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.”

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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.

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

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.”

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.”

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

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.

New story in Health from Time: Mexico’s President Is Resisting Coronavirus Restrictions as the Rest of the World Shuts Down

(MEXICO CITY) — Many countries in Latin America have taken aggressive measures to deal with the coronavirus such as closing their borders, dock and airports to foreigners, declaring states of emergencies and ordering business shutdowns.

Mexico, by contrast, has so far taken a “business as usual” attitude. People still crowd street markets picking through piles of fruit and vegetables. Cars and trucks continue to fill the streets and commuters throng subway trains, though the volume of traffic is noticeably lower.

President Andrés Manuel López Obrador and his government have said a shutdown of the country would disproportionately hurt poor people and also be a psychological weight on all Mexicans. They say there is no reason to impose major restrictions before health officials deem them necessary — a moment they are expecting in late March, based on the virus’ pattern elsewhere and the Feb. 27 date of Mexico’s first confirmed case.

The approach is worrying many experts.

But it is the president’s personal attitude that has Mexicans puzzled. He continues to attend mass public rallies, shaking hands and kissing babies. Asked how he was protecting Mexico, López Obrador removed two religious amulets from his wallet and proudly showed them off.

“The protective shield is the ‘Get thee behind me, Satan,’” López Obrador said, reading off the inscription on the amulet, “Stop, enemy, for the Heart of Jesus is with me.”

López Obrador, often described as a leftist, is in fact a nationalist with deep religious feelings.

“I think President López Obrador is trying to project confidence and minimize the risk,” said Jesus Silva-Herzog, a political commentator and professor at the Tecnológico de Monterrey University.

But, Silva-Herzog added, “I think that what he has wound up doing is minimizing the risks associated with the emergency, and sending messages that contradict what is being said almost everywhere else.”

Mexico reported its first death from the virus Wednesday — a 41-year-old man said to have been obese and suffering from diabetes. As of late Thursday, the country has 164 confirmed cases of coronavirus, up from just over 40 a week ago.

Still, Hugo López-Gatell, deputy secretary in the Health Ministry and the administration’s public face of López Obrador’s coronavirus response team, said the country remains in what it calls phase 1 of the epidemic, with all cases related to importation from other countries and no community transmission.

Federal officials have suspended classes for about a month beginning after Friday’s school sessions and are encouraging things like social distancing, working from home and following hygienic measures recommended by international and domestic health experts.

Some large events have been called off, yet others such as a multi-day music festival attended by tens of thousands in Mexico City were allowed to proceed. Federal officials recommend that “non-essential” gatherings should not be larger than 5,000 people, while local authorities in the capital have said events topping 1,000 people should be canceled.

Mexico has only 5,000 emergency beds, and about 1,500 intensive care or sealed rooms, for a population of over 125 million, but officials still exude a sense of calm at their daily briefings on the virus. And some observers say they are chilled by remarks like López Obrador’s.

“I think this has shown a lack of respect by the president,” said Carlos Padilla, a Mexico City business administrator. “I think he should be doing a better job of protecting the public, in every sense.”

Once community transmission begins — and Mexican officials make no secret that they know it is coming, sooner rather than later — the country is likely to see more aggressive measures.

“We are prepared. We have enough budget. All the resources we need,” López Obrador said Thursday.

Some, however, are beginning to be nervous about the lack of response now, including among the president’s political opposition. The conservative National Action Party sent a letter to the Pan American Health Organization on Thursday expressing its “deep concern about the government’s actions in the face of the COVID-19 pandemic.”

Former diplomat Enrique Berruga Filloy said in a column for the newspaper El Universal on Thursday that Mexico’s geographic advantages gave it more leeway to plan for the virus and take timely actions, but that the administration has squandered the chance.

“The tsunami is coming and we, instead of seeking safety, are playing on the beach,” Berruga Filloy wrote.

Like in other countries, Mexico’s stock market has been hit hard by coronavirus concerns. The peso has slid precipitously, trading over 24 to the dollar at times this week for the first time in history.

Alfredo Coutiño of Moody’s Analytics said Mexico’s markets “are now realizing that the country is facing a higher risk of contamination by the coronavirus” with the Mexican economy already weak.

Despite assurances from officials, Mexico and its health system are showing “real vulnerability,” Coutiño said.

He said investors particularly don’t like the lack of government measures to protect the economy and the people. “Fiscal and monetary policies are running far behind the curve,” he said.

National Action senators proposed a package of measures this week that would include measures such as lowering interest rates, stimulating home construction and infrastructure, reactivating private investment in the energy sector and transferring money to the Health Department. But López Obrador is known for a visceral dislike of spending and deficits.

López-Gatell displayed the administration’s attitude Thursday when he said everything is going according to plan.

“All of the scenarios that we foresaw for what was going to happen, are happening,” he said. “This will allow us to keep to a well-planned, well-calculated technical plan of action.”

López Obrador, who enjoys approval ratings that would be the envy of many a world leader, said Thursday that military medical workers and installations would be part of the pandemic response. But he ruled out any curfew or troop deployments, saying he wanted nothing to do with tough measures that could be seen as authoritarian.

New story in Health from Time: California Announces Statewide ‘Stay at Home’ Order to Stop Coronavirus. Here’s What That Means

California’s governor has issued a statewide stay at home order in an attempt to stop the spread of COVID-19 in the state after warning that 56% of the population is at risk of getting the coronavirus.

Gov. Gavin Newsom called on all Californians to stay at home, except for essential reasons like buying groceries or seeking medical care.

“We need to bend the curve in the state of California, and in order to do that, we need to recognize the reality, the fact is, the experience we’re having on the ground throughout the state of California… require us to adjust our thinking and to adjust our activities,” Newsom said.

There are 675 confirmed cases of COVID-19 in California and there have been 24 deaths—not counting the Americans who touched down in California on U.S. repatriation flights from abroad. In a letter sent on Wednesday, Newsom warned President Donald Trump that 56% of the population—more than 25 million people—could be infected over the next eight weeks.

Governor Gavin Newsom makes a major announcement on California’s response to the COVID-19 outbreak. https://t.co/VlQM38OkYK

— Office of the Governor of California (@CAgovernor) March 20, 2020

The latest measures follow a “safer at home” order by the city of Los Angeles on Thursday and a ‘“shelter in place” order for the San Francisco Bay area on Tuesday.

Here’s what to know about California’s new stay at home order.

When does the ‘stay at home’ order go into effect?

The new measures go into effect on Thursday evening.

Where does this apply?

Residents across the entire state are being asked to stay at home, except for essential purposes.

Some who work in essential state and local government jobs will continue working, including police officers.

How long will it last?

The measures are in force until further notice.

Newsom said at a news conference on Thursday night that the next eight weeks are critical, but didn’t give a timeline for when it would end.

“We could not give you a deadline that we could really believe in,” Newsom said in a press conference. “This is a dynamic situation.”

What’s still open?

Essential services such as gas stations, pharmacies, food stores, banks and laundromats will remain open.

Bars, gyms and other entertainment venues will be closed. Restaurants are closed to dine-in customers.

What can I do?

State officials are asking people to stay home except to get food, care for a relative or friend, get necessary medical care or to go to an essential job.

“I can assure you home isolation is not my preferred choice, I know it’s not yours, but it’s a necessary one,” Newsom said.

Authorities are urging residents to avoid large gatherings, and to stay at least six feet away from other people if they need to leave their homes.

How will California enforce the order?

Newsom said in his press conference that he doesn’t believe that law enforcement actions are required to convince Californians to follow the order.

“People will self-regulate their behavior, they’ll begin to adjust and adapt,” he said. “We will have social pressure that will encourage people to do the right thing.”

New story in Health from Time: The Best Way to Love Your Neighbor Right Now Is to Stay Home

In the aftermath of murdering his brother Abel, Cain is posed a simple question by God. “Where is your brother Abel?” God asks. Cain–we imagine him here as a sullen teenager, which perhaps he was–responds with a question of his own. “I do not know,” he says. “Am I my brother’s keeper?” It’s an insubordinate question, a trick of a young man trying to shirk responsibility and hide a dark secret.

I live in San Francisco, where we were recently ordered to “shelter in place” for at least the next three weeks. “Sheltering in place” means not leaving the house except for essential errands, like picking up groceries or medication or getting medical attention. My family and I recently moved into a new neighborhood, and I’ve been eager to meet our neighbors, but the sheltering order has put a stop to our plans to knock on their doors with cookies and greetings.

Similar orders are likely to be enacted across the country as the coronavirus continues to infect and kill patients and overwhelm our healthcare system. Since the virus can be transmitted by people who feel entirely well, staying home may be the best defense we have against spreading it. Staying home is an act of care for our neighbors. To stay home these days is to say “yes” to the question, “Am I my brother’s keeper?”

Many of us have seen people posting on social media that they’re frustrated about having to stay at home. We’ve seen photos of restaurants in which people are clearly not six feet apart, videos of spring breakers refusing to let a pandemic ruin their party. When I see these images, I think of my 88-year-old grandmother who lives in Los Angeles. Under normal circumstances, she and her best friend–who is 93 and lives, independently, in the same condominium complex–go out to eat a couple of times a week, usually to Olive Garden or In-N-Out or, for a nice occasion, The Cheesecake Factory. They attend church together. My grandmother goes to the library regularly, plays cards with friends, gets her hair done every few weeks by the same woman who has been doing it for decades.

This past week, my grandmother and her best friend both stayed home from church. They ate all their meals at home. My grandmother drove by the library to return the five novels she read last week. They were closed, which, I told her, was for the best. “You never know who touched those books last,” I said. She agreed, although I knew she was sad that she couldn’t get anything new to read. She lives alone and already spends a lot of her time feeling lonely.

My grandmother is one of the millions of people who are especially susceptible to the coronavirus, and more likely to die from it if they contract it. You probably know someone in that group as well–someone with a compromised immune system, or an underlying condition, or someone over 65. When you’re a healthy 34-year-old, as I am, the threat of the coronavirus can seem distant, just like the threat of death (though recent research suggests young people may be at higher risk than previously understood). And when you live in a culture that values individualism and productivity, as ours does, it can be disorienting to be told that you can no longer get things done the way you used to. But if I want to love my neighbors, it is my responsibility to do whatever I can–even the things that inconvenience me–to prolong the lives of others.

After Cain asks God about being his brother’s keeper, God responds with thunder. “Listen; your brother’s blood is crying out to me from the ground!” Thousands of people have already died from this virus; scientists predict that millions more may still die. If I were to do anything to add to that number, the blood of those who died would cry out from the ground. By sacrificing our own routines and maybe even briefly our senses of identity, we keep our brothers and sisters safe.

New story in Health from Time: Actor Daniel Dae Kim Shares His Coronavirus Diagnosis and Calls for an End to ‘Cowardly’ Anti-Asian Racism

American actor Daniel Dae Kim announced on Thursday that he has tested positive for COVID-19, the disease caused by the novel coronavirus.

Kim — who is known for his roles on Hawaii Five-0 and Lost — shared the news in a 10-minute video posted to his Instagram. He had been filming the series New Amsterdam in New York City for the past several weeks before the show halted production because of the threat of the virus. In a darkly ironic twist, he was playing a doctor working to respond to a flu pandemic.

Kim, 51, said he began feeling ill while returning home on a flight to Hawaii, and later began to experience chest tightness, body aches and a fever. He said he self-isolated since returning, leaving only to go to a drive-through coronavirus testing facility in Honolulu.

The actor explained that while he was diagnosed with COVID-19 and has experienced symptoms, he has not needed to go to the hospital and has started to feel better. His family has all tested negative for the virus.

View this post on Instagram

Hi everyone- yesterday I was diagnosed with COVID-19, the disease caused by the coronavirus. Looks like I’ll be ok, but I wanted share my journey with you in the hopes that you find it informative or helpful. Hope you all stay safe, calm, and above all, healthy.

A post shared by Daniel Dae Kim (@danieldaekim) on Mar 19, 2020 at 10:34am PDT

In the video, Kim also spoke out against the xenophobia and anti-Asian racism that’s risen since the coronavirus crisis began.

“Please, please stop the prejudice and senseless violence against Asian people,” he said. “Randomly beating elderly, sometimes homeless Asian Americans is cowardly, heartbreaking and it’s inexcusable.” Racist attacks against Asian people have been reported in Los Angeles, New York and other cities around the world.

Kim, who was born in South Korea but raised in the U.S., also subtly addressed President Donald Trump‘s decision to refer to COVID-19 as “the Chinese virus,” which many have decried as racist. An image of the President’s prepared remarks on Thursday show the word “corona” crossed out and replaced with “Chinese.”

Jabin Botsford—The Washington Post/Getty ImagesA close-up of President Trump’s notes shows where the word “Corona” was crossed out and replaced with “Chinese” during a briefing at the White House on March 19, 2020.

“Yes, I’m Asian. And yes, I have coronavirus. But I did not get it from China, I got it in America. In New York City,” Kim said in the Instagram video. “Despite what certain political leaders want to call it, I don’t consider the place where it’s from as important as the people who are sick and dying.”

“If I did, I would call this thing the ‘New York virus,’ but that would be silly, right?” he continued.

Stars including Tom Hanks and Idris Elba have also announced they contracted the virus. As of Thursday evening ET, there are at least 242,191 confirmed cases and at least 9,843 deaths from the virus around the world, according to a tracker from Johns Hopkins University.

“I’m grateful to be alive and healthy,” Kim said, thanking his friends, family and fans for their support. “It gives me hope that through our collective efforts we can beat this thing and flatten the curve.”