S. as the outbreak escalated means they were trying to do basically everything they could to get these out,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

The relaxed rules drew concern from Congress, where a subcommittee of the Committee on Oversight and Reform detailed the FDA’s failure to “police the test market.” Groups such as the Association of Public Health Laboratories also raised questions. Scott Becker, the APHL’s chief executive, said he spoke to top officials at the U.S. Department of Health and Human Services in early April.

“We just let loose and we said, ‘This is a really bad policy,’” Becker said. “‘We’re going to get flooded and we’re going to lose control of quality. We’re not going to know what to do with the results.’”

That’s exactly what has happened, said Osterholm. “The FDA needs to bring much more discipline to this area and they need to articulate it clearly,” he said.

A key issue is the accuracy of the tests, which rely on measures known as sensitivity and specificity. A highly sensitive test will capture all true positive results. A highly specific test would identify all true negative results.

In April, researchers at the University of California-San Francisco, led by immunologist Dr. Alexander Marson, analyzed 14 COVID-19 serology tests on the market and found that all but one turned up false-positive results, indicating that someone had antibodies to the coronavirus when they actually did not. False-positive rates reached as high as 16% in the study, which has not yet been peer-reviewed.

Unreliable results worry Dr. Jeff Duchin, the public health officer for Seattle and King County, Washington, where the first surge of COVID cases emerged in the U.S. A person who tests positive for antibodies that don’t exist may mistakenly believe he or she is free to ignore guidance about preventing infection, potentially spreading the disease. “Regardless of whether you test positive or negative, the workplace still needs to take steps,” he said. “They shouldn’t think a testing program in any way relieves them of that responsibility.”

FDA officials said they’re working now with the National Cancer Institute to independently validate serology tests on the market. Until that list is public, users must rely on the relatively few that have received the emergency-use authorizations to date. More than 190 others have asked for that authorization, pending FDA review.

But consumers may have little control, because they are most likely getting tests from their employers or doctors, with little understanding of why those products were chosen.

“There isn’t a national standard, there isn’t a one-stop shop or a Consumer Reports for antibody tests,” Becker said. “I don’t expect a member of the public is going to be able to figure this out.”

Even savvy physicians can have trouble. US Acute Care Solutions, a physician-owned medical services group, was trying out a Chinese-made test supplied by Minneapolis-based Premier Biotech, with plans to test its staff of more than 3,500 doctors and employees, said the group’s chief medical officer, Dr. Amer Aldeen. That test has been widely used, including in recent controversial serology surveys conducted by Stanford University and the University of Southern California.

When USACS used it, the Premier test failed to detect antibodies in several employees who had been ill and tested positive for the coronavirus on diagnostic tests, Aldeen said. The results could have been caused by faulty instructions rather than flaws in the test itself, he said. Still, the Premier test has not received FDA authorization and the results gave him pause.

“It does no good to select a test that isn’t FDA-approved,” he said.

In a statement, Premier Biotech officials said they anticipate exceeding FDA standards, which call for tests that are at least 90% accurate in identifying positive antibodies in a sample and 95% accurate in identifying samples that contain no antibody.

Some might ask why the FDA didn’t just identify several reliable antibody tests and require their use to avoid the chaos. An FDA official said making that type of choice would be outside the scope of the agency’s responsibilities.

“FDA’s lane is to review these tests and make sure that they are safe and accurate for the American people,” said spokesperson Emma Spaulding. “It wouldn’t be within our lane to say which test must be used.”

Although health officials understand the desire for a test that could provide comfort amid the uncertainty of COVID-19, Duchin advised employers and consumers to wait a little longer.

“There are costs to testing with unvalidated tests that might outweigh the benefits of satisfying your curiosity,” he said.

Related Topics

Public Health

ICUs Become A ‘Delirium Factory’ For COVID Patients

Doctors are fighting not only to save lives from COVID-19, but also to protect patients’ brains.

Although COVID-19 is best known for damaging the lungs, it also increases the risk of life-threatening brain injuries — from mental confusion to hallucinations, seizures, coma, stroke and paralysis. The virus may invade the brain, as well as starve the organ of oxygen by damaging the lungs. To fight the infection, the immune system sometimes overreacts, battering the brain and other organs it normally protects.

Yet the pandemic has severely limited the ability of doctors and nurses to prevent and treat neurological complications. The severity of the disease and the heightened risk of infection have forced medical teams to abandon many of the practices that help them protect patients from delirium, a common side effect of mechanical ventilators and intensive care.

And while COVID-19 increases the risk of strokes, the pandemic has made it harder to diagnose them.

When doctors suspect a stroke, they usually order a brain MRI — a sophisticated type of scan. But many patients hospitalized with COVID-19 are too sick or unstable to be wheeled across the hospital to a scanner, said Dr. Kevin Sheth, a professor of neurology and neurosurgery at the Yale School of Medicine.

“Our hands are much more tied right now than before the pandemic,” says Dr. Sherry Chou, associate professor of critical care medicine, neurology and neurosurgery at the University of Pittsburgh School of Medicine.(Courtesy of Dr. Sherry Chou)

Many doctors also hesitate to request MRIs for fear that patients will contaminate the scanner and infect other patients and staff members.

“Our hands are much more tied right now than before the pandemic,” said Dr. Sherry Chou, an associate professor of critical care medicine, neurology and neurosurgery at the University of Pittsburgh School of Medicine.

In many cases, doctors can’t even examine patients’ reflexes and coordination because patients are so heavily sedated.

“We may not know if they’ve had a stroke,” Sheth said.

A study from Wuhan, China — where the first COVID-19 cases were detected — found 36% of patients had neurological symptoms, including headaches, changes in consciousness, strokes and lack of muscle coordination.

A smaller, French study observed such symptoms in 84% of patients, many of which persisted after people left the hospital.

Some hospitals are trying to get around these problems by using new technology to monitor and image the brain.

New York’s Northwell Health is using a mobile MRI machine for COVID patients, said Dr. Richard Temes, the health system’s director of neurocritical care. The scanner uses a low-field magnet, so it can be wheeled into hospital rooms and take pictures of the brain while patients are in bed.

New York’s Northwell Health is using a mobile MRI machine for patients with COVID-19, says Dr. Richard Temes, the health system’s director of neurocritical care.(Courtesy of Northwell Health)

Staffers at Northwell were also concerned about the infection risk from performing EEGs, tests that measure the brain’s electrical activity and help diagnose seizures, Temes said. Typically, technicians spend 30 to 40 minutes in close contact with patients in order to place electrodes around their skulls.

To reduce the risk of infection, Northwell is using a headband covered in electrodes, which can be placed on patients in just a couple of minutes, he said.

The Brain Under Attack

“Right now, we actually don’t know enough to say definitely how COVID-19 affects the brain and nervous system,” said Chou, who is leading an international study of neurological effects of the virus. “Until we can answer some of the most fundamental questions, it would be too early to speculate on treatments.”

Answering those questions is complicated by the limited data from patient autopsies, said Lena Al-Harthi, a professor and the chair of the microbial pathogens and immunity department at Rush Medical College in Chicago.

Authors of a recent study from Germany found the novel coronavirus in patients’ brains.

But many neuropathologists are unwilling or unable to perform brain autopsies, Al-Harthi said.

That’s because performing autopsies on patients who died of COVID-19 carries special risks, such as the aerosolization of the virus during brain removal. Pathologists need specialized facilities and equipment to conduct an autopsy safely.

Some of the best-known symptoms of COVID-19 might be caused by the virus invading the brain, said Dr. Robert Stevens, an associate professor of anesthesiology and critical care medicine at Johns Hopkins University.

Some of the best-known symptoms of COVID-19 could be caused by the virus’s invasion of nerve cells, says Dr. Robert Stevens, an associate professor of anesthesiology and critical care medicine at Johns Hopkins University.(Courtesy of Johns Hopkins)

Research shows that the coronavirus may enter a cell through a gateway known as the ACE-2 receptor. These receptors are found not only in the lung, but also on organs throughout the body, including many parts of the brain.

In a recent study, Japanese researchers reported finding the novel coronavirus in the cerebrospinal fluid that surrounds the brain and spinal cord.

Some of the most surprising symptoms of COVID-19 ― the loss of the senses of smell and taste ― remain incompletely understood, but may be related to the brain, Stevens said.

A study from Europe published in May found that 87% of patients with mild or moderate COVID-19 lost their sense of smell. Patients’ loss of smell couldn’t be explained by inflammation or nasal congestion, the study said. Stevens said it’s possible that the coronavirus interacts with nerve pathways from the nose to the brain, potentially affecting systems involved with processing scent.

A new study in JAMA provides additional evidence that the coronavirus invades the brain. Italian researchers found abnormalities in an MRI of the brain of a COVID-19 patient who lost her sense of smell.

Many COVID patients develop “silent hypoxia,” in which they are unaware that their oxygen levels have plummeted dangerously low, Stevens added.

When hypoxia occurs, regulatory centers in the brain stem — which control respiration — signal to the diaphragm and the muscles of the chest wall to work harder and faster to get more oxygen into the body and force out more carbon dioxide, Stevens said. The lack of this response in some patients with COVID-19 could indicate the brain stem is impaired.

Scientists suspect the virus is infecting the brain stem, preventing it from sending these signals, Temes said.

Collateral Damage

Well-intentioned efforts to save lives can also cause serious complications.

Many doctors put patients who are on mechanical ventilators into a deep sleep to prevent them from pulling out their breathing tubes, which would kill them, said Dr. Pratik Pandharipande, chief of anesthesiology and critical care medicine at Vanderbilt University School of Medicine in Nashville, Tennessee.

Both the disease itself and the use of sedatives can cause hallucinations, delirium and memory problems, said Dr. Jaspal Singh, a pulmonologist and critical care specialist at Atrium Health in Charlotte, North Carolina.

Many sedated patients experience terrifying hallucinations, which may return in recovery as nightmares and post-traumatic stress disorder.

Research shows 70% to 75% of patients on ventilators traditionally develop delirium. Delirious patients often “don’t realize they’re in the hospital,” Singh said. “They don’t recognize their family.”

In the French study in the New England Journal of Medicine, one-third of discharged COVID-19 patients suffered from “dysexecutive syndrome,” which can be characterized by inattention, disorientation or poorly organized movements in response to commands.

Research shows that patients who develop delirium — which can be an early sign of brain injury — are more likely to die than others. Those who survive often endure lengthy hospitalizations and are more likely to develop a long-term disability.

Under normal circumstances, hospitals would invite family members into the ICU to reassure patients and keep them grounded, said Dr. Carla Sevin, director of the ICU Recovery Center, also at Vanderbilt.

Many doctors now feel forced to prescribe heavy sedatives to COVID patients, says Dr. Carla Sevin, director of the ICU Recovery Center at Vanderbilt University School of Medicine in Nashville, Tennessee.(Courtesy of Vanderbilt)

Just allowing a family member to hold a patient’s hand can help, according to Dr. Lee Fleisher, chair of an American Society of Anesthesiologists committee on brain health. Nurses normally spend considerable time each day orienting patients by talking to them, reminding them where they are and why they’re in the hospital.

“You can decrease the need for some of these drugs just by talking to patients and providing light touch and comfort,” Fleisher said.

These and other innovative practices — such as helping patients to move around and get off a ventilator as soon as possible — can reduce the rate of delirium to 50%.

Hospitals have banned visitors, however, to avoid spreading the virus. That leaves COVID-19 patients to suffer alone, even though it’s well known that isolation increases the risk of delirium, Fleisher said.

Although many hospitals offer patients tablets or smartphones to allow them to videoconference with family, these devices provide limited comfort and companionship.

Doctors are also positioning patients with COVID-19 on their stomachs, rather than their backs, because a prone position seems to help clear the lungs and let patients breathe more comfortably.

But a prone position also can be uncomfortable, so that patients need more medication, Pandharipande said.

All of these factors make COVID-19 patients extremely vulnerable to delirium. In a recent article in Critical Care, researchers said the intensive care unit has become a “delirium factory.”

“The way we’re having to care for patients right now is probably contributing to more mortality and bad outcomes than the virus itself,” said Dr. Sharon Inouye, a geriatrician at Harvard Medical School and Hebrew SeniorLife, a long-term care facility in Boston. “A lot of the things we’d like to do are just very difficult.”

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Global Health Watch Public Health

E-Bikes Are Having Their Moment. They Deserve It.

Many of us are entering a new stage of pandemic grief: adaptation. We are asking ourselves: How do we live with this new reality?

For many Americans, part of the solution has been to buy an electric bike. The battery-powered two-wheelers have become a compelling alternative for commuters who are being discouraged from taking public transportation and Ubers. For others, the bikes provide much-needed fresh air after months of confinement.

So it’s no surprise that e-bikes are now as difficult to buy as a bottle of hand sanitizer was a few weeks ago. In March, sales of e-bikes jumped 85 percent from a year earlier, according to the NPD Group, a research firm. Amazon, Walmart and Specialized are sold out of most models. Even smaller brands like Ride1Up and VanMoof have waiting lists.

That’s a remarkable shift. For many years, e-bikes carried the stigma of being vehicles for lazy pedalers and seniors. The bikes draw power from a battery and motor to make pedaling significantly easier. You can also accelerate with the press of a button, transforming cycling from a strenuous exercise into a joy ride.

“I was convinced that e-bikes would completely change cities all over the world in the next 10 years, but it seems like because of this crisis, suddenly it’s all happening in the next three or four months,” said Taco Carlier, the chief executive of VanMoof, which is based in Amsterdam.

If you are contemplating an e-bike purchase, there are trade-offs to consider. For one, the battery packs and motors add bulk. For another, these ostentatious bikes may lure thieves.

To find out what you get for your money, I tested two different e-bikes on the streets and steep hills of San Francisco over the last two weeks. Both can be ordered online: VanMoof’s $1,998 S3, an internet-connected smart bike, and Ride1Up’s $1,495 700 Series, which is more like a normal bicycle with a battery and motor.

After the tests, I’m totally sold. E-bikes, I concluded, are for people who want to get around quickly with minimal effort — and that’s a large portion of the population. Here’s what you need to know.

Comparing the e-bikes.

ImageThe Ride1Up e-bike, which is faster, in front of the VanMoof, which has a longer range on a full battery charge.
The Ride1Up e-bike, which is faster, in front of the VanMoof, which has a longer range on a full battery charge.Credit…Jim Wilson/The New York Times

E-bikes come in many forms and with various features. They also range widely in price: Some cost a few hundred dollars, while others cost tens of thousands of dollars. In general, though, e-bikes fall into two camps:

  • E-bikes with pedal assistance. These use a motor system and sensors to detect how fast or hard you are pedaling and determine how much power to provide. So if you are pedaling hard or slow up a hill, the motor will use more power to assist you. Well-known brands include Trek, Specialized and Fuji.

  • E-bikes with a throttle. These work like the twist throttle on motorcycles and mo-peds. To accelerate, you press a trigger or twist a handlebar. Many modern e-bikes with a throttle also have pedal assist. Brands include Rad Power, Luna Cycle and Aventon.

VanMoof’s S3, which was released in late April, is a pedal-assist e-bike. Instead of a throttle, it has a Turbo Boost button on the right handlebar, which immediately gives a jolt of power. It has a top speed of about 20 miles per hour and can travel about 90 miles on a full charge.

VanMoof e-bikes are known for their antitheft security. Kicking a button on the rear brake activates an electronic lock, which makes the rear wheel unmovable. Trying to pick up the locked bike triggers a loud alarm. In addition, the bike includes GPS and a cellular connection to help you find it if it’s stolen, using VanMoof’s smartphone app.

Ride1Up’s 700 series has both a throttle and pedal assistance. On the left handlebar is a small screen with buttons to let you select the pedal-assist level; on the right handle bar is a gear shifter. With a larger, faster motor than the VanMoof, the Ride1Up has a top speed of 28 m.p.h. and can travel about 50 miles on a full charge.

Testing, testing.

Image
Ride1Up’s control panel offers nine pedal-assist levels.Credit…Jim Wilson/The New York Times

For two weeks, I alternated between riding the VanMoof and the Ride1Up. I found you get what you pay for: While $1,500 buys you a nice e-bike that takes time to get used to, like the Ride1Up, an additional $500 secures you a VanMoof, a smarter bike that is extremely simple to use.

The VanMoof’s motor system made pedaling feel more natural and smooth, like riding a normal bicycle but with a bit of oomph. The motor was also very quiet, and at points I forgot I was riding an e-bike. In areas where pedaling was more challenging, like hills, a press of the Turbo Boost button provided an extra push.

The Ride1Up bike was less intuitive. The control panel on the handlebar lets you choose from nine pedal-assist levels. Level 3 felt sufficient for getting me around the streets, but Level 5 felt better for getting up hills. Sometimes, when trying to pedal from a stop, I forgot to lower the pedal assist from Level 5, which caused the bike to jerk forward. That was a bit scary.

Ride1Up offers a YouTube tutorial on advanced settings for people to adjust the power of each pedal-assist level. Eventually, I reduced the power output for Levels 4 and 5, which made pedaling smoother.

As for the Ride1Up’s throttle, which is a trigger on the left handlebar, it was nice to have the option to accelerate without pedaling when I was getting exhausted. It did feel like cheating, though.

The downsides.

Image
The VanMoof weighs about 41 pounds. And the Ride1Up? About 55.Credit…Jim Wilson/The New York Times

Testing the two e-bikes underlined some of their trade-offs.

  • E-bikes are heavy. The VanMoof weighs about 41 pounds and the Ride1Up about 55 pounds — more than double the average road bike, which weighs about 20 pounds. You probably won’t want an e-bike if you’d have to regularly carry it up many flights of stairs.

  • Maintenance may be tricky. VanMoof and Ride1Up said their bikes were designed to be user-serviceable, and any local bike mechanic should also be able to service minor parts, like brake pads.

    But with e-bikes in general, you may need to seek help from the maker if something major goes wrong with proprietary electronic components. It’s a safer bet to buy your e-bike from a local store that can service it.

  • They may attract burglars. Parking the VanMoof made me anxious. Whenever I was locking it up, it got lots of attention from passers-by — it looks like an elegantly designed tech product.

    A VanMoof spokesman said that up to 20 of its bikes are reported stolen each month worldwide, and that 70 percent are found within two weeks. So make sure to have renters or home insurance that covers the theft of e-bikes. (VanMoof offers its own three-year insurance for $340.)

  • Batteries are expensive. Like smartphones, e-bikes use consumable batteries that eventually need to be replaced. With regular riding, the batteries for the VanMoof and the Ride1Up may deplete in three to five years. Replacements cost roughly $350.

But the pros outweigh the cons.

Despite some misgivings, my experience with e-bikes made me realize the benefits are far greater than the downsides.

Most important, e-bikes kept me out of my car. Whenever I had a reason to go outside — like making a trip to the grocery store or dropping off baked goods at a friend’s — I preferred riding an e-bike.

This will become increasingly important in the coming months. As businesses reopen, the Centers for Disease Control and Prevention has advised commuters to drive in cars alone. An e-bike may become crucial for squeezing through nightmare traffic.

There’s another benefit, which is important in hard times: E-bikes bring joy. I’m no fan of cycling in San Francisco, but on an e-bike, I saw more of the outdoors than I normally would, while keeping a safe distance from people. That beat bingeing on Netflix.

So I’ll probably buy an e-bike soon, even if it means getting on a waiting list. I figure we could all use a little more joy.

Open (Your Wallet) Wide: Dentists Charge Extra For Infection Control

After nearly two months at home due to the COVID-19 pandemic, Erica Schoenradt was making plans in May to see her dentist for a checkup.

Then she received a notice from Swish Dental that the cost of her next visit would include a new $20 “infection control fee” that would likely not be covered by her insurer.

“I was surprised and then annoyed,” said Schoenradt, 28, of Austin, Texas. She thought it made no sense for her dentist to charge her for keeping the office clean since the practice should be doing that anyway. She canceled the appointment for now.

Swish Dental is just one of a growing number of dental practices nationwide that in the past month have begun charging patients an infection control fee between $10 and $20.

Swish and others say they need the extra money to cover the cost of masks, face shields, gowns and air purifiers to help keep their offices free of the coronavirus. The price of equipment has risen dramatically because of unprecedented demand from health workers.

Dentists say they struggle to pay these extra costs particularly after most states shut down dental offices in March and April for all but emergency care to reserve personal protective equipment for hospital use. They are also seeing fewer patients than before the pandemic because some fear going back to the dentist and at the same time dentists need to space out appointments to keep the waiting room uncrowded.

Nearly two-thirds of dental offices across the country have reopened for routine care, according to the American Dental Association.

The association, which sets industry standards, says dentists who opt to charge the extra infection control fee should disclose it to patients ahead of each visit, a spokesperson said.

“The infection control fee is helping us mitigate the costs of the extra expenses,” said Michael Scialabba, a dentist and vice president of 42 North Dental, whose 75 dental offices in New England are charging an extra $10.

Why don’t dentists just raise prices instead? Dentists said they have little or no leverage with large insurance companies to force them to raise their reimbursement rates. The ADA asked insurers to take into account additional COVID costs dentists face and many insurers responded by agreeing to pay extra fees.

For example, Harrisburg, Pennyslvania-based United Concordia Dental agreed to pay dentists $10 per patient per visit in May and June to offset their PPE expenses for all fully insured clients. The company has more than 9 million members nationwide.

The new infection control fee upsets some patients, although most understand that the cost of dentistry has increased, said Rishi Desai, director of operations and finance at Swish Dental, which has eight locations in the Austin area. “We are just as frustrated with all of these, too, but as a small business we had to reassess things.”

Erica Schoenradt, of Austin, Texas, canceled her appointment with her dentist after learning that the practice would charge a $20 fee to help defray costs of masks, gowns and other equipment needed to guard against the coronavirus. (Courtesy of Erica Schoenradt)

Desai, whose wife, Viraj, is a dentist and the founder of the dental chain, said the extra money will help the practice survive. “We are not making money off this,” he said. “This is just to sustain us so we are not bleeding out cash.”

He noted that last year Swish was paying about $6 for a box of 20 face masks. Today, $6 buys a single mask. The dental office has installed sneeze guards, staffers are wearing face shields over their masks, and the offices have added air filtration systems and hired additional sanitation staff members to clean their offices every day.

He estimates the offices are working at only about half capacity since reopening in mid-May. In weighing how to handle the extra costs, Swish was reluctant to cut employee wages, he said. “Everyone is trying to figure this out,” he added.

Kim Hartlage, office manager of Klein Dental Group in Louisville, Kentucky, said insurers recommended the office add an infection control fee. The insurers balked at raising their reimbursement rates.

She said the small office has had to buy many more disposable masks and gloves. “We’ve had to step up our game,” she said. So far, she hasn’t heard any feedback on the $10 fee. “We have very understanding clients,” she said.

Tamar Lasky, an epidemiologist, said she likes her Owings Mills, Maryland, dentist and was glad the office was communicating the many precautions it was taking to prevent the spread of COVID-19. But she was stunned when informed by email that a $15 “infection control charge” would be added to her bill.

“I can readily imagine there are a range of additional expenses, as well as a loss of revenue associated with the pandemic, but infection control is not an extra service. It is part of the practice of dentistry,” Lasky said.

“I’m not sure what is the best solution to the increased costs of tighter infection control, but this new charge may not be covered by insurance, and that passes all the burden to the patient.”

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Benzodiazepines Tied to Higher Risk of Ectopic Pregnancy

Women who take benzodiazepines, such as Valium or Xanax, before becoming pregnant may be at increased risk for ectopic pregnancy, a new study found.

An ectopic, or tubal, pregnancy is one in which a fertilized egg grows outside the uterus, often in a fallopian tube, and it is a life-threatening event. The egg must be removed with medication or surgery. Benzodiazepines, sold by prescription under several brand names, are widely prescribed for anxiety, sleep problems and seizures.

The study, in Human Reproduction, used an insurance database of 1,691,366 pregnancies to track prescriptions for benzodiazepines in the 90 days before conception. Almost 18,000 of the of the women had used the drugs, and the scientists calculated that these women were 47 percent more likely to have a tubal pregnancy than those who did not.

The study controlled for other risks for tubal pregnancy, including sexually transmitted infections, pelvic infection, use of an intrauterine device, smoking and fertility treatments.

“Women planning a pregnancy who are using these drugs should talk to their care provider to see whether a change in treatment is possible, and then slowly change treatment before going off their contraceptive,” said the lead author, Elizabeth Wall-Wieler, a postdoctoral fellow at Stanford University. “Women for whom there is no alternative, or who have an unplanned pregnancy, should let their care provider know, and those pregnancies should be monitored carefully. The key to treating ectopic pregnancy is to treat it early.”

Police Using Rubber Bullets On Protesters That Can Kill, Blind Or Maim For Life

In cities across the country, police departments have attempted to quell unrest spurred by the death of George Floyd by firing rubber bullets into crowds, even though five decades of evidence shows such weapons can disable, disfigure and even kill.

In addition to rubber bullets — which often have a metal core — police have used tear gas, flash grenades, pepper spray gas and projectiles to control crowds of demonstrators demanding justice for 46-year-old George Floyd, who died after a Minneapolis police officer knelt on his neck, while other officers restrained his body. Some peaceful demonstrations have turned violent, with people smashing windows, setting buildings afire and looting stores.

The use by police of rubber bullets has provoked outrage, as graphic images have flashed on social media showing people who have lost an eye or suffered other injuries after being hit.

A study published in 2017 in the BMJ found that 3% of people hit by rubber bullets died of the injury. Fifteen percent of the 1,984 people studied were permanently injured by the rubber bullets, also known as “kinetic impact projectiles.”

Rubber bullets should be used only to control “an extremely dangerous crowd,” said Brian Higgins, the former police chief of Bergen County, New Jersey.

“Shooting them into open crowds is reckless and dangerous,” said Dr. Douglas Lazzaro, a professor and expert in eye trauma at NYU Langone Health.

In the past week, a grandmother in La Mesa, California, was hospitalized in an intensive care unit after being hit between the eyes with a rubber bullet. Actor Kendrick Sampson said he was hit by rubber bullets seven times at a Los Angeles protest.

In Washington, D.C., the National Guard allegedly fired rubber bullets Monday to disperse peaceful protesters near a historic church where President Donald Trump was subsequently photographed.

In a statement, Attorney General William Barr defended the actions of local and federal law enforcement officers in Washington, saying they had “made significant progress in restoring order to the nation’s capital.”

Barr did not mention the use of tear gas or rubber bullets.

Freelance photographer Linda Tirado said she was blinded by a rubber bullet at a protest in Minneapolis.

In an email, Minneapolis Police Department spokesperson John Elder said, “We use 40 mm less-lethal foam marking rounds. We do not use rubber bullets.”

No one knows how often police use rubber bullets, or how many people are harmed every year, said Dr. Rohini Haar, a lecturer at the University of California-Berkeley School of Public Health and medical expert with Physicians for Human Rights. Many victims don’t go to the hospital.

Police are not required to document their use of rubber bullets, so there is no national data to show how often they’re used, said Higgins, now an adjunct professor at the John Jay College of Criminal Justice in New York. There are no nationally agreed-upon standards for their use.

When aimed at the legs, rubber bullets can stop a dangerous person or crowd from getting closer to a police officer, Lazzaro said.

But when fired at close range, rubber bullets can penetrate the skin, break bones, fracture the skull and explode the eyeball, he said. Rubber bullets can cause traumatic brain injuries and “serious abdominal injury, including injuries to the spleen and bowel along with major blood vessels,” said Dr. Robert Glatter, an emergency physician at New York’s Lenox Hill Hospital and a spokesperson for the American College of Emergency Physicians.

Firing rubber bullets from a distance decreases both their force and their accuracy, increasing the risk of shooting people in the face or hitting bystanders, Lazzaro said.

Physicians for Human Rights, a nonprofit advocacy group based in New York, has called for rubber bullets to be banned.

The British military developed rubber bullets 50 years ago to control nationalist rioters in Northern Ireland, although the United Kingdom stopped using them decades ago. Rubber bullets are used by Israeli security forces against Palestinian demonstrators. French police were criticized for using rubber bullets last year after dozens of “yellow jacket” demonstrators were blinded and hundreds were injured.

“Rubber bullets are used almost every day somewhere in the world,” Haar said. “Using them against unarmed civilians is a huge violation of human rights.”

Many “less than lethal” police weapons can cause serious harm, according to Physicians for Human Rights.

  • Acoustic weapons, such as sound cannons that make painfully loud noises, can damage hearing.
  • Tear gas can make it difficult to see and breathe.
  • Pepper spray, while painful and irritating, doesn’t cause permanent damage, Lazzaro said.
  • Pepper spray balls, which have been used to quell recent protests, can be deadly when used incorrectly. In 2004, a 21-year-old Boston woman was hit in the eye and killed by a pepper spray pellet fired by police to disperse crowds celebrating the city’s World Series win.
  • Disorientation devices that create loud noises and bright lights, known as concussion grenade or flash-bangs, can cause severe burns and blast injuries, including damage to the ear drum. Panicked crowds can cause crush injuries.
  • Water cannons can cause internal injuries, falls and even frostbite during cold weather.
  • Physical force, such as hitting someone to subdue them, causes about 1 in 3 people to be hospitalized, said Dr. Howie Mell, a spokesperson for the American College of Emergency Physicians and former tactical physician, who worked with SWAT teams.

Rubber bullets are less harmful than subduing people by “physical force or regular bullets, Mell said. “But we’re firing a lot more of them this week than we usually do.”

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Don’t Text and Drive to Save Young Lives

Enforcement of laws against texting while driving sharply reduces fatalities among teenage drivers, according to a new analysis.

Researchers studied data on 38,215 drivers, ages 16 to 19, who were involved in fatal crashes from 2007 to 2017. In 2007, only 15 states had distracted driving laws. By 2017, 46 states had them in some form.

In states with primary texting laws — those that allow police to pull over and cite a driver for texting alone without another offense — the rate of teenage driver fatalities was 29 percent lower than in states with no texting laws at all. In states with only secondary texting laws, which don’t allow the police to pull you over simply because you are texting, it was still 15 percent lower.

Teenage passengers were also less likely to die where texting laws were in effect. There was a 38 percent lower fatality rate for states with primary laws, and a 27 percent lower rate for those with secondary enforcement. The study is in Pediatrics.

“It would be nice to make texting while driving as taboo as drunk driving,” said the lead author, Dr. Michael R. Flaherty, a pediatric critical care physician at MassGeneral Hospital for Children in Boston. “And parents should set the example for their teenagers and younger children by always refraining from using a device while driving.”

State laws vary, but according to the National Conference of State Legislatures website, Montana is today the only state with no regulations on texting while driving.

Contratar a un “ejército” diverso para rastrear COVID-19 durante la reapertura

Como rastreadora de contactos, a Teresa Ayala-Castillo a veces le preguntan si los tés de hierbas y el Vicks VapoRub pueden tratar a COVID-19.

Estas terapias no son exactamente una guía oficial de salud, pero Ayala-Castillo no se sorprende. Escucha y luego sugiere otras ideas, como descansar y beber mucho líquido.

“No quiero decirles que son cuentos, porque estos remedios son cosas con las que estoy 100% familiarizada ya que mi mamá los usó conmigo”, dijo Ayala-Castillo, una ecuatoriana-estadounidense bilingüe, de primera generación, que trabaja para la ciudad de Long Beach, California.

Los departamentos de salud de los Estados Unidos trabajan a un ritmo frenético para dotar de personal a sus “ejércitos” de rastreadores de contactos para controlar la propagación del coronavirus que causa COVID-19.

Los expertos estiman que los departamentos de salud locales y estatales tendrán que agregar entre 100.000 y 300.000 personas para que la economía vuelva a funcionar.

Mientras organizan estos grupos, muchos estados y localidades quieren contratar a personas de minorías raciales y étnicas más afectadas por el virus. Entienden la necesidad de contar con rastreadores capacitados y culturalmente competentes que puedan convertir a contactos desconfiados o renuentes en participantes entusiastas en la campaña para erradicar el virus.

Las actividades de rastreo del virus varían según el estado. La mayoría han creado planes para añadir rastreadores de contactos mediante la contratación o el voluntariado, pero los más ricos —incluidos California, Connecticut, Massachusetts, Nueva Jersey, Nueva York y Washington— llevan ventaja, aseguró Marcus Plescia, director médico de la Asociación de Funcionarios de Salud Estatales y Territoriales.

Delaware, cuya meta es comenzar las contrataciones en un mes, dará prioridad a personas de comunidades vulnerables y que sean bilingües. Y Minnesota contrata personal con cuotas de diversidad que coinciden con la demografía de los casos de COVID-19 del estado.

“No hay una fórmula mágica que asegure el éxito de esa llamada y establezca una conversación productiva”, señaló Chris Elvrum, del Departamento de Salud de Minnesota. “Tenemos que entender que existen diferentes maneras de abordar el tema para las diferentes comunidades”.

El rastreo de la enfermedad funciona así: luego que alguien da positivo para COVID-19, un investigador del departamento de salud local llama al paciente para hacerle preguntas específicas sobre su salud, sus movimientos y con quién interactuó durante un cierto período de tiempo.

Luego, un rastreador llama a las personas identificadas por el paciente para hacerles saber que estuvieron potencialmente expuestos al virus. A estos contactos se les pide permanecer en casa por 14 días. Si viven con otras personas, la recomendación puede extenderse a esos individuos.

Si se siguen las órdenes de permanecer en casa, resulta relativamente fácil averiguar quién puede haber estado expuesto a la enfermedad, dicen funcionarios de salud.

Las personas infectadas por lo general sólo han estado con familiares o amigos cercanos y a menudo advierten a los contactos que esperen una llamada del departamento de salud, explicó Emily Holman, quien maneja el área enfermedades contagiosas de Long Beach.

Pero en algunos casos se puede requerir la presencia de trabajadores de campo, indicó la doctora Kara Odom Walker, secretaria del Departamento de Salud y Servicios Sociales de Delaware.

“Hay algunas comunidades que no van a responder a una llamada telefónica, a un mensaje de texto o a una carta”, dijo Walker. “Eso podría deberse a una falta de cultura de la salud, al miedo, o al estatus migratorio”.

Hasta ahora, la mayoría sigue las instrucciones, aseguran los funcionarios. Holman estima que menos del 1% de los contactados en Long Beach se negaron a participar.

Pero surgen problemas, especialmente entre quienes no pueden trabajar desde casa o son el único sustento de sus hijos, apuntó Elvrum.

Las personas notificadas sobre su contacto con alguien con COVID pueden pensar que la llamada es parte de un fraude, o preocuparse de que la información sea compartida con las autoridades de inmigración o que les cueste su trabajo.

Los departamentos de salud no tienen que entregar la información recopilada con fines médicos a las autoridades federales de inmigración, pero se necesita un rastreador de contactos sensible, empático y conocedor de la cultura para explicar esto.

“Necesitas a alguien que sea un agente cultural para decir, no sólo que estas medidas son para protegerte, sino para decir que confíes en mí y que todo irá bien”, comentó Walker. “Yo voy a asegurarme personalmente de que tienes lo que necesitas para una cuarentena segura”.

Teresa Ayala-Castillo, quien ha trabajado para la ciudad de Long Beach durante 20 años, fue supervisora de facturación antes de ser reasignada para localizar a los pacientes con COVID-19 en marzo. Ella dice que su experiencia como ecuatoriana estadounidense de primera generación ayuda a las personas a sentirse a gusto con ella por teléfono. (Cortesía de Teresa Ayala-Castillo)

Minnesota pondrá a 1,400 empleados a trabajar en la localización de contactos para julio, informó Elvrum. Los contratos estipulan que buscan a personas de grupos raciales y étnicos proporcionales a su número en el estado o al porcentaje de casos positivos de COVID-19 en esos grupos. Lo que sea más alto.

Se contrata a personas que hablen hmong, somalí y español, según Kou Thao, quien dirige el Centro para la Equidad en la Salud del Departamento de Salud de Minnesota.

Un 23% de los casos positivos del estado se registran entre personas de raza negra, que constituye sólo el 7% de la población total del estado. Los hispanos constituyen el 19% de los casos y el 6% de la población. Sin embargo, alrededor del 22% de los casos son desconocidos.

Virginia, que cuenta con 200 rastreadores de contactos y espera contratar un total de 1,300 empleados para apoyar el esfuerzo, busca personas que hablen de mandarín, criollo haitiano, español y bengalí, según Mona Bector, comisionada del Departamento de Salud del estado.

Virginia ha recibido más de 6,000 curriculums para estos puestos, dijo Bector.

Long Beach se enorgullece de una fuerza laboral diversa que refleja la población de la ciudad. Los funcionarios sacaron a sus rastreadores de contactos e intérpretes, incluyendo a Ayala-Castillo, de los miembros del personal municipal que hablan samoano, jemer, tagalo, español, vietnamita, mandarín y otros idiomas para crear una plantilla de 60 personas. Su objetivo es tener 200 personas entrenadas y listas para ser desplegadas cuando sea necesario.

Tener trabajadores que puedan hablar con los contactos en el idioma que prefieran es un paso importante, expresó Crystal Watson, del Centro de Seguridad Sanitaria de Johns Hopkins. Ser capaz de extraer información mientras se es sensible a las preocupaciones y desconfianzas de los pacientes es primordial, añadió.

El sargento Jairo Paulino, de 38 años, miembro de la Guardia Nacional de Delaware, es uno de los militares bilingües que se ofrecen a ayudar con las llamadas a los contactos de COVID-19. Cuando empezó el trabajo a mediados de mayo, notó que había un “gran atraso” en la lista de nombres porque el estado no tenía suficientes hispanohablantes para contactarlos a todos con rapidez.

Paulino nació en la República Dominicana y llegó a Nueva York de niño. Creció traduciendo para su padre y asistiendo a la iglesia; ambas referencias ayudan a construir la confianza en la comunidad latina, dijo.

El escaso acceso a Internet también plantea un desafío. En Tulare, un condado rural en el centro de California, los trabajadores de la salud piden a los pacientes que utilicen un portal en línea para ayudar a agilizar la recopilación de datos de sus contactos. Sin embargo, entre el 5% y el 10% de las personas no pueden conectarse a Internet, explicó Tiffany Swarthout, del departamento de salud del condado. En esos casos, los trabajadores de la salud hablarán con el paciente por teléfono.

Las preocupaciones laborales representan otra área de dificultad para los rastreadores de contactos. Algunas personas son reacias a quedarse en casa porque no tienen ingresos, especialmente si la pandemia ha dejado a miembros de la familia sin trabajo, señaló Jody Menick, una enfermera que supervisa la localización de contactos en el condado de Montgomery, Maryland, en las afueras de Washington, D.C.

Algunos empleadores solicitan pruebas de que los pacientes y sus contactos pueden regresar con seguridad después de la cuarentena, y algunas jurisdicciones proporcionan cartas oficiales que especifican el período de cuarentena del trabajador.

Pero los trabajadores indocumentados, que cuentan con menos protecciones que los empleados con estatus legal, han sido presionados para que se presenten a trabajar, contó Menick, poniéndoles en una situación muy difícil.

“¿Voy a conseguir dinero para comprar comida para mi familia, o me voy a quedar en casa?”

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Tiny Love Stories: ‘Why Aren’t You Happy?’

Single Dad Lockdown

I’m trapped in the house with Tenzing, my 6-year-old son. I cook vegetables for him, set up Zoom classes, play Monopoly Junior. He wants to pillow fight when I’m working, ride on my back when I’m reading. Does he watch too much YouTube? Should we sneak into the playground? When will this end? It’s a relief when his mother picks him up for her four days. But as soon as he’s gone, I call her to ask how he’s doing. I’d rather have him driving me crazy than feel his absence in this house. — Ranjan Adiga

ImageMe and my mini me.
Me and my mini me.

Never Too Old for Butterflies

A man shows up at my nonprofit. He appears to be more interested in me than in his volunteer tasks. “I’m in a committed relationship,” I tell him the third time he comes back. He asks, “Why aren’t you happy?” Huh? I have a house, children, dog and retirement account. “I’m fine,” I reply. I’m almost 60, too old for these butterflies. Too old to remake my life. A close friend dies in a motorcycle accident. He always asked me why I put myself last. Was I happy? Six years with my new love and life, I’ve never been so happy. — Susan Murphy

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Embracing my happiness.

A Gleeful Scream on Graduation Day

Although I woke up 1,667 miles from my university on graduation day, I was greeted with diploma-shaped balloons, a whiteboard emblazoned with “Congratulations!” and childhood pictures plastered across my bedroom door. The morning continued with freshly made masala dosa and culminated with my parents competing to take a picture of my graduation slide as my name was read. My mother’s face fell when she thought she’d missed it. Upon discovering that she had captured the moment, she let out a gleeful scream. As we hugged, I decided not to mention that our online graduation was being fully recorded. — Julie Thamby

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Selfie with my mother during my graduation.

The World From Our Window

May 25, 2020, was our second anniversary. Thinking about our wedding feels like staring into the sun — so brilliant that it hurts. In photos we embrace people more freely than it seems we ever will again. But I know that’s not true. This afternoon, the street outside our Brooklyn window is closed to traffic. We spend the day watching a girl learn to ride her bike. Then another joins her. Their little circles, slowly getting wide, are a comfort. We’ll have ease again. Until then, I have a person to join me at the window and watch the world. — Lindsay Vranizan

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Together in our window.

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How a Delay in Colonoscopy Screening May Affect Cancer Risk

Current guidelines recommend a colonoscopy starting at age 45 to 50, and then one every 10 years afterward if the results are negative. Those guidelines should still be followed, though for people at low risk for colon cancer, delays in colonoscopy screening may not dramatically affect cancer risk, a new study suggests.

The analysis, in Annals of Internal Medicine, included 165,887 men and women aged 50 to 66 who had a single negative colonoscopy. At 17 years after the initial test, compared with the general population, the group had a 72 percent lower rate of colon cancer and an 81 percent lower rate of death — not significantly different from results at 10 years and earlier.

But the finding pertains only to people with no polyps or other lesions, benign or malignant, at the first colonoscopy, and who are at low risk for colon cancer. It does not apply to anyone with a family history of colorectal cancer, inflammatory bowel conditions, or any other factors that increase colon cancer risk.

Most important, the finding depends on high-quality colonoscopy performed by a skilled endoscopist on a patient with adequate bowel preparation.

“It’s impossible to achieve zero risk,” said the lead author, Dr. Nastazja Dagny Pilonis, a researcher at the National Research Institute of Oncology in Warsaw. “But if you have a negative colonoscopy, and your bowel was adequately prepared, and your endoscopist was skilled, then you are at very low risk of colon cancer for at least 17 years.”

Hiring A Diverse Army To Track COVID-19 Amid Reopening

As a contact tracer, Teresa Ayala-Castillo is sometimes asked whether herbal teas and Vicks VapoRub can treat COVID-19. These therapies aren’t exactly official health guidance, but Ayala-Castillo isn’t fazed. She listens and then suggests other ideas — like getting rest and drinking plenty of fluids.

“I don’t want to call them old wives’ tales, but these remedies are things that I’m 100% familiar with because my mom used them on me,” said Ayala-Castillo, a bilingual first-generation Ecuadorian American who works for the city of Long Beach, California.

Health departments across the U.S. are working at a furious pace to staff their armies of contact tracers to control the spread of the coronavirus that causes COVID-19. Experts estimate local and state health departments will have to add 100,000 to 300,000 people to get the economy back on track.

As they build these forces, many states and localities are trying hard to hire from the racial and ethnic minority communities hit hardest by the virus. They’re anticipating a need for skilled, culturally competent tracers who can convert suspicious or hesitant contacts into enthusiastic, willing participants in the drive to stamp out the virus.

Virus-tracking activities vary by state. Most states have created plans to add contact tracers through hiring or volunteering, but wealthier ones — including California, Connecticut, Massachusetts, New Jersey, New York and Washington — are further along than others, said Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials.

Delaware, which aims to begin hiring in a month, plans to prioritize hires from vulnerable communities with bilingual language skills. Minnesota is hammering out staffing contracts with diversity quotas that match the demographics of the state’s COVID-19 cases.

“One size does not fit all for making that first call and being successful in having them pick up the phone and have a good conversation,” said Chris Elvrum, a deputy incident manager at the Minnesota Department of Health. “We need to recognize that we have to approach it in different ways for different cultural communities in the state.”

Tracking the disease works like this: After someone tests positive for COVID-19, a case investigator from the local health department calls the patient to ask detailed questions about her health, movements and whom she interacted with over a certain time frame. A contact tracer then calls everyone the patient named to let them know they were potentially exposed to the virus. These contacts are instructed to stay home and self-quarantine for 14 days after the exposure. If they live with other people, the recommendation may extend to those individuals.

Under stay-at-home orders, it’s often relatively easy to figure out who may have been exposed to the disease, health officials say. Infected people usually have been around only family or close friends and will often warn contacts to expect a call from the health department, said Emily Holman, communicable disease controller for Long Beach.

But shoe-leather fieldworkers may be required in some instances, said Dr. Kara Odom Walker, secretary of the Delaware Department of Health and Social Services. “There are some communities that aren’t going to respond to a phone call, a text message or a letter,” said Walker. “That could be due to health literacy issues, which could be due to fear, or documentation status.”

So far, most people are following instructions, say officials. Holman estimates that fewer than 1% of those contacted in Long Beach refused to participate.

Teresa Ayala-Castillo, who has worked for the city of Long Beach for 20 years, was a billing supervisor before being reassigned to contact tracing for COVID-19 patients in March. She says her background as a first-generation Ecuadorian American helps people feel at ease with her on the phone. (Courtesy of Teresa Ayala-Castillo)

But some defiance is likely, especially among those who cannot work from home or are the only provider for their children, Elvrum said. People being notified about contacts with a COVID-positive patient might think the call is a scam, or worry the information will be shared with immigration authorities or cost them their job. Health departments do not have to turn information collected for medical purposes over to federal immigration enforcement, but it takes a sensitive, empathetic and knowledgeable contact tracer to explain this.

“You need someone to be a cultural broker to say, not only are these policies in place to protect you, but I’m telling you to trust me that this will be OK,” Walker said. “I’m going to make sure you have what you need to safely quarantine.”

Minnesota plans to dedicate 1,400 staffers to contact tracing by July, Elvrum said. Contracts with two companies involved in the hiring stipulate that they bring on people of racial and ethnic groups proportional to their numbers in the state or the percentage of positive COVID-19 cases in those groups — whichever is higher.

They’re seeking hires who speak Hmong, Somali and Spanish, said Kou Thao, director of the Center for Health Equity in the Minnesota Department of Health.

About 23% of the state’s positive cases are among black people, who make up only 7% of the state population. Hispanics make up 19% of cases — and 6% of the population. However, about 22% of the cases are unknown.

Virginia, which has 200 contact tracers and hopes to hire a total of 1,300 staff to support the effort, is looking for speakers of Mandarin, Haitian Creole, Spanish and Bengali, said Mona Bector, deputy commissioner for administration at the Virginia Department of Health.

The state has received more than 6,000 résumés for these positions, Bector said.

Long Beach prides itself on a diverse workforce that reflects the city’s population. Officials pulled their contact tracers and interpreters, including Ayala-Castillo, from municipal staff members who speak Samoan, Khmer, Tagalog, Spanish, Vietnamese, Mandarin and other languages to create a staff of 60. Their goal is to have 200 people trained and ready to deploy as needed.

Having workers who can speak to contacts in the language they prefer is a step forward, said Crystal Watson, a senior scholar from the Johns Hopkins Center for Health Security. Being able to extract information while being sensitive to patients’ concerns and mistrust is paramount, she added.

Sgt. Jairo Paulino, a 38-year-old member of the Delaware National Guard, is one of several bilingual guardsmen volunteering to help call COVID-19 contacts. When he started the job in mid-May, he noticed there was a “major backlog” of names because the state didn’t have enough Spanish speakers to reach out to everyone quickly.

Paulino was born in the Dominican Republic and moved to New York as a boy. He grew up translating for his father and attending church — both elements that help build trust in the Latino community, he said.

Poor access to the internet also poses a challenge. In Tulare, a rural county in central California, health workers ask patients to use an online portal to help streamline data collection of their contacts. However, 5% to 10% of people cannot get online, said Tiffany Swarthout, an administrative specialist at the county health department. In those cases, health workers will speak to the patient on the phone.

Employment concerns represent another tricky area for contact tracers. Some people they reach out to may hesitate to stay home because they are strapped for cash, especially if the pandemic has left members of the family without work, said Jody Menick, a nurse who supervises contact tracing in Montgomery County, Maryland, just outside Washington, D.C.

Some employers are requesting proof that patients and contacts were safe to return after quarantine, and some areas provide official letters that specify the worker’s quarantine period.

But undocumented workers — who have fewer protections than employees with legal status — have been pressured to show up to work in her area, Menick said, leaving them with a difficult decision.

“Am I going to have money to buy food for my family, or am I going to stay home?”

Related Topics

California Public Health States

Pandemic Presents New Hurdles, And Hope, For People Struggling With Addiction

Before Philadelphia shut down to slow the spread of the coronavirus, Ed had a routine: most mornings he would head to a nearby McDonald’s to brush his teeth, wash his face and — when he had the money — buy a cup of coffee. He would bounce between homeless shelters and try to get a shower. But since businesses closed and many shelters stopped taking new admissions, Ed has been mostly shut off from that routine.

He’s still living on the streets.

“I’ll be honest, I don’t really sleep too much,” said Ed, who’s 51 and struggling with addiction. “Every four or five days I get a couple hours.”

KHN agreed not to use his last name because he uses illegal drugs.

Philadelphia has the highest overdose rate of any big city in America — in 2019, more than three people a day died of drug overdoses there, on average. Before the coronavirus began spreading across the United States, the opioid overdose epidemic was the biggest health crisis on the minds of many city officials and public health experts. The coronavirus pandemic has largely eclipsed the conversation around the opioid crisis. But the crisis still rages on despite business closures, the cancellation of in-person treatment appointments and the strain on many addiction resources in the city.

When his usual shelter wasn’t an option anymore, Ed tried to get into residential drug treatment. He figured that would be a good way to try to get back on his feet and, if nothing else, get a few good nights of rest. But he had contracted pinkeye, a symptom thought to be associated with the virus that leads to COVID-19, so the evaluation center didn’t want to place him in an inpatient facility until he’d gotten the pinkeye checked out. But he couldn’t see a doctor because he didn’t have a phone for a telehealth appointment.

“I got myself stuck, and I’m trying to pull everything back together before it totally blows up,” he said.

Rosalind Pichardo wants to help people in Ed’s situation. Before the pandemic, Pichardo would hit the streets of her neighborhood, Kensington, which has the highest drug overdose rate in Philadelphia. She’d head out with a bag full of snack bars, cookies and Narcan, the opioid overdose reversal drug.

She’d hand Narcan out to people using drugs, and people selling drugs — anyone who wanted it. Pichardo started her own organization, Operation Save Our City, which initially set out to work with survivors of gun violence in the neighborhood. When she realized that overdoses were killing people too, she began getting more involved with the harm reduction movement and started handing out Narcan through the city’s syringe exchange.

When Pennsylvania’s stay-at-home order went into effect, Pichardo and others worried that more people might start using drugs alone, and that fewer first responders would be patrolling the streets or nearby and able to revive them if they overdosed.

So, Pichardo and other harm reduction activists gave out even more Narcan. A representative for Prevention Point Philadelphia, the group that operates a large syringe exchange program in the city, said that during the first month of the city’s stay-at-home order, they handed out almost twice as much Narcan as usual.

After the lockdowns and social distancing began, Pichardo worried that more people would be using drugs alone, leading to more overdoses. But Philadelphia’s fatal overdose rate during the pandemic remains about the same as it was this time last year. Pichardo said she thinks that’s evidence that flooding the streets with Narcan is working — that people are continuing to use drugs, and maybe even using more drugs, but that users are utilizing Narcan more often and administering it to one another.

That is the hope. But Pichardo said users don’t always have a buddy to keep watch, and during the pandemic first responders have seemed much more hesitant to intervene. For example, she recently administered Narcan to three people in Kensington who overdosed near a subway station, while two police officers stood by and watched. Before the pandemic, they would often be right there with her, helping.

To reverse the overdoses, Pichardo crouched over the people who she said had started turning blue as their oxygen levels dropped. She injected the Narcan into their noses, using a disposable plastic applicator. Normally, she would perform rescue breathing, too, but since the pandemic began she has started carrying an Ambu bag, which pumps air into a person’s lungs and avoids mouth-to-mouth resuscitation. Among the three people, she said, it took six doses of Narcan to revive them. The police officers didn’t step in to help but did toss several overdose-reversal doses toward Pichardo as she worked.

“I don’t expect ’em to give ’em rescue breaths if they don’t want to, but at least administer the lifesaving drug,” Pichardo said.

In her work as a volunteer, she has reversed almost 400 overdoses, she estimated.

“There’s social distancing — to a limit,” Pichardo said, “I think when someone’s life is in jeopardy, they’re worth saving. You just can’t watch people die.”

Even before Philadelphia officially issued its stay-at-home order, city police announced they would stop making low-level arrests, including for narcotics. The idea was to reduce contact overall, help keep the jail population low and reduce the risk of the virus getting passed around inside. But Pichardo and other community activists said the decreased law enforcement emboldened drug dealers in the Kensington neighborhood, where open-air drug sales and use are common.

“You can tell they have everything down pat, from the lookout to the corner boys to the one actually holding the product — the one holding the product’s got some good PPE gear,” said Pichardo.

More dealers working openly on the street has led to more fights over territory, she added, which in turn has meant more violence. While overall crime in Philadelphia and other major cities has declined during the pandemic, gun violence has spiked.

Police resumed arrests at the beginning of May.

Now when she goes out to offer relief and hand out Narcan, Pichardo packs a few extra things in her bag of supplies: face masks, gloves and gun locks.

“It’s like the survival kit of the ’hood,” she said.

For those struggling with addiction who are ready to start recovery, newly relaxed federal restrictions have made it easier to get medications that curb opioid cravings and stem withdrawal. Several efforts are underway among Philadelphia-based public health groups and criminal justice advocacy organizations to give cellphones to people who are homeless or coming out of jail, so they can make a telehealth appointment and get quicker access to a prescription for those medicines.

During the pandemic, people taking medication-assisted treatment can renew their prescription every month instead of every week, which helps decrease trips to the pharmacy. It is too soon to know if more people are taking advantage of the new rules, and accessing medication-assisted treatment via telehealth, but if that turns out to be the case, many addiction medicine specialists argue the new rules should become permanent, even after the pandemic ends.

“If we find that these relaxed restrictions are bringing more people to the table, that presents enormous ethical questions about whether or not the DEA should reinstate these restrictive policies that they had going in the first place,” said Dr. Ben Cocchiaro, a physician who treats people with substance-use disorder.

Cocchiaro said the whole point of addiction treatment is to facilitate help as soon as someone is ready for it. He hopes if access to recovery can be made simpler during a pandemic, it can remain that way afterward.

This story is part of a partnership that includes WHYY, NPR and Kaiser Health News.

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Mental Health Public Health States

California AG Seeks More Power To Battle Merger-Hungry Health Care Chains

California’s health care industry has a consolidation problem.

Independent physician practices, outpatient clinics and hospitals are merging or getting gobbled up by private equity firms or large health care systems. A single company can dominate an entire community, and in some cases, vast swaths of the state.

Such dominance can inflate prices, and consumers end up facing higher insurance premiums, more expensive outpatient services and bigger out-of-pocket costs to see specialists.

Now that COVID-19 has slammed the health care industry, especially the small practices that are barely seeing patients, the trend is likely to accelerate.

“I don’t see anything that’s going to stop this wave of consolidations amongst docs,” said Glenn Melnick, a health care economist at the University of Southern California.

“If this thing goes on a long time,” he said of the coronavirus, “then it becomes a tsunami.”

California Attorney General Xavier Becerra has made battling health care consolidation a signature issue since he took office in 2017. With the additional pressure that COVID-19 is putting on vulnerable practices and facilities, Becerra is now pressing the state legislature to expand his authority to slow health care mergers.

“We find that in these times of crisis, economic and health crisis, that the smaller health care players and stakeholders are oftentimes most at risk of being swallowed up by the big fish,” Becerra told California Healthline.

His success would fundamentally change how the health care industry merges and grows in California.

When a health care system, private equity firm or hedge fund plans to merge with or acquire another practice or facility — whether that means buying a small practice or joining a multistate hospital chain — Becerra wants to know about it. He wants written notice, and the ability to deny any sale that doesn’t deliver better access, cost or quality health care to Californians.

Becerra already can regulate mergers among nonprofit health care facilities. Under SB-977, a collaboration between Becerra’s office and the legislature, he would get the ability to regulate the for-profit sector as well.

“Certainly it would put California where it’s accustomed to being,” Becerra said. “At the head of the pack.”

The bill has support from organized labor and consumer advocacy groups. Gov. Gavin Newsom has come out against health care consolidation in the past but hasn’t taken an official stance on the bill.

Yet Becerra isn’t convinced passage will be smooth.

“The biggest concern I have is the legislation will be killed by the industry,” he said. “We’ll end up seeing over-consolidation because decent practices that got on the edge could not swim with sharks.”

Indeed, health care industry players are already lining up against the bill. Alex Hawthorne, a lobbyist for the California Hospital Association, said that hospitals are stretched thin because of the pandemic, and that now isn’t the time for Becerra to be meddling in routine agreements between practices.

“It bestows absolute and arbitrary discretion on the office of the attorney general,” Hawthorne said at a budget hearing in May.

In 2010, about 25% of California physicians worked in a practice owned by a hospital. By 2016, more than 40% of doctors worked in hospital-owned practices, according to research published in the journal Health Affairs in 2018.

There’s evidence that consolidation can hurt consumers. A separate 2018 study found that the cost of medical procedures in highly consolidated Northern California was 20% to 30% higher than in Southern California.

Since 2018, California’s attorney general has had the authority to regulate mergers among nonprofit health care systems, which Becerra exercised the same year when considering a merger between two health care giants: Dignity Health and Catholic Health Initiatives. He said he would approve the deal only if the systems agreed to certain requirements, such as starting a homelessness program.

Later that year, Becerra joined a suit against Sutter Health for using its market power to drive up health care costs in Northern California.

The lawsuit alleged that Sutter, which has 24 hospitals and 34 surgery centers, had spent years buying up practices and facilities, giving insurers little choice but to include them in their networks and agree to higher rates for services.

In October 2019, Becerra secured a $575 million settlement against Sutter, which has yet to be finalized or paid out, that requires Sutter to change how it charges insurance companies and give patients more information about prices.

Sutter Health opposes SB-977, which was introduced in February by state Sen. Bill Monning (D-Carmel). The measure is intended to address some of the challenges Becerra encountered with the Sutter case, Becerra said.

“The best way to prevent problems from occurring in a merger is just to prevent the merger altogether,” said Jaime King, associate dean at UC Hastings College of the Law in San Francisco. “It’s really hard to unwind a merger after you’ve already done it.”

Under the measure, the attorney general must be notified before a system, hedge fund or private equity firm attempts to enter into a merger, acquisition or another kind of affiliation change with another practice or facility. The bill defines a health care system as one with two or more hospitals in multiple counties, or three or more hospitals within one county.

That would trigger a public review process allowing supporters and opponents to make their cases to a review board. The board would assess the transaction, using criteria to determine whether it would improve access, quality and price.

The bill also would make it illegal for systems to act anti-competitively and give the attorney general the power to bring a civil suit against monopolistic systems.

The Senate Health Committee approved the bill, which is expected to be heard in another committee this week.

“Maybe it does mean consolidation should occur, but only because we’ve done the oversight to make sure it’s because of quality and access,” Becerra said. “Not because a big fish wants to make bigger profit.”

The measure includes waivers for rural practices and a fast-track review process for transactions under $500,000.

The California Chamber of Commerce opposes the bill, as does the California Medical Association, which represents doctors. While the California Medical Association is concerned about the survival of small physician practices, it believes the bill is too broad and should focus more tightly on hospital consolidation, said spokesperson Anthony York.

“This approach will only further force smaller providers out of business,” especially as the health systems respond to the COVID-19 emergency, the group’s legislative advocate, Amy Durbin, wrote in a letter of opposition.

For many independent practices struggling for survival, the debate over Becerra’s powers is academic.

Dr. Sarah Azad, who owns a women’s health practice in Mountain View, California, said at least three independent practices in her area have started the process to merge or sell since March because of dramatically lower patient volume.

Her practice is fine for now, despite the fact that her patient volume was only about 30% of normal in March and 60% of normal in April. Azad received a loan from the federal Paycheck Protection Program for small businesses so she could pay her five doctors in May.

“If you catch me on a bad month, I feel like we’re one disaster away from bankruptcy,” Azad said.

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

Related Topics

California Health Industry

Getting Back to ‘Normal’ May Not Be So Easy. Crisis Experts Can Help.

After 80 days of lockdown, my husband and I yearned for company. Since New York City is slowly easing restrictions, we decided to ask friends for a socially distanced lunch. I planned the social experiment with the precision I do when reporting in war zones.

We would invite only two people, for just two hours. We would choose only those we knew had been strict quarantineers and had gotten coronavirus tests. We would insist on face covers and a checklist of taboos that included touching your dinnerware but nothing else. We’d convene in the garden out back, with no lingering inside.

After tallying these rigid ground rules, we actually found a couple willing to endure the constraints. I looked forward to a relaxing reunion.

Instead I was on guard the whole time. It’s hard to police friends, and folks get sloppy when they’re happy to see each other. Everyone violated the six-foot decree. Masks slipped down. Someone touched the salad bowl without gloves. They both asked to use the bathroom.

Our encounter brought home to me how stressful this transition period, when we’re not fully taking refuge but still in danger of exposure, will be. The lockdown cave had its lonely challenges, but we were safe inside. In the cocoon, we did not go in and out of high alert in an ambiguous situation.

Now, as we venture outside with a mix of masked and unmasked faces, emerging feels like a Wild West of germs. We’re making up rules as we go along. After finally getting used to confinement, I find myself on edge figuring out how to behave with less restraints.

The assessment process of “what risks do I take?” reminds me of what I’ve done in 30 years of covering conflicts in war zones around the globe and teaching seminars for journalists to protect themselves. Except now we’re dodging pedestrians instead of land mines. I find myself constantly assessing how to avoid those cigar smokers on the corner, how to get to the deli when it’s empty, whether I can trust my own closest friends to wipe the bathroom faucets after use.

Having adjusted to lockdown, we’re stretching the emotional rubber band by loosening limitations. We don’t have a clear picture of how the new-new normal will play out. We might have to withdraw again with a new viral surge.

Humans can take only so much change.

“We are adaptable, but we’re also a little rigid,” says Gil Reyes, a clinician from Santa Barbara, Calif., who specializes in the psychology of violent and destructive events. “You want things to be the way they were before. Anything that takes us out of the known way to do things is a stressor.”

Further strain comes from the sheer number of calculations one must make when venturing out. We have so many choices at every moment of potential exposure.

“It’s exhausting,” agrees Elana Newman, an expert on psychological trauma who teaches at the University of Tulsa. “In the absence of any certainty, every person has to make a cost-benefit about every activity they engage in. Is this a high-risk or a low-risk action? Is it worth it to me?”

Anxiety about this gamble is particularly severe for those who are already hard hit by grief and financial loss, or do essential work that requires exposure, says Elissa Epel, vice chair of the department of psychiatry at the University of California, San Francisco

“Feeling safe is key to recovery from trauma and avoiding long-term mental health consequences like PTSD,” she says. That’s hard to achieve when people lack physical safety as well as the security that they are bonded with others around them who are taking the same precautions.

But there are ways to navigate this jarring new situation. Here’s the advice that these experts gave, corroborated by my years of crisis reporting and by living through this pandemic.

  • Frequently Asked Questions and Advice

    Updated June 1, 2020

    • How do we start exercising again without hurting ourselves after months of lockdown?

      Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.

    • My state is reopening. Is it safe to go out?

      States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.

    • What’s the risk of catching coronavirus from a surface?

      Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

    • What are the symptoms of coronavirus?

      Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

    • How can I protect myself while flying?

      If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

    • How many people have lost their jobs due to coronavirus in the U.S.?

      More than 40 million people — the equivalent of 1 in 4 U.S. workers — have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.

    • Should I wear a mask?

      The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.

    • What should I do if I feel sick?

      If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

    • How can I help?

      Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities.


Accept. In order to keep the blood pressure down, try to embrace a Zen acceptance that life is not risk-free, says Dr. Epel. Breathe deeply. You can’t control reckless behavior by others but you can control your responses. “Exercise compassion toward their different worldview,” she says. “Maybe they’re giving haircuts too early because of financial need. Maybe they truly believe the virus is a hoax.” Fuming that they aren’t complying with safety regulations will only make you feel worse.

Seek support. Surround yourself with people who make you feel supported and positive. “Social connection is the biggest factor shoring up emotional resilience,” says Jack Saul, a psychologist and leading expert on collective trauma and healing. “Recovery comes when people connect with other people and talk about what they’ve been through and feel supported.”

Take it slow. Move outward slowly. “Don’t jump into the hustle and bustle all at once,” says Dr. Reyes. Perhaps start with a socially distanced walk. Graduate to a backyard gathering with a couple of people you trust. Make clear that safety rules are for their protection as well as yours. And continue with the hand-washing, distancing and face coverings. That much you can control.

Be clear. You have a right to set conditions in your house. Don’t feel shy reminding visitors, politely, if they’ve lapsed. It’s your home.

Practice makes perfect. This new modus operandi will be taxing at first, but after some practice it will begin to feel automatic. I find that when I first get to a dangerous country, I’m self-regulating at 100 percent. After a while I go into automatic pilot and it becomes rote to know what to look for and how to react. I identify patterns: This street is particularly problematic, that person is too reckless. We simply need time to find our footing.

Assess and debrief. Think of the first encounters as dress rehearsals. After the experimental lunch, I sat down and analyzed what worked and what didn’t. I came up with a plan. Next time I’ll hand out gloves and disposable spoons at the door. I’ll place disinfectant with a sign in the bathroom. I’ll chalk the table with six-foot marks.

And I’ll feel more at ease being prepared.

Judith Matloff teaches crisis reporting at Columbia’s Graduate School of Journalism. She just published a manual for hazards, “How to Drag a Body and Other Safety Tips You Hope to Never Need.

How You Should Read Coronavirus Studies, or Any Science Paper

A lot of people are reading scientific papers for the first time these days, hoping to make sense of the coronavirus pandemic. If you’re one of them, be advised the scientific paper is a peculiar literary genre that can take some getting used to. And also bear in mind that these are not typical times for scientific publishing.

It is hard to think of another moment in history when so many scientists turned their attention to one subject with such speed. In mid-January, scientific papers began trickling out with the first details about the new coronavirus. By the end of the month, the journal Nature marveled that over 50 papers had been published. That number has swelled over the past few months at an exponential rate, fitting for a pandemic.

The National Library of Medicine’s database at the start of June contains over 17,000 published papers about the new coronavirus. A website called bioRxiv, which hosts studies that have yet to go through peer review, contains over 4,000 papers.

In earlier times, few people aside from scientists would have laid eyes on these papers. Months or years after they were written, they’d wind up in printed journals tucked away on a library shelf. But now the world can surf the rising tide of research on the new coronavirus. The vast majority of papers about it can be read for free online.

But just because scientific papers are easier to get hold of doesn’t mean that they are easy to make sense of. Reading them can be a challenge for the layperson, even one with some science education. It’s not just the jargon that scientists use to compress a lot of results into a small space. Just like sonnets, sagas and short stories, scientific papers are a genre with its own unwritten rules, rules that have developed over generations.

The first scientific papers read more like letters among friends, recounting hobbies and oddities. The first issue of the Philosophical Transactions of the Royal Society, published on May 30, 1667, included brief dispatches with titles such as “An account of the improvement of optick glasses,” and “An account of a very odd monstrous calf.”

When natural philosophers sent their letters to 17th-century journals, the editors decided whether they were worth publishing or not. But after 200 years of scientific advances, Victorian scientists could no longer be experts on everything. Journal editors sent papers to outside specialists who understood the details of a particular branch of research better than most scientists.

By the mid-1900s, this practice evolved into a practice known as peer review. A journal would publish a paper only after a panel of outside experts decided it was acceptable. Sometimes the reviewers rejected the paper outright; other times they required the fixing of weak points — either by revising the paper or doing additional research.

Along the way, scientific papers also developed a distinctive narrative arc. A paper published in Philosophical Transactions today is no longer a gossipy letter, but a four-part story. Papers typically open with some history, giving a justification for the new research they contain. The authors then lay out the methods they used to carry out that research — how they eavesdropped on lions, how they measured chemicals in Martian dust. Then the papers present results, followed by a discussion of what those results mean. Scientists will typically point out the shortcomings in their own research and offer ideas for new studies to see if their interpretations hold water.

As a science writer, I’ve been reading scientific papers for 30 years. I’d guess that I’ve read tens of thousands of them, in search of new advances to write about, or to do background research for stories. While I’m not a scientist myself, I’ve gotten pretty comfortable navigating around them.

One lesson I’ve learned is that it can take work to piece together the story underlying a paper. If I call scientists and simply ask them to tell me about what they’ve done, they can offer me a riveting narrative of intellectual exploration. But on the page, we readers have to assemble the story for ourselves.

Part of the problem may be that many scientists don’t get much training in writing. As a result, it can be hard to figure out precisely what question a paper is tackling, how the results answer it and why any of it really matters.

The demands of peer review — satisfying the demands of several different experts — can also make papers even more of a chore to read. Journals can make matters worse by requiring scientists to chop up their papers in chunks, some of which are exiled into a supplementary file. Reading a paper can be like reading a novel and realizing only at the end that Chapters 14, 30, and 41 were published separately.

The coronavirus pandemic now presents an extra challenge: There are far more papers than anyone could ever read. If you use a tool like Google Scholar, you may be able to zero in on some of the papers that are already getting cited by other scientists. They can provide the outlines of the past few months of scientific history — the isolation of the coronavirus, for example, the sequencing of its genome, the discovery that it spreads quickly from person to person even before symptoms emerge. Papers like these will be cited by generations of scientists yet to be born.

Most won’t, though. When you read through a scientific paper, it’s important to maintain a healthy skepticism. The ongoing flood of papers that have yet to be peer-reviewed — known as preprints — includes a lot of weak research and misleading claims. Some are withdrawn by the authors. Many will never make it into a journal. But some of them are earning sensational headlines before burning out in obscurity.

In April, for example, a team of Stanford researchers published a preprint in which they asserted that the fatality rate of Covid-19 was far lower than other experts estimated. When Andrew Gelman, a Columbia University statistician, read their preprint, he was so angry he publicly demanded an apology.

“We wasted time and effort discussing this paper whose main selling point was some numbers that were essentially the product of a statistical error,” he wrote on his blog.

  • Frequently Asked Questions and Advice

    Updated June 1, 2020

    • How do we start exercising again without hurting ourselves after months of lockdown?

      Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.

    • My state is reopening. Is it safe to go out?

      States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.

    • What’s the risk of catching coronavirus from a surface?

      Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

    • What are the symptoms of coronavirus?

      Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

    • How can I protect myself while flying?

      If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

    • How many people have lost their jobs due to coronavirus in the U.S.?

      More than 40 million people — the equivalent of 1 in 4 U.S. workers — have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.

    • Should I wear a mask?

      The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.

    • What should I do if I feel sick?

      If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

    • How can I help?

      Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities.


But just because a paper passes peer review doesn’t mean it’s above scrutiny. In April, when French researchers published a study suggesting that hydroxychloroquine might be effective against Covid-19, other scientists pointed out that it was small and not rigorously designed. In May, a much bigger paper was published in the Lancet suggesting that the drug could increase the risk of death. A hundred leading scientists published an open letter questioning the authenticity of the database on which the study relied.

When you read a scientific paper, try to think about it the way other scientists do. Ask some basic questions to judge its merit. Is it based on a few patients or thousands? Is it mixing up correlation and causation? Do the authors actually present the evidence required to come to their conclusions?

One shortcut that can sometimes help you learn how to read a paper like a scientist is by making judicious use of social media. Leading epidemiologists and virologists have been posting thoughtful threads on Twitter, for example, laying out why they think new papers are good or bad. But always make sure you’re following people with deep expertise, and not bots or agents of disinformation peddling conspiracy nonsense.

Science has always traveled down a bumpy road. Now it is in an extraordinary rush, with the world looking for every new preprint and peer-reviewed paper in the hope that some clue will emerge that helps save millions of lives.

Yet our current plight does not change the nature of the scientific paper. It’s never a revelation of absolute truth. At best, it’s a status report on our best understanding of nature’s mysteries.

After 6 Months, Important Mysteries About Coronavirus Endure

In the time since the world’s scientists and public health officials first became widely aware of the new coronavirus in January, they’ve had six months to learn about it.

They’ve reached many conclusions about the virus and the illness it causes, from the importance of wearing masks to contain it, to the unusual range of symptoms it provokes.

But there are major gaps in scientific knowledge about the virus. In the half year that journalists of the health and science desk of The Times have been reporting on Sars-CoV-2, we have identified some of the enduring uncertainties. How scientists resolve some of these mysteries will shape our future with the coronavirus.

How many people have been infected.

By

Image
Credit…Jens Mortensen for The New York Times

One of the epidemic’s great unknowns is how many Americans have been infected so far.

Only about 1.9 million Americans had tested positive as of May 28, according to the Centers for Disease Control and Prevention — or perhaps only about 1.7 million according to the Johns Hopkins Center for Health Security, which produces a frequently cited map of world cases.

Statisticians believe the actual number of cases is higher, but it is not clear by how much.

They have more confidence in the accuracy of data produced by states that do the most testing. On that score, New York is a leader; it has tested about 9.6 percent of its population, which is almost double the national average. (Rhode Island tested 13 percent of its people, beating New York, but its population is small.)

New York has also done tens of thousands of antibody tests for surveillance purposes. On May 22, Gov. Andrew Cuomo announced that, according to these tests, about a fifth of all New York City residents have had the virus, as had about 27 percent of thousands of black and Hispanic New Yorkers who were tested at their local churches.

If that same pattern were assumed to hold in other hard-hit big cities like Chicago, New Orleans, Detroit and Miami, it is likely that somewhere between 3 and 4 million urban Americans were infected.

Even if that figure was doubled or tripled — which is probably generous — to account for Americans infected all around the country before the lockdowns, that would still be only 9 to 12 million people.

That is in line with the low end of estimates made in mid-April, before antibody testing began; different modelers predicted then that between 3 and 10 percent of the country was infected.

In any case, since this is a country of 330 million, a mere 10 million or even 20 million infected would be a drop in the bucket. As the country comes out of lockdown, the vast majority of Americans remain vulnerable to the virus.

Nor will the country be able to spot all of those who get it. The C.D.C.’s “best estimate,” according to the pandemic scenarios it issued May 22, is that about 35 percent of those infected have no symptoms.

Currently, about 21,000 Americans are getting infected each day. If a third of them show no symptoms, almost 210,000 “silent spreaders” are created each month.

It seems impossible to imagine that any contact-tracing program, no matter how large, will be able to keep up with that.

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The amount of virus it takes to make you sick.

By

Here’s what we can say for sure about the minimum number of viral particles it takes to seed a coronavirus infection: The number is somewhere between one and one million.

If you push scientists harder, they might offer a slightly smaller range of a few hundred to a few thousand — and some might even bravely throw out an estimate in the high hundreds, based on what they have learned about the behavior of the coronavirus that caused the 2002-03 SARS epidemic.

But the bottom line is that no one will know for sure until more research is completed.

“It’s very unsatisfying to tell people, ‘Oh we don’t know,’” said Angela Rasmussen, a virologist at Columbia University in New York. “People do have a lot of questions about this.”

It’s difficult to say anything definitive about the coronavirus because it behaves like an influenza virus in how easily it is transmitted, and in that people can pass it on even when they don’t seem sick. But its structure, origin in bats and overall symptoms are similar to those of its cousin coronaviruses.

So scientists cannot say whether touching a surface with a smidgen of virus or breathing air with a few droplets exhaled by a sick person will make you ill. But it is safe to say exposure to more of the coronavirus is more likely to cause infection, and also to lead to more severe symptoms. That’s why it’s important to avoid crowded indoor spaces, wear masks and wash your hands. Each of those steps can decrease your chances of being exposed to large amounts of virus.

Why some people get so much sicker than others.

By

Covid-19 is a mercurial disease. While some people experience only mild, fleeting symptoms, others are knocked over with a severe flulike illness that can last several weeks. A minority of patients develop life-threatening complications. Death can ensue.

Why do some people sail through the illness, and others develop the severe inflammation and lung damage that are hallmarks of the disease? It is one of the great mysteries of Covid-19.

Experts say the patient’s immune response to the viral infection determines the severity of the illness. If the immune system goes into overdrive, it can trigger a cascade of harmful effects, injuring the lungs and other organs.

Immune function declines with age, and elderly people with Covid-19 are among the most vulnerable to poor outcomes, as are those with chronic health conditions like high blood pressure, diabetes and cardiovascular disease. Obesity, which affects 4 in 10 American adults, also appears to exacerbate the illness.

Men are at greater risk for critical illness and death, a sex disparity that may be explained by women’s more robust immune systems, scientists say.

Generally speaking, patients get sicker faster if they are exposed to a large dose of the virus when they are first infected, said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University.

Much scientific inquiry has focused on the role of a receptor called angiotensin-converting enzyme 2, or ACE2, which is the entry way for coronaviruses into the cells. The receptor is found on the outer surfaces of cells in the lungs, blood vessels, intestines and other organs, as well as in the back of the throat and high up in the nasal passage.

When the pandemic started, there was concern that people taking blood pressure medications like ACE inhibitors could be at greater risk from the coronavirus, but so far studies have not found that to be the case, and doctors are urging patients to continue their medications.

Though the SARS-CoV-2 virus attaches to the receptor in order to penetrate cells, ACE2 also helps regulate blood pressure and inflammation. Some scientists have suggested that children may be less susceptible to infection with Covid-19 because they have fewer of these receptors. ACE2 is also regulated differently in men and women, according to scientists who study sex differences in medicine, and men tend to develop hypertension, or high blood pressure, at younger ages than women. But much is still unknown.

“ACE2 can play two very critical roles, getting the virus into the cell, but also modulating some of the damage that takes place in the blood vessels and the lungs,” said Dr. Ankit B. Patel, a nephrologist at Brigham and Women’s Hospital in Boston. “So it’s a double-edged sword in a sense, and that’s made the whole story all the more complicated.”

The role of children in spreading the virus.

By

Image
Credit…Jens Mortensen for The New York Times

There are many crucial unresolved questions about children and Covid-19. Finding the answers is not only important for them and their families, but for society at large, as communities plan to reopen schools, day care centers, playgrounds and other places children frequent.

  • Frequently Asked Questions and Advice

    Updated June 1, 2020

    • How do we start exercising again without hurting ourselves after months of lockdown?

      Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.

    • My state is reopening. Is it safe to go out?

      States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.

    • What’s the risk of catching coronavirus from a surface?

      Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

    • What are the symptoms of coronavirus?

      Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

    • How can I protect myself while flying?

      If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

    • How many people have lost their jobs due to coronavirus in the U.S.?

      More than 40 million people — the equivalent of 1 in 4 U.S. workers — have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.

    • Should I wear a mask?

      The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.

    • What should I do if I feel sick?

      If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

    • How can I help?

      Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities.


One puzzle is what role children play in spreading the virus. They seem less likely to become seriously ill than adults, making up about 2 percent of confirmed American coronavirus cases. There are different theories about whether that is because children are less likely to become infected to begin with, or whether the virus infects them just as easily but mostly causes few or no symptoms.

Either way, a growing body of evidence suggests that infected children can transmit the virus, possibly as easily as adults. And one recent study suggests that when children attend school, they come in contact with three times as many people as average adults do, providing more opportunities for children to become infected and infect others.

Although far fewer children than adults have experienced severe symptoms, some children have become devastatingly ill and there have been at least 20 deaths of children from Covid-19 in the United States and elsewhere. Reports from hospitals suggest that the children most vulnerable to the respiratory failure adults develop are those who already have a serious medical condition. Some studies also suggest that infants and preschoolers may be more vulnerable than older children.

But a small number of other children, including teenagers, who did not have any symptoms when they were first infected, have developed a newly-identified inflammatory syndrome that can cause serious heart problems. The syndrome, which seems to occur weeks after infection and to result from a revved-up immune response to the virus, has been reported Europe and throughout the United States and has caused several deaths. Doctors are urgently trying to understand what causes the syndrome, why it afflicts some children and not others, and how to best treat or prevent it.

When or where the new coronavirus started spreading.

By

Image
Credit…Jens Mortensen for The New York Times

The notion of a single patient zero is both theatrical and real: In any new epidemic, some unlucky soul seeds the first infection, several links of which are fated to seed chains of their own and spark a viral Big Bang.

By analyzing the genetic material of people who test positive, scientists can trace the lineage of each virus back to a common ancestor, and often to an individual carrier. The first confirmed coronavirus case in the United States was a man who landed at Seattle-Tacoma Airport on Jan. 15, from China. Other introductions came in February, and scientists are now closing in on who, exactly, sparked the outbreak in Washington State.

New York confirmed its first case on March 1, and by that time there were already thousands of infected people walking around, for a week or more. Scientist have found genetic signatures on the viruses studied so far that link them to Europe, likely brought in by some of the millions of people arriving in New York in February, and it is likely that there were multiple introductions that spread widely: patients zero, plural.

The first infected arrivals in a community are not necessarily the ones who light the fuse. In a report published last week, genetic scientists argued that infected people were among both Americans and Europeans in January, but that most of those viruses fizzled out. And French doctors recently reported that a respiratory sample from a man hospitalized near Paris, in late December, tested positive. That virus, too, likely died out. France’s outbreak did not start until many weeks later.

The world’s patient zero, in China, began infecting others in the late fall of last year, the evidence thus far suggests. An analysis of the first 41 confirmed cases, all in people who had visited the same seafood market in Wuhan, indicates that the first hospital admission was on Dec. 16, 2019. The patient first noticed symptoms on Dec. 1, so the infection dates back earlier. Several scientists have estimated that the first outbreak began in late or mid-November, and have inferred a probable common viral ancestor, though additional virus samples could change the picture.

The level of detective work required to find the actual patient zero might be steeper than it appears. At least one genetic scientist has argued that the virus could have first infected humans — likely from a pangolin — well before last fall, in a form that did not cause sickness. It then evolved its pathogenic features over time, while circulating. If that’s the case, the question “Who came first?” may go without a conclusive answer for some time, perhaps for good.

How long you’ll be immune after infection.

By

Are people infected with the coronavirus protected from further infection? And, if yes, for how long?

The answers to these questions have broad implications for reopening the economy and allowing the public to live with less fear of infection in the short term — and for the effectiveness of vaccines in the long term.

Scientists have made steady, if incremental, progress in getting to the answers. When the body encounters any virus, it typically makes antibodies, some of which are powerful enough to neutralize the pathogen and prevent reinfection. It also produces large numbers of immune cells that can kill the virus.

Most tests that look for antibodies to the coronavirus have been flawed. But at least one team with a reliable test reported that most people, including those who were only mildly ill, make powerful antibodies. Data on immune cells has been slower to emerge, but a few studies suggest a robust response from immune cells as well.

What remains unknown is how long this immunity will last. There have been some reports of reinfection, but scientists have said that they are a result either of faulty testing, or of viral remnants that circulate long after the active infection has ended.

They are hopeful that based on other coronaviruses that cause the common cold, SARS or MERS, immunity to the new coronavirus might last at least a year, but it remains a mystery for now.

Six Months of Coronavirus: Here’s Some of What We’ve Learned

We don’t really know when the novel coronavirus first began infecting people. But as we turn a page on our calendars into June, it is fair to say that Sars-Cov-2 has been with us now for a full six months.

At first, it had no name or true identity. Early in January, news reports referred to strange and threatening symptoms that had sickened dozens of people in a large Chinese city with which many people in the world were probably not familiar. After half a year, that large metropolis, Wuhan, is well-known, as is the coronavirus and the illness it causes, Covid-19.

In that time, many reporters and editors on the health and science desk at The New York Times have shifted our journalistic focus as we have sought to tell the story of the coronavirus pandemic. While much remains unknown and mysterious after six months, there are some things we’re pretty sure of. These are some of those insights.

We’ll have to live with this for a long time.

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Summer is almost here, states are reopening and new coronavirus cases are declining or, at least, holding steady in many parts of the United States. At least 100 scientific teams around the world are racing to develop a vaccine.

That’s about it for the good news.

The virus has shown no sign of going away: We will be in this pandemic era for the long haul, likely a year or more. The masks, the social distancing, the fretful hand-washing, the aching withdrawal from friends and family — those steps are still the best hope of staying well, and will be for some time to come.

“This virus just may become another endemic virus in our communities, and this virus may never go away,” Dr. Mike Ryan, the executive director of the World Health Organization’s health emergencies program, warned last month. Some scientists think that the longer we live with the virus, the milder its effects will become, but that remains to be seen.

Predictions that millions of doses of a vaccine may be available by the end of this year may be too rosy. No vaccine has ever been created that fast.

The disease would be less frightening if there were a treatment that could cure it or, at least, prevent severe illness. But there is not. Remdesivir, the eagerly awaited antiviral drug? “Modest” benefit is the highest mark experts give it.

Which brings us back to masks and social distancing, which have come to feel quite antisocial. If only we could go back to life the way it used to be.

We cannot. Not yet. There are just enough wild cards with this disease — perfectly healthy adults and children who inexplicably become very, very sick — that no one can afford to be cavalier about catching it. About 35 percent of infected people have no symptoms at all, so if they are out and about, they could unknowingly infect other people.

Enormous questions loom. Can workplaces be made safe? What about trains, subways, airplanes, school buses? How many people can work from home? When would it be safe to reopen schools? How do you get a 6-year-old with the attention span of a squirrel to socially distance?

The bottom line: Wear a mask, keep your distance. When the time comes in the fall, get a flu shot, to protect yourself from one respiratory disease you can avoid and to help keep emergency rooms and urgent care from being overwhelmed. Hope for a treatment, a cure, a vaccine. Be patient. We have to pace ourselves. If there’s such a thing as a disease marathon, this is it.

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You should be wearing a mask.

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The debate over whether Americans should wear face masks to control coronavirus transmission has been settled. Although public health authorities gave confusing and often contradictory advice in the early months of the pandemic, most experts now agree that if everyone wears a mask, individuals protect one another.

Researchers know that even simple masks can effectively stop droplets spewing from an infected wearer’s nose or mouth. In a study published in April in Nature, scientists showed that when people who are infected with influenza, rhinovirus or a mild cold-causing coronavirus wore a mask, it blocked nearly 100 percent of the viral droplets they exhaled, as well as some tiny aerosol particles.

Still, mask wearing remains uneven in many parts of the United States. But governments and businesses are beginning to require, or at least recommend, that masks be worn in many public settings.

There is also growing evidence that some kinds of masks may protect you from other people’s germs. High-grade N95 masks are cleared by federal public health agencies because they filter out at least 95 percent of particles that are 0.3 microns in diameter when properly worn. One study showed that N95s were able to capture over 90 percent of viral particles, even if the particles were about one-fifth the size of a coronavirus. Other studies have shown that flat, blue surgical masks block between 50 to 80 percent of particles, whereas cloth masks block 10 to 30 percent of tiny particles.

“Wearing a mask is better than nothing,” said Dr. Robert Atmar, an infectious disease specialist at Baylor College of Medicine. Because the coronavirus typically infects people by entering their body through the mouth and nose, covering these areas can act as the first line of defense against the virus, he said.

Donning a face covering is also likely to prevent you from touching your face, which is another way the coronavirus can be transmitted from contaminated surfaces to unsuspecting individuals. And when combined with hand washing and other protective measures, such as social distancing, masks help reduce the transmission of disease, Dr. Atmar said.

American public health infrastructure needs an update.

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The United States knows how to fight wars. But, as the past few months have shown, the American response to pathogens can easily become a shambles — even though pathogens kill more Americans than many wars have.

We have no viral Pentagon. The Centers for Disease Control and Prevention is more of an F.B.I. for outbreak investigations than a war machine. For years — under both the Obama and Trump administrations — its leaders have had to seek clearance for almost every utterance.

Dr. Anthony S. Fauci, the most prominent of the doctors advising the coronavirus task force, is actually the head of a research institute, the National Institute for Allergy and Infectious Disease, rather than of the medical equivalent of a combat battalion.

The Surgeon Generalis essentially an admiral without a crew. He dispenses health warnings and recommendations, but the Public Health Services Commissioned Corps, which reports to him, are only about 6,500 strong, and many members have other jobs, often at the C.D.C.

Almost all the front-line troops — the contact tracers, the laboratory technicians, the epidemiologists, the staff in state and city hospitals — are paid by state and local health departments whose budgets have shriveled for years. These soldiers are led by 50 commanders, in the form of governors, and with that many in charge, it is amazing that any response moves forward.

The rest of the response is in the hands of thousands of private militias — hospitals, insurers, doctors, nurses, respiratory technicians, pharmacists and so on, all of whom have individual employers. Within limits, they can do what they want. When they cannot get something they need from overseasthey are largely powerless without federal logistical help.

As war does to defeated nations, pandemics expose the weaknesses of their systems. Our patchwork and uncoordinated response has produced more than 100,000 deaths; surely we can do better.

“The superpowers have their priorities all wrong,” Dr. Michael Ryan, the head of the W.H.O.’s emergencies program, said recently.

“They spend billions on missiles and submarines, and on fighting terrorism, and pennies on viruses. You can start peace talks with your enemy. You can change your policies to lessen the threat of terrorism. But you cannot negotiate with a virus, and we know that new threats are coming along every year.”

Responding to the virus is extraordinarily expensive.

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The federal government has spent hundreds of billions of dollars and promised to spend more than $2 trillion to address the coronavirus pandemic.

Of that money, $2 billion has gone to helping companies develop new vaccines, expanding testing capacity nationwide and shoring up the economic fallout since the beginning of March. (Even more could be on the way, but how much and when is unclear.)

The vast majority of this spending has been aimed at blunting the economic pain of small businesses shutting down and people losing their jobs or being furloughed. Congress also provided additional money for Medicaid and other social programs.

Hospitals, community health centers and other providers have been allocated $175 billion to cover the cost of caring for patients with Covid-19 and for the visits, procedures and surgeries that were canceled because of the pandemic. In the latest bill, $25 billion was targeted for coronavirus testing.

Many experts say more funding is needed, but there is ample controversy over how the money already allocated is being spent and which entities are getting funds. Various groups like the Committee for a Responsible Federal Budget are tracking the spending. By that organization’s calculation, roughly $1.6 trillion has already been disbursed or committed. The Federal Reserve has also provided more than $2 trillion in emergency lending, asset purchases and other activities, it said.

We have a long way to go to fix virus testing.

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The landscape for testing looks far better than it did in the early days of the outbreak, when a botched rollout of coronavirus tests failed to detect the spread of the virus in the United States.

Today, hundreds of thousands of tests a day are being conducted in the United States, and in some areas it is so widely available that public health officials have complained they do not have enough takers. In Los Angeles, where testing is free to everyone, a drive-through site at Dodgers Stadium can process 6,000 people a day.

The range of tests available is also expanding. Tests that once required a health care worker to insert a swab through the nose to the back of the throat can now be done with a swipe inside the nose, or by spitting into a cup. A handful of companies now sell at-home test kits, and a test from Abbott can detect the virus in as little as five minutes.

In addition to the tests that detect active infections, Americans can also get tested for antibodies to the virus, which shows whether they have ever been infected, and could help give a better picture for how widely the coronavirus has spread in communities.

But despite this progress, the United States still has a long way to go. Public health experts say that anywhere from 900,000 tests to millions a day will be needed to screen hospital patients, nursing home residents and employees returning to work.

And even as testing is abundant in some areas, it is still hard to come by in others. Shortages of key supplies needed to run the tests — such as swabs and chemical reagents — have persisted. The federal government has effectively delegated oversight to the states, creating a patchwork of policies and putting states in competition with one another. Even tracking the number of tests conducted has proved difficult, after the C.D.C. and several states began lumping tests for the virus as well as antibodies together, to the bafflement of epidemiologists trying to track active infections, which the antibody tests do not show.

We can’t count on herd immunity to keep us healthy.

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The idea is simplicity itself: If enough of the population has antibodies to the novel coronavirus, the virus will hit too many dead ends to continue infecting people. That is herd immunity.

That is the great hope for a vaccine. But it may not happen, even if a vaccine becomes available, as experience with flu vaccines shows.

Dr. Paul Offit of Children’s Hospital of Philadelphia and the University of Pennsylvania noted that while vaccines eliminated measles, rubella and smallpox and almost eliminated polio in the United States, vaccines against influenza and whooping cough have not stopped outbreaks. (With some parents declining measles vaccines, the disease is coming back.)

Influenza and whooping cough have spread, even after enough people in a community have been vaccinated to, in theory, stop the diseases. That’s because the antibodies that protect people against viruses infecting mucosal surfaces like the lining of the nose tend to be short-lived.

Vaccines against respiratory diseases are, at best, modestly effective, agreed Dr. Arnold Monto of the University of Michigan,

Since the coronavirus usually starts by infecting the respiratory system, Dr. Monto suspects that a Covid-19 vaccine would have a similar effect to a flu vaccine — it will reduce the incidence of the disease and make it less severe on average, but it will not make Covid-19 go away.

  • Frequently Asked Questions and Advice

    Updated June 1, 2020

    • How do we start exercising again without hurting ourselves after months of lockdown?

      Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.

    • My state is reopening. Is it safe to go out?

      States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.

    • What’s the risk of catching coronavirus from a surface?

      Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

    • What are the symptoms of coronavirus?

      Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

    • How can I protect myself while flying?

      If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

    • How many people have lost their jobs due to coronavirus in the U.S.?

      More than 40 million people — the equivalent of 1 in 4 U.S. workers — have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.

    • Should I wear a mask?

      The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.

    • What should I do if I feel sick?

      If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

    • How can I help?

      Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities.


He would like the virus to disappear, of course, but a vaccine that reduces the disease’s spread and severity is a lot better than nothing.

“As an older person, what I want is not to end up on a respirator,” Dr. Monto said.

The virus produces more symptoms than expected.

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Covid-19 is a viral respiratory illness. Many early descriptions of symptoms focused on patients being short of breath and eventually being placed on ventilators. But the virus does not confine its assault to the lungs, and doctors have identified a number of symptoms and syndromes associated with it.

In some patients, the virus propels the immune system into overdrive, causing the lungs to fill with fluid and damaging multiple organs, including the brain, heart, kidneys and liver.

The first symptoms of an infection are usually a cough and shortness of breath. But in April the C.D.C. added to the list of early signs sore throat, fever, chills and muscle aches. Gastrointestinal upset, such as diarrhea and nausea, has also been observed.

Another telltale sign of infection may be a sudden, profound diminution of one’s sense of smell and taste. Teenagers and young adults in some cases have developed painful red and purple lesions on the fingers and toes, but few other serious symptoms.

Severe disease leads to pneumonia and acute respiratory distress syndrome. The blood oxygen levels plummet, and patients may get supplemental oxygen or be placed on a machine, called a ventilator, to help them breathe.

But even without lung impairment, the disease can cause injury to the kidneys, heart or liver. Critically ill patients are prone to developing dangerous blood clots in the legs and the lungs. In rare cases, the disease triggers ischemic strokes that block the arteries supplying blood to the brain, or brain impairments, such as altered mental status or encephalopathy.

Death can result from heart failure, kidney failure, multiple organ failure, respiratory distress or shock.

We can worry a bit less about infection from surfaces.

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The news, when it was reported, added a frightening twist to the threat from the coronavirus: A study in March in The New England Journal of Medicine found that under laboratory conditions, the virus can survive for up to three days on some surfaces, such as plastic and steel, and on cardboard for up to 24 hours.

Other studies reported finding the virus on air vents in hospital rooms and on computer mice, sickbed handrails and doorknobs.

Many people grew worried that by touching a surface that had been covered in droplets by an infected person, and then touching their own mouth, nose or eyes, they then would contract the virus.

You should still wear a mask, avoid touching your face in public and keep washing your hands. But none of these studies tested for live virus, only for traces of its genetic material. Other scientists commenting on these studies said virus on these surfaces might degrade more quickly. The Centers for Disease Control and Prevention has said since March that contaminated surfaces are “not thought to be the main way” the virus spreads.

The main driver of infection is thought to be directly inhaling droplets released when an infected person sneezes, coughs, sings or talks. The C.D.C. recently made changes to its website to make this message even more explicit.

We can also worry less about a mutating virus.

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In February, three experts on viruses published an editorial in a journal headlined “We Shouldn’t Worry When a Virus Mutates During Outbreaks.”

But worry we did. As the coronavirus pandemic swept the planet, headlines and tweets poured forth that the new coronavirus was undergoing dangerous mutations.

Many of these worries were based on a misunderstanding of what it means when a virus mutates. When an infected cell produces new viruses, it sometimes makes mistakes in copying the viral genes. Those mistakes are mutations, and it turns out that most are bad for the viruses, getting in the way of their ability to hijack our cells.

The viruses that do manage to spread to new hosts have mutations, too. But those mutations often don’t have any significant effect. The alterations they bring to a virus’s genes don’t lead to any change in how the virus works.

Scientists have identified harmless new mutations in different lineages of the new coronavirus. These lineages are not dangerous new strains.

Some of these lineages have come to be the most common version of the coronavirus in some countries. Again, that doesn’t mean that they’ve got some evolutionary edge. There’s a very common phenomenon in nature called the founder effect: Whatever mutations happen to be common in the founders of a new population will end up common in their descendants.

It is possible for viruses to gain mutations that do affect the way they work. The new coronavirus will be no different. But the only way to know if a new mutation is significant or not is to carry out research. It will take a lot of evidence to reject the more likely hypothesis: that a new mutation has no importance at all.

Fortunately, it doesn’t look like coronaviruses will be picking up these new mutations very quickly. Compared with other viruses, scientists have found, the new coronavirus has a relatively slow rate of new mutations.

That’s a big relief for vaccine makers. Influenza viruses mutate so quickly that people need to get a new flu shot each year to stay protected. H.I.V. has so much genetic diversity that an effective vaccine against it has yet to be found. The new coronavirus poses immense challenges to vaccine makers, but most of them have to do with manufacturing billions of doses in a matter of months.

We have enough worries when it comes to Covid-19; no need to add needless ones to the list.

We can’t count on warm weather to defeat the virus.

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The hot and humid weather of summer will not stop the pandemic. More sunlight and humidity may slow down its spread, but we probably won’t know by how much. Other factors, like reduced travel, increased personal distance, closed schools, canceled gatherings and mask-wearing, have effects that would outweigh the influence of the weather.

A few things are known about conditions that do or do not favor the virus. The ultraviolet rays in sunlight help destroy the virus on surfaces and some studies have shown a small effect from humidity. It seems to last longest on hard surfaces like plastic and metal. It won’t survive in pool or lake or seawater. Wind disperses it. Risk of transmission is lower outdoors than indoors.

A wooden bench under a bright sun at a breezy beach is a better bet than a metal and plastic recliner on the shady side of the pool. But if someone infected sits near you and coughs, or talks a lot or sings, it doesn’t really matter where you’re sitting and how nice a day it is.

“The virus doesn’t need favorable conditions,” said Peter Juni, an epidemiologist at the University of Toronto. It has a world population with no immunity waiting to be infected. Bring on the sun; the novel coronavirus will survive.

Air conditioning may blow the virus right to your restaurant table.

On Memorial Day, many people in the United States gathered in congenial closeness in lovely weather without masks. If any of them were infected and breathing, they probably infected someone else. The same will be true on July 4. Even if the weather is glorious.

Gay Couples Can Teach Straight People a Thing or Two About Arguing

Elana Arian and Julia Cadrain, a same-sex couple in Brooklyn, recently fought about a hat.

OK, it wasn’t really about the hat. (It never is.)

Cadrain likes things tidy. Really tidy. To the point where it annoys her entire family.

“I put things away while they’re still using them,” she admitted.

So when Cadrain found one of Arian’s favorite hats lying around, she promptly scooped it up, but neglected to store it properly. Arian later discovered her hat had accidentally been crushed.

“I was irrationally so angry about that,” Arian said.

They took a long walk, and had an honest, calm conversation. Soon, they realized that Arian’s frustration was actually about something deeper.

“One of the things that came up was this stress that we’re both under as a result of the quarantine,” Cadrain, 37, said. The couple is caring for their 9-month-old daughter while also guiding their 7-year-old daughter through distance learning. Arian, 39, a freelance musician, is working much less than she typically would. They had each been coping with this in different ways.

“It feels like a very lesbian way to fight. There’s definitely never any yelling. There’s no voice-raising,” Cadrain said. “It’s more kind of tense and quiet and sort of process heavy.”

But is there really a lesbian way to fight? Or a way to address conflict that is specific to gay men? While there is not much research to draw from, the studies that do exist suggest that, on average, same-sex couples resolve conflict more constructively than different-sex couples, and with less animosity.

There are always exceptions, and even the healthiest of gay couples are not continually basking in a rainbow-hued utopia. They have problems just like everyone else.

If they did not, “I’d be out of business,” said Rick Miller, a psychotherapist in Boston who works with gay and straight couples.

Likewise, it is unfair to lump all straight couples together, and disingenuous to suggest that they are not capable of arguing in a healthy way.

But because male and female same-sex couples each have different strengths that help them endure, we can all learn from them, Miller said.

Here are some constructive methods to handle disagreements, as observed by researchers of gay couples:

Use humor to diffuse anger

Cracking a joke in the midst of a heated moment can backfire, but when done properly, “it almost immediately releases the tension,” said Robert Rave, 45, who lives with his husband, David Forrest, in Los Angeles.

Rave cited a recent car trip where Forrest, 35, used humor to help end an escalating argument over whether they should rely on Google Maps.

“For me, as a general rule, I self-admittedly will get very much in my head. And David will just simply take the piss out of it and make me laugh,” Rave said.

A 2003 study compared 40 same-sex couples with 40 heterosexual couples over the course of 12 years to learn what makes same-sex relationships succeed or fail. The findings suggested that same-sex couples tended to be more positive when bringing up a disagreement and were also more likely to remain positive after a disagreement when compared to heterosexual couples.

“Gay and lesbian couples were gentler in raising issues, far less defensive, and used more humor than heterosexual partners,” said John M. Gottman, Ph.D., the lead author of the study and co-founder of the Gottman Institute, an organization that provides resources, like workshops and online courses, to help couples strengthen relationships and offers professional training to clinicians. “These were large differences.”

Stay calm

If you find that your heart is pounding during an argument, take a break, said Julie S. Gottman, Ph.D., co-founder and president of the Gottman Institute.

“During the time when you’re apart don’t think about the fight. Instead, practice something self-soothing, like reading a book, something distracting so that your body can calm down,” she said.

But if you need to leave, you should always say when you are going to come back and rejoin the conversation, she said, adding that the minimum amount of time away should be 30 minutes and the maximum should be 24 hours.

Gay men were less likely to go into fight-or-flight mode when they were in conflict, said the Gottmans, who are married, and they also reach resolutions more quickly than different-sex couples.

Treating your partner with respect is always important, but especially during an argument when you might say things you’ll later regret. When you’re heart is racing, “all you perceive is attack, no matter what your partner is saying,” Dr. Julie Gottman said.

And that’s exactly why Rave and Forrest try to end an argument quickly.

“Life is too short to have everything be so dramatic,” Rave said.

A 2018 study suggested that when members of a same-sex couple try to influence one another, they are more likely to offer encouragement and praise rather than criticism or lectures when compared to different-sex couples.

Be mindful of each other’s emotional needs

Unlike gay men, women who are married to women are “constantly monitoring each other’s emotions and needs and responding to them — but they are doing it for each other, so it’s reciprocated,” said Debra Umberson, Ph.D., a professor of sociology and the director of the Population Research Center at the University of Texas at Austin.

Two men, in contrast, do less monitoring, which is less labor-intensive.

“They’re on the same page about it,” said Dr. Umberson, who has studied gay couples for more than a decade. Two men will tell each other what they need or speak up when there is an issue.

If a couple has similar philosophies about emotional monitoring, there is less potential for conflict between them, Dr. Umberson said.

In heterosexual couples, women are the ones who tend to do emotional monitoring and responding, but the men tend to be unaware of it and often are not doing it, she added — and that can negatively affect the couple by making them feel more frustrated, worried, irritable or upset.

Dr. Umberson’s latest study, published in May, examined the psychological toll of providing for the emotional needs of a spouse. The researchers found that the well-being of women married to women seemed to be affected less by the work of assessing and managing each other’s emotions than that of women married to men. Earlier research suggests this could be because lesbians are more reciprocal in taking care of a spouse’s emotional needs and also have a greater appreciation for doing so.

Strive for equality in your relationship

Same-sex couples do not have traditional societal roles defining which tasks each member of the couple ought to perform at home or how they ought to relate to one another, which allows them to create their own dynamic.

Straight couples should negotiate and discuss things more, Cadrain suggested, and “don’t presume certain roles or jobs in terms of who is the breadwinner or how the household is taken care of.”

Although Arian cannot remember the last time she made the bed, she has other responsibilities, like being the chef of the family — or as Cadrain calls her, “C.E.O. of the food and the nourishment.” And because Arian was a teacher for many years, she is responsible for distance learning and staying on top of their 7-year-old’s schooling.

They do not typically fight about chores, the couple said, because they try to divide them based on what they like to do best or which of them is best positioned to complete a task.

“I suspect that has to do with gender roles not being present,” Arian said.

In heterosexual couples, researchers have found more of a power difference between members of the couple than among same-sex couples, Dr. John Gottman said.

“The same-sex couples we studied were very aware to try to make the power relationships more equal between them,” he said.

And if members of a same-sex couple disagree, they are more likely to listen to one another’s point of view, he added.

The Gottmans’ 2019 study, an assessment of more than 40,000 couples worldwide who were about to begin couples therapy, found that same-sex couples have a better quality of intimacy and friendship in their relationships.

Recognize and appreciate your differences

Each person brings their own baggage and their own way of looking at the world, Miller said.

“Really appreciating those differences and similarities and figuring out how to deal with it together — that’s what makes a healthy couple. And that goes across all borders, groups and genders,” he added.

Cadrain and Arian, for example, said they tried to be mindful of each other’s different communication styles.

“I tend to kind of under-communicate when I’m upset,” said Arian, who said she has a temper but often becomes restrained and terse during arguments. “I’m not proud of it.”

Cadrain, however, likes to talk things out — sometimes before Arian is ready. Simply being aware of their differences helps them manage conflicts when they arise.

Rave and Forrest are also different in a lot of ways: Forrest likes to go out and be social; Rave is more of a homebody. This has been a point of contention in their relationship.

“Allowing space for the person to be themselves is so important, and not shaming that person into what you want them to be,” Forrest said.

Finally, when thinking about your differences, try not to focus too much on the negative.

“Look for what your partner is doing right rather than always looking for what your partner is doing wrong,” Dr. Julie Gottman said.

Pregnancy Loss Tied to Increased Risk of Type 2 Diabetes

Loss of a pregnancy may increase a woman’s risk of developing Type 2 diabetes, Danish researchers report.

Their study, in Diabetologia, included 24,774 women who developed diabetes after pregnancy and 247,740 controls who did not.

Compared with women who had been pregnant without losing a baby, those who lost one were at an 18 percent increased risk for diabetes, those who lost two were at a 38 percent higher risk and those who lost three or more had a 71 percent higher risk. The study adjusted for obesity and gestational diabetes, which are known to be associated with the development of Type 2 diabetes.

The reason for the association remains unknown. It may be that the same genetic background increases the risk for both pregnancy loss and diabetes, or that pre-diabetes present before the diagnosis of diabetes could lead to both. In any case, the authors stress that the observational finding does not prove cause and effect.

The lead author, Dr. Pia Egerup, a researcher at the Recurrent Pregnancy Loss Unit of the Rigshospitalet and Hvidovre Hospital in Copenhagen, said that the most important clinical implication is that pregnancy loss is a risk factor for diabetes.

“Pregnancy loss is not only due to fetal disease,” she said. “A large proportion are healthy fetuses lost because of maternal conditions. As clinicians, we want to optimize pregnancy success and minimize the risk for future diabetes.”

Por qué los recortes en salud perjudican siempre a los californianos más vulnerables

Shirley Madden, de 83 años, depende de un cuidador y de sus dos hijas para seguir viviendo en casa, y no en una residencia.

Sus hijas, Carrie, de 55 años, y Kristy Madden, de 60, usan sillas de ruedas y necesitan un segundo cuidador que las ayude en su vida diaria.

Pero ese apoyo crítico para el cuidado, además de otros beneficios de atención médica para millones de californianos, podrían reducirse para ayudar a cubrir el enorme déficit presupuestario provocado por el coronavirus.

El gobernador de California, Gavin Newsom, ha propuesto recortes presupuestarios drásticos a los programas de salud pública, incluyendo Medi-Cal, el programa de Medicaid de California para personas de bajos ingresos, cuando se espera un aumento de inscripciones debido a la pérdida récord de empleos por culpa de la pandemia.

Los expertos temen que estos recortes puedan poner en peligro los miles de millones de dólares en fondos federales de emergencia para la salud asignados a California.

“Entiendo que hay una pandemia y que la situación es mala y que todo el mundo sufre”, dijo Carrie Madden de Chatsworth, California. Carrie y su hermana padecen distrofia muscular y su madre ha sobrevivido a un ataque al corazón mientras lucha contra la demencia.

Los temores de Madden se ven agravados por la crisis de COVID-19, que ha afectado con más fuerza a los mayores y a quienes tienen enfermedades crónicas. No quiere que su madre, su hermana o ella misma terminen en una residencia o en cualquier centro de cuidados a largo plazo, que son los lugares con más brotes.

“Este es el enfoque equivocado”, señaló. “Hará que las personas discapacitadas terminen en residencias para mayores”.

En todo el país, los estados consideran recortes a Medicaid para equilibrar sus presupuestos. En parte porque la salud suele ser la mayor parte del gasto estatal, después de la educación.

También proyectan que más gente se inscribirá en el programa de salud pública, a medida que el número de estadounidenses desempleados alcance niveles astronómicos. Más de 20 millones de estadounidenses solicitaron el subsidio de desempleo en abril, elevando la tasa de personas sin trabajo al 14,7%, la peor desde la Gran Depresión de la década de 1930.

Nueva York aprobó recortes a Medicaid que entrarán en vigor cuando termine la emergencia federal, mientras que Georgia ha dado instrucciones a todas sus agencias para reducir el gasto en un 14%.

En California, donde casi 2,9 millones de personas han solicitado el desempleo en los últimos dos meses, Newsom describió los recortes propuestos como “prudentes” y “estratégicos”, un giro enorme a los grandes planes que dio a conocer a principios de este año para ampliar la atención médica a algunos de los residentes más necesitados.

Para hacer frente a un déficit estimado de $54 mil millones en el presupuesto estatal 2020-21, Newsom propone un recorte de $205 millones —una reducción del 7% en las horas de los cuidadores— al programa de Servicios de Apoyo en el Hogar del que dependen los Maddens.

El programa, financiado principalmente por Medi-Cal, paga a los cuidadores para dar de comer a las personas que necesitan ayuda para vivir de forma independiente, lavar su ropa, bañarlos, administrarles tratamientos médicos y mantener su hogar limpio.

La lista de los otros recortes es larga: reducirá o eliminará programas que permiten a los mayores de bajos ingresos y a los discapacitados vivir en su propio hogar, como la atención médica diurna y el apoyo de los trabajadores sociales.

Propone facilitar al estado el cobro del pago póstumo de los fallecidos, mayores de 55 años, y afiliados a Medi-Cal, por una amplia gama de gastos médicos a través del controvertido “Programa de Recuperación de Bienes“. Sugiere que se reinstauren requisitos de ingresos más estrictos para que algunas personas mayores y las que tengan discapacidades puedan tener derecho a Medi-Cal gratuito.

Y ha pedido a los legisladores que eliminen $54,7 millones en beneficios “opcionales” de Medi-Cal, como la atención de podología para adultos, gafas, terapia del habla y exámenes de audición; beneficios que los mismos legisladores restauraron recientemente después de recortarlos durante la última recesión.

“No son beneficios opcionales para una persona que ha sufrido un derrame cerebral o necesita dientes para comer”, explicó Tricia Berke Vinson, una abogada de la Sociedad de Ayuda Legal del condado de San Mateo.

“Entiendo que estamos en una crisis presupuestaria”, añadió. “Pero no creo que se pueda equilibrar a costa de adultos mayores y enfermos”.

Médicos, dentistas y otros proveedores de atención de salud que tratan a pacientes de Medi-Cal también podrían perder $1,200 millones en pagos suplementarios que se derivan de la Propuesta 56, un impuesto sobre el tabaco que los votantes aprobaron en 2016.

La propuesta del gobernador demócrata incluye un “detonante” automático para eliminar los recortes si el estado obtiene más dólares federales para la crisis de la COVID, trasladando la responsabilidad al Congreso para negociar otro paquete de estímulo.

No se sabe si los legisladores aceptarán los enormes recortes a Medi-Cal que el gobernador ha propuesto. Por ejemplo, el plan del Senado estatal preserva la financiación de Medi-Cal y supone que el Congreso aprobará otro proyecto de ley de estímulo.

Ambas cámaras de la legislatura deben llegar a un acuerdo y presentar su versión del presupuesto al gobernador antes del 15 de junio.

“Salvar estos programas es salvar vidas y ahorrar dinero”, indicó el legisador Jim Wood (demócrata de Santa Rosa), presidente del Comité de Salud de la Asamblea. “Corten estos programas y los costos aumentarán y se perderán vidas”.

Tanto los expertos como algunos legisladores temen que el enfoque de Newsom pueda poner en peligro los miles de millones de dólares, en fondos federales de emergencia para la salud, que ya están asignados a California.

Los estados que abandonan a los inscritos en Medicaid, o reducen sus beneficios, corren el riesgo de perder los pagos federales de salud adicionales autorizados por el Congreso esta primavera, expresó Edwin Park, experto en Medicaid y profesor de la Escuela McCourt de Política Pública de la Universidad de Georgetown.

“El gobierno federal ha dicho que no se puede reducir la elegibilidad ni cancelar o recortar los beneficios”, dijo Park, y señaló que los legisladores de Nueva York retrasaron los recortes de Medicaid del estado hasta después de que terminara la emergencia federal, para asegurarse de que recibirán la ayuda federal ahora.

Los Centros de Servicios de Medicare y Medicaid no respondieron a las solicitudes de comentarios. La guía publicada en su sitio web sugiere que los estados deben mantener intactos los programas de Medicaid.

Se espera que California reciba $5.1 mil millones en fondos federales adicionales para Medi-Cal hasta el 30 de junio de 2021, según el presupuesto que Newsom hizo público a mediados de mayo.

La administración Newsom no cree que los recortes presupuestarios de Medi-Cal le cuesten al estado el dinero federal adicional ya aprobado por el Congreso.

“Nunca hay una garantía hasta que hablemos con el gobierno federal. Así que hasta entonces, es difícil decir qué se va a hacer a nivel federal”, dijo Yang Lee, analista del Departamento de Finanzas del estado.

La administración Newsom calcula que unos dos millones de californianos se inscribirán en Medi-Cal para julio como resultado de la pandemia, lo que eleva la inscripción en el programa a 14.5 millones, más de un tercio de todos los californianos.

La administración estima $3,100 millones en gastos adicionales para cubrir a los nuevos inscritos. La Legislative Analyst’s Office cree que esa cifra representa un exceso de $750 millones, en parte porque los nuevos inscritos serán principalmente personas más jóvenes y saludables que no necesitan tanta atención como los mayores de bajos ingresos y las personas con discapacidades.

Para muchos de los inscritos, las propuestas de Newsom recortarían múltiples beneficios.

Cynde Soto, de 63 años, dijo que se sintió como si “alguien me hubiera dado un puñetazo en el estómago” cuando supo que el plan del gobernador recortaría el presupuesto de los Servicios de Apoyo en el Hogar. Esta residente de Long Beach, que es tetrapléjica,  teme que los recortes del estado la obliguen a ir a una residencia de mayores. Además, teme perder la atención dental y de visión de Medi-Cal si se aprueban los otros recortes de Newsom.

“Es una pesadilla. No sé qué voy a hacer”, comentó Soto. “¿Por qué siempre somos los primeros a los que golpean?”.

Related Topics

California Cost and Quality Insurance Medi-Cal Noticias En Español States