npr--2020-04-02--Want To See What Your City's Pandemic Plan Says? Good Luck.

Want To See What Your City 's Pandemic Plan Says ?
Good Luck .
The response to the growing threat of the coronavirus has varied widely in cities and counties across the country .
Some are sheltering in place ; others are n't .
Some have closed public parks entirely , while others have opted to keep parks open but close playgrounds .
So are things going according to plan ?
It 's difficult to say .
That 's because many of the largest cities in the United States keep their local pandemic response plans under lock and key , @ @ @ @ @ @ @ critiquing — how their governments will respond to a public health emergency .
NPR reached out to the public health departments responsible for serving the most populous cities in the United States .
We could confirm that only one of the 15 largest cities had their most current pandemic response plan posted publicly online : San Diego .
Other cities sent NPR their plans directly , but seven denied NPR immediate access , some saying their plans are not public documents .
Of the plans NPR was able to obtain or find , @ @ @ @ @ @ @ ago .
Several cities cited security concerns as a reason for not posting their pandemic response plans publicly .
For example , a spokesperson for Columbus , Ohio , said `` disclosure of some information in this plan could compromise the security of essential equipment , personnel , services , and systems of Columbus Public Health . ''
A spokesperson for Jacksonville , Fla. , said the city 's plan `` contains sensitive information that could put the health and safety of citizens at risk if disclosed . ''
In response to a @ @ @ @ @ @ @ Sunshine Law , the city released a plan with the majority of pages redacted .
`` I can imagine that some of their thinking on these issues was formed back in the early years of this century when a good deal of the public health response and the response at county levels and state levels was formed around concerns about public health emergencies arising from terrorist attacks , including bioterrorism , '' says Alex Capron , a professor of law and medicine , specializing in healthcare policy and ethics , at the University @ @ @ @ @ @ @ lack thereof — may be another reason local governments struggle to post updated plans , or keep them current in the first place .
According to a 2016 study , government public health spending fell by nearly 10 percent per person since 2008 .
Capron says these plans are n't just bureaucratic documents : If shared , they can help lay a foundation of trust , so the public will actually follow key guidance , like social distancing .
Keeping these local plans confidential , he says , does not give the public @ @ @ @ @ @ @ are being made .
The stakes of these decisions , Capron says , can literally be ones of life or death .
`` Overall , it seems to me that it 's the exact opposite of what we need , '' Capron says .
`` If we get to the point , which we are likely to get to in some areas , that our hospitals are overwhelmed with acute cases of respiratory distress arising from the novel coronavirus , we 're going to have situations in which not all patients will be @ @ @ @ @ @ @ care and some of them will die because they 're not getting that care ...
The sooner public health officials acknowledge that there are going to be these choices and share how they 're approaching them , the better . ''
The 2017 pandemic response plan from the Centers for Disease Control and Prevention , which provides public health guidance to state and local governments , specifically urges clear communication during a pandemic , saying `` timely and strong lines of communication will ensure the consistency and effectiveness of information and local decision @ @ @ @ @ @ @ '' The World Health Organization , in its 2017 guidance on pandemic influenza risk management , also highlights the importance of local transparency , saying the objective is to `` develop and maintain public trust in local and national health systems and to convey realistic expectations about capacities '' for emergency risk management .
`` Stopping the speed of community transmission , mitigating the effects , that 's still possible , but it depends upon the public having faith in the people who are telling them what they should do , '' says @ @ @ @ @ @ @ to trust the public if we 're going to call on the public to be a huge part of the response . ''
A lot of the decisions that get made in a public health crisis are local ones : When to cancel events , when to close schools , bars and restaurants .
Local pandemic plans can be useful in guiding those decisions , but they can also help serve as a set of instructions for how to keep critical infrastructure like water and electricity working , says David Brett-Major , an @ @ @ @ @ @ @ Nebraska Medical Center who has worked with the World Health Organization on crises like the 2014 Ebola epidemic in West Africa .
Brett-Major says local plans can help lay out how a city government will tackle the ripple effects of a pandemic , like what happens if hospitals run out of masks or no longer have enough health care workers .
`` If I have a dollar for emergency response , '' Brett-Major says .
`` And I give that dollar to somebody .
Can she then go actually hire someone to help @ @ @ @ @ @ @ He says money suddenly might not be that useful if there is n't any more gear to buy in the first place .
And he says even just writing down what could go wrong can help lawmakers think through those scenarios before they happen .
`` Plans provide a framework for how people might work together , '' says Brett-Major .
`` And so the existential value of doing these plans is that people suddenly realize what their interests are .
They 've had time to think about it .
And they 've @ @ @ @ @ @ @ might have to reach in order to be able to attain those interests . ''
But if a community member wanted to see what those considerations were in their city , in some cases they 'd be out of luck .
Of the 15 cities NPR reached out to , several local governments had plans posted publicly that were out of date .
In Texas , the city of Austin published its last preparedness and response plan — which instructs city officials to communicate by distributing CD-ROMs — in 2006 .
Its internal @ @ @ @ @ @ @ were updated in 2011 , but can only be requested via the state 's public records act .
A spokesperson for Houston also said its plans need to be requested through the state 's public information act , while acknowledging that the plans currently on its website , which were from 2006 , were out of date .
After NPR asked about the old plans , the city removed them from its website .
Two other large cities in Texas , Dallas and Fort Worth , could not be reached at all regarding @ @ @ @ @ @ @ Los Angeles and San Jose also did not respond to requests for the city 's most updated pandemic plan .
Brett-Major says that ideally , local public health departments would update their pandemic response plans — and practice them — regularly .
Instead , he says , plans are often updated after a public health scare , like SARS in the early 2000 's .
`` They happen in fits and spurts when really they ought to be dynamic , '' Brett-Major says .
`` Our attention follows the news cycle . ''
@ @ @ @ @ @ @ , only six told NPR they have an infectious disease or pandemic plan that 's been updated in the past two years .
One key reason to keep plans up to date is how rapidly communication can change over time , says Krutika Kuppalli , an infectious disease physician and an emerging leader in biosecurity fellow at the Johns Hopkins Center for Health Security .
`` One of the things that has been astounding to me and my colleagues in this outbreak is the amount of communication that 's happening over social media @ @ @ @ @ @ @ to the 2014 Ebola outbreak , there was communication over social media , but not to the extent that is happening now , '' Kuppalli says .
She said if plans are n't updated regularly , they might miss key ways to communicate , like social media and smartphone push alerts .
Take the publicly posted plans from Austin , which are from 2006 : Twitter was founded that year and Facebook two years prior , but neither had reached anywhere near the level of cultural importance they hold now .
`` Preparedness @ @ @ @ @ @ @ n't unfortunately think about a lot in this society that we live in , '' Kuppalli says .
`` And so we tend to be more reactive than proactive .
And so then when something happens , like what we 're dealing with now , we are trying to scramble and put things together . ''

Want To See What Your City's Pandemic Plan Says? Good Luck.
Enlarge this image toggle caption David Paul Morris/Bloomberg via Getty Images David Paul Morris/Bloomberg via Getty Images
The response to the growing threat of the coronavirus has varied widely in cities and counties across the country. Some are sheltering in place; others aren't. Some have closed public parks entirely, while others have opted to keep parks open but close playgrounds.
So are things going according to plan? It's difficult to say.
That's because many of the largest cities in the United States keep their local pandemic response plans under lock and key, preventing the public from knowing — or critiquing — how their governments will respond to a public health emergency.
NPR reached out to the public health departments responsible for serving the most populous cities in the United States. We could confirm that only one of the 15 largest cities had their most current pandemic response plan posted publicly online: San Diego. Other cities sent NPR their plans directly, but seven denied NPR immediate access, some saying their plans are not public documents. Of the plans NPR was able to obtain or find, some were last updated nearly a decade ago.
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Several cities cited security concerns as a reason for not posting their pandemic response plans publicly. For example, a spokesperson for Columbus, Ohio, said "disclosure of some information in this plan could compromise the security of essential equipment, personnel, services, and systems of Columbus Public Health." A spokesperson for Jacksonville, Fla., said the city's plan "contains sensitive information that could put the health and safety of citizens at risk if disclosed." In response to a request made by NPR under the Florida Sunshine Law, the city released a plan with the majority of pages redacted.
"I can imagine that some of their thinking on these issues was formed back in the early years of this century when a good deal of the public health response and the response at county levels and state levels was formed around concerns about public health emergencies arising from terrorist attacks, including bioterrorism," says Alex Capron, a professor of law and medicine, specializing in healthcare policy and ethics, at the University of Southern California.
Funding — or lack thereof — may be another reason local governments struggle to post updated plans, or keep them current in the first place. According to a 2016 study, government public health spending fell by nearly 10 percent per person since 2008.
Capron says these plans aren't just bureaucratic documents: If shared, they can help lay a foundation of trust, so the public will actually follow key guidance, like social distancing. Keeping these local plans confidential, he says, does not give the public a chance to understand why certain decisions are being made. The stakes of these decisions, Capron says, can literally be ones of life or death.
"Overall, it seems to me that it's the exact opposite of what we need," Capron says. "If we get to the point, which we are likely to get to in some areas, that our hospitals are overwhelmed with acute cases of respiratory distress arising from the novel coronavirus, we're going to have situations in which not all patients will be able to get the highest level of care and some of them will die because they're not getting that care... The sooner public health officials acknowledge that there are going to be these choices and share how they're approaching them, the better."
The 2017 pandemic response plan from the Centers for Disease Control and Prevention, which provides public health guidance to state and local governments, specifically urges clear communication during a pandemic, saying "timely and strong lines of communication will ensure the consistency and effectiveness of information and local decision making before and during a pandemic." The World Health Organization, in its 2017 guidance on pandemic influenza risk management, also highlights the importance of local transparency, saying the objective is to "develop and maintain public trust in local and national health systems and to convey realistic expectations about capacities" for emergency risk management.
"Stopping the speed of community transmission, mitigating the effects, that's still possible, but it depends upon the public having faith in the people who are telling them what they should do," says Capron. "I think we have to trust the public if we're going to call on the public to be a huge part of the response."
A lot of the decisions that get made in a public health crisis are local ones: When to cancel events, when to close schools, bars and restaurants. Local pandemic plans can be useful in guiding those decisions, but they can also help serve as a set of instructions for how to keep critical infrastructure like water and electricity working, says David Brett-Major, an infectious disease physician at the University of Nebraska Medical Center who has worked with the World Health Organization on crises like the 2014 Ebola epidemic in West Africa.
Brett-Major says local plans can help lay out how a city government will tackle the ripple effects of a pandemic, like what happens if hospitals run out of masks or no longer have enough health care workers.
"If I have a dollar for emergency response," Brett-Major says. "And I give that dollar to somebody. Can she then go actually hire someone to help? Or buy the gear?"
He says money suddenly might not be that useful if there isn't any more gear to buy in the first place. And he says even just writing down what could go wrong can help lawmakers think through those scenarios before they happen.
"Plans provide a framework for how people might work together," says Brett-Major. "And so the existential value of doing these plans is that people suddenly realize what their interests are. They've had time to think about it. And they've also started to realize who else they might have to reach in order to be able to attain those interests."
But if a community member wanted to see what those considerations were in their city, in some cases they'd be out of luck. Of the 15 cities NPR reached out to, several local governments had plans posted publicly that were out of date.
In Texas, the city of Austin published its last preparedness and response plan — which instructs city officials to communicate by distributing CD-ROMs — in 2006. Its internal plans, a city official says, were updated in 2011, but can only be requested via the state's public records act. A spokesperson for Houston also said its plans need to be requested through the state's public information act, while acknowledging that the plans currently on its website, which were from 2006, were out of date. After NPR asked about the old plans, the city removed them from its website.
Two other large cities in Texas, Dallas and Fort Worth, could not be reached at all regarding their pandemic plans. In California, Los Angeles and San Jose also did not respond to requests for the city's most updated pandemic plan.
Brett-Major says that ideally, local public health departments would update their pandemic response plans — and practice them — regularly. Instead, he says, plans are often updated after a public health scare, like SARS in the early 2000's.
"They happen in fits and spurts when really they ought to be dynamic," Brett-Major says. "Our attention follows the news cycle."
Of the 15 cities we looked at, only six told NPR they have an infectious disease or pandemic plan that's been updated in the past two years.
One key reason to keep plans up to date is how rapidly communication can change over time, says Krutika Kuppalli, an infectious disease physician and an emerging leader in biosecurity fellow at the Johns Hopkins Center for Health Security.
"One of the things that has been astounding to me and my colleagues in this outbreak is the amount of communication that's happening over social media. And even if I think back to the 2014 Ebola outbreak, there was communication over social media, but not to the extent that is happening now," Kuppalli says.
She said if plans aren't updated regularly, they might miss key ways to communicate, like social media and smartphone push alerts. Take the publicly posted plans from Austin, which are from 2006: Twitter was founded that year and Facebook two years prior, but neither had reached anywhere near the level of cultural importance they hold now.
"Preparedness and responses are things that we don't unfortunately think about a lot in this society that we live in," Kuppalli says. "And so we tend to be more reactive than proactive. And so then when something happens, like what we're dealing with now, we are trying to scramble and put things together."


npr--2020-04-02--Tennessee Orders Residents To Remain Home

Amid mounting pressure from medical professionals and local leaders , Tennessee Gov .
Bill Lee has ordered residents to stay home unless it 's essential .
Lee said during a coronavirus press briefing Thursday afternoon that he decided to issue a new executive order after data revealed that movement around the state has been on the rise in recent days , even after he issued a less strict `` Safer at Home '' order last month .
The governor said he expects April to be particularly tough for people in Tennessee .
Estimates by the University of Washington suggest , @ @ @ @ @ @ @ will peak in Tennessee on April 19 , leading to a shortage of more than 7,800 hospital beds .
`` We must take this seriously .
We must stay at home .
We must work together , and that is a critically important message that I would have for every Tennessean , '' Lee said .
`` We have made an additional effort today to require that , and that 's important in an effort to save lives right here in Tennessee . ''
The announcement comes after multiple high-profile leaders have criticized @ @ @ @ @ @ @ order , including former U.S. Sen. Bill Frist and Gov .
Andy Beshear in neighboring Kentucky .

Tennessee Orders Residents To Remain Home
Enlarge this image toggle caption Mark Humphrey/AP Mark Humphrey/AP
Amid mounting pressure from medical professionals and local leaders, Tennessee Gov. Bill Lee has ordered residents to stay home unless it's essential.
Lee said during a coronavirus press briefing Thursday afternoon that he decided to issue a new executive order after data revealed that movement around the state has been on the rise in recent days, even after he issued a less strict "Safer at Home" order last month.
The governor said he expects April to be particularly tough for people in Tennessee. Estimates by the University of Washington suggest, if current trends continue, COVID-19 cases will peak in Tennessee on April 19, leading to a shortage of more than 7,800 hospital beds.
"We must take this seriously. We must stay at home. We must work together, and that is a critically important message that I would have for every Tennessean," Lee said. "We have made an additional effort today to require that, and that's important in an effort to save lives right here in Tennessee."
The announcement comes after multiple high-profile leaders have criticized Lee for waiting to issue a shelter-in-place order, including former U.S. Sen. Bill Frist and Gov. Andy Beshear in neighboring Kentucky.


npr--2020-04-02--Get Money Out To The Economy Quickly, Ex-Treasury Secretary Says

Get Money Out To The Economy Quickly , Ex-Treasury Secretary Says Hank Paulson says the world and America are `` facing a health and economic crisis unlike anything in our modern history . ''
Paulson knows a thing or two about a financial crisis .
In 2008 , as Treasury secretary , he helped steer the United States out of the worst financial crisis since the Great Depression .
He says the coronavirus crisis — which has brought much of the U.S. economy to a halt and put millions suddenly out of work — is very different from 2008 , @ @ @ @ @ @ @ to collapsing .
This crisis `` did n't begin in our financial system , which was very strong , '' Paulson tells NPR 's Steve Inskeep .
`` Today , the economy is suffering because it was shut down to protect human health — having nothing to do with the underlying strength of the economy or the financial system . ''
Getting through it and limiting the damage to the economy will require huge tasks : containing the virus and implementing Congress 's $ 2 trillion economic rescue package quickly , he says @ @ @ @ @ @ @ to most Americans and a boost to the unemployment insurance program .
`` We 've got to get money moving out into the economy to the people who need it — the most vulnerable , to the small businesses , to the big businesses .
And that 's the big job ahead of us , '' Paulson says .
However , according to a memo drafted by House Democrats , people who do not have direct deposit information on file with the Internal Revenue Service may have to wait up to 20 weeks @ @ @ @ @ @ @ Mnuchin has acknowledged it would take more time for those who did n't have addresses on file but suggested on Sunday that he expected payments to go out by mid-April .
Paulson says Mnuchin and Federal Reserve Chairman Jerome Powell have `` got their work cut out for them to get this money out where it 's needed . ''
Paulson has this additional advice for getting through the crisis : `` It 's vital we remember that we do n't need to let fear and panic defeat us , and we should @ @ @ @ @ @ @ `` The best-case scenario is ... we contain the virus quickly because the extent of the damage to the U.S. economy is going to be determined by how quickly we can begin to resume normal business activity in different industries in different parts of the country , '' he says .
The worst case , he says , is `` this takes a long time .
And if it takes a long time , you know what ?
We 're still going to get through it . ''
Could the country see another @ @ @ @ @ @ @ think so , '' Paulson says .
`` We have tools and knowledge we did n't have before .
And I think we 're a rich country and we have strong institutions and a strong history .
And our government knows how to work . ''

Get Money Out To The Economy Quickly, Ex-Treasury Secretary Says
Enlarge this image toggle caption Pablo Martinez Monsivais/AP Pablo Martinez Monsivais/AP
Updated at 5:36 p.m. ET
Hank Paulson says the world and America are "facing a health and economic crisis unlike anything in our modern history."
Paulson knows a thing or two about a financial crisis. In 2008, as Treasury secretary, he helped steer the United States out of the worst financial crisis since the Great Depression.
He says the coronavirus crisis — which has brought much of the U.S. economy to a halt and put millions suddenly out of work — is very different from 2008, when the global financial system came close to collapsing.
This crisis "didn't begin in our financial system, which was very strong," Paulson tells NPR's Steve Inskeep. "Today, the economy is suffering because it was shut down to protect human health — having nothing to do with the underlying strength of the economy or the financial system."
Getting through it and limiting the damage to the economy will require huge tasks: containing the virus and implementing Congress's $2 trillion economic rescue package quickly, he says. That includes direct $1,200 payments to most Americans and a boost to the unemployment insurance program.
"We've got to get money moving out into the economy to the people who need it — the most vulnerable, to the small businesses, to the big businesses. And that's the big job ahead of us," Paulson says.
However, according to a memo drafted by House Democrats, people who do not have direct deposit information on file with the Internal Revenue Service may have to wait up to 20 weeks to receive cash payments
Treasury Secretary Steven Mnuchin has acknowledged it would take more time for those who didn't have addresses on file but suggested on Sunday that he expected payments to go out by mid-April.
Paulson says Mnuchin and Federal Reserve Chairman Jerome Powell have "got their work cut out for them to get this money out where it's needed."
Paulson has this additional advice for getting through the crisis: "It's vital we remember that we don't need to let fear and panic defeat us, and we shouldn't let divisiveness defeat us."
"The best-case scenario is ... we contain the virus quickly because the extent of the damage to the U.S. economy is going to be determined by how quickly we can begin to resume normal business activity in different industries in different parts of the country," he says.
The worst case, he says, is "this takes a long time. And if it takes a long time, you know what? We're still going to get through it."
Could the country see another Great Depression?
"I don't think so," Paulson says. "We have tools and knowledge we didn't have before. And I think we're a rich country and we have strong institutions and a strong history. And our government knows how to work."


npr--2020-04-02--WATCH: Coronavirus Task Force Holds Briefing Amid Record Unemployment Numbers

The government has gone to work disbursing the billions of dollars Washington has committed to sustain the economy after the deep shock it has undergone in the pandemic , the White House promised on Thursday .
Treasury Secretary Steven Mnuchin and Jovita Carranza , head of the Small Business Administration , vowed that some of the first systems for loans or payments would be up and running as soon as Friday .
Meanwhile the Treasury Department , the SBA , the IRS and other agencies are gearing up to implement the programs contained in the $ 2 trillion relief legislation @ @ @ @ @ @ @ Trump , officials said .
Nearly 10 million people have filed for unemployment in the last two weeks alone , according to the Labor Department .
Social distancing and other virus mitigation measures have paralyzed much of the economy because they have grievous effects on restaurants , brick-and-mortar businesses and travel .
Carranza said she worries about each one of the nation 's roughly 30 million small businesses .
The White House convened a briefing to provide an update on its response to the pandemic at 5 p.m .
ET .
Watch live @ @ @ @ @ @ @ be quick The treasury secretary vowed that his department and its agencies appreciate the value of time in terms of making payments , loans and other such assistance available amidst the ongoing crisis .
The first direct payments to eligible taxpayers will begin to arrive within two weeks , Mnuchin vowed — an upgrade , he said , from his earlier promise of three weeks .
Mnuchin rejected suggestions that some Americans might not receive checks for another several months , but he acknowledged that some people might need to upload their direct @ @ @ @ @ @ @ portal in order to guide authorities on where to send it .
The goal is not to send paper checks , Mnuchin said ; the best case is for Americans to receive their relief payments electronically .
`` This money does no good if it shows up in four months and we 'll deliver on that , '' he said .
Forgiveable small business loans and other assistance also will be available as soon as practical , Mnuchin said .
The broad goal is to provide as much liquidity as possible to the @ @ @ @ @ @ @ weeks to keep employees on payrolls and permit businesses to get back to operating as soon as public health officials give the all clear , Mnuchin said .
He acknowledged that the Treasury Department 's mandate and the loan authorizations for the Federal Reserve add up to a program of unprecedented scale — some $ 6 trillion , taken together — but only spending of that magnitude can answer the mail for this disaster , he said .
`` We 're going through something that we 've never done before , '' Mnuchin @ @ @ @ @ @ @ acknowledged that the unprecedented scale of the program might mean there are growing pains or delays with actually getting cash into the hands of those who need it .
`` That does n't mean that everybody is going to get their loan tomorrow , '' he said .
But : `` The system will be up and running . ''
Skeptics including majority House Democrats have sought some kind of special oversight of the pandemic relief spending given the sheer quantity of money involved .
House Speaker Nancy Pelosi , D-Calif. , is @ @ @ @ @ @ @ way the money is spent .
Mnuchin said he did n't think that was necessary and that the House 's standing Oversight Committee could oversee the relief program in the same way it oversees the rest of the functions of the government .
The treasury secretary has become a key interlocutor between Trump and Pelosi and Senate Majority Leader Mitch McConnell , R-Ky. Mnuchin was asked whether the congressional leaders might agree to more relief or stimulus if the current 10 weeks ' worth of spending was n't sufficient .
`` If we @ @ @ @ @ @ @ support the American economy , that 's what we 'll be doing , '' he said .
Added Trump , later in the news conference : `` We will probably do more . ''
Vice President Mike Pence said on Thursday that the Centers for Disease Control and Prevention would issue guidance `` in the next several days '' on the hotly debated question about recommending face coverings for every person .
Dr. Deborah Birx , a top physician coordinating the White House 's coronavirus response , told reporters she worried that a @ @ @ @ @ @ @ of security .
A mask over the mouth and nose does n't protect the eyes , for example , Birx pointed out — another way people can become infected .
What Americans really should be doing is keeping apart , washing their hands and following the other public health guidelines , she said .
But the continued increase in the number of recorded cases showed that in many places , they are n't , Birx lamented .
Trump , for his part , has been a booster of face-coverings , especially scarves .
@ @ @ @ @ @ @ thinks people should wear scarves and he said Thursday that `` in many cases , the scarf is better , it 's thicker . ''
Ahead of the Thursday briefing , President Trump issued an order under the Defense Production Act to `` facilitate the supply of materials '' to six companies making ventilators .
Those companies are General Electric , Hill-Rom Holdings , Medtronic , ResMed , Philips and Vyaire Medical .
In a statement , the president said the order will help domestic manufacturers `` secure the supplies they need to @ @ @ @ @ @ @ .
I am grateful to these and other domestic manufacturers for ramping up their production of ventilators during this difficult time . ''
Trump said the order will remove obstacles in the supply chain , but did n't go into specifics on the nature of the obstacles .
Trump showed reporters what he said was a letter describing the results of the second test he has taken for COVID-19 .
The president said he only needed about a minute to take the test itself and then got his result within about 15 minutes @ @ @ @ @ @ @ first one .
`` I took it out of curiosity to see how quickly it worked , '' Trump said .
Trump has been in meetings with people who have tested positive for COVID-19 , which is why he took the first test , but he did n't suggest on Thursday there had been any medical necessity for the second one .

Government Works To Begin Disbursing Loans And Payments Amid Record Unemployment
Enlarge this image toggle caption Mandel Ngan/AFP via Getty Images Mandel Ngan/AFP via Getty Images
Updated at 7:37 p.m. ET
The government has gone to work disbursing the billions of dollars Washington has committed to sustain the economy after the deep shock it has undergone in the pandemic, the White House promised on Thursday.
Treasury Secretary Steven Mnuchin and Jovita Carranza, head of the Small Business Administration, vowed that some of the first systems for loans or payments would be up and running as soon as Friday.
Meanwhile the Treasury Department, the SBA, the IRS and other agencies are gearing up to implement the programs contained in the $2 trillion relief legislation passed by Congress and signed by President Trump, officials said.
Nearly 10 million people have filed for unemployment in the last two weeks alone, according to the Labor Department.
Social distancing and other virus mitigation measures have paralyzed much of the economy because they have grievous effects on restaurants, brick-and-mortar businesses and travel. Carranza said she worries about each one of the nation's roughly 30 million small businesses.
The White House convened a briefing to provide an update on its response to the pandemic at 5 p.m. ET. Watch live here.
Mnuchin: The checks will be quick
The treasury secretary vowed that his department and its agencies appreciate the value of time in terms of making payments, loans and other such assistance available amidst the ongoing crisis.
The first direct payments to eligible taxpayers will begin to arrive within two weeks, Mnuchin vowed — an upgrade, he said, from his earlier promise of three weeks.
Mnuchin rejected suggestions that some Americans might not receive checks for another several months, but he acknowledged that some people might need to upload their direct deposit or other information to a web portal in order to guide authorities on where to send it.
The goal is not to send paper checks, Mnuchin said; the best case is for Americans to receive their relief payments electronically.
"This money does no good if it shows up in four months and we'll deliver on that," he said.
Loan programs also getting underway
Forgiveable small business loans and other assistance also will be available as soon as practical, Mnuchin said.
The broad goal is to provide as much liquidity as possible to the world's largest economy for about ten weeks to keep employees on payrolls and permit businesses to get back to operating as soon as public health officials give the all clear, Mnuchin said.
He acknowledged that the Treasury Department's mandate and the loan authorizations for the Federal Reserve add up to a program of unprecedented scale — some $6 trillion, taken together — but only spending of that magnitude can answer the mail for this disaster, he said.
"We're going through something that we've never done before," Mnuchin said.
All the same, he acknowledged that the unprecedented scale of the program might mean there are growing pains or delays with actually getting cash into the hands of those who need it.
"That doesn't mean that everybody is going to get their loan tomorrow," he said. But: "The system will be up and running."
Oversight dispute
Skeptics including majority House Democrats have sought some kind of special oversight of the pandemic relief spending given the sheer quantity of money involved.
House Speaker Nancy Pelosi, D-Calif., is forming a select committee to monitor the way the money is spent.
Mnuchin said he didn't think that was necessary and that the House's standing Oversight Committee could oversee the relief program in the same way it oversees the rest of the functions of the government.
The treasury secretary has become a key interlocutor between Trump and Pelosi and Senate Majority Leader Mitch McConnell, R-Ky. Mnuchin was asked whether the congressional leaders might agree to more relief or stimulus if the current 10 weeks' worth of spending wasn't sufficient.
"If we need to go back to Congress to support the American economy, that's what we'll be doing," he said.
Added Trump, later in the news conference: "We will probably do more."
Mask dispute wears on
Vice President Mike Pence said on Thursday that the Centers for Disease Control and Prevention would issue guidance "in the next several days" on the hotly debated question about recommending face coverings for every person.
Dr. Deborah Birx, a top physician coordinating the White House's coronavirus response, told reporters she worried that a mask recommendation might create a false sense of security.
A mask over the mouth and nose doesn't protect the eyes, for example, Birx pointed out — another way people can become infected.
What Americans really should be doing is keeping apart, washing their hands and following the other public health guidelines, she said. But the continued increase in the number of recorded cases showed that in many places, they aren't, Birx lamented.
Trump, for his part, has been a booster of face-coverings, especially scarves. The president continues to repeat that he thinks people should wear scarves and he said Thursday that "in many cases, the scarf is better, it's thicker."
Defense production act
Ahead of the Thursday briefing, President Trump issued an order under the Defense Production Act to "facilitate the supply of materials" to six companies making ventilators. Those companies are General Electric, Hill-Rom Holdings, Medtronic, ResMed, Philips and Vyaire Medical.
In a statement, the president said the order will help domestic manufacturers "secure the supplies they need to build ventilators needed to defeat the virus. I am grateful to these and other domestic manufacturers for ramping up their production of ventilators during this difficult time."
Trump said the order will remove obstacles in the supply chain, but didn't go into specifics on the nature of the obstacles.
Trump's second test negative
Trump showed reporters what he said was a letter describing the results of the second test he has taken for COVID-19. The president said he only needed about a minute to take the test itself and then got his result within about 15 minutes — negative, just as with his first one.
"I took it out of curiosity to see how quickly it worked," Trump said.
Trump has been in meetings with people who have tested positive for COVID-19, which is why he took the first test, but he didn't suggest on Thursday there had been any medical necessity for the second one.


npr--2020-04-02--U.K. Health Workers Decry Low Rate Of Coronavirus Tests For Medical Staff

The British government is under fire for only testing a tiny percentage of National Health Service staff as deaths from COVID-19 in the United Kingdom rapidly rise to nearly 3,000 .
`` Shambles ! ''
reads the headline in the Daily Mirror .
Prime Minister Boris Johnson , who has COVID-19 , pledged the government was going all out to support front-line health care workers .
`` We shipped , just in the last couple of weeks , 390 million separate pieces of personal protective equipment and we 're also massively increasing testing , '' Johnson said Wednesday via cellphone @ @ @ @ @ @ @ But Libby Nolan , a nurse from Wales who has coronavirus symptoms and is waiting on test results , notes that Johnson was tested quickly , unlike the tens of thousands of health care staff who remain untested in self-isolation , unable to work .
`` He stood and said , 'We 're all in this together , ' '' Nolan says , referring to the prime minister .
`` Well , we 're not .
He 's completely failing us . ''
Responding to public anger , Health Secretary Matt Hancock said @ @ @ @ @ @ @ carry out 100,000 tests a day by the end of this month .
Hancock , who has just come out of self-isolation after contracting COVID-19 , said the government would increase testing by working with universities and private companies such as Amazon and Boots , a British health and pharmacy chain , to do more swab testing .
As of Thursday , just over 163,000 people have been tested for the virus , in a country with a population of more than 66 million ; more than 33,000 have tested positive .
The @ @ @ @ @ @ @ volume of testing has been so low .
Health care workers say not only has the lack of testing sidelined staff , but it has also prevented those still on the job from working more efficiently and aggressively .
Anna Kahn-Leavitt , a doctor who works in intensive care , says if staff at her London hospital knew they had already been exposed to the virus , they could do the riskier work and spare others .
`` If we knew that there were a third of us who 'd all had coronavirus @ @ @ @ @ @ @ '' Kahn-Leavitt says , `` then , of course , we should be the ones to do all the invasive procedures on coronavirus patients . ''

U.K. Health Workers Decry Low Rate Of Coronavirus Tests For Medical Staff
Enlarge this image toggle caption Alberto Pezzali/AP Alberto Pezzali/AP
The British government is under fire for only testing a tiny percentage of National Health Service staff as deaths from COVID-19 in the United Kingdom rapidly rise to nearly 3,000.
"Shambles!" reads the headline in the Daily Mirror.
"550,000 NHS staff, only 2,000 tested," roars the Daily Mail.
Prime Minister Boris Johnson, who has COVID-19, pledged the government was going all out to support front-line health care workers.
"We shipped, just in the last couple of weeks, 390 million separate pieces of personal protective equipment and we're also massively increasing testing," Johnson said Wednesday via cellphone video from self-isolation in Downing Street.
But Libby Nolan, a nurse from Wales who has coronavirus symptoms and is waiting on test results, notes that Johnson was tested quickly, unlike the tens of thousands of health care staff who remain untested in self-isolation, unable to work.
"He stood and said, 'We're all in this together,'" Nolan says, referring to the prime minister. "Well, we're not. He's completely failing us."
Responding to public anger, Health Secretary Matt Hancock said on Thursday that the goal is to carry out 100,000 tests a day in England by the end of this month. Hancock, who has just come out of self-isolation after contracting COVID-19, said the government would increase testing by working with universities and private companies such as Amazon and Boots, a British health and pharmacy chain, to do more swab testing.
As of Thursday, just over 163,000 people have been tested for the virus, in a country with a population of more than 66 million; more than 33,000 have tested positive. The government has struggled to explain why the volume of testing has been so low.
Health care workers say not only has the lack of testing sidelined staff, but it has also prevented those still on the job from working more efficiently and aggressively.
Anna Kahn-Leavitt, a doctor who works in intensive care, says if staff at her London hospital knew they had already been exposed to the virus, they could do the riskier work and spare others.
"If we knew that there were a third of us who'd all had coronavirus already and had an antibody response," Kahn-Leavitt says, "then, of course, we should be the ones to do all the invasive procedures on coronavirus patients."


npr--2020-04-02--FDA Loosens Restrictions On Gay Blood Donors Amid 'Urgent Need' Caused By Coronavirus

FDA Loosens Restrictions On Gay Blood Donors Amid 'Urgent Need ' Caused By Coronavirus The federal government on Thursday relaxed restrictions on receiving blood donations from gay men and other groups as the country confronts a severe drop in the U.S. blood supply that officials described as urgent and unprecedented .
The Food and Drug Administration 's new rules are intended to spur a wave of donations as the coronavirus outbreak has caused donor centers to be closed and blood drives to be canceled nationwide .
Under the new policy , men who have had sex with other men will @ @ @ @ @ @ @ .
Federal rules previously made such donors wait 12 months before giving blood .
That wait has been shortened to three months .
LGBTQ rights advocates cautiously welcomed the policy change , saying federal officials should remove all wait times for gay men , saying such a rule stigmatizes gay and bisexual men .
`` LGBTQ Americans can hold their heads up today and know that our voices will always triumph over discrimination , '' said GLAAD President and CEO Sarah Kate Ellis , noting the change is `` in line with science @ @ @ @ @ @ @ added : `` We will keep fighting until the deferral period is lifted and gay and bi men , and all LGBTQ people , are treated equal to others . ''
The year-long wait policy also applies to women who have had sex with gay or bisexual men and those who have been received tattoos and piercings in the past year .
The FDA 's rule changes lowers the wait period for those group to three months as well .
The new policies were reached , according to the FDA , following recent @ @ @ @ @ @ @ criteria can be modified without impacting the safety of the blood supply .
Federal officials say the rule change will stay in place even after the pandemic ends .
`` Maintaining an adequate blood supply is vital to public health .
Blood donors help patients of all ages – accident and burn victims , heart surgery and organ transplant patients and those battling cancer and other life-threatening conditions , '' FDA officials said in a statement .
In 2015 , the U.S. lifted a decades-long lifetime ban on blood donations from gay and @ @ @ @ @ @ @ AIDS epidemic to protect people from receiving blood transfusions from getting HIV .
Instead , regulators placed a one-year wait time on gay and bisexual blood donors .
But modern blood screenings can detect HIV , leading gay rights advocates to say any wait time is unnecessary .
Blood tests can remain negative for about nine days after someone has been infected with HIV .
Before someone donates blood , they are screened for a host of infectious diseases , including HIV .
Coronavirus is most often transmitted between people who are in @ @ @ @ @ @ @ through respiratory droplets from coughing , sneezing or talking , according to the Centers for Disease Control and Prevention .
People are not at risk of contracting coronavirus through the blood donation process , according to AABB , a nonprofit that represents the blood transfusion field .

FDA Loosens Restrictions On Gay Blood Donors Amid 'Urgent Need' Caused By Coronavirus
Enlarge this image toggle caption Damian Dovarganes/AP Damian Dovarganes/AP
The federal government on Thursday relaxed restrictions on receiving blood donations from gay men and other groups as the country confronts a severe drop in the U.S. blood supply that officials described as urgent and unprecedented.
The Food and Drug Administration's new rules are intended to spur a wave of donations as the coronavirus outbreak has caused donor centers to be closed and blood drives to be canceled nationwide.
Under the new policy, men who have had sex with other men will be able to give blood more quickly. Federal rules previously made such donors wait 12 months before giving blood. That wait has been shortened to three months.
LGBTQ rights advocates cautiously welcomed the policy change, saying federal officials should remove all wait times for gay men, saying such a rule stigmatizes gay and bisexual men.
"LGBTQ Americans can hold their heads up today and know that our voices will always triumph over discrimination," said GLAAD President and CEO Sarah Kate Ellis, noting the change is "in line with science, but remains imperfect."
Ellis added: "We will keep fighting until the deferral period is lifted and gay and bi men, and all LGBTQ people, are treated equal to others."
The year-long wait policy also applies to women who have had sex with gay or bisexual men and those who have been received tattoos and piercings in the past year. The FDA's rule changes lowers the wait period for those group to three months as well.
The new policies were reached, according to the FDA, following recent studies and epidemiological data concluded that eligibility criteria can be modified without impacting the safety of the blood supply.
Federal officials say the rule change will stay in place even after the pandemic ends.
"Maintaining an adequate blood supply is vital to public health. Blood donors help patients of all ages – accident and burn victims, heart surgery and organ transplant patients and those battling cancer and other life-threatening conditions," FDA officials said in a statement.
In 2015, the U.S. lifted a decades-long lifetime ban on blood donations from gay and bisexual men that was imposed during the AIDS epidemic to protect people from receiving blood transfusions from getting HIV. Instead, regulators placed a one-year wait time on gay and bisexual blood donors.
But modern blood screenings can detect HIV, leading gay rights advocates to say any wait time is unnecessary.
Blood tests can remain negative for about nine days after someone has been infected with HIV.
Before someone donates blood, they are screened for a host of infectious diseases, including HIV.
Coronavirus is most often transmitted between people who are in close contact with each other, or through respiratory droplets from coughing, sneezing or talking, according to the Centers for Disease Control and Prevention.
People are not at risk of contracting coronavirus through the blood donation process, according to AABB, a nonprofit that represents the blood transfusion field.


npr--2020-04-02--Greece Records First Coronavirus Cases Among Refugees, Imposes Quarantine On Camp

Greece Records First Coronavirus Cases Among Refugees , Imposes Quarantine On Camp Since the outbreak of the coronavirus pandemic , medical personnel , human rights groups and others have warned of catastrophe if COVID-19 spreads to the roughly 60,000 refugees living in often-squalid camps in Greece .
Now the virus has arrived .
This week , at least 20 refugees living in the Ritsona camp , near Athens , have tested positive for COVID-19 .
The camp is now on lockdown for the next two weeks .
`` No one can go in or out '' except for essential personnel @ @ @ @ @ @ @ Mitarakis told Greece 's SKAI radio on Thursday .
Authorities were first alerted earlier this week , when a 19-year-old resident of the camp tested positive for COVID-19 after giving birth at an Athens hospital .
Healthcare workers immediately began testing more than 60 Ritsona camp residents who had come into contact with the woman .
The 20 who tested positive for COVID-19 currently do not have symptoms , Greece 's migration ministry says .
Testing of the 2,700 refugees living in Ritsona will continue during the 14-day quarantine .
`` It is @ @ @ @ @ @ @ s ] and refugees on the mainland and the islands , are ensured equal access to health services including prevention , testing and treatment , especially in times like these , '' said Gianluca Rocco , chief of the International Organization for Migration 's mission in Greece .
Ritsona is one of Greece 's better-maintained refugee camps .
The worst camps are on the Aegean islands , where 41,000 asylum seekers are crammed into migrant centers designed to hold a few thousand .
At the most notorious camp , Moria , on the @ @ @ @ @ @ @ `` just one water tap for every 1,300 people and no soap available , '' Dr. Hilde Vochten , the medical coordinator for Doctors Without Borders ( MSF ) in Greece , said in a statement in mid-March .
`` This means that recommended measures such as frequent hand washing and social distancing to prevent the spread of the virus are just impossible . ''
MSF , Amnesty International and Germany 's Protestant Church federation , Evangelische Kirche Deutschland , have pleaded with the Greek government to move the refugees out of these @ @ @ @ @ @ @ Those seeking protection in the refugee camps face a catastrophe as soon as COVID-19 breaks out there , '' warned Bishop Heinrich Bedford-Strohm , chair of the Evangelische Kirche Deutschland council .
Mitarakis , the Greek migration minister , told members of the European Parliament 's home affairs committee that there is no room on the Greek mainland for the refugees .
`` We will strongly welcome any offers of relocation from member states that have capacity , '' he told the lawmakers Thursday , `` because we can not resolve this crisis @ @ @ @ @ @ @ Union is deeply divided on the issue of refugee relocation .
On Wednesday , the European Court of Justice said three anti-migrant EU countries — Hungary , Slovakia and the Czech Republic — broke EU law by refusing to accept refugees under a EU-mandated relocation program .

Greece Records First Coronavirus Cases Among Refugees, Imposes Quarantine On Camp
Enlarge this image toggle caption Thanassis Stavrakis/AP Thanassis Stavrakis/AP
Since the outbreak of the coronavirus pandemic, medical personnel, human rights groups and others have warned of catastrophe if COVID-19 spreads to the roughly 60,000 refugees living in often-squalid camps in Greece.
Now the virus has arrived. This week, at least 20 refugees living in the Ritsona camp, near Athens, have tested positive for COVID-19. The camp is now on lockdown for the next two weeks.
"No one can go in or out" except for essential personnel like healthcare workers, Migration Minister Notis Mitarakis told Greece's SKAI radio on Thursday.
Authorities were first alerted earlier this week, when a 19-year-old resident of the camp tested positive for COVID-19 after giving birth at an Athens hospital. Healthcare workers immediately began testing more than 60 Ritsona camp residents who had come into contact with the woman. The 20 who tested positive for COVID-19 currently do not have symptoms, Greece's migration ministry says.
Testing of the 2,700 refugees living in Ritsona will continue during the 14-day quarantine.
"It is critical that everyone, including migrant[s] and refugees on the mainland and the islands, are ensured equal access to health services including prevention, testing and treatment, especially in times like these," said Gianluca Rocco, chief of the International Organization for Migration's mission in Greece.
Ritsona is one of Greece's better-maintained refugee camps. The worst camps are on the Aegean islands, where 41,000 asylum seekers are crammed into migrant centers designed to hold a few thousand.
At the most notorious camp, Moria, on the island of Lesvos, some areas have "just one water tap for every 1,300 people and no soap available," Dr. Hilde Vochten, the medical coordinator for Doctors Without Borders (MSF) in Greece, said in a statement in mid-March. "This means that recommended measures such as frequent hand washing and social distancing to prevent the spread of the virus are just impossible."
MSF, Amnesty International and Germany's Protestant Church federation, Evangelische Kirche Deutschland, have pleaded with the Greek government to move the refugees out of these camps and onto the mainland.
"Those seeking protection in the refugee camps face a catastrophe as soon as COVID-19 breaks out there," warned Bishop Heinrich Bedford-Strohm, chair of the Evangelische Kirche Deutschland council.
Mitarakis, the Greek migration minister, told members of the European Parliament's home affairs committee that there is no room on the Greek mainland for the refugees.
"We will strongly welcome any offers of relocation from member states that have capacity," he told the lawmakers Thursday, "because we cannot resolve this crisis instantly and alone."
The European Union is deeply divided on the issue of refugee relocation. On Wednesday, the European Court of Justice said three anti-migrant EU countries — Hungary, Slovakia and the Czech Republic — broke EU law by refusing to accept refugees under a EU-mandated relocation program.


npr--2020-04-02--1 Million Coronavirus Cases Have Now Been Reported Worldwide

1 Million Coronavirus Cases Have Now Been Reported Worldwide Countries around the world have now reported more than 1 million coronavirus cases , as the COVID-19 pandemic continues to grow .
The respiratory disease has killed more than 51,000 people and is found in at least 181 countries and regions .
The updated numbers come from a coronavirus dashboard created by Johns Hopkins University 's Whiting School of Engineering , which tracks the data in near real time .
The global case total includes some 209,000 people who have recovered from COVID-19 .
But the number of new cases has @ @ @ @ @ @ @ Spain in recent weeks , driving the outbreak to alarming new heights .
The COVID-19 pandemic is severely disrupting daily life , closing schools and businesses and forcing travel restrictions on billions of people worldwide .
It is overwhelming health care systems with floods of critically ill patients .
In many places , the virus is also triggering vital shortages of medical equipment and daily necessities .
`` This virus , which was unknown to us three months ago , has exposed the weaknesses and inequities in our health systems and societies , @ @ @ @ @ @ @ Ghebreyesus said on Thursday .
The coronavirus has revealed `` our lack of preparedness , and the gaps in our supply chains and other essential systems , '' Tedros added .
The U.S. has confirmed 234,000 cases — the most in the world — including more than 5,600 deaths .
Italy has more than 115,000 cases and nearly 14,000 deaths , and Spain has more than 110,000 cases .
China , the original epicenter of the outbreak , is still reporting less than 83,000 cases .
After two months of mandated lockdowns , @ @ @ @ @ @ @ from their homes .
But there are also reports of mysterious second-time infections in Wuhan , where the coronavirus was first detected in late 2019 .
While acknowledging the rising death toll from the coronavirus , Tedros also warned that the pandemic is causing a cascade effect that , for some , will prove deadly .
If over-stressed health systems fail to protect and treat patients , he said , COVID-19 will have an even more drastic effect .
`` We know that when health systems are overwhelmed , mortality from vaccine-preventable and @ @ @ @ @ @ @ '' Tedros said .
He added , `` Gaps in essential care can result in many more deaths than the coronavirus itself . ''
Researchers are desperately seeking a way to prevent or cure the new coronavirus , including nearly 50 potential vaccines and 25 possible antibody treatments , according to the Milken Institute 's online tracking tool .
The fight against COVID-19 includes an international `` Solidarity trial '' that the WHO is organizing to assess potential treatments .
So far , 74 countries have either joined or started the process of @ @ @ @ @ @ @ More than 200 patients have been randomly assigned to one part of the study .
The Solidarity trial is comparing four drugs and drug combinations .
The project includes the experimental Ebola drug remdesivir , the malaria drug chloroquine and the combination of lopinavir and ritonavir — two protease inhibitors that have been used to combat HIV .

1 Million Coronavirus Cases Have Now Been Reported Worldwide
Enlarge this image toggle caption Sergio Perez/Reuters Sergio Perez/Reuters
Countries around the world have now reported more than 1 million coronavirus cases, as the COVID-19 pandemic continues to grow. The respiratory disease has killed more than 51,000 people and is found in at least 181 countries and regions.
The updated numbers come from a coronavirus dashboard created by Johns Hopkins University's Whiting School of Engineering, which tracks the data in near real time.
The global case total includes some 209,000 people who have recovered from COVID-19. But the number of new cases has skyrocketed in the U.S., Italy and Spain in recent weeks, driving the outbreak to alarming new heights.
The COVID-19 pandemic is severely disrupting daily life, closing schools and businesses and forcing travel restrictions on billions of people worldwide. It is overwhelming health care systems with floods of critically ill patients. In many places, the virus is also triggering vital shortages of medical equipment and daily necessities.
"This virus, which was unknown to us three months ago, has exposed the weaknesses and inequities in our health systems and societies," World Health Organization Director-General Tedros Adhanom Ghebreyesus said on Thursday.
The coronavirus has revealed "our lack of preparedness, and the gaps in our supply chains and other essential systems," Tedros added.
The U.S. has confirmed 234,000 cases — the most in the world — including more than 5,600 deaths. Italy has more than 115,000 cases and nearly 14,000 deaths, and Spain has more than 110,000 cases.
China, the original epicenter of the outbreak, is still reporting less than 83,000 cases. After two months of mandated lockdowns, people have finally begun to venture out from their homes. But there are also reports of mysterious second-time infections in Wuhan, where the coronavirus was first detected in late 2019.
While acknowledging the rising death toll from the coronavirus, Tedros also warned that the pandemic is causing a cascade effect that, for some, will prove deadly. If over-stressed health systems fail to protect and treat patients, he said, COVID-19 will have an even more drastic effect.
"We know that when health systems are overwhelmed, mortality from vaccine-preventable and other treatable conditions will increase dramatically," Tedros said. He added, "Gaps in essential care can result in many more deaths than the coronavirus itself."
Researchers are desperately seeking a way to prevent or cure the new coronavirus, including nearly 50 potential vaccines and 25 possible antibody treatments, according to the Milken Institute's online tracking tool.
The fight against COVID-19 includes an international "Solidarity trial" that the WHO is organizing to assess potential treatments. So far, 74 countries have either joined or started the process of contributing, Tedros said on Thursday. More than 200 patients have been randomly assigned to one part of the study.
The Solidarity trial is comparing four drugs and drug combinations. The project includes the experimental Ebola drug remdesivir, the malaria drug chloroquine and the combination of lopinavir and ritonavir — two protease inhibitors that have been used to combat HIV.


npr--2020-04-02--Ventilators Are No Panacea For Critically Ill COVID-19 Patients

Ventilators Are No Panacea For Critically Ill COVID-19 Patients Most coronavirus patients who end up on ventilators go on to die , according to several small studies from the U.S. , China and Europe .
And many of the patients who continue to live ca n't be taken off the mechanical breathing machines .
`` It 's very concerning to see how many patients who require ventilation do not make it out of the hospital , '' says Dr. Tiffany Osborn , a critical care specialist at Washington University in St. Louis who has been caring for coronavirus patients at @ @ @ @ @ @ @ by Negin Hajizadeh , a pulmonary critical care doctor at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell on Long Island , N.Y. '' We have had several patients between the hospitals across the Northwell system that have come off the breathing machine , '' Hajizadeh says .
`` But the vast majority are unable to . ''
The largest study so far to look at mortality among coronavirus patients on ventilators was done by the Intensive Care National Audit & Research Centre in London .
It found that among 98 @ @ @ @ @ @ @ 33 were discharged alive .
The numbers from a study of Wuhan , China , are even grimmer .
Only 3 of 22 ventilated patients survived .
And a study of 18 ventilated patients in Washington state found that nine were still alive when the study ended , but only six had recovered enough to breathe on their own .
All the early research suggests that once coronavirus patients are placed on a ventilator , they will probably need to stay on it for weeks .
And the longer patients remain on a @ @ @ @ @ @ @ are to die .
`` We 're not sure how much help ventilators are going to be , '' Osborn says .
`` They may help keep somebody alive in the short term .
We 're not sure if it 's going to help keep someone alive in the long term . ''
Patients need a ventilator when their lungs can no longer deliver enough oxygen to keep the body going .
And it 's an extreme measure , Osborn says .
`` We give sedation so the person goes to sleep .
@ @ @ @ @ @ @ their breathing , '' she says .
Next , a long plastic tube is inserted through the trachea and vocal cords .
That allows a machine to deliver small puffs of highly oxygenated air to the lungs .
Unfortunately , Osborn says , `` the ventilator itself can do damage to the lung tissue based on how much pressure is required to help oxygen get processed by the lungs . ''
And coronavirus patients often need dangerously high levels of both pressure and oxygen because their lungs have so much inflammation .
Another @ @ @ @ @ @ @ that the tube carrying air and extra oxygen to the lungs provides a pathway for dangerous germs .
Many ventilated patients get a new lung infection , a problem known as ventilator-associated pneumonia .
Ventilators have been seen as critical to treating coronavirus patients because the devices are very successful when used to treat common forms of pneumonia , says Hajizadeh .
`` We treat patients for several days , and then we get the antibiotics into the body and the patient recovers , '' she says .
`` Unfortunately with this COVID-associated @ @ @ @ @ @ @ we know work for sure . ''
Also , the coronavirus often does a lot more damage to a person 's lungs than pneumonia associated with the flu .
`` There is fluid and other toxic chemicals , cytokines we call them , raging throughout the lung tissue , '' she says .
In some patients , the damage is so bad that even ventilation wo n't help .
So doctors have sometimes tried an even more extreme measure called extracorporeal membrane oxygenation , or ECMO , which delivers oxygen directly to a @ @ @ @ @ @ @ still a stopgap measure .
`` Remember , ECMO too is a life-supporting treatment , '' Hajizadeh says .
`` So it 's a bridge while we are allowing the lung to heal itself from a pneumonia . ''
But lungs do n't always heal , no matter how much help they get from a machine , Osborn says .
So people need to be diligent about social distancing to keep the virus from spreading .
`` I know that at times it gets frustrating , '' she says .
`` But it @ @ @ @ @ @ @ and your family but for the other people you care about to shelter in place until this is over . ''
Osborn should know .
When she 's not caring for patients at the hospital , she 's living in a camper to avoid putting her family at risk .

Ventilators Are No Panacea For Critically Ill COVID-19 Patients
Enlarge this image toggle caption Taechit Taechamanodom/Getty Images Taechit Taechamanodom/Getty Images
Most coronavirus patients who end up on ventilators go on to die, according to several small studies from the U.S., China and Europe.
And many of the patients who continue to live can't be taken off the mechanical breathing machines.
"It's very concerning to see how many patients who require ventilation do not make it out of the hospital," says Dr. Tiffany Osborn, a critical care specialist at Washington University in St. Louis who has been caring for coronavirus patients at Barnes-Jewish Hospital.
That concern is echoed by Negin Hajizadeh, a pulmonary critical care doctor at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell on Long Island, N.Y.
"We have had several patients between the hospitals across the Northwell system that have come off the breathing machine," Hajizadeh says. "But the vast majority are unable to."
The largest study so far to look at mortality among coronavirus patients on ventilators was done by the Intensive Care National Audit & Research Centre in London. It found that among 98 ventilated patients in the U.K., just 33 were discharged alive.
The numbers from a study of Wuhan, China, are even grimmer. Only 3 of 22 ventilated patients survived.
And a study of 18 ventilated patients in Washington state found that nine were still alive when the study ended, but only six had recovered enough to breathe on their own.
All the early research suggests that once coronavirus patients are placed on a ventilator, they will probably need to stay on it for weeks. And the longer patients remain on a breathing machine, the more likely they are to die.
"We're not sure how much help ventilators are going to be," Osborn says. "They may help keep somebody alive in the short term. We're not sure if it's going to help keep someone alive in the long term."
Patients need a ventilator when their lungs can no longer deliver enough oxygen to keep the body going. And it's an extreme measure, Osborn says.
"We give sedation so the person goes to sleep. Then we provide a paralytic that stops their breathing," she says.
Next, a long plastic tube is inserted through the trachea and vocal cords. That allows a machine to deliver small puffs of highly oxygenated air to the lungs.
Unfortunately, Osborn says, "the ventilator itself can do damage to the lung tissue based on how much pressure is required to help oxygen get processed by the lungs."
And coronavirus patients often need dangerously high levels of both pressure and oxygen because their lungs have so much inflammation.
Another risk from being on a ventilator is that the tube carrying air and extra oxygen to the lungs provides a pathway for dangerous germs. Many ventilated patients get a new lung infection, a problem known as ventilator-associated pneumonia.
Ventilators have been seen as critical to treating coronavirus patients because the devices are very successful when used to treat common forms of pneumonia, says Hajizadeh.
toggle caption John Minchillo/AP
"We treat patients for several days, and then we get the antibiotics into the body and the patient recovers," she says. "Unfortunately with this COVID-associated pneumonia, there are no treatments that we know work for sure."
Also, the coronavirus often does a lot more damage to a person's lungs than pneumonia associated with the flu. "There is fluid and other toxic chemicals, cytokines we call them, raging throughout the lung tissue," she says.
In some patients, the damage is so bad that even ventilation won't help. So doctors have sometimes tried an even more extreme measure called extracorporeal membrane oxygenation, or ECMO, which delivers oxygen directly to a patient's bloodstream.
But this is still a stopgap measure. "Remember, ECMO too is a life-supporting treatment," Hajizadeh says. "So it's a bridge while we are allowing the lung to heal itself from a pneumonia."
But lungs don't always heal, no matter how much help they get from a machine, Osborn says. So people need to be diligent about social distancing to keep the virus from spreading.
"I know that at times it gets frustrating," she says. "But it's really important not only for yourself and your family but for the other people you care about to shelter in place until this is over."
Osborn should know. When she's not caring for patients at the hospital, she's living in a camper to avoid putting her family at risk.


npr--2020-04-02--Alternative Mourning Rituals Offer Comfort And Closure During An Outbreak

Alternative Mourning Rituals Offer Comfort And Closure During An Outbreak Editor 's note : The death of a loved one during an epidemic is especially tough .
Because of fears of contagion , family members may not have been able to spend time with the dying person in their final days and hours , or traditional funeral services and burials may not have been possible .
That is happening in some instances with COVID-19 , in particular with older people who are isolated from family after a diagnosis and who become seriously ill. And it has happened during the Ebola @ @ @ @ @ @ @ the Democratic Republic of Congo .
The consequences of this kind of scenario are severe .
Families may feel they do not have an opportunity to bid farewell .
In areas where Ebola spread , community members often came to mistrust medical workers due to the lack of contact with dying family members .
Here is a report on the issues that arose in Congo — and solutions that gave family members peace of mind as well as more faith in the health-care establishment .
When Marie Jeanne Kaswera lost her husband to @ @ @ @ @ @ @ epidemic in the Democratic Republic of Congo , she says she was `` overwhelmed by negative thoughts and despair . ''
She could not wash him or display his body at home , preventing friends , family and neighbors from paying him their final respect , as is required in her country 's custom .
`` I was very hurt , '' says Kaswera , who was unable to attend her husband 's funeral or perform any burial rituals according to local convention .
`` I wondered if he really died because I @ @ @ @ @ @ @ body . ''
The disease hit the DRC in August 2018 and has claimed the lives of over 2,200 people , according to the World Health Organization .
Because a dead body can transmit the virus for up to a week after death , the Ministry of Health prohibited all traditional burials , which include close contact with the corpse .
Public health authorities mandate that families are kept at a safe distance from the body , and most burials are carried out by members of the Ebola response team .
But these @ @ @ @ @ @ @ between community members and health workers .
A Congolese psychologist and counselors at a group called the Bethesda Counselling Centre are helping Kaswera — and others who lost loved ones to Ebola — to find solace and closure through alternative burial rituals .
With a team of four counselors , psychologist Noé Kasali — who heads Bethesda 's counseling program in Beni , an Ebola-affected city in the northeast of DRC — has helped ease mourning for those who have lost a loved one to Ebola .
They have done this by creating @ @ @ @ @ @ @ that are a critical part of the Nande culture — the largest ethnic group in Beni — but without the body of the deceased present .
In Nande tradition , Kasali explains , Kaswera would have been able to wash the body of her husband and dress him in fresh clothes .
Then she would display him in a coffin for friends , family and neighbors to see .
Visitors would come to pay their respects — which often includes touching the body of the deceased — and sing , dance and cry @ @ @ @ @ @ @ able to perform rituals [ is ] devastating for people , '' says Kasali .
`` It prolongs their suffering . ''
Kasali launched Bethesda 's alternative burial program back in May 2019 .
Since then , his team has counseled 122 families .
His team gets in touch with families through referrals from respected community leaders .
The program lasts for four weeks , in which counselors take participants through three steps .
The first step is for family members mourning a death to gather at a place they select — for @ @ @ @ @ @ @ in church or at home .
There , counselors introduce the program and give people the opportunity to ask questions about the Ebola virus and the death of their loved one .
Many families have unanswered questions : Is it really true that a virus caused my father to die ?
Why him ?
Did I do something wrong ?
During this session , counselors listen to and try to address such concerns .
Bethesda 's staff live in the same city and are part of the same culture and speak the same @ @ @ @ @ @ @ people , '' says Kasali .
`` Their grief is also ours . ''
The second step is for families to come together to share stories about their deceased relatives , using photographs , prayer , music and letters — a substitute for the dances and songs by mourners that are part of traditional burial parties .
In this step , the families are also encouraged to write letters to their deceased loved ones , including memories of times together .
The process is designed to provide a way to express thoughts often @ @ @ @ @ @ @ .
The letters are to be kept in a dedicated place at home such as a special box or a locked drawer — and to be read from time to time .
`` It was powerful to write the words you were unable to say , '' says Kasali .
The activity offered the families a form of closure – a way of processing grief and letting go , he says .
The third and last step of Bethesda 's program tries to replicate the rite of planting trees and flowers on top @ @ @ @ @ @ @ a crucial part of Nande burials .
Kasali and colleagues invite families to pick a different yet special place for planting : next to a tree where the deceased used to shelter from the sun , or an empty plot of earth next to the family home .
By planting trees and flowers , living memorials are created – a space where people can mourn and remember , an alternative to the graveside .
`` Families [ who ] have not put a stem or flower on the grave of their loved ones— @ @ @ @ @ @ @ in their soul .
The stems grow to become flowers or bushes that represent the person who died , '' says Kasali .
Marie Jeanne Kaswera went through the program a few months ago after her husband died of Ebola .
She knows he was buried by a burial team , but she does not know where : `` My children and I did not participate in the burial .
At that time nobody was allowed . ''
Without knowing where he was buried , she had assumed that a memorial tree could @ @ @ @ @ @ @ by Kasali 's team offered her closure .
`` It will always help me to remember my husband whenever I see the tree , '' she says .
So far , families have planted almost a hundred trees — and flowers as well — in and around Beni in honor of those who have died from Ebola .
Bethesda 's approach is promising , says Ashley Nemiro , from the MHPSS Collaborative , which provides mental health and psychosocial support services in humanitarian emergencies .
Nemiro , a licensed therapist who has worked @ @ @ @ @ @ @ International Rescue Committee , believes that such models should be replicated and scaled up in future Ebola epidemics .
Carmen Valle Trabadelo , a psychologist at the MHPSS Collaborative , adds that the Bethesda program , drawing on existing research about mental health and mourning , provides an opportunity for families to reflect on the loss of their loved ones and the anger or sadness they might feel .
`` It is exactly the type of work that is needed in DRC , '' she says .
Ingrid Gercama is a freelance journalist @ @ @ @ @ @ @ about the social impacts of Ebola since the outbreak in West Africa in 2014-2016 .
Theresa Jones is a researcher in the field of global health .
Trained as a psychologist , she has previously worked for Doctors Without Borders and the International Rescue Committee .

Alternative Mourning Rituals Offer Comfort And Closure During An Outbreak
Enlarge this image toggle caption Concorde Amani / Bethesda Counselling Centre Concorde Amani / Bethesda Counselling Centre
Editor's note: The death of a loved one during an epidemic is especially tough. Because of fears of contagion, family members may not have been able to spend time with the dying person in their final days and hours, or traditional funeral services and burials may not have been possible. That is happening in some instances with COVID-19, in particular with older people who are isolated from family after a diagnosis and who become seriously ill. And it has happened during the Ebola outbreaks of 2014-2016 and the outbreak in the Democratic Republic of Congo.
The consequences of this kind of scenario are severe. Families may feel they do not have an opportunity to bid farewell. In areas where Ebola spread, community members often came to mistrust medical workers due to the lack of contact with dying family members. Here is a report on the issues that arose in Congo — and solutions that gave family members peace of mind as well as more faith in the health-care establishment.
When Marie Jeanne Kaswera lost her husband to Ebola at the start of the devastating epidemic in the Democratic Republic of Congo, she says she was "overwhelmed by negative thoughts and despair." She could not wash him or display his body at home, preventing friends, family and neighbors from paying him their final respect, as is required in her country's custom.
"I was very hurt," says Kaswera, who was unable to attend her husband's funeral or perform any burial rituals according to local convention. "I wondered if he really died because I never got to see and hold his body."
The disease hit the DRC in August 2018 and has claimed the lives of over 2,200 people, according to the World Health Organization. Because a dead body can transmit the virus for up to a week after death, the Ministry of Health prohibited all traditional burials, which include close contact with the corpse. Public health authorities mandate that families are kept at a safe distance from the body, and most burials are carried out by members of the Ebola response team. But these measures have created a sense of mistrust between community members and health workers.
A Congolese psychologist and counselors at a group called the Bethesda Counselling Centre are helping Kaswera — and others who lost loved ones to Ebola — to find solace and closure through alternative burial rituals.
With a team of four counselors, psychologist Noé Kasali — who heads Bethesda's counseling program in Beni, an Ebola-affected city in the northeast of DRC — has helped ease mourning for those who have lost a loved one to Ebola. They have done this by creating new interpretations of the traditional funeral ceremonies that are a critical part of the Nande culture — the largest ethnic group in Beni — but without the body of the deceased present.
In Nande tradition, Kasali explains, Kaswera would have been able to wash the body of her husband and dress him in fresh clothes. Then she would display him in a coffin for friends, family and neighbors to see. Visitors would come to pay their respects — which often includes touching the body of the deceased — and sing, dance and cry through the night.
"Not being able to perform rituals [is] devastating for people," says Kasali. "It prolongs their suffering."
Kasali launched Bethesda's alternative burial program back in May 2019. Since then, his team has counseled 122 families. His team gets in touch with families through referrals from respected community leaders. The program lasts for four weeks, in which counselors take participants through three steps.
The first step is for family members mourning a death to gather at a place they select — for example, beneath a favorite tree, in church or at home. There, counselors introduce the program and give people the opportunity to ask questions about the Ebola virus and the death of their loved one. Many families have unanswered questions: Is it really true that a virus caused my father to die? Why him? Did I do something wrong?
During this session, counselors listen to and try to address such concerns. Bethesda's staff live in the same city and are part of the same culture and speak the same local language. "It is our people," says Kasali. "Their grief is also ours."
The second step is for families to come together to share stories about their deceased relatives, using photographs, prayer, music and letters — a substitute for the dances and songs by mourners that are part of traditional burial parties.
In this step, the families are also encouraged to write letters to their deceased loved ones, including memories of times together. The process is designed to provide a way to express thoughts often left unspoken because of the sudden death. The letters are to be kept in a dedicated place at home such as a special box or a locked drawer — and to be read from time to time.
"It was powerful to write the words you were unable to say," says Kasali. The activity offered the families a form of closure – a way of processing grief and letting go, he says.
The third and last step of Bethesda's program tries to replicate the rite of planting trees and flowers on top of a loved ones' grave, a crucial part of Nande burials. Kasali and colleagues invite families to pick a different yet special place for planting: next to a tree where the deceased used to shelter from the sun, or an empty plot of earth next to the family home. By planting trees and flowers, living memorials are created – a space where people can mourn and remember, an alternative to the graveside.
"Families [who] have not put a stem or flower on the grave of their loved ones— [it] leaves a big gap in their soul. The stems grow to become flowers or bushes that represent the person who died," says Kasali.
Marie Jeanne Kaswera went through the program a few months ago after her husband died of Ebola. She knows he was buried by a burial team, but she does not know where: "My children and I did not participate in the burial. At that time nobody was allowed." Without knowing where he was buried, she had assumed that a memorial tree could not be planted.
The activities suggested by Kasali's team offered her closure. "It will always help me to remember my husband whenever I see the tree," she says.
So far, families have planted almost a hundred trees — and flowers as well — in and around Beni in honor of those who have died from Ebola.
Bethesda's approach is promising, says Ashley Nemiro, from the MHPSS Collaborative, which provides mental health and psychosocial support services in humanitarian emergencies. Nemiro, a licensed therapist who has worked with the World Health Organization and the International Rescue Committee, believes that such models should be replicated and scaled up in future Ebola epidemics.
Carmen Valle Trabadelo, a psychologist at the MHPSS Collaborative, adds that the Bethesda program, drawing on existing research about mental health and mourning, provides an opportunity for families to reflect on the loss of their loved ones and the anger or sadness they might feel.
"It is exactly the type of work that is needed in DRC," she says.
Ingrid Gercama is a freelance journalist and anthropologist. She has been writing about the social impacts of Ebola since the outbreak in West Africa in 2014-2016.
Theresa Jones is a researcher in the field of global health. Trained as a psychologist, she has previously worked for Doctors Without Borders and the International Rescue Committee.


npr--2020-04-02--Cruise Ships With Sick People Dock In Florida

Carrying passengers and crew sick with COVID-19 , the Holland America cruise ship Zaandam docked in Ft. Lauderdale , Fla. today .
It and its sister ship the Rotterdam were allowed to dock and begin disembarking passengers after officials reached an agreement with Holland America 's parent company , Carnival Cruise Line .
The Zaandam has been at sea on what began as a South American cruise since March 7 .
After some on the ship began to develop flu-like symptoms , Chile and several other countries refused to allow any passengers to disembark .
Holland America says nearly 200 @ @ @ @ @ @ @ and four people died .
The company sent a second ship , the Rotterdam , to bring medical supplies and personnel to the Zaandam .
Some healthy passengers were transferred to the new ship to minimize their chances of being exposed to the coronavirus .
The company says as many as nine people on the Zaandam need hospitalization .
Holland America says a local hospital in Broward County , Fla. has agreed to admit them .
Thursday morning , Broward County Commissioner Michael Udine released a statement saying local officials , working with @ @ @ @ @ @ @ Protection and the Centers for Disease Control and Prevention had reached an agreement with Carnival .
It will allow healthy passengers to disembark and take cars , charter flights or hired buses home .
The company says approximately 45 passengers still have `` mild illness and are unfit to travel at this time . ''
That group will remain on board and isolate themselves until they have recovered and , under CDC guidelines , are allowed to travel .
After saying for days , that he did n't believe the two ships should @ @ @ @ @ @ @ , Gov .
Ron DeSantis relented late yesterday .
The number of patients needing treatment he said is `` very manageable and the local hospital system thinks they can manage it . ''

Cruise Ships With Sick People Dock In Florida
Enlarge this image toggle caption VW Pics/Universal Images Group via Getty VW Pics/Universal Images Group via Getty
Carrying passengers and crew sick with COVID-19, the Holland America cruise ship Zaandam docked in Ft. Lauderdale, Fla. today. It and its sister ship the Rotterdam were allowed to dock and begin disembarking passengers after officials reached an agreement with Holland America's parent company, Carnival Cruise Line.
The Zaandam has been at sea on what began as a South American cruise since March 7. After some on the ship began to develop flu-like symptoms, Chile and several other countries refused to allow any passengers to disembark.
Holland America says nearly 200 passengers and crew eventually became sick, and four people died. The company sent a second ship, the Rotterdam, to bring medical supplies and personnel to the Zaandam. Some healthy passengers were transferred to the new ship to minimize their chances of being exposed to the coronavirus.
The company says as many as nine people on the Zaandam need hospitalization. Holland America says a local hospital in Broward County, Fla. has agreed to admit them.
Thursday morning, Broward County Commissioner Michael Udine released a statement saying local officials, working with the Coast Guard, Customs and Border Protection and the Centers for Disease Control and Prevention had reached an agreement with Carnival. It will allow healthy passengers to disembark and take cars, charter flights or hired buses home. The company says approximately 45 passengers still have "mild illness and are unfit to travel at this time." That group will remain on board and isolate themselves until they have recovered and, under CDC guidelines, are allowed to travel.
After saying for days, that he didn't believe the two ships should be allowed to dock in Ft. Lauderdale, Gov. Ron DeSantis relented late yesterday. The number of patients needing treatment he said is "very manageable and the local hospital system thinks they can manage it."