Monthly Archives: May 2020

A doctor wearing a face mask looks at a CT image of a lung of a patient at a hospital in Wuhan, China. AFP via Getty Images hide caption

A doctor wearing a face mask looks at a CT image of a lung of a patient at a hospital in Wuhan, China.

Updated on March 17 at 6:43 p.m. ET:

Thousands of people have now died from COVID-19 the name for the disease caused by the coronavirus first identified in Wuhan, China.

According to the World Health Organization, the disease is relatively mild in about 80% of cases.

What does mild mean?

And how does this disease turn fatal?

The first symptoms of COVID-19 are pretty common with respiratory illnesses fever, a dry cough and shortness of breath, says Dr. Carlos del Rio, a professor of medicine and global health at Emory University who has consulted with colleagues treating coronavirus patients in China and Germany. "Some people also get a headache, sore throat," he says. Fatigue has also been reported and less commonly, diarrhea. It may feel as if you have a cold. Or you may feel that flu-like feeling of being hit by a train.

Doctors say these patients with milder symptoms should check in with their physician to make sure their symptoms don't progress to something more serious, but they don't require major medical intervention.

But the new coronavirus attacks the lungs, and in about 20% of patients, infections can get more serious. As the virus enters lung cells, it starts to replicate, destroying the cells, explains Dr. Yoko Furuya, an infectious disease specialist at Columbia University Irving Medical Center.

"Because our body senses all of those viruses as basically foreign invaders, that triggers our immune system to sweep in and try to contain and control the virus and stop it from making more and more copies of itself," she says.

But Furuya says that this immune system response to this invader can also destroy lung tissue and cause inflammation. The end result can be pneumonia. That means the air sacs in the lungs become inflamed and filled with fluid, making it harder to breathe.

Del Rio says that these symptoms can also make it harder for the lungs to get oxygen to your blood, potentially triggering a cascade of problems. "The lack of oxygen leads to more inflammation, more problems in the body. Organs need oxygen to function, right? So when you don't have oxygen there, then your liver dies and your kidney dies," he says. Lack of oxygen can also lead to septic shock.

The most severe cases about 6% of patients end up in intensive care with multi-organ failure, respiratory failure and septic shock, according to a February report from the WHO. And many hospitalized patients require supplemental oxygen. In extreme cases, they need mechanical ventilation including the use of a sophisticated technology known as ECMO (extracorporeal membrane oxygenation), which basically acts as the patient's lungs, adding oxygen to their blood and removing carbon dioxide. The technology "allows us to save more severe patients," Dr. Sylvie Briand, director of the WHO's pandemic and epidemic diseases department, said at a press conference In February.

Many of the more serious cases have been in people who are middle-aged and elderly Furuya notes that our immune system gets weaker as we age. She says for long-term smokers, it could be even worse because their airways and lungs are more vulnerable. People with other underlying medical conditions, such as heart disease, diabetes or chronic lung disease, have also proved most vulnerable. Furuya says those kinds of conditions can make it harder for the body to recover from infections.

"Of course, you have outliers people who are young and otherwise previously healthy who are dying," Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told NPR's 1A show. "But if you look at the vast majority of the people who have serious disease and who will ultimately die, they are in that group that are either elderly and/or have underlying conditions."

Estimates for the case fatality rate for COVID-19 vary depending on the country. But data from both China and Lombardy, Italy, show the fatality rate starts rising for people in their 60s. In Lombardy, for instance, the case fatality rate for those in their 60s is nearly 3 percent. It's nearly 10 percent for people in their 70s and more than 16 percent for those in their 80s.

Del Rio notes that it's not just COVID-19 that can bring on multi-organ failure. Just last month, he saw the same thing in a previously healthy flu patient in the U.S. who had not gotten a flu shot.

"He went in to a doctor. They said, 'You have the flu don't worry.' He went home. Two days later, he was in the ER. Five days later, he was very sick and in the ICU" with organ failure, del Rio says. While it's possible for patients who reach this stage to survive, recovery can take many weeks or months.

In fact, many infectious disease experts have been making comparisons between this new coronavirus and the flu and common cold, because it appears to be highly transmissible.

"What this is acting like it's spreading much more rapidly than SARS [severe acute respiratory syndrome], the other coronavirus, but the fatality rate is much less," Fauci told 1A. "It's acting much more like a really bad influenza."

What experts fear is that, like the flu, COVID-19 will keep coming back year after year. But unlike the flu, there is no vaccine yet for the coronavirus disease.

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How Patients Die After Contracting COVID-19, The New ...

How dangerous is the virus?

There are three parameters to understand in order to assess the magnitude of the risk posed by this novel coronavirus:

The attack rate or transmissibility (how rapidly the disease spreads) of a virus is indicated by its reproductive number (Ro, pronounced R-nought or r-zero), which represents the average number of people to which a single infected person will transmit the virus.

WHO's estimated (on Jan. 23) Ro to be between 1.4 and 2.5. [13]

Other studies have estimated a Ro between 3.6 and 4.0, and between 2.24 to 3.58. [23].

Preliminary studies had estimated Ro to be between 1.5 and 3.5. [5][6][7]

An outbreak with a reproductive number of below 1 will gradually disappear.

For comparison, the Ro for the common flu is 1.3 and for SARS it was 2.0.

See full details: Coronavirus Fatality Rate

The novel coronavirus' case fatality rate has been estimated at around 2%, in the WHO press conference held on January 29, 2020 [16] . However, it noted that, without knowing how many were infected, it was too early to be able to put a percentage on the mortality rate figure.

A prior estimate [9] had put that number at 3%.

Fatality rate can change as a virus can mutate, according to epidemiologists.

For comparison, the case fatality rate for SARS was 10%, and for MERS 34%.

See full details: COVID-19 Coronavirus Incubation Period

Symptoms of COVID-19 may appear in as few as 2 days or as long as 14 (estimated ranges vary from 2-10 days, 2-14 days, and 10-14 days, see details), during which the virus is contagious but the patient does not display any symptom (asymptomatic transmission).

See latest findings: Age, Sex, Demographics of COVID-19 Cases and Deaths

According to early estimates by China's National Health Commission (NHC), about 80% of those who died were over the age of 60 and 75% of them hadpre-existing health conditions such as cardiovascular diseases anddiabetes.[24]

According to the WHO Situation Report no. 7 issued on Jan. 27:

A study of 138 hospitalized patients with NCIP found that the median age was 56 years (interquartile range, 42-68; range, 22-92 years) and 75 (54.3%) were men.[25]

The WHO, in its Myth busters FAQs, addresses the question: "Does the new coronavirus affect older people, or are younger people also susceptible?" by answering that:

As of Jan. 29, according to French authorities, the conditions of the two earliest Paris cases had worsened and the patients were being treated in intensive care, according to French authorities. The patients have been described as a young couple aged 30 and 31 years old, both Chinese citizens from Wuhan who were asymptomatic when they arrived in Paris on January 18 [19].

The NHC reported the details of the first 17 deaths up to 24 pm on January 22, 2020. The deaths included 13 males and 4 females. The median age of the deaths was 75 (range 48-89) years.[21]

See full details: WHO coronavirus updates

On January 30, the World Health Organization declared the coronavirus outbreak a Global Public Health Emergency.

For more information from the WHO regarding novel coronavirus: WHO page on Novel Coronavirus (2019-nCoV)

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Coronavirus Update (Live): 3,173,442 Cases and ... - zonix.net

Amid Ongoing COVID-19 Pandemic, Governor Cuomo Announces Results of Completed Antibody Testing Study of 15,000 People Showing 12.3 Percent of Population Has COVID-19 Antibodies | Governor Andrew M. Cuomo Skip to main content

State Will Distribute Over7 Million More Cloth Masks to Vulnerable New Yorkers and Frontline Workers Across the State

State is Distributing $25 Million to Food Banks Across the State Through the Nourish New York Initiative

Confirms 4,663 Additional Coronavirus Cases in New York State - Bringing Statewide Total to 312,977; New Cases in 44 Counties

Amid the ongoing COVID-19 pandemic, Governor Andrew M. Cuomo today announced the results of the state's completed antibody testing study, showing 12.3 percent of the population have COVID-19 antibodies. The survey developed a baseline infection rate by testing 15,000 peopleat grocery stores and community centers across the state over the past two weeks.Of those tested, 11.5% of women tested positive and 13.1% of men tested positive. A regional breakdown of the results is below:

Region

Percent Positive

Capital District

2.2%

Central NY

1.9%

Finger Lakes

2.6%

Hudson Valley(Without Westchester/Rockland)

3%

Long Island

11.4%

Mohawk Valley

2.7%

North Country

1.2%

NYC

19.9%

Southern Tier

2.4%

Westchester/Rockland

13.8%

Western NY

6%

Audio Photos

The Governor also announced that the state will distribute over seven million more cloth masks to vulnerable New Yorkers and essential workers across the state. The masks will be distributed as follows:

While we're in uncharted waters it doesn't mean we proceed blindly, and the results of the 15,000 people tested in our antibody survey program - thelargest survey in the nation - will inform our strategy moving forward

The Governor also announced the state is distributing $25 million to food banks across the state through the Nourish New York Initiative. The Nourish New York initiative, announced earlier this week by Governor Cuomo, is working to quickly reroute NewYork's surplus agricultural products to the populations who need them most through New York's network of food banks. Funding will be distributed as follows:

"While we're in uncharted waters it doesn't mean we proceed blindly, and the results of the 15,000 people tested in our antibody survey program - thelargest survey in the nation - will inform our strategy moving forward,"Governor Cuomo said."We're also going to undertake a full survey of antibody testing for transit workers, who have been on the front lines of this crisis. We've said thank you to our essential workers thousands of times but actions speak louder than words, and we want them to know that we're doing everything we can do to keep them safe."

Finally, the Governor confirmed 4,663 additional cases of novel coronavirus, bringing the statewide total to 312,977 confirmed cases in New York State. Of the 312,977 total individuals who tested positive for the virus, the geographic breakdown is as follows:

County

Total Positive

New Positive

Albany

1,238

34

Allegany

35

0

Broome

305

6

Cattaraugus

50

1

Cayuga

51

0

Chautauqua

35

0

Chemung

124

1

Chenango

99

0

Clinton

62

1

Columbia

205

3

Cortland

28

0

Delaware

61

0

Dutchess

3,049

47

Erie

3,598

117

Essex

28

0

Franklin

15

0

Fulton

79

4

Genesee

155

1

Greene

142

3

Hamilton

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Amid Ongoing COVID-19 Pandemic, Governor Cuomo Announces Results of Completed Antibody Testing Study of 15000 People Showing 12.3 Percent of...

A new strain of Coronavirus, COVID 19, is spreading around the world, causing deaths and major disruption to the global economy.

Responding to this crisis requires global cooperation among governments, international organizations and the business community, which is at the centre of the World Economic Forums mission as the International Organization for Public-Private Cooperation.

The Forum has created the COVID Action Platform, a global platform to convene the business community for collective action, protect peoples livelihoods and facilitate business continuity, and mobilize support for the COVID-19 response. The platform is created with the support of the World Health Organization and is open to all businesses and industry groups, as well as other stakeholders, aiming to integrate and inform joint action.

As an organization, the Forum has a track record of supporting efforts to contain epidemics. In 2017, at our Annual Meeting, the Coalition for Epidemic Preparedness Innovations (CEPI) was launched bringing together experts from government, business, health, academia and civil society to accelerate the development of vaccines. CEPI is currently supporting the race to develop a vaccine against this strand of the coronavirus.

1. How COVID-19 is affecting the globe

Regulators in the US have allowed the emergency use of the experimental drug remdesivir, which appears to help some coronavirus patients recover faster.

Gilead, the company which makes the antiviral drug, said it had helped improve outcomes for patients with COVID-19, the respiratory disease caused by the novel coronavirus, and provided data suggesting it worked better when given earlier in the course of infection.

During a meeting with President Donald Trump, Gilead Chief Executive Daniel ODay said the company was donating 1.5 million vials of the drug to help patients.

Remdesivir is the first drug shown to help fight Covid-19. In a study of 1,063 patients, preliminary results showed that the drug shortened the time to recovery by 31%, or about four days on average, for hospitalized patients.

Those given the drug were able to leave the hospital in 11 days on average versus 15 days for a comparison group.

A new partnership was announced Friday with the European Investment Bank (EIB) to provide grants and financial support to scale up the funding needed to strengthen supply chains while investing in infrastructure and global health preparedness. The key focus areas include:

A selection of "ominous and risky trends" could lead to major challenges in the next decade writes economist Nouriel Roubini in an article for Project Syndicate. Some of these trends include: a massive increase in fiscal deficits, the combination of unfunded healthcare programs and aging populations, and the growing risk of deflation.

These risks and others loomed large before the pandemic, but COVID-19 has brought them to the forefront. Should we survive these factors, Roubini writes, the coming 2030s could reward us with a combination of technology and leadership that "may be able to reduce, resolve, or minimize many of these problems, giving rise to a more inclusive, cooperative, and stable international order."

Sam Leakey, a Programme Specialist in Science and Society for the World Economic Forum answered a number of questions on vaccines recently for Agenda. Among them? How vaccine hesitancy could impact efforts to eradicate COVID-19.

According to Leakey, the challenge with vaccines is that theyre so successful in preventing diseases that the reason theyre necessary becomes less apparent.

Hesitancy, as well as deprioritization, is more likely down the line, after the disease has been controlled. "If in two, three or more years time, weve had a successful vaccine and were not seeing new COVID-19 infections, people may increasingly choose not to be vaccinated".

Environmental degradation has weakened animal habitats, creating the unnatural conditions that allowed for the novel coronavirus to jump from animals to humans, writes Andrew Mitchell, Founder and Senior Adviser for non-profit Global Canopy in Agenda this week. Several laboratories have investigated the coronavirus genome and the human version of the coronavirus suggests an intermediary such as the pangolin allowed the virus to jump from bats to humans, as the pangolin version of the virus has an ability to bind onto human cells and pangolins were sold in illegal markets.

Writes Mitchell: "Only an unnatural cocktail that brings all of these wildlife elements together alongside humans can turbocharge the conditions needed for multiple mutations to take place, resulting in one which eventually outfoxes our immunity - and so the virus explodes".

License and Republishing

World Economic Forum articles may be republished in accordance with our Terms of Use.

Written by

Linda Lacina, Digital Editor, World Economic Forum

The views expressed in this article are those of the author alone and not the World Economic Forum.

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COVID-19: What you need to know about the coronavirus pandemic on 2 May - World Economic Forum

Are there COVID-19 coronaviruses lurking in your laundry? (Photo: Getty)

Assuming that you wear clothes, you may have been wondering how long the COVID-19 coronavirus may stay on your various garments. After all, clothing is what typically keeps many of your body parts away from everything else. The answer though is a bit like Miley Cyruss wardrobe: complicated.

When it comes to estimating how long the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may stay on objects, many have referred to a research letter published in the New England Journal of Medicine. The research letter reported the results of a study that tested how long the SARS-CoV2 could remain detectable in the air and on surfaces. This included the virus remaining in the air for up to three hours, on copper for up to four hours, on cardboard for up to 24 hours, and on plastic and stainless steel for up to two to three days. Youll notice that most typical clothing materials are not on this list, unless you happen to wear a suit of copper armor or a cardboard box.

So which of the items is most like your clothes? Well, as suggested by an article in New York Times by Tara Parker-Pope who talked to an aerosol scientist and a pediatric infectious disease specialist, it could be cardboard because both can consist of fibers that absorb moisture. The virus needs some moisture to survive. Without it, the virus can quickly dry up and no longer be viable. So should you assume that the virus can survive on your clothes for up to 24 hours? Maybe. Perhaps.

Keep in mind that clothes arent necessarily all fabric. They may have metal or plastic parts like buttons or clasps. Thats certainly the case if your clothes have giant plastic windows on them. In theory, the virus could survive longer on less absorbent portions of your clothes.

Then theres the question of what may happen if your clothes get and stay wet. This may be because of rain, sweat, or excessive tears from the fact that you bought clothes with giant plastic windows on them. If your clothes dont dry quickly, could they harbor viruses for longer periods of time?

There havent been enough studies to tell for sure how long the virus may linger on different articles of clothing. So its probably best to take proper precautions if you think that your clothes have been exposed to the virus.

Your clothes probably won't be exposed to the virus by simply running or walking by yourself. ... [+] (Photo: Getty)

Keep in mind that if youve spent the past few days at home with no one else but your hole-filled undergarments, your clothes in all likelihood have not been exposed to the SARS-CoV2. Similarly, if youve maintained good social distancing while outside and not contacted anything that could be contaminated, chances are your clothes have not been contaminated.

Contamination could occur if either someone who is contagious or a contaminated object touches your clothes. A contagious person coughing, sneezing, or panting close enough to your clothes could also put your clothes at risk. This may be an issue if you are someone who regularly comes into contact with people with COVID-19, such as a caretaker or a health care professional, as Joshua Cohen covered previously for Forbes.

If you suspect contamination, take off your clothes as soon you can after the exposure. If the exposure occurred in a grocery store, do not do this immediately, as this may cause additional problems. Instead, wait until you are actually in a position to legally take off your clothes, such as when you reach your home.

When taking off your clothes, try not to touch your face or contaminate other things with the clothes. This is not the time to touch your finger to your lip to look sultry while undressing. After they are off your body, place your clothes in a safe location where they cant potentially contaminate other things.

Whenever handling any clothes that may have the virus, whether they are your clothes or someone elses, such as someone whom you know has COVID-19, follow the Centers for Disease Control and Prevention (CDC) recommendations for handling at-risk clothing. Wear disposable gloves, if available, and toss them, the gloves and not the clothing, immediately after use. If you only have non-disposable gloves, keep them dedicated to situations where you are touching or disinfecting things that may have the coronavirus. Dont use them subsequently for anything else like cooking or doing face palms. If you have no gloves readily available, keep your hands away from your gigantic face while handling the laundry, and wash your hands thoroughly immediately after touching the laundry.

The CDC also recommends against shaking potentially contaminated laundry, which could spray the virus and other lovely little things into the air. If you have the urge to shake something, shake your booty instead. One exception, dont shake your booty if you are wearing pants that may be contaminated.

Be sure to disinfect or safely dispose of anything the laundry may have in turn contaminated. If this happens to be your booty, take a shower instead. Do not put chemical disinfectants that are meant for objects on or in your body in any way.

Once the suspect clothes are in the washing machine, set the water temperature to the warmest that the clothes can handle. Use appropriate amounts of laundry detergent. Otherwise, you are simply wetting and spinning you clothes, sort of like putting them on a merry-go-round in the rain. Laundry detergent should be able to disrupt the viruss structure, so it should be fine to wash other clothes with the potentially contaminated ones. Once the washing is done, dry your clothes completely, which can serve as an additional way of disrupting the virus.

Take additional precautions when washing your clothes at a laundromat. (Photo: Getty)

All of this may be more challenging if you dont have your own washing machine and dryer. If you must go to a laundromat, be careful about what you and your clothes touch. If possible disinfect all surfaces and objects that you may contact, such as any laundry carts, washer and dyer buttons and handles, and tables used for folding laundry. Make sure that you stay at least six feet away from others. This is not the time for pick-up lines such as the one offered by Rachel Shatto writing for the Elite Daily: Hey, nice folding technique! But Id rather see those clothes crumpled on your floor.

Don't do this. (Photo: Getty)

Theres one set of apparel that requires a different type of care and precautions. No, not your boa, but your shoes. Your shoes are probably not made completely out of fabric. A shoe completely made out of cotton, for example, tends to be called something else: a sock. Plus, who knows what you shoes may be picking up while they are dragging across floors and other surfaces. Moreover, many shoes cant readily go into the washing machine.

When you cant easily and safely launder your shoes, take them off and leave them outside your living quarters. Either do a Mr. Rogers and change to house shoes or go shoe-less while inside your apartment, home, or castle. Dont try any kind of cleaning technique that put you at risk for getting infected. This could in theory happen while you are wiping your shoes with a wet towel that may end up spraying some contaminated droplets into the air.

Again, dont be paranoid about your clothes. Simply going outside is not going to allow your clothes to catch the virus from the air like a big baseball mitt. Nonetheless, if you think that you may have come into contact with the virus, it is a good idea to take appropriate precautions. You dont want this virus to catch you with your pants down.

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How Long Does COVID-19 Coronavirus Live On Clothes? How To Wash Them - Forbes

In mid-February, just before the reality of Covid-19 took hold in the United States, I was in Loreto, Perus largest province, working with a medical team to provide health care to villages generally cut off from such services. These were mainly communities of huts on or along the Maraon River, with limited or no access to running water, toilets, electricity, or cellphone reception.

Little did I know that the trip would provide me with valuable lessons about what I would be facing on my return home.

In Loreto, the clinics we worked in often consisted of school desks covered with tablecloths. Even the most basic personal protective equipment, like gloves and hand sanitizer, were in short supply, if available at all. The types of medications were limited, and the only imaging we had access to was the portable ultrasound machine we had brought with us.

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I remember thinking that patient management and care would be so much easier if I had a proper exam table and access to a CT scanner or at least more than one hand-washing station. I believed that my gaps as a provider would magically close when I was back in the land of evidenced-based guidelines, with ample access to labs and imaging.

Maybe I was uninformed. Maybe I was in denial. Either way, I was wrong.

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Three days after my return to North America, the World Health Organization declared Covid-19 to be a pandemic. Since then, the disease has taken an immense toll on Americans, and is pushing our hospitals to the brink. The Society of Critical Care Medicine reports that the U.S. health care system has about 62,000 full-featured ventilators, but projections show that as many as 960,000 people will need ventilator support.

I thought I was coming back to more: More evidence. More testing. More capability. But Im learning that more does not always translate to better or enough.

As a fourth-year medical student on the cusp of starting my residency, I am familiar with U.S. hospitals and clinics. Simple amenities like gloves, masks, and hand sanitizer come prepackaged with each patient room, safeguards that make you feel like you have some control over the illnesses your patients are combating.

Covid-19 has attacked this security blanket.

The limitations of U.S. emergency rooms amid the Covid-19 pandemic share an uncanny resemblance to the pop-up clinics we held in Loreto. And the lessons learned there are applicable to handling the Covid-19 crisis here in the U.S.

Stepping off a plane in a foreign country can feel both jarring and overwhelming, just like stepping into this pandemic. Weve been forced to lean into that discomfort.

Providing medical care in a low-income country throws you into a novel environment with new people, culture, and smells. The humidity forces you to spend your entire day drenched in your own sweat. Both are situations that Covid-19 practitioners experience daily.

In Loreto, as we treated unfamiliar medical conditions we had to learn about traditional therapies used in the village. Similarly, clinicians in the U.S. and elsewhere must learn about innovations real or not for treating the acute respiratory distress that can accompany severe cases of this viral infection.

Working on global health comes with unpredictable exposures. Before traveling to Loreto, I got vaccinated against typhoid and yellow fever, and took antimalaria medicine every day. Yet that didnt prepare me for everything. When we arrived in Peru, a major dengue outbreak had struck the region. The treatment for dengue, like the treatment for uncomplicated Covid-19, is little more than supportive care. Prevention is key for both bug spray for dengue, social distancing for Covid-19. Both work if done correctly and consistently, but neither is 100% effective.

Like many regions around the world, Loreto had limited resources for medical care. We ran short of gauze for dressing wounds, speculums for gynecologic exams, and many other necessities. Whats more, we often could not see everyone who needed help. And only the sickest patients with treatable conditions were sent to the city hospitals for additional intervention. Learning to navigate a novel environment with scarce resources was daunting, but possible.

Learning how to triage acuity and severity was essential to daily success in the field, something that health care workers treating Covid-19 in some cities now do. Although it may seem that decisions on who gets a ventilator or an ICU bed are incredibly challenging and nuanced, we faced similar issues in Loreto. Rationing supplies, adapting workflows, and prioritizing goals are vital skills in places where health care is minimal, as well as in hospitals currently overflowing with Covid-19 patients.

Coping with the reality that not everything is fixable can be challenging for health care providers who find solace in their ability to solve problems. Yet our capacity to design creative solutions is limitless, even when a crisis like Covid-19 makes us feel trapped and helpless. Adopting a mindset of iterative growth will help combat the novel coronavirus more successfully. What worked yesterday might not work today, and thats OK.

Providing health care in low-income countries forces clinicians to acknowledge the beauty and the frustration of the unknown. Timelines arent always followed despite the best of intentions. The water will run out. The cargo boat with much-needed medical supplies will be late. The lodge generator will stop. There will be termites in your room. The boats hull will start to fill with water better yet, the engine will fail resulting in a comical and stressful Amazon River rescue.

Similarly, hospitals, clinics, medical schools, states, and our nation are operating on a minute-by-minute basis during the current pandemic. Each new day comes with the unknown of what our new normal will look like. Knowledge about the virus, health policy, state and federal strategies, and even how and when to get groceries are constantly evolving.

Almost overnight, millions of Americans began working from home. Teachers transitioned to distance learning. Hospitals without telemedicine infrastructure rapidly developed it. Patients were moved, physician schedules altered, and surgeries cancelled. States instituted shelter-in-place orders.

Reflection during the heat of the moment is challenging. In Loreto and similar communities with limited resources, is it better to use a less-effective second-line treatment or no treatment at all? What can be done to have a more sustainable impact on village health? What should be done differently on a return visit? Reflecting on the successes, downfalls, aspirations, trauma, and unintended consequences is imperative.

The same can be said about the Covid-19 pandemic. Even as cases and deaths mount and health systems become overwhelmed, exploring the ethics and effectiveness of pandemic-related strategy, policy, and clinical research is essential. Are investigations on Covid-19 being executed with ethically sound protocols? Which communities are being marginalized in the care they received?

I never expected my trip to Peru to have the immediate relevance it does to the challenges our health care system is facing today. As I venture into residency to work as a physician, Im grateful for the lessons I learned in Loreto and know they will guide my approach to beginning my residency an unfamiliar environment with new and unforeseen responsibilities.

Like my trip, the Covid-19 pandemic will eventually come to an end. The novelty will fade, the sweat will dry, the adversity will foster innovation, and hindsight will bring additional clarity. Until then, our grit, creativity, and capacity to adapt to the unknown will see us through.

Lakshmi Ramachandran is a fourth-year medical student at Western Michigan University Homer Stryker M.D. School of Medicine with a masters degree in public health from the Harvard T.H. Chan School of Public Health. She expects to begin a residency in obstetrics and gynecology at the University of California, Los Angeles, in June.

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A service trip to Peru offers lessons for treating Covid-19 in the US - STAT

NEW HANOVER COUNTY, NC (WWAY) New Hanover County expanded diagnostic testing to all residents this week, and as of Friday, 186 people have been tested.

Of those tested, 47 are negative, 139 are still pending, and there are no positive lab results at this time.

Board of Commissioners Chair Julia Olson-Boseman says Our first week of expanded testing has been a success, and we want to continue this important service in the coming weeks to even more people especially those who have limited access to healthcare or to a COVID-19 test.

People with COVID-19 have had a wide range of symptoms reported ranging from mild symptoms to severe illness. Symptoms typically appear two to 14 days after exposure to the virus, and may include any of the following:

Residents who are experiencing COVID-19 symptoms can call the New Hanover County Coronavirus Call Center at 910-798-6800 Monday through Friday, 8 a.m. to 5 p.m., to be screened by a public health nurse before being referred for a diagnostic test at no charge.

More information about the process and criteria for New Hanover Countys expanded testing can be found atHealth.NHCgov.com/Coronavirus.

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New Hanover County tests more than 180 people for COVID-19 in first week - WWAY NewsChannel 3

Up to 2% of Moscows population may be infected with coronavirus, the citys mayor warned on Saturday, as hospitals in the Russian capital were overwhelmed and another top government tested positive.

Covid-19 took hold relatively late in Russia, but is now growing fast, with the country showing the second-highest spread of the disease in the world. A record 9,623 new cases on Saturday indicated infections have not yet reached a plateau.

If Moscow mayor Sergei Sobyanins estimate is correct, that would mean more than 240,000 people may have the virus, four times official figures for the city. Hospitals in the capital are already at capacity, with television footage showing ambulances forced to wait for hours to deliver the infected.

On Friday authorities announced the housing minister was the latest top official to test positive. Vladimir Putin has not been pictured in public for nearly a month and is working from his residence outside Moscow.

There are fears outbreaks may have festered undetected in other areas that initially appeared to have escaped the worst ravages of the disease.

In Somalia, medics, funeral workers and gravediggers have reported an unprecedented surge of deaths in recent days in the capital Mogadishu, suggesting official counts of Covid-19 deaths -- currently just 601 confirmed cases and 28 deaths -- reflect only a fraction of the viruss toll.

Mohamed Osman Warsame, an ambulance driver, said he had transported between 15 and 18 corpses to cemeteries in the capital every day for the last two weeks, many times above the usual daily figure of between two and four. There are a lot of deaths. It is like we are in a deadly war. People are dying so fast, Warsame said.

On the island of Bali, an entire hamlet has been locked down after rapid testing showed hundreds of residents were probably infected, the Jakarta Post reported. Out of 1,200 initial tests, 400 returned a reactive result; authorities will follow up with swab tests to confirm infection rates.

Increasingly intense efforts to stop the spread of the disease have raised concerns about human rights and civil liberties. Malaysia has been criticised by the UN after detaining hundreds of undocumented migrants, including young children and Rohingya refugees, as part of its efforts to contain coronavirus.

The UN said the arrests could push vulnerable groups into hiding and prevent them from seeking treatment, and warned that overcrowded detention centres carried a high risk of increasing the viruss spread.

Privacy advocates in India have also attacked a government order that all public and private sector employees should use a government-backed Bluetooth tracing app, as New Delhi begins easing some of its lockdown measures in lower-risk areas.

Critics warn that it is unclear how the data will be used. They stress India lacks privacy laws to govern the app. New Delhi has said the app will not infringe on privacy as all data is collected anonymously.

Worldwide there are now 3.4 million cases of coronavirus and more than 238,000 deaths, although many countries that have passed the peak of their infections are now working on relaxing their lockdown restrictions.

Singapores health minister said on Saturday that it will start easing some curbs after a second wave of the coronavirus concentrated in the states crowded migrant worker dormitories appeared to subside, with some students allowed back to school later this month.

In Spain on Saturday adults were allowed out to exercise for the first time since March; as the country goes back to work, the government has made facemasks compulsory on buses, tubes and trains. Nearly 15 million will be handed out by authorities and charities.

All governments, however, are moving cautiously, for fear of a second wave. In China the northeastern city of Harbin shut-dine in services at restaurants and cafes as the rest of the country was easing restrictions for the May Day holiday.

Mainland China reported only one new case on Saturday, but Heilongjiang province is currently dealing with the countrys biggest remaining coronavirus cluster, with half of 140 recent local transmissions, according to a Reuters tally.

In the US, Australia and the UK, there has been a focus on how and why residential facilities have become deadly incubators for the disease.

A nursing home in New York has reported a horrifying death toll of 98 people from the coronavirus, one of the worst outbreaks in the country and a shock even in hard-hit New York. An official state tally of nursing home deaths had previously listed only 13 as of Friday.

In the UK, the coronavirus death toll increased sharply this week after officials began counting fatalities from the countrys nursing homes alongside deaths in hospitals. Britain now has the third highest number of deaths in the world, 27,510, according to the Johns Hopkins University tracker, behind only the US and Italy.

In Australia, although the virus has been brought under control far more quickly, deaths also continued to mount at a care home in western Sydney. Thirteen residents account for over 10% of the total national death toll of only 93, and it is threatening to overtake the Ruby Princess cruise ship as the single biggest source of deaths in the country.

Elsewhere around the world, key developments include:

The US Federal Drug Administration has given approval for the experimental drug remdesivir to be used in an emergency on patients suffering from Covid-19.

Also in the US, the White House has barred the administrations top pandemic expert, Dr Anthony Fauci, from giving evidence at a Congressional hearing. It said it was not appropriate for a member of the pandemic response team to testify.

Europes tourism industry, and its host economies such as Spain, Italy and Greece, face being ruined by the shutdown driven by the virus. The European Commission estimates that the EUs hotels and restaurants will lose half their income this year.

The UK government has been urged to prioritise spending on the poorest areas of the country after official statistics revealed that those regions have borne the brunt of the deaths from Covid-19. Read our report on life in one of the nations poorest boroughs, Newham in east London.

The economic toll of the crisis has continued as stock markets fell sharply on Friday, largely thanks to the ongoing war of words between the US and China. In the UK, the Financial Times has reported that Rolls-Royce plans to shed 8,000 of its 52,000-strong workforce.

Californias governor, Gavin Newsom, promised to make meaningful changes to stay-at-home orders in the coming days as thousands of protesters gathered across the state to condemn the lockdown, and in defiance of its ordnances.

Donald Trump has told Michigans governor, Gretchen Whitmer, that she should make a deal with anti-lockdown protesters after groups of heavily armed men swarmed the state capitol. Whitmer rejected making a deal during a public health emergency, but said some outdoor work will be allowed to resume next week.

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Russia now has second-highest rate of Covid-19 spread as other countries ease restrictions - The Guardian

A COVID-19 antibody testing center is seen at Steve's 9th Street Market in Brooklyn on April 25. Here's a quick guide to sorting out the pluses and minuses to each type of test. Michael Nagle/Xinhua News Agency/Getty Images hide caption

A COVID-19 antibody testing center is seen at Steve's 9th Street Market in Brooklyn on April 25. Here's a quick guide to sorting out the pluses and minuses to each type of test.

Testing for the coronavirus has been very much in the news. The first and most urgent focus is on increasing access to tests to diagnose people with current infections. But now other tests are appearing as well. Antibody tests, which can identify people with signs of past infection, are starting to be available. And a third type of test is on the way.

Here's a quick guide to sorting out the pluses and minuses to each type of test.

What it does: Doctors use this test to diagnose people who are currently sick with COVID-19. This is the one we've been hearing so much about.

How it works: This test uses a sample of mucus typically taken from a person's nose or throat. The test may also work on saliva that's under investigation. It looks for the genetic material of the coronavirus. The test uses a technology called PCR (polymerase chain reaction), which greatly amplifies the viral genetic material if it is present. That material is detectable when a person is actively infected.

How accurate is it: Generally speaking, these are the most reliable tests. However, a few days may pass before the virus starts replicating in the throat and nose, so the test won't identify someone who has recently been infected. And swabs can sometimes fail to pick up signs of active infection.

How quick is it: These samples are generally sent to centralized labs for analysis, so it can take several days to get results back. Wait times were longer earlier in the pandemic because of a testing backlog. There are also two rapid PCR tests, which can be run on specialized equipment already widely distributed throughout the U.S. The speediest one, by Abbott Laboratories, can provide a result in 13 minutes, but one study suggests this test can miss more than 10% of cases.

What it does: Antibody tests identify people who have previously been infected with the coronavirus. They do not show whether a person is currently infected. This is primarily a good way to track the spread of the coronavirus through a population.

How it works: This is a blood test. It looks for antibodies to the coronavirus. Your body produces antibodies in response to an infectious agent such as a virus. These antibodies generally arise after four days to more than a week after infection, so they are not used to diagnose current disease.

How accurate is it: There are more than 120 antibody tests on the market. The Food and Drug Administration has allowed them to be marketed without FDA authorization, and quality is a great concern. A few tests have voluntarily submitted to extra FDA approval. Other tests are being validated by individual medical labs or university researchers.

In general, these tests aren't reliable enough for individuals to act based on the results. And researchers say, even if you were certain you had antibodies to the coronavirus, it's still unknown if that protects you from getting sick again. Still, these tests can provide good information about rates of infection in a community, where errors in an individual result have less impact.

How quick is it: These tests generally produce results in a few minutes, based on a drop of blood taken from the finger. Some research labs use a more sophisticated antibody test, called an Elisa (Enzyme-linked immunoassay) that are more accurate but are not as widely available.

What it does: This test identifies people who are currently infected with the coronavirus. It may be used as a quick test to detect active infections. Initially it will not be used to diagnose disease, but it may be used to screen people to identify those who need a more definitive test.

How it works: Antigen tests can identify virus in nose and throat secretions. It does this by looking for proteins on the surface of the virus (as opposed to the diagnostic test, which looks for genetic material that is carried inside the virus). This is the same technology used in your doctor's office for rapid strep testing.

How accurate is it: These tests are not yet on the market, so there is currently no information about their accuracy. Researchers do not expect it to be as accurate as the PCR diagnostic test, but it is possible they could be used to screen patients for infection. Dr. Jordan Laser, a lab director at Northwell Health, notes antigen testing is used for rapid strep tests, which are reliable, and rapid flu tests, which are not.

How quick is it: These tests should provide results in just a few minutes. As a result, they could be used to screen people in hospitals, certain workplaces, or in other instances where it's important to find out quickly whether someone is currently at risk of spreading the disease. But unless these tests are proven to be highly accurate, physicians would still need to follow up a positive result with a PCR test to make a medical diagnosis.

You can contact NPR science correspondent Richard Harris at rharris@npr.org.

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Antibody, Antigen And PCR Tests For COVID-19: Know The Differences : Shots - Health News - NPR

Congress has opened a probe into Carnival Corporation, the operator of the Princess Cruises line of cruise ships, over its handling of COVID-19 outbreaks, according to a report from Bloomberg. Officials are now requesting Carnival turn over documents and communications about its coronavirus response and its plans for future improvement.

The investigation, led by the US House Committee on Transportation and Infrastructure, is specifically looking into how much Carnival executives were aware of the severity of the coronavirus outbreaks on its cruise ships and the lack of action it took during active cruises after being informed of the risks. More than 1,500 confirmed COVID-19 cases can be traced back to the company's cruise ships, and dozens of Carnival customers and crew members have since died from the virus.

The probe cites a damning Bloomberg feature story from writers Austin Carr and Chris Palmeri from last month that delves intricately into how Florida-based Carnival handled news of the COVID-19 outbreaks aboard nine of its ships. The story itself, which everyone should go read, is astonishing, featuring illuminating interviews with crew members and passengers and a lengthy sit-down with Carnival CEO Arnold Donald. It paints the picture of a company that, even in early March as the threat of the novel coronavirus become abundantly clear worldwide, did not take action fast enough to order its passengers into self-isolation and dock its cruise ships. Instead, many ships decided to let customers remain in extremely close contact with one another in swimming pools and in dining areas featuring buffets.

We would hope that the reality of the COVID-19 pandemic will place a renewed emphasis on public health and passenger safety, but frankly that has not been seen up to this point, wrote House member Peter DeFazio (D-OR) in the letter sent to Carnival announcing the investigation. It seems as though Carnival Corporation and its portfolio of nine cruise lines, which represents 109 cruise ships, is still trying to sell this cruise line fantasy and ignoring the public health threat.

Bloomberg reports that many of the customers who received refunds from Carnival were given the option to receive the credit for a future cruise, and Carnival in some cases sweetened the deal by giving out free vouchers as well. While the company suspended its cruises starting in March, some passengers and crew remain stuck on ships around the world. Our goal is the same as the committees goal, Carnival said in a statement to Bloomberg, to protect the health, safety and well-being of our guests and crew, along with compliance and environmental protection.

In addition to the House probe, Australian police last month launched a criminal investigation into how Carnival handled the docking of one of its Princess ships, the Ruby Princess, in Sydney on March 19th. The investigation is looking into whether Carnival officials misled Australian authorities about the COVID-19 outbreak aboard the ship, as Carnival customers at the time made up nearly one-third of all Australian deaths from the virus.

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Congress is investigating cruise ship company Carnival over COVID-19 outbreaks - The Verge