New story in Health from Time: Why It’s So Hard to Get Coronavirus Testing in the U.S. Right Now

When employees of Massachusetts biotech company Biogen were informed in late February that several among them had been diagnosed with the infection after a company-wide meeting, they immediately went to hospitals for testing, but were turned away. Because of the scarce number of tests available in the U.S., doctors, upon the advice of the Centers for Disease Control (CDC), were following strict protocols for who could be tested: people who had symptoms and had traveled to a country where cases were endemic, or had been in close contact with someone who had tested positive. Most of the Biogen employees didn’t have any of the symptoms of fever, cough or difficult breathing that are the hallmarks of COVID-19, but understandably wanted to know if they had been exposed.

Two weeks after the meeting, 77 of Massachusetts’ 95 confirmed cases are Biogen employees.

The criteria for who can be tested have since been relaxed, and doctors can now order the test for any patient, using their best judgement on whether it’s necessary. Still, testing in the US lags far behind that in other countries, due to a combination of technical and policy issues, as well as political pressure.

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When the first cases of COVID-19 were reported in the US, two labs at the CDC were the only ones permitted to conduct COVID-19 testing, using a test developed by the agency’s own researchers. When the CDC tried to expand testing by providing its test kits to state and local public health labs, there were problems with the initial version of the kits, which the CDC then reworked.

That delay, along with the growing number of undetected cases in the U.S., prompted the Food and Drug Administration (FDA) on Feb. 29 to expand its approval criteria to allow any qualified lab to develop its own test. Two of the largest diagnostic commercial labs, Quest Diagnostics and LabCorp, have begun testing this week but are still conducting only a few thousand a day as they scale up capacity.

“My people have been working all weekend, 24-7,” says Dr. Jon Cohen, CEO of BioReference Laboratories, which plans to roll out its test this week. “Within a week, if not sooner, we should be able to do 1,000 to 2,000 tests a day, and from there, scale up higher.” A spokesperson for North Carolina-based LabCorp says the company has been conducting several thousand tests a day since March 5, and plans to add staff and equipment to increase that number. Quest Diagnostics, based in New Jersey, says the company released its COVID-19 test on March 9, and plans to perform tens of thousands of tests a week within six weeks.

Taken together, that’s still a tiny fraction of the number that should be conducted in a country of 327 million people, say experts. As of March 11, CDC, state and public health labs have conducted more than 11,000 tests since mid-January. By comparison, South Korea has tested more than 200,000 of its population of 51 million since January.

In the US, rollout of widespread testing is plagued by not only logistical issues but political over-promising and supply constraints. When the FDA expanded its approval criteria at the end of February, agency commissioner Dr. Stephen Hahn predicted that the policy would lead to enough test kits for more than a million people within a week; when that goal wasn’t met, White House Coronavirus Task Force point person Mike Pence was forced to extend the target date by a week as companies scrambled to familiarize themselves with the test and order the chemicals and reagents they needed.

Even when tests are available, there’s the question of how and where people will take them. Because COVID-19 is proving highly contagious, doctors and hospitals are reluctant to encourage people with symptoms to come into offices to provide samples. Public health officials and lab companies are exploring new ways of running these tests, including at drive-through facilities, or separate tents that some hospitals are setting up outside of their emergency rooms, to minimize contact that potentially positive people would have with other patients.

There are also still technical hurdles for some of the labs that are trying to run the CDC test. Smaller labs, including those at major hospitals, are struggling to meet some of the FDA’s approval requirements. For example, the technicians need to show that they have the technical and chemical expertise to perform the test properly to get a valid result both on a large number of samples as well as a range of samples types, including the most difficult type to work with, sputum (the material from the lungs that is released when you cough). But, “the numbers of samples we need to validate is close to impossible for a single lab to have,” says Michael Mina, director of viral diagnostics at Brigham and Women’s Hospital.

Cohen notes that another challenge for some labs involves extracting the virus from the sample. The COVID-19 test actually picks up fragments of genetic material of SARS-CoV-2, the virus that causes the illness, in the form of RNA, so pulling the virus out of the sample is critical. “The kit that the CDC sends, for example, includes [testing chemicals] but what it doesn’t include is the extraction needed to pull out the viral RNA,” he says. “That’s a big lift for some labs to do.” Instead, they turn to other providers like Qiagen. But there is already a backlog, says Dr. Thomas Theuringer, spokesperson for the company. “This demand is challenging our capacity to supply certain RNA extraction kits used for SARS-CoV-2 related lab-based tests.” In response, the company has ramped up production at its manufacturing sites in Germany, Spain and the US to meet the surge in demand, but in the meanwhile, labs are looking for ways to avoid these supply chokepoints by coming up with other ways to handle the RNA extraction.

For Americans on the ground, this is all moving far too slowly.

Liz Satterfield was diagnosed with metastatic breast cancer in 2016. Despite the difficult prognosis for her disease, “I was beating the odds,” she says. “Then something like COVID-19 comes along.” Satterfield is currently on two different chemotherapy treatments, which can wipe out her immune system and make her susceptible to practically any infection circulating around her—including COVID-19.

To make matters worse, Satterfield and her partner live in Kirkland, Washington, which has among the largest clusters of COVID-19 infections in the country, and has recorded the highest death rate in the US from the disease. The couple and their two-year-old daughter live a mile from the long term care facility where nearly two dozen people have died of the disease.

“Not only am I a cancer patient, but I live in the epicenter of this outbreak,” she says. “Absolutely I want to get tested and I want my whole family tested. My wife is young and female, so she is in the category that she could likely be positive and display no symptoms. We’re also not seeing an explosion of cases among children, so my [two year old] daughter could also be in that category. They could be silent carriers.”

But when she saw her oncologist last week, Satterfield didn’t even bother asking for testing, because she knew that since she wasn’t showing symptoms, doctors wouldn’t likely prescribe a test. There just simply aren’t enough tests to go around, and that’s terrifying to Satterfield and millions of other Americans.

“The lack of testing availability up to now scares the crap out of me,” she says.

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New story in Health from Time: Donald Trump’s Travel Ban Piles More Economic Pain on Europe

With a global pandemic comes global pain. That became clear on Wednesday night after President Donald Trump abruptly imposed stringent 30-day travel restrictions between the U.S. and much of Europe—ones that could threaten the West’s core ties, cut deeply into trade, and ravage the travel and tourism industries.

Labeling COVID-19 a “foreign virus,” Trump said in an Oval Office address that non-U.S. citizens who had been in the 26 European countries that make up the Schengen border-free zone in the past two weeks would not be allowed to enter the U.S. after midnight Friday. Europe has seen a total of about 22,100 cases of the virus, over half of them in Italy alone, where the death toll has surpassed 1,000.

Blindsided by Trump’s announcement, the European Union’s two top leaders, Commission President Ursula von der Leyen and Council President Charles Michel, said the U.S. President’s travel ban was “taken unilaterally and without consultation,” and complicated solutions needed to contain the virus. “The coronavirus is a global crisis, not limited to any continent,” they said in a statement. “It requires cooperation rather than unilateral action.”

Hours after Trump’s announcement, the stampede of Americans out of Europe was well underway. They included hundreds of young students attending Spring semester programs on the continent, and who spent Thursday scrambling to book plane tickets home, and packing up their temporary rental apartments. “This is scaring a lot of people,” says Kiana Taghavi, 21, a Columbia University political science student. She is booked to fly home from Paris to her parents in Seattle on Friday morning, after university authorities advised students to leave Europe as quickly as possible.

Taghavi says her friends were flying home on Thursday and Friday, from Budapest, Madrid, Copenhagen, and elsewhere. Having dreamed of studying in Paris since she was 12 years old, she was bitterly disappointed at the decision. “This is not what I envisioned, but it is totally out of my control,” she says.

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Along with those Americans go a lot of dollars that would otherwise have been spent in Europe. In 2018, tourism represented over 10% of the EU’s total GDP. Much of that comes from across the Atlantic; just under 12 million Americans flew to Europe as tourists in 2018.

Every year, an estimated 2 million Americans visit Paris—the world’s second most-visited city after Bangkok. Officials in Paris are already concerned about the impact on visitor numbers. “The summer will be tough,” Corinne Menegaux, head of the Paris Tourism Office, told TIME on Thursday. She said long-haul flight reservations to the French capital—one of the most touristed cities in the world—are down 21% for the high season between April and June, and that she was bracing for many small, independent hotels to close. “They do not have the cash to wait a few months.”

Trump’s travel ban comes after a sharp drop in tourists from China, which in recent years has hugely boosted its tourism to Europe. Arrivals in Paris from northern Asia plummeted 34.6% last month alone, according to the city. And while Chinese tourists comprise only about 3% of Paris’s foreign visitors, they have developed a reputation for spending money at high-end stores like Hermes and Louis Vuitton—a valuable boost to the luxury industry.

In other E.U. countries heavily dependent on tourism, travel agents were counting the cost of Trump’s decision. Antonis Kollidas, owner of Elysium Travel in Athens, Greece, awoke on Thursday morning to a text message from a group of 14 Chicago tourists, canceling their nine-day tour of the country, which was due to start on March 20.

“This time last year we had 40 reservations,” Kollidas says. “Now we have three reservations, and they all might cancel.” He said he and his two brothers, with whom he launched the company four years ago, were likely to shut the business until later this year, rather than pay to keep it open through months with no tourists.

Trump’s decision threatens to exacerbate an already dire economic situation that has unfolded rapidly since the coronavirus hit in January. The European Central Bank President Christine Lagarde told reporters on Thursday afternoon that the virus’s lightning spread across the E.U.’s 27 member countries in just two weeks was a “major shock” to the economy.

Lagarde—who led the International Monetary Fund until last year—appealed to the E.U.’s leaders to take swift action to contain the virus, and to support businesses, employees and regular citizens. If they did, she said, the crisis would be “severe but temporary,” but once the virus dissipates, “the economy will bounce back.”

But just how long that might take is now of a matter of dire urgency in Europe. Financial analysts bracing for a recession say the crisis does not resemble previous ones, including Europe’s deep economic downturn last decade, when debt-ridden countries like Greece and Portugal needed giant bailouts from the E.U. and the IMF.

“Recessions are usually caused by oil price shocks, or people being very pessimistic,” says Eric Lonergan, a hedge-fund manager at M&G Investments in London. “Here you have a very real cause now.”

With the virus as the culprit, there was no one country or government to blame in Europe—unlike last decade, when wealthy countries like the U.K. and Germany resented spending money salvaging the economies of those who blew their budgets. “There is a real chance to recover unity that was lost during the Eurocrisis,” Lonergan says. “They need to show complete unity, and financial unity.”

That could be difficult, however. Von der Leyen, who became E.U. President only in December, has proposed only patchy E.U.-wide responses to the coronavirus, and has resisted closing borders—a long-held demand from hardline nationalists on the continent.

“Now closing borders is too late,” says Daniel Gros, director of the Center for Economic Policy Studies in Brussels, a nonpartisan E.U. policy shop. “There has been very little coordination.” E.U. leaders have appealed to countries to pool their resources as needed, but few seem willing to agree to that, while infection rates are rising. “No one is going to want to share,” Gros says.

For many regular Europeans, just making it through the next few months will be difficult. “This summer will be a difficult period for all of Europe unfortunately,” says Fotis Provatas, chairman of the Chamber of Greek-Chinese Economic Cooperation in Athens.

He says that after years of deep economic crisis in Greece, business had markedly improved recently, and last month, Athens’ port of Piraeus last month began work on the Chinese-owned cruise-ship port, which is aimed at boosting Chinese tourism to the area. “We were expecting so much this year,” he says. “Maybe everything will begin normally from September.”

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

New story in Health from Time: These Italian Kids Are Going to School Online During the Coronavirus Lockdown

Until two weeks ago, Leonardo Bruti Liberati’s weekdays consisted of racing to school in Milan, and after class, to his piano lessons, Boy Scouts sessions, rock climbing and swimming. In late March, he was meant to travel to the United Nations in New York, with teenagers from across the world, to participate in the Model U.N. session for youth.

Then in late February his life was drastically upturned, along with millions of others, when Italy’s government put the north of the country on lockdown in an effort to contain the spread of the COVID-19 virus. On Sunday, Italy extended the lockdown to the entire country, shutting all schools and severely restricting the movements of some 60 million people—the biggest quarantine outside China since the coronavirus crisis erupted in January. As of Wednesday, 631 people had died of the virus in Italy.

Now, the 16-year-old is confined to his three-bedroom family apartment in Milan. Yet while his private school, Famiglia e Scuola, is shut, classes still continue under quarantine, in an ongoing experiment in remote learning.

On Wednesday, Leonardo let TIME watch how the quarantine schooling works, as students logged into Google Hangout to attend their regular morning class in Ancient Greek. For Leonardo, it was a welcome chance to see his friends, from whom he has been isolated for weeks. One hitch: The teachers have bluntly told him that his adored golden retriever, Dag II, is no longer welcome to sit on his lap during lessons.

The classes are a distraction from the more serious concerns about the outbreak. “I worry about my grandmother,” Leonardo says. “She is 101.”

But there are many other daily complications too to life under quarantine — it has taken days to find a clinic still open and capable of attending to Leonardo’s brother Frederico, 12, who broke his hand while skiing last month, during the glorious days before the virus hit Italy.

The family also needed to find an open clinic capable of extracting a ball from Dag II’s stomach — the hound swallowed one during a rare walk in the park.

New story in Health from Time: Why Public Health Experts Say Trump’s Travel Ban Won’t Curb the Spread of COVID-19 in the U.S.

President Donald Trump announced on Wednesday night that travel from Europe to the U.S. will be largely suspended for 30 days starting Friday in an effort to curb the spread of the novel coronavirus. But public health experts say the travel ban — which does not apply to American citizens or permanent legal residents and their families — is unlikely to stop the spread of the novel coronavirus that causes COVID-19 in the U.S.

“This is the most aggressive and comprehensive effort to confront a foreign virus in modern history,” Trump said in his nationwide address just hours after the World Health Organization’s (WHO) announcement that coronavirus is now a pandemic. “I will always put the wellbeing of America first.”

Under the new regulation, all 26 countries in the Schengen area are subject to the same restrictions, despite great variation in the number of cases amongst European countries. The ban also does not apply to the United Kingdom, which has more cases than many European countries, raising questions about how the U.S. government went about deciding what nations would and would not be banned.

But public health experts warn that even with the travel ban, the virus will still spread. And travel bans risk discouraging people from disclosing their previous countries of travel. The WHO says that denying entry to passengers arriving from affected countries are “usually not effective in preventing the importation of cases but may have significant economic and social impact.”

“We’ve known from the start that travel bans are not effective,” Paul Hunter, a professor in medicine at the University of East Anglia told TIME. “I don’t think there is any scientific justification for them and I don’t think it will reduce the disease burden in the U.S.”

While Francois Balloux, a professor of computational systems biology at University College London tells TIME that travel bans can be effective, that’s only when there’s no local person-to-person transmission already in place. The U.S. has at least 1, 323 cases in 38 states, which experts say make the proliferation of the virus inevitable

“The U.S. has more cases than some of the countries they are banning,” Balloux says, noting that the ban is “completely ridiculous.”

While Trump has promised to make health services and testing more readily available, there have been widespread reports of people struggling to get tested. Experts say it is likely that many cases in the U.S. have already gone undetected. “I think it’s likely, though not for certain, that the American estimates are lower than the actual disease burden,” Hunter says. He adds, “the U.S. problem is not anymore about trying to reduce virus importation. It’s about how on earth are you going to manage the spread within your population.”

Meanwhile, the ban has already taken an economic toll on the global economy. After Trump’s announcement, U.S. stocks fell by 8% this morning while European shares tumbled. Public health experts warn that an economic downturn will negatively affect the ability for countries to respond to the pandemic, noting that a strong Gross Domestic Product (GDP) is closely correlated with good health outcomes and longer life expectancy.

“I really resent this idea that there is a trade of between managing epidemics and paying economic costs,” Balloux says. “That is a misunderstanding: if you want to save lives, you have to keep the economy afloat.”

The U.S. government’s drastic measures have elicited condemnation by European politicians, who were reportedly not given forewarning of the travel ban.

In a statement, the European Commission, the governing body of the European Union said, “the coronavirus is a global crisis, not limited to any continent and it requires cooperation rather than unilateral action,” adding, “the European Union disapproves of the fact that the U.S. decision to impose a travel ban was taken unilaterally and without consultation.”

Experts say that in the case of a pandemic, which necessitates global cooperation, nationalist approaches to governing can be dangerous to disease prevention and response. “If you antagonize your key partners, you send a signal that there is no global coordination response,” Baloux says.

Rather than a travel ban, experts say the U.S. government should be focussing its energy on providing adequate testing and care for its citizens. Unlike most European countries, the U.S. does not have universal health care or paid sick leaving, increasing the likelihood that people will not get tested and go to work infected, further spreading the disease. “If you have a system where a large portion of the population cannot be tested because of the costs involved, Hunter says, “then you are never going to control this.”

New story in Health from Time: Exclusive: Here’s How Fast the Coronavirus Could Rapidly Infect Over 1 Million Americans

As the novel coronavirus saturates the news, forcing colleges and sports leagues to shut down and infiltrating Hollywood, many Americans are understandably wondering when it will arrive at their doorstep. While the number of known cases in the U.S. appears to be comparatively low as of now, the figures are almost certain to spike very soon, as both testing and exposure increase. While COVID-19 has unquestionably spread further than officially known, it is poised to round the curb and spread widely across the U.S. By the end of April, there will be no dispute that COVID-19 is not a “foreign virus.”

To better understand outbreaks like this, the Centers for Disease Control and Prevention (CDC) consults a network of academics and industry experts who specialize in modeling the spread of contagious diseases. One of those outside groups, the Laboratory for the Modeling of Biological and Socio-technical Systems at Northeastern University, provided TIME with exclusive access to 100 of the different coronavirus scenarios it has generated in its efforts to support the CDC.

For the following interactive, TIME picked five of Northeastern’s potential scenarios that most closely align with the growth of COVID-19 cases we’ve already seen in the U.S. These models vary from detection levels of about 40% of those who contract the illness (under the “High” scenario) to 25% (in the “Low” scenario). They also account for the fact that the actual number of infected individuals is and will continue to remain significantly higher than the number of confirmed cases. That’s because not all infected individuals will exhibit symptoms or be tested, even though they remain contagious.

To create this interactive, the Northeastern team provided TIME with potential day-by-day growth in COVID-19 cases across 483 U.S. locations, organized around transportation hubs and dating from the emergence of the virus through April 30. This feature, which TIME produced in-house with the consultation of the researchers to ensure accuracy, will continue to be updated as the model adapts once more is known about the virus’ behavior — for instance, whether it might be highly seasonal, like the flu.

The purpose of this visualization, and of Northeastern’s research more broadly, is not to predict what will happen, but rather forecast what could occur under a variety of conditions that remain unknown or unknowable. But the conclusion the models offer is clear: The degree to which the U.S. government and the healthcare industry can coordinate efforts to test individuals more effectively — a process that has been confusing, slow and riddled with errors — could mean the difference between tens of thousands of cases over the next six weeks, or well over a million.

“What we’re seeing now is really just the tip of the iceberg,” says Alessandro Vespignani, the director of the Northeastern lab, who worked alongside colleagues Matteo Chinazzi and Ana Pastore y Piontti on this research. “That’s the problem of not doing extensive testing. Because testing has been limited here, I would be inclined toward the worst case scenarios.” (The researchers also provided TIME with a catastrophic scenario in which virtually no one is tested, which is not visualized here because attempts to produce images of the outcome repeatedly crashed this reporter’s computer. Suffice it to say the entire map quickly becomes completely orange.)

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The model that produced these scenarios consists of two streams of information. The first is what Vespignani called “the ‘business as usual’ of the world.” This includes a vast amount of data on global populations gathered from each country’s version of the Census Bureau (as well as many other sources), with a focus on population density and mobility, from daily commuting patterns to the volume of international travel.

The second set of parameters fed into the model involve the nature of this coronavirus, which at this point is much less well understood. The challenge with a “novel” coronavirus, after all, is that it’s new. Every communicable disease behaves differently, which poses a problem for gaming out the transmission of one that wasn’t known to exist until very recently.

“For the flu, or ebola, or more regular diseases, we have quite a good understanding of the mechanism of transmission and so forth,” Vespignani said. “For [COVID-19], the problem is we didn’t know anything until two months ago. Now, every day that goes by we add a little piece to the puzzle and we can fill the model with those numbers.”

The most important factors that researchers like Vespignani need to consider include a virus’ “reproduction number” (a value that represents how contagious it is) as well as its incubation time (the period between infection and the onset of symptoms). Given that COVID-19 can produce minor or no symptoms in healthy individuals, the models in this case must also account for the detection rate.

Even if the coronavirus was better understood, the most complex simulations in the world would still produce scenarios with a wide variety of severity. Like all models, whether for election outcomes, sporting events or the path of a hurricane, there is variability that cannot be predicted or packaged into a variable — a margin of uncertainty known as “stochastic” events that exhibit random behavior.

“Let’s imagine you are sick with COVID, and you go into a coffee place. You might sneeze there or sneeze two minutes later when you get into the car and you are alone,” Vespignani said. “Unfortunately, nobody will ever be able to model for that. For this reason, all models are stochastic models.”

It is natural to wonder, then, why so much effort goes into computing models that produce such a range of outcomes. Again, the power of the discipline is not in correctly predicting what will occur, but demonstrating how the possible scenarios change based on different inputs. As the maps provided here demonstrate, the effective use of widespread testing, even of asymptomatic individuals, will be critical in mitigating the potentially catastrophic impact. Every variable is a clue, and every adjustment to its value — picture a giant machine with hundreds of levers in different positions — offers another hint as to what can contain a pandemic.

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

Covid-19 scare in Maharashtra: Government plans to rope in private labs to speed up screening, testing

Announcing plans to rope in private sector hospitals and diagnostic laboratories to speed up screening and testing for Covid-19, CM Uddhav Thackeray said the state government has asked the Union health minister to authorize some more private labs in the state to conduct Covid-19 tests as currently, it takes up to six hours for results to be received.

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New story in Health from Time: Why Wearing a Face Mask Is Encouraged in Asia, but Shunned in the U.S.

Cheryl Man is usually the only one wearing a face mask on her New York City subway train. She notices this, but other people on the train notice, too. Usually she just gets odd stares from other commuters. But on Tuesday morning, when she was walking to school, a group of teens jeered at her and coughed in her direction.

“I felt very humiliated and misunderstood,” says Man, a 20-year-old student and research assistant who is ethnically Chinese.

Man also feels the stigma at her workplace, where she keeps her mask on. None of her colleagues wear a face mask, and some of them have asked her if she is sick.

“Why do they think it’s about me? It’s a civic duty,” she says. “If I have a mask on, and if—touch wood—I’m infected, I could cut the chain off where I am. That could save a lot of people.”

That’s what health experts in Hong Kong, where Man was born and raised, say, and it’s advice she trusts. Nearly everyone on Hong Kong’s streets, trains and buses has been wearing a mask for weeks—since news emerged of mysterious viral pneumonia in Wuhan, China that was later identified and named COVID-19. The Hong Kong government and leading health experts also recommend wearing masks as a way to help prevent the spread of the coronavirus, which the WHO declared a global pandemic on Wednesday.

Read more: Coronavirus May Disproportionately Hurt the Poor—And That’s Bad for Everyone

Paul Yeung—Bloomberg/Getty ImagesOffice workers wearing masks carry take-out lunch orders while walking towards in Admiralty, Hong Kong, on Mar. 2, 2020.

While wearing a mask has become the norm in many places in Asia, the mask frenzy has hit nowhere as hard as Hong Kong. At the height of COVID-19 panic, residents lined up overnight outside drugstores to buy face masks. South Korea, Singapore and Japan have distributed face masks to residents. Taiwan and Thailand have banned the export of masks to meet soaring local demand.

Yet, in the U.S., wearing a face mask when healthy has become discouraged to the point of becoming socially unacceptable. The U.S. government, in line with World Health Organization recommendations, says only those who are sick, or their caregivers, should wear masks.

A tweet from Surgeon General Jerome Adams sums up the argument: “Seriously people- STOP BUYING MASKS! They are NOT effective in preventing general public from catching #Coronavirus, but if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk!”

Seriously people- STOP BUYING MASKS!

They are NOT effective in preventing general public from catching #Coronavirus, but if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk!
https://t.co/UxZRwxxKL9

— U.S. Surgeon General (@Surgeon_General) February 29, 2020

Two schools of thought, not enough research

As COVID-19 continues to spread globally, it has become clear there are two schools of thought in regards to face masks for the public.

On the one hand is the view shared by Dr. William Schaffner, a professor in Vanderbilt University’s Division of Infectious Diseases, who says that medical masks commonly worn by members of the public do not fit snugly around the nose, cheeks and chin.

Read more: States Need Medical Supplies to Fight Coronavirus. Can the National Stockpile Keep Up With Demand?

“And if there’s a general recommendation that people wear face masks, we won’t have enough supply for healthcare workers,” he says, adding that his colleagues have already been reporting shortages. “The priority should be face masks to use in the healthcare environment, rather than in our community.”

Spencer Platt—Getty Images A man wears a medical mask on the subway in New York City, New York on Mar. 11, 2020.

He calls the evidence supporting the effectiveness of the general public wearing masks “scanty.”

But, David Hui, a respiratory medicine expert at the Chinese University of Hong Kong who studied the 2002 to 2003 outbreak of severe acute respiratory syndrome (SARS) extensively, says it’s “common sense” that wearing a mask would protect against infectious diseases like COVID-19.

“If you are standing in front of someone who is sick, the mask will give some protection,” Hui says. “The mask provides a barrier from respiratory droplets, which is predominantly how the virus spreads.”

He also says that the role of a face mask may be especially important in the epidemic due to the nature of the virus. Patients with COVID-19 often have mild or even no symptoms, and some researchers believe it can also be transmitted when patients are asymptomatic—meaning patients can be contagious and don’t know they’re sick.

Hui adds that the lack of solid evidence supporting the effectiveness of masks against the virus is no reason to dismiss its use, because there may never be definitive scientific proof. A properly controlled study would be impossible to conduct ethically, he explains. “You can’t randomize people to not wear a mask, and some to wear a mask, and then expose them all to the virus,” he says.

Different cultural norms

But even before the coronavirus outbreak, masks were a common sight across East Asia—worn for a variety of reasons. It’s common for people who are ill and want to protect the people around them to wear masks. Others wear masks during cold and flu season to protect themselves.

In Japan, people wear masks for non-medical reasons ranging from wanting to hide a swollen lip or a red nose during allergy season, to keeping warm during the winter, says Mitsutoshi Horii, a sociology professor at Japan’s Shumei University, who works in the United Kingdom. Masks in Japan come in cloth and printed variations, and can also be worn for style. They can also be seen on the streets of Hong Kong.

The difference in perception of the mask comes down, in part, to cultural norms about covering your face, he says. “In social interactions in the West, you need to show your identity and make eye contact. Facial expression is very important.”

Read more: Coronavirus: A Glossary of Terms to Help You Understand the Unfolding Crisis

Japanese trainee teachers he hosted at the U.K. campus where he works at had a first taste of the cultural difference when they arrived. Horii says the university explicitly advised them not to wear face masks when teaching at local schools.

“If they wear masks, the kids could get scared,” he says.

The shadow of SARS 17 years ago also helps to explain the prevalence of masks, especially in Hong Kong. Perhaps nowhere in the world was hit as hard as Hong Kong, where almost 300 died of the virus—accounting for over a third of official SARS fatalities worldwide.

“It was largely the shock of SARS that shaped this local etiquette,” Ria Sinha, a senior research fellow at the University of Hong Kong’s Center for the Humanities and Medicine, tells TIME. “Although the younger generation do not remember SARS, their parents and grandparents did experience the fear and uncertainty of a novel infectious disease, and the loss of daily normality.”

Wearing a mask, she explains, has become a “symbol and a tool of protection and solidarity”—even if research proving their efficacy is lacking. “Mask wearing is not always a medical decision for many people, but bound up in sociocultural practice,” she adds.

The social pressures of wearing a mask (or not)

But Man and others in the West are finding that wearing a masks represents can also draw unwanted attention, and even make them targets. Even as COVID-19 cases in the U.S. have surged to more than 1,300 (Hong Kong currently has 129 confirmed cases, about 100 fewer than the New York area), Man says about a quarter of her friends from Hong Kong, mainland China and South Korea won’t wear masks over concerns about racism and xenophobia that has risen with the virus.

Read more: As Coronavirus Spreads, So Does Xenophobia and Anti-Asian Racism

And while most people in Hong Kong are masked up, there are outliers. Andy Chan, 29, says he thinks city-wide mask-wearing is fueling unnecessary panic.

“People look at me funny because I don’t wear a mask,” Chan says. “But I think the only thing that’s laughable is everyone buying into this excessive fear. People are being led by emotion, not science.”

Still, Charlotte Ho, a 55-year-old stay-at-home mother in Hong Kong, represents the majority view. She says she wouldn’t even leave her building to buy groceries without a mask. If she sees somebody not wearing a mask, she says she would stay away—”just in case.”

“Wearing a face mask is just common sense. It creates a barrier, so nothing can touch your nose and mouth. Why wouldn’t I wear a face mask?” Says Ho.

India quarantines itself from world for a month to fight coronavirus

India on Wednesday evening decided to virtually quarantine itself from the rest of the world, suspending all visas, except those issued for diplomatic, official, UN-international organisations, employment and projects till April 15.

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COVID-19 now a pandemic: WHO chief

The new coronavirus outbreak can now be described as a pandemic, the head of the World Health Organization announced Wednesday.

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New story in Health from Time: COVID-19 Can Live on Some Surfaces for Up to 3 Days, New Tests Show

The new coronavirus can live in the air for several hours and on some surfaces for as long as two to three days, tests by U.S. government and other scientists have found.

Their work, published Wednesday, suggests that the virus can spread through the air as well as from touching things that were contaminated by others who have it, in addition to direct person-to-person contact.

Since emerging in China late last year, the new virus has infected more than 120,000 people worldwide and caused more than 4,300 deaths — far more than the 2003 SARS outbreak caused by a genetically similar virus.

For this study, researchers used a nebulizer device to put samples of the new virus into the air, imitating what might happen if an infected person coughed or made the virus airborne some other way.

The found that viable virus could be detected up to three hours later in the air, up to four hours on copper, up to 24 hours on cardboard and up to two to three days on plastic and stainless steel.

Similar results were obtained from tests they did on the virus that caused the 2003 SARS outbreak, so differences in durability of the virus do not account for how much more widely the new one has spread, researchers say.

The tests were done by scientists from the National Institutes of Health, Princeton University and the University of California, Los Angeles, with funding from the U.S. government and the National Science Foundation.

The findings have not been reviewed by other scientists yet and were posted on a site where researchers can quickly share their work before publication.

“It’s a solid piece of work that answers questions people have been asking,” and shows the value and importance of the hygiene advice that public health officials have been stressing, said Julie Fischer, a microbiology professor at Georgetown University.

“What we need to be doing is washing our hands, being aware that people who are infected may be contaminating surfaces,” and keeping hands away from the face, she said.

New story in Health from Time: Why Are So Many Politicians Testing Positive with COVID-19?

Among the 121,061 to have been infected by the COVID-19 virus so far, one class of notable people appear to have been affected more than others — politicians.

“There are far more politicians who have been infected than you would have by statistical chance,” Francois Balloux, a professor of computational systems biology at University College London tells TIME. “Politicians are over-represented in the number of people who have been diagnosed.”

In Iran and across Europe, several high profile politicians have revealed they are battling the novel coronavirus.

Iraj Harirchi, the head of the Iranian counter-coronavirus task force, was diagnosed on Feb. 25 after downplaying the severity of the outbreak. A further 20 Iranian lawmakers have since been infected and isolated, and at least two have died. The head of Iran’s crisis management organization Esmail Najjar has also been placed in isolation after contracting COVID-19.

In Europe, senior politicians in France, the U.K., Spain and Italy are among those infected. The French Culture Minister Franck Riester tested positive on March 9, the ministry said, noting that Riester had been at the National Assembly where 5 people were found to have the virus. Nadine Dorries, a United Kingdom Health Minister also tested positive with the virus this week. Before falling ill, she interacted with Prime Minister Boris Johnson as well as other prominent politicians. In neighboring Spain, Javier Ortega Smith, a secretary general of the far-right Vox party has also been infected with the virus and is calling for the closure of Spain’s Congress of Deputies.

In Italy, which has witnessed the highest number of deaths and cases outside of China, the leader of the Italian Democratic Party Nicola Zingaretti announced in a Facebook video that he too has contracted the virus. “Well, it’s arrived,” Zingaretti said in a video posted on March 7. “I also have coronavirus.”

There are several potential explanations for why politicians are testing positive with COVID-19 at higher rates than the general population, experts say. “Politicians are in contact with many many people, probably more than the average person,” Balloux says. “They are always shaking hands and always meeting people. That might explain it.”

Politicians may also be more likely to get tested for coronavirus quickly, compared to the average citizen. While a non-politician will call a coronavirus hotline when they begin showing symptoms, “politicians get tested right away,” Balloux says, adding that “anyone else with similar symptoms and no travel history would not be tested.”

Politicians also tend to be older than the median age, and consequently likelier to be susceptible to catching the virus.

While politicians are facing above-average rates of coronavirus, many political establishments worldwide have not closed, further proliferating the spread of the virus. While politicians from Mongolia to Scotland have self-isolated after being exposed to COVID-19, other politicians such as President Donald Trump have not — despite having come into contact with colleagues who are now self-quarantining.

“If this was a school or university, there would be no hesitation to close,” Balloux says. “It’s ironic that the people creating the guidelines aren’t following them.”

New story in Health from Time: Mapping the Spread of the Coronavirus Outbreak Around the U.S. and the World

Since the first case of COVID-19 was identified in central China in December, the illness has spread across the world, leading to an outbreak that the World Health Organization has called a pandemic. The maps and charts below show the extent of the spread, and will be updated daily with data gathered from over a dozen sources by the Johns Hopkins University Center for Systems Science and Engineering.

Where COVID-19 has spread in the U.S.

Testing for the novel coronavirus that causes COVID-19 was slow to roll out in the U.S., but as more and more Americans get tested, it’s becoming clear that the illness is already spreading in the U.S. It has now been confirmed in some three dozen states, with the largest clusters in Washington state, California and New York.

Where COVID-19 has spread around the world

Over 110 countries and territories, representing every corner of the globe, have now reported at least one case of the novel coronavirus. In total, there are now over 110,000 cases and over 4,000 related deaths.

Which countries have the most COVID-19 cases?

China remains the country with the most coronavirus cases and related deaths, by a significant margin. However, in recent weeks, China has seen fewer and fewer new cases per day, while the count in places like Italy, Iran, Germany, France and the U.S. have risen.

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

New story in Health from Time: World Health Organization Declares COVID-19 a “Pandemic.” Here’s What That Means

The World Health Organization (WHO) on March 11 declared COVID-19 a pandemic, pointing to the over 118,000 cases of the coronavirus illness in over 110 countries and territories around the world and the sustained risk of further global spread.

“This is not just a public health crisis, it is a crisis that will touch every sector,” said Dr. Tedros Adhanom Ghebreyesus, WHO director-general, at a media briefing. “So every sector and every individual must be involved in the fights.”

An epidemic refers to an uptick in the spread of a disease within a specific community. By contrast, the WHO defines a pandemic as global spread of a new disease, though the specific threshold for meeting that criteria is fuzzy. The term is most often applied to new influenza strains, and the CDC says it’s used when viruses “are able to infect people easily and spread from person to person in an efficient and sustained way” in multiple regions. The declaration refers to the spread of a disease, rather than the severity of the illness it causes.

In some ways, declaring a pandemic is more art than science. “Pandemics mean different things to different people,” National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci said in February. “It really is borderline semantics, to be honest with you.”

During multiple prior press briefings, WHO officials maintained that COVID-19 had “pandemic potential,” but stopped short of declaring it one. The agency did, in January, call it a public health emergency of international concern, a slightly different label that refers to an “extraordinary event” that “constitute[s] a public health risk to other States through the international spread of disease.”

“Pandemic is not a word to use lightly or carelessly. It is a word that, if misused, can cause unreasonable fear, or unjustified acceptance that the fight is over, leading to unnecessary suffering and death,” said Dr. Tedros on March 11. “Describing the situation as a pandemic does not change WHO’s assessment of the threat posed by this coronavirus. It doesn’t change what WHO is doing, and it doesn’t change what countries should do.”

SARS-CoV-2, the virus that causes COVID-19, is thought to have first jumped from an animal host to humans in Wuhan, China. At least at first, most cases were seen within China and among people who had traveled there, as well as those travelers’ close contacts. While these cases were concerning, they did suggest a pandemic, because there was not significant spread outside of China.

But as the total number of infections rose, so too did the number of cases that spread from person-to-person within communities around the world. Cases have now been confirmed on every continent except Antarctica, and secondary disease hotspots have emerged in places such as South Korea, Italy and Iran.

All of these factors helped inform the WHO’s pandemic declaration, which signals to the world that continued spread is likely, and that countries should prepare for the possibility of widespread community transmission. It may also inform travel policy, and prompt cities and countries to flesh out plans for quarantines and possible disruptions to public events, if the need arises. It can also kickstart the expedited development of therapeutics and vaccines.

A pandemic declaration is fairly unusual. Severe Acute Respiratory Syndrome (SARS), a coronavirus related to COVID-19, and which infected about 8,000 people across 26 countries in 2003, did not reach pandemic status, for example.

The WHO last used the label during the 2009 H1N1 (or “swine flu”) outbreak, but got pushback for that choice. Critics argued that the situation was not serious enough to warrant a pandemic declaration, and that giving it one caused unnecessary panic and precautions.

New story in Health from Time: How to Take Care of Your Hands When You’re Washing Them So Much to Prevent Coronavirus

As the coronavirus that causes COVID-19 continues to spread globally, health officials have emphasized that washing one’s hands regularly and properly is one of the most effective ways to prevent the spread of infection.

Guidance from the Centers for Disease Control and Prevention (CDC) says people should scrub their hands for at least 20 seconds to effectively curb the spread of germs. Alcohol-based hand sanitizers that contain at least 60% alcohol can also be used to rid your hands of germs, though they are not as effective as soap and water at removing visible dirt or harmful chemicals. Sanitizers also do not get rid of all germ types.

Frequent hand washing, though a reliable way to ward off illness, can lead to and exacerbate dry skin issues, according to dermatologists.

“Coronavirus is changing some of our hygiene habits. People are washing hands more frequently with soap and water,” says Dr. Mary Stevenson, an assistant professor of dermatology at NYU Langone Health, who says she washes her hands about 75 times per day. “You’re supposed to do it for 20 seconds, and often, people fall short of this. If they’re doing it the whole time now, they might have issues, especially in the winter, with dry and cracked skin.”

Here’s how to care for your skin after washing your hands.

Why frequent washing and sanitizing can cause dry skin

Soap and water rinses away germs and dirt, but also strips the natural, protective oils in your skin, causing it to dry out, according to Dr. Justin Ko, chief of medical dermatology at Stanford Health Care. He says, as a medical professional, he washes his hands around 100 times per day.

“Because you caused so much irritation, your hands get dry, cracked and raw,” Ko says. Cracks that form on skin can increase your risk of contracting infections through the fissures and also lead to conditions such as eczema.

Alcohol-based hand sanitizers, which kill the microbes on skin without removing any debris, irritate hands less than soap, according to Ko. He suggests using hand sanitizers when it makes most sense, like after touching a door handle or another surface that might carry germs, instead of repeatedly washing your hands. While the CDC recommends using hand sanitizer when soap and water is not available, the agency says sanitizers do not get rid of all types of germs and that only soap can wash away visible dirt or grease.

Dr. Stevenson says taking preventative measures to moisturize your hands after washing them will help.

“Once your skin is dry and inflamed, it becomes a much harder circle of the chicken and the egg to get out of,” she says. “The more you practice these things, the better.”

How to keep your hands clean and moisturized

Once you’ve washed your hands for at least 20 seconds, Stevenson suggests patting them dry rather than rubbing them, which can irritate the skin.

“You want to pat yourself dry and leave a small amount of dampness, and then moisturize to lock in the water,” she says.

Once your hands are dry, immediately use a hand cream to seal in the moisture. Ideal hand creams should not include irritants, such as retinol or other anti-aging serums, allergens or fragrances, Stevenson says.

Hand soap should also be gentle and fragrance-free, Stevenson adds. “You don’t want to use something that’s meant to clean the pasta sauce off your bowl,” she says.

Among the many kinds of moisturizers, hand creams are better than body lotion because they are more nourishing, according to Ko. Lotions, which are primarily water-based, can further dry out skin because the water evaporates, he says. Creams, which are often oil-based, are more effective after washing hands.

“It’s got what we’d want to add back into the skin,” Ko says. “Lotion is fine in many instances, but not when it comes to protecting our hands.”

Ko says using hand cream after washing your hands is a safe and clean way to prevent dry skin, and he suggests people carry their own personal tubes of moisturizer to avoid spreading germs by sharing with others.

Gloves and Vaseline can help with heavy washing and cracks

In addition to making a routine out of using hand cream after washing your hands, a humidifier can help keep the air — and in turn, your skin— moist, Stevenson says.

Stevenson, who suffers from eczema and is prone to very dry skin in the winter months, says to cover up any cracks that form on the skin with bandaids or a liquid adhesive. People with chronic conditions that cause dry skin must take steps to avoid cracked skin, Stevenson says.

Ko says that people whose skin is sensitive to harsh chemicals should handle cleaning supplies, like Clorox wipes, while wearing gloves.

Both doctors recommend applying thick hand creams or Vaseline after washing hands and especially before going to bed.

“Nighttime is a really good time to give your skin a rest. Put on a really thick cream and if you can, put on a pair of cotton gloves,” Ko says. “If you can tolerate that for a few hours before bed, or even overnight, that utilizes all that downtime to hydrate the skin to get it back into gear.”

New story in Health from Time: 7-Eleven Owner Arrested After Selling ‘Dangerous’ Homemade Sanitizer

The owner of a 7-Eleven in River Vale, New Jersey has been arrested after allegedly making and selling a “dangerous ‘spray sanitizer'” that resulted in apparent burns on children’s skin, authorities said. This comes amid a nationwide shortage of hand sanitizer, as people stock up on cleaning supplies in the face of a coronavirus outbreak.

Read more: Americans Are Stockpiling Cleaning Products Due to COVID-19 Fears. Do They Actually Prevent Coronavirus?

Manisha Bharade, 47, was arrested Tuesday and charged with deceptive business practices and endangering the welfare of a child, according to Bergen County prosecutors.

Police responded to the 7-Eleven in River Vale on Monday night to seize the remaining bottles of an item that was sold as “spray sanitizer,” after social media posts showed three 10-year-old boys and one 11-year-old boy had suffered apparent burns on their arms and legs after using the product.

“While further investigation is underway, our first priority is to make the public aware that they should not use this item if they purchased it at the River Vale 7-Eleven,” Lieutenant John DeVoe said in a statement on Monday. “As far as we know, this issue is limited to the River Vale store at this time. From the information that we received, approximately one dozen of the bottles were sold to customers today.”

Bharade allegedly mixed commercially available foaming sanitizer with water and packaged it for resale. A chemical reaction from the mixture caused the burns, according to Bergen County prosecutors. Bharade could not immediately be reached for comment.

The New Jersey Division of Consumer Affairs has also opened an investigation into the sale of other health and sanitation products at the store in the months since the coronavirus outbreak began in China.

“Let me be perfectly clear: if you try to take advantage of our residents during a public health emergency, we will hold you accountable,” New Jersey Attorney General Gurbir Grewal said in a statement. “Retailers who try to make a quick buck by exploiting others will face civil and criminal consequences.”

As of Wednesday morning, there were more than 1,000 confirmed cases of coronavirus, which causes a disease known as COVID-19, across the United States, including 29 deaths, according to a virus tracker from researchers at Johns Hopkins University.

The Centers for Disease Control and Prevention has recommended that people wash their hands regularly with soap for at least 20 seconds to avoid getting sick. If soap and water are not available, the agency recommends using a hand sanitizer that contains at least 60% alcohol.