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Apr 28, 2020

Coronavirus Live Updates: W.H.O. Warns Pandemic Is ‘Far From Over’ as Nations Edge Toward Reopening


22-28 minutes - Source: NYT


At least a dozen U.S. states forged ahead with a variety of strategies to ease restrictions. The C.D.C. expanded the list of symptoms associated with the virus.
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Detected infections of the coronavirus in the United States approached one million. More than 50,000 have died.
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Credit...Juan Arredondo for The New York Times

The C.D.C. expands the list of symptoms, and the W.H.O. warns of a long road ahead.

Even as governors across the United States proceeded cautiously with plans to allow businesses to reopen and other nations looked for ways to restart stalled economies, the workings of the virus continued to vex the scientific and medical community.
For weeks, most people in the United States have been told that they qualify for a test only if they have three symptoms associated with the disease: high fever, cough and shortness of breath.
As health experts have gained more experience with Covid-19, the disease caused by the virus, they are finding that many infected people have no fevers or that their fevers wax and wane over a period of weeks and are sometimes accompanied by chills.
The Centers for Disease Control has now expanded the list of symptoms to include repeated shaking with chills, muscle pain, headache, sore throat and a loss of taste or smell.
That differs from the guidance of the World Health Organization, which says that the most common symptoms are fever, dry cough and tiredness.
“Some patients may have aches and pains, nasal congestion, sore throat or diarrhea,” the W.H.O. says. “These symptoms are usually mild and begin gradually.”
With more than 200,000 people killed by the virus and roughly three million detected infections, there remains no effective therapeutic treatment. While the worldwide race for a vaccine to stop the coronavirus is gathering speed, success is still months away at the earliest.
The Jenner Institute at Oxford University is scheduling tests of a new coronavirus vaccine on more than 6,000 people by the end of next month, hoping to show not only that it is safe, but also that it works.
The Oxford scientists say that with an emergency approval from regulators, the first few million doses of their vaccine could be available by September — at least several months ahead of any of the other announced efforts — if it proves to be effective.
Dr. Tedros Adhanom Ghebreyesus, the director of the W.H.O., told a virtual news conference in Geneva on Monday that the pandemic was far from over.
“We have a long road ahead of us and a lot of work to do,” he said.

President Trump unveils plan to help states expand testing. Experts say it is not enough.

In the seven weeks since the president promised that anyone who needed a test could get one, the United States has conducted about 5.4 million tests, far more than any other country, but still the equivalent of only about 1.6 percent of the total population.
A group of experts convened by Harvard University’s Edmond J. Safra Center for Ethics has called for five million tests a day by early June, ramping up to 20 million per day by late July.
Under growing pressure to expand coronavirus testing as states move to reopen their economies, President Trump unveiled a plan on Monday to ramp up the federal government’s help to states, but his proposal ran far short of what most public health experts say is necessary.
Mr. Trump’s announcement came after weeks of his insisting, inaccurately, that the nation’s testing capability was “fully sufficient to begin opening up the country,” as he put it on April 18. Numerous public health experts say that is untrue, and Mr. Trump’s plan may do little to fix it.
An administration official said the federal government aimed to give states the ability to test at least 2 percent of their populations per month, though the president did not use that figure and it was not in his written plan. Instead, Mr. Trump and other officials with him in the Rose Garden said the United States would “double” the number of tests it had been conducting.
“These were not complaining people. They had everything they needed. They had their ventilators, they had their testing,” Mr. Trump said on Monday after a call with governors. “We’re getting them what they need.”
In fact, governors have been complaining that they do not have nearly enough tests to give them the kind of information they need to make difficult decisions about reopening. They say they are competing with one another — and with other countries — for the components that make up the testing kits, including nasal swabs and needed chemicals.
Rather than one coordinated federal response, the Trump administration has been engaging on an ad hoc basis as states take the lead.

States have different strategies for restarting the economy. Trump suggests opening some schools.

More than a dozen states moved ahead with tentative plans to gradually reopen their economies, but even as they pressed ahead, there remained no agreed-upon strategy for the best way to safely navigate from lockdowns to some form of new normal.
In some states, restaurants would remain closed. In others, they would be allowed to open with stringent new seating requirements. From the construction industry to entertainment, the rules of engagement varied depending on the state or city.
Gov. Greg Abbott of Texas announced that stores, restaurants, movie theaters and malls would be allowed to reopen with limited capacity on Friday. In Ohio, Gov. Mike DeWine unveiled a more incremental plan that would allow manufacturing work to resume and offices to reopen next week.
Arizona and Florida have stay-at-home orders that are set to expire on Thursday, but the governors of both states have been vague about their plans.
Organized like a PowerPoint presentation with roughly 25 slides, the tutorial describes what the virus is; how it is treated; how to avoid getting it; and the conditions laid down by the state — wearing masks, not congregating — for a safe work environment.
Each employee is supposed to fill out a short form attesting to having read the material. Vermont will not actually police compliance, although Gov. Phil Scott said that every company should appoint a safety officer to monitor work conditions.
“This is evolving, it’s not perfect, it’s not a flip of the switch, it is just something we have to provide, guidance, and there is going to be some social pressure as well to adhere to these procedures,” Mr. Scott told reporters on Monday. “I think guidance and education is the best policy.”
The state allowed people in solitary professions to return to work last week, including appraisers, property managers and attorneys who work alone.
It added manufacturing and construction businesses on Monday but limited the number of workers at any one location to five. Outdoor retailers like gardening centers and greenhouses can also reopen, but with a maximum of 10 people.
Even as governors moved to ease restrictions, business owners were often left trying to make sense of a cacophony of messages from President Trump, governors, county commissioners and mayors.
“I couldn’t sleep last night because I was so confused,” Jose Oregel said on Monday morning before reopening his barbershop in Greeley, Colo.
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In a call with the nation’s governors, Mr. Trump’s growing impatience with the restrictions was evident.
He suggested that some governors should move to reopen their public schools before the end of the academic year.
“Some of you might start to think about school openings,” Mr. Trump said, according to an audio recording obtained by The New York Times. “The young children have done very well in this disaster that we’ve all gone through, so a lot of people are thinking about the school openings.”
At least one state was already moving forward with the possibility of reopening schools. Montana, which has among the fewest cases and deaths, will give schools the option to reopen starting May 7.

Officials seek more flexibility on virus relief funds for states.

Lawmakers and state officials say the Trump administration is unreasonably restricting how local governments can spend federal aid as they struggle to stay afloat and as Republicans raise doubts about providing added financial relief to hard-pressed communities.
The officials say new Treasury Department rules that prohibit local governments from using their share of $150 billion provided last month for “revenue replacement” are impractical. Requiring that such assistance be confined to costs directly tied to the pandemic will be of limited help, they say, particularly in communities that have a low incidence of cases but have seen their revenue dry up because of the shutdown of the economy.
“It is clear the revenue loss is going to be coronavirus related; it is just that the expenditures are not specifically for coronavirus,” said Senator Sherrod Brown of Ohio, one of 46 senators in the Democratic caucus who signed a letter made public on Sunday urging the administration to revise the ban.
The Federal Reserve said on Monday that it would substantially expand its municipal lending program, allowing smaller cities and counties to sell their investment-grade debt to the central bank.
The push for more state freedom in spending the first batch of money allocated by Congress last month comes as the clash intensifies over whether states should get hundreds of billions of dollars more in the next stage of emergency legislation — or whether there should be another recovery measure in the short term at all.

Scientists fear that Trump’s bleach remarks could embolden a fringe movement.

President Trump’s statements at a White House briefing last week about potentially using disinfectants to treat the virus have put him in the company of pseudoscientists and purveyors of phony elixirs who promote and sell industrial bleach as a “miracle cure” for autism, malaria and other medical conditions.
But some scientists express fear that Mr. Trump’s remarks could breathe life into a fringe movement that embraces the medicinal powers of a powerful industrial bleach known as chlorine dioxide, which the president did not mention specifically.
“For a lot of people, Trump represents an alternative to pointy-headed experts in white lab coats who speak a language we can’t understand,” said Dr. Alan Levinovitz, a professor at James Madison University who studies the relationship between science and religion. “When you feel existentially threatened by a deadly virus, and the president says you can take control of your health with a product in your kitchen cabinet, that’s incredibly empowering.”
The problem, of course, is that ingesting or injecting industrial bleach can be deadly. Chlorine dioxide destroys red blood cells, wreaks havoc on the digestive system and can cause severe damage to the liver and kidneys.

Program to provide assistance to small businesses gets off to a rocky start.

Minutes after a $310 billion aid program for small companies opened for business on Monday, the online portal for submitting applications crashed. And it kept crashing all day, much to the frustration of bankers around the country who were trying — and failing — to apply on behalf of desperate clients.
Some bankers were so irritated that they vented on social media against the Small Business Administration, which is running the program. Rob Nichols, the chief executive of the American Bankers Association, wrote on Twitter that the trade group’s members were “deeply frustrated” at their inability to access the system. Until the problems were fixed, he said, “#AmericasBanks will not be able to help more struggling small businesses.”
Pent-up demand for the funds has been intense, after the program’s initial $342 billion funding ran out in under two weeks, stranding hundreds of thousands of applicants whose loans did not get processed. Last week, Congress approved the additional $310 billion for small businesses hit by the coronavirus pandemic. Bankers were expecting the money to once again run out quickly, and so on Monday at 10:30 a.m., when round two opened, they were ready to go.
But for the second time in a month, the relief effort, called the Paycheck Protection Program, turned into chaos, sowing confusion among lenders and borrowers. A centerpiece of the government’s $2 trillion economic stimulus package, the program offers small companies — typically those with up to 500 workers — forgivable loans of up to $10 million. The S.B.A. is backing the loans, but customers must apply through financial institutions.
When the aid program first went live on April 3, the Treasury Department’s goal was to quickly steer money to the neediest businesses — hair salons, coffee shops, dry cleaners and others. But many large banks needed more time to set up their systems and held off for days on taking applications, leading to an outcry from borrowers who could not afford to keep waiting. Many were also furious that hundreds of publicly traded companies, as well as wealthy clients of some big banks, got access to those funds.

Reduced death tolls in New York and New Jersey have leaders optimistic.

New York and New Jersey, the two states hit hardest by the virus, have shown enough progress that their governors started on Monday to offer details on how reopening might go in the months ahead.
The optimistic signs came as both states announced one-day death tolls — 337 in New York, and 106 in New Jersey — that were less than half of their peaks.
Gov. Andrew M. Cuomo of New York suggested that some businesses in what he called low-risk industries like construction or manufacturing might restart in parts of the state after May 15. Much of the state, including New York City and its suburbs, would remain shut down longer, he said.
”I don’t think you’ll see us taking in each case identical steps, but I think you’ll see our steps harmonized,” Mr. Murphy said.
Mr. Murphy said schools in New Jersey might be able to reopen before the end of June. And Mayor Bill de Blasio of New York said he thought the city’s beaches could be partially open by the end of the summer.
Even as the virus’s spread appeared to be slowing, Mr. Cuomo cautioned that the economic effects of the outbreak had probably not reached their peak. With over a million New Yorkers out of work, food banks across the state are experiencing huge jumps in demand, he said.

Abortions via telemedicine nearly double during the U.S. shutdown.

Abortion through telemedicine is a quietly growing phenomenon, driven in part by restrictions from conservative states and the Trump administration that have limited access to abortion clinics.
Now, the coronavirus pandemic is catapulting demand for telemedicine abortion to a new level. With much of the nation under strict stay-at-home advisories, several states, including Arkansas, Oklahoma and Texas, have sought to suspend access to surgical abortions during the crisis.
A telemedicine program has been allowed to operate as a research study for several years under a special arrangement with the Food and Drug Administration. It allows women seeking abortions to have video consultations with certified doctors and then receive abortion pills by mail.
Over the past year, the program, called TelAbortion, has expanded to serve 13 states. Not including two recently added states, about twice as many women had abortions through the program in March and April as in January and February.
As of April 22, TelAbortion had mailed 841 packages containing abortion pills and confirmed 611 completed abortions, according to Dr. Elizabeth Raymond, senior medical associate at Gynuity Health Projects, which runs the program.

How to keep your home tidy and filled with the essentials.

While stuck indoors, you can finally address tasks you’ve long put off, such as organizing your shelves. Here are some tips on how to keep your house well stocked.

Follow updates on the pandemic from our team of international correspondents.

Some students returned to school in China, where social distancing measures and grueling placement exams awaited.
Reporting was contributed by Pam Belluck, Michael Gold, Jack Healy, Shawn Hubler, Andrew Jacobs, Marc Santora, and Neil MacFarquhar.
  • Updated April 11, 2020
    • When will this end?

      This is a difficult question, because a lot depends on how well the virus is contained. A better question might be: “How will we know when to reopen the country?” In an American Enterprise Institute report, Scott Gottlieb, Caitlin Rivers, Mark B. McClellan, Lauren Silvis and Crystal Watson staked out four goal posts for recovery: Hospitals in the state must be able to safely treat all patients requiring hospitalization, without resorting to crisis standards of care; the state needs to be able to at least test everyone who has symptoms; the state is able to conduct monitoring of confirmed cases and contacts; and there must be a sustained reduction in cases for at least 14 days.
    • What should I do if I feel sick?

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

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

      It seems to spread very easily from person to person, especially in homes, hospitals and other confined spaces. The pathogen can be carried on tiny respiratory droplets that fall as they are coughed or sneezed out. It may also be transmitted when we touch a contaminated surface and then touch our face.
    • Is there a vaccine yet?

      No. Clinical trials are underway in the United States, China and Europe. But American officials and pharmaceutical executives have said that a vaccine remains at least 12 to 18 months away.
    • What makes this outbreak so different?

      Unlike the flu, there is no known treatment or vaccine, and little is known about this particular virus so far. It seems to be more lethal than the flu, but the numbers are still uncertain. And it hits the elderly and those with underlying conditions — not just those with respiratory diseases — particularly hard.
    • What if somebody in my family gets sick?

      If the family member doesn’t need hospitalization and can be cared for at home, you should help him or her with basic needs and monitor the symptoms, while also keeping as much distance as possible, according to guidelines issued by the C.D.C. If there’s space, the sick family member should stay in a separate room and use a separate bathroom. If masks are available, both the sick person and the caregiver should wear them when the caregiver enters the room. Make sure not to share any dishes or other household items and to regularly clean surfaces like counters, doorknobs, toilets and tables. Don’t forget to wash your hands frequently.
    • Should I stock up on groceries?

      Plan two weeks of meals if possible. But people should not hoard food or supplies. Despite the empty shelves, the supply chain remains strong. And remember to wipe the handle of the grocery cart with a disinfecting wipe and wash your hands as soon as you get home.
    • Should I pull my money from the markets?

      That’s not a good idea. Even if you’re retired, having a balanced portfolio of stocks and bonds so that your money keeps up with inflation, or even grows, makes sense. But retirees may want to think about having enough cash set aside for a year’s worth of living expenses and big payments needed over the next five years.

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