Monthly Archives: May 2020

As I write, the contest for explanation is well under wayDonald Trump is to blame, or Barack Obama, or the Centers for Disease Control and Prevention, or China, or the U.S. militarys biowarfare experiments, or Bill Gates. Nobody has yet invoked eight-legged worms. But in our age of social media, the engines of rumor, prejudice, and superstition may have even greater power than they did in the era of the Black Death.

Christopher Columbuss journey to the Americas set off the worst demographic catastrophe in history. The indigenous societies of the Americas had few communicable diseasesno smallpox, no measles, no cholera, no typhoid, no malaria, no bubonic plague. When Europeans imported these diseases into the Western Hemisphere, it was as if all the suffering and death these ailments had caused in Europe during the previous millennia were compressed into about 150 years.

From March 2002: Charles C. Mann on the year 1491

Somewhere between two-thirds and nine-tenths of the people in the Americas died. Many later European settlers, like my umpteen-great-grandparents, believed they were coming to a vacant wilderness. But the land was not empty; it had been emptieda world of loss encompassed in a shift of tense.

Absent the diseases, it is difficult to imagine how small groups of poorly equipped Europeans at the end of very long supply chains could have survived and even thrived in the alien ecosystems of the Americas. I fully support banning travel from Europe to prevent the spread of infectious disease, the Cherokee journalist Rebecca Nagle remarked after President Trump announced his plan to do this. I just think its 528 years too late.

For Native Americans, the epidemic era lasted for centuries, as did its repercussions. Isolated Hawaii had almost no bacterial or viral disease until 1778, when the islands were discovered by Captain James Cook. Islanders learned the cruel facts of contagion so rapidly that by 1806, local leaders were refusing to allow European ships to dock if they had sick people on board. Nonetheless, Hawaiis king and queen traveled from their clean islands to London, that cesspool of disease, arriving in May 1824. By July they were deadmeasles.

Kamehameha II and Kammalu had gone to Britain to negotiate an alliance against the United States, which they correctly believed had designs on their nation. Their deaths scuttled the talks, and their successor, 12-year-old King Kamehameha III, could not resume them. The results changed the islands political destiny. Undeterred by the British navy, the U.S. annexed Hawaii in 1898. Historians have seldom noted the connection between measles and the presidency of Barack Obama.

As a rule, epidemics create what researchers call a U-shaped curve of mortalityhigh death rates among the very young and very old, lower rates among working-age adults. (The 1918 flu was an exception; a disproportionate number of 20-somethings perished.) For Native peoples, the U-shaped curve was as devastating as the sheer loss of life. As an indigenous archaeologist once put it to me, the epidemics simultaneously robbed his nation of its future and its past: the former, by killing all the children; the latter, by killing all the elders, who were its storehouses of wisdom and experience.

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How Will the Coronavirus Change Us? - The Atlantic

Researcher Francois Balloux of the University College London Genetics Institute and his colleagues in the United Kingdom pulled viral sequences from a giant global database that scientists around the world are using to share data.

They looked at samples taken at different times and from different places, and said they indicate that the virus began infecting people at the end of 2019.

"Our results are in line with previous estimates and point to all sequences sharing a common ancestor towards the end of 2019, supporting this as the period when SARS-CoV-2 jumped into its human host," the team wrote in a report, published in the journal Infection, Genetics and Evolution.

Balloux told CNN his team is "really, really, really confident" about when the host jumped.

They also found genetic evidence that supports suspicions the virus was infecting people in Europe, the United States and elsewhere weeks or even months before the first official cases were reported in January and February.

One US community is checking to see whether there were cases there that went undiagnosed in 2019.

In Chicago, the Cook County Medical Examiner's Office said it will review deaths involving heart attacks and pneumonia for indications of Covid-19 as far back as November, Cook County spokesperson Natalia Derevyanny told CNN.

The first known coronavirus death in the county was March 16.

The office will look at viral pneumonia cases along with heart attacks caused by arteries being blocked (arterial thrombosis), as opposed to cases brought on by heart failure.

"The goal is to see if this virus was present before we knew of it," Derevyanny said.

While Derevyanny called the decision to look back to November an arbitrary timeframe, if a positive case is discovered it will prompt the office to look back even further.

The investigation may include additional testing of preserved tissue samples, Derevyanny said.

Cuomo: It comes down to how much you value life

New York Gov. Andrew Cuomo on Tuesday said debates on how soon states should ease social distancing restrictions come down to the value of human life -- and that policymakers are avoiding saying so explicitly.

"The fundamental question, which we're not articulating, is how much is a human life worth?" Cuomo said at a news conference.

"The faster we reopen, the lower the economic cost. But, the higher the human cost, because (of) more lives lost," Cuomo said in a news conference. "That ... is the decision we are really making."

But easing restrictions now may come with a heavy price.

"It's the balance of something that's a very difficult choice," Dr. Anthony Fauci, the country's leading infectious disease expert, told CNN Monday night. "How many deaths and how much suffering are you willing to accept to get back to what you want to be some form of normality, sooner rather than later?"

At least 42 states will have eased restrictions by Sunday, ranging from simply opening state parks to allowing some businesses to restart. That includes California -- the first state to implement a sweeping stay-at-home order -- where some stores will be allowed to reopen this week.

So far, the US has recorded more than 1,200,000 infections and at least 71,043 deaths.

Poll: Majority prioritizes preventing illness over economy

A majority of Americans who answered a Monmouth University poll, meanwhile, indicated they prioritize preventing illnesses over long-term economic concerns.

In the poll, conducted Thursday though Monday, adults were asked which should be the more important factor in deciding whether to lift outbreak restrictions -- ensuring as few people as possible get sick from the coronavirus, or ensuring the economy doesn't enter a deep and lengthy downturn.

About 56% answered the former; 33% said the latter; 9% said both equally. The poll of 808 adults in the United States has a margin of error of +/- 3.5 percentage points, Monmouth said Tuesday.

More vaccine candidates tested in the US

Researchers continue to race for a potential coronavirus vaccine -- and another group of candidates is being tested on people in the United States.

US pharmaceutical giant Pfizer and German biotechnology company BioNTech have begun testing four coronavirus vaccine candidates in humans in New York and Maryland, the companies said Tuesday.

The first stage of the US trial will enroll up to 360 healthy adults, starting with ages 18 to 55 and eventually including ages 65 to 85, the companies said.

These companies aren't the first with a vaccine program this far along.

The World Health Organization says 108 potential Covid-19 vaccines are in development around the world -- up from 102 on April 30. Eight of the potential vaccine programs have been approved for clinical trials, WHO says.

How governors are moving forward

California was one of the states where crowds gathered over the weekend as thousands of protesters descended on the state's Capitol and an Orange County beach to protest social distancing orders.

The governor on Monday announced retail shops in the state -- including clothing stores, florists and bookstores -- can begin to reopen Friday, after health officials said the state was meeting important metrics including sufficient test and tracing capacity.

Los Angeles Mayor Eric Garcetti said he didn't think his city would reopen this week, saying Monday that despite the governor's announcement, different parts of the state may see different timelines for reopening.

In Michigan, Gov. Gretchen Whitmer said the lockdown will continue "until at least May 15," warning that reopening the state too soon could lead to a second shutdown.

Reeves' plan also allows dining service in restaurants, as long as the institutions follow guidelines provided by the state, including a mandatory deep cleaning.

"I don't want to wait if there are steps that we believe we can safely take now to ease the burden on Mississippians fighting this virus," he said.

Protests against masks

CNN's Frederick Pleitgen, Jacqueline Howard, Elizabeth Cohen and Jennifer Henderson contributed to this report.

Continued here:

New evidence indicates coronavirus was infecting people in Europe and the US before the first official cases were reported - CNN

Among the most important unanswered questions about Covid-19 is this: What role do children play in keeping the pandemic going?

Fewer children seem to get infected by the coronavirus than adults, and most of those who do have mild symptoms, if any. But do they pass the virus on to adults and continue the chain of transmission?

The answer is key to deciding whether and when to reopen schools, a step that President Trump urged states to consider before the summer.

Two new studies offer compelling evidence that children can transmit the virus. Neither proved it, but the evidence was strong enough to suggest that schools should be kept closed for now, many epidemiologists who were not involved in the research said.

Many other countries, including Israel, Finland, France, Germany, the Netherlands and the United Kingdom have all either reopened schools or are considering doing so in the next few weeks.

In some of those countries, the rate of community transmission is low enough to take the risk. But in others, including the United States, reopening schools may nudge the epidemics reproduction number the number of new infections estimated to stem from a single case, commonly referred to as R0 to dangerous levels, epidemiologists warned after reviewing the results from the new studies.

In one study, published last week in the journal Science, a team analyzed data from two cities in China Wuhan, where the virus first emerged, and Shanghai and found that children were about a third as susceptible to coronavirus infection as adults were. But when schools were open, they found, children had about three times as many contacts as adults, and three times as many opportunities to become infected, essentially evening out their risk.

Based on their data, the researchers estimated that closing schools is not enough on its own to stop an outbreak, but it can reduce the surge by about 40 to 60 percent and slow the epidemics course.

My simulation shows that yes, if you reopen the schools, youll see a big increase in the reproduction number, which is exactly what you dont want, said Marco Ajelli, a mathematical epidemiologist who did the work while at the Bruno Kessler Foundation in Trento, Italy.

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The second study, by a group of German researchers, was more straightforward. The team tested children and adults and found that children who test positive harbor just as much virus as adults do sometimes more and so, presumably, are just as infectious.

Are any of these studies definitive? The answer is No, of course not, said Jeffrey Shaman, an epidemiologist at Columbia University who was not involved in either study. But, he said, to open schools because of some uninvestigated notion that children arent really involved in this, that would be a very foolish thing.

The German study was led by Christian Drosten, a virologist who has ascended to something like celebrity status in recent months for his candid and clear commentary on the pandemic. Dr. Drosten leads a large virology lab in Berlin that has tested about 60,000 people for the coronavirus. Consistent with other studies, he and his colleagues found many more infected adults than children.

The team also analyzed a group of 47 infected children between ages 1 and 11. Fifteen of them had an underlying condition or were hospitalized, but the remaining were mostly free of symptoms. The children who were asymptomatic had viral loads that were just as high or higher than the symptomatic children or adults.

In this cloud of children, there are these few children that have a virus concentration that is sky-high, Dr. Drosten said.

He noted that there is a significant body of work suggesting that a persons viral load tracks closely with their infectiousness. So Im a bit reluctant to happily recommend to politicians that we can now reopen day cares and schools.

Dr. Drosten said he posted his study on his labs website ahead of its peer review because of the ongoing discussion about schools in Germany.

Many statisticians contacted him via Twitter suggesting one or another more sophisticated analysis. His team applied the suggestions, Dr. Drosten said, and even invited one of the statisticians to collaborate.

But the message of the paper is really unchanged by any type of more sophisticated statistical analysis, he said. For the United States to even consider reopening schools, he said, I think its way too early.

In the China study, the researchers created a contact matrix of 636 people in Wuhan and 557 people in Shanghai. They called each of these people and asked them to recall everyone theyd had contact with the day before the call.

They defined a contact as either an in-person conversation involving three or more words or physical touch such as a handshake, and asked for the age of each contact as well as the relationship to the survey participant.

Comparing the lockdown with a baseline survey from Shanghai in 2018, they found that the number of contacts during the lockdown decreased by about a factor of seven in Wuhan and eight in Shanghai.

There was a huge decrease in the number of contacts, Dr. Ajelli said. In both of those places, that explains why the epidemic came under control.

The researchers also had access to a rich data set from Hunan provinces Center for Disease Control and Prevention. Officials in the province traced 7,000 contacts of 137 confirmed cases, observed them over 14 days and tested them for coronavirus infection. They had information not just for people who became ill, but for those who became infected and remained asymptomatic, and for anyone who remained virus-free.

Data from hospitals or from households tend to focus only on people who are symptomatic or severely ill, Dr. Ajelli noted. This kind of data is better.

The researchers stratified the data from these contacts by age and found that children between the ages of 0 and 14 years are about a third less susceptible to coronavirus infection than those ages 15 to 64, and adults 65 or older are more susceptible by about 50 percent.

They also estimated that closing schools can lower the reproduction number again, the estimate of the number of infections tied to a single case by about 0.3; an epidemic starts to grow exponentially once this metric tops 1.

In many parts of the United States, the number is already hovering around 0.8, Dr. Ajelli said. If youre so close to the threshold, an addition of 0.3 can be devastating.

However, some other experts noted that keeping schools closed indefinitely is not just impractical, but may do lasting harm to children.

Jennifer Nuzzo, an epidemiologist at Johns Hopkins Universitys Bloomberg School of Public Health, said the decision to reopen schools cannot be made based solely on trying to prevent transmission.

I think we have to take a holistic view of the impact of school closures on kids and our families, Dr. Nuzzo said. I do worry at some point, the accumulated harms from the measures may exceed the harm to the kids from the virus.

E-learning approaches may temporarily provide children with a routine, but any parent will tell you its not really learning, she said. Children are known to backslide during the summer months, and adding several more months to that might permanently hurt them, and particularly those who are already struggling.

Im not saying we need to absolutely rip off the Band-aid and reopen schools tomorrow, she said, but we have to consider these other endpoints.

Dr. Nuzzo also pointed to a study in the Netherlands, conducted by the Dutch government, which concluded that patients under 20 years play a much smaller role in the spread than adults and the elderly.

But other experts said that study was not well designed because it looked at household transmission. Unless the scientists deliberately tested everyone, they would have noticed and tested only more severe infections which tend to be among adults, said Bill Hanage, an epidemiologist at the Harvard T.H. Chan School of Public Health.

Assumptions that children are not involved in the epidemiology, because they do not have severe illness, are exactly the kind of assumption that you really, really need to question in the face of a pandemic, Dr. Hanage said. Because if its wrong, it has really pretty disastrous consequences.

The experts all agreed on one thing: that governments should hold active discussions on what reopening schools looks like. Students could be scheduled to come to school on different days to reduce the number of people in the building at one time, for example; desks could be placed six feet apart; and schools could avoid having students gather in large groups.

Teachers with underlying health conditions or of advanced age should be allowed to opt out and given alternative jobs outside the classroom, if possible, Dr. Nuzzo said, and children with underlying conditions should continue to learn from home.

The leaders of the two new studies, Dr. Drosten and Dr. Ajelli, were both more circumspect, saying their role is merely to provide the data that governments can use to make policies.

Im somehow the bringer of the bad news but I cant change the news, Dr. Drosten said. Its in the data.

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New Studies Add to Evidence that Children May Transmit the Coronavirus - The New York Times

Ventilators have become the single most important piece of medical equipment for critically ill coronavirus patients whose damaged lungs prevent them from getting enough oxygen to vital organs. The machines work by forcing air deep into the lungs, dislodging the fluid and accumulated pus that interfere with the exchange of oxygen, a process orchestrated by tiny air sacs known as alveoli.

Lungs are complex organs that deliver oxygen to the bloodstream and keep organs functioning.

Human lungs are spongy vessels made up of millions of microscopic, balloon-shaped air sacs called alveoli, the workhorse of the respiratory system where the exchange of gases takes place.

A single alveolus, no bigger than the width of a human hair, is ringed by a mesh of tiny capillaries that transport oxygen to the bloodstream.

A single alveolus, no bigger than the width of a human hair, is ringed by a mesh of tiny capillaries that transport oxygen to the bloodstream.

A single alveolus, no bigger than the width of a human hair, is ringed by a mesh of tiny capillaries that transport oxygen to the bloodstream.

Ventilators are not a cure for Covid-19 patients, but mechanical breathing assistance can keep patients alive while they battle the infection.

Critical care ventilators are more than just air pumps. They are finely tuned machines with software that must be constantly adjusted by skilled medical workers to ensure that patients receive the right combination of oxygen level, pressure, breath volume and breathing rate.

Non-coronavirus patients on ventilators have about a 50 percent survival rate. The mortality rate for coronavirus patients on ventilators is not yet clear in part because, with no proven method of treatment for the virus, coronavirus patients are often being kept on these machines for weeks in order to keep them breathing long enough to give their lungs a chance to heal.

Exhaled air is filtered for viral particles

Air supplied to the patient

contains 21-100% oxygen

Air supplied to the patient

contains 21-100% oxygen

Exhaled air

is filtered

for viral particles

Intubation is fraught. Patients must be heavily sedated to allow doctors to insert a breathing tube into the lungs and to prevent them from waking up and pulling out the tubes. Because too much air pressure can damage the lungs, intubated patients must be constantly monitored.

Fears of a ventilator shortage in New York and the poor prognosis for intubated patients have helped spur innovations for sustaining patients without relying on critical care ventilators.

Health care providers have embraced a maneuver that has long been used for ventilated patients periodically turning them on their stomach to increase lung capacity. Proning, as its called, opens up areas of the lungs that are normally compressed by the weight of the heart when lying on ones back. Doctors are currently studying whether using proning for some patients in respiratory distress can allow them to recover without being placed on ventilators.

Flipping over patients in acute respiratory distress, doctors have discovered, can markedly increase oxygenation. The process can be labor-intensive, however, requiring staff to turn over patients several times a day.

Medical workers have increasingly turned to CPAP and BiPAP machines, inexpensive air pumps used by millions of Americans with sleep apnea, chronic obstructive pulmonary disease and other breathing disorders. Hospitals have been repurposing unused machines and using them both with or without intubation to send pressurized air into the lungs of coronavirus patients.

Soft and transparent plastic helmet

holds positive pressure inside

Room oxygen

supply option

Soft collar

seals helmet at the neck

Plastic helmet

holds positive

pressure inside

Room oxygen

supply option

To reduce the risk of infection for hospital workers, doctors have also been fitting patients with jury-rigged helmets that deliver oxygen via CPAP machines while filtering out exhaled viral particles. The helmets were pioneered by Italian doctors forced to improvise because of a shortage of intensive care ventilators.

See more here:

In the Fight to Treat Coronavirus, Your Lungs Are a Battlefield - The New York Times

Written by Amitabh Sinha, Edited by Explained Desk | Pune | Updated: May 9, 2020 2:22:04 pm Fridays Coronavirus count of new cases was a little less than the previous day, and it is now the first time in two weeks that the daily count has declined for two consecutive days.

Odisha saw its highest single-day surge of Coronavirus cases so far, reporting as many as 78 new cases on Friday to take its tally to 287. The state had been reporting low numbers of Coronavirus infections till now, but in the last two days 107 cases have been discovered, mainly amongst the migrant workers returning from other states, triggering an alarm in Bhubaneswar.

More than 80 per cent of the states cases, 240 of the 287, are concentrated in the five districts of Ganjam, Khurda, Jajpur, Bhadrak and Baleshwar. These are the areas that have received maximum number of returning migrant workers. About 8000 workers have returned to Ganjam in the last few days, and suddenly, the districts Coronavirus count has shot up. 79 of the 83 cases in Ganjam, now the worst affected district in Odisha, were discovered in the last three days.

In the country as a whole, 3340 new cases were discovered on Friday, taking the total count of confirmed Coronavirus infections to 59,564. Fridays count of new cases was a little less than the previous day, and it is now the first time in two weeks that the daily count has declined for two consecutive days, even though by a small amount. On Thursday, India had added 3355 new cases, which was 175 less than the previous day, and Fridays count was 15 less than Thursday. Coronavirus LIVE Updates

Kerala discovered its first case in three days, just one patient in Ernakulam. The state now has 503 confirmed cases, 484 of whom have already recovered.

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Tamil Nadu continued to add new cases in large numbers. On Friday, the state discovered 600 new cases to take its tally to 6009. The number of cases has tripled in the last ten days, from 2058 on April 28 to 6009 now, thanks to the discovery of the Koyambedu market cluster in Chennai, and the states aggressive testing in the last few days. Tamil Nadu overtook Maharashtra on Thursday to emerge as the state that has conducted the most number of tests in the country. On Friday, it consolidated its lead further, carrying out 13,980 tests to Maharashtras 10,245. Tamil Nadu has now done 2.16 lakh tests, while Maharashtra, which has three times greater caseload, has done 2.12 lakh.

At least 95 deaths were reported from the country on Friday, 39 of them from Maharashtra and 24 from Gujarat. The death toll in the country has now crossed 1950. Some doubts have been raised about the number of deaths being reported by Delhi, after a few hospitals in the Capital reported many more deaths than officially acknowledged so far. According to data put out by Delhi government, there have been 68 deaths in the Capital so far. But the total of the numbers reported from five of the biggest COVID hospitals in Delhi add up to at least 116. Delhi government bulletins have reported only 33 deaths from these hospitals. Delhi government officials maintained that a death audit committee set up by it was investigating every death, and was reporting the data accurately and transparently.

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Coronavirus numbers explained: Why Odisha is seeing a spike in new cases - The Indian Express

The text messages to the Chinese activist streamed in from ordinary Wuhan residents, making the same extraordinary request: Help me sue the Chinese government. One said his mother had died from the coronavirus after being turned away from multiple hospitals. Another said her father-in-law had died in quarantine.

But after weeks of back-and-forth planning, the seven residents who had reached out to Yang Zhanqing, the activist, suddenly changed their minds in late April, or stopped responding. At least two of them had been threatened by the police, Mr. Yang said.

The Chinese authorities are clamping down as grieving relatives, along with activists, press the ruling Communist Party for an accounting of what went wrong in Wuhan, the city where the coronavirus killed thousands before spreading to the rest of China and the world.

Lawyers have been warned not to file suit against the government. The police have interrogated bereaved family members who connected with others like them online. Volunteers who tried to thwart the states censorship apparatus by preserving reports about the outbreak have disappeared.

They are worried that if people defend their rights, the international community will know what the real situation is like in Wuhan and the true experiences of the families there, said Mr. Yang, who is living in New York, where he fled after he was briefly detained for his work in China.

The crackdown underscores the partys fear that any attempt to dwell on what happened in Wuhan, or to hold officials responsible, will undermine the states narrative that only Chinas authoritarian system saved the country from a devastating health crisis.

To inspire patriotic fervor, state propaganda has portrayed the dead not as victims, but as martyrs. Censors have deleted Chinese news reports that exposed officials early efforts to hide the severity of the outbreak.

The party has long been wary of public grief and the dangers it could pose to its rule.

In 2008, after an earthquake in Sichuan Province killed at least 69,000 people, Chinese officials offered hush money to parents whose children died. Following a deadly train crash in the city of Wenzhou in 2011, officials prevented relatives from visiting the site. Each June, the authorities in Beijing silence family members of protesters who were killed in the 1989 crackdown on the Tiananmen Square pro-democracy movement.

Now, some say the government is imposing the same kind of collective amnesia around the outbreak.

Three volunteers involved in Terminus2049, an online project that archived censored news articles about the outbreak, went missing in Beijing last month and are presumed to have been detained.

I had previously told him: You guys probably face some risk doing this project. But I didnt know how much, said Chen Kun, whose brother, Chen Mei, is one of the volunteers who disappeared.

I had said that maybe he would be summoned by the police for a talk, and they would ask him to take down the site, he said. I didnt think it would be this serious.

Mr. Chen said he had no information about his brothers disappearance. But he had spoken to the relatives of one of the other missing volunteers, Cai Wei, who said that Mr. Cai and his girlfriend had been detained and accused of picking quarrels and provoking trouble, a vague charge that the government often uses against dissidents.

Reached by telephone on Tuesday, an employee at a police station in the Beijing district where Chen Mei lives said he was unclear about the case. The groups site on GitHub, a platform popular with coders, is now blocked in China.

Volunteers for similar online projects have also been questioned by the authorities in recent days. In blog posts and private messages, members of such communities have warned each other to scrub their computers. The organizers of another GitHub project, 2019ncovmemory, which also republished censored material about the outbreak, have set their archive to private.

To the authorities, it seems no public criticism can be left unchecked. The police in Hubei, the province that includes Wuhan and was hardest hit by the outbreak, arrested a woman last month for organizing a protest against high vegetable prices. An official at a Wuhan hospital was removed from his post after he criticized the use of traditional Chinese medicine to treat coronavirus patients, which the authorities had promoted.

The crackdown has been most galling to people mourning family members. They say they are being harassed and subjected to close monitoring as they try to reckon with their losses.

The coronavirus killed nearly 4,000 people in Wuhan, according to Chinas official figures. Some residents believe the true toll is much higher. The government fired two high-ranking local officials, but that is not enough for many grieving relatives, who say they want fair compensation for their losses and harsher punishment for officials.

Zhang Hai is certain that his father, who died in February, was infected with the coronavirus at a Wuhan hospital. He says he still supports the party but thinks local officials should be held responsible for initially hiding the fact that the virus could spread among humans. Had he known the risk, he said, he would not have sent his father to the hospital for treatment.

Mr. Zhang said several Chinese reporters who had interviewed him about his demands later told him that their editors had pulled the articles before publication. He posted calls online to set up a monument in honor of the victims of the epidemic in Wuhan, but censors quickly scrubbed the messages. Officials have pressed him to bury his fathers ashes, but he has so far refused; he says they have insisted on assigning him minders, who he believes would be there to ensure that he caused no trouble.

They spend so much time trying to control us, Mr. Zhang said. Why cant they use this energy to address our concerns instead?

In March, the police visited a Wuhan resident who had started a chat group of more than 100 people who lost relatives to the virus, according to two members of the group, one of whom shared a video of the encounter. The group was ordered to disband.

Mr. Yang, the activist in New York, said at least two of the seven Wuhan residents who had contacted him about taking legal measures against the government dropped the idea after being threatened by the police.

Even if the other plaintiffs were willing to move forward, they might have trouble finding lawyers. After Mr. Yang and a group of human rights lawyers in China issued an open call in March for people who wanted to sue the government, several lawyers around the country received verbal warnings from judicial officials, Mr. Yang said.

The officials told them not to write open letters or create disturbances by filing claims for compensation, according to Chen Jiangang, a member of the group. Mr. Chen, who fled to the United States last year, said he had heard from several lawyers who were warned.

If anyone dares to make a request and the government fails to meet it, they immediately are seen as a threat to national security, Mr. Chen said. It doesnt matter whether youre a lawyer or a victim, its like youre imprisoned.

Some aggrieved residents have pressed ahead despite the government clampdown. Last month, Tan Jun, a civil servant in Yichang, a city in Hubei Province, became the first person to publicly attempt to sue the authorities over their response to the outbreak.

Mr. Tan, who works in the citys parks department, accused the provincial government of concealing and covering up the true nature of the virus, leading people to ignore the viruss danger, relax their vigilance and neglect their self-protection, according to a copy of the complaint shared online. He pointed to officials decision to host a banquet for 40,000 families in Wuhan in early January, even as the virus was spreading.

He urged the government to issue an apology on the front page of the Hubei Daily, a local newspaper.

In a brief phone call, Mr. Tan confirmed that he had submitted a complaint to the Intermediate Peoples Court in Wuhan, but he declined to be interviewed because he is a civil servant.

With Chinas judiciary tightly controlled by the central government, it was unclear whether Mr. Tan would get his day in court. Articles about Mr. Tan have been censored on Chinese social media. Calls to the court in Wuhan on Thursday rang unanswered.

Liu Yi contributed research.

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Coronavirus Survivors Want Answers, and China Is Silencing Them - The New York Times

The World Health Organization lists the most common symptoms of Covid-19 as fever, tiredness and a dry cough. Others include a runny nose, sore throat, nasal congestion, pain, diarrhoea and the loss of sense of taste and/or smell. But there are also other more unusual symptoms that patients have presented.

Patients in several countries have reported rashes on their toes, resembling chilblains, in many cases unaccompanied by any of the usual symptoms of the virus. The condition has been dubbed Covid toe. The rashes can take the form of red or purple lesions and, despite the name, can be found on the side or sole of the foot, or even on hands and fingers. The European Journal of Pediatric Dermatology reported an epidemic of cases among children and adolescents in Italy. It said that unlike other rashes associated with coronavirus, it had not been previously observed.

Conjunctivitis has been a rare symptom in cases of Covid-19, with viral particles being found in tears. In the UK, the Royal College of Ophthalmologists and College of Optometrists says: It is recognised that any upper respiratory tract infection may result in viral conjunctivitis as a secondary complication, and this is also the case with Covid-19. However, it is unlikely that a person would present with viral conjunctivitis secondary to Covid-19 without other symptoms of fever or a continuous cough as conjunctivitis seems to be a late feature where is has occurred.

A peer-reviewed Spanish study, published in the British Journal of Dermatology last week, found that 6% of the 375 coronavirus cases examined involved necrosis, the death of body tissue due to a lack of blood supply, or livedo, discolouration of the skin. The skin can become mottled and have purple or red patchy areas, which may appear in a lace-like pattern. In the study, it was generally found in older patients with more severe cases of Covid-19. However, this was not consistent across the board and necrosis was also found in some people with coronavirus who did not require hospitalisation.

A study of 214 patients in China, published in Jama Neurology last month, found that just over a third (36.4%) had experienced neurological symptoms such as dizziness or headaches, increasing to 45.5% in those with severe coronavirus infections. Commenting on the research, Prof Ian Jones, professor of virology at the University of Reading, said: It happens, but is generally not what coronaviruses do. At the moment neurological complications might best be considered a consequence of Covid-19 disease severity rather than a distinct new concern.

Some patients have complained about a tingling, fizzing or even burning sensation. Dr Waleed Javaid, the director of infection prevention and control at Mount Sinai hospital in New York, told Today.com it was likely the patients immune response to Covid-19 rather than the virus itself was causing such sensations. He said: Theres a widespread immune response that is happening. Our immune cells get activated so a lot of chemicals get released throughout our body and that can present or feel like theres some fizzing. When our immune response is acting up, people can feel different sensations I have heard of similar experiences in the past with other illnesses.

This article was amended on 8 May 2020 to correct a reference to livedo that should have said necrosis.

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Rashes, headaches, tingling: the less common coronavirus symptoms that patients have - The Guardian