npr--2020-03-22--Pregnant And Worried About Coronavirus? How To Stay Safe And Make A Game Plan

Pregnant And Worried About Coronavirus ?
How To Stay Safe And Make A Game Plan Pregnancy can sometimes be an uncertain and stressful period in the best of circumstances .
But during a pandemic , that anxiety can quickly multiply .
Researchers are working quickly to learn more about what the new coronavirus — and its impact on our daily lives — means right now for people who are pregnant .
And health care providers are game-planning with mothers about how to best manage care in light of growing limits on public contact .
Here 's what we know so @ @ @ @ @ @ @ if I 'm pregnant ?
?
`` The good news is that thus far there has n't been any indication that pregnant women are more severely affected '' by the novel virus , says Denise Jamieson , chair of the Department of Gynecology and Obstetrics at Emory University Healthcare and a senior author of a prepress review paper slated to publish in the American Journal of Obstetrics & Gynecology .
This comes as a welcome surprise , as the similar coronavirus that caused SARS ( severe acute respiratory syndrome ) had a much @ @ @ @ @ @ @ about 25 % , according to the limited data available from the 2003 outbreak ) than for the general population ( about 10 % ) .
The current , hopeful assessments of the new coronavirus are based in large part on a study published online last month in The Lancet of nine pregnant women in their third trimester in Wuhan , China , who had COVID-19-caused pneumonia .
None of the women developed severe illness , and all of their babies were born healthy .
`` According to the current evidence in China @ @ @ @ @ @ @ with COVID-19 is consistent with that of ordinary adults , '' says Jie Qiao , director of the National Clinical Research Center of Obstetrics and Gynecology Disease in China who was not involved in that study but authored a commentary about it in the same issue of The Lancet .
Jamieson notes , however , `` we do n't have very much evidence from this coronavirus . ''
And although the data from third-trimester pregnancies appeared reassuring , we do n't yet know much about the first or second trimester during a COVID-19 @ @ @ @ @ @ @ other experts are closely following the evolving data .
What extra precautions should I take while pregnant ?
The immune system 's efficacy dips during pregnancy , which places pregnant people at a higher risk for contracting many transmissible illnesses – whether food-borne or respiratory .
`` They should be considered an at-risk group , '' Jamieson says .
Official recommendations during pregnancy are currently about the same as for the general population , including avoiding crowds , staying away from sick people , washing hands frequently , and not touching the face @ @ @ @ @ @ @ further , adding that she recommends avoiding public areas if possible – and wearing a face mask when out .
And talk to your doctor about telemedicine , to avoid unnecessary visits to the office .
`` Except important pregnancy check-ups , '' she says , `` consulting [ your ] doctors online is recommended . ''
Many offices are already working to consolidate in-person appointments ( for example , if someone is coming in for an ultrasound , a routine prenatal check might be added to the same visit ) .
In @ @ @ @ @ @ @ that it is important to consider how such a widespread outbreak could strain the health system , leading to disruptions in normal care .
To prepare for that , she says , she advises that pregnant people have their medical records on hand .
Neil Silverman , a clinical professor of obstetrics and gynecology at the David Geffen School of Medicine at the University of California , Los Angeles , adds that hospitals are already ramping up to increase the capacity to care for pregnant women .
What kind of contingency planning should @ @ @ @ @ @ @ change that is already occurring in many labor and delivery wards is that they are limiting the number of visitors who can accompany anyone admitted for delivery — including through the postpartum stay .
`` This has been , reasonably , upsetting , '' says Rachel Pilliod , an OB/GYN who teaches obstetrics and gynecology at Oregon Health & Science University .
`` We understand that giving birth is more than a physiological process , '' she says , and many families have expectations about sharing the occasion in person .
She advises @ @ @ @ @ @ @ to ask their provider and the place where they intend to deliver about their current rules on visitors .
Typically the limit has been to one other healthy adult for the duration of the hospital stay .
Ahead of delivery , Jamieson advocates that `` every pregnant woman and her family should have a plan , which should include what would happen if she or an additional caregiver gets sick . ''
For example , if a partner becomes ill with COVID-19 and is trying to self-isolate , is there another caregiver who @ @ @ @ @ @ @ a newborn and mother ?
And because the illness is riskier for older adults , where that once might have meant a new grandparent , a younger adult might be a better backup if possible .
What if I do get sick — how do I protect my newborn ?
If you do get sick near your delivery date with confirmed or even suspected COVID-19 , there 's special precautions to be aware of .
Though new mothers might not be at higher risk themselves , it is important to avoid passing the @ @ @ @ @ @ @ has not shown any evidence that the virus can be transmitted in utero , during delivery or through breastmilk .
But transmission can occur after birth when infants are in close contact with someone who has the illness .
This issue raises challenging decisions for families and health care providers .
The practice of keeping a newborn in the same hospital room as the mother after birth ( known as `` rooming-in '' ) has become popular in many U.S. hospitals .
But the U.S. Centers for Disease Control and Prevention currently recommends @ @ @ @ @ @ @ or suspected COVID-19 infections .
The guidelines ( as of publication ) say these infants should be placed in isolation and themselves treated as presumed coronavirus cases , being cared for by healthy caregivers and medical staff in protective garb .
`` The main purpose is to avoid close contact with mothers , isolating respiratory tract transmission and possible infection , '' Qiao says .
Pilliod noted that in her practice the CDC guidelines will be discussed with families so that they understand the risks and tradeoffs of their care decisions .
Healthy @ @ @ @ @ @ @ spend time with the newborns in isolation .
If an infant is taken to isolation directly after birth , the CDC recommends that ill women who would like to provide breast milk for their infant use a breast pump , being sure to practice good pumping hygiene .
Direct breastfeeding could also be possible if the infected mother wears a mask , but it is not currently the CDC 's first choice .
`` It 's a difficult decision , and I think the mother needs to be involved in the conversation about @ @ @ @ @ @ @ What else do I need to know if I get sick during pregnancy ?
Research is underway , but there is not currently a definitive treatment or preventative vaccine for COVID-19 .
Once these do emerge , there is a distinct possibility that they wo n't initially be approved for use during pregnancy and lactation .
`` This is one of the big concerns , '' Jamieson said .
For now , says Silverman , it is important to `` be aware of the potential symptoms so [ pregnant women ] can call @ @ @ @ @ @ @ , '' which include fever , respiratory symptoms or possibly even diarrhea .
Additionally , he notes , if they learn they have been in contact with someone who has tested positive for COVID-19 , they should monitor their own temperature and be especially aware of any respiratory symptoms .
Their health care provider can advise best steps for care and testing .
Qiao notes that individuals should also be careful when selecting over-the-counter medications for treating symptoms , as many standard remedies should be avoided during pregnancy ( including many cough and @ @ @ @ @ @ @ fever – medicines ) .
With the large uptick in the number of cases of the novel virus , researchers are gathering more data about the disease 's impact on pregnant people , fetuses and newborns .
Synthesizing all of that information will likely take additional time , but it will eventually help better guide public health and healthcare recommendations .
In the meantime , the best offense remains a good defense .
And that means pregnant people – and those around them – should follow the best current personal and social hygiene @ @ @ @ @ @ @ and their newborns safer by keeping everyone around them healthy as well , '' Pilliod says .
`` It takes a village to keep us all safe . ''

Pregnant And Worried About Coronavirus? How To Stay Safe And Make A Game Plan
Enlarge this image toggle caption Stringer/Getty Images Stringer/Getty Images
Pregnancy can sometimes be an uncertain and stressful period in the best of circumstances. But during a pandemic, that anxiety can quickly multiply. Researchers are working quickly to learn more about what the new coronavirus — as well as its impact on our daily lives — means right now for people who are pregnant. And health care providers are game-planning with mothers about how to best manage care in light of growing limits on public contact.
Here's what we know so far.
Am I more at risk if I'm pregnant??
"The good news is that thus far there hasn't been any indication that pregnant women are more severely affected" by the novel virus, says Dr. Denise Jamieson, chair of the department of gynecology and obstetrics at Emory Healthcare and a senior author of a prepress review paper slated to publish in the American Journal of Obstetrics & Gynecology.
This comes as a welcome surprise, as the similar coronavirus that caused SARS had a much higher fatality rate for pregnant people (about 25%, according to the limited data available from the 2003 outbreak) than for the general population (about 10%).
The current, hopeful assessments of the new coronavirus are based in large part on a study published online last month in The Lancet of nine pregnant women in their third trimester in Wuhan, China, who had pneumonia caused by COVID-19. None of the women developed severe illness, and all of their babies were born healthy.
"According to the current evidence in China, the clinical performance of pregnant women with COVID-19 is consistent with that of ordinary adults," says Jie Qiao, director of the National Clinical Research Center of Obstetrics and Gynecology Disease in China, who was not involved in that study but authored a commentary about it in the same issue of The Lancet.
Jamieson notes, however, that "we don't have very much evidence from this coronavirus." And although the data from third-trimester pregnancies appeared reassuring, we don't yet know much about the first or second trimester during a COVID-19 illness. So Jamieson, Qiao and other experts are closely following the evolving data.
What extra precautions should I take while pregnant?
The immune system's efficacy dips during pregnancy, which places pregnant people at a higher risk for contracting many transmissible illnesses — whether foodborne or respiratory. "They should be considered an at-risk group," Jamieson says.
Official recommendations during pregnancy are currently about the same as for the general population, including avoiding crowds, staying away from sick people, washing hands frequently and not touching the face.
Qiao takes these suggestions a step further, adding that she recommends avoiding public areas if possible — and wearing a face mask when out. And talk to your doctor about telemedicine, to avoid unnecessary visits to the office. "Except important pregnancy checkups," she says, "consulting [your] doctors online is recommended." Many offices are already working to consolidate in-person appointments (for example, if someone is coming in for an ultrasound, a routine prenatal check might be added to the same visit).
In addition to personal steps, Jamieson notes that it is important to consider how such a widespread outbreak could strain the health system, leading to disruptions in normal care. To prepare for that, she says, she advises that pregnant people have their medical records on hand.
Neil Silverman, a clinical professor of obstetrics and gynecology at the David Geffen School of Medicine at the University of California, Los Angeles, adds that hospitals are already ramping up to increase the capacity to care for pregnant women.
What kind of contingency planning should I do for delivery?
One big change that is already occurring in many labor and delivery wards is that they are limiting the number of visitors who can accompany anyone admitted for delivery — including through the postpartum stay. "This has been, reasonably, upsetting," says Rachel Pilliod, an OB-GYN who teaches obstetrics and gynecology at Oregon Health & Science University. "We understand that giving birth is more than a physiological process," she says, and many families have expectations about sharing the occasion in person.
She advises women who might deliver during the pandemic to ask their provider and the place where they intend to deliver about current rules on visitors. Typically the limit has been to one other healthy adult for the duration of the hospital stay.
Ahead of delivery, Jamieson advocates that "every pregnant woman and her family should have a plan, which should include what would happen if she or an additional caregiver gets sick." For example, if a partner becomes ill with COVID-19 and is trying to self-isolate, is there another caregiver who can step in to help care for a newborn and mother? And because the illness is riskier for older adults, if the other caregiver might have once meant a new grandparent, a younger adult might be a better backup if possible.
If I do get sick, how do I protect my newborn?
If you do get sick near your delivery date with confirmed or even suspected COVID-19, there are special precautions to be aware of. Though new mothers might not be at higher risk themselves, it is important to avoid passing the virus to a newborn.
Early research has not shown any evidence that the virus can be transmitted in utero, during delivery or through breast milk. But transmission can occur after birth when infants are in close contact with someone who has the illness.
This issue raises challenging decisions for families and health care providers. The practice of keeping a newborn in the same hospital room as the mother after birth (known as "rooming-in") has become popular in many U.S. hospitals. But the U.S. Centers for Disease Control and Prevention currently recommends avoiding rooming-in for new mothers with diagnosed or suspected COVID-19 infections. The guidelines (as of publication) say these infants should be placed in isolation and themselves be treated as presumed coronavirus cases, being cared for by healthy caregivers and medical staff in protective garb. "The main purpose is to avoid close contact with mothers, isolating respiratory tract transmission and possible infection," Qiao says.
Pilliod notes that in her practice, the CDC guidelines will be discussed with families so that they understand the risks and trade-offs of their care decisions. Healthy family members may have the choice to spend time with the newborns in isolation.
If an infant is taken to isolation directly after birth, the CDC recommends that ill women who would like to provide breast milk for their infant use a breast pump, being sure to practice good pumping hygiene. Direct breastfeeding could also be possible if the infected mother wears a mask, but it is not currently the CDC's first choice. "It's a difficult decision, and I think the mother needs to be involved in the conversation about the risks," Jamieson says.
What else do I need to know if I get sick during pregnancy?
Research is underway, but there is not currently a definitive treatment or vaccine for COVID-19. Once these do emerge, it's a distinct possibility that they won't initially be approved for use during pregnancy and lactation. "This is one of the big concerns," Jamieson says.
For now, says Silverman, it is important to "be aware of the potential symptoms so [pregnant women] can call their health provider if they have any," which include fever, respiratory symptoms or possibly even diarrhea. Additionally, he notes, if they learn they have been in contact with someone who has tested positive for COVID-19, they should monitor their own temperature and be especially aware of any respiratory symptoms. Their health care provider can advise best steps for care and testing.
Qiao notes that individuals should also be careful when selecting over-the-counter medications for treating symptoms, as many standard remedies should be avoided during pregnancy (including many cough and cold — as well as pain and fever — medicines).
With the large uptick in the number of cases of the novel virus, researchers are gathering more data about the disease's impact on pregnant people, fetuses and newborns. Synthesizing all of that information will likely take additional time, but it will eventually help better guide public health and health care recommendations.
In the meantime, the best offense remains a good defense. And that means pregnant people — and those around them — should follow the best current personal and social hygiene recommendations. "We keep pregnant women and their newborns safer by keeping everyone around them healthy as well," Pilliod says. "It takes a village to keep us all safe."


npr--2020-03-22--In Oregon, Neighbors Use Social Media To Offer — And Ask For — Help

In Oregon , Neighbors Use Social Media To Offer — And Ask For — Help Orders to stay home leave many people glued to their screens .
In rural Oregon , some people are turning their time on social media into tangible help for neighbors coping with coronavirus .
`` I never thought I would say this , but we 're using Facebook to express love to our neighbors in really meaningful ways , '' said Morgan Schmidt , moderator of a group for Bend , Ore. residents , where housebound people can crowdsource help with daily tasks .
`` @ @ @ @ @ @ @ a gentleman who just said , `` I 'm immunocompromised .
I do n't want to go into Safeway .
Can I have someone run in and grab my groceries and put them in my trunk ? ''
recalled Schmidt .
Her days blur together since that first post in Pandemic Partners - Bend .
Normally , she 's a Presbyterian pastor .
As the state banned gatherings and shuttered schools to try and slow the spread of coronavirus , her church also closed .
She 's pivoted to full time social media @ @ @ @ @ @ @ .
`` I would comfortably say we have thousands of people ready to help , '' Schmidt said .
One person who asked for help is Mary Sheridan .
She 's been at home with two kids and the dog , ever since she came down with a fever and a cough .
The family has n't been tested for coronavirus , as those tests remain largely inaccessible in Oregon .
`` I 'm trying to stay informed , but not freak out , especially since ...
I 'm sick , and people @ @ @ @ @ @ @ gotten sick , too , '' Sheridan said .
When her digital thermometer died recently , she posted to Pandemic Partners , and `` within an hour , I had actually two different people stop by with batteries . ''
Now , Sheridan also has a list of people who live nearby and want to help if she needs it .
Fellow group member Diane Murray Fleck had n't been sick , and said the posts made her more aware of what others are struggling with behind closed doors .
`` We have @ @ @ @ @ @ @ not lose our humanity , '' she said .
Ten people accepted her offer to drop off dinner .
`` Moms home with young kids ... another woman ordered a meal for her elderly mother .
A gentleman was a diabetic and wanted a home cooked meal ... And someone else nominated another family that they knew was very quietly challenged , and probably not going to reach out for themselves . ''
At each stop , she threw in `` a roll of toilet paper with the garlic bread and the lasagna @ @ @ @ @ @ @ The deed helped her and her 12-year-old daughter deal with their own anxieties .
`` The fact that there was still something we could do for others , and be safe at the same time , '' Fleck said .
Bend 's Facebook group for neighborly goodwill also gets inundated with posts seeking medical advice .
Moderators refer them to doctors .
For Schmidt , the Presbyterian pastor , responding to other messages has been heartbreakingly difficult .
`` We 've had a couple of questions from people who are like , ' @ @ @ @ @ @ @ for a test to come back and I do n't have housing right now , ' '' she said .
But , finding housing in rural Oregon is tough even when someone is n't sick .
Schmidt connects the people with housing needs to social workers .
Her group limits the focus to acts of kindness most easily performed by neighbors : errands , groceries , dog walks .
`` These are bite-sized ways of responding that actually make a world of difference , '' she said .

In Oregon, Neighbors Use Social Media To Offer — And Ask For — Help
Enlarge this image toggle caption Courtesy of Dave Felton Courtesy of Dave Felton
Updated on March 23 at 12:21 p.m. ET
Orders to stay home leave many people glued to their screens. In rural Oregon, some people are turning their time on social media into tangible help for neighbors coping with coronavirus.
"I never thought I would say this, but we're using Facebook to express love to our neighbors in really meaningful ways," said Morgan Schmidt, moderator of a group for Bend, Ore. residents, where housebound people can crowdsource help with daily tasks.
"One of our first requests...was a gentleman who just said, "I'm immunocompromised. I don't want to go into Safeway. Can I have someone run in and grab my groceries and put them in my trunk?" recalled Schmidt.
Her days blur together since that first post in Pandemic Partners - Bend. Normally, she's a Presbyterian pastor. As the state banned gatherings and shuttered schools to try and slow the spread of coronavirus, her church also closed. She's pivoted to full time social media manager. Her Facebook group exploded overnight.
"I would comfortably say we have thousands of people ready to help," Schmidt said.
One person who asked for help is Mary Sheridan. She's been at home with two kids and the dog, ever since she came down with a fever and a cough. At the time we spoke, her family hadn't been tested for the coronavirus — though she later learned she had tested positive.
"I'm trying to stay informed, but not freak out, especially since ... I'm sick, and people I have been in contact with have gotten sick, too," Sheridan said at the time.
When her digital thermometer died recently, she posted to Pandemic Partners, and "within an hour, I had actually two different people stop by with batteries."
Now, Sheridan also has a list of people who live nearby and want to help if she needs it.
Fellow group member Diane Murray Fleck hadn't been sick, and said the posts made her more aware of what others are struggling with behind closed doors.
"We have to balance protecting ourselves, but also not lose our humanity," she said.
Ten people accepted her offer to drop off dinner.
"Moms home with young kids... another woman ordered a meal for her elderly mother. A gentleman was a diabetic and wanted a home cooked meal... And someone else nominated another family that they knew was very quietly challenged, and probably not going to reach out for themselves."
At each stop, she threw in "a roll of toilet paper with the garlic bread and the lasagna, just as a joke."
The deed helped her and her 12-year-old daughter deal with their own anxieties.
"The fact that there was still something we could do for others, and be safe at the same time," Fleck said.
Bend's Facebook group for neighborly goodwill also gets inundated with posts seeking medical advice. Moderators refer them to doctors.
For Schmidt, the Presbyterian pastor, responding to other messages has been heartbreakingly difficult.
"We've had a couple of questions from people who are like, 'I'm sick and I am waiting for a test to come back and I don't have housing right now,'" she said.
But, finding housing in rural Oregon is tough even when someone isn't sick. Schmidt connects the people with housing needs to social workers. Her group limits the focus to acts of kindness most easily performed by neighbors: errands, groceries, dog walks.
"These are bite-sized ways of responding that actually make a world of difference," she said.


npr--2020-03-21--U.S. Hospitals Prepare Guidelines For Who Gets Care Amid Coronavirus Surge

U.S .
Hospitals Prepare Guidelines For Who Gets Care Amid Coronavirus Surge As COVID-19 spreads rapidly through the United States , many American doctors could soon be making the decisions that overwhelmed health care workers in Italy are already facing : Which patients get life-saving treatment and which ones do not ?
Every accredited hospital in the U.S. is required to have some mechanism for addressing ethical issues like this — typically , an ethics committee made up of not just medical professionals , but often also social workers , pastors and patient advocates .
Sometimes in partnership with hospital @ @ @ @ @ @ @ prioritizing patient care if there 's a resource shortage .
As the number of coronavirus cases rises in the U.S. , hospitals have a new urgency in revisiting and updating those guidelines .
They vary from hospital to hospital , but their overall goal is usually to save the most lives .
So hospitals consider a combination of factors : age , life expectancy , how severe a patient 's illness is , how likely treatment is to help , and whether a patient has additional illnesses that could shorten their life span @ @ @ @ @ @ @ .
Hospitals can then use those factors to develop scoring systems or clinical scores to prioritize care .
In early March , as the coronavirus outbreak worsened in Italy , an Italian medical association issued guidelines finding that doctors might have to prioritize younger COVID-19 patients over older ones .
`` It may be necessary to place an age limit '' on access to intensive care , the guidelines advised , with the goal of preserving limited health care resources for patients more likely to survive .
But age is rarely the only @ @ @ @ @ @ @ example , a 20-year-old will not always get priority over a 60-year-old , especially if that 20-year-old has additional health problems that could mean the 60-year-old is likely to live longer anyway .
Scoring systems can disadvantage older patients because as people age they become more susceptible to disease , which can hurt their clinical scores .
Another potential factor is `` social usefulness , '' a concept that might favor , for example , a sick nurse because that person could go on to save other lives .
`` Some people think @ @ @ @ @ @ @ to help address a crisis in the future if they were to recover , like health care workers and first responders , maybe should receive some sort of priority in triaging scarce resources , '' said Dr. Emily Rubin , a pulmonary and critical care physician at Massachusetts General Hospital in Boston and a co-chair of the hospital 's ethics committee .
Could other professions also be a factor , meaning that a hospital might prioritize , say , a hedge fund manager over a landscaper ?
That 's unlikely , according to @ @ @ @ @ @ @ and public health specialist who directs the University of Colorado 's Center for Bioethics and Humanities .
Wynia said most hospitals should operate on the principle that every human life has equal worth , so patients are clinically evaluated the same regardless of their employment , gender , race , insurance or whether they have children .
`` So if you had someone who was an upstanding member of the local community or a big donor to the hospital or a well-known politician versus a clerk at the 7-Eleven or a homeless person @ @ @ @ @ @ @ those patients should be evaluated equally .
There 's already evidence when it comes to coronavirus testing that rich and powerful people are getting greater access than ordinary Americans .
But ideally , hospital decision-makers would have `` blinded '' information that prevents them from knowing details about a patient 's source of payment , race , gender and other personal details , unless it 's clinically relevant , Wynia said .
Hospitals could adopt a lottery or first-come-first-served system for triaging patients , but that might mean someone less sick is treated @ @ @ @ @ @ @ to achieve the goal of saving the most lives .
Hospitals could treat worse-off patients first , but if those people are unlikely to survive , doctors might be better off focusing on people who are less ill .
Whether any of these guidelines would work in an extreme crisis situation , when hospitals may have few clinical details about patients , is an open question .
`` A million intricacies '' could come into play in a real-world setting , Rubin said .
Numerous doctors interviewed by NPR said the U.S. lacks @ @ @ @ @ @ @ coronavirus pandemic could play out , but said guidelines at least offer general principles for steering hospital decision-making .
They also said guidelines must be transparent so the public has faith they are fair and ethically justifiable .
Wynia predicts many hospitals will soon begin releasing their triage guidelines in case the U.S. ends up in an Italy-like situation .
And guidelines are needed not just for determining which patients to treat , but how long to treat them .
Nancy Berlinger , a research scholar at the nonprofit bioethics think tank the @ @ @ @ @ @ @ posed an ethical dilemma .
`` Let 's say a patient is on a ventilator but is n't improving , and this patient might — might — do better if they were allowed to stay on the ventilator longer , but there are people waiting for that ventilator , '' Berlinger said .
`` Do you withdraw the ventilation earlier than you might normally do ?
So it 's not just who gets the vent , it 's also who stays on it . ''
For now , U.S. hospitals are unsure whether @ @ @ @ @ @ @ the coronavirus pandemic , but they must brace for the possibility .
`` This is a worst-case scenario that we 're talking about , '' Wynia said .
`` We hope we never get there , but we have to get ready for the worst .
And it would be irresponsible not to be getting ready right now because of what we 're seeing in other places around the world where things really have gone very , very badly and where they have run out of equipment , supplies , staff , space @ @ @ @ @ @ @ be prepared for that . ''

U.S. Hospitals Prepare Guidelines For Who Gets Care Amid Coronavirus Surge
Enlarge this image toggle caption Andreas Solaro/AFP via Getty Images Andreas Solaro/AFP via Getty Images
As COVID-19 spreads rapidly through the United States, many American doctors could soon be making the decisions that overwhelmed health care workers in Italy are already facing: Which patients get lifesaving treatment, and which ones do not?
Every accredited hospital in the U.S. is required to have some mechanism for addressing ethical issues like this — typically, an ethics committee made up of not just medical professionals but often also social workers, pastors and patient advocates. Sometimes in partnership with hospital triage committees, they create guidelines for prioritizing patient care if there's a resource shortage.
As the number of coronavirus cases rises in the U.S., hospitals have a new urgency in revisiting and updating those guidelines.
They vary from hospital to hospital, but their overall goal is usually to save the most lives. So hospitals consider a combination of factors: age, life expectancy, how severe a patient's illness is, how likely treatment is to help and whether a patient has additional illnesses that could shorten the person's life span, such as cancer or heart disease. Hospitals can then use those factors to develop scoring systems or clinical scores to prioritize care.
In early March, as the coronavirus outbreak worsened in Italy, an Italian medical association issued guidelines finding that doctors might have to prioritize younger COVID-19 patients over older ones. "It may be necessary to place an age limit" on access to intensive care, the guidelines advised, with the goal of preserving limited health care resources for patients more likely to survive.
But age is rarely the only factor in such decision-making. For example, a 20-year-old will not always get priority over a 60-year-old, especially if that 20-year-old has additional health problems that could mean the 60-year-old is likely to live longer anyway. Scoring systems can disadvantage older patients, because as people age they become more susceptible to disease, which can hurt their clinical scores.
Another potential factor is "social usefulness," a concept that might favor, for example, a sick nurse because that person could go on to save other lives.
"Some people think that people who are in a position to help address a crisis in the future if they were to recover, like health care workers and first responders, maybe should receive some sort of priority in triaging scarce resources," said Emily Rubin, a pulmonary and critical care physician at Massachusetts General Hospital in Boston and a co-chair of the hospital's ethics committee.
Could other professions also be a factor, meaning that a hospital might prioritize, say, a hedge fund manager over a landscaper? That's unlikely, according to Dr. Matthew Wynia, an infectious disease and public health specialist who directs the University of Colorado's Center for Bioethics and Humanities.
Wynia said most hospitals should operate on the principle that every human life has equal worth, so patients are clinically evaluated the same regardless of their employment, gender, race or insurance, or whether they have children.
"So if you had someone who was an upstanding member of the local community or a big donor to the hospital or a well-known politician versus a clerk at the 7-Eleven or a homeless person," Wynia said, each of those patients should be evaluated equally.
There's already evidence that when it comes to coronavirus testing, rich and powerful people are getting greater access than ordinary Americans.
But ideally, hospital decision-makers would have "blinded" information that prevented them from knowing details about a patient's source of payment, race, gender and other personal details, unless it were clinically relevant, Wynia said.
Hospitals could adopt a lottery or first-come-first-served system for triaging patients, but that might mean someone less sick is treated before someone more sick, potentially failing to achieve the goal of saving the most lives. Hospitals could treat worse-off patients first, but if those people are unlikely to survive, doctors might be better off focusing on people who are less ill.
Whether any of these guidelines would work in an extreme crisis situation, when hospitals may have few clinical details about patients, is an open question.
"A million intricacies" could come into play in a real-world setting, Rubin said.
Numerous doctors interviewed by NPR said the U.S. lacks an exact historical comparison for how the coronavirus pandemic could play out but said guidelines at least offer general principles for steering hospital decision-making.
They also said guidelines must be transparent so the public has faith that the guidelines are fair and ethically justifiable. Wynia predicts that many hospitals will soon begin releasing their triage guidelines in case the U.S. ends up in an Italy-like situation.
And guidelines are needed not just for determining which patients to treat but how long to treat them. Nancy Berlinger, a research scholar at the Hastings Center, a nonprofit bioethics think tank in Garrison, N.Y., posed an ethical dilemma.
"Let's say a patient is on a ventilator but isn't improving, and this patient might — might — do better if they were allowed to stay on the ventilator longer, but there are people waiting for that ventilator," Berlinger said. "Do you withdraw the ventilation earlier than you might normally do? So it's not just who gets the vent — it's also who stays on it."
For now, U.S. hospitals are unsure whether their triage guidelines will be needed in the coronavirus pandemic, but they must brace for the possibility.
"This is a worst-case scenario that we're talking about," Wynia said. "We hope we never get there, but we have to get ready for the worst. And it would be irresponsible not to be getting ready right now because of what we're seeing in other places around the world where things really have gone very, very badly and where they have run out of equipment, supplies, staff, space, people. So we need to be prepared for that."


npr--2020-03-21--In Ohio, A Debate About Whether Abortion Counts As An 'Essential Service'

In Ohio , A Debate About Whether Abortion Counts As An 'Essential Service' Updated March 22 at 5:58 a.m .
ET Abortion rights groups are accusing the attorney general of Ohio of using the coronavirus crisis to restrict abortion access after clinics in the state were sent letters this week faulting them for not complying with an order aimed at preserving a limited supply of surgical equipment and protective gear .
In a letter dated on Tuesday , Ohio 's Department of Health ordered all non-essential surgical and elective procedures postponed so that protective equipment like masks and gowns can @ @ @ @ @ @ @ patients .
Ohio has seen 174 coronavirus cases and three deaths .
The order outlines several criteria for non-essential services , including procedures that can be delayed without risking a patient 's life or long-term health , and without rapidly worsening a health condition .
Following the order , the office of Attorney General Dave Yost issued letters instructing Planned Parenthood and other abortion providers to stop performing procedures that `` can be delayed without undue risk to the current or future health of the patient . ''
Reproductive rights groups say abortion @ @ @ @ @ @ @ subject to delays , as many health procedures are postponed nationwide during the coronavirus outbreak .
Planned Parenthood issued a statement saying it is complying with the order by stopping non-essential services and taking other steps to conserve equipment .
The statement added , `` Under that order , Planned Parenthood can still continue providing essential procedures , including surgical abortion , and our health centers continue to offer other health care services that our patients depend on . ''
In a statement , Ilyse Hogue , the president of NARAL Pro-Choice America @ @ @ @ @ @ @ are `` brazenly exploiting a global pandemic to roll back access to abortion care . ''
The statement noted that Gov .
Mike DeWine signed a bill into law last year prohibiting abortion after cardiac activity can be detected , before many women know they 're pregnant .
That law , like several similar bills passed last year , was blocked by a federal judge .
In response to complaints , the attorney general 's office says the order does not apply solely to abortion providers and noted that a urology group also @ @ @ @ @ @ @ with the Department of Health order .
The American College of Obstetricians and Gynecologists and several other reproductive health groups have issued a statement opposing the delay or cancellation of abortion procedures because of the coronavirus outbreak , describing abortion as a `` time-sensitive service for which a delay of several weeks , or in some cases days , may increase the risks or potentially make it completely inaccessible . ''

In Ohio And Texas, A Debate Over Whether Abortion Is 'Essential Service'
Updated 4:28 p.m. ET
Abortion rights groups are accusing the attorney general of Ohio of using the coronavirus crisis to restrict abortion access after clinics in the state were sent letters this week faulting them for not complying with an order aimed at preserving a limited supply of surgical equipment and protective gear.
In a letter dated on Tuesday, Ohio's Department of Health ordered all non-essential surgical and elective procedures postponed so that protective equipment like masks and gowns can be reserved for doctors caring for coronavirus patients. Ohio has seen 174 coronavirus cases and three deaths.
The order outlines several criteria for non-essential services, including procedures that can be delayed without risking a patient's life or long-term health, and without rapidly worsening a health condition.
Following the order, the office of Attorney General Dave Yost issued letters instructing Planned Parenthood and other abortion providers to stop performing procedures that "can be delayed without undue risk to the current or future health of the patient."
Reproductive rights groups say abortion should be considered an essential service not subject to delays, as many health procedures are postponed nationwide during the coronavirus outbreak. Meanwhile, abortion rights opponents are calling on governors of additional states to stop procedures during the coronavirus outbreak.
Planned Parenthood officials issued a statement saying it is complying with the Ohio order by stopping non-essential services and taking other steps to conserve equipment. The statement added, "Under that order, Planned Parenthood can still continue providing essential procedures, including surgical abortion, and our health centers continue to offer other health care services that our patients depend on."
In a statement, Ilyse Hogue, the president of NARAL Pro-Choice America, said politicians who oppose abortion rights are "brazenly exploiting a global pandemic to roll back access to abortion care."
The statement noted that Gov. Mike DeWine signed a bill into law last year prohibiting abortion after cardiac activity can be detected, before many women know they're pregnant. That law, like several similar bills passed last year, was blocked by a federal judge.
In response to complaints, the attorney general's office says the order does not apply solely to abortion providers and noted that a urology group also received a letter instructing it to comply with the Department of Health order.
On Monday, Texas Attorney Ken Paxton released a statement warning all licensed health facilities "including abortion providers" to "postpone all surgeries and procedures that are not immediately medically necessary" in response to an order issued by Gov. Greg Abbott over the weekend. Violators face $1,000 fine or up to 180 days in jail, according to the Texas attorney general.
The American College of Obstetricians and Gynecologists and several other reproductive health groups have issued a statement opposing the delay or cancellation of abortion procedures because of the coronavirus outbreak, describing abortion as a "time-sensitive service for which a delay of several weeks, or in some cases days, may increase the risks or potentially make it completely inaccessible."


npr--2020-03-21--Pence Tests Negative For COVID-19; 'Hundreds Of Millions' Of Face Masks In Production

Pence Tests Negative For COVID-19 ; 'Hundreds Of Millions ' Of Face Masks In Production Vice President Mike Pence and his wife have both tested negative for COVID-19 , his office announced on Saturday .
`` Pleased to report that the COVID-19 test results came back negative for both Vice President @ Mike_Pence and Second Lady @ KarenPence , '' Katie Miller , the vice president 's press secretary , said in a tweet .
Earlier on Saturday , Pence announced that he and his wife would be tested for the COVID-19 coronavirus , following confirmation that an aide on @ @ @ @ @ @ @ disease last week .
Pence made the remarks at a news conference following the coronavirus task force meeting at the White House .
Earlier in the week the vice president , who leads the task force , told reporters that he has not been tested for the virus because the White House doctor had told him he did n't need to be .
`` I 'm pleased to report that he is doing well , '' Pence said of his aide , adding that `` he had mild cold-like symptoms for a day @ @ @ @ @ @ @ all contact-tracing has been completed and neither he nor the president had direct contact with the aide .
Regardless , he said , he would undergo testing later in the day .
He also offered the latest figures on the number of Americans who have been tested : More than 195,000 people have been tested , not including those who were tested in county hospitals or health care labs around the nation .
Of those , roughly 19,350 have tested positive for the coronavirus , Pence said .
President Trump , who was @ @ @ @ @ @ @ at the White House , ran through the list of steps the administration has taken to fight the spread of the virus , including an order for `` hundreds of millions '' of face masks and other supplies for health care professionals .
`` We started with very few masks and now we 're making tens of millions of masks , '' Trump said after blaming previous administrations for the stockpile shortages the country now faces .
He later specified the government has issued a contract for 500 million N95 masks , saying @ @ @ @ @ @ @ hospitals and other health care centers .
Part of the demand for supplies is being met by the private sector in `` sixth gear , '' he said , which is heeding the call to make masks , swabs and ventilators by pivoting from their primary industries to making the desperately needed supplies .
Trump praised Hanes , the cotton clothing maker , for retrofitting its manufacturing capabilities to produce masks for medical use .
He also noted the shift by alcohol distilleries in Tennessee , Kentucky and West Virginia toward making hand @ @ @ @ @ @ @ all 50 states .
He touted his work on legislation to bring economic relief to businesses and workers .
He said his administration will give people extra time to file taxes , moving the deadline from April 15 to July 15 .
Additionally , he said students will not face interest penalties or fines for delaying student loan payments .
Homeowners will also get help : Foreclosures and evictions on HUD loans are suspended for the next 60 days .
Trump talked about reaching agreements with Canada and Mexico to halt the entry @ @ @ @ @ @ @ virus , '' a term some have criticized as stigmatizing .
Adm. Brett Giroir , head of the U.S. Public Health Service , is leading the effort to expand testing .
He said the agency is distributing equipment from the Strategic National Stockpile to `` many states '' on a daily basis .
But there 's no clear answer to when states would have enough masks or other equipment .
Giroir said the outcry for more tests is not necessarily an issue of supply — he said there are tens of thousands of @ @ @ @ @ @ @ sure the right facilities are getting the right kind of tests and training .
This week , governors across the country warned that they were seeing shortages of supplies needed for testing , including testing reagents , used to create a chemical reaction to detect the virus , and swabs .
On Friday , Health and Human Services Secretary Alex Azar said there had been `` tremendous progress '' in lab testing and dismissed complaints about shortages as `` anecdotal . ''
But groups that represent public health labs , epidemiologists and state @ @ @ @ @ @ @ were `` widespread shortages of laboratory supplies and reagents . ''
The Association of Public Health Laboratories said testing should be reserved for health care workers and first responders , older Americans with symptoms and other people at high risk of getting seriously ill from the virus .
The groups said mass testing would quickly deplete supplies , and it instead urged people with mild respiratory illness to stay at home and isolate themselves .
Hospitals have also said health care workers lack masks and other gear needed to protect themselves when treating @ @ @ @ @ @ @ on Friday that there would be an announcement this weekend about what he called `` a major acquisition '' of masks .
A week ago , Trump and Pence had said there would be a website where people could find out whether they needed to be tested for the virus and direct them to nearby drive-though sites .
While a division of Google 's parent company has developed a pilot project in San Francisco , no website for national use has materialized .
After the president thanked Google for developing the website last @ @ @ @ @ @ @ a statement saying the life sciences division , Verily , was only in the `` early stages '' of such a rollout .

Pence Tests Negative For COVID-19; 'Hundreds Of Millions' Of Face Masks In Production
Enlarge this image toggle caption Patrick Semansky/AP Patrick Semansky/AP
Updated at 8:55 p.m. ET
Vice President Mike Pence and his wife have both tested negative for COVID-19, his office announced on Saturday.
"Pleased to report that the COVID-19 test results came back negative for both Vice President @Mike_Pence and Second Lady @KarenPence," Katie Miller, the vice president's press secretary, said in a tweet.
Earlier on Saturday, Pence announced that he and his wife would be tested for the COVID-19 coronavirus, following confirmation that an aide on his staff was diagnosed with the respiratory disease last week.
Pence made the remarks at a news conference following the coronavirus task force meeting at the White House. Earlier in the week the vice president,who leads the task force, told reporters that he has not been tested for the virus because the White House doctor had told him he didn't need to be.
"I'm pleased to report that he is doing well," Pence said of his aide, adding that "he had mild cold-like symptoms for a day and half."
Pence explained that all contact-tracing has been completed and neither he nor the president had direct contact with the aide. Regardless, he said, he would undergo testing later in the day.
He also offered the latest figures on the number of Americans who have been tested: More than 195,000 people have been tested, not including those who were tested in county hospitals or health care labs around the nation. Of those, roughly 19,350 have tested positive for the coronavirus, Pence said.
President Trump, who was first to speak at the news conference at the White House, ran through the list of steps the administration has taken to fight the spread of the virus, including an order for "hundreds of millions" of face masks and other supplies for health care professionals.
"We started with very few masks and now we're making tens of millions of masks," Trump said after blaming previous administrations for the stockpile shortages the country now faces.
He later specified the government has issued a contract for 500 million N95 masks, saying they are "now" available to hospitals and other health care centers.
Part of the demand for supplies is being met by the private sector in "sixth gear," he said, which is heeding the call to make masks, swabs and ventilators by pivoting from their primary industries to making the desperately needed supplies.
Trump praised Hanes, the cotton clothing maker, for retrofitting its manufacturing capabilities to produce masks for medical use. He also noted the shift by alcohol distilleries in Tennessee, Kentucky and West Virginia toward making hand sanitizer products that will be distributed throughout all 50 states.
He touted his work on legislation to bring economic relief to businesses and workers. He said his administration will give people extra time to file taxes, moving the deadline from April 15 to July 15. Additionally, he said students will not face interest penalties or fines for delaying student loan payments. Homeowners will also get help: Foreclosures and evictions on HUD loans are suspended for the next 60 days.
Trump talked about reaching agreements with Canada and Mexico to halt the entry of what he called the "Chinese virus," a term some have criticized as stigmatizing.
Adm. Brett Giroir, head of the U.S. Public Health Service, is leading the effort to expand testing. He said the agency is distributing equipment from the Strategic National Stockpile to "many states" on a daily basis.
But there's no clear answer to when states would have enough masks or other equipment.
Giroir said the outcry for more tests is not necessarily an issue of supply — he said there are tens of thousands of tests out there — but of making sure the right facilities are getting the right kind of tests and training.
This week, governors across the country warned that they were seeing shortages of supplies needed for testing, including testing reagents, used to create a chemical reaction to detect the virus, and swabs. On Friday, Health and Human Services Secretary Alex Azar said there had been "tremendous progress" in lab testing and dismissed complaints about shortages as "anecdotal."
But groups that represent public health labs, epidemiologists and state health officials said late Friday that there were "widespread shortages of laboratory supplies and reagents."
The Association of Public Health Laboratories said testing should be reserved for health care workers and first responders, older Americans with symptoms and other people at high risk of getting seriously ill from the virus.
The groups said mass testing would quickly deplete supplies, and it instead urged people with mild respiratory illness to stay at home and isolate themselves.
Hospitals have also said health care workers lack masks and other gear needed to protect themselves when treating patients with the virus. Pence said on Friday that there would be an announcement this weekend about what he called "a major acquisition" of masks.
A week ago, Trump and Pence had said there would be a website where people could find out whether they needed to be tested for the virus and direct them to nearby drive-though sites. While a division of Google's parent company has developed a pilot project in San Francisco, no website for national use has materialized.
After the president thanked Google for developing the website last week, the tech company put out a statement saying the life sciences division, Verily, was only in the "early stages" of such a rollout.


npr--2020-03-22--Mexico To Begin "Healthy Distancing" Amid Criticism It Has Done Too Little Too Late

Mexico To Begin `` Healthy Distancing '' Amid Criticism It Has Done Too Little Too Late Mexico 's health officials say it 's time to keep your distance .
Beginning Monday , people will be urged to maintain safe distances from each other , and if possible , work from home .
Public schools , which were open through Friday , will remain closed until at least April 20 .
As of Saturday night , Mexico 's Secretary of Health reported 251 confirmed cases and two deaths from COVID-19 .
Some state and cities have already imposed stricter measures .
@ @ @ @ @ @ @ that bars , theaters and museums would be closed , also beginning Monday .
Local officials , political opponents and newspaper columnists have criticized President Andrés Manuel López Obrador for not taking tougher measures to stop the spread of the coronavirus .
Multiple Central American countries have closed their borders and stopped air traffic from overseas .
But Mexico is still allowing flights from the United States and Europe .
On Friday , the U.S. and Mexico agreed to allow only `` essential traffic '' across their shared land border .
Cross-border commerce @ @ @ @ @ @ @ to get to their jobs .
The government released a cartoon character Saturday named `` Susana Distancia . ''
The costumed superhero stretches out her arms to show the distance one should keep from others .
But until now , `` social distancing '' guidelines have been merely suggestions and President López Obrador has continued to hug , shake hands and take selfies with supporters at government events .
At a press conference last week , he seemed to make light of the coronavirus threat , digging religious amulets out of his pocket @ @ @ @ @ @ @ '' But in a nod to the growing criticism of his relaxed approach , the events López Obrador held this weekend in the southern state of Oaxaca were smaller .
His tone , however , was criticized for failing to convey urgency .
`` We have to continue working in spite of the threat of coronavirus , '' he said as he oversaw progress of construction of a new highway in Oaxaca on Saturday .
`` I believe we would be wrong to panic , if we just stopped and we did nothing @ @ @ @ @ @ @ López Obrador barely mentioned the health crisis as he spoke at another highway construction project .
As he has in the past , the president emphasized the heavy burden mass closures would place on Mexico 's poor .
But he assured the crowd Mexico could weather the crisis , pointing to its $ 10 billion cash reserve .
Although the Mexican peso has fallen sharply in recent days , now trading at 24 to the U.S. dollar , López Obrador urged his country 's central bank not to use its reserves to shore @ @ @ @ @ @ @ an optimistic note : `` If we continue working with honesty , austerity and efficiency , we will be able to confront the crisis and move ahead , '' he said .

Mexico To Begin 'Healthy Distancing' Amid Criticism It Has Done Too Little Too Late
Mexico's health officials say it's time to keep your distance. Beginning Monday, people will be urged to maintain safe distances from one another and, if possible, work from home. Public schools, which were open through Friday, will remain closed until at least April 20.
As of Saturday night, Mexico's Secretary of Health reported 251 confirmed cases and two deaths from the coronavirus disease COVID-19. Some state and cities have already imposed stricter measures. On Sunday, Mexico City's mayor announced that bars, theaters and museums would be closed, also beginning Monday.
Local officials, political opponents and newspaper columnists have criticized President Andrés Manuel López Obrador for not taking tougher measures to stop the spread of the coronavirus. Multiple Central American countries have closed their borders and stopped air traffic from overseas. But Mexico is still allowing flights from the United States and Europe. On Friday, the U.S. and Mexico agreed to allow only "essential traffic" across their shared land border. Cross-border commerce will continue and workers will be able to get to their jobs.
The government released a cartoon character Saturday named "Susana Distancia." The costumed superhero stretches out her arms to show the distance one should keep from others. But until now, "social distancing" guidelines have been merely suggestions and President López Obrador has continued to hug, shake hands and take selfies with supporters at government events. At a press conference last week, he seemed to make light of the coronavirus threat, digging religious amulets out of his pocket that he called "protective shields."
But in a nod to the growing criticism of his relaxed approach, the events López Obrador held this weekend in the southern state of Oaxaca were smaller.
His tone, however, was criticized for failing to convey urgency. "We have to continue working in spite of the threat of coronavirus," he said as he oversaw progress of construction of a new highway in Oaxaca on Saturday. "I believe we would be wrong to panic, if we just stopped and we did nothing," he said.
Sunday, López Obrador barely mentioned the health crisis as he spoke at another highway construction project. As he has in the past, the president emphasized the heavy burden mass closures would place on Mexico's poor. But he assured the crowd Mexico could weather the crisis, pointing to its $10 billion cash reserve. Although the Mexican peso has fallen sharply in recent days, now trading at 24 to the U.S. dollar, López Obrador urged his country's central bank not to use its reserves to shore up the currency.
López Obrador struck an optimistic note: "If we continue working with honesty, austerity and efficiency, we will be able to confront the crisis and move ahead," he said.


npr--2020-03-22--India Observes 14 hours Of Self-Quarantine

Can a single day of `` encouraged '' social distancing save a country of 1.3 billion people from the coronavirus ?
That 's at least what Prime Minister Narendra Modi sees as the first step in combating the virus in India .
On Sunday , millions across India self-quarantined themselves in their homes after Modi appealed to citizens to observe March 22 as `` Janta curfew , '' or a voluntary `` public curfew '' day , to demonstrate support both for social distancing and the nation 's medical community .
`` To not follow these guidelines would be an @ @ @ @ @ @ @ , '' Modi said last week .
`` Leave your house only if it is essential . ''
While public health experts caution that such a narrow window of observance will do little to slow down the spread of the coronavirus , some residents voiced hope that a designated day for social distancing will drive home the seriousness of the situation in cities and in rural areas , where close to 70 % of the population lives .
Social media was flooded with posts of Indians coming on to their balconies on Sunday @ @ @ @ @ @ @ and operators of essential services .
`` He ( Modi ) did that to get the local people at the lowest level to understand that this is an emergency , '' said Tanisha Fagwani , a Mumbai resident .
Prior to Modi 's announcement , Fagwani said that many of her friends and coworkers did not fully grasp the concept of social distancing .
Of the more than 375 confirmed cases in India , at least 74 are in the state of Maharashtra .
In its capital Mumbai , one of the most @ @ @ @ @ @ @ more cases were confirmed on Sunday .
The city is home to an estimated 12 million people and the largest slum in Asia .
However , in villages 120 miles northwest of the capital New Delhi , the virus is viewed by many as a disease of the elite , said Mohit Sharma .
He said that things around his village seemed `` business as usual . ''
`` Unless there is strict enforcement by official forces , appeals wo n't work in villages , '' said Sharma , who works in Hisar @ @ @ @ @ @ @ .
`` If it enters the village , it will become a very tough situation . ''
Sharma is among those who have been critical of Modi 's response to the pandemic , describing Sunday 's call for social distancing as `` a show . ''
`` The government has totally failed , '' said Sharma .
`` ... For common man and people below the poverty people , he did not announce any economic relief or food assistance programs . ''
At least 80 cities in India have decided to impose some @ @ @ @ @ @ @ These cities have agreed to suspend public transportation like trains , metros and bus services .
Most states have shut down malls , movie halls and non-essential establishments .
Only essential services like gas stations , pharmacies , police stations will be allowed to operate during the lockdown .

India Observes 14 Hours Of Self-Quarantine
Can a single day of "encouraged" social distancing save a country of 1.3 billion people from the coronavirus?
That's at least what Prime Minister Narendra Modi sees as the first step in combating the virus in India.
On Sunday, millions across India self-quarantined themselves in their homes after Modi appealed to citizens to observe March 22 as "Janta curfew," or a voluntary "public curfew" day, to demonstrate support both for social distancing and the nation's medical community.
"To not follow these guidelines would be an injustice to your family and loved ones," Modi said last week. "Leave your house only if it is essential."
While public health experts caution that such a narrow window of observance will do little to slow down the spread of the coronavirus, some residents voiced hope that a designated day for social distancing will drive home the seriousness of the situation in cities and in rural areas, where close to 70% of the population lives.
Social media was flooded with posts of Indians coming on to their balconies on Sunday to express gratitude for doctors, nurses and operators of essential services.
"He (Modi) did that to get the local people at the lowest level to understand that this is an emergency," said Tanisha Fagwani, a Mumbai resident. Prior to Modi's announcement, Fagwani said that many of her friends and coworkers did not fully grasp the concept of social distancing.
Of the more than 375 confirmed cases in India, at least 74 are in the state of Maharashtra. In its capital Mumbai, one of the most densely populated cities in India, six more cases were confirmed on Sunday. The city is home to an estimated 12 million people and the largest slum in Asia.
However, in villages 120 miles northwest of the capital New Delhi, the virus is viewed by many as a disease of the elite, said Mohit Sharma. He said that things around his village seemed "business as usual."
"Unless there is strict enforcement by official forces, appeals won't work in villages," said Sharma, who works in Hisar for the opposition party Indian National Congress. "If it enters the village, it will become a very tough situation."
Sharma is among those who have been critical of Modi's response to the pandemic, describing Sunday's call for social distancing as "a show."
"The government has totally failed," Sharma said. "... For common man and people below the poverty line, he did not announce any economic relief or food assistance programs."
At least 80 cities in India have decided to impose some form of lockdown until March 31st. These cities have agreed to suspend public transportation like trains, metros and bus services. Most states have shut down malls, movie halls and non-essential establishments. Only essential services like gas stations, pharmacies, police stations will be allowed to operate during the lockdown.


npr--2020-03-22--German Chancellor Angela Merkel Goes Into Self-Isolation

German Chancellor Angela Merkel has put herself under self-quarantine after learning that her doctor who had vaccinated her against pneumonia on Friday has tested positive for COVID-19 .
Merkel will be tested regularly in the coming days as she plans to carry out her duties from home , and Germany 's government will continue to operate as planned , with Merkel 's cabinet set to meet Monday to discuss a stimulus package of roughly $ 160 billion to help keep Germany afloat as it suffers from the pandemic .
As of Sunday , Germany had nearly 24,000 confirmed cases of @ @ @ @ @ @ @ , according to tracking by Johns Hopkins University .
The news of Merkel 's quarantine came soon after her government imposed new social-distancing rules that limit public gatherings to two people , not including families .
Under the new restrictions , restaurants will be allowed to stay open , but provide only takeout and delivery services .
People will still be allowed to go to work and to leave home to care for relatives , shop and visit doctors .
From now in Germany , when people do go outside , they are @ @ @ @ @ @ @ four feet from anyone else .
Germany 's new social distancing rules come into effect after authorities said too many Germans were not following guidelines set last week , urging them to stay at home to slow the spread of the virus .
Instead , in the past week , city parks in Berlin were full of people as spring weather hit the region , and groups of young people held so-called corona parties , some of which had to be broken up by police .
Germany is just one of many countries @ @ @ @ @ @ @ the virus .
The U.S. government has said that no more than 10 people should gather in one place , while Switzerland says people in groups of fewer than five must stay at least two meters apart or face a fine .
Italy and Spain have taken more stringent measures , not allowing people to leave their homes unless to conduct essential activities like buying food , filling a prescription or seeing a doctor .

German Chancellor Angela Merkel Goes Into Self-Isolation
Enlarge this image toggle caption Pool/Getty Images Pool/Getty Images
German Chancellor Angela Merkel has put herself under self-quarantine after learning that her doctor who had vaccinated her against pneumonia on Friday has tested positive for COVID-19.
Merkel will be tested regularly in the coming days as she plans to carry out her duties from home, and Germany's government will continue to operate as planned, with Merkel's cabinet set to meet Monday to discuss a stimulus package of roughly $160 billion to help keep Germany afloat as it suffers from the pandemic.
As of Sunday, Germany had nearly 24,000 confirmed cases of the coronavirus with more than 90 deaths, according to tracking by Johns Hopkins University. The news of Merkel's quarantine came soon after her government imposed new social-distancing rules that limit public gatherings to two people, not including families. Under the new restrictions, restaurants will be allowed to stay open, but provide only takeout and delivery services. People will still be allowed to go to work and to leave home to care for relatives, shop and visit doctors.
From now in Germany, when people do go outside, they are being told to keep a distance of four feet from anyone else. Germany's new social distancing rules come into effect after authorities said too many Germans were not following guidelines set last week, urging them to stay at home to slow the spread of the virus. Instead, in the past week, city parks in Berlin were full of people as spring weather hit the region, and groups of young people held so-called corona parties, some of which had to be broken up by police.
Germany is just one of many countries limiting crowds to slow the spread of the virus. The U.S. government has said that no more than 10 people should gather in one place, while Switzerland says people in groups of fewer than five must stay at least two meters apart or face a fine. Italy and Spain have taken more stringent measures, not allowing people to leave their homes unless to conduct essential activities like buying food, filling a prescription or seeing a doctor.


npr--2020-03-22--New York Governor Cuomo Calls For Army Corps To Help Build Temporary Hospitals

New York Governor Cuomo Calls For Army Corps To Help Build Temporary Hospitals Facing a rapid increase in the number of confirmed coronavirus cases , Governor Andrew Cuomo says New York is ready for the Army Corps of Engineers to start building temporary hospitals in the state immediately .
Cuomo said he had toured and formally approved four sites in the state , including the Javits Center in Manhattan and others in Westchester County and Long Island .
`` Time matters , minutes count , '' Cuomo said at a press conference in Albany on Sunday .
`` From my @ @ @ @ @ @ @ '' Cuomo also urged the federal government to nationalize the effort to acquire protective medical supplies — including masks , gowns and gloves — that are in short supply .
He says masks that used to cost 85 cents are now priced at $ 7 as states are forced to bid against each other for limited supplies .
`` I think the federal government should order factories to manufacture masks , gowns , ventilators , '' said Cuomo .
`` The essential medical equipment , that 's going to make a difference between @ @ @ @ @ @ @ is blamed for more than 100 deaths in New York , while the number of confirmed cases has climbed to more than 15,000 .
That 's by far the most of any state , though Cuomo said that 's partly because New York is testing more aggressively than other states .
If the infection rate continues its current trajectory , Cuomo says the state will need 110,000 hospital beds at its peak – more than twice as many as it has currently .
Cuomo announced that a clinical trial of new drugs to @ @ @ @ @ @ @ begin on Tuesday in New York .
He also vented his frustration that New York City residents continued to congregate in the city 's parks over the weekend , despite an order to avoid nonessential gatherings to slow the spread of the virus .
`` It 's insensitive , it 's arrogant , it 's self-destructive , it 's disrespectful and it has to stop now , '' Cuomo said .
`` This is not a joke , and I am not kidding . ''

New York Gov. Cuomo Calls For Army Corps To Help Build Temporary Hospitals
Facing a rapid increase in the number of confirmed coronavirus cases, Gov. Andrew Cuomo says New York state is ready for the Army Corps of Engineers to start building temporary hospitals in the state immediately.
Cuomo said he had toured and formally approved four sites in the state, including the Javits Center in Manhattan and others in Westchester County and Long Island.
"Time matters, minutes count," Cuomo said at a press conference in Albany on Sunday. "From my perspective, construction can start tomorrow."
Cuomo also urged the federal government to nationalize the effort to acquire protective medical supplies — including masks, gowns and gloves — that are in short supply. He says masks that used to cost 85 cents are now priced at $7 as states are forced to bid against each other for limited supplies.
"I think the federal government should order factories to manufacture masks, gowns, ventilators," said Cuomo. "The essential medical equipment, that's going to make a difference between life and death."
The coronavirus is blamed for more than 100 deaths in New York, while the number of confirmed cases has climbed to more than 15,000. That's by far the most of any state, though Cuomo said that's partly because New York is testing more aggressively than other states. If the infection rate continues its current trajectory, Cuomo says the state will need 110,000 hospital beds at its peak – more than twice as many as it has currently.
Cuomo announced that a clinical trial of new drugs to treat COVID-19, including Hydroxychloroquine, would begin on Tuesday in New York.
He also vented his frustration that New York City residents continued to congregate in the city's parks over the weekend, despite an order to avoid nonessential gatherings to slow the spread of the virus.
"It's insensitive, it's arrogant, it's self-destructive, it's disrespectful and it has to stop now," Cuomo said. "This is not a joke, and I am not kidding."


npr--2020-03-22--Trump Urges Car Companies To Make Ventilators Without Imposing Defense Production Act

President Trump said auto executives are being given the `` go ahead '' to make ventilators and other metal products to help combat the shortages due to the coronavirus pandemic .
It 's unclear what other `` metal '' products Trump was referring to .
Despite the encouraging tweet , at this point Trump has not officially ordered any companies to make these critical supplies through the Defense Production Act , which he invoked on Wednesday .
The DPA , a law dating back to the Cold War , allows for the control of the production and distribution of scarce @ @ @ @ @ @ @ defense . ''
In his executive order , Trump specifically cites personal protective equipment ( like face masks ) and ventilators as meeting the criteria in this provision .
On CNN Sunday morning , FEMA administrator Pete Gaynor cleared up some confusion , explaining Trump has n't had to enforce the Defense Production Act because critical supplies are being donated by companies .
`` We have n't yet and it really is leverage you know , to demonstrate that we can use it , the president can use it any time , '' @ @ @ @ @ @ @ 's happening without using that lever . ''
Trump called out Ford , General Motors and Tesla by name in his tweet on Sunday .
NPR 's Camila Domonoske reported last week that both Ford and General Motors have talked with the White House about the possibility of manufacturing these critical supplies .
On Friday , General Motors announced it was partnering with Ventec Life Systems , a medical device company , to increase production of its respiratory care systems , rather than making ventilators on its own .
According to a joint @ @ @ @ @ @ @ logistics , purchasing and manufacturing expertise to build more of its critically important ventilators .
`` We are working closely with Ventec to rapidly scale up production of their critically important respiratory products to support our country 's fight against the COVID-19 pandemic , '' said Mary Barra , GM Chairman and CEO .
`` We will continue to explore ways to help in this time of crisis . ''
Elon Musk , CEO of Tesla , chimed in on Twitter , saying he had a `` long engineering '' discussion with the @ @ @ @ @ @ @ .
In the U.K. , the British government has asked companies to start work on producing basic ventilators to help the country 's National Health Service cope with the spread of coronavirus , according to Reuters .
And in Italy , army technicians have been sent to help on production lines at ventilator companies , Reuters reported .

Trump Urges Car Companies To Make Ventilators Without Imposing Defense Production Act
Enlarge this image toggle caption Jeff Kowalsky/Bloomberg via Getty Images Jeff Kowalsky/Bloomberg via Getty Images
President Trump said auto executives are being given the "go ahead" to make ventilators and other metal products to help combat the shortages due to the coronavirus pandemic. It's unclear what other "metal" products Trump was referring to.
Despite the encouraging tweet, at this point Trump has not officially ordered any companies to make these critical supplies through the Defense Production Act, which he invoked on Wednesday.
The DPA, a law dating back to the Cold War, allows for the control of the production and distribution of scarce materials deemed "essential to the national defense." In his executive order, Trump specifically cites personal protective equipment (like face masks) and ventilators as meeting the criteria in this provision.
On CNN Sunday morning, FEMA administrator Pete Gaynor cleared up some confusion, explaining Trump hasn't had to enforce the Defense Production Act because critical supplies are being donated by companies.
"We haven't yet and it really is leverage you know, to demonstrate that we can use it, the president can use it any time," Gaynor said on CNN. "It's happening without using that lever."
Trump called out Ford, General Motors and Tesla by name in his tweet on Sunday.
NPR's Camila Domonoske reported last week that both Ford and General Motors have talked with the White House about the possibility of manufacturing these critical supplies.
On Friday, General Motors announced it was partnering with Ventec Life Systems, a medical device company, to increase production of its respiratory care systems, rather than making ventilators on its own.
According to a joint statement, Ventec will leverage GM's logistics, purchasing and manufacturing expertise to build more of its critically important ventilators.
"We are working closely with Ventec to rapidly scale up production of their critically important respiratory products to support our country's fight against the COVID-19 pandemic," said Mary Barra, GM Chairman and CEO. "We will continue to explore ways to help in this time of crisis."
Elon Musk, CEO of Tesla, chimed in on Twitter, saying he had a "long engineering" discussion with the company Medtronic, a medical device maker.
In the U.K., the British government has asked companies to start work on producing basic ventilators to help the country's National Health Service cope with the spread of coronavirus, according to Reuters.
And in Italy, army technicians have been sent to help on production lines at ventilator companies, Reuters reported.


npr--2020-03-22--Study Calculates Just How Much Age, Medical Conditions Raise Odds Of Severe COVID-19

Study Calculates Just How Much Age , Medical Conditions Raise Odds Of Severe COVID-19 People age 50 and older are around 2-and-a-half times more likely to progress to a severe case of COVID-19 .
That 's according to a new study that quantifies the risk factors that increase the odds that people infected with the coronavirus will develop a severe case of the disease .
The research , conducted by doctors in Shanghai , is a meta-analysis that examined data from 30 studies conducted between December 2019 and Feb. 19 involving 53,000 patients with confirmed cases of COVID-19 .
Most @ @ @ @ @ @ @ and other Chinese cities , though the analysis did include three studies involving patients from the United States , Australia and Korea .
Cases were considered to be severe if they had symptoms such as shortness of breath requiring 30 or more breaths per minutes ( 12 to 20 breaths a minute is considered normal for an adult ) ; dangerously low levels of oxygen in the blood ; and radiographic evidence of lung damage that had grown by 50 % or more within a 24 to 48 hour period .
Being male @ @ @ @ @ @ @ illness by 1.3 times , while smoking made it a little over 1 to 2-and-a-half times more likely .
Overall , patients with underlying medical conditions including hypertension , diabetes and cardiovascular disease were 2 to 3 times more likely to progress to severe illness .
Certain conditions raised those odds further : For instance , people with chronic obstructive pulmonary disorder were anywhere from 2-and-a-half to nearly 11 times more likely to get severely ill. Kidney disease is also likely a big risk factor .
While the research did n't pinpoint exactly @ @ @ @ @ @ @ 's somewhere between 2- and 16-fold .
The researchers say the findings suggest doctors should give more attention and care to older patients with these underlying risk factors .
The researchers did n't explain why certain underlying conditions made patients more vulnerable to severe COVID-19 disease , though they did say that all the conditions cited above can involve an inflammatory response from the body .
Patients with chronic kidney disease may be more vulnerable because their kidneys are already weak and damaged , and severe coronavirus infection can further damage those organs @ @ @ @ @ @ @ have missed dialysis sessions or other regular medical care because they were under quarantine or because the local medical system had to shift resources to focus on the growing epidemic .

Study Calculates Just How Much Age, Medical Conditions Raise Odds Of Severe COVID-19
People age 50 and older are around 2-and-a-half times more likely to progress to a severe case of COVID-19. That's according to a new study that quantifies the risk factors that increase the odds that people infected with the coronavirus will develop a severe case of the disease.
The research, conducted by doctors in Shanghai, is a meta-analysis that examined data from 30 studies conducted between December 2019 and Feb. 19 involving 53,000 patients with confirmed cases of COVID-19. Most of the studies were conducted in Wuhan and other Chinese cities, though the analysis did include three studies involving patients from the United States, Australia and Korea.
Cases were considered to be severe if they had symptoms such as shortness of breath requiring 30 or more breaths per minutes (12 to 20 breaths a minute is considered normal for an adult); dangerously low levels of oxygen in the blood; and radiographic evidence of lung damage that had grown by 50% or more within a 24 to 48 hour period.
Being male increased the odds of progressing to severe illness by 1.3 times, while smoking made it a little over 1 to 2-and-a-half times more likely, the study found. Overall, patients with underlying medical conditions including hypertension, diabetes and cardiovascular disease were 2 to 3 times more likely to progress to severe illness.
Certain conditions raised those odds further, according to the study: For instance, people with chronic obstructive pulmonary disorder were anywhere from 2-and-a-half to nearly 11 times more likely to get severely ill. Kidney disease is also likely a big risk factor. While the research didn't pinpoint exactly how big that risk is, it suggested it's somewhere between 2- and 16-fold.
The researchers say the findings suggest doctors should give more attention and care to older patients with these underlying risk factors.
The researchers didn't explain why certain underlying conditions appeared to make patients more vulnerable to severe COVID-19 disease, though they did say that all the conditions cited above can involve an inflammatory response from the body. Patients with chronic kidney disease may be more vulnerable because their kidneys are already weak and damaged, and severe coronavirus infection can further damage those organs. It's possible such patients may have missed dialysis sessions or other regular medical care because they were under quarantine or because the local medical system had to shift resources to focus on the growing epidemic.
Other research has also suggested that people with hypertension may be at greater risk from COVID-19. However, neither that earlier study nor the current one made it clear whether the apparent elevated risk was among people whose condition was under control with medication or not, or whether they had other underlying health problems. "It does not make a lot of sense that if somebody is otherwise healthy and young and they have hypertension alone, that they should be at increased risk,"Dr. Mariell Jessup, chief science and medical officer at the American Heart Association, told NPR about the prior finding. However, she noted that so little is known about this coronavirus that everyone should take precautions.
Like a lot of research on this fast-moving pandemic, the new study was released prior to peer review on a preprint server to speed up the sharing of information among scientists.


npr--2020-03-22--No Deal Yet For Massive Coronavirus Aid Package

No Deal Yet For Massive Coronavirus Aid Package Top congressional leaders said Sunday they have not yet reached an agreement on the latest — and largest — coronavirus response bill , but they plan to keep negotiating in hopes of finishing a package before a Senate vote that was set for Monday .
House Speaker Nancy Pelosi , D-Calif. , told reporters there is still no deal , after a meeting with the four top congressional leaders and Treasury Secretary Steven Mnuchin .
`` We 'll be introducing our own bill , '' Pelosi told reporters .
Senate Majority Leader @ @ @ @ @ @ @ Senate bill , which he says was fine-tuned in bipartisan talks over the past two days , needs to be passed as is .
`` It is thoroughly bipartisan , as our process demands ; now what we need to do is to move forward , '' McConnell said on the Senate floor .
`` This national crisis is not going to wait around if Congress slips back into conventional politics or haggles endlessly over the finer points . ''
The package in question is larger than two others that have passed in @ @ @ @ @ @ @ some negotiators floating a price tag of $ 1 trillion .
McConnell pressured Democrats to accept the plan , even as Democrats were circulating concerns with the legislation .
McConnell had scheduled a procedural vote for 3 p.m .
ET Sunday , but moved it back to 6 p.m. Senate Minority Leader Chuck Schumer , D-N.Y. , called McConnell 's bill `` highly partisan . ''
He added : `` Our staffs now — Democrats and Republicans — are working to change the problematic provisions and others in the bill , and I @ @ @ @ @ @ @ truly bipartisan agreement — that means that Democrats and Republicans — before 6:00 p.m. '' Among the issues still to be resolved are restrictions on loans made to large corporations , like airlines , according to a source familiar with the talks .
Democrats say the legislation does not include sufficient protections to prevent stock buybacks and make sure that workers keep jobs .
Democrats have also called for further protections against executive raises and bonuses , and are criticizing a provision that would give Mnuchin broad discretion to waive some compensation rules @ @ @ @ @ @ @ a `` $ 500 billion corporate slush fund . ''
They are also calling for the legislation to include additional unemployment funding , expanded food stamps benefits and more student loan relief , among other demands .
The Senate was set to vote on Sunday on what is known as a shell bill .
It is a placeholder that , if passed , will allow the Senate to dispense with necessary waiting and debate periods required by Senate rules .
Earlier this month , President Trump signed into law an $ 8 billion @ @ @ @ @ @ @ for testing of the virus and lowered costs for related medical treatments .
A second measure , signed into law last week , provides paid sick and family leave for some U.S. workers impacted by the illness , expands unemployment assistance , and increases resources for testing .

Coronavirus Aid Bill In Limbo After Procedural Vote Fails
Enlarge this image toggle caption Saul Loeb/AFP via Getty Images Saul Loeb/AFP via Getty Images
Updated at 7:39 p.m. ET
The future of a coronavirus aid package that's likely to top $1 trillion is in limbo following the failure of a necessary procedural vote in the Senate.
The measure, which required 60 votes to pass, garnered just 47 votes on Sunday evening, with Democrats refusing to back the Republican-led plan. Democrats are calling for changes to the legislation, including further expansion of unemployment insurance and more restrictions on federal assistance provided to large corporations.
Senate Minority Leader Chuck Schumer, D-N.Y., said negotiations are continuing and the Senate "can and will" overcome their differences.
"Changes to the legislation are being made even as we speak," Schumer said on the Senate floor following the vote. "We are closer than we have been at any point of the last 48 hours."
Among the issues still to be resolved are restrictions on loans made to large corporations, like airlines, according to a source familiar with the talks. Democrats say the legislation does not include sufficient protections to prevent stock buybacks and to make sure that workers keep jobs. Democrats have also called for further protections against executive raises and bonuses, and are criticizing a provision that would give Treasury Secretary Steven Mnuchin broad discretion to waive some compensation rules.
Democrats are calling the corporate funding a "$500 billion corporate slush fund." They are also calling for the legislation to include additional unemployment funding, expanded food stamps benefits and more student loan relief, among other demands.
Senate Majority Leader Mitch McConnell, R-Ky., admonished Democrats for voting against the procedural measure, which would have provided 30 hours before a vote on any final bill.
"The American people are watching this spectacle," McConnell said on the Senate floor. "The notion that we have time to play games here with the American economy and the American people is utterly absurd."
The package in question is larger than two others that have passed in terms of size and scope — and several of Democrats' demands would further expand that figure.
The entire day of negotiations was mired in partisan disagreement. House Speaker Nancy Pelosi emerged from a bipartisan leadership meeting with Mnuchin around midday vowing to introduce her own separate legislation.
Meanwhile, McConnell had maintained that the Senate bill in question was fine-tuned in bipartisan talks over the past two days, and needs to be passed as is.
"It is thoroughly bipartisan, as our process demands; now what we need to do is to move forward," McConnell said earlier on the Senate floor. "This national crisis is not going to wait around if Congress slips back into conventional politics or haggles endlessly over the finer points."
Earlier this month, President Trump signed into law an $8 billion coronavirus response package, which boosted funding for testing of the virus and lowered costs for related medical treatments. A second measure, signed into law last week, provides paid sick and family leave for some U.S. workers impacted by the illness, expands unemployment assistance, and increases resources for testing.


npr--2020-03-22--Sen. Rand Paul Has Tested Positive For The Coronavirus

Sen. Rand Paul Has Tested Positive For The Coronavirus Sen. Rand Paul , R-Ky. , has become the first senator to test positive for the coronavirus .
His staff says he is asymptomatic .
In a statement released on Sunday , Paul 's deputy chief of staff , Sergio Gor , wrote : '' Senator Rand Paul has tested positive for COVID-19 .
He is feeling fine and is in quarantine .
He is asymptomatic and was tested out of an abundance of caution due to his extensive travel and events .
He was not aware of any direct contact @ @ @ @ @ @ @ to be back in the Senate after his quarantine period ends and will continue to work for the people of Kentucky at this difficult time .
Ten days ago , our D.C. office began operating remotely , hence virtually no staff has had contact with Senator Paul . ''
Paul , a physician , was one of eight Republican senators who voted against a coronavirus relief package last week , after the Senate opposed his efforts to offset spending on the legislation .
Paul 's staff explained his decision to get tested in @ @ @ @ @ @ @ Similar to the President and the Vice President , Senator Rand Paul decided to get tested after attending an event where two individuals subsequently tested positive for COVID-19 , even though he was n't aware of any direct contact with either one of them , '' the statement read .
`` Additionally , due to a prior lung injury , and subsequent surgery on his lung , Senator Paul is in a higher risk category as it relates to pulmonary issues . ''
His positive test comes amid continuing shortages of tests nationwide @ @ @ @ @ @ @ on Saturday : As of 5:30 p.m .
ET Sunday , at least two Republican senators had announced they are self-quarantining after contact with Paul — Utah 's Mitt Romney and Mike Lee .
Sens .
Cory Gardner , R-Colo. , and Rick Scott , R-Fla. , were already in self-quarantine due to contact with others who tested positive for the virus .
That leaves 48 Republicans in the Senate available to vote , which could affect legislation , as any measure would need either unanimous consent or 60 votes to pass a @ @ @ @ @ @ @ , Congress does not currently allow remote voting .

Sen. Rand Paul Has Tested Positive For The Coronavirus
Enlarge this image toggle caption Sarah Silbiger/Getty Images Sarah Silbiger/Getty Images
Updated at 5:53 p.m. ET
Sen. Rand Paul, R-Ky., has become the first senator to test positive for the coronavirus. His staff says he is asymptomatic.
In a statement released on Sunday, Paul's deputy chief of staff, Sergio Gor, wrote:
"Senator Rand Paul has tested positive for COVID-19. He is feeling fine and is in quarantine. He is asymptomatic and was tested out of an abundance of caution due to his extensive travel and events. He was not aware of any direct contact with any infected person. He expects to be back in the Senate after his quarantine period ends and will continue to work for the people of Kentucky at this difficult time. Ten days ago, our D.C. office began operating remotely, hence virtually no staff has had contact with Senator Paul."
Paul, a physician, was one of eight Republican senators who voted against a coronavirus relief package last week, after the Senate opposed his efforts to offset spending on the legislation.
Paul's staff explained his decision to get tested in a statement later on Sunday.
"Similar to the President and the Vice President, Senator Rand Paul decided to get tested after attending an event where two individuals subsequently tested positive for COVID-19, even though he wasn't aware of any direct contact with either one of them," the statement read. "Additionally, due to a prior lung injury, and subsequent surgery on his lung, Senator Paul is in a higher risk category as it relates to pulmonary issues."
His positive test comes amid continuing shortages of tests nationwide. As NPR's Vanessa Romo reported on Saturday:
State and local government leaders have been putting pressure on the Trump administration and the coronavirus task force led by Vice President Mike Pence to address widespread testing shortages. In response, the administration has turned to the private sector to help develop tests, vaccines and therapeutic medicines to help stem the pandemic.
As of 5:30 p.m. ET Sunday, at least two Republican senators had announced they are self-quarantining after contact with Paul — Utah's Mitt Romney and Mike Lee. Sens. Cory Gardner, R-Colo., and Rick Scott, R-Fla., were already in self-quarantine due to contact with others who tested positive for the virus. That leaves 48 Republicans in the Senate available to vote, which could affect legislation, as any measure would need either unanimous consent or 60 votes to pass a necessary procedural vote. As a reminder, Congress does not currently allow remote voting.