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https://www.washingtonpost.com/world/2020/03/11/coronavirus-live-updates/

LIVE UPDATES: WHO DECLARES CORONAVIRUS A PANDEMIC; ITALY HALTS NEARLY ALL COMMERCIAL ACTIVITY

By Alex Horton, Miriam Berger, Lateshia Beachum, Hannah Knowles and Michael Brice-Saddler | Published March 11 at 7:19 PM ET | Washington Post | Posted March 11, 2020 |

The World Health Organization declared coronavirus a pandemic, with WHO Director-General Tedros Adhanom Ghebreyesus saying: “We are deeply concerned both by the alarming levels of spread and severity — and by the alarming levels of inaction.”

The WHO’s Wednesday declaration came as the number of known novel coronavirus cases surpassed 120,000 worldwide. Speaking on Capitol Hill, Anthony Fauci, the long-standing director of the National Institute of Allergy and Infection Diseases declared “it’s going to get worse.”

President Trump said he will address the nation at 9 p.m.

In the United States, where there are now more than 1,000 cases, the White House is considering moving all of Europe to a Level 3 travel advisory, discouraging all nonessential travel to those regions. Meanwhile, Italy tried to stymie coronavirus’s spread by ordering a halt to nearly all commercial activity, aside from supermarkets and pharmacies.

HERE ARE THE LATEST DEVELOPMENTS :

*The Dow reached bear-market territory on a nearly 1,500-point skid as panic intensified about the coronavirus, which threatens to debilitate global economies and bring on a recession.

*Ohio will limit large gatherings; Washington state introduced similar measures in a few counties. The NCAA announced that its basketball tournaments will be held without fans in attendance.

*India’s health ministry announced it was suspending all existing visas from across the world till April 15.

*German Chancellor Angela Merkel warned Wednesday that up to 70 percent of her country could end up infected.

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08:19 PM: WORK-FROM-HOME AT GOOGLE EXPOSES CLASS DIVIDE: CONTRACTORS VS. FULL-TIME

Growing fears around the spread of coronavirus have exposed class divides in the tech industry’s two-tiered system for white collar workers, where contractors do similar work as full-time employees — such as engineering or product management — but often for no equity, less pay, and fewer benefits.

Google on Tuesday publicized extending safety protections to contractors, including establishing a covid-19 fund to provide paid sick leave for contingent workers if they have symptoms or are quarantined. The company also advised employees in North America to work from home until at least April 10, according to a Tuesday email viewed by The Post.

But some Google contractors say they are still in limbo, unsure if they can exercise those benefits. On Wednesday, Google’s office in Pittsburgh was a ghost town, save for contractors employed by HCL Technologies, who work on Google Shopping. HCL employees in Pittsburgh, who recently unionized, believe it’s technically feasible to perform their job from home, if given permission. However, workers were told Wednesday afternoon that HCL is still talking to Google and can’t provide an update for 24 to 48 hours.

In the midst of that uncertainty, one contractor whose wife had symptoms of coronavirus came into Google’s Pittsburgh office Wednesday, another HCL employee told The Post, noting that dogs are no longer allowed in the Pittsburgh office as a temporary precaution. “So even dogs are more important of a priority than us,” he said.

HCL did not immediately respond to request for comment. In a statement to The Post, Google spokesperson Jenn Kaiser said, “To serve our users and keep our products running, some work, performed by Google employees, temporary staff and vendors alike, can only be done by people physically present at offices. We’re taking all necessary and recommended precautions, including increased sanitization and social distancing, a public health best practice.”

By: Nitasha Tiku

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08:04 PM: ELECTIONS OFFICIALS scramble for OPTIONS AS VIRUS WORRIES MOUNT

Elections officials have stocked up on hand sanitizer and disinfecting wipes. Many are urging voters to cast absentee ballots or vote early to avoid crowds.

But as the coronavirus pandemic worsens, local and state officials are scrambling to identify other options if public health leaders ultimately determine that there are risks to visiting polling places — an assessment that could change the basic mechanics of running an election midstream in a presidential campaign year.

“If you’re talking about something on that level, then we’re clearly facing a crisis and not just an emergency, and public health and safety will have to dictate whatever we do,” said Ohio Secretary of State Frank LaRose, who said he would follow the advice of public health officials and law enforcement.

"One of the very few things that would take precedent over a free and fair election is public health and safety, right?” LaRose said, adding that such a move would be a last resort.

Read more about the effort to keep elections virus-free.

By: ELISE VIEBECK

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07:59 PM: NBA discusses coronavirus response but doesn’t immediately announce plan for games, fan attendance

The NBA’s Board of Governors held a conference call Wednesday to discuss the league’s coronavirus response options, but reached no consensus as to whether games should proceed as normal, whether they should be held without fans in attendance, or

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07:19 PM: U.S. EMBASSY EMPLOYEE IS JAMAICANS SECOND CASE

A U.S. Embassy employee in Kingston, Jamaica, has become the island nation’s second confirmed case of the novel coronavirus, Jamaican Health Minister Chris Tufton announced on Twitter late Wednesday.

The U.S. State Department did not immediately respond to a request for comment.

Confirmation of the case came one day after Jamaica announced that a female British national, who arrived in the country on March 4, had tested positive for the virus.

Though far from the epicenter of the crisis, Jamaica is grappling with the fallout, facing a loss of 50,000 cruise ship passengers in recent weeks and a sharp falloff in some tourism-related business. The country has set up strict health protocols aimed at preventing the spread of the virus and has led at least one cruise ships to bypass its port in Ocho Rios. It has also effectively barred one vessel due to reports of sick passengers aboard.

Across Jamaica, nearly three dozen people remain quarantined after traveling to countries reporting large numbers of cases. The Jamaican government has also banned travel to and from China, Iran, South Korea, Italy and Singapore and suspended flights from Spain, France and Germany.

By: ANTHONY FABIOLA

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07:15 PM: HOW MUCH WORSE IS CORONAVIRUS GOING TO GET IN U.S.? NEW FORECASTS AND MODELS ARE GRIM

A rash of alarming forecasts about the coronavirus pandemic emerged Wednesday. The World Health Organization officially declared it a pandemic. German Chancellor Angela Merkel said 70 percent of Germany’s population could become infected. Meanwhile, new models painted a grim picture of what worst-case scenario might look like.

“Bottom line, it’s going to get worse,” Anthony Fauci, long-standing director of the U.S. National Institute of Allergy and Infectious Diseases, said at a congressional hearing.

Experts have produced forecasts of likely infections, serious illnesses and death tolls, based on what is known about the novel coronavirus and how past epidemics have played out, and they suggest that the United States — which has surpassed 1,000 confirmed novel-coronavirus infections and 30 deaths — must prepare for a potentially historic pandemic.

One forecast, developed by former CDC director Tom Frieden at the nonprofit organization Resolve to Save Lives, found that deaths in the United States could range widely, depending on what percentage of the population gets infected and how lethal the disease proves to be. Frieden, who oversaw the 2009 H1N1 influenza pandemic, the 2014 Ebola epidemic and the 2016 Zika epidemic, says in a worst-case scenario, but one that is not implausible, half the U.S. population would get infected and more than 1 million people would die.

But the model’s range varied widely from 327 (best case) to 1,635,000 (worst case). The deaths would not necessarily happen over a month or a year, but could happen in two or three years, he said.

By: JOEL ACHENBACH, WILLIAM WAN and LENA H. SUN

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06:57 PM: El SALVADOR BEGINS NATIONWIDE QUARANTINE DESPITE HAVING NO CONFIRMED CASES

El Salvador’s president, Nayib Bukele, announced Wednesday that the country — which does not have a single confirmed coronavirus case — will begin a nationwide quarantine that will last for 30 days.

Schools will be closed for 21 days. “I know this will be criticized, but let’s put ourselves in Italy’s shoes. Italy wishes they could’ve done this before,” he said.

“Our health system is not at Italy’s level, it’s not at South Korea’s level,” he added.

Earlier, Bukele banned travel from China, South Korea, Italy, Iran, France, Spain and Germany.

By: KEVIN SIEFF

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06:35 PM: CAPITOL PREPARES TO SHUT DOWN PUBLIC TOURS

The Capitol is preparing to shut down public tours because of the growing coronavirus pandemic, according to two congressional officials.

The announcement is being prepared by the House and Senate sergeant-at-arms, according to the officials, who spoke on the condition of anonymity ahead of the official notification. Between 3 and 5 million tourists, from both the United States and abroad, visit Capitol Hill each year, according to the Architect of the Capitol.

Lawmakers have generally resisted efforts to stop legislative operations even as the outbreak expands, continuing to hold hearings and conduct business.

By: SEUNG MIN KIM

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06:26 PM: PRESSURED BY TRUMP ADMINISTRATION, CRUISE INDUSTRY TO RESTRICT OLDER TRAVELERS IN RESPONSE TO CORONAVIRUS

Responding to a directive from the federal government, the beleaguered cruise industry has crafted a coronavirus response plan that will keep more people off its ships.

Passengers who are 70 and older will be required to produce a doctor’s note attesting that they are healthy enough to take a cruise, according to a source familiar with the plan who was not authorized to speak publicly about it. That person said keeping the most vulnerable population off ships was a priority of the Trump administration. About 14 percent of cruise passengers in 2018 — about 4 million people — were 70 or older, an industry report showed.

USA Today first reported details of the plan Wednesday.

Travelers will be warned frequently before a trip that anyone with underlying health conditions is heavily discouraged from getting on a cruise ship. Those who are obviously ill will not be allowed to board, according to the source.

All passengers will be subject to a temperature check before they can get on a ship, and those with a reading of 100.4 degrees or higher will not be allowed to sail.

The Cruise Lines International Association had previously announced that anyone who had visited Iran, South Korea or China, including Macao and Hong Kong, or areas in Italy subject to government lockdown, within the past 14 days, would not be allowed to board. The new plan expands that list to include all of Italy as well as Japan.

According to the source, the plan also addresses testing passengers for the virus while they are on ships and how cruise lines will pay for the care of sick passengers or crew so that the burden doesn’t fall on the U.S. government. The source described it as “a pretty hefty investment by the industry.”

By: HANNAH SAMPSON

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06:11 PM: HOSPITAL INDUSTRY ASKS WHITE HOUSE TO DECLARE A NATIONAL EMERGENCY

Hospital industry leaders are urging the Trump administration to declare the covid-19 outbreak a national emergency or a national disaster to “ensure that health care services and sufficient health care items are available to respond.”

During a Wednesday afternoon meeting at the White House with Vice President Pence and Seema Verma, administrator of the Centers for Medicare and Medicaid Services, the American Hospital Association’s president and several hospital chief executives said the federal public health emergency declared at the end of January is inadequate.

The meeting echoed a letter to the vice president sent on Tuesday by Richard Pollack, the hospital association’s president. The letter explained that only with a national emergency or disaster could the government loosen a variety of health-care rules, helping to cope with a surge of seriously ill, infected patients.

According to the letter, a declared emergency or disaster would, for instance, eliminate a Medicare rule that patients need to have been hospitalized for at least three nights before the vast insurance program for older Americans pays for nursing home stays — freeing hospital beds more quickly for the sickest patients with the new virus. It also would help patients stay longer in certain types of small rural hospitals, as well as making it easier for doctors licensed in one state to pitch in elsewhere, where the outbreak is particularly severe.

The letter noted that the government has loosened such rules after major hurricanes and floods and during the swine flu pandemic a decade ago.

The hospital leaders also urged the White House to provide federal help for the testing and care of people exposed to the coronavirus who are uninsured.

By: AMY GOLDSTEIN

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06:09 PM: SENATE DEMOCRATS URGE TRUMP TO UTILIZE $40 BILLION IN DISASTER RELIEF FUNDS TO COMBAT CORONAVIRUS

Three dozen Senate Democrats on Wednesday sent a letter to Trump urging him to immediately consider state disaster declaration requests in order to release more than $40 billion in federal relief funds.

In their letter, the senators called on Trump to invoke the 1988 Stafford Act, which enables the Federal Emergency Management Agency to coordinate disaster relief efforts. Members of Trump’s coronavirus task force have discussed doing so, officials have told The Washington Post in recent days.

“It is crucial that your administration employ a whole-of-government approach in responding to COVID-19,” the senators wrote. “This includes working closely with state, local, and tribal officials and providing necessary resources to those on the frontlines. We strongly urge FEMA to stand ready to provide emergency protective measures to prevent and mitigate the spread of disease, save lives, and protect public health and safety, should any state request assistance.”

The release of the letter comes hours before Trump is expected to address the nation in a prime-time address from the Oval Office.

By: FELICIA SONMEZ

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05:53 PM: FIVE MORE DEATHS AT ASSISTED-LIVING FACILITIES REPORTED IN WASHINGTON STATE IN ONE DAY

Washington state announced five more coronavirus fatalities on Wednesday, all linked to nursing homes or assisted-living facilities. The news pushed the nationwide death count to at least 36; 29 of those are in Washington state.

King County, where most of the deaths have occurred amid nursing home outbreaks, reported four more deaths and 44 new patients. The county, which includes Seattle, now has 234 confirmed cases.

The newly announced deaths include three residents at Life Care Center, the facility where the outbreak has been especially horrific and where staff say they have seen patients go from showing no symptoms to death in a matter of hours. Two of the deceased were in their 90s, one woman in her 60s.

Another King County woman who died in her 90s lived at the Redmond Care and Rehabilitation Center nursing home.

Snohomish County also reported Wednesday that a man in his 80s who was “connected” to an assisted-living facility, Josephine Caring Community, had died.

By: HANNAH KNOWLES

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05:44 PM: BIDEN CANCELS MORE CAMPAIGN EVENTS OVER VIRUS; PENCE STILL SET TO STUMP IN WISCONSIN

In response to the worsening coronavirus outbreak, Biden’s team has canceled additional campaign events in Illinois and Florida to “minimize health risks for staff and supporters” and will hold “virtual events” instead.

The decision comes as the former vice president plans to speak about the global pandemic Thursday. Ahead of those remarks, he has set up his own public health advisory committee with boldface names from the Obama administration, including Vivek H. Murthy, who was surgeon general under President Barack Obama, and Lisa Monaco, former homeland security and counterterrorism adviser to Obama.

The committee will provide “science-based, expert advice,” Biden’s campaign said.

“The campaign’s top priority is and will continue to be the health and safety of the public,” it said. “Members of the committee will provide ongoing counsel to the campaign, which will in turn continue to update the public regarding operational decisions.”

The former vice president’s approach stands in contrast to Trump, who has said that he would continue holding rallies and attending public events and has played down the severity of the spreading virus. In a Fox Business Network interview Wednesday, Trump campaign spokeswoman Kayleigh McEnany claimed without evidence that political considerations — and not coronavirus concerns — are the reason Biden has canceled his events.

Meanwhile, Vice President Pence, who is running the government’s response to the coronavirus outbreak, is still planning to attend a campaign event in Wisconsin next week for a congressional special election as Democrats and many organizations cancel large events.

In a C-SPAN interview Wednesday, Pence was asked whether he was personally concerned about attending these large events.

“I’m not concerned,” he said, “but we’ll follow the facts every single day about what makes the most sense for the American people.”

By: COLBY ITKOWITZ

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05:37 PM: D.C. MAYOR DECLARES STATE OF EMERGENCY AFTER PERSON-TO-PERSON CORONAVIRUS TRANSMISSIONS

D.C. Mayor Muriel E. Bowser (D) declared a state of emergency in the nation’s capital because of coronavirus, giving herself the power to order mandatory quarantines and to crack down on price gouging. Health officials said six more people have tested positive for coronavirus in the District, including two cases where the cause of transmission is unknown. That brings the total number of cases to 10. Officials said person-to-person transmission has started in the District.

Bowser’s emergency declaration came hours after the District urged the cancellations of all mass gatherings through the end of March. Bowser said the city government was pulling all permits for public gatherings and that she could order closure of other gatherings if necessary.

After the rector of Christ Church Georgetown tested positive for coronavirus, the District has asked hundreds of people who visited the church to self-quarantine for 14 days after their last visit. D.C. health officials expanded the self-quarantine to people who visited the church through March 6 after the organist tested positive, including a Saturday funeral where he played.

Bowser has said the city has leased a private facility that can be used to quarantine up to 50 people, but declined to reveal its location. Officials said quarantine orders could be used for people at high risk of exposing the virus to others or those who do not comply with self-quarantine requests.

By: FENIT NIRAPPIL

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05:29 PM: ITALY HALTS NEARLY ALL COMMERCIAL ACTIVITY ASIDE FROM SUPERMARKETS AND PHARMACIES

ROME — Italy on Wednesday ramped up the severity of its national lockdown, ordering a halt to nearly all commercial activity aside from supermarkets and pharmacies, in the latest dramatic step to slow the country’s coronavirus spread.

With the decision, announced by Prime Minister Giuseppe Conte, Italy has engineered nearly as thorough a commercial halt as seems imaginable.

Once the decree takes effect — Conte did not specify when — only the most essential parts of society will continue to function. Farms can still produce food, and factories can still churn out products, but people will have almost no reason to leave the house.

“You’re changing your life’s habits, making sacrifices, but these renunciations are offering a great, precious contribution to the country,�� Conte said. “Italy is showing it’s a great community, united and responsible.”

On Monday, Conte had imposed a nationwide lockdown, limiting travel abroad and across regions. With it came other restrictions: the closure of theaters, museums, sporting events. But Italy had still been operating at a crawl. Gelaterias were open, with people lining up a few feet away from one another. Barbershops were open. Cafes were open, with limited hours and restrictions on the number of people allowed inside.

Conte received strong political pressure from politicians in the north, the region at the epicenter of the outbreak, to further tighten the measures as the number of coronavirus cases continues to accelerate. Italy has more than 10,500 active cases, and the number of people who have died of the virus has risen in three days from 366 to 827.

By: CHICO HARLAN

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05:22 PM: MAJOR UNION CALLS ON TRUMP TO PROVIDE TWO WEEKS OF PAID SICK LEAVE FOR EVERY AMERICAN WORKER

United Food and Commercial Workers, the largest private-sector union in the United States with 1.3 million workers in retail and health care, asked President Trump and Congress on Wednesday to pass a new economic aid package that would provide a minimum of two weeks of paid sick leave for all American workers.

The union’s proposed economic package also includes unemployment benefits for workers who have been laid off or had their hours disrupted, payroll tax cuts for lower- and middle-income workers, as well as protection from unfair termination or discrimination for workers suspected of being exposed to coronavirus.

UFCW President Anthony “Marc” Perrone outlined the policy proposal in a letter to Trump, House Speaker Nancy Pelosi (D-Calif.), Senate Minority Leader Charles E. Schumer (D-N.Y.) and House Minority Leader Kevin McCarthy (R-Calif.). The letter noted that 80 million American workers, or 59 percent of the country’s workforce, are hourly employees who receive payment only for the hours they work.

“Respectfully, I am urging each of our nation’s elected leaders to develop immediate policies that ensure that workers — salaried and hourly — do not have to choose between work and health,” the letter said.

By: NITASHA TIKU

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04:45 PM: NCAA BASKETBALL TOURNAMENTS WILL OPEN WITH NO FANS

The NCAA men’s and women’s basketball tournaments will be played in nearly empty arenas because of concerns about the coronavirus, NCAA President Mark Emmert announced Wednesday afternoon amid swelling recommendations and orders from public officials, one of the most significant public actions in the face of the outbreak in the United States.

The games, which begin Tuesday night in Dayton, Ohio, will be played “with only essential staff and limited family attendance,” Emmert said in a news release.

“While I understand how disappointing this is for all fans of our sports, my decision is based on the current understanding of how covid-19 is progressing in the United States,” he said. “This decision is in the best interest of public health, including that of coaches, administrators, fans and, most importantly, our student-athletes. We recognize the opportunity to compete in an NCAA national championship is an experience of a lifetime for the students and their families. Today, we will move forward and conduct championships consistent with the current information and will continue to monitor and make adjustments as needed.”

By: ADAM KILGORE

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04:44 PM: WHEN’S THE LAST TIME THE WHO DECLARED A GLOBAL PANDEMIC?

The last time the World Health Organization declared a pandemic was during the 2009 H1N1 swine flu, and it triggered aggressive actions, such as millions in spending to buy vaccines.

But H1N1 turned out not to be as deadly and disruptive as feared, and a lot of governments were mad about buying vaccines that they ended up not using and harshly criticized the WHO for its declaration. Burned by that response, WHO got rid of the six-stage procedure that led up to it declaring that flu a pandemic.

“Each time they went up a stage, it raised alarm. When they finally reached pandemic stage it caused enormous panic,” said Lawrence Gostin, global health law professor at Georgetown University. “It was so dysfunctional and caused so much fear and panic that WHO abandoned that approach.”

The WHO’s current approach has been much more vague, essentially leaving it up to leaders to declare a pandemic when they deem it necessary. For weeks now, the WHO has hesitated to make the pandemic declaration for fear of inciting panic and causing some countries to sag in their efforts, even though many epidemiologists believed the coronavirus had already spread to pandemic levels.

“In many ways, whether we’re in a pandemic is a semantic question,” said Alexandra Phelan, a global health lawyer at Georgetown’s Center for Global Health Science and Security.

By: WILLIAM WAN

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04:40 PM: TRUMP CAMPAIGN CLAIMS WITHOUT EVIDENCE THAT BIDEN WAS ‘LOOKING FOR AN EXCUSE TO GET OFF THE CAMPAIGN TRAIL’

In a Fox Business Network interview Wednesday, Trump campaign spokeswoman Kayleigh McEnany claimed, without evidence, that political considerations — and not coronavirus concerns — are the reason Biden has canceled his recent events.

“Joe Biden is looking for an excuse to get off the campaign trail, and let me just add, the media’s best hope is for Donald Trump to suspend his rallies,” McEnany said. “They’ve been wanting him to stop this, they know it’s his avenue to speak directly to the American people. So, we’re going to follow the president’s lead; we’re not going to cave to the media. And Joe Biden, we’re certainly not going to follow his lead as he tries to hide from the American people.”

Biden and Sanders called off their Tuesday night campaign rallies in Ohio after Mike DeWine, the state’s Republican governor, suggested that the campaigns to do so in an effort to stem the spread of the coronavirus.

McEnany also defended Trump’s decision to continue holding large campaign rallies despite the advice of experts, including Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases.

“The president is the best authority on this issue,” McEnany said. “He takes into consult the words of everyone around him. That would include [Health and Human Services Secretary] Alex Azar; that would include Dr. Fauci; that would include others. So, I’ll leave it to the president. Right now, we’re proceeding as normal.”

She also said that there is no need for Trump to stop shaking hands with supporters, arguing that it’s part of the president’s job.

“He’s taking precautions, he’s washing his hands — we’re all doing that, but he’s a man of the people, he talks to the people, he shakes their hands. That’s the nature of the business,” she said.

By: FELICIA SONMEZ

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04:31 PM: HEALTH-CARE CLINICS FOR THE POOR FACE SHORTAGES OF PROTECTIVE GEAR

The nation’s community health centers, which care for some of the nation’s most vulnerable patients, are ill-equipped with masks and other protective equipment needed for workers to test and care for people who may have been exposed to the coronavirus, according to a new survey.

The survey in early March of more than 600 health centers in 47 states, sponsored by a private relief organization, found that 1 in 4 such clinics said they had a source that could provide and resupply N95 masks for the next month or two. Half said they did not, while the remaining clinics said they were not sure. Nearly two-thirds said they lacked a supplier to restock latex gloves.

The survey was sponsored by Direct Relief, a California-based aid organization that donated supplies to China early in the coronavirus epidemic and has been turning its attention lately to the United States.

Free clinics and federally funded health centers treat some of the country’s poorest patients. Under the Affordable Care Act, some of their clientele have gotten private health plans or have been able to join Medicaid. But the clinics still tend to be shoestring operations with many uninsured patients. And the federal funding that some receive is often uncertain in Congress until the last minute — as is happening again this year.

The survey found that only about 10 percent of the health centers said they were unconcerned about their ability to handle a surge of patients during the covid-19 epidemic.

By: AMY GOLDSTEIN

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04:27 PM: TRUMP SAYS HE WILL ADDRESS THE NATION TONIGHT

President Trump said he will address the nation Wednesday evening about the coronavirus and that his remarks from the White House will probably be at 9 p.m.

He gave no other details during a brief portion of a meeting with bankers that was open to reporters, other than that he will discuss both economic and health issues.

“We are talking about various forms of stimulus,” he said. Trump added: “The payroll tax would be great. Dems are not in favor of it. I’m trying to figure out why.” Many Republicans also oppose cutting the payroll tax.

Trump has spoken almost daily about the spread of the virus, but until now he had not done so in such a formal setting. The speech is expected to be from the Oval Office, a setting that underscores the national security implications of the spreading virus.

By: ANNE GEARAN

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04:25 PM: NATIONAL CATHEDRAL AND HUNDREDS OF OTHER CHURCHES IN WASHINGTON AREA TO CLOSE FOR TWO WEEKS

Episcopal churches in the District and the Maryland and Virginia suburbs — including Washington National Cathedral — are closing for two weeks because of the coronavirus, church leaders said Wednesday.

Bishop Mariann Budde, who oversees 88 congregations in the District and Maryland that serve about 38,000 people, said all buildings would be completely closed until March 25, a measure that includes weekday activities and Sunday services. Susan Goff, bishop of the Episcopal Diocese of Virginia, said 179 churches in the Virginia suburbs, with about 68,000 members, would do the same.

The announcement came hours after D.C. health officials asked organizations to postpone any “mass gatherings” involving 1,000 people or more in the city until at least March 31.

Goff said the last time that churches canceled en masse over health concerns was for the flu of 1918.

A spokesman for Budde said the diocese will stream services from the cathedral on Sundays — with no audience.

By: MICHELLE BOORSTEIN and SARAH PULLIAM BAILEY

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04:22 PM: STATE DEPARTMENT AND USAID SUSPEND NON-ESSENTIAL TRAVEL

The State Department and the U.S. Agency for International Development have suspended nonessential travel for employees in response to the outbreak of the coronavirus, a move that requires diplomats and aid workers to receive sign-off from managers that future travel is “mission-critical,” said two U.S. officials familiar with the matter.

The move demonstrates the urgency with which U.S. agencies view the spread of the disease even as President Trump downplays the threat posed by the virus. At the same time, the policy has created confusion within the State Department and USAID as various bureaus, embassies and offices weigh the importance of the thousands of trips, conferences and meetings U.S. personnel embark on every year.

One State Department official, who spoke on the condition of anonymity because she was not authorized to discuss internal matters, said it was discouraging when an upcoming trip she viewed as critical to her job was canceled by her boss, who believed it did not meet that threshold.

By: JOHN HUDSON

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04:18 PM: DOW REACHES BEAR-MARKET TERRITORY ON A NEARLY 1,500-POINT SKID, ENDING RECORD 11-YEAR STOCK RALLY

Wall Street went into a deep slump Wednesday, falling so far and so fast that the Dow Jones industrial average officially tipped into a bear market, ending a record 11-year stock rally.

The bear market reflects a 20 percent fall from record highs, which the Dow hit less than a month ago, and came as the coronavirus officially became a pandemic.

The World Health Organization’s declaration Wednesday signaled that health experts believe efforts should shift from trying to contain the virus to mitigation.

The Dow — already deep in the red for the day — plunged further, tumbling almost to the 1,500-points-down mark, after the WHO announcement.

“Bear markets are ugly,” said Michael Farr, president of Farr, Miller and Washington. “They’re painful and they all last too long. Sadly, it seems that a new one is just getting started.”

All 11 S&P stock market sectors turned negative on Wednesday. Real estate, utilities and energy — often safe havens for nervous investors — were faring the worst. The health sector was the least affected by the sell-off. UnitedHealth Group was the lone component of the Dow‘s 30 blue chips to show a gain. Boeing shed 18 percent of its value.

By: TAYLOR TELFORD and THOMAS HEATH

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04:02 PM: DELAWARE REPORTS FIRST POSITIVE TEST; MORE THAN 40 STATES NOW CONFIRM INFECTIONS

Delaware on Wednesday announced its first positive test for the coronavirus, as more than 40 states report infections.

The Delaware patient, a man older than 50, whom officials say is “doing well,” lives in New Castle County and is “associated with the University of Delaware community,” the state’s public health department said in a statement. Before the case was announced, the university said it was “gearing up for online delivery of all of our courses in the event that we have confirmed COVID-19 cases on campus.”

The Delaware patient was exposed to the virus in another state, authorities said, and self-isolated at home right away when his symptoms began. Officials are working to identify contacts.

“We understand that news of a positive case in the state is concerning,” said public health director Karyl Rattay in a statement, “but this is something we have been preparing for over the last several weeks.”

By: HANNAH KNOWLES

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03:58 PM: AMTRAK RIDERSHIP PLUMMETS AMID OUTBREAK

The coronavirus outbreak has brought a steep fall in March passenger numbers and revenue for Amtrak, and the nation’s passenger rail company is warning of hard times ahead.

Ridership is down, cancellations are up by more than 300 percent, and future bookings have fallen by half, Amtrak said Wednesday, citing the public health crisis that has led Americans to cancel travel in recent days.

If the trend continues, Amtrak said revenue losses could be in the “several hundred million dollars” and throw off the company’s growth projections for this year. A plan to reduce spending is in place, and it includes service cuts and layoffs.

Ridership declines over the past few weeks have been sharp in the Northeast Corridor and on Amtrak’s National Network, and it is getting worse every day, Stephen Gardner, senior executive vice president and chief operating and commercial officer at Amtrak, said in a memo to workers on Wednesday.

“At this rate, we believe we will likely suffer the loss of several hundred million dollars in revenue during this fiscal year — and we might lose more,” Gardner said.

Amtrak has begun “aggressive measures to cut costs,” Gardner said.

“You should expect significant reductions in train service across portions of our network in response to the sharp drop in ridership. Shortly, we will begin rolling out our voluntary leave program for those non-mission critical employees that are willing to take time off on an unpaid basis,” he said.

This week, Amtrak canceled its Acela nonstop trips between Washington and New York to reduce service as demand dropped. The daily nonstop Acela service is suspended through May 26, the company said. More service could be halted across the network of about 300 daily trains nationwide.

The company has suspended change fees on all existing and new reservations for tickets purchased before April 30 to accommodate concerned travelers.

By: LUZ LAZO

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03:46 PM: OHIO TO LIMIT LARGE GATHERINGS IN DRAMATIC NEW MOVE TO FIGHT VIRUS

Ohio will limit large gatherings in a dramatic bid to combat the novel coronavirus, Gov. Mike DeWine (R) announced Wednesday, shortly after Washington state turned to similar measures in a few counties.

DeWine said he will soon issue an order enforcing Tuesday’s recommendation against mass gatherings and spectators at indoor sporting events but would not yet close K-12 schools, though he tweeted that “we may get to that point.”

“We are doing the things we are doing because we have the potential to become like Italy,” he tweeted, referencing the European country’s nationwide restrictions on movement. “We are taking the actions we are taking now to try to avoid that. The situation will get bad before it gets better, but it is in our hands to determine what the outcome will be.”

DeWine also said Wednesday that he will order that visitors to nursing homes and assisted-living facilities be limited to one per day per resident. The elderly are most vulnerable to the coronavirus, and outbreaks at nursing homes in Washington state have been deadly. Authorities in Ohio will require that all individuals who enter such facilities be screened for illness and have their temperatures taken, DeWine announced.

Four people in the state have tested positive, he said, as authorities called evidence of the virus’s community spread a “game changer" requiring more serious measures.

“You’re going to see us taking more aggressive actions now," said Amy Acton, the director of the state’s department of health. "Please know that we’re doing this to protect Ohioans and protect our healthcare system.”

“We shouldn’t panic, but we should take rational actions to protect ourselves, our loved ones, and others,” DeWine tweeted Wednesday afternoon.

Have you tried to get tested for coronavirus and been turned away? Share your experience with The Post.

By: HANNAH KNOWLES

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03:35 PM: WASHINGTON STATE’S CORONAVIRUS DEATH TOLL AT 25

Another coronavirus patient in Washington state has died, officials announced Wednesday, bringing the death toll there to 25.

The newly reported death occurred in Snohomish County, where officials say there are 68 confirmed cases of the virus. The county now has two recorded fatalities — still far less than King County, where almost two dozen have died as outbreaks hit nursing homes. The elderly are most vulnerable to the virus.

Snohomish and King are among the counties where Gov. Jay Inslee (D) on Wednesday imposed a ban on gatherings of more than 250 people, seeking to contain the spread of infection.

Nationwide, the coronavirus has killed more than 30 people and the number of cases has surpassed 1,000.

By: HANNAH KNOWLES

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03:27 PM: BOEING WILL CASH OUT $13.8 BILLION LOAN AND FREEZE HIRING AMID MARKET TURMOIL

Boeing plans to cash out a $13.8 billion loan meant to cover costs related to the grounding of the 737 Max passenger jet, a person familiar with the matter said Wednesday, as recent market volatility creates new risks at a time when the company’s business is already in a historically fragile state.

Boeing declined to comment on the loan cash out, but said it would put a hold on all new hires pending a “review of priorities and critical needs.”

The company’s stock was down 16 percent by late afternoon Wednesday.

By: AARON GREGG

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03:20 PM: HUNDREDS OF THOUSANDS OF STUDENTS SHIFTING TO ONLINE LEARNING IN NEW YORK, ONE OF SEVERAL NEW MEASURES ANNOUNCED BY CUOMO

New York Gov. Andrew M. Cuomo (D) on Wednesday announced sweeping new measures to combat coronavirus, including distance learning for hundreds of thousands of students at public schools and paid leave for quarantined or isolated government workers.

New York also will start contracting with private labs to increase its testing capacity, Cuomo said as the state’s cases topped 200, adding that he spoke with 28 labs earlier in the day. Lawmakers and public health officials around the country have been frustrated with delays in rolling out widespread testing that could help show the full extent in the United States of what’s now a global pandemic.

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meryableblog · 5 years

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How to deal with Anxiety About Coronavirus (COVID-19)

It’s terrifying to find out that an illness like coronavirus (COVID-19) is spreading across the world. the first stages of an epidemic are often especially anxiety-provoking. During this point, you don’t skills widespread or deadly the illness goes to finish up being.

Feelings of fear, anxiety, sadness, and uncertainty are normal during an epidemic. Fortunately, being proactive about your psychological state can help to stay both your mind and body stronger.

Ways to require care of yourself include:

Reading the news from reliable sources (and take breaks from the news) Recognizing the items you'll control, like having good hygiene Taking measures as long as recommended by the CDC Practicing self-care Seeking professional help from a licensed psychological state professional if necessary Ways to Manage Stress The way you deal with stress can go an extended way toward ensuring that you’re taking helpful action in managing your psychological state. Here are ways to assist you to ease anxiety surrounding coronavirus.

Read news from trustworthy sources. Avoid media outlets that build hype or linger over things that can’t be controlled. Instead, address sources that give reliable information about the way to protect yourself, like the Centers for Disease Control and Prevention (CDC).

Develop an action plan. There are always some steps you'll fancy decrease risk. it's going to be as simple as washing your hands well and limiting travel. But recognizing these can remind you to specialize in belongings you have control over. Just confirm the steps you’re taking are actions recommended by reputable sources.

Set limits on your media consumption. Tuning into media stories that mention how briskly an illness is spreading, or what percentage people are becoming sick, will increase your anxiety. Limit your media consumption to a particular time-frame or a particular number of articles.

While it’s helpful to remain informed, it’s also important you don’t allow yourself to be bombarded with anxiety-provoking news all day.

Avoid the herd mentality. Be aware that a lot of people take action that doesn’t help. Don’t hop on a bandwagon simply because people are wearing masks or performing specific cleaning rituals (unless those things are recommended by the CDC). Otherwise, your actions could convince be unhelpful—or maybe even destructive.

Practice good self-care. Eating a diet, getting much sleep, and interesting in leisure activities are always key to helping you stay as physically and psychologically healthy as possible during stressful times. Good self-care also keeps your system robust.

Seek professional help. If your psychological state is being impacted by the strain of the coronavirus, then you'll want to hunt professional help. A licensed psychological state professional can assist you to manage your fears while also empowering you to form the simplest decisions for you and your family.

The Best Online Therapy Programs Mental Health Concerns In addition to psychological state concerns that will arise as a result of anxiety surrounding an epidemic, it is vital to watch existing psychological state conditions to make sure they do not worsen.

Depression and Anxiety Researchers have found that some individuals may experience psychological state problems for the primary time during an epidemic. Adjustment issues, depression, and anxiety may arise.

A study from the Ebola virus outbreak in Sierra Leone,1 indicated that increased numbers of individuals reported psychological state and psychosocial problems. A study from the H1N1 influenza outbreak in 20092 indicated a rise during a sort of emotional symptoms, including somatoform disorders (symptoms like pain and fatigue that cannot be fully explained by a physical cause).

Additionally, some existing psychological state conditions may worsen. Research suggests that individuals who are especially susceptible to stress and anxiety could also be at the very best risk.

Severe anxiety can also cause a rise in substance use. Individuals who are in recovery may become more likely to relapse as their stress levels increase.

Researchers from Carleton University in Ottawa, Canada, found that folks who were the smallest amount ready to tolerate uncertainty experienced the foremost anxiety during the H1N1 pandemic.3 Those individuals were also less likely to believe they might do anything to guard themselves.

Caretakers could also be at especially high risk for emotional symptoms during an epidemic also. they'll experience:

increased depression and anxiety increased concerned about protecting their loved ones guilt about causing/not preventing a loved one's illness if they become sick In turn, children often adopt the coping strategies they observe in their parents. Parents who grow anxious during an epidemic may find yourself witnessing their children develop anxiety all along with them.

High anxiety and feelings of helplessness can encourage some individuals to adopt unproven remedies or prevention methods. a number of these methods could also be harmful both to individuals and to the community as an entire. So it’s important to make sure that any actions you're taking are literally helpful.

Rumination or Isolation Personal reactions to increased fears may differ. But many individuals experience increased rumination about the likelihood of getting sick. they'll also greatly modify their behavior when doing so isn’t warranted (e.g., isolating themselves or preparing for catastrophic outcomes).

Individuals with certain vulnerabilities may experience a rise in psychosis or paranoia. this will involve a bent to include outbreak-related facts into, or as justification for his or her delusional thinking.

How Do I React? You may witness people around you panicking. On the opposite hand, you'll experience those don't seem concerned in the least when an epidemic is on the increase, assured that it won't affect them. you'll end up feeling all types of emotions—or maybe, you're confused and do not skills to feel.

Responding to the Unfamiliar People tend to overreact to unknown threats as easily as they underreact to familiar threats. as an example, although car crashes are common, driving or riding during a car probably doesn’t feel scary since you presumably roll in the hay on a daily basis.

Similarly, you would possibly not be that scared of the flu. After all, you’ve survived up so far by either beating the flu or avoiding it. Yet influenza sickens the maximum amount as 20% of the population in any given year, and thousands of individuals die from it.

But the vaccination rate for the flu within us is typically but 50%—most people just aren’t scared of it. The reverse is additionally true; what we all know less about is more likely to form us nervous.

You're more likely to develop serious anxiety surrounding what you're less conversant in. this is often one of The explanations why pandemics of the past, like the Ebola virus and Zika virus, created a spike in anxiety for many individuals.

Being bombarded with news that constantly talks about death tolls, and reports that emphasize what percentage are sick can cause people to overestimate the risks they face in contracting the illness.

However, reliable sources of media also can have positive effects during an epidemic.

Media's Influence One reason for this might stem from the way the brain responds to novel threats. A 2013 study published in PLOS One4 found that the amygdala portion of the brain (a part of the brain involved in processing emotional responses) experiences increased activity when faced with unfamiliar threats. This results in heightened anxiety. The amygdala responds differently when faced with a well-known threat, however.

The media can fuel anxiety by continuously reporting on the “spread” of an illness just like the coronavirus. However, when used appropriately, the media also can be an ally in disseminating useful information.

Positive vs. Negative Use of Media During the 2009 H1N1 influenza pandemic, Australian and Swedish media outlets both reported accurately on the risks of contracting the illness.

Swedish media outlets, however, were simpler because they reported on how viewers could protect themselves and reduce their risk of getting sick. they freely admitted to uncertainties about the epidemic but encouraged people to urge vaccinated as how to assist keep other members of the community safe.

Australian media, on the opposite hand, largely chose to focus the bulk of their attention on reporting public agency missteps during the outbreak. this might have negatively affected the likelihood that Australians felt an urgency to leap out and obtain vaccinations.

Before the pandemic, Sweden and Australia had similar vaccination rates. Following the outbreak, the vaccine rate was 60% in Sweden and 18% in Australia.5

As a result, researchers discovered that news reports can reduce panic within the public by recommending concrete, detailed actions for people to require. This approach may prevent individuals from overreacting or taking drastic measures when a replacement threat emerges.

Fortunately, most pandemics disappear almost as quickly as they start. But managing your anxiety as you learn more about the outbreak, or discovering the way to protect yourself, are often difficult. Fortunately, getting proactive about your psychological well-being can help manage your psychological state during these times of uncertainty.

#corona virus #covid2019 #covid-19 #stayhome #staystrong #stay safe

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behealthy99 · 3 years

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Coronavirus: Study deliberately exposes people to COVID, finds that symptoms developed much quicker than thought

New Post has been published on https://behealthy99.com/coronavirus-study-deliberately-exposes-people-to-covid-finds-that-symptoms-developed-much-quicker-than-thought/

Coronavirus: Study deliberately exposes people to COVID, finds that symptoms developed much quicker than thought

In a first-of-its-kind COVID-19 human challenge study, where healthy and young individuals were intentionally exposed to the coronavirus, UK scientists have found out that people developed the symptoms in less than 2 days after exposure. Only half of participants who were exposed to the coronavirus developed infections, with mostly mild symptoms, the study on 34 individuals, aged 18–30, has found.

People who were infected with the virus developed their first symptoms and tested positive, in less than two days after exposure, on average, the study found.

This contrasts with the 5 day incubation period that other studies have documented till now. High viral levels persisted for an average of 9 days, and sometimes up to 12, the study has found.

The results of the study have been posted on 2 February to the Research Square preprint server and have not been peer-reviewed.

The first group of participants were exposed to the virus in early 2021 and were quarantined at a high-level isolation unit at the Royal Free Hospital in London. The participants were exposed to a low dose of virus which is equivalent to the amount of virus in a single respiratory droplet.

Also Read: The complete list of COVID vaccines currently in use in India

The common symptoms were sore throats, runny noses and sneezing and fever was less common in the participants. No one developed the persistent cough. Fever and persistent cough are considered to be a hallmark of COVID-19 symptoms.

“Mild-to-moderate symptoms were reported by 16 (89%) infected individuals, beginning 2-4 days post-inoculation. Anosmia/dysosmia developed more gradually in 12 (67%) participants,” the study has found.

The scientists have found that 18 individuals were infected with viral load rising and peaking at 5 days post-inoculation. Their study has found that a viable virus was recoverable from the nose up to 10 days post-inoculation. The study holds that the isolation period should be 10 days after the onset of the symptom in order to minimise further transmission.

The study has established that there is no quantitative correlation between viral load and symptoms.

Also Read: How Omicron symptoms may vary in vaccinated vs. unvaccinated individuals

It has said that lateral flow tests are a good indicator of viable viruses and can interrupt their spread. “However, lateral flow results were strongly associated with viable virus and modelling showed that twice-weekly rapid tests could diagnose infection before 70-80% of viable virus had been generated,” it has said.

In this study ancestral strain of the coronavirus was used. The team plans to launch another challenge trial that will expose vaccinated people to the Delta SARS-CoV-2 variant. That study will attempt to identify immune factors that protect people from ‘breakthrough’ infection after vaccination, as per a Nature report.

Human-challenge trial studies have been used earlier to study influenza, malaria and numerous other infections.

#News

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shutterbulky · 3 years

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What is Flurona and Symptoms of COVID Vs Flu

What is Flurona? When a patient has both the flu and COVID, this is known as Flurona. Although the name may appear to be a joke, the World Health Organization reports that incidences of influenza and COVID-19 are extremely real. According to The Times of Israel, Israel just confirmed its first case of so-called flurona on Thursday. The dual infection was discovered in an unvaccinated pregnant…

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slipperycatto · 3 years

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Typical CFS (chronic fatigue syndrome) vs. Post-Covid19 syndrome

Okay! So, I am hoping this post will reach the people who are also struggling with the havoc and chronic issues covid-19 can wreak upon your body; I certainly would love to hear your experiences and match them up with mine. I am not a medical professional (as evidenced by my horrid little "essay" that I have come to share with you all. I say essay in the loosest of terms, cconsidering I am not an exemplary writer, and you are entitled to your opinions on my post) , but I would still love to correlate on this and perhaps find a reason as to the differeing symptoms.

Without further ado, here are my thoughts on the variant of cfs caused by Covid-19.

For all unaware of what Chronic fatigue syndrome is, put simply (too simply, because I have no medical experience except for being stuck with needles and having joint tests) a medical condition caused by a viral infection. It is characterised by these symptoms:

-fatigue and muscle weakness exacerbated by physical and mental strain

-issues concentrating

-memory problems

-joint pain

-chest pain, though I am fairly certain that this, in addition to difficulty breathing, is fairly unique to the Covid-19 variant

-heart palpitations

-depression and anxiety

There are, of course, more symptoms, but this is unfortunately a brief overview, and outlining all of the possible symptoms would be a long and, quite frankly, tiring endeavour.

Onto the variations in symptoms that I am at least fairly certain of:

-loss of taste and sense of smell

-difficulty breathing

Now, here is where we start to get into a little bit of my own experiences and a small amount of my personal medical history. If this is not of importance to you and you simply wanted to hear some thoughts on the contrasts of cfs and post-Covid19 syndrome, then this is your cue to leave, as this is most likely of no interest.

My own variation, which is a slight mix of both variations, the first caused by influenza at an early age, coupled with depression, anxiety, and psychosis, and the second; the latter form of cfs, seems to have flare-ups and even the strangest amount of a paralytic quality.

The first variant did not affect the quality of my life; I was easily tired and would often feel exhausted from the lightest exercise, certainly, but nothing extreme.

Recently, I have had to start using a cane to walk. Caused by the post-Covid19 syndrome, my life has been drastically affected. I cannot go long distances without my cane, and if I do so I collapse or my vision starts to become affected.

If you stuck through my little sidetracked description, then let me generalise a little bit from my brief research on the two kinds of cfs.

Chronic fatigue syndrome is caused by any viral infection; however, in Covid-19 it seems to be a higher chance (this may be due to more attention and researchdevoted specifically to the post-Covid19 effects), with more specific symptoms.

It seems that the covid version is somewhat more volatile, including symptoms such as trouble breathing and chest pain; seeming to be more related to covid symptoms themselves.

It's actually quite similar in appearance to narcolepsy symptom-wise, including difficulty sleeping at night, bouts of fatigue and passing out during the day, and even small amounts of paralysis, though the paralysis was my own experience and I have seen nothing so far in my small amounts of research.

It's sort of like having a constant, slightly less extreme version of covid but constantly over the course of months and even years. (And do believe me- I've had it since around January before quarantine. I am absolutely certain it can last that long.)

It additionally has the normal chronic fatigue syndrome symptoms such as: joint pain, dizziness when standing or moving, random bouts of muscle weakness, muscle weakness caused by movement or mental strain.

All very interesting and I do wonder how the forementioned prior fatigue changed my symptons- if it did at all. There is, of course, a point to be argued that it was not worsened by this factor but simply made less noticeable by it.

#Chronic fatigue syndrome #cfs #chronic fatigue #covid 19 #chronic pain

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scentedrunawayshark · 3 years

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Health Care for African Americans

Almost 44 million American citizens are Black or African American, making up 13.4% of the U.S. population. This demographic experiences a long-standing and disproportionate burden regarding health and access to medical care in this country. And while the Affordable Care Act has made securing health insurance coverage more attainable for Black Americans, about half of the 30 million adults currently uninsured are people of color. For those who do have coverage, some significant healthcare disparities still persist.

Contents [hide]

What Are Healthcare Disparities?

What Forces Are Driving These Disparities?

Black vs. White Health Burdens

Preventable Cancers

Caught in the Medicaid Gap

Algorithmic Bias

Racial Inequity and COVID-19

Insurance Access and Maternal Health

Unequal Treatment

Influence of Shared Ethnicities

How TrueCoverage Can Help

Children’s Health

Cardiovascular Disease

Cancer

Mental Health

What Are Healthcare Disparities?

A healthcare disparity refers to differences among groups regarding access to and utilization of care, care quality and health insurance coverage. These disparities are closely associated with social, environmental or economic disadvantages. The Kaiser Family Foundation warns: “Disparities in health and healthcare not only affect the groups facing disparities, but also limit overall gains in quality of care and health for the broader population and result in unnecessary costs.”

And it’s not just a problem for members of the disadvantaged populations; health disparities exact a steep cost on broader society as well. According to a 2018 study by the W. K. Kellogg Foundation, health inequities cause us to lose $93 billion in excess medical care expenditures and $42 billion in unrealized productivity. Estimating that 3.5 million years of life are lost due to premature deaths, the report states that life spans shortened by health disparities cost the economy $175 billion.

What Forces Are Driving These Disparities?

A variety of individual and systemic factors form interrelated and complicated barriers to health and healthcare in the Black community. Among the most significant are:

Providers: Cultural bias, miscommunication, racism

Healthcare system overall: Funding of care, organization

Moreover, a host of other social, environmental and economic determinants interconnect and reinforce healthcare outcomes. For instance, gender, geography, socioeconomic status or sexual orientation may influence one’s ability to obtain quality medical services. Health inequalities among the African American population are also apparent throughout the life course, from the womb to older age.

Black vs. White Health Burdens

The American Cancer Society reports that Black Americans have the highest mortality rate and shortest survival of any ethnic group for most cancers in the U.S. The death rate is also higher among Black folks with respect to hypertension, heart disease, diabetes, stroke, influenza and pneumonia and HIV/AIDS. Life expectancy is lower for Black adults than for White ones. Disparities that persist include:

Children’s Health

2.2 times higher infant mortality rate

1.8 times more likely to be diagnosed with asthma

Cardiovascular Disease

Men 30% more likely to have hypertension

Women 60% more likely to have hypertension

Less likely to keep blood pressure under control

Cancer

Women 40% more likely to succumb to breast cancer

Men 1.3 times more likely to develop colorectal cancer

Men 2.5 times more likely to succumb to prostate cancer

Mental Health

20% more likely to report psychological distress

50% less likely to receive mental health counseling or treatment

Preventable Cancers

The American Cancer Society states that at least 42% of newly diagnosed cancers among Black Americans are among those cases that are considered preventable. Many cancers caused by infectious microbes could also be avoided through treatment of the infection and vaccination. Early detection and screening could help avert cervical and colorectal cancers as well.

Caught in the Medicaid Gap

As of 2017, 58% of the Black population in the United States lived in southern states, most of which have not adopted ACA’s optional Medicaid expansion provisions. Alabama, Florida, Georgia, South Carolina, North Carolina, Tennessee and Texas — all states with significantly large Black communities — are among the 14 states that have not yet expanded their Medicaid programs as of January 2020. In these states, over two million adults who would otherwise qualify for expanded Medicaid programs are trapped in a “coverage gap” in which their incomes exceed Medicaid eligibility limits but fall below the poverty level, the minimum for Marketplace premium tax credits.

Overall, over 90% of adults in the coverage gap live in the South. One-third of these individuals reside in Texas, 17% live in Florida and 11% are in Georgia. These states — and the South in general — have more poor uninsured adults and more limited Medicaid than other parts of the country. Citizens in the South continue to face limited options for affordable health care.

Algorithmic Bias

A 2019 study concluded that a widely used algorithm to allocate healthcare to patients systematically discriminates against African Americans. This algorithm, used to help manage care for about 200 million Americans each year, is less likely to refer Blacks with complex medical conditions than equally ill Whites to personalized care programs. Researchers discovered that Blacks were generally given lower risk scores than Whites. As a result, African American Americans had to be sicker than Whites before receiving referrals for additional medical assistance.

Racial Inequity and COVID-19

The CDC cites mounting evidence suggesting that COVID-19 disproportionately impacts African Americans and other ethnic minority populations. Long-standing inequities and injustices have placed many minorities at a greater risk of becoming ill and dying from this pandemic. The CDC states that social factors such as poverty and access to health care contribute to a wide spectrum of risks and outcomes related to health and quality of life for Blacks.

Insurance Access and Maternal Health

According to a 2020 Michigan Medicine study, almost half of all Black, Latina and Indigenous women had gaps in insurance coverage between pre-conception and post-delivery, compared to one-fourth of White women. Research indicates that two-thirds of pregnancy-related deaths among Black women are preventable. These mothers are 3 times more likely than White mothers to die from childbirth-related complications

Unequal Treatment

Research suggests that Blacks experience more obstacles than Whites with respect to trusting healthcare providers and are often discriminated against by their doctors. In a 2016 study, African American patients reported that clinicians commonly discredit their reported symptoms and do not respect the patients’ perspectives with regard to their own health. These issues pose significant barriers to cultivating productive patient-provider relationships for Black Americans.

Influence of Shared Ethnicities

Given that only 5% of all U.S. physicians are Black, it’s easy to understand why many Black Americans are apprehensive about their doctor-patient relationships. According to Michigan Medicine physician Ryan Huetro, M.D., African American patients are typically more comfortable seeing a Black doctor. He notes growing evidence of several positive outcomes when doctors and patients share the same racial identity:

Improved time together

Improved wait times for treatment

Adherence to medication

Shared decision-making

Patient understanding of health risks

Patient perceptions of treatment decisions

Decreased implicit bias on the part of the doctor

How TrueCoverage Can Help

At TrueCoverage, our goal is to help you find comprehensive health insurance coverage that fits your budget. We are your one-stop insurance shop, serving as a marketplace, personal broker and personal advisor with access to over 50,000 solutions. Our licensed agents are standing by to provide free customer support 24/7 with cutting-edge technology and resources for getting the best plans at the best price. Contact us today for a free health insurance quote to secure the coverage you need.

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paradisetechsoftsolutions · 3 years

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Coronavirus (COVID-19) vs Seasonal Allergies in India

Is it Coronavirus or Seasonal Allergies?

The foremost advisory signs of COVID-19 (Coronavirus (COVID-19) vs Seasonal Allergies) , the disease caused by the new coronavirus, are fever, fatigue, and a dry cough. Sometimes, it also causes cold-like symptoms like Rhinorrhea. During allergy season, it may be hard to tell the difference between COVID-19 and allergies.

Allergy symptoms happen partly because of inflammation. That’s caused by your body overreacting to things like pollen or mold.

Note: If you encounter any of these symptoms Coronavirus (COVID-19) vs Seasonal Allergies, or your cough gets worse to the point of shortness of breath, please call your healthcare provider and seek immediate medical attention.

This becomes even more significant if you undergo such seasonal allergies, as coughs and sneezes are the most common ways of transmitting an upper-respiratory virus-like COVID-19. If you’re a silent carrier of Coronavirus (COVID-19) vs or any Seasonal Allergies who’s only coughing because of pollen, those coughs still serve to propel viral particles out into the air and toward other people.

Of course, it is spring; so many people may be undergoing their seasonal springtime tree pollen allergies. Cold Viruses also endure quite common, just as was true before the coronavirus. And although influenza season is coming to an end, perhaps you’ve wondered if some of your symptoms could be the flu.

Are your symptoms consistent with allergies?

Spring, with its budding trees and warmer weather, means allergy season for many of us. As you see the trees in your area budding, that means the pollen counts will also be increasing. Due to Coronavirus (COVID-19) vs Seasonal Allergies in India, cases and so the situation getting scarier day by day.

Key symptoms: Two strong indicators that suggest allergies: if you’ve had springtime allergies before, and if the itch is a prominent component of your symptoms. People with allergies often have itchy eyes, itchy nose, and sneezing, as well as less-specific allergy symptoms such as a runny, congested nose, and a sore throat or cough that is generally due to postnasal drip.

This noxious virus can cause pneumonia-like symptoms too. And if the people who are fallen ill are reported to suffer coughs, fever, and other difficulties in breathing. This is viral pneumonia that simply can cause and in fact, the antibiotics found of no use.

Around the world, in most of the cases, people won't know whether they are suffering from Coronavirus (COVID-19) vs Seasonal Allergies in India that's been called Rhinovirus. It takes around 5 days to start showing the symptoms, researchers have said but some people will get seasonal symptoms much later than this. The incubation period lasts up to 14 days, the World Health Organization (WHO) says.

Clinical Presentation

Incubation period

The incubation period for Coronavirus (COVID-19) is thought to extend to 14 days, with a median time of 4-5 days from exposure to symptoms onset. One study reported that 97.5% of persons with Coronavirus (COVID-19) who develop symptoms will do so within 11.5 days of SARS-CoV-2 infection.

Presentation

The signs and symptoms of Coronavirus (COVID-19) present at illness onset vary, but over the course of the disease, most persons with Coronavirus (COVID-19) will experience the following:

Fever (83–99%)

Cough (59–82%)

Fatigue (44–70%)

Anorexia (40–84%)

Shortness of breath (31–40%)

Sputum production (28–33%)

Myalgias (11–35%)

Some persons with Coronavirus (COVID-19) vs Seasonal Allergies in India, have experienced other gastrointestinal symptoms such as diarrhea and nausea prior to developing fever and lower respiratory tract signs and symptoms.9 Anosmia or ageusia preceding the onset of respiratory symptoms has been anecdotally reported12, but more information is needed to understand its role in identifying COVID-19.

Several studies have reported that the signs and symptoms of Coronavirus (COVID-19) vs Seasonal Allergies in children are similar to adults and are usually milder compared to adults.13-17 For more information on the clinical presentation and course among children, see Information for Pediatric Healthcare Providers.

These viruses are typically responsible for common colds more than serious diseases. However, coronaviruses (COVID-19) are also behind some more severe outbreaks.

“It’s still early in the COVID-19 phase,” Shum says. “People are still attributing their symptoms to their allergies.”

Ending Note:

It’s important to note that this article is not intended to provide comprehensive medical advice. If you have concerns, please always contact your doctor and use general best practices. "So, Have you or someone you know been affected by Coronavirus (COVID-19) vs Seasonal Allergies in India or nearby to you at any place? Share your experiences with us by commenting in the comments section".

Stay Home & Stay Safe!

#Coronavirus or Seasonal Allergies #Seasonal Allergies in India #Clinical Presentation

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didanawisgi · 3 years

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Peter Doshi: Pfizer and Moderna’s “95% effective” vaccines—we need more details and the raw data

January 4, 2021

On 5 February 2021 we published a clarification to this piece. It is available here.

Five weeks ago, when I raised questions about the results of Pfizer’s and Moderna’s covid-19 vaccine trials, all that was in the public domain were the study protocols and a few press releases. Today, two journal publicationsand around 400 pages of summary data are available in the form of multiple reports presented by and to theFDA prior to the agency’s emergency authorization of each company’s mRNA vaccine. While some of the additional details are reassuring, some are not. Here I outline new concerns about the trustworthiness and meaningfulness of the reported efficacy results.

“Suspected covid-19”

All attention has focused on the dramatic efficacy results: Pfizer reported 170 PCR confirmed covid-19 cases, split 8 to 162 between vaccine and placebo groups. But these numbers were dwarfed by a category of disease called “suspected covid-19”—those with symptomatic covid-19 that were not PCR confirmed. According to FDA’s report on Pfizer’s vaccine, there were “3410 total cases of suspected, but unconfirmed covid-19 in the overall study population, 1594 occurred in the vaccine group vs. 1816 in the placebo group.”

With 20 times more suspected than confirmed cases, this category of disease cannot be ignored simply because there was no positive PCR test result. Indeed this makes it all the more urgent to understand. A rough estimate of vaccine efficacy against developing covid-19 symptoms, with or without a positive PCR test result, would be a relative risk reduction of 19% (see footnote)—far below the 50% effectiveness threshold for authorization set by regulators. Even after removing cases occurring within 7 days of vaccination (409 on Pfizer’s vaccine vs. 287 on placebo), which should include the majority of symptoms due to short-term vaccine reactogenicity, vaccine efficacy remains low: 29% (see footnote).

If many or most of these suspected cases were in people who had a false negative PCR test result, this would dramatically decrease vaccine efficacy. But considering that influenza-like illnesses have always had myriadcauses—rhinoviruses, influenza viruses, other coronaviruses, adenoviruses, respiratory syncytial virus, etc.—some or many of the suspected covid-19 cases may be due to a different causative agent.

But why should etiology matter? If those experiencing “suspected covid-19” had essentially the same clinical course as confirmed covid-19, then “suspected plus confirmed covid-19” may be a more clinically meaningful endpoint than just confirmed covid-19.

However, if confirmed covid-19 is on average more severe than suspected covid-19, we must still keep in mind that at the end of the day, it is not average clinical severity that matters, it’s the incidence of severe disease that affects hospital admissions. With 20 times more suspected covid-19 than confirmed covid-19, and trials not designed to assess whether the vaccines can interrupt viral transmission, an analysis of severe disease irrespective of etiologic agent—namely, rates of hospitalizations, ICU cases, and deaths amongst trial participants—seems warranted, and is the only way to assess the vaccines’ real ability to take the edge off the pandemic.

There is a clear need for data to answer these questions, but Pfizer’s 92-page report didn’t mention the 3410 “suspected covid-19” cases. Nor did its publication in the New England Journal of Medicine. Nor did any of the reports on Moderna’s vaccine. The only source that appears to have reported it is FDA’s review of Pfizer’s vaccine.

The 371 individuals excluded from Pfizer vaccine efficacy analysis

Another reason we need more data is to analyse an unexplained detail found in a table of FDA’s review of Pfizer’s vaccine: 371 individuals excluded from the efficacy analysis for “important protocol deviations on or prior to 7 days after Dose 2.” What is concerning is the imbalance between randomized groups in the number of these excluded individuals: 311 from the vaccine group vs 60 on placebo. (In contrast, in Moderna’s trial, there were just 36 participants excluded from the efficacy analysis for “major protocol deviation”—12 vaccine group vs 24 placebo group.)

What were these protocol deviations in Pfizer’s study, and why were there five times more participants excluded in the vaccine group? The FDA report doesn’t say, and these exclusions are difficult to even spot in Pfizer’s report and journal publication.

Fever and pain medications, unblinding, and primary event adjudication committees

Last month I expressed concern about the potential confounding role of pain and fever medications to treat symptoms. I posited that such drugs could mask symptoms, leading to underdetection of covid-19 cases, possibly in greater numbers in people who received the vaccine in an effort to prevent or treat adverse events. However, it seems their potential to confound results was fairly limited: although the results indicate that these medicines were taken around 3–4 times more often in vaccine versus placebo recipients (at least for Pfizer’s vaccine—Moderna did not report as clearly), their use was presumably concentrated in the first week after vaccine use, taken to relieve post-injection local and systemic adverse events. But the cumulative incidencecurves suggest a fairly constant rate of confirmed covid-19 cases over time, with symptom onset dates extending well beyond a week after dosing.

That said, the higher rate of medication use in the vaccine arm provides further reason to worry about unofficial unblinding. Given the vaccines’ reactogenicity, it’s hard to imagine participants and investigators could not make educated guesses about which group they were in. The primary endpoint in the trials is relatively subjective making unblinding an important concern. Yet neither FDA nor the companies seem to have formally probed the reliability of the blinding procedure, and its effects on the reported outcomes.

Nor do we know enough about the processes of the primary event adjudication committees that counted covid-19 cases. Were they blinded to antibody data and information on patients’ symptoms in the first week after vaccination? What criteria did they employ, and why, with a primary event consisting of a patient-reported outcome (covid-19 symptoms) and PCR test result, was such a committee even necessary? It’s also important to understand who was on these committees. While Moderna has named its four-member adjudication committee—all university-affiliated physicians—Pfizer’s protocol says three Pfizer employees did the work. Yes, Pfizer staff members.

Vaccine efficacy in people who already had covid?

Individuals with a known history of SARS-CoV-2 infection or previous diagnosis of Covid-19 were excluded from Moderna’s and Pfizer’s trials. But still 1125 (3.0%) and 675 (2.2%) of participants in Pfizer’s and Moderna’s trials, respectively, were deemed to be positive for SARS-CoV-2 at baseline.

Vaccine safety and efficacy in these recipients has not received much attention, but as increasingly large portions of many countries’ populations may be “post-Covid,” these data seem important—and all the more so as the US CDC recommends offering vaccine “regardless of history of prior symptomatic or asymptomatic SARS-CoV-2 infection.” This follows on from the agency’s conclusions, regarding Pfizer’s vaccine, that it had ≥92% efficacy and “no specific safety concerns” in people with previous SARS-CoV-2 infection.

By my count, Pfizer apparently reported 8 cases of confirmed, symptomatic Covid-19 in people positive for SARS-CoV-2 at baseline (1 in the vaccine group, 7 in the placebo group, using the differences between Tables 9 and 10) and Moderna, 1 case (placebo group; Table 12).

But with only around four to 31 reinfections documented globally, how, in trials of tens of thousands, with median follow-up of two months, could there be nine confirmed covid-19 cases among those with SARS-CoV-2 infection at baseline? Is this representative of meaningful vaccine efficacy, as CDC seems to have endorsed? Or could it be something else, like prevention of covid-19 symptoms, possibly by the vaccine or by the use of medicines which suppress symptoms, and nothing to do with reinfection?

We need the raw data

Addressing the many open questions about these trials requires access to the raw trial data. But no company seems to have shared data with any third party at this point.

Pfizer says it is making data available “upon request, and subject to review.” This stops far short of making data publicly available, but at least leaves the door open. How open is unclear, since the study protocol says Pfizer will only start making data available 24 months after study completion.

Moderna’s data sharing statement states data “may be available upon request once the trial is complete.” This translates to sometime in mid-to-late 2022, as follow-up is planned for 2 years.

Things may be no different for the Oxford/AstraZeneca vaccine which has pledged patient-level data “when the trial is complete.” And the ClinicalTrials.gov entry for the Russian Sputnik V vaccine says there are no plans to share individual participant data.

The European Medicines Agency and Health Canada, however, may share data for any authorized vaccines much earlier. EMA has already pledged to publish the data submitted by Pfizer on its website “in due course,” as has Health Canada.

Peter Doshi, associate editor, The BMJ

Competing interests: I have been pursuing the public release of vaccine trial protocols, and have co-signed open letters calling for independence and transparency in covid-19 vaccine related decision making.

Spanish translation of this article

Footnote

Calculations in this article are as follows: 19% = 1 – (8+1594)/(162+1816); 29% = 1 – (8 + 1594 – 409)/(162 + 1816 – 287). I ignored denominators as they are similar between groups.

#family medicine #internal medicine #virology #epidemiology #covid-19 #covid-19 vaccine #controversy #debate

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scentedrunawayshark · 3 years

Text

Health Care for African Americans

Contents [hide]

What Are Healthcare Disparities?

What Forces Are Driving These Disparities?

Black vs. White Health Burdens

Preventable Cancers

Caught in the Medicaid Gap

Algorithmic Bias

Racial Inequity and COVID-19

Insurance Access and Maternal Health

Unequal Treatment

Influence of Shared Ethnicities

How TrueCoverage Can Help

Children’s Health

Cardiovascular Disease

Cancer

Mental Health

What Are Healthcare Disparities?

What Forces Are Driving These Disparities?

A variety of individual and systemic factors form interrelated and complicated barriers to health and healthcare in the Black community. Among the most significant are:

Providers: Cultural bias, miscommunication, racism

Healthcare system overall: Funding of care, organization

Black vs. White Health Burdens

Children’s Health

2.2 times higher infant mortality rate

1.8 times more likely to be diagnosed with asthma

Cardiovascular Disease

Men 30% more likely to have hypertension

Women 60% more likely to have hypertension

Less likely to keep blood pressure under control

Cancer

Women 40% more likely to succumb to breast cancer

Men 1.3 times more likely to develop colorectal cancer

Men 2.5 times more likely to succumb to prostate cancer

Mental Health

20% more likely to report psychological distress

50% less likely to receive mental health counseling or treatment

Preventable Cancers

Caught in the Medicaid Gap

Algorithmic Bias

Racial Inequity and COVID-19

Insurance Access and Maternal Health

Unequal Treatment

Influence of Shared Ethnicities

Improved time together

Improved wait times for treatment

Adherence to medication

Shared decision-making

Patient understanding of health risks

Patient perceptions of treatment decisions

Decreased implicit bias on the part of the doctor

How TrueCoverage Can Help

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lupine-publishers-sjpbs · 4 years

Text

Lupine Publishers | Insights About a Pandemic: Clinical Approach

Lupine Publishers | Scholarly Journal Of Psychology And Behavioral Sciences

Abstract

Many changes have occurred in our world in so many little time, as a novel situation that we all have had to cope with such as a sudden and unexpected pandemic. Psychological approaches such as skepticism, uncontrollability, new emotions to new stimuli, irrational thoughts or behaviors are some common consequences of the situation and we will elaborate them briefly in this text. Some basic clinical and medical explanations about the intermediate specie, common symptoms or possible brain affection are described in the text. With the perspective of a healthy future without viruses attacks, based on Scientific knowledge and the experience of producing laboratory experimental results.

Introduction

The global pandemic year 2020 has been a humanitarian challenge that affected everybody and has changed our lives and routines. Because of the sudden appearance, there is very few experts on Pandemic in the general population. Fear of disease has been daily present in our thoughts and worries in a much higher percentage: ten percent of patients infected with the SARS-CoV-2 generates a severe acute respiratory syndrome and becomes critical, requiring special care from the intensive care unit (UCI). The autoimmune response to this virus in the fight for self-cure might be disproportionate some cases, causing excessive swelling in vital organs which leads to incompatibilities to life. Skepticism and disbelief were common false friends present at the beginning of the spread of the plague. Uncertain or the complete absence of knowledge about its origin, its nature, its spreading behavior, how the metabolism might react, its effects over the organism, medicines to prevent (vaccine) or to cure, etc., were adding panic and fears to the situation, creating the ideal environment for corrupted approaches, faked information, shamanic cures, discrimination or unhealthy unsupportive responses. Government control measures meant in some cases extreme surveillance and complaints from neighbors without much evidence about other people behavior. An infected person could be forcibly examined and quarantined against his/her will. Scientific and clinical teams have worked hard together and improved our contrastable information about the virus and disease: a) the spread ration (R0 = basic reproduction number) of this virus is higher than a normal flu (R0 = 2.5 vs R0 = 1.3), b) the spread mechanism is so aggressive and long lasting (saliva which might remains over superficies for up several days). Coronaviruses over inanimate surfaces like metal plastic, metal or glass had been observed for up 9 days, being the minimal contact time for contagious of 30 seconds [1]. Some cases its effects over organism are of a considerable damage and harm for human life. Mean for incubation period is 5.2 days with the 95th percentile of the distribution at 12.5 days [1], having the 80% of patient’s mild symptoms but the amount of virus enough to spread it.

Intermediate Specie

The host creature for the virus was the bat, because of zoonoses, since this winged creature is the only mammal capable of powered flight for migration and having a longer range to spread the virus very rapidly, compared to land mammals. The most likely path of contaminations would be from the bat to the humans through saliva onto fomites or surfaces or through virus-laden aerosolized urine and faeces, with another intermediate specie (Figure 1) [2, 3]. Bats are able to maintain virus CoVs long-term without showing clinical symptoms or diseases [2]. Common spreader of diseases, the bat has been the inspiration for horror stories such as Dracula and vampires which needs to find new blood to drink for spreading the undead course. Many previous diseases such as Black Death, Spanish influenza, and HIV/AIDS, were caused by zoonoses Lloyd- Smith [4]. Civets, horses, and great apes have been found to be intermediate species for several coronaviruses spreading and amplifying the virus, to subsequently infect humans [2,3].

However, where the fist bat was infected to spill it over to humans remains unclear. How the virus survived outside of it reservoir host to contaminate the recipient host is known yet. The virus exposition had to be in sufficient quantity and time for generating an infection and disease in some intermediate specie. Health authorities are not able yet to accurately find and describe the Patient Zero in the Northern Italian outbreak [3, 5]. Progresses in understanding and combating zoonoses from Science would need a new generation of research schemas that addresses a broader approach of research with including several animals host species to study and several scientific disciplines all together [4].

Skepticism or Denialism

Cognitive skepticism is “an attitude of doubt or a disposition to incredulity either in general or in a particular object” . In 1980 Bertram Brookes published his pseudo-mathematical equation which he was working on for several years:

K (S ) + ΔI = K (S + ΔS )

Where K (S ) means knowledge structure to be known and ΔI the increase of information about the structure. In his own words, the equation “states in its very general way that the knowledge structure K (S )is changed to the new modified structure K (S + ΔS ) by the information ΔI, the is indication the effect of the modification” [6, 7]. According to the formula, the bigger amount of information about the structure, the bigger change over the new knowledge compared to its original. Skepticism might be happening with a small bit of knowledge (ΔI ) which remains the original and new structure almost identical. Concerning to the virus, skepticism might have happened at some point, when curative resources were aimed at the beginning for exaggerated cares to only a few first cases, without a clear perception of coming or priority risks [8].

In Spain there has been 27.135 deceases (6-6-2020), 52 were professionals caregivers (Physicians, Nurses, Psychologist, etc.) from whom 40.961 have been infected (data Red Nacional de Vigilancia Epodemiológica 05-29-2020) (Figure 2). In the Netherlands due to the COVID-19 there was an excess of mortality of about 8,600 people in the period March 9 - May 10 according to the Central Bureau of Statistics (CBS). On the same day, RIVM announced that up to 28% of all registered contamination cases were healthcare workers, or about 8,000 cases. The risk of infection depends not only on personal risks factors, but also upon the general state of the other individuals in the population [4]. During first period and concurrently, different tests for diagnoses where made: positive antibodies tests (light green bars) and PCR, IgM (dark green bars). Second period only PCR and IgM were apply (dark green bars). From Centro de Coordinación de Alertas y Emergencias Sanitarias. Ministerio de Sanidad. Gobierno de España. So many Scientific publications are in the air and some has been published without time to contrast: experimental results are published within only 10 days of revision, being this way of information more similar to the daily News reports than to the rigorously procedure for Scientific texts. Publications based only in N=1 patient have been accepted when that would be unthinkable for Journals in any other circumstances, when life is not under risk. Controlled experiments with manipulated variables compared to control groups and reviewers work would be desirable but were practically inexistent. However, difficulties of working with any sort of mammalian virus hinders such experimentation [3]. That causes contradictive information in a number of Scientific publications during pandemic time, without a calm or quiet study and reading other papers published. However, Science still goes on and a promising treatment with a monoclonal antibody compound against COVID-19 Figure 3 has been experimentally checked in vitro with therapeutically efficacy in Thailand and Holland (Utrecht and Rotterdam) [9,10]. Neutralizing antibodies can alter the course of infection or protect against the virus [10], however large production of monoclonal antibodies might not be affordable in labor intensity, expenses and time consuming [9].

Likely a vaccine is going to be available in 2021 or earlier, because not only massive disease has to be prevented, but also some consequences for health and psychological sequels which are happening in patients after the disease. Inappropriate perception of the facts, worries about well-being of their families and irrational believes are some facts which are causing excessive stress response [11,12]. Parallel clinical diseases have been concurrently diagnosed in COVID-19 patients in relation to the stress, anxiety, immune-depression and also related to disseminated intravascular coagulation and blood coagulation alterations, leading to acral ischemia or dry gangrene [1, 13]. Autoimmune diseases concomitant to the disease COVID-19 or even to the lockout have been found: dermatological no specific reactions in children and adult were described, being unknown yet or remaining unclear whether they come up in response to an infection for the virus or to an emotional/hypersensible reaction [1, 13], in some cases without hospitalization required. To an accurate diagnose, a number of reverse transcription polymerase chain reaction (RTPCR) kits with different primers and probes have been designed to detect SARS-CoV-2 presence genetically. Thermocyclers, incubation temperatures and times have been optimized to get the faster results: in the one-step assay, reverse transcription of SARS-CoV-2 and PCR amplification are happening into one unique simultaneously reaction [14].

Circulation of blood and changes in its coagulation pattern (thrombus, skin deceleration) were found, but no clarity whether they were a cause concurring with the infection or a consequence for the medication. Urticaria, morbilliform rash, vesicular eruptions, acral lesions (“COVID toes”), livedoid eruptions appeared in patients infected. Further microscopically analysis of the skin reveals groups of apoptotic keratinocytes in the epidermis, suggesting a viral exanthema [15]. Symptoms related to the loss of olfaction and taste during the infection COVID-19 (anosmia or hyposmia) were found in a few patients, likely due to the lower respiratory track diseases in uncomplicated early stage (fever, dry cough, weakness) [16-18].

A majority of Androgenetic Alopecia (79%) in male patients and 42% in female patients has been coincident among patients hospitalized due to severe COVID-19 (“Gabrin sign”), suggesting a possible influence of the Androgen Receptor through its effect over the enzyme angiotensin-converting enzyme 2 (ACE2), both genes (AR, ACE2) located in chromosome X [17,18]. Some patients infected with SARS-CoV-2 showed neurological signs such as headache (about 8%), nausea and vomiting (1%) and in severe patients, acute cerebrovascular diseases and impaired consciousness. Patients with acute SARS-CoV illness had evidences of the virus in their cerebrospinal fluid (Figure 4) [16]. In this brief revision we are exploring new emotions caused by several unpredictable situations due to the pandemic, irrational thoughts and we are including one psychological test for a better approach to a relocation of the locus of control.

New Emotions

Ideas and believes might have a really huge impact over our health and metabolism: for instance, consumption of meat of wild animals has become a sign of social status in some areas of the world [22] and it seems the COVID-19 has been mainly caused for that rare habit. Education on these ideas with empirical data and contrasted information might be of great necessity to avoid further zoonoses. The strategies for preventing spread of outbreaks are mitigation (isolation plus quarantined plus social distancing) and suppression (isolation plus quarantined plus social distancing and closing schools, Universities and businesses). Those measures of isolation of confirmed and suspected cases and the rapid and effective contacts tracing of clinical cases have been succeeded for the majority of scenarios: with a R0 = 2.5 the 70 % of contacts were possible to be traced and isolation was assumed to be 100 % effective at preventing further transmission [23]. The word quarantine was firstly used in Venice, year 1127, when leprosy and later on with Black Death happened [24]. United Kingdom 300 years later established the quarantine as an imposition in response to a plague. All these measures imply a serious restriction for people´s free will and their personal decisions, imposing the necessity of changing their routines, habits and lives till that moment. Some keys to deal with these hyper-protective measures to the subdued population were provided to the population, especially in order to prevent rebellions and for controlling the intensity of relief of de-escalated measures. Stigmatization and negative feelings, some of them negative against affected persons, also happened before in History (Spanish flu, bubonic plague, etc.). Even health care workers have suffered from a greater stigmatization and rejection from people in their local neighborhoods than the general public [24]. Post-traumatic stress symptoms, confusion, anger, exhaustion, mass hysteria, obsession of contamination, detachment from others, anxiety, indignation, irritability, frustration, boredom, financial loss, annoyance, fear, isolation, helplessness, loneliness, less happiness, etc. are some consequences described which have an impact over our psychological state and the general population [11, 24, 25]. Stigmatizations causes damage in psychological health and common coexistence, that is why the World Health Organization (WHO) have tried to prevent it from the very beginning, renaming on February the 11th the disease as COVID-19 [16], with no link to the area or region where it firstly showed up to avoid discrimination against Chinese population. The enemy is the virus, but many unreasonable behaviors might have happened because our inertial reactions to blame something else and because our psychological necessity of visualizing the hated target. Worries of people changed to be mainly focus on their health and family instead of in leisure and friends [11]. Victimization is an approach that patients with severe sequels might apply themselves, because in some cases posterior to the infection a long time has to be dedicated to rehabilitation therapies. Social distancing together with barrier methods (facial masks) and respiratory hygiene (washing hands and good breathing habits) are some keys suggested to avoid disease and improve general health [25]. In children a relative resistance to SARS-CoV-2 has been described, however the reason why is not clear yet [26].

But as human spirit uses to do, also good emotions and feelings happened: for instance an increase in faith for Science and its curative labor during these months, because a vaccine would be a very efficient measure and perhaps the only one, to reduce anxiety and fears on general population. Messages about death and religion became salient to comfort tense moods and bring more positive emotions, after January 20th when Dr. Zhong Nan Shan made a public announcement of this virus in CCTV [11, 18]. Music, routine games, allowed recreational activities and generous musical and artistic performances have been shared between common people and neighborhoods every day. King of the Netherlands Willem- Allexander comforted and warned people to avoid loneliness: “Alertness, solidarity and warmth: as long as we keep those three, we can handle this crisis together, even if it takes a little longer.” King said. In Spain admiration and respect have been shown everyday with applauses toward the caregivers and their current difficult work. As Sir Ludwig Guttmann said, “this is especially the time we need to “love our paraplegics” [27].

Irrational Thoughts And Behaviors

Our common enemy is a virus which is a target not visible. Understanding about that fact is not an easy goal. The lockout has reduced social interactions or hobbies to be distracted, then an increase in bad, harmful, and toxic habits (alcohol, drugs) and thoughts through rumination has happened. Under these unexpected circumstances with any or few psychological tools to deal, people are more likely to develop negative emotions (aversion, anxiety) and negative cognitive assessment about self-protection, life satisfaction or social risks, which may result in excessive avoidance behaviors and blind conformity [11]. Some behaviors as repeated washing hands like an obsessivecompulsive disorder (OCD) might be “normalized” and even socially rewarded in the middle of the pandemic [25]. The OCD and specifically its compulsive nature is clinically defined by the DSM-5 (300.3) as: “1. Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g. praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.” However, the temporal criteria makes the diagnoses more restrictive: B. The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day). About the prevalence: The 12-month prevalence of OCD in the United States is 1.2%, with a similar prevalence internationally (1.1%-1.8%). The frustration related to quarantine goes to several psychological problems including depression and post-traumatic stress disorder. Post-traumatic stress disorder is typified by recurrent, extremely vivid memories of traumatic events and the avoidance of everything that brings them to mind, along with depression, addiction, increased watchfulness, aggression, shame, nightmares, flashbacks, feelings of guilt, raised heart-rate, shallow sleep, frequented waking and excessive irritability (“having a short fuse”) [28, 29]. Moreover this environment pushes people to consume high sugar foods (chocolate, soft drinks, saturated fats) to boost their mood and release dopamine in the brain, which increases obesity. Sleep disturbances also increases food intake and physical activities has been reduced because to the lockdown, to the point some countries should be prepared for the upcoming epidemic of “depreobessed patients” [30]. Anxiety, depression, indignation and other negative cognitive indicators were wildly described in an affected population [11]. Physical exercises might be a good solution to prevent obesity, to a better sleep and healthy breathing space habits and for our immune system [31, 32].

Locus of Control Internal Vs External

The concept of locus of control was firstly described by Julian B. Rotter in 1954, referring to a personality trait based on the degree that people believe to have about their own control over the outcome of events vs the power of external forces beyond their particular influence (Figure 5). Attributional styles and self-efficacy concepts are built upon this trait, which may lead to neuroticism, poor self-efficacy or low self-esteem. In Figure 5: Metaphorical representation of an external locus of control, being the subject unable to freely move or to think without instructions coming from their ties. In order to restore our confidence and start new fresh acting on our internal locus of control areas and to learn from our mistakes, we suggest to read and answer this inventory elaborated by Rotter, to improve our knowledge about differences in loci of control and to get a better perspective of our own power over the events [26-31]. Many external places are suggested in this questionnaire as “common areas to blame” as responsible for our own decisions and paths taken: politicians, teachers, leaders, mates, friends, parents, genes, conflicts, luck, accidents, few trials, etc (Table 1).

During the lockout and because of pandemic restrictions, locus of control of people has been dramatically changed to be almost completely external to their will, with the sudden imposition of new rules which changed their control over their routines and lives. No chance of choosing about where to be or what to do, because suppression measures closed every places people used to go. Under this extremes circumstances, the locus of control might be relocated and focused on smaller areas where the person has a real control, such as the time of their days, the space of their homes, the few indoor activities, etc. Much more creativity and imagination are required from population, who is asked to keep calm and be patient while their range of maneuvering is considerable limited and restricted. Uncomfortable forced coexistence might lead to many conflicts that might be avoid: confusion about who is the enemy, the easily spread of fake news, rumors or even magic cures about the disease, passive and victimizes attitudes in healthy people, personalization of the information given by media or newspapers about the pandemic.

Conclusion

With this virus and at a very high cost we have learned several important lessons. Among them, the humble assumption that a tiny creature without superior intelligence or brain is capable of putting us in check and making us tremble at the foundations of our civilization. For the virus itself it is not a matter of ideology or power, or right or wrong, or races nor colors, or amount of military arsenal. Another lesson would be the fact that every person has its own immune system and reacts differently to the same virus. Every disease each people has suffered makes the history of his/her immune system which allows a particular fight against the virus. Among all our immune systems, the virus is mutating and we are working in a team against the common enemy. We, as a specie with brain and higher intelligence, will find hopefully soon safe vaccines for everybody according to their body weights and metabolism

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