Coronavirus in India: Total lockdown in 30 states/UTs; curfew pass needed to enter Delhi

As most of India went into shutdown in a mega effort to stop the spread of Covid-19 — complete lockdowns were announced in 30 states/ UTs and a total of 548 districts

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India to spend $1.3 billion to boost pharmaceutical production

The program includes spending on infrastructure for drug manufacturing centers, and financial incentives of up to 20% of incremental sales value over the next eight years, according to a government statement.

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DCGI to fast-track approval for Covid-19 drug, vaccine

The DCGI has offered seven measures for speeding up the process, from giving fast-track approval for repurposed drug to waiving animal study and offering flexible pathways which earlier would have taken months. It said applications from companies will be given “high priority” and that it will assist the companies in speeding up their research.

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World ramps up restrictions as virus cases top 300,000

The pandemic has sparked fears of a global recession, prompting governments to unleash gigantic emergency measures to avoid an economic meltdown.

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Coronavirus in India: 3 deaths, 68 new cases as total infected count hits 400

On Sunday, 68 new cases were reported by 14 states in all, the second highest for a single day after 77 cases reported on Saturday.

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New story in Health from Time: What Astronauts Can Teach Us About Isolation and Quarantine

It’s not hard to practice social distancing at Russia’s Baikonur Cosmodrome. Once you get away from the hangars and launch pad and the railroad line that connects them, the place is practically bucolic—a large, leafy compound of low-slung buildings, less a space complex than a sort of Camp David in Kazakhstan. That’s a very good thing for a crew preparing to take off for the International Space Station (ISS) aboard a Soyuz spacecraft, since they spend their last two weeks before launch in medical quarantine, living together, along with their back-up crew, in bungalow-like quarters. Baikonur staffers who come into contact with them are gowned, gloved and masked like surgeons, all in an effort to make sure no illnesses are carried to the ISS.

One thing astronauts who are not actually in space at the moment have on the rest of us is that, given their experience with quarantine and isolation, they’re far less likely than we are to go stir-crazy while stuck at home during the corona crisis. As a result, they have a lot to teach us. One thing we share with them is that staying occupied always helps.

“The amount of time Shuttle astronauts were isolated [missions averaged two weeks in length] was less than what our current shelter in place is going to be and the most important difference is we were ragged busy!” wrote retired astronaut Marsha Ivins, a veteran of five shuttle missions, in an email to TIME. “We were working 18-hour days before, during and after the mission.”

That kind of schedule-filling helps during the long-term isolation of three-, six-, and 12-month rotations aboard the space station too.

“The key to any successful expedition is to keep the crew busy,” says former NASA astronaut and space station veteran Terry Virts. “A busy crew is a happy crew—and a bored crew is a disaster. This is a great time for people to do the things they’ve been delaying for years—organize the house, start writing that novel, organize your family photos and scan the old photo albums, come up with a financial plan once the economy turns somewhat normal again—and it will.”

Then too there is the matter of the people you live with in such close quarters—whether on the ground or aboard the station. While sheltering in place might seem especially challenging for people living alone—an arrangement that describes 28% of American households, according to the U.S. Census Bureau—there is something wearying about coming face to face with the same faces every day.

“I remember many of the long-duration crews mentioning that seeing a new crew after two or three months was great because it was suddenly people who weren’t them,” says Ivins. “On my relatively short flights I was also happy in a few mission cases to be done with people who were us.”

Keep up to date with our daily coronavirus newsletter by clicking here.

The lesson for people isolating now is not so much to have some new faces over, since that defeats the whole point of social distancing, but to have time apart from the ones in your household. That might mean taking a walk or even deliberately splitting up—someone going into the backyard while someone heads for the front yard and someone else gets the den.

None of that works as well as it could, of course, if there are contrarians in the brood, and every family has them—people inclined toward short tempers or crankiness under stress. While it is the responsibility of those more-snappish folks to keep their worst tendencies in harness, it helps if the rest of the family strives for greater tolerance.

Perhaps the most grueling of all space-isolation experiments was the 1965 Gemini 7 mission. It lasted just two weeks, but they were two miserable weeks. Astronauts Frank Borman and Jim Lovell were squeezed shoulder-to-shoulder in airline-coach-sized seats, with a wall on both sides (no aisle seats here) and the ceiling barely three inches above their heads. Borman and Lovell ate, slept and took care of other bodily business in those conditions for a full fortnight. Both astronauts came to describe the mission as “two weeks in a men’s room.”

They survived it all because NASA knew its astronauts well and was very adept at pairing up personalities. Borman was and remains an agreeable sort, but he was also an exceedingly serious, by-the-book astronaut. Lovell was and remains looser, easily among the most affable astronauts in the old corps. “If you can’t get along with Lovell,” Borman told me in 2015 when I was writing a book on Apollo 8, another mission they flew together, “you can’t get a long with anyone.” The combination of the strict Borman and the looser Lovell made for both a tight ship and a minimum of friction.

For all the deep experience Ivins, Virts, Lovell and Borman share, however, there might be no one better able to help terrestrial humans through the challenges of isolation than the veterans of the first three successful lunar landings. They not only went into medical quarantine before each mission, then flew the mission all alone together, they also spent three more weeks in lockdown after they came home, just in case they were carrying any lunar pathogens.

In a delightful story just published in Ars Technica, Apollo 11’s Buzz Aldrin shared the secret of how he’s passing the time while trying to stay safe from coronavirus: “Lying on my ass and locking the door,” he said simply.

Intended or not, Buzz’s message is a little like Virts’s words on the economy: Relax. This will get better; these times will pass. Viruses and bacteria have had their way with humanity since we emerged on the savannah, and we have had our way right back at them—first via our immune systems, later by acquired knowledge of social distancing and good hygiene, and later still by advanced science, vaccinating and medicating the pathogens into submission.

COVID-19 is, in some ways, Apollo 13: It blindsided us, it’s challenging us, and for now it feels like it’s defeating us. But we’re smarter and nimbler than an insensible virus and there should be no doubt who will win in the end. See y’all at splashdown.

---

A version of this article was originally published in TIME’s Space newsletter. Click here to sign up to receive these stories early.

India observes Janata curfew, millions stay indoors

As the 14-hour 'Janata curfew' got underway at 7 am, people kept themselves indoors as part of the social distancing exercise to help stop the spread of the virus. All markets and establishments except those dealing in essential goods and services are closed for the day. The 'Janata curfew' will end at 9 pm.

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Govt okays Rs 14K healthcare package to boost domestic manufacturing of bulk drugs

In a big boost to domestic manufacturing of bulk drug in the country, the government on Saturday announced a Rs 14,000-crore package that would incentivise production of active pharmaceutical ingredient (API) and medical devices in the country and reduce dependence on import for critical healthcare needs.

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KOLKATA : Man with no travel history tests +ve, state count at 4

A 57-year-old man with no foreign-travel history and a 23-year-old woman who returned from Scotland tested positive for Covid-19 within 24 hours in Bengal, taking the total number of confirmed cases in the state to four.

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New story in Health from Time: Gov. Cuomo Plans to Address Mental Health After Announcing More Than 10,000 Coronavirus Cases in New York State

In a press conference on Saturday, New York Gov. Andrew Cuomo announced the state is working to set up a network in which people can speak to mental health professionals about the emotional toll of the COVID-19 crisis.

He asked the professional mental health community — including psychiatrists, psychologists and therapists — to volunteer their time to get the network up and running. Sessions would be held over the phone or on over video chat, he explained. He said that if they get enough volunteers, New York state will set up a Mental Health Electronic Help Center.

Mental health is a vital part of public health.

We're asking psychologists and therapists to pitch in and volunteer their services to help with New York's #Coronavirus response.

To sign up, visit: https://t.co/4LJxeIdhRE

Stress and anxiety are very real.

— Andrew Cuomo (@NYGovCuomo) March 21, 2020

The initiative is the first move by a U.S. state government to try to address the mental health consequences that have arisen from the COVID-19 crisis.

“We talk about the economic consequences, but we also need to talk about the social consequences,” he said. “But the stress, the anxiety, the emotions that are provoked by this crisis are truly significant, and people are struggling with the emotions as much as they are struggling with the economics.”

“They’re nervous, they’re anxious, they’re isolated. It can bring all sorts of emotions and feelings to the surface,” he continued. “When you’re isolated you don’t have people to talk to.”

On Friday, Cuomo issued an executive order telling New Yorkers to stay home unless for essential travel. Schools, businesses and religious centers — which can often function as emotional support systems — have all closed to help stem the spread of virus. A recent Reuters/Ipso poll found that 48% of Americans feel that the coronavirus is an “imminent threat” to the United State, 20 points more than in a March 2-3 poll.

According to MIT Technology Review, use of mental health apps and tele-therapy has skyrocketed since the coronavirus crisis began. While some have released their contents for free, most charge patrons for speaking with a professional. The New York state network would be free to the public, according to Cuomo.

During the same press conference, Cuomo also announced that there are now at least 10,356 confirmed cases of COVID-19, the disease caused by the novel coronavirus, in the state. He also said about 15% of those cases have needed hospitalization.

Cuomo also told the public not to listen to rumors about how the government is responding to the crisis. He urged New Yorkers to to coronavirus.health.ny.gov to submit questions to his team, which he said his team will respond to.

“Yeah, we have a problem. Yes we will will deal with it. Yes we will overcome it,” he said. “But let’s find out better selves in doing it. And let New York lead the way.”

Indian Pharmaceutical Alliance commits to help fight Covid-19

"We are closely monitoring orders and inventories. With an adequate stock of active pharma ingredients, finished product formulations and channel availability, we'd be able to sustain the supply of medicines for the coming months. We are not aware of any medicines shortage, to date," the alliance said.

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Coronavirus outbreak: 627 die in Italy in 24 hrs, global toll crosses 10,000

The peril posed by the twin scourges of pestilence and material ruin brought on by the swift advance of the coronavirus deepened on Friday as the global death toll hit 10,000 and jobless numbers soared.

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Finland is again world's happiest country: UN

Good cheer may feel in short supply as the world reels under a global pandemic, but experts at the United Nations on Friday declared Finland to be the world's happiest nation for the third year running.

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New story in Health from Time: Coughing, Fainting, Breathing Problems: Stranded Cruise Ship Passengers Describe Chaotic Flight Home to U.S.

(ATLANTA) — On a chaotic flight home, some passengers who had been stranded for days aboard a cruise ship after being exposed to the coronavirus suffered breathing problems, many coughed and several fainted with no food or medical personnel provided, travelers said Friday

“It was a suicide mission,” said passenger Jenny Harrell, of Fredericksburg, Virginia. “It was a mass triage with absolutely no direction and the crew going, ‘What should we do now?’” Decisions were left up to the passengers, said Harrell, who had some emergency medical training in the past and helped a physician who was also among the passengers.

The jet carrying 359 people, including hundreds of American and Canadian passengers from a Costa Cruises ship flying home from France, landed at Atlanta’s international airport as emergency responders, and health and customs officials deployed to screen them for the coronavirus.

Read more: The Grand Princess Has Docked in California. Here’s What to Know About the History of Quarantine on Ships

Three people on the flight tested positive for the coronavirus before landing but had no symptoms, the U.S. Department of Health and Human Services and the Centers for Disease Control and Prevention said. Thirteen others were sick but hadn’t been tested, and one passenger was sent to a local hospital.

Harrell, 51, said she isolated two other passengers who were having breathing problems. One had a chronic lung disease and needed to be hooked to a ventilator, she said. Another passenger had an asthma attack and several others fainted, apparently from low blood sugar levels. Harrell said many travelers were coughing and she helped treat people who had a fever.

“There should have been medical personnel on that flight,” Harrell said.

Costa Luminosa passengers also complained they were given no food other than orange juice and crackers in more than 24 hours — the time it took to disembark in Marseille, France, to fly to Atlanta, and be cleared by officials.

At one point, Harrell said, the flight attendants handed her the cabin microphone. “I basically took over the plane,” she said. “I couldn’t even make this up for a movie.”

In another instance, the co-pilot asked her and others whether they should land in Bermuda, instead of continuing all the way to Atlanta.

“We didn’t have a choice. We had been turned away for the last eight days,” Harrell said.

Read more: Understanding the Coronavirus Pandemic, in Five Charts

For many, the flight was a culmination of an already harrowing journey that began on March 5 in Fort Lauderdale. Some passengers said they wanted to cancel the trans-Atlantic cruise, but the company refused to give them a refund, assuring them it was safe to go three days before the U.S. State Department issued a warning for U.S. citizens not to travel on cruise ships.

On March 8, an Italian woman disembarked in Puerto Rico with breathing problems. She and her husband, who also got off the boat, were hospitalized and tested positive for the new coronavirus. Since the new cases came to light, the Costa Luminosa was denied entry to several countries.

The 1,400 passenger ship was finally allowed permission to dock in Marseille, France, under strict quarantine conditions. The local administration for the Marseille region said in a statement that 36 people have tested positive for the new virus.

The screening process for the passengers who got on the flight to the U.S. isn’t clear, but Harrell said many of the passengers were visibly sick when they boarded the jet. “They just wanted us to get home so we could be taken care of here,” she said. “Everybody, basically, on that flight had medical conditions.”

After the plane landed, Harrell called 911 because CDC officials wanted to start screening, but she demanded food first. She was afraid they would have to wait for a long process before they had anything to eat.

The CDC said all passengers were screened and “three passengers who were reportedly tested previously and found to be positive for COVID-19 were separated from other passengers.” Federal officials are working with Georgia authorities to determine a plan for those passengers.

Harrell said officials measured their temperatures, but only certain passengers were tested for the virus. She was cleared to fly back home to Virginia, where she was told to stay home for 14 days.

___

Gomez Licon reported from Miami.

New story in Health from Time: Pence Staffer Tests Positive for Coronavirus

(WASHINGTON) — The White House says a member of Vice President Mike Pence’s staff has tested positive for coronavirus.

Pence’s spokeswoman Katie Miller said Friday that the staff member, who is not being identified, did not have “close contact” to either the vice president or President Donald Trump.

Read more: Mike Pence’s ‘High Risk’ Coronavirus Response Will Impact His Political Future—and American Lives

Miller said contact tracing, or contacting everyone the individual has been in contact with, is being conducted in accordance with guidelines issued by the Centers for Disease Control and Prevention.

Miller says Pence’s office was notified Friday evening of the positive test result.

New story in Health from Time: Can Coronavirus Affect Pregnancy or Newborns? Here’s What the Experts Say

More than 130 million women give birth around the world each year. During pregnancy, changes in the immune system make women generally more susceptible to respiratory infections. And this year, pregnant women also have to worry about COVID-19, a virus that can affect a person’s lungs and airways.

The U.K. government announced on Monday that pregnant women were at an increased risk of severe illness from coronavirus (COVID-19). Speaking at a press conference, Public Health England chief medical officer Chris Whitty said people in the “high risk” category should stay at home for 12 weeks. (That includes people over 70, people with underlying health conditions and pregnant women.) Whitty described the advice to pregnant women as “a precautionary measure” because “we are early in our understanding of this virus and we want to be sure.”

However, this doesn’t square with guidance issued by other public health officials. During a press briefing on March 16, the World Health Organization Director-General Tedros Adhanom Ghebreyesus said, “there is no evidence that pregnant women present with different signs or symptoms or are at higher risk of severe illness.”

According to Dr. Amir Khan, a general practitioner in England’s northern city of Bradford and a senior lecturer at both Leeds and Bradford University, “anyone who is immunocompromised, such as pregnant women, are at an increased risk of developing things like pneumonia and then going into respiratory distress. That’s the real risk.”

Specific demographic data is limited, making it too early to say for certain whether the coronavirus poses a particular threat to pregnant women. “It seems that pregnant women infected with the virus do not have a more severe illness than the general population. However this is based on limited data” says Cynthia DeTata, assistant professor of obstetrics and gynecology at the Stanford University School of Medicine. “We know that the seasonal flu, and prior SARS and MERS infections were more severe in pregnant women,” she adds.

On Feb. 28, for example, the World Health Organization (WHO) published an analysis of 147 pregnant women (64 of whom were confirmed to have coronavirus, 82 who were suspected and one who had no symptoms) and found that 8% had a severe condition and 1% were critically ill. Most people (about 80%) recover from the disease without needing special treatment but one out of every six people who gets COVID-19 becomes seriously ill and develops difficulty breathing, according to the WHO.

Keep up to date with our daily coronavirus newsletter by clicking here.

Can coronavirus cause complications in pregnancy?

There is currently no evidence that pregnant women infected with coronavirus are at an increased risk of miscarriage or that the virus can pass to a developing fetus while a woman is pregnant, according to advice issued by the U.K.’s Royal College of Obstetrics and Gynecology on March 18.

A newborn baby tested positive for coronavirus in London last week, according to reports on March 14, the youngest known case of the cvirus. The mother had also tested positive for the virus, with results coming after the birth. However, it is unclear how the disease was transmitted—in the womb, or after birth.

“All the evidence suggests none of the virus can be found in the amniotic fluid or the placenta. But we do know that other types of coronaviruses can be found in the placenta,” Khan says.

One very small study, published in The Lancet on Feb. 12, looked at nine coronavirus-positive pregnant women in their third trimester in the Wuhan region of China—the original epicenter of the outbreak—and found no evidence that the virus was transferred from mother to fetus.

“To date, the main risks for pregnant women are the same for everyone else,” says Denise Jamieson, the chairwoman of gynecology and obstetrics at the Emory University School of Medicine. “If pregnant women were much more severely affected with all the cases worldwide, I would think that we would be getting some indication of that. And we haven’t. But we do need more information.”

RAUL ARBOLEDA/AFP via Getty ImagesA pregnant woman wears a face mask as a preventative measure against the spread of the new coronavirus, COVID-19, as she waits for the bus in Bogota, on March 16, 2020.

What precautions should pregnant women take against coronavirus?

U.S. experts say that, for now, women should comply with the same recommendations that governments have made for other people.

Khan, however, says measures that apply to high risk groups apply to pregnant women. “They’re not the same as the general public. The U.K. recommends that pregnant women should self-isolate for 12 weeks, they should be working from home and minimizing their contact with people.”

The U.K.’s RCOG says women should not miss their appointments and should be in touch with their designated midwife team regarding the best course of action. Some visits may be deferred after appropriate telephone consultations, especially if there is no concern about fetal movements and general maternal wellbeing.

“We’re still advising people to go to their appointments, stick to their birthing plans and not to suddenly make drastic changes like having home births. Last minute changes to birth plans is often where things go wrong,” says Khan. Pregnant women should not be avoiding their prenatal checkups, agrees DeTata.

“Obstetricians, individual obstetric practices and health systems are making decisions about which prenatal care visits can be safely combined and options for telehealth visits,” says Jamieson. “We don’t have evidence that the risks are greater for pregnant women compared to the general population. But pregnant women, just like everyone else, are at risk of the disease. We need to do all we can to protect pregnant women and their babies,” she adds.

The challenge is that prenatal care is very “hands on,” says DeTata, involving “listening to the heart tones of the baby, determining the position of the baby, ultrasounds of the baby and so on. None of this can be done via a phone call.”

There are things that can be done to make hospital visits safer, though. “We can make sure that waiting rooms aren’t crowded, they’re constantly clean, and well and ill women are separated,” says Jamieson.

What are the risks of coronavirus to newborns?

One encouraging fact is that the virus that causes COVID-19 has not been found in breastmilk, according to the U.S. Centers for Disease Control and Prevention (CDC). Khan says “if you are feeding a baby and you have no symptoms, hand hygiene is key. If you do have symptoms then you need to pump the breast milk into a bottle and get someone else to feed the baby,” says Khan. “We don’t recommend stopping breast feeding in total if a woman has symptoms because the baby needs the antibodies in the milk, which will give it the best possible chances against getting the virus,” he adds.

Individual guidance, however, may depend on how ill the mother is with the coronavirus. The RCOG says that in any case, a discussion about the risks and benefits of breastfeeding should take place between the mother and her family and the maternity team.

So far, children account for the smallest share of infections identified. A study of 2,143 children with confirmed or suspected cases of the coronavirus in China, published online in the journal Pediatrics on March 16, found that 94.1% of the children were either asymptomatic or had mild or moderate cases, and only 5.9% percent of them had critical or severe cases, much lower than the 18.5% of adult patients in China in the same time period. But of the few children who do develop serious cases, those under the age of 5 are the most at risk while infants under 12 months in most danger, according to the study.

The CDC advises a mother who is symptomatic to take all possible precautions before handling their baby, including washing their hands before touching the baby and wearing a face mask while breastfeeding. If a mother chooses to feed her baby with formula or expressed milk, the RCOG recommends that she strictly follows sterilization guidelines.

Please send any tips, leads, and stories to virus@time.com.

Here’s what you need to know about coronavirus:

• What to know and what to do about the global pandemic
• Where has coronavirus spread in the U.S. and around the world?
• Why is it so hard to get a COVID-19 test in the U.S.?
• How should you self-quarantine if you may have been exposed to coronavirus?
• How can you stay physically and mentally healthy while stuck at home?
• Which events have been canceled because of the coronavirus?
• Should you order takeout? Can you go to the park? Here’s what a medical ethicist says
• How can you stay productive while working from home?

New story in Health from Time: COVID-19 Testing Is Supposed to Be Free. Here’s Why You Might Still Get Billed

Jena Starkes is pretty realistic about the challenges she faces when confronting COVID-19: it could get rough. The 45-year-old lives with her 81-year-old mother in Brooklyn, and in recent days, as the outbreak has worsened, she felt there was not much they could do.

“If I get it and I give it to her, it is unlikely that she would survive,” Starkes says. But, she adds, because she doesn’t have insurance for herself — and can’t afford out-of-pocket hospitalization — her own health is hardly secure either.

“If I get it bad, I would probably just die,” she says. “What if I had to be ventilated? What if I had to pay $300 for a test? I literally could not.”

Keep up to date with our daily coronavirus newsletter by clicking here.

Starkes is trying to be careful about social distancing so she doesn’t get her mother sick, but her concerns are real. She owns her own web design business and she can’t afford to pay for an individual insurance plan, and while her mother’s Medicare covers some costs, the co-pays are a strain. “On a normal day, there is no system. There’s no way for me to get to go to a doctor for a reasonable cost,” Starkes says. “We are barely making our rent as it is.”

On March 18, Congress attempted to address some of Starkes’ problems by passing the Families First Coronavirus Response Act. But there are a number of ways the bill fails to protect people like her. It offers limited provisions on paid sick leave and unemployment insurance, but it does not address the cost of actually being treated for the virus. And while it supposedly made getting tested for the coronavirus free, it probably won’t always work out that way.

“That’s nice,” Starkes says of the new law, “but we’re all still in the same boat.”

Here is what you need to know about getting tested for COVID-19.

How much will getting tested cost me?

It’s supposed to be free. The new law mandates that Medicare, Medicaid, other government plans, and most private plans cover COVID-19 testing — and all testing-related services — entirely. That means no co-pays, no deductibles, no co-insurance charges. Free.

But beware. Our health care system is a mess and the law does not explicitly prohibit charging you if you go to an out-of-network provider. It also doesn’t address other “surprise billing” problems.

The law requires insurers to cover testing and doctor’s office, urgent care, telehealth or emergency room visits as long as the services “relate to the furnishing or administration” of a COVID-19 test or “to the evaluation of such individual for purposes of determining the need” of a test. That means that if your visit does not result in a COVID-19 test, if you get tested somewhere that is not in your insurance plan’s network, or if you’re treated in anyway besides just getting a test, you could end up with a bill.

“When your health plan has to cover [testing], that just means the health plan has to cover what it would say is a reasonable charge,” explains Karen Pollitz, a senior fellow at the nonpartisan Kaiser Family Foundation. “The difference between what your health plan thinks is reasonable and what the provider bills you, that’s on you.”

The law also only covers testing starting the day it was enacted, March 18. So if you got tested before then, this will not apply to those services.

What if I don’t have insurance?

You should theoretically still be able to get tested for free. The March 18 law offers two solutions. The first is that it gives $1 billion to the National Disaster Medical System to reimburse medical providers for testing and diagnosing uninsured patients. That means that medical providers would be able to submit your bill directly to the federal government and get reimbursed without you having to be involved.

The other solution is that the law boosts funding for Medicaid and allows states to choose to cover uninsured residents’ testing for free through that program — meaning you would be temporarily enrolled in your state’s Medicaid program for the purposes of being tested.

People like Starkes should be able to take advantage of these provisions to get a free COVID-19 test, but there’s still the chance that she could end up with charges the government considers not directly related to the test.

Can I sign up for health insurance now?

Before Congress passed the new law, a number of states started acting to cover COVID-19 testing and other services. Many of these measures apply only to people with health insurance, but Maryland, Massachusetts, Nevada, New York, Rhode Island and Washington have all created “special enrollment periods” that allow people to sign up for insurance mid-year. The Commonwealth Fund, a health care think tank, has a tracker listing each state’s actions to help its residents with the COVID-19 outbreak.

For some portion of the more than 27 million Americans like Starkes, who are uninsured — and the many others who are underinsured — that’s not much of a boon. Starkes says she couldn’t afford to buy health insurance prior to the coronavirus pandemic. Now that the economy is grinding to a halt, she’s in no better position to pony up a large premium every month.

The work for her web design business can largely be done remotely, but as many businesses close amid the pandemic, it may get more difficult to find people to hire her. Starkes’ mother has also stopped earning money from her part-time job with New York City’s Teaching Fellows program since the city shut down its schools due to the virus, and won’t make more unless they figure out a remote learning setup.

“There’s an awful lot of ex-middle class people like me, who have slipped under the radar, who make way too much money to qualify for government assistance, and yet absolutely cannot pay the ‘affordable’ insurance costs every month,” says Starkes. “That sucks. But that’s America. That’s who we are.”

New story in Health from Time: This Italian Photographer Is Documenting Her Life in the Coronavirus Lockdown

Photographer Lucia Buricelli lives alone in a studio apartment in Milan. On March 9, Italy became the first democratic country since the Second World War to impose a nationwide lockdown, extending measures that had already been in place in northern Italy since a day earlier. Buricelli — like most of her 62 million fellow Italians — has stayed home to stop the spread of the new coronavirus. Italy is the epicenter of the outbreak in Europe with more than 41,000 confirmed cases and over 3,400 deaths so far. On Thursday, its death toll overtook China’s.

Italy’s nationwide quarantine has since become a precedent for other countries, including Spain and France. Italy’s ban, which has only left grocery stores, banks, and pharmacies open, is expected to remain in place until April 3, although it may be extended.

Buricelli, a Venice native, has hardly left her home for over a week. (The lockdown allows exceptions for necessities — more food, medicine, or work — if the person has a certified note.)

Lucia Buricelli for TIMELeft: 11.50 am bathroom details. Right: 12.36 pm detail of a dress on the bedroom window.

Lucia Buricelli for TIME1:26 P.M. Putting clean clothes in order

Lucia Buricelli for TIMELeft: 3:50 P.M. View from the balcony; Right: 3:40 P.M. Taking care of a plant

“It’s not fun for me, but if you have to do it, you do it,” Buricell says, admitting she is bored all by herself. The 25-year-old goes out once a week to buy groceries. Prior to the lockdown, she went to work every day, went out in the evenings and enjoyed making pictures outside. But she reasons that if the doctors can do what they’re doing, the least she can do is stay home and try to help contain the virus.

“In the beginning, everybody took it a bit lightly,” she says. “That’s why we have so many cases.”

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Lucia Buricelli for TIME3:29 P.M. Brushing my teeth

Lucia Buricelli for TIMELeft: 10:23 A.M. View from the window on my floor; Right: 3:08 P.M. Fridge detail

Lucia Buricelli for TIME11:04 A.M. Trying to use iron my clothes

Milan is the capital of Lombardy, the region in Northern Italy that has been at the heart of Italy’s coronavirus outbreak, with almost 2,000 deaths already. Public spaces are bare and residents have been forced to develop new ways of life. Buricelli’s friends are anxious — some have already left the area to be with family, while others simply stay at home in Milan. “I have a friend that lives 10 minutes from me, and she’s not been out for three weeks,” she says. Every day, she has been calling friends to keep in touch, even though she used to dislike talking on the phone.

Buricelli feels healthy, with no symptoms or known contact with a patient. However, since a case was confirmed in her building on Monday, she has grown more wary. She regularly checks on her parents, who are in their sixties and live in Venice. “Today we talked two times,” she said on Tuesday. “I call them because of course I get worried. Coronavirus hits older people [harder].”

She particularly misses her father. “He keeps sending me humorous material about the virus. We all know the situation, you know? He’s just trying to be optimistic about it.” She plans to return to Venice once the travel ban is lifted.

Lucia Buricelli for TIME5:27 P.M. Playing the ukulele

Lucia Buricelli for TIME2:20 P.M. Eating pasta

Lucia Buricelli for TIME5:44 P.M. Listening to music

The photographer is trying to stay positive. Since the lockdown, Buricelli has been working with TIME to document her new daily routines, views from her window, as well as herself, turning to photography for creative inspiration during a difficult time. She plans to continue this series until April 3. And if the ban lasts longer? “I don’t want to consider the possibility.”

Please send any tips, leads, and stories to virus@time.com.

Lucia Buricelli for TIME9:49 A.M. Preparing the dishwasher

Lucia Buricelli for TIME3:40 P.M. Watering the plant

Lucia Buricelli for TIMELeft: 2:50 P.M. A bag of trash; Right: 12:15 P.M. Fruit on the window

Lucia Buricelli for TIME5:20 P.M. Reading some poetry

Lucia Buricelli for TIME2:50 P.M. Bringing the trash downstairs

Lucia Buricelli for TIME4:43 P.M. Reading in bed

Lucia Buricelli for TIME5:56 P.M. Working on the computer

New story in Health from Time: Millennials Aren’t Taking Coronavirus Seriously, a Top WHO Official Warns

One of the World Health Organization’s top officials in charge of fighting the coronavirus pandemic has a stark warning for millennials and other young people about the threat of COVID-19 amid reports that some are shrugging off pleas from health officials to stay home.

“This is one of the most serious diseases you will face in your lifetime, and recognize that and respect it,” Dr. Bruce Aylward, senior adviser to the Director-General of the World Health Organization (WHO), told TIME via telephone on Thursday from his office in Geneva.

While the risks of severe complications or death are much higher for older people and those with underlying health conditions, Aylward says COVID-19 is more dangerous for young people than many realize.

“One of the things that terrifies me now is, as this is spread in the west is, there’s this sense of invulnerability among millennials,” he says.

(The age range of the millennial generation varies, with some sources defining it as 1981 to 1996, though the U.S. Census has said it includes those born between 1982 and 2000.)

“We don’t understand why some young healthy people progress to severe disease and even die, and others don’t,” he says. “Never, never underestimate a new disease, there’s just too much unknown.”

Aylward’s warning comes on the heels of the release of a preliminary analysis on Wednesday by the Centers for Disease Control and Prevention (CDC) that suggests 38% of coronavirus patients in the U.S. who were sick enough to be hospitalized were under the age of 55.

“Ten percent of the people who are in ICUs in Italy are in their 20s, 30s or 40s, these are young, healthy people with no co-morbidities, no other diseases,” he says.

The doctor, who lead a joint WHO-China mission into China in February to study the effectiveness of the coronavirus response in the country, says frontline doctors there couldn’t pinpoint what factors were leading the virus to kill some young people. “They said, ‘We simply don’t know.'”

Earlier this week, French health ministry official Jérome Salomon said half of the 300 to 400 coronavirus patients treated in ICUs in Paris were younger than 65. And half of the ICU patients in the Netherlands were younger than 50, according to a study of hospital admissions presented at a conference of intensive care specialists

“There are concerning reports coming out of France and Italy about some young people getting seriously ill, and very seriously ill in the ICUs,” Dr. Deborah Birx, the response coordinator of the U.S. coronavirus task force, warned at a White House news conference on Wednesday.

President Donald Trump reinforced her warning during the press conference. “We don’t want them gathering, and I see they do gather, including on beaches and in restaurants, young people. They don’t realize, and they’re feeling invincible,” he said.

The president’s comments came as some have ignored health officials calls for people to avoid crowds and stay at home. Some young people are capitalizing on cheap airline tickets to travel, despite a CDC warning that “crowded travel settings, like airports, may increase chances of getting COVID-19. Police vehicles had to be deployed to clear partiers from New Orleans’ famed Bourbon Street. And Florida beaches were packed with spring breakers this week.

“If I get corona, I get corona,” one spring breaker in Miami told Reuters. “At the end of the day, I’m not going to let it stop me from partying…We’ve been waiting for Miami spring break for a while.”

Jason Lee—The Sun News/APDespite warnings from government officials take caution and self distance because of coronavirus, many college students, some from Coastal Carolina University, hang out on the beach at 65th Avenue North in Myrtle Beach, S.C. on March 19, 2020.

But Alyward cautions that even if the virus causes only mild symptoms in a majority of people who become infected, the long-term health implications may be serious. According to one recent study by the Hong Kong’s Hospital Authority on released patients, some of those who recover from the virus are left with 20 to 30% reduced lung function and suffer from shortness of breath from just walking quickly.

He also urges young people to consider the role they play in stopping the virus, which spreads by close contact and through respiratory droplets produced when an infected person coughs or sneezes.

“You are not an island in this, you are part of a broader community, you are part of transmission chains, if you get infected you are making this much more complicated and you are putting people in danger, not just yourself,” he says.

And while there remain many unknowns about COVID-19, Aylward says that there is one thing that’s for certain: “What we do know is it will kill young people, it will make young people sick in large numbers. You’ve gotta respect this.”

New story in Health from Time: Hong Kong Records Its Biggest Rise in Coronavirus Cases as New Wave of Infections Crashes Into Asia

Hong Kong recorded what is by far its biggest daily jump in coronavirus cases on Friday—the latest in a new phase of infected travelers, many of whom are returning to the city from Europe, the United States and Southeast Asia.

The city is not alone in facing the increasing threat of imported cases. Taiwan, which also saw a daily record increase in the number of new cases, reported 27 additional infections on Friday—most of which are travel-related. In Singapore, 24 out of 32 newly infected patients had a history of travel to Southeast Asia, Europe and North America.

All three places managed to fend off the first wave of the coronavirus outbreak, when it was spreading across mainland China—despite having close economic ties and a large number of travelers from the mainland.

The new wave is crashing across the region as the number of officially reported new cases in the mainland has dropped to just a handful. On Thursday, Chinese officials reported zero new domestic coronavirus infections.

Read more: What We Can Learn From Singapore, Taiwan and Hong Kong About Handling Coronavirus

In Hong Kong, 36 of the 48 COVID-19 cases reported Friday had overseas travel records, Dr. Chuang Shuk-kwan, head of the communicable disease branch of Hong Kong’s Centre for Health Protection, said during an afternoon press conference. The cases involve travel to over a dozen countries, including Singapore, the Philippines, Austria, Portugal, United Kingdom, Canada and the United States. The newly confirmed cases brings the total in Hong Kong to 256.

Among the infected is a four-year-old girl whose father is believed to have contracted the virus during a trip to London. A taxi driver who did not travel abroad recently, but takes one or two trips to and from the airport daily, has also been diagnosed with the coronavirus.

Experts are concerned that the wave of sick travelers returning to Asia could mean a surge in local infections and the risk of a community outbreak.

Read more: A Silent Epidemic? Experts Fear the Coronavirus Is Spreading Undetected in Southeast Asia

“We’re moving into a new phase,” Ben Cowling, a professor of infectious disease epidemiology at the University of Hong Kong, tells TIME.

“In one or two weeks time, we could see outbreaks where we don’t really know where people got [the virus]. Maybe someone who came in with the infection wasn’t identified, spreads it to a family member, who spreads it to the community. That’s going to happen in Hong Kong, and in other parts of Asia,” Cowling adds.

In Hong Kong, over 90% of the new cases in the past two weeks had links to overseas travel, according to the South China Morning Post.

Globally, almost 245,000 cases of the novel coronavirus have been confirmed, according to John Hopkins University’s virus tracker. Earlier this week, the total number of infections outside mainland China surpassed the number in the country. On Thursday, the death toll in Italy, which has more than 41,000 cases, exceeded the number of fatalities in China. Worldwide, the virus has killed more than 10,000 people.