Indian Council of Medical Research (ICMR) on Tuesday released guidelines for testing for Covid-19 by private laboratories and requested them to process the tests free of cost.
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Tuesday, March 17, 2020
New story in Health from Time: There’s No Social Distancing With Small Children: Parents and Childcare Providers Grapple With Options
Nerida Brownlee and her husband have three children under 3 years old. When they were told to work from home, the Philadelphia couple had what they thought was a long and careful conversation with their nanny about whether she was comfortable still looking after their 8-month-old twins and 2-year-old son. They all agreed to minimize their contact with people outside their two families, to practice self-quarantine and careful hygiene and for her drive to work. They’d already spent so much time together, it seemed like a safe option.
Nevertheless, one working day later, their nanny texted them to say she was quitting.
“She had watched the news, and she was very worried,” says Brownlee, who works for an international human rights nonprofit. “I totally understand her decision. She probably didn’t have the heart to actually say it to me.” Brownlee intends to call her and tell her she will keep paying her, in the hope that she will come back when she feels it’s safe to do so, but in the meantime, she has to scramble to find a way to get her work done.
Liliana Maslog is a nanny, part of a nanny-share program that has her looking after toddlers from two different families in Mt. Pleasant, N.Y. On Mar. 12, as it became clear that the virus was spreading very swiftly, one of her families told her to stay at home the following week, but the other family still wanted her to work.
“I didn’t know what to do,” says Maslog, who has a 7-year-old child of her own, whose school is now closed. Her husband is an assistant building manager and cannot work from home. Having worried about it all weekend, she resolved to tell the other family that she couldn’t come in, even if that meant she would not get paid. But they called Sunday night and said they’d changed their minds and she should stay home and they would pay her.
Parents and childcare workers are facing this dilemma across the country, especially now that many districts are closing schools. Many parents simply cannot stay home. But there are also genuine questions about whether they can ask other people to look after their children, when all efforts are being made to limit contagion. In one of the series of cascading dominoes that are toppling the norms of 21st century life as people have known it, parents are now scrambling to find a way to work, while childcare workers have to face the question of whether they can work safely—or afford not to work.
Childcare in the U.S. has always been a very haphazard business, with parents sewing together whatever crazy quilt they can to cover their needs, and childcare workers living very insecure lives, both financially and in the arrangements they have made to have their own children cared for. Childcare centers are high-risk, low-revenue businesses, often just one small misfortune away from not being able to operate.
A huge disruptive force like a pandemic can wreak havoc in solid well-run businesses—like, say, the New York Stock Exchange. Its effect on people’s precarious childcare arrangements can be catastrophic. “We’ve never had this before,” says Maslog, who has been a professional nanny for 18 years. “There’s no system or arrangement to tell us what to do. ”
Jessica, who did not give her full name in fear of losing her job, works for a childcare center in Fairfield, Conn. Her employer is open and still accepting children. She took Monday off but was told to report for work on Tuesday, or risk not being paid. “Last week I was a little more comfortable with working,” she says. “But now I’m very much back and forth.” She decided not to go in.
Childcare work is very hands-on. There is no social distancing with small children and none with toddlers. “When I’m feeding the child, I’m touching all the things in their lunchboxes,” Jessica notes. She’s worried about her susceptibility to the virus. “A lot of the parents work in New York City, and they go in on the train,” she notes. Some of them have a history of bringing children in with illnesses. But she’s also worried about the children and their parents too. She lives with 20-something sons, who are doing their own version of social distancing. She would hate to infect anybody else.
About half the parents at the center where Jessica works have stopped sending their children in, she says, but the center is staying open. Because it’s so hard for childcare centers to turn a profit, she thinks her employers may need to keep the center open in order to avoid offering refunds. She keeps asking: “What’s the right thing to do for me? And for others?”
Meanwhile, in the small town of Montpelier, Ind., Kali Matheney would love for the childcare center where she works to be open, because it’s her only source of income. But once the local school closed down, the church-based childcare center next door closed as well. Matheney, who has a 2-year-old son, is still doing respite care for a child with special needs, but her family is having to get by mostly on her husband’s income from his shifts at a local factory.
“We just won’t have any leftover money from our budget,” says Matheney. “Without allowing for extra saving we can get by.”
Audrey Toda, an ob-gyn from Woodside, Calif., has been relying on the Bright Horizons childcare center at her husband’s pharmaceutical office to look after their 7-month-old and 4-year-old while they work. But it is closing as of March 17, and neither she nor her husband can do their work from home. Their fallback position has always been Toda’s parents.
“But my parents are in their 70s and I’m trying to protect them,” says Toda. (The virus has been much more deadly among those in their 70s and 80s.) In the interim, her 30-year-old brother-in-law is stepping in to help.
Parents say their plans change hourly, as a new development arises. On March 16, San Francisco and most of the Bay Area announced that all residents should shelter-in-place—that is, stay home unless absolutely necessary. Only nannies who are needed for healthcare reasons are allowed to work. New York City Mayor Bill de Blasio has suggested he is considering a similar measure, so many more parents could soon be winging it on their own.
So far, parents have discovered, flexibility is the key skill they’ve needed. Brownlee and her husband thought they might take the children for three hours each, but that plan fell apart on the first day. Now she’s trying to get three hours of work done in the morning, another four between the hours of 8 p.m. and midnight, and to squeeze some of the simpler tasks in between.
She recognizes she’s one of the lucky ones. Her employers understand the difficulty of the situation, and with some rearranging, she can work from home. She has a basement the kids can play in and she and her spouse are both home, so they can trade off easily. But it’s still a work in progress.
“I don’t even have it that difficult and I’m finding it impossible. I’m figuring out what can you do on your phone while you’re in a tent playing maracas,” she says. But not all work is so easily dispensed with. “The stuff I need to think about will have to come later.”
New story in Health from Time: West Virginia Just Became the Last State to Report a COVID-19 Case. It Was Only a Matter of Time
Every U.S. state has now reported at least one confirmed case of COVID-19, following a positive diagnosis out of West Virginia.
West Virginia Gov. Jim Justice confirmed the case Tuesday evening, saying it had been detected in the state’s Eastern Panhandle. “This is real and it’s really concerning,” Justice said.
The case comes just a day after President Donald Trump praised Justice—who he called “Big Jim” at a Monday press conference—for “doing a good job” in keeping West Virginia free of COVID-19. Doctors, lawmakers and West Virginians were quick to point out, though, that the state’s conspicuous lack of COVID-19 cases was likely due to limited testing capacity, rather than a singular stroke of public-health preparedness.
Justice on Monday declared a state of emergency, while Sen. Joe Manchin tweeted earlier on Tuesday that “West Virginians should not let their guard down on #coronavirus just because we don’t have a confirmed case. We need to act now to prevent a catastrophic outcome for our state.”
Pamela Brannon knows about the state’s limited testing capacity as well as anyone.
She returned from a month-long trip from Uganda on March 8. About a week later, a cough unlike any she’d had before settled deep in her chest.
Brannon, 54, called her doctor on March 14, asking where she could get tested for COVID-19 near her home in Charles Town, W.V. She was transferred to a public health hotline where the answer came back in minutes: she couldn’t get tested, at least not in West Virginia.
“There are no cases [in West Virginia] because they’re not testing,” Brannon told TIME Tuesday afternoon, shortly before the state’s first case was confirmed. “The thing that’s so scary about that is it’s going to give people a sense of false security.” She says she is not afraid for herself, but for those with poorer health and fewer resources than she has.
People in every U.S. state have been turned away from medical centers unable to meet demand for COVID-19 testing, due to slow rollout of testing kits to public-health agencies and stringent criteria meant to preserve available tests for the highest risk patients. But in West Virginia—a state with among the worst health outcomes in the country, and where about a fifth of adults do not have a health care provider—the situation has been especially bleak.
State health officials said only 84 West Virginians had been tested as of March 17, and only 500 test kits were available for the state’s roughly 1.8 million residents.
Those 84 people had to meet a strict case definition to get tested. According to a statement issued March 16, the state is prioritizing testing for patients with respiratory symptoms or concurrent underlying conditions serious enough to require hospitalization and who have no other explanatory diagnosis, as well as people who are showing symptoms such as fever, cough and shortness of breath; have had close contact with a confirmed COVID-19 patient or traveled to a heavily affected area; and have no other explanatory diagnosis. Providers must consult public health authorities before completing testing.
There are signs that testing capacity is improving, both in West Virginia and nationwide. West Virginia State Health Officer Dr. Cathy Slemp told West Virginia’s Metro News that availability of tests should improve as private labs roll out their tests, supplementing public-health supplies. A spokesperson at WVU Medicine, the state’s largest health care provider, also said it is working to develop its own test.
While they’re a step in the right direction, those steps provide little solace to patients like Brannon.
Brannon’s journey to testing spanned three different states. After being turned down in West Virginia, she called a hospital in Virginia, which told her she couldn’t get tested without authorization from her doctor. With few options left and ever-worsening symptoms, she drove to a hospital in Frederick, Md., where she waited about four hours to get medical attention. Even then, protocol mandated that doctors first test her for the flu and other respiratory illnesses, to rule those out before moving on to COVID-19. As of writing, Brannon still does not know why she is sick.
“I can’t believe what I’ve been through in the last few days. It’s incredible,” she says. “Why did I have to drive 45 minutes from my home to get this test? I am worn out. I just want a bath and my bed and my dog.”
New story in Health from Time: The U.S. Military Has Joined the War Against the Coronavirus. But Its Firepower is Limited.
Amid public calls for additional U.S. military support in the national fight against the novel coronavirus, Defense Secretary Mark Esper committed Tuesday to making 5 million respirator masks, 2,000 ventilators and as many as 16 military labs available to help combat the deadly contagion.
It is the latest in a series of actions undertaken by the Pentagon as public health professionals across the U.S. fight a surge of COVID-19 cases. Already more than 1,560 National Guard members have been activated in 22 states to plan for medical response, collect and deliver testing samples and support state emergency-operations centers.
From the beginning of the COVID-19 outbreak, the military has supported the Department of Health and Human Services, freeing up space on military bases to house Americans who needed to be quarantined following evacuations from China or coronavirus-stricken cruise ships. Within days, American troops could also be called upon by President Donald Trump and top public health officials to stand up tent hospitals, renovate buildings for overflow facilities and carry out other tasks necessary to curb the spread of the pathogen. The military’s two 1,000-patient hospital ships, USNS Comfort and USNS Mercy, are being prepared on the East and West coasts to provide support in case civilian hospitals are overwhelmed.
But Esper offered a note of caution about the ability of the ships—and more broadly, the military as a whole—to deal with the pandemic. “They don’t have necessarily the space, the segregated spaces, you need to deal with infectious diseases,” he told reporters at the Pentagon. “So one of the ways by which you could use either field hospitals, the hospital ships or things in between, is to take the pressure off of civilian hospitals when it comes to trauma cases, is to open up civilian hospital rooms for infectious diseases.”
Senior Pentagon officials noted this week that there are limits and compromises to mobilizing military support to deal with this pandemic. For instance, the U.S. military’s skills are not best suited for treating respiratory diseases. Air Force Brig. Gen. Paul Friedrichs, a physician on the Pentagon’s Joint Staff, downplayed the military’s hospital surge capabilities. The Defense Department runs 36 hospitals across the U.S., but Friedrichs said most of those are small community hospitals that typically deal with young, healthy active-duty service members and their families. And while U.S. troops routinely set up field hospitals, the facilities are small and designed for trauma care, such as treating troops in combat.
“We don’t have any 500-bed hospitals designed for infectious disease. That does not exist in the inventory,” Friedrichs told reporters Monday. “We do have tent hospitals. They are deployable hospitals. The challenge is, they are designed to take care of trauma patients and combat casualties.”
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U.S. forces are accustomed to supporting relief efforts during natural disasters, which tend to strike a single region. The coronavirus pandemic is ravaging the U.S. in waves, hitting all 50 states, with multiple major outbreaks. American troops can easily construct field hospitals, but the limiting factor is equipment and personnel, which is badly needed across the country. “So, even if we are able to build tents for hospitals, we still need the doctors, we need the nurses,” Pentagon spokesman Jonathan Rath Hoffman said Monday. “We need the orderlies. We need the equipment and all that in there.”
Medical doctors within the National Guard and the military reserve forces can be called upon to provide support. But these physicians serve the same role in civilian life. So if they had to staff a tent hospital, it would be at the expense of their local community. “The simple fact is many of those medical professionals who staff those units come from the private sector,” Esper said. “So we got to be very careful that we don’t take from one part of [a state] to set up a field hospital in another part.”
Esper committed to working with governors across the country, including New York Governor Andrew Cuomo, who requested the services of the Army Corps of Engineers to build “temporary medical facilities.” But he pointed out the agency does not build projects, but rather contracts others to do them—a process that can take months.
The Army Corps of Engineers, for its part, said that “as a precautionary measure” it “has begun assessing our capabilities” in anticipation of requests related to the coronavirus crisis. “At this time, however, USACE has not been assigned a COVID-19 support mission.”
William D. Hartung, a security analyst at the Center for International Policy, said Pentagon officials rightly point out that there are real-world limitations to relying on the military as a major player in responding to the COVID-19 crisis. “There is no substitute for a robust civilian response,” he said. “However, given that we are facing a national emergency, the Department of Defense should be showing a greater sense of urgency and flexibility in determining how best to add its existing resources to the fight against the coronavirus.”
The military has a long history of responding to natural disasters in the U.S. and overseas. With its near-limitless reach by air, land and sea, U.S. forces can provide goods, services and logistics support to those in need. And it may be in this customary role that the nation can expect the most robust U.S. military support going forward.
New story in Health from Time: Living In Unrelated Isolation, Some Big Brother Contestants Around the World Are Still to Learn About the Coronavirus Pandemic
Across the globe, contestants on the TV show Big Brother — a reality TV competition that sees contestants being locked in a house-styled TV set and isolated from the outside world — are likely among some of the last people to learn about the coronavirus pandemic, and its spread worldwide. The hundred-some people, across studios in Sweden, Brazil, and India, among other countries, are modeling self-quarantine in ways they didn’t even realize.
Big Brother began in the Netherlands in the late 1990s and and has become a reality TV staple in numerous countries, including the United States. Versions of the show are currently airing in six countries and a season is also being taped in Australia to air at a later date.
The 13 contestants currently appearing on the German version of the reality show, Big Brother Deutschland, have not heard about the outside world since the show began filming on Feb. 6. According to Deadline, four contestants who entered German Big Brother house on March 6 were instructed to not tell anyone about the outbreak.
But following criticism in recent days, German broadcaster Sat.1 announced on Tuesday that they would be told about the coronavirus in a live broadcast airing at 7 p.m. local time, given how serious the situation has become.
When the German season first began taping, coronavirus had spread primarily across Asia. As of Tuesday morning ET, the virus has also spread through Europe, North America and South America, infecting over 187,600 people and killing over 7,400, according to a tracker by Johns Hopkins University. The show’s host Jochen Schropp and an on-set physician will tell the housemates about the spread of the virus, which has lead Germany to close its borders, shutdown schools and shutter shops. Contestants will also be shown video messages from their relatives.
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Germany’s Big Brother is not the only edition of the show informing its contestants. Filming for the Australian version of the show began three weeks ago, but Australian news site 7news reported on Monday that a spokesperson for the show had confirmed that “Housemates have been brought across the current situation and we are in constant contact with the families to keep all involved up to date.” (Unlike almost all other editions of the show, this new season of Big Brother Australia is not airing episodes or footage live, rather it is taping now for broadcast later in the year.)
Big Brother‘s Canadian edition, which has forgone its usual live studio audience due to the threat of coronavirus, has also told its contestants about the pandemic and will continue to update them as the crisis develop, Global News reports. Before the contestants were informed about the change, they were filmed wondering why they couldn’t hear audience reactions during the weekly live episodes which see contestants eliminated, leaving one participant to wonder if “the house was now soundproof.”
Contestants on Italy’s Grande Fratello VIP — a Big Brother spin-off featuring famous participants — were reportedly told of the coronavirus’ spread in their country last week. Outside of China, Italy is now the country worst hit with the virus, having over 27,900 confirmed cases and over 2,100 deaths as of Tuesday afternoon ET. Contestants on a season of Big Brother currently airing in Sweden (Big Brother Sverige) have also been informed. (Both the Italian and Swedish shows have, in recent weeks, foregone the standard Big Brother practice of introducing new players, or guests, into the contestants’ house.)
However, the contestants on both Brazilian Big Brother and Israeli Big Brother (HaAh HaGadol), who have all been in isolation since January, have reportedly still not been informed; Brazilian network Globo has said it will inform the contestants shortly and update them on their families, per Deadline.
Bigg Boss Malayalam, an edition of Indian Big Brother, is also on the air; six contestants had to temporarily leave the house in February because of a viral eye infection, according to The Times of India. While it is unclear whether the participants have been informed of coronavirus’ spread, Indian news sites report one evicted contestant taken into custody by Indian police after leaving the show, when he was greeted by crowds of fans at an airport in breach of rules implementing social distancing.
Coronavirus has also seen the premieres of Big Brother seasons in Portugal and Greece delayed.
This won’t be the first time Big Brother has broken its isolation rule to inform contestants about current events. In past seasons of U.S. edition Big Brother specifically, producers informed the final three contestants of Big Brother 2 that there had been an attack in New York on 9/11 — and that a relative of one contestant, Monica Bailey, was among missing World Trade Center workers — although the contestants said they did not learn the full details of the tragedy until the series finale on Sept. 20.
And after Donald Trump won the 2016 presidential election, host Julie Chen told contestants on a spin-off series, Big Brother Brother: Over The Top, of the results on Nov. 11 in a clip that went viral.
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New story in Health from Time: Some Supermarkets Are Launching Senior-Only Hours During the Coronavirus Pandemic. Not All Retailers Think That’s a Good Idea
As the elderly have emerged as a category of vulnerable people most endangered by the coronavirus pandemic, store chains across the U.S. are announcing hours specifically dedicated to senior shoppers.
National chains including Stop & Shop and Dollar General have announced senior hours, as have many regional chains such as Zannoto’s Family Markets in San Jose, Calif., DeCicco & Sons in New York and Vista Supermarkets in El Paso, Texas. The announcements come as retailers across the country struggle to keep shelves stocked with food, sanitation products and other household goods like toilet paper — despite pleas from officials against hoarding and “panic buying.”
Stop & Shop, a grocery chain with more than 400 locations across north eastern states, said Monday that it would open stores early to accommodate people age 60 and older from 6:00-7:30 a.m. daily. Dollar General, which operates more than 15,000 stores in 44 states, will dedicate each store’s first hour open for business to seniors.
“During these unprecedented times, Dollar General is diligently working to meet the ongoing needs of our customers and communities,” Todd Vasos, Dollar General CEO, said in a public statement Monday. “We are proud to live our mission and provide customers with everyday low prices on the household essentials that are used and replenished most often.”
Other retailers, however, have said they would not implement senior hours and are instead encouraging online orders and curbside pickup. Popular Texas grocery store chain H-E-B told CNN Business that it made the decision not to implement senior hours after speaking with health officials.
“Our leadership team studied this option thoroughly and due to recommendations from health officials we have determined this is not the best and safest option for our customers,” the company said in a statement to CNN Business. “H-E-B takes care of Texas and we feel asking a group to congregate at our stores in a certain timeframe is not a safe idea.”
Felicia Wu, professor of food science and human nutrition at Michigan State University, tells TIME that, no matter what, there are risks associated with going out into locations where many people may gather.
“The safest option, if it is possible, is to have more vulnerable individuals… ask someone else who is not part of a vulnerable group to do the shopping for them,” Wu tells TIME in an emailed statement. “If that is not possible, then I do think it is a good idea for grocery stores to have dedicated hours that are for more vulnerable populations to shop — [times at] which there will be fewer people, and where cleaning can take place beforehand.”
Wu adds that stores should consider if the hours they’re dedicating are feasible for the elderly (as well as for other vulnerable groups of people, such as those who are immunocompromised or have chronic heart or lung diseases). Stores should also consider offering instructions about how far people should stay away from each other while shopping, wipe down counters and other surfaces before people arrive and provide sanitary wipes and hand sanitizer at the doors so that people can wipe their hands and their cart handles.
“To the workers who are cleaning these shopping areas, we are grateful,” Wu says. “These workers should wash their hands carefully beforehand and afterwards to ensure their own safety and the safety of others.”
New story in Health from Time: What the U.S. Needs to do Today to Follow South Korea Model for Fighting Coronavirus
The United States has a narrow window of opportunity to determine the fate of its coronavirus crisis. Will we end up looking like Italy or South Korea?
Italy’s health system has imploded under the strain of new cases and the shortage of ventilators means doctors must make agonizing decisions on who to save and who to let die. In contrast, South Korea acted swiftly and boldly to “flatten the curve”— the government did everything it could to slow the rate of increase and so reduce the burden of the illness on the country’s clinics and hospitals.
Right now, the number of new cases of confirmed infection in the U.S. is doubling every four days. This puts us on a trajectory towards becoming Italy. On March 16, a research team at Imperial College London published a new study suggesting that without taking control measures, there would be about 2.2 million deaths in the U.S.
We could still avoid this catastrophic scenario. We will need to act urgently, ruthlessly, and aggressively to adopt five key measures that helped to flatten the curve in places like Japan, Hong Kong, Singapore, and South Korea.
- Testing, Testing, Testing
The nationwide shortage of coronavirus test kits here in the U.S. is not just a disgrace, it is emblematic of a country totally ill prepared to fight a deadly pandemic. Right now, with so little testing, we are shooting in the dark when it comes to our control efforts. It’s the equivalent of a surgeon trying to do an operation with the lights off.
Why is it so critical for us to have a massive surge in testing? People who are sick need to get the right diagnosis and clinical care. We know, for example, that if you are hospitalized with COVID-19, there’s a high chance you’ll need transfer to the intensive care unit.
People with mild symptoms who get tested can self-isolate and help stop the spread of the virus. If one person has the disease, we can then test those they have been in contact with (known as “contact tracing”). In other words, testing and contact tracing can help to break the chain of transmission. As Dr Tedros Ghebreyesus, the World Health Organization’s director general, says: “Find, isolate, test and treat every case, and trace every contact.”
Testing also allows clinics and hospitals to become better prepared, as they know how many cases to expect. And, crucially, testing helps us to know where the disease is, how it is evolving, and where to target our efforts to control it. It identifies the hot spots of infections.
Countries that have flattened the curve made testing widely and freely available, using innovative approaches like mass drive-thru test centers. South Korea has been conducting around 12,000-15,000 tests every day, and has the capacity to do 20,000 daily. While it is hard to get accurate estimates, the CDC reports that only around 25,000 tests have been conducted in total nationwide by CDC or public health labs in the U.S.—compare this with the roughly 250,000 tests that South Korea has done to date.
We are seeing promising signs in the right direction. The House just passed a bill that guarantees free testing. Target, Walgreens, CVS, and Walmart will soon offer drive-thru testing. The CDC promises to ship out more test kits to state and local public health labs and it has relaxed its guidelines on who can get tested. But test shortages remain, and we’re still playing catch up.
2. Communicate and coordinate
There’s one striking message from a new analysis of how Hong Kong, Singapore, and Japan were able to contain COVID-19. In all three locations, there was excellent communication and coordination between different government departments and between the central and regional governments.
In Singapore, for example, “there are almost daily meetings between Regional Health System managers, hospital leaders, and the Ministry of Health.” Clear COVID-19 plans and protocols are in place so that all key players at all levels of the health system know what they are supposed to do. There’s also explicit, detailed information given daily to the public on the state of the outbreak.
Unfortunately, in the US, the COVID-19 response led by Vice President Mike Pence has suffered from extremely poor communication from the outset. The flailing Trump Administration downplayed the threat from day one and Trump himself has stated many factually incorrect things about the virus. There is still no clarity on who is responsible for what. With very little clear and credible guidance from the federal government, cities, counties, and states have had to do their best on their own.
3. Use social distancing to protect the vulnerable
Most of the transmission in the U.S. is happening within our borders (so-called community transmission), which is one reason why Trump’s travel ban is now so pointless.
A critical tool for breaking this community transmission is “social distancing”—staying away from places where people congregate (movie theaters, bars, restaurants, shopping centers), avoiding mass gatherings (like religious services and concerts), and maintaining a distance of at least six feet from other people. Countries that flattened the curve have taken a variety of approaches to breaking community transmission, from school and office closures to suspending public transportation.
People can transmit the virus without knowing they are infected. When we decide to have a beer or cocktail at our favorite crowded bar, we could end up spreading the coronavirus to our friend, who then transmits it to their aging mother who has heart disease and who could end up getting sick or even dying. We are all potential links in the transmission chain, which is why social distancing is so important.
Although the CDC left it extremely late, it finally issued guidelines recommending that there should be no gatherings of 50 people or more. That’s a small step in the right direction, but it does not go far enough. The guideline “does not apply to the day to day operation of organizations such as schools, institutes of higher learning, or businesses.”
Trump himself went further saying people should avoid groups of 10 or more, but his guidelines “are not mandatory and fall short of a national quarantine and internal travel restrictions, which many health officials had urged.”
The poor communication and coordination between the federal government and states means some states have started to adopt social distancing approaches, but others have not—so it’s luck of the draw when it comes to whether you’re at risk. In North Carolina, where I live, for example, decisions to close schools were initially made on a county-by-county basis, creating a confusing patchwork of closures. On Saturday, Gov. Roy Cooper finally stepped in and ordered all of the state’s public schools closed for at least two weeks. Similar inconsistencies abound among cities’ and states’ bans on public gatherings. If social distancing has a hope of working, we need to apply it uniformly.
4. Protect our health workers
Our most precious resource right now is our health workers. Along with our botched roll out of coronavirus testing, we should also be ashamed of how we have broken our promise to protect these heroes—our national shortage of protective equipment means doctors, nurses, physical therapists, and other front-line workers are getting infected and risk death. Two emergency physicians, one in Washington state and one in New Jersey, are now in critical condition with COVID-19. Such infections also put even more strain on the health system, and continue to fuel the cycle of transmission.
Rapidly scaling up and deploying the production of protective equipment for health workers is not just a public health necessity. It’s also a moral emergency. What kind of a nation are we if we can’t protect those who are literally putting their lives on the line night and day to care for our sick?
5. Expect and plan for a rise in cases
As Dr. Anthony Fauci, director of the National Institutes of Allergy and Infectious Diseases, has warned, “things will get worse than they are right now.” Every health care setting across the country, especially hospitals, should take steps now to prepare for a rise in cases, including scaling up their supplies of equipment such as ventilators. It was therefore disheartening to hear Trump tell governors yesterday, “Respirators, ventilators, all of the equipment — try getting it yourselves.” The federal government needs to step up at times like these. There needs to be an emergency injection of funding to expand our strategic national stockpile of ventilators.
All in all, it’s too soon to throw in the towel and accept an Italian scenario. With five key measures—testing and contact tracing, communication and coordination, social distancing, protecting health workers, and health systems planning—we could still become South Korea.
New story in Health from Time: Becton Dickinson Seeks Emergency FDA Approval for a Two-Hour Coronavirus Test
Becton Dickinson, a medical technology company, submitted a request to the Food and Drug Administration (FDA) for approval of what could be the fastest COVID-19 test on the market so far. The New Jersey-based company says its test could deliver results to hospitals in as few as two hours.
According to Becton Dickinson (BD) CEO Tom Polen, the test has already been used in China, including at the pandemic’s epicenter in Wuhan, and in Europe. The company has partnered with Alabama-based biotech company BioGX and asked the FDA for approval to use its test in the U.S. under the agency’s Emergency Use Authorization, which allows expedited review of new tests under emergency circumstances such as a pandemic. BioGX provides molecules and reagent products needed to formulate tests on the BD technology platform.
Already, some 500 hospitals across nearly every state in the country use BD’s testing machines and platforms to diagnose other respiratory illnesses, including the flu. So adding the COVID-19 test shouldn’t create an undue burden or require additional expertise. “I don’t think there will be tests that are any faster at this point than [two hours],” says Polen. “It’s a fully automated test so you snap in the test strip, put in the sample, close the door and press the button and the results come out in about two hours.”
Currently, health officials at state and local public health departments can use the manual Centers for Disease Control test, which takes at least 24 hours, or order tests from commercial testing companies which could take several days because samples have to be shipped to the labs.
Chinese health authorities used the BD platform to create their own test for COVID-19 as cases began spreading in Wuhan and throughout the country, and in the past week, European health officials also started to rely on the testing machines.
Polen says the company is also working on a separate, even faster test that could be available at retail clinics in the US and produce results in about 10 minutes. That test would run on another of the company’s machines — which is handheld and about the size of a cell phone — which tests for flu and strep, and is currently in 25,000 facilities like retail clinics and doctors’ offices. BD scientists are working with U.S. government researchers to identify the right antibody that could be used as a target for that test. Polen declined to predict how long it will take to develop, but when it becomes available, doctors could run the test in their offices, technicians could perform it in walk in clinics, or mobile teams of health care providers could test people in their homes to avoid transmission of the virus. “That would be a game changer to have a point-of-care, handheld test,” he says.
New story in Health from Time: Lessons From the Future: Advice From People Who Have Been Living With the Threat of COVID-19 for Weeks
Before COVID-19 swept across western Europe and caused schools and bars to close across the United States, it threatened East and Southeast Asia.
Millions of Americans and Europeans are now learning to cope with changes to their daily lives brought on by coronavirus precautions—changes that have been a reality since January or February across mainland China and in places like Hong Kong, Singapore and Taiwan.
For weeks, in many places across Asia, children have been home from school, employees have been working from home and people have been learning to conduct their lives amid the outbreak.
With that in mind, here is some advice for staying safe, healthy and productive through the disruption and danger of COVID-19—from people who have already experienced it.
Keep things in perspective
“You’re not alone. Your fears are not atypical. Knowing that this too shall pass, just like those newborn days with your kids, that’s an important message. This isn’t the beginning of the end. Keeping that perspective, and also humor has really helped me… Like recognizing that I’m wearing a mask, stockpiling toilet paper, and that this is ridiculous, right?”
— Stephanie Young, 39, therapist and mother of two in Hong Kong
Make sure your kids are active, occupied and well-rested
“No matter what age they are, kids absolutely need to get some physical activity in their day. I make it a point every day that all three [of my kids] have to go outside, even if just for a walk or to ride their bikes. I also make [my kids] have little exercise breaks between their online classes if they can, like 50 jumping jacks or 20 squats…
It’s good to keep your kids a little busy. If they’re bored, they get frustrated and that’s when they have their tantrums. Even if school doesn’t necessarily have online work for them, you can find something basic for their age, whether it’s math or language or science related… And it’s definitely important to have a routine, to keep a normalcy.”
— Nicole Serje, 43, of Hong Kong, whose three children have been home from school since January
“I would suggest that the most important part of the routine is the inclusion of mindful breaks away from the screen and sedentary seated time. At school, children are often on the move, not just at break and lunch play, but when relocating from class to class and also within the classroom itself. This needs to be replicated as much as possible at home to ensure there is movement throughout the child’s day. This may take the form of short mini brain breaks, mindfulness, yoga, free play, structured exercise, rest and sleep.”
— Luke Schroder, 38, grade school teacher from the U.K. living in Hong Kong
Talk to your kids about COVID-19
“Obviously it’s highly age-dependent. With your younger school-aged kids it’s acknowledging the facts around what a virus is, and comparing it to other things they’re familiar with in school. Here in Asia we have discussions of hand foot and mouth [disease] and head lice is everywhere. All of those things that are highly contractable and contagious that they’re familiar with already is probably a good place to start and won’t amplify this to make it seem scary. I’m really cognizant of [my boys’] media access and what they hear the adults talking about. That’s another one: just limiting the overhearing helps.
The older kids, I’m teaching high school kids, their access to information is so intense and immersive that parents just have to try to mitigate that in some way, or at least balance it because they get all the headlines just as much as we do.”
— Stephanie Young, 39, therapist and mother of two in Hong Kong
Practice social distancing, but don’t isolate yourself
“I wish I had known how key social distancing is for containing COVID-19. Unfortunately, we are seeing the impact of national containment measures not being enacted quick enough in the West. Considering this late response and how highly contagious COVID-19 is, I would have tried to warn more friends and family members back in the U.S. to start practicing social distancing as soon as possible...
For practicing social distancing without being totally isolated socially, I recommend having regular tele-meetups with friends—arrange lunches, coffee chats, or even workouts over FaceTime. Mental health check-ins via telephone or video with friends and family members are great.”
— Ahereen Ayub, 30, who was quarantined in her Beijing home for 14 days
Read more: What Is ‘Social Distancing?’ Here’s How to Best Practice It as Coronavirus Spreads
Keep your hands to yourself
“When you’re outside, try not to touch things. People may have sneezed on their hands and touched the surroundings, and the germs can last for days. When you touch it, and you bring your hands to a mucosal surface (like your eyes, nose and mouth), then you could get the disease. You can use a tissue to push door handles or [elevator] buttons for example, so that you’re not in contact with any potential bacteria directly. If you are not near a sink, use hand sanitizer.”
— TT Chan, 26, medical worker at a Hong Kong hospital
Read more: The Secret to Keeping Your Kids Happy, Busy and Learning if Their School Closes Due to Coronavirus
Cancel your travel plans
“I really encourage people not to travel at this time. It’s quite risky to travel, especially these few weeks when it’s already spreading to all countries worldwide. I think the most worrying thing is that when you travel out there are no travel restrictions, but when you come back maybe there is and you need to quarantine yourself. The situation is changing quickly and you don’t know whether the policy will be tightened and maybe you can’t go back to work.”
— Wilson Hung, 41, who had to self-isolate for 14 days in Taipei, Taiwan after returning from a four-day vacation to Japan
“Be prepared for the possibility that mass closures, including schools, could be extended and your current home routine could be a new normal for the foreseeable future. Cancel any upcoming travel plans—besides the fact that there may be airline cancellations and more tightened travel restrictions on Americans flying in and out of other countries (and perhaps restrictions for domestic travel), the biggest reason everyone needs to take containment measures seriously is to protect those most at risk of being severely affected by COVID-19, and to spare the healthcare system from a possible overload.”
— Ahereen Ayub, 30, who was quarantined in her Beijing home for 14 days
Create a distraction-free work space at home
“I recommend creating a physical separation between your work and home life. For me, I’ve repurposed a section of my apartment as my work space. And when I’m in my work space, I’m working. When I leave it, then that’s a break. It’s the place I use to hold myself accountable.“
— Ashton Smalling, 25, English teacher from Texas living in Seoul, South Korea
“Give yourself breaks. Not just lunch breaks, but time to just get out of your chair, look out the window and come back with a more focused mind. Otherwise you could get burned out very easily and lose motivation.”
— Jeremy Tan, 28, copywriter in Singapore
Read more: How to Stay Productive When Working From Home
If you’re in quarantine, don’t stress yourself out
“I’d encourage people to take some deep breaths and really come to terms with the idea that you’re just going to be alone for a couple of weeks. It doesn’t have to be a bad thing. With the right mindset, people can embrace this as a sanctuary. It’s a good time for people to pamper themselves, to do things that you normally don’t have time to do because you’re racing around with work, school and taking care of your kids. Try to stay busy with things that bring you some joy. It’s when people sit and get too deep in their heads that they start to think bad things.”
— Sarah Arana, 53, who spent 12 days quarantined on the Diamond Princess cruise ship, followed by a 14-day quarantine at Travis Air Force Base, Calif.
Stay on top of the latest news, but don’t fixate on it 24/7
“Knowing what measures are in place in your local community is important. You want to know whether your library, your post office is open before making a wasted trip for example. But it’s not healthy to be watching the news all the time. Turn off the news, put on some Netflix, read a book, occupy your mind with other things. Life still goes on.”
— Mandy Chan, 33, administrative assistant in Hong Kong
Additional reporting by Laignee Barron and Amy Gunia in Hong Kong, Charlie Campbell in Shanghai and Louise Watt in Taipei, Taiwan
Sun Pharma board approves Rs 1,700 cr share buy-back offer
New Delhi: Drug major Sun Pharmaceutical Industries on Tuesday said its board has approved Rs 1,700 crore share buyback offer at a maximum price of Rs 425 per share.
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Coronavirus: Elective surgeries may be deferred as government plans 273 ventilators for patients
Leaving nothing to chance, the government is gearing up for contingencies especially with regard to availability of ventilators should Covid-19 spread and the number of infected cases spike.
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New story in Health from Time: Shiite Hardliners in Iran Storm 2 Shrines That Were Closed to Stop Coronavirus Spread
(DUBAI, United Arab Emirates) — Hard-line Shiite faithful in Iran pushed their way into the courtyards of two major shrines just closed over fears of the new coronavirus, Iranian state media reported Tuesday, as the Islamic Republic pressed on with its struggle to control the Mideast’s worst outbreak.
Roughly nine out of 10 of the over 17,000 cases of the new virus confirmed across the Middle East come from Iran, where authorities denied for days the risk the outbreak posed. Officials have now implemented new checks for people trying to leave major cities ahead of Nowruz, the Persian New Year, on Friday, but have hesitated to quarantine the areas.
Late on Monday night, angry crowds stormed into the courtyards of Mashhad’s Imam Reza shrine and Qom’s Fatima Masumeh shrine. Crowds typically pray there 24 hours a day, seven days a week, touching and kissing the shrine. That’s worried health officials, who for weeks ordered Iran’s Shiite clergy to close them.
Earlier on Monday, the state TV had announced the shrines’ closure, sparking the demonstrations.
“We are here to say that Tehran is damn wrong to do that!” one Shiite cleric shouted at the shrine in Mashhad, according to online video. Others joined him in chanting: “The health minister is damn wrong to do that, the president is damn wrong to do that!”
Police later dispersed the crowds, state media reported. Religious authorities and a prominent Qom seminary called the demonstration an “insult” to the shrine in a statement, urging the faithful to rely on “wisdom and patience” amid the closure.
Iran’s shrines draw Shiites from all over the Mideast for pilgrimages, likely contributing to the spread of the virus across the region. Saudi Arabia earlier closed off Islam’s holiest sites over fear of the virus spreading.
President Hassan Rouhani on Tuesday said despite the closures, “our soul is closer to the saints more than at any time.”
State TV reported that Iran had deployed teams to screen travelers leaving major cities in 13 provinces, including the capital, Tehran. But Iran has 31 provinces and authorities haven’t taken the step to lock down the country like in the allied nations of Iraq and Lebanon.
The teams check travelers’ temperatures and will send those with fevers to quarantine centers. Iran has been urging people to stay home, but many have ignored the call.
Apparently in efforts to curb the spread of the virus, Iran has released 85,000 prisoners on temporary leave, judiciary spokesman Gholamhossein Esmaili said Tuesday. He said that included half of all “security-related” prisoners, without elaborating. Western nations have called on Iran to release dual nationals and others held allegedly as bargaining chips in negotiations.
Among those released is Mohammad Hossein Karroubi, the son of opposition leader Mehdi Karroubi, who was in jail for nearly two months.
Most people infected by the new coronavirus experience only mild or moderate symptoms, such as fever and cough, and recover within weeks. But the virus is highly contagious and can be spread by people with no visible symptoms. For some, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia.
In Oman, the sultanate announced anyone coming from abroad would be subject to quarantine.
Meanwhile in Israel, the Defense Ministry was to roll out its plan to use near-empty hotel facilities, ravaged by the crash in tourism, as recovery centers for patients diagnosed with COVID-19, the illness caused by the virus.
Two hotels are to begin receiving patients on Tuesday with others likely to follow. The facilities are to be overseen by medical officials with patients quarantined in rooms, and food and other amenities delivered to the rooms by protected hotel staff.
Israel’s Defense Minister Naftali Bennett issued orders Tuesday to allow into Israel only those Palestinian workers and merchants whose work is deemed essential in health, agriculture, nursing and construction. Workers allowed in will stay in Israel for between one and two months.
Also, following an overnight Cabinet approval, Israel’s internal Shin Bet security service said it will begin deploying its phone-tracking technology to combat the spread of the virus. The Shin Bet insisted the use will be limited only to help “save lives” and warn those who have been exposed. Amid secrecy concerns, it said the technology won’t be used to enforce quarantines and the data will only be stored temporarily and available to just a select group of agents. The emergency ordinance will be effective for 30 days.
Coronavirus latest updates: 64-year-old patient passes away at Mumbai's Kasturba hospital, toll rises to 3 in India
The confirmed cases include 22 foreign nationals and two persons who died in Delhi and Karnataka.
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Patanjali fined Rs 75.08 crore for not passing GST benefits to consumers
The authority has directed the company to deposit the amount, along with 18% GST, to consumer welfare funds of Centre and the states within three months, according to an order passed on March 12.
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