npr--2020-03-14--Trump Steps In To Help Oil Industry Facing Its Own Coronavirus Crisis

Trump Steps In To Help Oil Industry Facing Its Own Coronavirus Crisis Oil prices bounced back a bit after President Trump said the Department of Energy would buy crude for the nation 's strategic petroleum reserve .
`` We 're going to fill it right to the top , '' Trump said Friday in a wide-ranging news conference at the White House .
He said it will save taxpayers `` billions and billions of dollars '' while helping an industry that 's been reeling .
While oil prices increased nearly 5 % after Friday 's announcement , that was just @ @ @ @ @ @ @ earlier in the week .
In South Texas , Rudy Martinez immediately experienced the effects of the past week 's collapse in crude oil prices .
`` I actually have a little man camp and these guys are on the way out because they lost contracts , '' says Martinez , who has eight rooms he rents to out-of-town oilfield workers in Karnes City , Texas .
`` The workers get their per-diem and I charge them $ 100 a person [ per week ] .
Actually I 'd like to charge them @ @ @ @ @ @ @ now that it 's tapered off , it 's hard to charge them that because they ca n't pay it , '' he says .
Back when the oil business was really booming in Karnes City , Martinez says he could charge up to $ 2000 a week per person .
This is one small example of what declining oil prices mean for the rural communities that depend on the oil business .
And there 's a lot at stake for the U.S. , the world 's largest producer of crude oil .
@ @ @ @ @ @ @ fears the coronavirus epidemic threatened world economic growth .
Demand was also down as large gatherings were canceled and people started staying home to avoid getting sick .
Then prices plunged after Saudi Arabia and Russia failed to agree on production cuts and instead entered a price war last Sunday .
In a stunning reversal , Saudi Arabia said it would actually boost oil production and offer a massive discount for its customers .
U.S. oil companies , especially smaller ones , are now looking to make deep cuts .
Industry analysts warn @ @ @ @ @ @ @ remains where it 's fallen to , in the $ 30 per barrel range .
Companies operating in Texas 's Eagle Ford Shale need prices between $ 40 to $ 60 a barrel to remain profitable .
'We were here before the oil' Karnes City was transformed by the oil drilling boom that started about a decade back .
Karnes County National Bank President Trip Ruckman says there were local farmers and ranchers who were just getting by , then all of a sudden showed up at his bank with a $ 1 @ @ @ @ @ @ @ Right now it can still look pretty busy around town .
There are trucks on the roads and a few local hotels are still full .
Ruckman says it takes time for drillers to wind down production plans that already were being implemented when prices collapsed .
`` Probably , in a few weeks to a month or two , I think you 're going to see things slow down .
But we 'll still be here — we were here before the oil , '' says Ruckman , who tries to stay @ @ @ @ @ @ @ community .
There have been reports the Trump administration may be willing to help the oil industry in other ways .
For example , the White House could reduce federal royalties for oil pumped on government land or offshore .
The administration could also offer low-interest government-backed loans .
Groups focused on climate change have criticized such ideas .
`` The last people who deserve taxpayers ' money are the billionaires that created and profited from the climate crisis , '' says Jack Shapiro of the environmental group Greenpeace .
One potential bright @ @ @ @ @ @ @ .
Lower oil prices will mean cheaper gas for motorists in coming months .
Usually when gas prices go down people drive more and choose bigger cars , which increases consumption .
But with many limiting travel out of concern over the coronavirus , this time might be the exception .

Trump Steps In To Help Oil Industry Facing Its Own Coronavirus Crisis
Enlarge this image toggle caption Jeff Brady/NPR Jeff Brady/NPR
Oil prices bounced back a bit after President Trump said the Department of Energy would buy crude for the nation's strategic petroleum reserve.
"We're going to fill it right to the top," Trump said Friday in a wide-ranging news conference at the White House. He said it will save taxpayers "billions and billions of dollars" while helping an industry that's been reeling.
While oil prices increased nearly 5% after Friday's announcement, that was just a fraction of the amount they lost earlier in the week.
In South Texas, Rudy Martinez immediately experienced the effects of the past week's collapse in crude oil prices.
"I actually have a little man camp and these guys are on the way out because they lost contracts," says Martinez, who has eight rooms he rents to out-of-town oilfield workers in Karnes City, Texas.
"The workers get their per-diem and I charge them $100 a person [per week]. Actually I'd like to charge them a little more than that, but now that it's tapered off, it's hard to charge them that because they can't pay it," he says.
Back when the oil business was really booming in Karnes City, Martinez says he could charge up to $2000 a week per person.
This is one small example of what declining oil prices mean for the rural communities that depend on the oil business. And there's a lot at stake for the U.S., the world's largest producer of crude oil.
Oil prices had been falling out of fears the coronavirus epidemic threatened world economic growth. Demand was also down as large gatherings were canceled and people started staying home to avoid getting sick.
Then prices plunged after Saudi Arabia and Russia failed to agree on production cuts and instead entered a price war last Sunday. In a stunning reversal, Saudi Arabia said it would actually boost oil production and offer a massive discount for its customers.
U.S. oil companies, especially smaller ones, are now looking to make deep cuts. Industry analysts warn of possible bankruptcies, especially if oil remains where it's fallen to, in the $30 per barrel range. Companies operating in Texas's Eagle Ford Shale need prices between $40 to $60 a barrel to remain profitable.
'We were here before the oil'
Karnes City was transformed by the oil drilling boom that started about a decade back. Karnes County National Bank President Trip Ruckman says there were local farmers and ranchers who were just getting by, then all of a sudden showed up at his bank with a $1 million oil royalty check in hand.
Enlarge this image toggle caption Jeff Brady/NPR Jeff Brady/NPR
Right now it can still look pretty busy around town. There are trucks on the roads and a few local hotels are still full. Ruckman says it takes time for drillers to wind down production plans that already were being implemented when prices collapsed.
"Probably, in a few weeks to a month or two, I think you're going to see things slow down. But we'll still be here — we were here before the oil," says Ruckman, who tries to stay optimistic about the financial future of his community.
There have been reports the Trump administration may be willing to help the oil industry in other ways. For example, the White House could reduce federal royalties for oil pumped on government land or offshore. The administration could also offer low-interest government-backed loans.
Groups focused on climate change have criticized such ideas.
"The last people who deserve taxpayers' money are the billionaires that created and profited from the climate crisis," says Jack Shapiro of the environmental group Greenpeace.
One potential bright spot in all this is gasoline prices. Lower oil prices will mean cheaper gas for motorists in coming months.
Usually when gas prices go down people drive more and choose bigger cars, which increases consumption. But with many limiting travel out of concern over the coronavirus, this time might be the exception.


npr--2020-03-14--Australia's Fire-Ravaged Forests are Recovering. Ecologists Hope It Lasts

In the back corner of a burned lot in Australia 's fire-ravaged South Coast stands a torched tree .
It 's uppermost branches reach into a cloudless sky , brittle and bare .
Against its charred trunk rests half-burned rubble , remains from the gift shop it used to shade .
But that 's not where local resident Claire Polach is pointing .
She gestures to the middle part of the tree , where lime green leaves sprout from blackened bark , as if the tree is wearing a shaggy sweater .
To Polach , the burst of regrowth is @ @ @ @ @ @ @ long assault of flame and smoke , the second-hottest summer on record and a multi-year drought , Australia 's nature `` is doing it 's thing . ''
As for people like her , recovering from the same ?
`` We 'll follow the nature , '' she says .
This cycle of fire , rain and recovery has played out in Australia for millennia .
The majority of the country 's forests are uniquely adapted to fire .
Some species need it .
`` Australia is , more than any other , @ @ @ @ @ @ @ and historian Stephen Pyne in his book `` World Fire . ''
But scientists have long warned that a warming climate could mean more severe fires , more often .
Now there are concerns that even a fire continent will struggle to recover from the scale and severity of recent events .
New research published in the journal Nature Climate Change found that a staggering 21 percent of Australia 's forested area burned in the 2019-2020 fire season , a figure the authors say is `` globally unprecedented '' and may indicate `` @ @ @ @ @ @ @ under climate change has arrived earlier than anticipated . ''
The question now is whether Australia 's nature can keep pace .
His eyes on a narrow dirt road in front of him , Colin Brown gestures his head at the walls of burned trees passing on either side of his rumbling fire tanker .
`` Good way to assess how bad the fire was is the scorch marks on the trees , '' he says .
Two trucks ahead of him is a team of ecologists from the Australian National University , @ @ @ @ @ @ @ the damage caused by a recent fire .
Brown , a deputy captain with the Rural Fire Service in New South Wales , already has a pretty good idea of it .
He , like tens of thousands of other volunteer firefighters , has spent the last few months chasing flames across eastern Australia 's eucalypt-covered mountains , doing what he could to protect homes , ranches and other people tucked between .
`` It 's always difficult in Australia because the whole climate is drought and fire , '' Brown says , @ @ @ @ @ @ @ the surrounding trees .
`` But what we 're seeing is more intense drought and more intense fires . ''
A recent study by a group of international scientists confirmed what Brown and many others suspected : human-caused climate change contributed to the conditions they saw over the last few months , making them 30 percent more likely .
`` The weather 's just different , '' Brown says .
Outside , the scorch marks now reach the tops of the trees .
The ground below is littered with fallen logs and dead @ @ @ @ @ @ @ puts on a helmet , a caution against any weakened trees that have yet to fall .
The team of ecologists spreads out in the forest .
Some gather around a firefighter who 's showing videos of the blaze on his cellphone .
Michael Doherty , a plant ecologist , walks to the base of a charred tree about 50 yards off the road .
It 's a young brown barrel , he says , `` a eucalypt and it 's showing a flash of epicormic growth after the fires . ''
His @ @ @ @ @ @ @ a cluster of olive green leaves that 's sprouting from the tree 's trunk at about chest height .
It 's a response to damage from the fire , Doherty says , and proof that the tree is n't actually dead .
It 's canopy has been scorched , killing its leaves , but dormant buds were waiting beneath its bark .
These epicormic shoots allow the tree to continue gathering sunlight and photosynthesize , keeping it alive while the canopy recovers .
The burst of regrowth is n't surprising to Doherty , @ @ @ @ @ @ @ to recover after bushfire .
But he says he is encouraged .
`` Notwithstanding climate change , we 're still seeing the ecosystems recover as we might expect they would , '' he says .
Whether they 'll continue to recover , he says , is more uncertain .
A chief concern for ecologists is that as the climate warms and fire conditions become more common , the time between wildfire events will shorten .
This is problematic for species that have evolved to cope with fire on an irregular basis .
`` @ @ @ @ @ @ @ fires , this vegetation might not have the break it needs to [ fully ] recover , '' says Marta Yebra , a research fellow from ANU who studies fire severity .
Compounding the problem , as climate change brings hotter temperatures and more erratic precipitation , recovery for some species might take longer than normal .
That could give less dominant species an upper-hand .
Scientists have already documented this happening in the Western U.S. Patches of California 's Sierra Nevada forests are morphing from mixed conifer to shrub fields .
Ecologists @ @ @ @ @ @ @ the Greater Yellowstone Area could become more permanent grassland .
Research in Australia has found that shrub growth after severe fires can promote further fire , creating the potential for a runaway effect .
`` Far from seeing ecosystem collapse , I think we could see ecosystem change , '' Doherty says .
`` And that change may or may not be desirable from a human point of view . ''
Desirable in that a forest will still exist .
Not desirable in that some of the species humans love may not .
@ @ @ @ @ @ @ icon : the koala .
A recent report by the International Fund for Animal Welfare , a global conservation group , estimated that nearly 4,000 koalas were killed in New South Wales in the recent fires .
The report says that should be viewed as a low estimate because it only accounts for part of the fire season , and does n't take into consideration longer-term impacts like the loss of habitat and food .
Koalas are slow-moving marsupials that live in trees , which makes them particularly at risk of bushfire .
@ @ @ @ @ @ @ escape flames , and they 're limited in their ability to relocate after a fire to more suitable habitat .
At a makeshift rescue facility at the Australian National University , biologists from the university are taking care of koalas that were rescued from the fires - some before the flames reached them , others after .
Those that have been brought in after the fires `` are just skin and bone , '' says Dr. Kara Youngentob , whose helping care for the rescued koalas .
In one cage , a male @ @ @ @ @ @ @ hands in his lap .
The koala has been named Paul , after one of the American firefighters who died while assisting in the past season 's fires .
The skin on its hands is still pink .
Bandages were removed just a few days before .
The goal is to rehabilitate Paul and the other koalas at this facility until they 're ready to be reintroduced into the surrounding bush , a task made more difficult by the scale of the fires .
Already , koalas and many of Australia 's other @ @ @ @ @ @ @ of human threats : vehicles , habitat loss , invasive species and disease .
The Australian government recently released a report identifying 113 animal species that are in need of `` urgent help . ''
Human-caused climate change is just the latest blow .
Ecologists have known for a long time that a warming climate would mean significant changes for ecosystems and people , Youngentob says .
`` The question was just a matter of what the scale was going to be . ''
She pauses , as a baby koala clings to @ @ @ @ @ @ @ .
`` I think we 're seeing what that scale can be , '' she says .
`` And much faster than we thought we would . ''

Australia's Fire-Ravaged Forests Are Recovering. Ecologists Hope It Lasts
Enlarge this image toggle caption Nathan Rott/NPR Nathan Rott/NPR
Updated on March 17 at 9:02 p.m. ET
In the back corner of a burned lot in Australia's fire-ravaged South Coast stands a torched tree. It's uppermost branches reach into a cloudless sky, brittle and bare. Against its charred trunk rests half-burned rubble, remains from the gift shop it used to shade.
But that's not where local resident Claire Polach is pointing. She gestures to the middle part of the tree, where lime green leaves sprout from blackened bark, as if the tree is wearing a shaggy sweater.
To Polach, the burst of regrowth is a sign that despite a months' long assault of flame and smoke, the second-hottest summer on record and a multi-year drought, Australia's nature "is doing it's thing."
As for people like her, recovering from the same? "We'll follow the nature," she says.
toggle caption Nathan Rott/NPR
This cycle of fire, rain and recovery has played out in Australia for millennia. The majority of the country's forests are uniquely adapted to fire. Some species need it. "Australia is, more than any other, a fire continent," writes ecologist and historian Stephen Pyne in his book "World Fire."
But scientists have long warned that a warming climate could mean more severe fires, more often. Now there are concerns that even a fire continent will struggle to recover from the scale and severity of recent events.
New research published in the journal Nature Climate Change found that a staggering 21 percent of Australia's forested area burned in the 2019-2020 fire season, a figure the authors say is "globally unprecedented" and may indicate "the more flammable future projected to eventuate under climate change has arrived earlier than anticipated."
The question now is whether Australia's nature can keep pace.
toggle caption Nathan Rott/NPR
Recovering for now
His eyes on a narrow dirt road in front of him, Colin Brown gestures his head at the walls of burned trees passing on either side of his rumbling fire tanker.
"Good way to assess how bad the fire was is the scorch marks on the trees," he says. Two trucks ahead of him is a team of ecologists from the Australian National University, here in Tallaganda National Park to survey the damage caused by a recent fire.
Brown, a deputy captain with the Rural Fire Service in New South Wales, already has a pretty good idea of it. He, like tens of thousands of other volunteer firefighters, has spent the last few months chasing flames across eastern Australia's eucalypt-covered mountains, doing what he could to protect homes, ranches and other people tucked between.
"It's always difficult in Australia because the whole climate is drought and fire," Brown says, as the torch marks climb higher in the surrounding trees. "But what we're seeing is more intense drought and more intense fires."
toggle caption Nathan Rott/NPR
A recent study by a group of international scientists confirmed what Brown and many others suspected: human-caused climate change contributed to the conditions they saw over the last few months, making them 30 percent more likely. "The weather's just different," Brown says.
Outside, the scorch marks now reach the tops of the trees. The ground below is littered with fallen logs and dead leaves. Brown stops the engine and puts on a helmet, a caution against any weakened trees that have yet to fall.
The team of ecologists spreads out in the forest. Some gather around a firefighter who's showing videos of the blaze on his cellphone.
Michael Doherty, a plant ecologist, walks to the base of a charred tree about 50 yards off the road. It's a young brown barrel, he says, "a eucalypt and it's showing a flash of epicormic growth after the fires."
toggle caption Nathan Rott/NPR
His fingers run through that epicormic growth — a cluster of olive green leaves that's sprouting from the tree's trunk at about chest height. It's a response to damage from the fire, Doherty says, and proof that the tree isn't actually dead.
It's canopy has been scorched, killing its leaves, but dormant buds were waiting beneath its bark. These epicormic shoots allow the tree to continue gathering sunlight and photosynthesize, keeping it alive while the canopy recovers.
The burst of regrowth isn't surprising to Doherty, whose research focuses on forests' ability to recover after bushfire. But he says he is encouraged.
"Notwithstanding climate change, we're still seeing the ecosystems recover as we might expect they would," he says.
Whether they'll continue to recover, he says, is more uncertain.
A different landscape
A chief concern for ecologists is that as the climate warms and fire conditions become more common, the time between wildfire events will shorten. This is problematic for species that have evolved to cope with fire on an irregular basis.
"If we get more and more frequent fires, this vegetation might not have the break it needs to [fully] recover," says Marta Yebra, a research fellow from ANU who studies fire severity.
Compounding the problem, as climate change brings hotter temperatures and more erratic precipitation, recovery for some species might take longer than normal. That could give less dominant species an upper-hand.
Enlarge this image toggle caption Nathan Rott/NPR Nathan Rott/NPR
Scientists have already documented this happening in the Western U.S.
Patches of California's Sierra Nevada forests are morphing from mixed conifer to shrub fields. Ecologists say the lodgepole pine forests that dominate the Greater Yellowstone Area could become more permanent grassland.
Research in Australia has found that shrub growth after severe fires can promote further fire, creating the potential for a runaway effect.
"Far from seeing ecosystem collapse, I think we could see ecosystem change," Doherty says. "And that change may or may not be desirable from a human point of view."
Desirable in that a forest will still exist. Not desirable in that some of the species humans love may not.
Skin and bone
One of those species is an Australian icon: the koala.
A recent report by the International Fund for Animal Welfare, a global conservation group, estimated that at least 4,000 koalas — and as many as 5,000 — were killed in New South Wales in the recent fires. The report considers longer-term impacts like the loss of habitat and food.
toggle caption Nathan Rott/NPR
Koalas are slow-moving marsupials that live in trees, which makes them particularly at risk of bushfire. They're limited in their ability to escape flames, and they're limited in their ability to relocate after a fire to more suitable habitat.
At a makeshift rescue facility at the Australian National University, biologists from the university are taking care of koalas that were rescued from the fires - some before the flames reached them, others after.
Those that have been brought in after the fires "are just skin and bone," says Dr. Kara Youngentob, whose helping care for the rescued koalas.
Others were burned.
In one cage, a male koala sits on the ground cradling his hands in his lap. The koala has been named Paul, after one of the American firefighters who died while assisting in the past season's fires. The skin on its hands is still pink. Bandages were removed just a few days before.
The goal is to rehabilitate Paul and the other koalas at this facility until they're ready to be reintroduced into the surrounding bush, a task made more difficult by the scale of the fires.
toggle caption Nathan Rott/NPR
Already, koalas and many of Australia's other endemic species have dealt with a multitude of human threats: vehicles, habitat loss, invasive species and disease. The Australian government recently released a report identifying 113 animal species that are in need of "urgent help."
Human-caused climate change is just the latest blow.
Ecologists have known for a long time that a warming climate would mean significant changes for ecosystems and people, Youngentob says. "The question was just a matter of what the scale was going to be."
She pauses, as a baby koala clings to an adopted parent in a nearby cage.
"I think we're seeing what that scale can be," she says. "And much faster than we thought we would."


npr--2020-03-14--As The Pandemic Spreads, Will There Be Enough Ventilators?

As The Pandemic Spreads , Will There Be Enough Ventilators ?
As the coronavirus that causes COVID-19 spreads across the United States , there are continuing concerns among hospitals , public health experts and government leaders that hospital intensive care units would be hard-pressed to handle a surge in seriously ill patients .
A key limiting factor to being able to provide good care , they say , is the number of ventilation machines — ventilators — a hospital has on hand to help the most seriously ill patients breathe .
`` The coronavirus , like many respiratory viruses , @ @ @ @ @ @ @ '' explains Dr. William Graham Carlos a pulmonary critical care specialist at Indiana University School of Medicine `` And when the lungs become inflamed , the membranes that transfer oxygen from the air into the blood become blocked . ''
When patients develop this type of viral pneumonia , they often require bedside ventilators which , Carlos says `` can supply higher levels of oxygen and also help push air into the lungs to open them up , and afford more opportunity to get oxygen into the patient . ''
Ventilators are generally @ @ @ @ @ @ @ patients in critical care who need them do get better .
These machines can be crucial to sustaining life in certain emergency situations .
And if there is a surge in seriously ill patients , as COVID-19 spreads , ventilators could be in short supply , from hospital to hospital or nationally .
And if there 's an increase in very sick patients on a scale like what happened in China , Dr. Eric Toner says , the U.S. is not prepared .
Toner studies hospital preparedness for pandemics at the Johns Hopkins @ @ @ @ @ @ @ are not prepared , nor is any place prepared for a Wuhan-like outbreak , '' Toner tells NPR , `` and we would see the same sort of bad outcomes that they saw in Wuhan — with a very high case fatality rate , due largely to people not being able to access the needed intensive care . ''
Toner says all hospitals have some lifesaving ventilators , but that number is proportional to the number of hospital beds in the institution .
An average-sized hospital with 150 beds , for example , @ @ @ @ @ @ @ were needed , hospitals that need them could rent them , he says — at least for now .
But if there 's a surge of need in a particular community — patients with serious pneumonia from COVID-19 or pneumonia related to flu , for example — all hospitals in the area would be competing to rent from the same place .
`` So that 's a very finite resource '' he says .
The latest study available estimates there are about 62,000 ventilators in hospitals nationwide .
That figure is seven years @ @ @ @ @ @ @ be higher .
There are also some machines in federally stockpiled emergency supplies , though the exact number is n't public .
`` There is a strategic national stockpile of ventilators , but the numbers are classified , '' says Toner .
It 's been `` publicly stated , '' he says , that there are about 10,000 ventilators in the national stockpile .
`` That number might be a bit outdated , but it 's probably about right , '' he says .
Other estimates range from 4,000 to somewhat less than @ @ @ @ @ @ @ be an important addition , Toner says it likely would n't be enough to sustain the entire country through an experience like that seen in Wuhan , China .
If there 's not enough capacity at one hospital , it may be possible to transfer patients to another , he says .
`` Not every community is going to be hit simultaneously ; some cities will be badly affected while others are not so badly affected and then the wave of disease will move on . ''
So , in some cases , @ @ @ @ @ @ @ patients could be transferred from an area where ventilators are scarce to an area where the supply is adequate .
But if hospitals continue to be overwhelmed , he says , at that point , `` tough decisions would have to be made about who gets access to a ventilator and who does not . ''
All health care providers and hospitals are now working overtime to try to prevent that sort of scenario .
Dr. Craig Coopersmith with Emory University School of Medicine , and a spokesperson for the Society of Critical @ @ @ @ @ @ @ all across America that medical communities are working together to prepare .
Evergreen Hospital in Washington State , for example , which treated some of the first U.S. COVID-19 patients in late February , this week posted online its own `` Lessons for Hospitals . ''
There has been a lot of ongoing communication , Coopersmith says , between hospitals , professional societies and individuals — in person , by phone and via shared Listservs and social media .
`` In multiple ways , people are linking with each other to say ' @ @ @ @ @ @ @ in isolation ; tell me how you 're doing this , let me tell you how I 'm doing this and let 's share lessons with each other , ' `` Coopersmith says .
The pandemic , he adds , is `` remarkably challenging .
But he sees the health care system 's response to it as remarkably heartening , `` with everyone working together to ensure what 's best for patients , caregivers and the community . ''

As The Pandemic Spreads, Will There Be Enough Ventilators?
Enlarge this image toggle caption Taechit Taechamanodom/Getty Images Taechit Taechamanodom/Getty Images
As the coronavirus that causes COVID-19 spreads across the United States, there are continuing concerns among hospitals, public health experts and government leaders that hospital intensive care units would be hard-pressed to handle a surge in seriously ill patients.
A key limiting factor to being able to provide good care, they say, is the number of ventilation machines — ventilators — a hospital has on hand to help the most seriously ill patients breathe.
"The coronavirus, like many respiratory viruses, can cause inflammation in the lungs," explains Dr. William Graham Carlos a pulmonary critical care specialist at Indiana University School of Medicine "And when the lungs become inflamed, the membranes that transfer oxygen from the air into the blood become blocked."
When patients develop this type of viral pneumonia, they often require bedside ventilators which, Carlos says "can supply higher levels of oxygen and also help push air into the lungs to open them up, and afford more opportunity to get oxygen into the patient."
Ventilators are generally a temporary bridge to recovery — many patients in critical care who need them do get better. These machines can be crucial to sustaining life in certain emergency situations. And if there is a surge in seriously ill patients, as COVID-19 spreads, ventilators could be in short supply, from hospital to hospital or nationally.
And if there's an increase in very sick patients on a scale like what happened in China, Dr. Eric Toner says, the U.S. is not prepared. Toner studies hospital preparedness for pandemics at the Johns Hopkins Center for Health Security.
"We are not prepared, nor is any place prepared for a Wuhan-like outbreak," Toner tells NPR, "and we would see the same sort of bad outcomes that they saw in Wuhan — with a very high case fatality rate, due largely to people not being able to access the needed intensive care."
Toner says all hospitals have some lifesaving ventilators, but that number is proportional to the number of hospital beds in the institution. An average-sized hospital with 150 beds, for example, might have 20 ventilators. If more were needed, hospitals that need them could rent them, he says — at least for now. But if there's a surge of need in a particular community — patients with serious pneumonia from COVID-19 or pneumonia related to flu, for example — all hospitals in the area would be competing to rent from the same place. "So that's a very finite resource" he says.
The latest study available estimates there are about 62,000 ventilators in hospitals nationwide. That figure is seven years old — so the actual number could be higher.
There are also some machines in federally stockpiled emergency supplies, though the exact number isn't public.
"There is a strategic national stockpile of ventilators, but the numbers are classified," says Toner. It's been "publicly stated," he says, that there are about 10,000 ventilators in the national stockpile. "That number might be a bit outdated, but it's probably about right," he says. Other estimates range from 4,000 to somewhat less than 10,000.
While any extra ventilators would be an important addition, Toner says it likely wouldn't be enough to sustain the entire country through an experience like that seen in Wuhan, China.
If there's not enough capacity at one hospital, it may be possible to transfer patients to another, he says.
"Not every community is going to be hit simultaneously; some cities will be badly affected while others are not so badly affected and then the wave of disease will move on." So, in some cases, Toner says, it seems likely that patients could be transferred from an area where ventilators are scarce to an area where the supply is adequate.
But if hospitals continue to be overwhelmed, he says, at that point, "tough decisions would have to be made about who gets access to a ventilator and who does not."
All health care providers and hospitals are now working overtime to try to prevent that sort of scenario.
Dr. Craig Coopersmith with Emory University School of Medicine, and a spokesperson for the Society of Critical Care Medicine, says he sees signs all across America that medical communities are working together to prepare.
Evergreen Hospital in Washington State, for example, which treated some of the first U.S. COVID-19 patients in late February, this week posted online its own "Lessons for Hospitals." There has been a lot of ongoing communication, Coopersmith says, between hospitals, professional societies and individuals — in person, by phone and via shared Listservs and social media.
"In multiple ways, people are linking with each other to say 'I'm not going to do this in isolation; tell me how you're doing this, let me tell you how I'm doing this and let's share lessons with each other,' " Coopersmith says.
The pandemic, he adds, is "remarkably challenging. But he sees the health care system's response to it as remarkably heartening, "with everyone working together to ensure what's best for patients, caregivers and the community."


npr--2020-03-14--Judge Blocks Rule That Would Have Kicked 700,000 People Off SNAP

Judge Blocks Rule That Would Have Kicked 700,000 People Off SNAP A federal judge has issued an injunction blocking the Trump administration from adopting a rule change that would force nearly 700,000 Americans off food stamps , officially known as the Supplemental Nutrition Assistance Program , or SNAP .
The rule change was set to take April 1 .
In a ruling issued Friday evening in Washington , D.C. , U.S. District Court Judge Beryl Howell called the rule change capricious , arbitrary and likely unlawful .
The rule change would have required able-bodied adults without children to work at @ @ @ @ @ @ @ to qualify for SNAP benefits past three months .
It would also have limited states ' usual ability to waive those requirements depending on economic conditions .
The preliminary injunction will preserve that flexibility .
Critics have called on the U.S. Department of Agriculture to suspend implementation of the new rule , especially in light of the economic crisis spurred by the coronavirus pandemic .
Earlier this week , Agriculture Secretary Sonny Perdue said the department planned to move ahead with the rule .
In her ruling , Howell cited concerns raised by @ @ @ @ @ @ @ on the most vulnerable Americans .
`` Especially now , as a global pandemic poses widespread health risks , guaranteeing that government officials at both the federal and state levels have flexibility to address the nutritional needs of residents and ensure their well-being through programs like SNAP , is essential , '' she wrote .
The change to SNAP is now blocked from taking effect pending the outcome of a lawsuit by 19 states plus the District of Columbia and New York City .
`` This is a major victory for our country @ @ @ @ @ @ @ SNAP to eat , '' D.C. Attorney General Karl A. Racine , who co-led the coalition behind the lawsuit , said in a statement .
`` The Trump administration 's rule would have forced hundreds of thousands of people who could not find work , including 13,000 District residents , to go hungry .
That could have been catastrophic in the midst of our current public health emergency . ''

Judge Blocks Rule That Would Have Kicked 700,000 People Off SNAP
Enlarge this image toggle caption Portland Press Herald via Getty Images Portland Press Herald via Getty Images
A federal judge has issued an injunction blocking the Trump administration from adopting a rule change that would force nearly 700,000 Americans off food stamps, officially known as the Supplemental Nutrition Assistance Program, or SNAP. The rule change was set to take effect April 1.
In a ruling issued Friday evening in Washington, D.C., U.S. District Court Judge Beryl Howell called the rule change capricious, arbitrary and likely unlawful.
The rule change would have required able-bodied adults without children to work at least 20 hours a week in order to qualify for SNAP benefits past three months. It would also have limited states' usual ability to waive those requirements depending on economic conditions. The preliminary injunction will preserve that flexibility.
The U.S. Department of Agriculture announced it was adopting the rule change in December, but critics have called on the department to suspend implementation, especially in light of the economic crisis spurred by the coronavirus pandemic. Earlier this week, Agriculture Secretary Sonny Perdue said the department planned to move ahead with the rule.
While the rule applies to "able-bodied adults without dependents," anti-hunger advocates note that category can include parents who don't have primary custody of their kids, youths who have recently aged out of foster care and some low-income college students.
In her ruling, Howell cited concerns raised by the spread of coronavirus and its effect on the most vulnerable Americans. "Especially now, as a global pandemic poses widespread health risks, guaranteeing that government officials at both the federal and state levels have flexibility to address the nutritional needs of residents and ensure their well-being through programs like SNAP, is essential," she wrote.
The change to SNAP is now blocked from taking effect pending the outcome of a lawsuit by 19 states plus the District of Columbia and New York City.
"This is a major victory for our country's most vulnerable residents who rely on SNAP to eat," D.C. Attorney General Karl A. Racine, who co-led the coalition behind the lawsuit, said in a statement. "The Trump administration's rule would have forced hundreds of thousands of people who could not find work, including 13,000 District residents, to go hungry. That could have been catastrophic in the midst of our current public health emergency."
"At a time of national crisis, this decision is a win for common sense and basic human decency," New York Attorney General Letitia James, who co-led the coalition with Racine, said in a statement. Her office noted that the change would have denied SNAP benefits to more than 50,000 people in New York City alone.
"As we find ourselves in the midst of a pandemic," James said, "the effects of this rule would be more destructive than ever."


npr--2020-03-13--Special Report: COVID-19 - What You Need To Know About Coronavirus

Special Report : COVID-19 - What You Need To Know About Coronavirus Host Lulu Garcia-Navarro shares some of NPR 's @ @ @ @ @ on coronavirus in a single special report .
This special addresses three key questions : @ @ @ @ @ virus itself and how it behaves ?
How are institutions , such as schools , @ @ @ @ @ industry , responding ?
And how can you protect yourself and your household ?
NPR @ @ @ @ @ answers .

Special Report: What You Need To Know About Coronavirus
Enlarge this image toggle caption Michael Dwyer/AP Michael Dwyer/AP
The new strain of coronavirus that has raced around the world, sickening and killing thousands of people, is now disrupting daily life across the United States. The White House has declared a national emergency, and nearly everyone has questions: How does the virus work? How should my school or business respond? What can I do to protect my household?
This special NPR report provides some answers.
Scientists say there's still a lot to learn about how this coronavirus behaves. It can be transmitted person to person, but also can live on some surfaces. NPR's Maria Godoy reports that about 80% percent of the cases are mild, with fever and cough as the most prominent symptoms. In some, that respiratory infection becomes more complicated and even fatal.
Experts in the U.S. are keeping an eye on what has worked – or hasn't – in other countries to help gauge an effective response. As school, religious services, conferences and sporting events are canceled nationwide, NPR's Nell Greenfieldboyce reports that health officials are dipping into a huge national stockpile of medical supplies to help.
Meanwhile, many Americans have been stockpiling supplies, arming themselves against the virus with hand sanitizer, dust masks and respirators. Do those things work? NPR's Joe Palca says they may, but not if you don't know how to use them.
Host Lulu Garcia-Navarro shares some of NPR's most practical and explanatory reporting on the novel coronavirus and COVID-19, the disease it causes, to tell you what you need to know about this growing threat.
Click the "Listen" button above to hear this NPR special.


npr--2020-03-13--No Need To Test Trump For Coronavirus, White House Doctor Says

No Need To Test Trump For Coronavirus , White House Doctor Says Updated at 12:28 a.m .
ET A day after his communications secretary went into quarantine after testing positive for coronavirus , Brazilian President Jair Bolsonaro on Friday moved swiftly to shoot down local news reports that he too had tested positive .
That was good news for President Trump .
`` Negative for COVID-19 , the Honorable President of the Republic , Jair Bolsonaro , '' the Brazilian president wrote on his official Twitter account .
`` DO N'T BELIEVE IN THE FAKE NEWS MEDIA . ''
Bolsonaro @ @ @ @ @ @ @ closely in Washington , six days after the Brazilian leader dined at Trump 's Mar-a-Lago resort with Trump , Vice President Pence , Trump 's daughter Ivanka and son-in-law Jared Kushner , and former New York City mayor Rudolph Giuliani .
Fabio Wajngarten , the coronavirus-infected Bolsonaro communications chief , had posed alongside Trump for a photo taken at the dinner .
Friday night Brazil said its charge d'affairs Nestor Forster , who was with Trump and Bolsonaro at the dinner , had also tested positive and had already been quarantining himself .
@ @ @ @ @ @ @ Prevention recommends in its coronavirus guidelines that people consider restricting their movements if they have been exposed to a confirmed case of COVID-19 but show no symptoms .
So far none of the federal officials who met with Brazil 's Bolsonaro and his infected communications secretary or Australia 's COVID-19 positive Dutton are known to have been infected .
Sens .
Lindsey Graham , R-S.C. , and Rick Scott , R-Fla. , met at the Florida dinner with Bolsonaro and both said they would self-quarantine .
Miami Mayor Francis Suarez , who met @ @ @ @ @ @ @ announced Thursday he had chosen to self-quarantine .
On Friday , Suarez revealed he had tested positive for coronavirus and recommended that people take precautions if he had shaken their hand or sneezed near them .
Trump , however , has shown no inclination to isolate himself after his weekend encounter with Bolsonaro 's communications secretary .
`` I take pictures and it lasts for literally seconds — I do n't know the gentleman that we 're talking about , I have no idea who he is , '' Trump said Friday when @ @ @ @ @ @ @ `` Now , I did sit with the president for probably two hours , but he 's tested negative , so that 's good . ''
The president was asked at a news conference in the Rose Garden of the White House on Friday afternoon if he was being selfish by not getting tested and potentially exposing others .
`` Well , I did n't say I was n't going to be tested , '' Trump replied .
Pressed on the point , Trump said , `` Most likely , yeah .
Most @ @ @ @ @ @ @ but because I think I will do it anyway . ''
But Friday night , Dr. Sean Conley , physician to the president , issued a statement saying Trump is at low risk for COVID-19 because his contact with the one of the infected individuals was `` extremely limited ( photograph , handshakes ) , '' and `` all interactions [ with the other person ] occurred before any symptom onset . ''
Trump himself has no symptoms and need not self-quarantine or even be tested , Conley said , but the doctor @ @ @ @ @ @ @ News ' Cecilia Vega on Friday whether Trump should be self-monitoring or in isolation getting tested , Dr. Anthony Fauci , the top infectious disease expert at the National Institutes of Health , demurred .
`` I leave that to the president 's White House physician who is an extremely competent individual who I know well , '' Fauci said .
But when pressed on whether if he himself would get tested if he came into contact with someone who had tested positive , Fauci was somewhat more forthcoming .
`` Likely I @ @ @ @ @ @ @ .
It depends on the circumstances , '' Fauci said .
`` We should follow the guidelines of the CDC about when you are at a risk what you should do . ''
A few days earlier , Ivanka Trump , U.S. Attorney General William Barr and acting Homeland Security Secretary Chad Wolf met in Washington with Australian Home Affairs Minister Peter Dutton .
On Friday Dutton , who had also met with White House counselor Kellyanne Conway , announced he had tested positive for coronavirus .
`` This morning I woke up @ @ @ @ @ @ @ .
I immediately contacted the Queensland Department of Health and was subsequently tested for COVID-19 , '' Dutton , who was hospitalized in Brisbane , wrote .
`` I feel fine and will provide an update in due course . ''
Whatever Trump 's plans regarding the virus , his daughter appeared to be taking precautions after learning Australia 's Dutton had tested positive for coronavirus eight days after meeting with her .
`` Exposures from the case were assessed and the White House Medical Unit confirmed , in accordance with CDC guidance @ @ @ @ @ @ @ and does not need to self-quarantine , '' White House deputy press secretary Judd Deere said in a statement .
`` She worked from home today out of an abundance of caution until guidance was given . ''
On Thursday evening , two days after declaring in Miami that the coronavirus outbreak `` is not all the mainstream media makes it out to be , '' Brazil 's Bolsonaro delivered nationally broadcast remarks about the pandemic while wearing a protective mask .
`` That coronavirus , it 's scary , '' Bolsonaro , @ @ @ @ @ @ @ religious evangelicals , exclaimed before giving a hand-washing demonstration using a squirt of hand sanitizer .
`` We ask God that this problem quickly dissipates from this country , and that everyone gets back to normal life . ''
And confirmation of his coronavirus infection comes at an awkward time for Australia 's Dutton , who last week was dismissing complaints of unsanitary conditions from some of the 240 Australians evacuated from China whom he had sent to remote Christmas Island for quarantine .
`` I think frankly , overwhelmingly , except for @ @ @ @ @ @ @ people are complimentary of what has happened , '' he said last month .
`` Should n't you be quarantined on Christmas Island ? ''
one wag on Twitter queried after Dutton became Australia 's first cabinet member to test positive for coronavirus .

No Need To Test Trump For Coronavirus, White House Doctor Says
Enlarge this image toggle caption Chip Somodevilla/Getty Images Chip Somodevilla/Getty Images
Updated at 12:28 a.m. ET
A day after his communications secretary went into quarantine after testing positive for coronavirus, Brazilian President Jair Bolsonaro on Friday moved swiftly to shoot down local news reports that he too had tested positive. That was good news for President Trump.
"Negative for COVID-19, the Honorable President of the Republic, Jair Bolsonaro," the Brazilian president wrote on his official Twitter account. "DON'T BELIEVE IN THE FAKE NEWS MEDIA."
Bolsonaro's coronavirus test results were being watched closely in Washington, six days after the Brazilian leader dined at Trump's Mar-a-Lago resort with Trump, Vice President Pence, Trump's daughter Ivanka and son-in-law Jared Kushner, and former New York City mayor Rudolph Giuliani.
Fabio Wajngarten, the coronavirus-infected Bolsonaro communications chief, had posed alongside Trump for a photo taken at the dinner.
Friday night Brazil said its charge d'affairs Nestor Forster, who was with Trump and Bolsonaro at the dinner, had also tested positive and had already been quarantining himself.
Well, I didn't say I wasn't going to be tested.
The U.S. Centers for Disease Control and Prevention recommends in its coronavirus guidelines that people consider restricting their movements if they have been exposed to a confirmed case of COVID-19 but show no symptoms.
So far none of the federal officials who met with Brazil's Bolsonaro and his infected communications secretary or Australia's COVID-19 positive Dutton are known to have been infected.
Sens. Lindsey Graham, R-S.C., and Rick Scott, R-Fla., met at the Florida dinner with Bolsonaro and both said they would self-quarantine.
Miami Mayor Francis Suarez, who met with Bolsonaro in Miami on Monday, announced Thursday he had chosen to self-quarantine.
On Friday, Suarez revealed he had tested positive for coronavirus and recommended that people take precautions if he had shaken their hand or sneezed near them.
Trump, however, has shown no inclination to isolate himself after his weekend encounter with Bolsonaro's communications secretary.
"I take pictures and it lasts for literally seconds — I don't know the gentleman that we're talking about, I have no idea who he is," Trump said Friday when asked about his contact with Wajngartner. "Now, I did sit with the president for probably two hours, but he's tested negative, so that's good."
The president was asked at a news conference in the Rose Garden of the White House on Friday afternoon if he was being selfish by not getting tested and potentially exposing others.
"Well, I didn't say I wasn't going to be tested," Trump replied. Pressed on the point, Trump said, "Most likely, yeah. Most likely. Not for that reason, but because I think I will do it anyway."
But Friday night, Dr. Sean Conley, physician to the president, issued a statement saying Trump is at low risk for COVID-19 because his contact with the one of the infected individuals was "extremely limited (photograph, handshakes)," and "all interactions [with the other person] occurred before any symptom onset."
Trump himself has no symptoms and need not self-quarantine or even be tested, Conley said, but the doctor will monitor him.
Asked by ABC News' Cecilia Vega on Friday whether Trump should be self-monitoring or in isolation getting tested, Dr. Anthony Fauci, the top infectious disease expert at the National Institutes of Health, demurred.
"I leave that to the president's White House physician who is an extremely competent individual who I know well," Fauci said.
But when pressed on whether if he himself would get tested if he came into contact with someone who had tested positive, Fauci was somewhat more forthcoming.
"Likely I would, but I'm not sure. It depends on the circumstances," Fauci said. "We should follow the guidelines of the CDC about when you are at a risk what you should do."
A few days earlier, Ivanka Trump, U.S. Attorney General William Barr and acting Homeland Security Secretary Chad Wolf met in Washington with Australian Home Affairs Minister Peter Dutton. On Friday Dutton, who had also met with White House counselor Kellyanne Conway, announced he had tested positive for coronavirus.
"This morning I woke up with a temperature and a sore throat. I immediately contacted the Queensland Department of Health and was subsequently tested for COVID-19," Dutton, who was hospitalized in Brisbane, wrote. "I feel fine and will provide an update in due course."
Whatever Trump's plans regarding the virus, his daughter appeared to be taking precautions after learning Australia's Dutton had tested positive for coronavirus eight days after meeting with her.
"Exposures from the case were assessed and the White House Medical Unit confirmed, in accordance with CDC guidance, that Ivanka is exhibiting no symptoms and does not need to self-quarantine," White House deputy press secretary Judd Deere said in a statement. "She worked from home today out of an abundance of caution until guidance was given."
On Thursday evening, two days after declaring in Miami that the coronavirus outbreak "is not all the mainstream media makes it out to be," Brazil's Bolsonaro delivered nationally broadcast remarks about the pandemic while wearing a protective mask.
"That coronavirus, it's scary," Bolsonaro, a hardline conservative with strong support from religious evangelicals, exclaimed before giving a hand-washing demonstration using a squirt of hand sanitizer. "We ask God that this problem quickly dissipates from this country, and that everyone gets back to normal life."
And confirmation of his coronavirus infection comes at an awkward time for Australia's Dutton, who last week was dismissing complaints of unsanitary conditions from some of the 240 Australians evacuated from China whom he had sent to remote Christmas Island for quarantine.
"I think frankly, overwhelmingly, except for one photo of one cockroach, most people are complimentary of what has happened," he said last month.
"Shouldn't you be quarantined on Christmas Island?" one wag on Twitter queried after Dutton became Australia's first cabinet member to test positive for coronavirus.


npr--2020-03-13--Flattening A Pandemic's Curve: Why Staying Home Now Can Save Lives

Flattening A Pandemic 's Curve : Why Staying Home Now Can Save Lives Do n't see the graphic above ?
Click here .
As the coronavirus continues to spread in the U.S. , more and more businesses are sending employees off to work from home .
Public schools are closing , universities are holding classes online , major events are getting canceled and cultural institutions are shutting their doors .
Even Disney World and Disneyland are set to close .
The disruption of daily life for many Americans is real and significant — but so are the potential life-saving benefits @ @ @ @ @ @ @ effort to do what epidemiologists call flattening the curve of the pandemic .
The idea is to increase social distancing in order to slow the spread of the virus , so that you do n't get a huge spike in the number of people getting sick all at once .
If that were to happen , there would n't be enough hospital beds or mechanical ventilators for everyone who needs them , and the U.S. hospital system would be overwhelmed .
That 's already happening in Italy .
`` If you think of @ @ @ @ @ @ @ car and it 's rush hour , and everybody wants to get on the car once , they start piling up at the door , '' says Drew Harris , a population health researcher at Thomas Jefferson University in Philadelphia .
`` They pile up on the platform .
There 's just not enough room in the car to take care of everybody , to accommodate everybody .
That 's the system that is overwhelmed .
It just ca n't handle it , and people wind up not getting services that they need @ @ @ @ @ @ @ a widely shared graphic visualizing just why it is so important to flatten the curve of a pandemic , including the current one — we 've reproduced his graphic at the top of this page .
The tan curve represents a scenario where the U.S. hospital system becomes inundated with coronavirus patients .
However , Harris says , if we can delay the spread of the virus so that new cases are n't popping up all at once , but rather , over the course of weeks or months , `` then the @ @ @ @ @ @ @ people who are possibly going to get sick and possibly need hospital care . ''
People would still get infected , he notes , but at a rate the healthcare system could actually keep up with — a scenario represented by the more gently sloped blue curve on the graph .
These two curves have already played out in the U.S. in an earlier age — during the 1918 flu pandemic .
Research has shown that the faster authorities moved to implement the kinds of social distancing measures designed to slow the transmission @ @ @ @ @ @ @ saved .
And the history of two U.S. cities — Philadelphia and St. Louis — illustrates just how big a difference those measures can make .
In Philadelphia , Harris notes , city officials ignored warnings from infectious disease experts that the flu was already circulating in their community .
Instead , they moved forward with a massive parade in support of World War I bonds that brought hundreds of thousands of people together .
`` Within 48 , 72 hours , thousands of people around the Philadelphia region started to die , @ @ @ @ @ @ @ , about 16,000 people had died .
Meanwhile , officials in St. Louis , Mo.
, had a vastly different public health response .
Within two days of the first reported cases , the city quickly moved to social isolation strategies , according to a 2007 analysis .
`` They really tried to limit the travel of people and implement public health 101 — isolating and treating the sick , quarantining the people who have been exposed to disease , closing the schools , encouraging social distancing of people , '' Harris says @ @ @ @ @ @ @ encouraging hand hygiene and other individual activities . ''
As a result , St. Louis suffered just one-eighth of the flu fatalities that Philadelphia saw , according to that 2007 research .
But if St. Louis had waited another week or two to act , it might have suffered a similar fate as Philadelphia , the researchers concluded .
At the time the 2007 research was released , Dr. Anthony Fauci , director of the National Institute of Allergy and Infectious Diseases and a leading adviser in the U.S. response to COVID-19 , @ @ @ @ @ @ @ intervention was critical in the midst of the 1918 pandemic .
As for just how big the current coronavirus pandemic will be in America ?
`` It is going to be totally dependent upon how we respond to it , '' Fauci told Congress earlier this week .
`` I ca n't give you a number , '' he said .
`` I ca n't give you a realistic number until we put into [ it ] the factor of how we respond .
If we 're complacent and do n't do really @ @ @ @ @ @ @ could go way up and be involved in many , many millions . ''

Flattening A Pandemic's Curve: Why Staying Home Now Can Save Lives
Loading...
Don't see the graphic above? Click here.
As the coronavirus continues to spread in the U.S., more and more businesses are sending employees off to work from home. Public schools are closing, universities are holding classes online, major events are getting canceled, and cultural institutions are shutting their doors. Even Disney World and Disneyland are set to close. The disruption of daily life for many Americans is real and significant — but so are the potential life-saving benefits.
It's all part of an effort to do what epidemiologists call flattening the curve of the pandemic. The idea is to increase social distancing in order to slow the spread of the virus, so that you don't get a huge spike in the number of people getting sick all at once. If that were to happen, there wouldn't be enough hospital beds or mechanical ventilators for everyone who needs them, and the U.S. hospital system would be overwhelmed. That's already happening in Italy.
"If you think of our health care system as a subway car and it's rush hour and everybody wants to get on the car once, they start piling up at the door," says Drew Harris, a population health researcher at Thomas Jefferson University in Philadelphia. "They pile up on the platform. There's just not enough room in the car to take care of everybody, to accommodate everybody. That's the system that is overwhelmed. It just can't handle it, and people wind up not getting services that they need."
Harris is the creator of a widely shared graphic visualizing just why it is so important to flatten the curve of a pandemic, including the current one — we've reproduced his graphic at the top of this page. The tan curve represents a scenario in which the U.S. hospital system becomes inundated with coronavirus patients.
However, Harris says, if we can delay the spread of the virus so that new cases aren't popping up all at once, but rather over the course of weeks or months, "then the system can adjust and accommodate all the people who are possibly going to get sick and possibly need hospital care." People would still get infected, he notes, but at a rate that the health care system could actually keep up with — a scenario represented by the more gently sloped blue curve on the graph.
These two curves have already played out in the U.S. in an earlier age — during the 1918 flu pandemic. Research has shown that the faster authorities moved to implement the kinds of social distancing measures designed to slow the transmission of disease, the more lives were saved. And the history of two U.S. cities — Philadelphia and St. Louis — illustrates just how big a difference those measures can make.
In Philadelphia, Harris notes, city officials ignored warnings from infectious disease experts that the flu was already circulating in their community. Instead, they moved forward with a massive parade in support of World War I bonds that brought hundreds of thousands of people together. "Within 48, 72 hours, thousands of people around the Philadelphia region started to die," Harris notes. Within six months, about 16,000 people had died.
Meanwhile, officials in St. Louis, Mo., had a vastly different public health response. Within two days of the first reported cases, the city quickly moved to social isolation strategies, according to a 2007 analysis.
"They really tried to limit the travel of people and implement Public Health 101 — isolating and treating the sick, quarantining the people who have been exposed to disease, closing the schools, encouraging social distancing of people," Harris says. "And, of course, encouraging hand hygiene and other individual activities."
As a result, St. Louis suffered just one-eighth of the flu fatalities that Philadelphia saw, according to that 2007 research. But if St. Louis had waited another week or two to act, it might have suffered a fate similar to Philadelphia's, the researchers concluded.
At the time the 2007 research was released, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and a leading adviser in the U.S. response to COVID-19, the disease caused by the current coronavirus, said the evidence was clear that early intervention was critical in the midst of the 1918 pandemic.
As for just how big the current coronavirus pandemic will be in America? "It is going to be totally dependent upon how we respond to it," Fauci told Congress earlier this week.
"I can't give you a number," he said. "I can't give you a realistic number until we put into [it] the factor of how we respond. If we're complacent and don't do really aggressive containment and mitigation, the number could go way up and be involved in many, many millions."


npr--2020-03-14--Rocket Attack Wounds U.S.-Led Coalition Troops, Iraqi Soldiers In Base Near Baghdad

More than two dozen rockets were fired at a military base north of Baghdad hosting American forces Saturday morning , wounding three members of the U.S.-led coalition and two Iraqi soldiers , the coalition 's spokesperson announced in a tweet .
Two of the wounded Americans suffered serious injures and are being treated at the military hospital at the Baghdad Airport base , according to Jonathan R. Hoffman , assistant to the Secretary of Defense for public affairs .
Iraqi security forces have made an initial arrest , Hoffman said , adding that the U.S. was investigating the attack with @ @ @ @ @ @ @ seven rocket launchers and 24 rockets that did not fire inside a garage in an area near Camp Taji base , where the rockets landed , Reuters reports .
No group has yet claimed responsibility for the attack .
The military said the U.S. or other foreign forces should not use this attack as an excuse for military action without Iraq 's approval and called on all foreign troops to quickly withdraw as the parliament asked , Reuters reports .
A Twitter account claiming to be the official Security Media Cell of the @ @ @ @ @ @ @ the Iraqi Parliament 's `` speedy implementation '' of its decision on the coalition 's withdrawal .
Camp Taji base suffered a rocket attack Wednesday , which killed two Americans and one member of Britain 's Armed Forces , injuring 14 others .
The U.S. subsequently launched retaliatory airstrikes against Kataib Hezbollah , an Iranian-backed militia group suspected for the attack .
Iraqi officials complained that the airstrikes instead killed three Iraqi soldiers , two police officers and a civilian worker , as well as damaged an unfinished civilian airport , the New @ @ @ @ @ @ @ McKenzie , the head of the military 's Central Command , dismissed the complaints .
U.S.-Iran relations have been in troubled waters since late December , with many military actions playing out on Iraqi soil .
On Dec. 29 , Kataib Hezbolla shot a barrage of rockets at a U.S. Military base near Kirkuk .
American forces retaliated against the Shia militia group in Iraq and Syria a few days later .
In January , a U.S. drone strike killed Maj. Gen. Qassem Soleimani and Iraqi militia commander Abu Mahdi al-Muhandis near Baghdad @ @ @ @ @ @ @ to what many feared to be the brink of war .
The Department of Defense justified the attack saying the general was `` actively developing plans to attack American diplomats and service members in Iraq and throughout the region . ''
Iraq 's caretaker prime minister and Parliament have recommended U.S. troops leave in the wake of Maj. Gen. Qassem Soleimani 's killing .
The U.S. protested .
Iran retaliated by launching ballistic missiles at the Ain al-Assad air base in Iraq and a second base at Irbil , which houses U.S. personnel @ @ @ @ @ @ @ least 34 U.S. service members .
Iran-backed militias say attacks on U.S. forces will continue until those troops leave Iraq , NPR 's Jane Arraf reports .
Vanessa Romo , Jane Arraf and Greg Myre contributed to this story .

Rocket Attack Wounds U.S.-Led Coalition Troops, Iraqi Soldiers In Base Near Baghdad
Enlarge this image toggle caption Anmar Khalil/AP Anmar Khalil/AP
Updated at 4:42 p.m. ET
More than two dozen rockets were fired at a military base north of Baghdad hosting American forces Saturday morning, wounding three members of the U.S.-led coalition and two Iraqi soldiers, the coalition's spokesperson announced in a tweet.
Two of the wounded Americans suffered serious injures and are being treated at the military hospital at the Baghdad Airport base, according to Jonathan R. Hoffman, assistant to the Secretary of Defense for public affairs. Iraqi security forces have made an initial arrest, Hoffman said, adding that the U.S. was investigating the attack with them.
Iraqi forces said they found seven rocket launchers and 24 rockets that did not fire inside a garage in an area near Camp Taji base, where the rockets landed, Reuters reports. No group has yet claimed responsibility for the attack.
The military said the U.S. or other foreign forces should not use this attack as an excuse for military action without Iraq's approval and called on all foreign troops to quickly withdraw as the parliament asked, Reuters reports.
A Twitter account claiming to be the official Security Media Cell of the Iraqi Prime Minister's office called for the Iraqi Parliament's "speedy implementation" of its decision on the coalition's withdrawal.
Camp Taji base suffered a rocket attack Wednesday, which killed two Americans and one member of Britain's Armed Forces, injuring 14 others.
The U.S. subsequently launched retaliatory airstrikes against Kataib Hezbollah, an Iranian-backed militia group suspected for the attack. Iraqi officials complained that the airstrikes instead killed three Iraqi soldiers, two police officers and a civilian worker, as well as damaged an unfinished civilian airport, the New York Times reports. Gen. Kenneth F. McKenzie, the head of the military's Central Command, dismissed the complaints.
U.S.-Iran relations have been in troubled waters since late December, with many military actions playing out on Iraqi soil. On Dec. 29, Kataib Hezbolla shot a barrage of rockets at a U.S. Military base near Kirkuk. American forces retaliated against the Shia militia group in Iraq and Syria a few days later.
In January, a U.S. drone strike killed Maj. Gen. Qassem Soleimani and Iraqi militia commander Abu Mahdi al-Muhandis near Baghdad's airport, pushing the two countries to what many feared to be the brink of war. The Department of Defense justified the attack saying the general was "actively developing plans to attack American diplomats and service members in Iraq and throughout the region."
Iraq's caretaker prime minister and Parliament have recommended U.S. troops leave in the wake of Maj. Gen. Qassem Soleimani's killing. The U.S. protested.
Iran retaliated by launching ballistic missiles at the Ain al-Assad air base in Iraq and a second base at Irbil, which houses U.S. personnel.
The strike on al-Assad injured at least 34 U.S. service members.
Iran-backed militias say attacks on U.S. forces will continue until those troops leave Iraq, NPR's Jane Arraf reports.
Vanessa Romo, Jane Arraf and Greg Myre contributed to this story.


npr--2020-03-14--Opinion: Early Coronavirus Testing Failures Will Cost Lives

The other night , I had a patient in the ER where I work come in with fever , cough and shortness of breath .
It would have been a routine visit , if not for the novel coronavirus currently sweeping the globe .
The patient was concerned about the virus , and so were we .
She had recently traveled to a conference in a country with known cases of COVID-19 , as the disease caused by the coronavirus is called .
She was middle-aged and had HIV , which we worried could increase her risk of serious illness @ @ @ @ @ @ @ department of health , where all testing in my state is currently performed , to request permission to test for the coronavirus .
Since the patient did not require hospital resources , like an oxygen mask or IV fluids , we discharged her home , urging her to self-quarantine and return if her symptoms worsened .
Every ER doctor that I work with already has several stories like this .
This week , in Massachusetts , testing has been permitted only for patients with respiratory symptoms requiring hospitalization , or for patients with @ @ @ @ @ @ @ areas or had contact with confirmed coronavirus cases .
Similar criteria apply in other states .
The problem with this approach is that , according to all indicators , it is almost certainly missing a large number of cases .
Strong evidence suggests that the coronavirus is already spreading within the community and has been for weeks .
After the first confirmed case appeared in the United States on Jan. 20 , scientists in Seattle who had been collecting swabs to study influenza went rogue and , against the directive of the Food @ @ @ @ @ @ @ Control and Prevention , developed a test and began looking for coronavirus in their flu samples .
In late February , they quickly found their first positive — a teenager with no recent travel and no sick contacts .
Genetic sequencing of the virus by the same researchers suggested that the virus had likely been circulating in the community for as long as six weeks .
Now cases with no recent travel and no known contacts are emerging everywhere .
Earlier this week , public health experts from Johns Hopkins confirmed that the @ @ @ @ @ @ @ community .
Put another way , this thing is probably out of the barn .
If that 's the case , then why are we still facing such strict limitations on who we can test ?
There is n't a clear answer , but it seems to be a function of a woefully inadequate supply of test kits .
In other words , what few tests we do have are being rationed for the people who need them most , like those requiring hospital admission .
While South Korea has run nearly 250,000 @ @ @ @ @ @ @ people per day , current estimates suggest the United States has performed only about 19,000 tests .
Here 's another way to express just how far behind we are in terms of testing — as of March 11 , the United States had performed only 23 tests per million people , while the U.K had performed 347 per million , Italy 826 per million , and South Korea 3,692 per million , according to an analysis by multiple media outlets and the COVID Tracking Project .
Ashish Jha , director of the Harvard @ @ @ @ @ @ @ Thursday that the United States ' response has been `` much , much worse than almost any other country that 's been affected . ''
He reached for words like `` stunning , '' `` fiasco '' and `` mind-blowing '' to describe the situation .
This leads to a second , much more important question — how were we so staggeringly unprepared to test for this virus ?
A number of hiccups have contributed .
First , many test kits released by the CDC on Feb. 4 were defective .
Designing and @ @ @ @ @ @ @ sometimes problems arise .
There have been reports that early Chinese tests may have had a false negative rate as high as 50 % .
But rather than encourage university labs and private companies to help with test development , the FDA withheld permission for such work until Feb. 29 .
Contrast this with the response in South Korea , where a private biotechnology company began developing a test on Jan. 16 , had a working version ready by Feb. 5t and had government approval for use one week later .
That company @ @ @ @ @ @ @ million people per week .
Private companies and academic labs are now developing their own tests .
The Cleveland Clinic recently announced it had developed a rapid test for the virus .
But concerns are mounting about a shortage of critical materials needed to run these tests .
The total failure to ensure that adequate testing would be available will likely prove to be the single most important factor in why the United States has been unable to contain the outbreak .
As previously reported by NPR , Hong Kong , Singapore and @ @ @ @ @ @ @ strategy very early on .
This allowed them to find the first few cases and isolate them , preventing unchecked community spread .
Because our government and public health authorities were unprepared , we have missed that precious opportunity in the United States , and it is going to cost people their lives .
This failure represents a profound abdication , at the highest levels of government , of responsibility to the health and security of the American population generally and of more vulnerable populations especially .
Public health experts have known of @ @ @ @ @ @ @ for more than 20 years , but the current administration limited funding to the CDC and disbanded a White House unit expressly dedicated to preparing for a pandemic just like this one .
Public statements from the top echelons of our government — false comparisons to seasonal influenza , wildly misleading promises about access to testing , reassurances that everything is `` perfect '' — continue to seed confusion and erode trust .
The most stunning illustration of this radical failure of leadership and responsibility occurred , for me , Thursday morning on @ @ @ @ @ @ @ testifying in front of Congress , and Rep. Debbie Wasserman Schultz was asking who was responsible for ensuring that those who needed to be tested could be tested .
After several attempts to dodge the question , Redfield fell silent .
He had no answer .
He stared down at his desk , before slowly turning to a man seated next to him .
It was Anthony Fauci , director of infectious diseases at the NIH .
He had the courage to say what Redfield would n't .
`` The system is not @ @ @ @ @ @ @ , '' he said .
`` And that is a failing . ''
What do we do now ?
We should still emphasize scaling up testing capacity in a massive way .
Knowing exactly who has the disease will enable more effective quarantines , protect vulnerable populations and mitigate community spread .
But the most critical measures occur at the individual level .
Everyone should practice social distancing .
That means curtailing all social interaction , canceling organized gatherings , working remotely , switching elbow bumps for handshakes and keeping a distance of @ @ @ @ @ @ @ Everyone should also practice obsessive hand hygiene .
That means washing your hands with soap and water for 20 seconds on a regular basis , and every time you come into contact with high-traffic areas , like a doorknob or subway pole .
Avoid touching your face for any reason — use a tissue to scratch an itch .
If you have any cold or flu-like symptoms , like fever , sore throat , cough , or muscle aches , you should wear a mask if you have access to one , isolate @ @ @ @ @ @ @ avoid contact with others as much as possible until at least two to three days after your symptoms have resolved .
If you develop difficulty breathing , chest pain , profound weakness or confusion , then it 's time to seek medical attention .
Community spread in the United States is already occurring , and the virus will likely reach a large number of people .
But this is not the nightmare scenario .
The nightmare scenario occurs if lots of people get sick at the same time .
This could lead to @ @ @ @ @ @ @ at hospitals all at once , which could easily overwhelm resources like oxygen tanks , ventilators and intensive care unit beds .
If this happens , then people will die who otherwise might have recovered .
Some European countries are already facing a situation like this .
It is imperative that we spread out infections over time , or flatten the curve .
This way hospitals will have adequate resources to treat everyone , and wo n't become overwhelmed .
How do we flatten the curve ?
All of the individual actions I @ @ @ @ @ @ @ this together .
If everyone does their part in limiting further spread , lives will be saved .
Clayton Dalton is a resident physician at Massachusetts General Hospital in Boston .

Opinion: Early Coronavirus Testing Failures Will Cost Lives
Enlarge this image toggle caption Ted S. Warren/AP Ted S. Warren/AP
The other night, I had a patient in the ER where I work come in with fever, cough and shortness of breath. It would have been a routine visit, if not for the novel coronavirus currently sweeping the globe. The patient was concerned about the virus, and so were we. She had recently traveled to a conference in a country with known cases of COVID-19, as the disease caused by the coronavirus is called. She was middle-aged and had HIV, which we worried could increase her risk of serious illness from the virus. We contacted the department of health, where all testing in my state is currently performed, to request permission to test for the coronavirus.
The verdict? Denied.
Since the patient did not require hospital resources, like an oxygen mask or IV fluids, we discharged her home, urging her to self-quarantine and return if her symptoms worsened.
Every ER doctor that I work with already has several stories like this. This week, in Massachusetts, testing has been permitted only for patients with respiratory symptoms requiring hospitalization, or for patients with such symptoms who have traveled to endemic areas or had contact with confirmed coronavirus cases. Similar criteria apply in other states. The problem with this approach is that, according to all indicators, it is almost certainly missing a large number of cases.
Strong evidence suggests that the coronavirus is already spreading within the community and has been for weeks. After the first confirmed case appeared in the United States on Jan. 20, scientists in Seattle who had been collecting swabs to study influenza went rogue and, against the directive of the Food and Drug Administration and Centers for Disease Control and Prevention, developed a test and began looking for coronavirus in their flu samples. In late February, they quickly found their first positive — a teenager with no recent travel and no sick contacts. Genetic sequencing of the virus by the same researchers suggested that the virus had likely been circulating in the community for as long as six weeks.
Now cases with no recent travel and no known contacts are emerging everywhere. Earlier this week, public health experts from Johns Hopkins confirmed that the virus is likely spreading undetected in the community. Put another way, this thing is probably out of the barn.
If that's the case, then why are we still facing such strict limitations on who we can test? There isn't a clear answer, but it seems to be a function of a woefully inadequate supply of test kits. In other words, what few tests we do have are being rationed for the people who need them most, like those requiring hospital admission. While South Korea has run nearly 250,000 tests and has capacity to test 10,000 people per day, current estimates suggest the United States has performed only about 19,000 tests. Here's another way to express just how far behind we are in terms of testing — as of March 11, the United States had performed only 23 tests per million people, while the U.K had performed 347 per million, Italy 826 per million, and South Korea 3,692 per million, according to an analysis by multiple media outlets and the COVID Tracking Project.
Ashish Jha, director of the Harvard Global Health Institute, told NPR on Thursday that the United States' response has been "much, much worse than almost any other country that's been affected." He reached for words like "stunning," "fiasco" and "mind-blowing" to describe the situation.
This leads to a second, much more important question — how were we so staggeringly unprepared to test for this virus? A number of hiccups have contributed. First, many test kits released by the CDC on Feb. 4 were defective. Designing and manufacturing these tests is challenging, and sometimes problems arise. There have been reports that early Chinese tests may have had a false negative rate as high as 50%. But rather than encourage university labs and private companies to help with test development, the FDA withheld permission for such work until Feb. 29. Contrast this with the response in South Korea, where a private biotechnology company began developing a test on Jan. 16, had a working version ready by Feb. 5t and had government approval for use one week later. That company is manufacturing enough kits to test a million people per week.
Private companies and academic labs are now developing their own tests. The Cleveland Clinic recently announced it had developed a rapid test for the virus. But concerns are mounting about a shortage of critical materials needed to run these tests.
The total failure to ensure that adequate testing would be available will likely prove to be the single most important factor in why the United States has been unable to contain the outbreak. As previously reported by NPR, Hong Kong, Singapore and South Korea all deployed an aggressive testing strategy very early on. This allowed them to find the first few cases and isolate them, preventing unchecked community spread. Because our government and public health authorities were unprepared, we have missed that precious opportunity in the United States, and it is going to cost people their lives.
This failure represents a profound abdication, at the highest levels of government, of responsibility to the health and security of the American population generally and of more vulnerable populations especially. Public health experts have known of the exceptional risk posed by novel coronaviruses for more than 20 years, but the current administration limited funding to the CDC and disbanded a White House unit expressly dedicated to preparing for a pandemic just like this one. Public statements from the top echelons of our government — false comparisons to seasonal influenza, wildly misleading promises about access to testing, reassurances that everything is "perfect" — continue to seed confusion and erode trust.
The most stunning illustration of this radical failure of leadership and responsibility occurred, for me, Thursday morning on C-SPAN. CDC Director Robert Redfield was testifying in front of Congress, and Rep. Debbie Wasserman Schultz was asking who was responsible for ensuring that those who needed to be tested could be tested. After several attempts to dodge the question, Redfield fell silent. He had no answer. He stared down at his desk, before slowly turning to a man seated next to him. It was Anthony Fauci, director of infectious diseases at the NIH. He had the courage to say what Redfield wouldn't.
"The system is not geared to what we need right now," he said. "And that is a failing."
What do we do now? We should still emphasize scaling up testing capacity in a massive way. Knowing exactly who has the disease will enable more effective quarantines, protect vulnerable populations and mitigate community spread. But the most critical measures occur at the individual level. Everyone should practice social distancing. That means curtailing all social interaction, canceling organized gatherings, working remotely, switching elbow bumps for handshakes and keeping a distance of several feet from others whenever possible. Everyone should also practice obsessive hand hygiene. That means washing your hands with soap and water for 20 seconds on a regular basis, and every time you come into contact with high-traffic areas, like a doorknob or subway pole. Avoid touching your face for any reason — use a tissue to scratch an itch.
If you have any cold or flu-like symptoms, like fever, sore throat, cough, or muscle aches, you should wear a mask if you have access to one, isolate yourself, keep washing your hands and avoid contact with others as much as possible until at least two to three days after your symptoms have resolved. If you develop difficulty breathing, chest pain, profound weakness or confusion, then it's time to seek medical attention.
Community spread in the United States is already occurring, and the virus will likely reach a large number of people. But this is not the nightmare scenario. The nightmare scenario occurs if lots of people get sick at the same time. This could lead to a massive surge of ill patients arriving at hospitals all at once, which could easily overwhelm resources like oxygen tanks, ventilators and intensive care unit beds. If this happens, then people will die who otherwise might have recovered. Some European countries are already facing a situation like this. It is imperative that we spread out infections over time, or flatten the curve. This way hospitals will have adequate resources to treat everyone, and won't become overwhelmed. How do we flatten the curve? All of the individual actions I described above.
We're all in this together. If everyone does their part in limiting further spread, lives will be saved.
Clayton Dalton is a resident physician at Massachusetts General Hospital in Boston.