Category Archives: Covid-19

A man wearing a face mask travels on a ferry to cross the Yangtze River in Wuhan in April. Chinese officials are working to silence people suspected of challenging the narrative that authorities in Wuhan and Beijing acted swiftly and efficiently to contain the coronavirus outbreak. Hector Retamal/AFP via Getty Images hide caption

A man wearing a face mask travels on a ferry to cross the Yangtze River in Wuhan in April. Chinese officials are working to silence people suspected of challenging the narrative that authorities in Wuhan and Beijing acted swiftly and efficiently to contain the coronavirus outbreak.

China's leaders have declared the coronavirus outbreak largely under control within its borders. Now, the authorities are working to control the narrative of how the country contained the virus by questioning and even detaining people who might possess information that challenges the official line.

Those being questioned include Internet-savvy archivists; families and their legal counsel suing the state for damages from the coronavirus epidemic; and even lauded volunteers who staffed critical emergency services from the epicenter city of Wuhan.

In February, during the peak of the outbreak in Wuhan, where the virus is believed to have originated, thousands of volunteers delivered supplies to hospitals, drove medical workers around the city and staffed online mental health services.

But now public security agents are questioning these volunteers over suspicions they provided foreign organizations with documentation that has led to accusations that China intentionally covered up the full extent of its coronavirus epidemic, according to two people familiar with the matter. They requested anonymity because those questioned were told by security agents to keep the matter confidential.

Some of the volunteers questioned ran a telephone hotline that became a well-known resource offering both counseling services and help finding open hospital beds as Wuhan's health care system became overwhelmed with COVID-19 patients.

Hotline volunteers kept active counts of hospital beds and emergency cases of the coronavirus across Wuhan information that could be used for estimating fatalities.

"The police say they have been investigating whether different Chinese volunteer groups provided U.S. intelligence agencies with the real death number of COVID-19 in China," said a person familiar with the police questioning who declined to be named for fear of retribution.

Another Shanghai-based volunteer group said a prominent organizer of theirs had also been questioned by public security agents in connection with possibly leaking information to foreign agencies and was asked to provide a list of names of other volunteers. The group, which denies leaking any information, said the organizer refused to identify the volunteers.

Official messaging from China's Communist Party insists the authorities in Wuhan and Beijing acted swiftly and efficiently to implement lockdown measures and contain the outbreak.

This effort to silence those who might provide information contradicting the official Chinese narrative comes as U.S. intelligence officials have been warning the White House that China vastly undercounted its coronavirus death toll, according to various U.S. news reports. The stakes are high: Missouri and Mississippi are suing China over damages from the coronavirus pandemic, and U.S. citizens have filed several related class-action lawsuits alleging China covered up the scope of the initial outbreak in Wuhan.

"A whitewash"

China has strenuously denied the allegations. "The sole purpose for some U.S. politicians trying to fool others with their obvious lies is to shift the blame of their own incompetence," a foreign ministry spokesperson said last month. A day later, China's state broadcaster ran a segment on its widely watched evening news program that featured footage of U.S. Secretary of State Mike Pompeo with "liar" stamped in red letters across his visage, in response to unfounded allegations from Pompeo that the coronavirus was leaked from a Wuhan lab.

Current efforts to conceal unfavorable information contrast with Chinese leaders' transparency pledge following the 2003 SARS epidemic, which health officials initially tried to hide, according to Susan Shirk, an expert on Chinese politics at the University of California, San Diego.

That year, Shirk points out, Chinese leadership changed hands Hu Jintao and Wen Jiabao took over as president and premier and promised to do things differently. "It was the new broom sweeping out the old ways of doing things and made a point of creating a new image emphasizing transparency," Shirk said.

But China's handling of the COVID-19 outbreak seems to revert to old ways. "[Chinese leaders] decided to not go with transparency but to go with a whitewash," Shirk says. "That's very different from SARS."

In several cases over the past month, China has outright detained those suspected of challenging the official version of how the outbreak was quickly brought to heel.

Eyes on GitHub

For the past three months, Beijing tech worker Chen Mei and more than a dozen other tech-savvy volunteers used GitHub, the open-source programming platform, to archive copies of nearly four dozen, often critical, journalistic reports and essays put together by Chinese writers, journalists, freelance bloggers and writers deleted by China's Internet censors.

Among the articles Chen and others archived was a widely read profile of Ai Fen, a Wuhan doctor who first forwarded a medical report in early January nearly three weeks before Chinese leader Xi Jinping warned the public about the epidemic to other doctors describing a mysterious SARS-like pneumonia arising in hospitals. GitHub, which is not blocked in China, is widely used by programmers and companies to collaborate on writing software.

Beijing tech worker Chen Mei and more than a dozen other tech-savvy volunteers used GitHub, the open-source programming platform, to archive copies of nearly four dozen, often critical, journalistic reports and essays put together by Chinese writers, journalists, freelance bloggers and writers deleted by China's Internet censors. Family of Chen Mei hide caption

Beijing tech worker Chen Mei and more than a dozen other tech-savvy volunteers used GitHub, the open-source programming platform, to archive copies of nearly four dozen, often critical, journalistic reports and essays put together by Chinese writers, journalists, freelance bloggers and writers deleted by China's Internet censors.

Then on April 19, Chen was suddenly detained, say three people close to him. Two friends Cai Wei, who helped update the GitHub archive, and Cai's girlfriend Xiaotang were also detained in Beijing on the same day as Chen for "picking quarrels and provoking trouble," according to a police notice seen by NPR. Lawyers for both Cai and Xiaotang say they have been unable to meet or communicate with their clients.

"Chen Mei used his personal ID on GitHub, so I sent him a message saying his ID was public and to be careful," said Lucy Qiu, a friend of Chen's. "That was our last contact."

NPR's calls to Beijing's Changping district police department, near where Chen lives, and calls and texts to the Chaoyang district police department, where the three are reportedly being held, were not answered.

Suing the city

Families demanding justice from the state have also been subject to sustained pressure from China's security apparatus.

"It is all part of social stability management," said a lawyer who has been providing legal aid to Wuhan residents. He requested anonymity because of the sensitivity of the topic. "They made a mistake, and they will not allow people to take them to court."

He is part of a group of about 20 lawyers who helped Wuhan residents seeking to sue the city and provincial government for allegedly mishandling the outbreak. They say that local officials failed to notify the public early enough about the virus' contagiousness and the extent of the outbreak in Wuhan.

In mid-April, several of the lawyers were called in by Chinese justice ministry officials and were told to stop their pro bono work. They were also asked to name the other lawyers in the group and plaintiffs. At least three plaintiffs have since dropped their cases after being coerced by police, according to those who were providing them legal assistance.

But a handful of Wuhan residents say they are pressing ahead with their lawsuits despite the danger in doing so. "What happened in Wuhan was a warning for the entire country. Leaders here created havoc for the entire country," one of the plaintiffs, whose mother died in February from the coronavirus, told NPR by phone. He vowed to continue with his lawsuit, saying it was his responsibility to push for an accurate accounting of human suffering during the lockdown.

Then he hung up abruptly, saying his phone was being monitored.

Originally posted here:

China Says It Contained COVID-19. Now It Fights To Control The Story - NPR

Fever, cough and shortness of breath were early on identified as symptoms of COVID-19, but additional symptoms are emerging. megamix/Getty Images hide caption

Fever, cough and shortness of breath were early on identified as symptoms of COVID-19, but additional symptoms are emerging.

When the coronavirus pandemic first emerged, public health officials told the world to watch out for its telltale symptoms: fever, dry cough and shortness of breath. But as the virus has spread across the globe, researchers have developed a more nuanced picture of how symptoms of infection can manifest themselves, especially in milder cases.

We're getting a "better understanding of how these symptoms express in the general population and not necessarily in hospitalized patients," which is whom most of the earlier studies from China looked at. "So it's a bit of a bigger picture," says Charitini Stavropoulou, an associate professor in health services research at City, University of London in the U.K., who led an analysis of known symptoms in milder cases as part of a collaboration with Oxford University.

Some of these symptoms, such as loss of smell or taste, are highly distinctive and a strong indicator of infection. Others, like headaches, chills or sore throat, are common to lots of illnesses. So how do you know when a symptom is cause to seek medical advice or testing? We asked doctors and public health and infectious disease researchers for their insights.

THE STANDARD 3

Fever: Some patients can experience fevers that last for days, while others might see their temperature go up and down, with peaks often occurring in the evening, says Dr. David Aronoff, chief of the Division of Infectious Diseases at Vanderbilt University Medical Center. "I think if someone has a fever, regardless of how long it's lasting, unless they can clearly attribute it to something else, that's a very reasonable symptom to seek an evaluation for," he says.

Stavropoulou's systematic review of the medical literature found that fever was reported in 82% to 87% of mild to moderate cases.

Dry cough: Cough was the second most common symptom after fever, though "coughing was not always there," Stavropoulou notes. "So while we think it's a main symptom, it appears only two out of three times for patients with COVID-19."

That said, cough remains a "very, very common symptom of the pneumonia that the virus can cause," says Aronoff. Given this fact, "if someone has a new cough or a new shortness of breath that's cropped up in the last three days or so, they should definitely get tested."

Shortness of breath: Stavropoulou's review found that this symptom occurs more frequently in severe cases "and indeed, in some studies, was a marker of severe disease." The two largest studies she looked at found that shortness of breath occurred in fewer than 8% of milder cases.

THE NEW 6 FROM THE CDC:

Chills/repeated shaking with chills: The chills generally precede a fever, though people don't always perceive when their temperature has spiked, Aronoff says. Sometimes, those chills can be accompanied by shaking, since shivering is our bodies' way of generating heat and raising our temperature, he says.

Muscle pain: Nearly 15% of COVID-19 patients experience muscle pain, according to a report published by the World Health Organization in February that analyzed nearly 56,000 confirmed cases in China. But that's hardly unique to this disease: Lots of viral infections can cause muscle aches and pains, which can result from an inflammatory response to a virus.

"I think all of us who have had the winter cold or flu have had experience with muscle pain, headache, sore throat," notes Aronoff. Given that we're no longer in the typical cold and flu season, if you're experiencing muscle pains and other flu-like symptoms, "we know that those can be associated with COVID-19," he says. "And it is very reasonable to get people thinking, you know, maybe I should get tested."

He added: "I would also include new-onset fatigue, out of proportion to what a patient would expect to be experiencing under whatever circumstances they are [in]," as a symptom.

However, fatigue on its own is not very predictive of disease, because it is also frequently reported by people who don't test positive, says Claire Steves, a geriatrician and senior lecturer at King's College London. She's one of the lead researchers on the COVID Symptom Tracker, an app-based project that has so far recruited 3 million people across the U.K. to log any symptoms even if they are not feeling sick. Researchers can use data from those who are eventually diagnosed with COVID-19 as an early radar on how symptoms develop in the population. (The COVID Symptom Tracker is now recruiting people in the U.S. to sign up as well.)

Steves' research is finding that certain symptoms tend to cluster together in people who test positive. For instance, fitter people in the 20-70 age range who experience loss of smell often also experience fatigue, and they tend to have a milder course of the disease, she says.

Headache: Headaches are a common experience for many adults. On its own, a headache should probably not be cause for alarm, especially if it behaves like other headaches you've experienced, says Aronoff.

"If somebody is only going to use headache as a trigger to go get tested for COVID[-19], that headache should be something that either is a headache that's new for them or that is sticking around a bit longer than they are used to," he says. "Or it's associated with another symptom that may also be subtle, like fatigue or feeling kind of worn out" especially if there's no good reason for the tiredness.

In fact, Steves says research out of the COVID Symptom Tracker suggests that headache "is an important symptom" seen early on in the course of the disease and it commonly occurs alongside other symptoms.

Sore throat: "We're seeing sore throat in COVID-19 patients," says Aronoff. "But it's what I would say [is] a minor symptom" one that's common to lots of other ailments.

Loss of taste or smell: This symptom has emerged as a strong indicator of infection one distinctive enough that it alone should be cause to seek testing, says Dr. Carol Yan, an otolaryngologist and head and neck surgeon at UC San Diego Health.

If someone is experiencing this symptom, "I would tell them that they should consider self-quarantining themselves and contacting their health care providers," says Yan. Most people who experience loss of smell or taste also have other symptoms, commonly fever, fatigue and malaise, she says. "But there's certainly a subset of people that we know have only smell and taste loss and no other symptoms" who ultimately test positive.

Yan's research has found that about 7 out of 10 patients reported an acute loss of sense of smell or taste at the time of their diagnosis.

Similar findings have emerged from the COVID Symptom Tracker. Among fit and healthy people ages 20 to 70, "the loss of sense of smell is a really good marker" of infection, Steves says.

In fact, this symptom is seen as such a strong indicator of infection that patients at UC San Diego Health are now routinely asked not just if they have a cough or fever but also if they're experiencing a loss of smell or taste, says Yan. "It's really being used as a good screening question and in helping triage patients."

The good news is that both Yan and Steves have found that people who lose their sense of smell or taste tend to experience a milder course of the disease. Yan says patients generally recover these senses in two to four weeks on average.

OTHER POTENTIAL RED FLAGS

Confusion and gastrointestinal issues: Stavropoulou's review of the medical literature found that, in most studies, gastrointestinal issues were reported in fewer than 10% of mild cases of COVID-19.

But Steves says emerging data from the COVID Symptom Tracker suggest that problems like diarrhea, nausea and abdominal pain tend to be more prominent in the frail elderly people who are over 70 and need help to get around. Acute confusion also seems to be an important symptom in this group, she says.

"Older and frailer and more co-morbid people" those with underlying conditions such as heart disease, diabetes or obesity "tend to be getting this cluster of abdominal symptoms and delirium symptoms and headache as well," Steves says.

She says it's important for caregivers to recognize that these symptoms in the frail elderly could be indicative of COVID-19, particularly in situations like nursing homes, "because that's where spread could occur."

AND THEN THERE'S THIS ...

Chilblains (pictured) are itchy, red, pink or purple inflammations of the skin's small blood vessels that can develop in body parts such as toes and fingers from exposure to colder temperatures or wet conditions. A similar-looking inflammation of the toes is an emerging symptom of COVID-19 and is being referred to as "COVID toes." Science Source hide caption

"COVID toes" and other skin manifestations: Dermatologists are now reporting that certain skin conditions appear to be emerging as symptoms of infection in milder cases. Among the most common and striking is "COVID toes," a condition resembling chilblains, or pernio, on the feet or toes, says Dr. Esther Freeman, director of global health dermatology at Massachusetts General Hospital and director of the international Dermatology COVID-19 Registry. The registry has received more than 400 reports from dermatologists in 21 countries, and a little under half are cases of COVID toes, she says.

Normally with chilblains, "you would see pink, red or purple lesions on the toes or sometimes on the hands," Freeman says. "That's often accompanied by swelling and can also be accompanied by a burning, itching or tender sensation," she says.

Chilblains are caused by inflammation in the small blood vessels of the skin, usually in reaction to colder temperatures or damp weather, Freeman says. "So, for example, spending a lot of time outside in wet socks could do it."

What's unusual is that during the coronavirus pandemic, "we're seeing patients who are living in warm climates or patients who have been sheltering inside and staying warm developing these lesions for the first time," she says.

"I have seen more toe consults in the past two weeks than I have in my entire prior career combined," Freeman says.

She says some patients develop COVID toes early on, along with other symptoms such as fever or cough. Others develop the condition well after their other symptoms have passed, almost like a post-viral response. And a third category of patients seems to develop COVID toes as the sole symptom.

Other skin conditions reported include hives and morbilliform, a measles-like rash on the chest, back, arms or legs. Freeman notes that viruses for example, those that cause measles or chickenpox often cause rashes, so dermatologists were expecting that with the coronavirus. But the toe manifestations were surprising.

While data are still emerging, Freeman says that in her opinion, dermatologic symptoms, such as COVID toes, should be considered as criteria for testing. But if you're having these symptoms, she says, "Please don't panic. Most of our patients who are developing these COVID toes are doing extremely well and are able to recover fully at home."

"I think it's also important to know that the purple lesions will go away on their own," she adds.

Read more:

Is It COVID-19 Or Something Else? What Experts Are Learning About Symptoms : Goats and Soda - NPR

SEATTLE Amid growing impatience over stay-at-home orders and rising unemployment, public health experts have worried that some people may try to expose themselves to the coronavirus in a risky bid to gain immunity.

County health officials in southeastern Washington State reported this week that they had evidence that one or more such gatherings had been linked to at least two new coronavirus cases. But on Wednesday night, the officials retracted those comments and said the so-called Covid-19 parties may have been more innocent gatherings.

Meghan DeBolt, the director of community health for Walla Walla County, said county officials were learning more about the cases that have emerged from the recent social gatherings. She said they were still hearing reports of parties where infected people were present but do not have evidence that the people who became ill after the gatherings had attended out of a desire to be exposed.

The county had said in a news release on Monday that the authorities were receiving reports of Covid-19 parties occurring in our community, where non-infected people mingle with an infected person in an effort to catch the virus. Officials later elaborated on those reports in interviews, saying the parties were discovered after tracing the paths of people who were found to be infected after the gatherings.

Officials in Walla Walla have been working in recent weeks to contain a large outbreak at a meat processing facility in the area. Ms. DeBolt said the county was not close to halting the rise in infections, and health officials are concerned that more people are engaging in ill-advised social interactions despite stay-at-home requirements.

We know that people are exhausted from isolation and quarantine, Ms. DeBolt said. We want to be able to reopen, too. We want to be able to go to restaurants and socialize with friends and family members. We need our communitys help to be diligent for a little bit longer so that we can get ahead of this.

The prospect of infection parties for people who wish to quickly contract the disease in the hope of gaining immunity has been a fear among some health experts because the country has a long history of people choosing purposeful infection.

Visit link:

Covid-19 Parties Probably Didnt Involve Intentional Spread - The New York Times

PIERRE, S.D. (KELO) The death toll from COVID-19 in South Dakota increased by two on Thursday, according to the latest update from the state department of health.

Total deaths reported is now at 31 in South Dakota. The two new deaths were listed as females over the age of 80-years-old in Minnehaha County.

Active cases of COVID-19 went to 846, up 73 from Wednesday (773).

Theres 2,905 total positive cases, up 126 from Wednesday (2,779). Recoveries went over 2,000 to 2,028, 51 more than Wednesday (1,977).

Current hospitalizations are at 70, down from Wednesday (72). Total hospitalizations are at 236, up from Wednesday (230).

Negative tests at at 17,209, up from Wednesday (16,637).

The amount of new tests reported was 698 on Thursday. 101 of the 126 new positive cases were Minnehaha County, where mass testing has been taking place this week for Smithfield employees and families.

Stay with KELOLAND News for more coverage online and on-air.

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COVID-19 update: South Dakota death toll up to 31, active cases at 846 as 698 new test results announced - KELOLAND.com

A mobile morgue at the Brooklyn Hospital Center, April 20, 2020. Photo: Ben Fractenberg/THE CITY

Need to know more about coronavirus in New York? Sign up for THE CITYsdaily morning newsletter.

The disparities in the COVID-19 deaths ravaging New York City extend to who is publicly memorialized.

Fewer than 5% of the nearly 20,000 New Yorkers killed by coronavirus so far have been remembered with a paid or staff-written news outlet obituary or other death notice, an analysis by THE CITY and Columbia Journalism Investigations found.

The team examined English-language media, as well as news sources in a number of other languages, among them Spanish and Korean.

The publicized deaths defined as accompanied by a victims name and other identifying information, such as age, home borough and next of kin skew male and younger. They also disproportionately come from wealthier enclaves of the city than the general population felled by the virus.

The result: The deaths of some groups hardest hit by coronavirus including black and Hispanic residents and recent immigrants living in poorer and more densely populated neighborhoods in The Bronx and Queens often go unnoticed by anyone other than their families, coworkers and friends.

Were hoping to change that but we need your help.

If someone you know a relative, a friend, a coworker, a neighbor, a client, etc. lived and died in New York City, and was a victim of coronavirus, tell us about them by filling out this short form.

Were looking for some basic information the persons age, where they lived, when they died and more.

Bronx Community Board 9 member Sharan Fernandez, 63, died April 10 from coronavirus complications. She didnt receive a formal public obituary, but her death was announced on Twitter by the community board. Photo: Courtesy of the Fernandez Family

But we also want you to tell us whats the one thing you most remember about the person what, in your eyes, made them a unique New Yorker.

Were encouraging people to share pictures, prayer cards, old news clippings anything that helps us show their life in the city. Well also need to know a little about you so we can follow-up as needed, to verify details.

This, to say the least, is a huge undertaking. We cant promise full-scale obituaries of thousands of people.

Were still figuring out how we will present the information we receive and are able to verify. We cant say how long it will take, though we suspect this project will build in stages.

Our goal, though, is clear: to put as many names, faces and details to the numbers as possible.

Were striving to give a sense of the unimaginable loss our city is experiencing while sharing both the burden of grief and the comfort of memories as we forge ahead together, as New Yorkers.

Keith Cousins is a reporting fellow for Columbia Journalism Investigations, an investigative reporting unit at the Columbia Journalism School. Funding for CJI is provided by the schools Investigative Reporting Resource.

The work of Derek Kravitz and Anjali Tsui is funded as part of Columbia Journalism Schools Brown Institute for Media Innovation.

Want to republish this story? See ourrepublication guidelines.

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Tell the Stories of the New Yorkers Lost to COVID-19 - THE CITY

In the past two weeks, one Covid-19 patient died following what several staff physicians described as gross mismanagement by healthcare workers at Rehoboth McKinley Christian hospital. Another patient suffered severe brain damage when a ventilator was improperly adjusted, according to those same physicians. And the hospitals critical care doctor, the only critical care physician in McKinley county, resigned, citing patient safety concerns.

On 5 May, an ad-hoc group of staff providers at the hospital, formally known as Rehoboth McKinley Christian Health Care Services, unanimously voted to submit a declaration of no confidence in Rehoboths CEO, David Conejo. The group, which formed this spring to protest conditions, followed up with a warning letter to the hospital board.

The letter charged Conejo with failing to effectively communicate, promoting a lack of transparency and poor fiscal management, and creating unsafe working conditions.

The rebelling staff accused Gallups second largest hospital of questionable leadership decision-making that led to severe staff shortages, a Searchlight New Mexico investigation found. Interviews with six doctors, three nurses and other caregivers, and a review of internal emails and written complaints, reveal a hospital in disarray.

Three physicians contacted by Searchlight agreed to go on the record in tandem. They are Chris Hoover, a urologist now directing the allocation of ventilators; Neil Jackson, a family medicine doctor now working in intensive care; and Andrea Walker, chief of obstetrics and gynecology.

Our hospital has not been safe in recent weeks, they said in a collective interview. And to not be transparent about this is medically unethical. Were working incredibly hard on the frontlines but due to managements poor choices, were left without the tools we need to fulfill our obligations to the community.

Critically understaffed for weeks while treating between 15 and 20 patients sick with Covid-19 the private non-profit hospital is faltering just as Gallup weathers a surge in coronavirus cases.

A 60-bed hospital with an eight-bed intensive care unit, Rehoboth has been operating far below minimum standards on nurse-patient ratios, Searchlight found. National nursing guidelines recommend that hospitals maintain one nurse to every three patients in most settings, with acute care units requiring a one-to-one or one-to-two ratio.

In recent weeks, Rehoboth has assigned one nurse to every two or three critical care patients and one nurse to up to seven patients in other units, said Val Wangler, the hospitals chief medical officer. One nurse, who asked for anonymity, told Searchlight that she was alone during one shift in late April.

Others had similar concerns. A labor and delivery nurse said in an email to staff physicians that she was overwhelmed and unable to respond to nonstop call lights.

I can say that I have never before in my career walked past a call light or intentionally ignored call lights in order to get through my day, wrote the nurse, who asked to remain anonymous. I did this all day on Wednesday.

She added: I am seeing images of helpless, desperate elderly patients tangled up in their beds and looking at me begging for help I have this feeling that I will enter a room and find a patient dead.

Conejo declined requests for comment. Responding on his behalf, Rehoboths public information officer wrote: Covid-19 is a new challenge for everyone. We are learning every day and our staff is working very hard to provide the best care possible for our Covid-19 patients.

Located at the edge of the Navajo Nation where the coronavirus infection rate is one of the highest in the US Gallup has become a center for the scourge. The city serves as a major shopping and medical hub for Navajo, Zuni and surrounding tribal communities, increasing the potential for widespread transmission. As of 6 May, the Navajo Nation had reported 2,654 confirmed coronavirus cases and 85 deaths.

On 1 May, the governor, Michelle Lujan Grisham, invoked an emergency declaration that closed all roads in and out of Gallup.

Private rural hospitals everywhere are struggling to maintain staff while losing revenue. They rely on privately insured patients and elective surgery to stay financially afloat. Rehoboth relies heavily on elective surgery for hospital revenues.

That all came to a stop on 25 March, when the governor temporarily ordered a halt to all elective surgery in New Mexico.

That same week, the hospital terminated the contracts of 17 nurses, most of them working in the emergency room and operating room. On 1 April, four hospital physicians delivered a letter to the administration, demanding to know what steps it would take to maintain patient care standards and safe staffing levels.

Conejo responded with his own series of letters and emails, arguing that because the hospital could no longer depend on elective surgery, the cuts had become financially necessary.

During one communication with staff, Conejo emailed a budget document that listed his annual salary of $674,481. In an accompanying document he wrote that he plans to give at least $50k in this current effort and that he generously gives of personal time and money to feed and clothe the poor.

Nine days later, on 15 April , Conejo again emailed staff, this time to say that the hospital had received nearly $3m in federal aid and expected to receive at least another $11m in federal loans.

He did not mention any plans to use those funds to address staffing shortages. By then, Rehoboth had lost even more workers 30 employees had tested positive for Covid-19, including 10 nurses.

There were errors happening that should never occur in any medical setting

The medical staff was outraged by what they called a lack of foresight by the CEO. At that point, management left us dangerously short-staffed and expected our nurses and medical assistants to work harder and for longer in areas outside of their expertise, said Hoover, Jackson and Walker. There were errors happening that should never occur in any medical setting.

According to two physicians who spoke to Searchlight, a Covid-positive patient spent the night of 26 April on a maladjusted ventilator. The equipment, which pushes oxygen to the lungs, had slipped out of the trachea and was resting in the patients mouth, rendering it useless for hours. The patient died in the following days.

A 27 April email from a doctor called for a peer review of the case and indicated that the medical staff had grossly mismanaged the ventilator.

Many of the nurses and doctors on duty were unprepared to care for such patients suffering from acute respiratory distress, according to several staff physicians. They blamed system inefficiencies, outdated equipment and a poorly trained support staff for negligence in failing to recognize the severity of the problems.

Many of the physicians and nurses had been hired by the hospital through remote staffing agencies, doctors said.

Rajiv Patel, the hospitals only critical care doctor, said he had become disillusioned with the inexperience of temporary staff and safety issues by late April.

It became clear to me that I could not safely keep and take care of critically ill, and especially ventilated Covid-19 patients, said Patel, who worked extended shifts almost every day for more than a month.

By 28 April, Patel and numerous colleagues had fashioned an agreement requiring that all ventilated patients at Rehoboth be transferred to better-equipped facilities around the state. Once that was finalized, Patel told the staff he was quitting Rehoboth. He said he remains committed to serving the communities of north-west New Mexico.

Since the end of March, when the hospital terminated the 17 nurses, it has hired only one new nurse and brought on no additional physicians, said Wangler. Across the street, Gallup Indian medical center has brought on seven physicians and 14 nurses on month-long voluntary assignments.

Nursing supervisors at Rehoboth are struggling to find more than three nurses a shift. For now, nurses describe an untenable and soul-crushing workload.

We need help, one nurse said. We deserve better.

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How a New Mexico hospital rebelled against its bosses as Covid-19 hit - The Guardian

A glimpse at Lyfts stock price Wednesday, which soared as much as 16.77% after first-quarter earnings were reported, suggested all was well in the ride-hailing companys world.

In this COVID 19-era, well is a relative term. Lyfts net losses did dramatically improve from the year-ago quarter (a loss of $398 million versus $1.1 billion in Q1 2019). However, Lyft was clear in its earnings call: COVID-19 had a profound impact on its customers and its business and the future was uncertain.

It is impossible to accurately predict the duration and depth of the economic downturn we face, Lyft CFO Brian Roberts said during an earnings call Wednesday afternoon. Our business may be impacted for an extended period of time. So we must be prepared to adapt accordingly.

The difficulty of predicting what will happen has hamstrung thousands of companies trying to navigate the COVID-19 pandemic. Last month, Lyft withdrew its previously provided revenue and adjusted EBITDA guidance for full year 2020 because of the vast unknowns.

Given this fluidity, it is impossible for us to predict with any certainty our results, Roberts said. After the requisite warnings, Roberts did eventually provide an outlook for the second quarter and it isnt pretty. The outlook focused on adjusted EBITDA, which doesnt give the most complete financial picture. It provides enough to understand that even with considerable cost-cutting measures, Lyft will suffer losses nearly four times wider than the first quarter.

Roberts said Lyft can manage to keep its second quarter adjusted EBITDA loss under $360 million if rides on its rideshare platform remain at April levels which were down 75% year-over-year for the remainder of the quarter. Lyft reported Wednesday an adjusted EBITDA loss of $85.2 million in the first quarter.

There are some early signs of a recovery. Ridership in the week ended May 3 was up 21% from the lows experienced in mid-April, according to Lyft. However,Lyft cant afford to simply hope rideshare will return. It has to and already has enact a plan that will allow it to navigate the pandemic and come out as a survivor. In other words, Lyft will be judged at how well can stem the losses and find new revenue streams.

Work to cut costs has already started.

The company put together an aggressive plan to strengthen its financial position, Lyft co-founder and CEO Logan Green said during the earnings call. Lyft reduced its more than 5,000-person workforce by 17% and furloughed nearly another 300. Lyft also initiated a three-month pay reduction for all salaried employees, ranging from 10% for its most non-hourly team members, up to 30% for its senior leadership team and board members.

Every other expense line is being scrutinized and no stone will be left unturned, Green said.

The company expects to be able to cut its annualized fixed costs by $300 million by the end of the year. The reductions are based on its original expectations for 2020. Lyft has also ended rider coupons once ridership began to decline in mid-March and paused adding new drivers in nearly all markets.

This reduces costs we incur associated with onboarding new drivers and helps protect utilization and earnings opportunities for existing drivers during this time of lower ride demand, Green said.

Lyft reduced its 2020 capital expenditure plan by $250 million. And its sought out cost savings on the insurance front. (The companysprimary auto insurance policies expire at the end of September; Roberts said theyre considering the best options to reduce future volatility, as well as lower overall costs.)

The company is also shifting attention and resources to projects that executives believe will improve its unit economics. Finding those revenue streams will be tricky. Lyft has already provided a few clues of where its headed.

The company will continue with its Essential Deliveries pilot that launched April 15. The initiative lets government agencies, local non-profits, businesses and healthcare organizations request on-demand delivery of meals, groceries, life-sustaining medical supplies, hygiene products and home necessities.

Green said the company will evaluate any future opportunities based on how it performs. But he quickly added that we have no interest in launching a consumer food delivery service. And so, we will not be doing that.

Green also seemed cautiously optimistic about a new lost cost product called Wait and Save, that allows Lyft optimize the marketplace and be more efficient with matching drivers and riders.

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How Lyft intends to navigate and survive COVID-19 - TechCrunch

But a US medical drone company has been getting blood and medical products to rural clinics and hospitals in Africa for several years and is now focusing its attention on the battle against COVID-19.

Drones are helping to deliver test kits and PPE to fight COVID-19.

Image: Zipline

Medicine for remote communities

An estimated 2 billion people lack access to basic medicines partly because they live in remote locations.

To help solve this problem, drone company Zipline has pioneered medical deliveries to rural communities in Rwanda and Ghana. Its lightweight drones deliver vital packages to clinics up to 85 kilometres away. Trips that might have taken an entire day by car could take 30 minutes or less by drone.

Now the company is using its drone deliveries to support the coronavirus fight in Africa and aims to do the same in the US.

The World Economic Forum is partnering with governments and companies to create flexible regulations that allow drones to be manufactured and used in various ways to help society and the economy.

Drones can do many wonderful things, but their upsides are often overshadowed by concerns about privacy, collisions and other potential dangers. To make matters worse, government regulations have not been able to keep up with the speed of technological innovation.

In 2017 the World Economic Forums Centre for the Fourth Industrial Revolution teamed up with the Government of Rwanda to draft the worlds first framework for governing drones at scale. Using a performance-based approach that set minimum safety requirements instead of equipment specifications, this innovative regulatory framework gave drone manufacturers the flexibility to design and test different types of drones. These drones have delivered life-saving vaccines, conducted agricultural land surveys, inspected infrastructure and had many other socially beneficial uses in Rwanda.

Today, the Centre for the Fourth Industrial Revolution is working with governments and companies in Africa, Asia, Europe and North America to co-design and pilot agile policies that bring all the social and economic benefits of drone technology while minimizing its risks.

Read more here, and contact us if you're interested in getting involved with the Centre for the Fourth Industrial Revolution's pioneering work in the governance of emerging technologies.

Drones have already played an important role in the fight against COVID-19, from disinfecting streets in China, to supplying medicine to a small community in Chile.

When the coronavirus hit Africa, Zipline adapted its cargo. Its distribution centres in Ghana now hold stocks of personal protective equipment (PPE) and its drones also deliver COVID-19 test samples, CNN Business reported.

We are stocking a whole bunch of COVID-19 products and delivering them to hospitals and health facilities, whenever they need them instantly, Zipline CEO and Schwab Foundation Social Entrepreneur, Keller Rinaudo, told CNN Business.

Another way drones could help, Rinaudo believes, is delivering more directly to the elderly and vulnerable who need to self-isolate: Suddenly theres a dramatic need to extend the reach of the hospital network and the healthcare system closer to where people live, he said. A neighbourhood drop-off point is being considered for those with chronic conditions who are often reliant on volunteers to collect and deliver medication.

Rinaudo thinks that drone deliveries could play a vital role both during the current crisis and in the coming months and years.

Elevating the conversation

The World Economic Forum, with partners including Zipline, the World Bank and the International Civil Aviation Organization (ICAO), have been raising awareness of how to accelerate the use of drones for good in Africa and beyond.

In early April, the Forums Aerospace and Drones community brought together more than 400 industry participants to discuss how drones can battle COVID-19 and how best to integrate them into supply-chains. David Moinina Senge, Chief Innovation Officer and Minister of Basic and Secondary Education for Sierra Leone, explained how drones can assist with data capture, medical supply-chain integration, and provide jobs for the developing tech sector.

Ironically for a company that began life in California and already has two distribution centres there, Zipline has no commercial operation in the United States. However, that may change.

In the coming weeks, Zipline will join two other companies - Matternet and Flytex - for an initiative using drones for COVID-19 response, using the technology to deliver PPE or medical supplies in three North Carolina cities.

License and Republishing

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

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

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Medical delivery drones are helping fight COVID-19 in Africa, and soon the US - World Economic Forum

Amid COVID-19 precautions, medical centers continue to treat patients with other serious conditions.

By Kelly ServickMay. 6, 2020 , 1:00 PM

Sciences COVID-19 reporting is supported by the Pulitzer Center.

Myron Cohen has run clinical trials through hurricanes and civil unrest. Now, the infectious disease researcher at the University of North Carolina, Chapel Hill, says he and his colleagues are in a new situation: trying to carry out large, international trials in the midst of coronavirus lockdowns. Cohen co-leads a network of HIV prevention trials, some of which have paused during the pandemic. But for other studies, he says, stopping would be of grave consequence to participants. So study teams have bought and shipped protective equipment to personnel at clinical trial sites, secured special permits where necessary for trial participants to leave their homes for medical visits, and arranged their private transportation to avoid public buses.

Not all clinical trials have had to go through such logistical gymnastics. But across diverse fields, investigators have managed to keep treating patients who might benefit from experimental therapies. Slowdowns and pauses in recruiting new participants will delay resultsbut for many studies, data are still flowing in.

Now, research teams are contemplating the ways the pandemic might insert itself into their trial results. Could changes induced by the pandemicincluding less consistent follow-up visits, reduced movement, poorer mental or physical health, or infection with the novel coronavirus itselfblur the statistical signals of a treatments risks and benefits?

Were all going to have to plan for how we account for the impact of COVID, says Janet Dancey, a medical oncologist at Queens University in Kingston, Canada. Many concerns remain hypothetical. Until researchers finish collecting and analyzing their data, they wont know whether coronavirus-related disruptions will undermine results. But Im worried about it, Dancey says.

Though medical centers around the world have shifted staff and resources to COVID-19, they also continue to bring in patients with other life-threatening diseases. Many institutions have stratified their ongoing clinical studies and halted any in which patients didn't stand to benefit directly. But for many cancer patients, participating in a clinical trial can provide the best available treatment, says Monica Bertagnolli, a cancer researcher at Harvard Medical School. Everybody who is already on a clinical trial is there because they have cancer or some serious condition, and this is a really important part of their treatment, she says. You dont want to deny that to patients.

The Alliance for Clinical Trials in Oncology, which conducts clinical trials across the United States and Canada, has not withdrawn any participants from treatment during the pandemic, says Bertagnolli, who chairs the organization. But, she adds, I wont say that the treatment hasnt been changed a little bit. In some cases, the pandemic has delayed imaging appointments and biopsies that can guide treatment plans and gauge how a tumor is changing. As a result, researchers might not be able to document how much a cancer has grown or spread at the exact time points specified in the trial design. (The U.S. Food and Drug Administration has indicated that deviations from study protocol to protect patients safety during the pandemic are justified.)

Im already seeing many more deviations, says Howard Burris, an oncologist and chief medical officer of Sarah Cannon, the Cancer Institute of HCA Healthcare, and president of the American Society of Clinical Oncology. Hes optimistic that small data gaps wont change big-picture trial results. Hopefully, in a randomized trial, those things sort of sort themselves out, he says. I think well be able to adjust.

But trial data might become muddied if some participants are sickened by the novel coronavirus or die from it, Dancey notes. Presumably, SARS-CoV-2 infections would be distributed randomly between a studys treatment and control groups. But they could still make it harder for researchers to pick up signals of benefit or to disentangle negative side effects of the experimental treatment. If there are competing causes of death that are going on, then it will be harder to show differences in outcomes, Dancey says. It reduces our power.

Other effects of the coronavirus pandemic on trial participants might be more subtle. For example, the results of HIV prevention trials depend in part on participants risk of contracting the virus, Cohen notes, and social distancing orders that limit intimacy might change that underlying risk. The researchers will have to take into account the fact that getting an experimental drug was far from the only change in participants lives over the course of the trial.

Trials focused on mental health could face other complications, says Lynnette Averill, a psychologist at the Yale School of Medicine, who is studying the anesthetic ketamine as a potential treatment for post-traumatic stress disorder (PTSD). A global pandemic where youre isolated and potentially have fears of you or your family being ill those things are highly stressful, and potentially traumatic, she says. This experience may be significant enough that there has to be some sort of analysis of the pandemic effect. We may in fact have entirely different cohorts pre- and postpandemic.

Averill also wonders whether investigators running trials of PTSD, anxiety, and depression will see a shift in the demographics of trial participants. The mental health effects of caring for COVID-19 patients in overstretched hospitals may make more health care workers eligible for such trials, for example.

Dancey, who directs both a research network that runs cancer trials and a funding organization that supports them, has been helping develop guidance for researchers on how to adapt studies during the pandemic. The best they can do, she says, is focus on a studys primary endpoint, make data collection as complete as possible, and document any deviations from the study plan. We have to make sure that people are looked afterwhether theyre patients with or without cancer, or health care professionals, she says. And then well look after the trial.

Excerpt from:

Clinical trials press on for conditions other than COVID-19. Will the pandemic's effects sneak into their data? - Science Magazine

A member of the US military who works at the White House, reportedly as one of Donald Trumps personal valets, has tested positive for coronavirus.

We were recently notified by the White House medical unit that a member of the United States military, who works on the White House campus, has tested positive for coronavirus, the deputy White House press secretary, Hogan Gidley, said in the statement.

The president and the vice-president have since tested negative for the virus and they remain in great health.

According to a report from CNN, the valet is a member of the US navy and started exhibiting symptoms on Wednesday morning. The person tested positive on Wednesday, the White House said.

This is the second individual confirmed to have tested positive for Covid-19 while working at the White House. A staffer in vice-president Mike Pences office tested positive for the virus in March. Several people present at Mar-a-Lago, Trumps private Florida club, were also diagnosed with Covid-19 in early March.

The news of the new case at the White House comes as the US begins to reopen its economy, despite urgent warnings from health experts that the move could prove to be a death sentence for many Americans.

Trump has praised governors of states that have started to loosen restrictions on social distancing and business activity, even though he has admitted that people will suffer as a result. Will some people be affected badly? Yes, Trump said on Tuesday. But we have to get our country open, and we have to get it open soon.

Public health experts have pointed out that Covid-19 infections and deaths are mounting dangerously in much of the US.

New York has drawn attention as a global hotspot for the virus but has now flattened its rate of infections, whereas large parts of the country are still to reach their own peak. When New York is discounted, the US is still on an upward trajectory of new infections.

The White House instituted safety protocols nearly two months ago, including temperature checks. Last month it began administering rapid Covid-19 tests to all those in close proximity to the president, with staffers being tested about once a week.

Several valets cater to the president and his guests at the White House, both in the West Wing and in the White House residence.

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One of Trumps personal valets tests positive for Covid-19 - The Guardian