npr--2020-03-10--How The Painstaking Work Of Contact Tracing Can Slow The Spread Of An Outbreak

How The Painstaking Work Of Contact Tracing Can Slow The Spread Of An Outbreak When I was a fourth-year medical student , I did a month-long rotation at the Centers for Disease Control and Prevention in Atlanta .
My first task was decidedly unglamorous : I sat in a cubicle and crunched data about fungal infections caused by contaminated contact lens solution .
So when my supervisor asked one afternoon if I wanted to help investigate a disease outbreak , I jumped at the chance .
My task would be to track down people who had been in direct contact @ @ @ @ @ @ @ contact tracing..
There was a cluster of travel-related mumps cases in the Midwest .
I immediately envisioned jetting around America 's heartland , swabbing people in hospitals and sampling the ductwork of airplanes — or at least , leaving the office .
Instead , I ended up in another cubicle on a different floor , cold calling an entire subdivision 's residents to ask scripted questions about fever and neck swelling , a telltale symptom of mumps .
Contact tracing can feel like drudgery , but in an outbreak , it 's vital @ @ @ @ @ @ @ the current COVID-19 outbreak , it helps make possible early diagnosis and getting care to people who need it .
The information it uncovers also helps public health authorities contain epidemics .
For clusters of new or poorly understood disease , the contact information can shed light on how a disease is spread .
Here 's how it works .
Epidemiologists , or `` disease detectives , '' start with the index patient , sometimes called `` patient zero . ''
Depending on what they already know about that patient 's condition — @ @ @ @ @ @ @ natural history , what symptoms it causes — they interview the patient to learn about their movements and identify all close contacts .
Sometimes , they ask the index patient to give a detailed history of where they have traveled , eaten , slept , and bathed .
On the basis of the answers , public health workers may contact the management of airlines , restaurants , hotels , hot tubs , shopping centers , public transit , and other public spaces where the index patient might have had contact with others while @ @ @ @ @ @ @ manifests , reservation logs , and other records — sometimes even surveillance tapes — to compile exhaustive lists of people potentially exposed to patient zero .
These lists become the basis of an enormous amount of outreach work in the early days of an outbreak .
Public health workers contact each of these people to explain their risk , offer screening for the infection and conduct regular monitoring for symptoms of the infection .
In the U.S. , that outreach often happens by phone .
In some cases of mass exposure to a @ @ @ @ @ @ @ outbreak originating at Disneyland in 2015 , media advisories are sometimes used .
In other situations , the outreach may take place in person , as much of it did during the Ebola outbreak that started in West Africa in 2014 .
In some cases , public health authorities may offer preventive advice or treatment for the infection .
They may tell these contacts to isolate themselves at home , as many COVID-19 patients have been asked to do .
And if one of these contacts turns out to have the disease of @ @ @ @ @ @ @ the same cycle of identifying and reaching out to contacts .
Contacts can add up fast , depending on how infectious the disease is and the environment in which it is spreading : even a moderately infectious disease like the seasonal flu can spread like wildfire in a crowded environment full of susceptible people , like a classroom or a subway car .
And the higher the number of contacts , the more outreach work needs to be done to trace them .
If epidemic spread outpaces contact tracing efforts , cases may @ @ @ @ @ @ @ of transmission , as they have recently done in several states .
That raises the concern that contact tracing is not enough — or is too late — to contain the epidemic .
But the detective work can still help .
`` Even if there 's a widespread epidemic where you do n't know your transmission chain , contact tracing still adds value , '' says Ranu Dhillon , an instructor and physician in the Division of Global Health Equity at the Brigham and Women 's Hospital in Boston .
Infected people still @ @ @ @ @ @ @ slows the spread of the disease .
But contact tracing is expensive — and if it 's not actually containing the disease , public health experts may add , and perhaps prioritize , broader community measures like widespread screening and travel restrictions .
In early March , when a resident of New Rochelle , N.Y. , was diagnosed with COVID-19 infection , a robust contact tracing effort led officials to not only recommend self-quarantine for his infected family members , but also to close his children 's schools , his synagogue , and @ @ @ @ @ @ @ had contact with the case .
On Tuesday , the governor of New York announced a `` containment zone '' would be created in a one-mile radius around the synagogue that seems to be the epicenter of the outbreak .
The containment plan does not include travel restrictions or road closures , but does include closures of schools and large gathering areas and a National Guard deployment to carry out school cleanings , as well as food deliveries meant to enable people to limit their movements .
These responses can often make a @ @ @ @ @ @ @ when it happens early enough : During the Ebola outbreak in West Africa , the early rollout of such measures alongside contact tracing efforts in Liberia may have played a role in the rapid decline of the country 's cases in September 2014 .
In Seattle and in California , contact tracing for COVID-19 cases continues while mitigation measures are being initiated , said Nancy Messonnier , director of the CDC 's National Center for Immunization and Respiratory Diseases , in a media briefing Monday .
Those mitigation measures include canceling or limiting @ @ @ @ @ @ @ closing schools , and other social distancing measures .
When there are many unknown transmission chains , or when communities do n't cooperate with public health efforts , the value of contact tracing really takes a dip , says Dhillon .
And when there are many contacts who are geographically widespread — as is often the case in our globalized society — it can become impossible for contact tracing to keep pace with the epidemic .
Although epidemiologists have tried to develop mathematical models to understand when the costs of contact tracing outweigh @ @ @ @ @ @ @ formula for determining when an outbreak has become too widespread for contact tracing to be of use , or when to switch from contact tracing to community mitigation measures .
In practicality , public health authorities often end up doing both at the same time : `` It 's not an on-off switch , it 's a dimmer , '' said Messonnier .
It often falls to local and regional health commissioners and other public health leaders to make the call , says Dhillon .
And when they 're in uncharted waters , @ @ @ @ @ @ @ those are not easy judgments , '' he says , `` and honestly , you 're not going to know if you 're really right .
You have to take all the evidence you have and make the best judgment you can . ''

How The Painstaking Work Of Contact Tracing Can Slow The Spread Of An Outbreak
Enlarge this image toggle caption Yana Paskova/Getty Images Yana Paskova/Getty Images
When I was a fourth-year medical student, I did a month-long rotation at the Centers for Disease Control and Prevention in Atlanta. My first task was decidedly unglamorous: I sat in a cubicle and crunched data about fungal infections caused by contaminated contact lens solution.
So when my supervisor asked one afternoon if I wanted to help investigate a disease outbreak, I jumped at the chance. My task would be to track down people who had been in direct contact with mumps patients, work known as contact tracing..
There was a cluster of travel-related mumps cases in the Midwest. I immediately envisioned jetting around America's heartland, swabbing people in hospitals and sampling the ductwork of airplanes — or at least, leaving the office.
Instead, I ended up in another cubicle on a different floor, cold calling an entire subdivision's residents to ask scripted questions about fever and neck swelling, a telltale symptom of mumps.
Contact tracing can feel like drudgery, but in an outbreak, it's vital to public health. During events like the current COVID-19 outbreak, it helps make possible early diagnosis and getting care to people who need it. The information it uncovers also helps public health authorities contain epidemics.
For clusters of new or poorly understood disease, the contact information can shed light on how a disease is spread.
Here's how it works. Epidemiologists, or "disease detectives," start with the index patient, sometimes called "patient zero." Depending on what they already know about that patient's condition — how the disease is spread, its natural history, what symptoms it causes — they interview the patient to learn about their movements and identify all close contacts. Sometimes, they ask the index patient to give a detailed history of where they have traveled, eaten, slept, and bathed.
On the basis of the answers, public health workers may contact the management of airlines, restaurants, hotels, hot tubs, shopping centers, public transit, and other public spaces where the index patient might have had contact with others while they were sick. They review passenger manifests, reservation logs, and other records — sometimes even surveillance tapes — to compile exhaustive lists of people potentially exposed to patient zero.
These lists become the basis of an enormous amount of outreach work in the early days of an outbreak. Public health workers contact each of these people to explain their risk, offer screening for the infection and conduct regular monitoring for symptoms of the infection.
In the U.S., that outreach often happens by phone. In some cases of mass exposure to a concerning infection, as in the measles outbreak originating at Disneyland in 2015, media advisories are sometimes used. In other situations, the outreach may take place in person, as much of it did during the Ebola outbreak that started in West Africa in 2014.
In some cases, public health authorities may offer preventive advice or treatment for the infection. They may tell these contacts to isolate themselves at home, as many COVID-19 patients have been asked to do. And if one of these contacts turns out to have the disease of interest, they become the focus of the same cycle of identifying and reaching out to contacts.
Contacts can add up fast, depending on how infectious the disease is and the environment in which it is spreading: even a moderately infectious disease like the seasonal flu can spread like wildfire in a crowded environment full of susceptible people, like a classroom or a subway car. And the higher the number of contacts, the more outreach work needs to be done to trace them.
If epidemic spread outpaces contact tracing efforts, cases may begin popping up outside of the chain of transmission, as they have recently done in several states. That raises the concern that contact tracing is not enough — or is too late — to contain the epidemic.
But the detective work can still help.
"Even if there's a widespread epidemic where you don't know your transmission chain, contact tracing still adds value," says Ranu Dhillon, an instructor and physician in the Division of Global Health Equity at the Brigham and Women's Hospital in Boston. Infected people still get identified and isolated early, which slows the spread of the disease.
But contact tracing is expensive — and if it's not actually containing the disease, public health experts may add, and perhaps prioritize, broader community measures like widespread screening and travel restrictions.
In early March, when a resident of New Rochelle, N.Y., was diagnosed with COVID-19 infection, a robust contact tracing effort led officials to not only recommend self-quarantine for his infected family members, but also to close his children's schools, his synagogue, and the law school of a student who had contact with the case.
On Tuesday, the governor of New York announced a "containment zone" would be created in a one-mile radius around the synagogue that seems to be the epicenter of the outbreak. The containment plan does not include travel restrictions or road closures, but does include closures of schools and large gathering areas and a National Guard deployment to carry out school cleanings, as well as food deliveries meant to enable people to limit their movements.
These responses can often make a difference in the dynamics of an outbreak when it happens early enough: During the Ebola outbreak in West Africa, the early rollout of such measures alongside contact tracing efforts in Liberia may have played a role in the rapid decline of the country's cases in September 2014.
In Seattle and in California, contact tracing for COVID-19 cases continues while mitigation measures are being initiated, said Nancy Messonnier, director of the CDC's National Center for Immunization and Respiratory Diseases, in a media briefing Monday. Those mitigation measures include canceling or limiting large gatherings, including sporting events, closing schools, and other social distancing measures.
When there are many unknown transmission chains, or when communities don't cooperate with public health efforts, the value of contact tracing really takes a dip, says Dhillon. And when there are many contacts who are geographically widespread — as is often the case in our globalized society — it can become impossible for contact tracing to keep pace with the epidemic.
Although epidemiologists have tried to develop mathematical models to understand when the costs of contact tracing outweigh its benefits, there is no real formula for determining when an outbreak has become too widespread for contact tracing to be of use, or when to switch from contact tracing to community mitigation measures.
In practicality, public health authorities often end up doing both at the same time: "It's not an on-off switch, it's a dimmer," said Messonnier.
It often falls to local and regional health commissioners and other public health leaders to make the call, says Dhillon. And when they're in uncharted waters, as they are with COVID-19, "those are not easy judgments," he says, "and honestly, you're not going to know if you're really right. You have to take all the evidence you have and make the best judgment you can."


npr--2020-03-10--Wells Fargo CEO: 'We Have Not Done What's Necessary To Address Our Shortcomings'

Wells Fargo CEO : 'We Have Not Done What 's Necessary To Address Our Shortcomings' Wells Fargo Chief Executive Officer and President Charles Scharf told lawmakers Tuesday that the scandal-plagued bank he now leads `` had a flawed business model '' and a structure and culture that `` were problematic . ''
He said that while he is confident that reform plans he 's implementing will work , such efforts will likely continue until at least 2021 .
Scharf , who was named the bank 's top executive in September , was peppered with questions from members of the House @ @ @ @ @ @ @ hours .
Lawmakers wanted to know how he plans to steer Wells Fargo back into the public 's good graces after years of cascading consumer abuse scandals .
They also pressed him on how the public could trust the financial institution , especially now , as many of its customers fear devastating economic impacts as a result of the spread of the coronavirus in the United States .
`` I took this job because I believe that our country and communities benefit from a strong Wells Fargo , '' Scharf said in his @ @ @ @ @ @ @ vowed to move the company in a `` significantly improved direction '' but also admitted : `` We have not done what 's necessary to address our shortcomings . ''
Wells Fargo has been engulfed in scandals in recent years , including a $ 3 billion settlement last month connected to illegal sales practices .
The company is still entangled in legal and financial woes stemming from a scandal that started in 2016 , in which investigators found that millions of accounts were opened without customers ' knowledge .
Scharf 's appearance on @ @ @ @ @ @ @ Fargo announced the resignations of two board members , including the now-former chairwoman Elizabeth Duke .
She and another board member , James Quigley , said they were stepping down to `` avoid distraction '' and allow Scharf the `` ability to turn the page . ''
Duke and Quigley are scheduled to testify before the same committee on Wednesday .
A spokesperson for Wells Fargo 's board told NPR both Quigley and Duke plan to appear .
The committee 's Democratic majority released a report last week accusing bank executives of failing @ @ @ @ @ @ @ exposing customers to `` countless abuses '' including wrongful foreclosure .
Rep. Maxine Waters , D-Calif. , who chairs the committee , started the hearing by acknowledging to Scharf that the company has faced tumult in recent years .
`` He is now the third Wells Fargo CEO to testify before this committee in less than three and a half years , '' Waters said .
`` I will note that each time a Wells Fargo CEO has testified before this committee he has soon resigned thereafter . ''
After the hearing concluded @ @ @ @ @ @ @ Department of Justice alleging previous Wells Fargo CEO Tim Sloan `` willfully '' gave false statements to the committee last year .
Waters said the matter involves `` a potential violation of a criminal statue '' and urged the Justice Department to review Sloan 's testimony `` and take such action as the DOJ deems appropriate . ''
Both the Justice Department and Wells Fargo declined comment to NPR regarding the letter .
As NPR has reported , Sloan , Scharf 's predecessor , resigned in March 2019 , weeks after he appeared @ @ @ @ @ @ @ the previous CEO , stepped down in October 2016 in the fallout over the accounts scandal .
Waters pressed Scharf about whether customers who were harmed by Wells Fargo would be identified to receive payment and have their credit reporting fixed within 30 days .
Scharf said the company is in the process of trying to `` remediate everything we possibly can '' without giving a specific timeline .
But he later added , `` As of now , our plans take us into 2021 to ensure that all the payments are made @ @ @ @ @ @ @ place as the Trump administration is attempting to sway lawmakers in favor of a plan to stabilize the economy amid fears of a widening coronavirus outbreak .
Wells Fargo announced earlier this week that it would make $ 6.25 million in donations to support the domestic and global public health response to the coronavirus .
The bank 's announcement did not specify whether it would provide relief for its customers if an outbreak should force workers to miss paychecks leading to late mortgage , credit card and other consumer debt payments .
`` @ @ @ @ @ @ @ be doing relative to late fees , missed payments and things like that , we want our customers to believe that we 're a source of strength for them , '' Scharf told lawmakers .
Waters fired back , `` I know that you understand we 'll be looking for a lot more specificity than you have just described . ''
Other committee members , like Rep. Patrick McHenry , R-N.C. , the ranking member on the committee , lamented that lawmakers do n't have the luxury to conduct `` politically motivated ideological @ @ @ @ @ @ @ '' `` There are serious things happening in the world while we 're having this hearing , '' McHenry said , adding that investors fear the spread of coronavirus is impacting the financial services industry , the economy and the markets .
`` Our constituents have real concerns and they expect us to put aside politics and focus on the urgent matter at hand , '' McHenry said .

Wells Fargo CEO: 'We Have Not Done What's Necessary To Address Our Shortcomings'
Enlarge this image toggle caption Alex Brandon/AP Alex Brandon/AP
Updated 4:45 p.m. ET
Wells Fargo Chief Executive Officer and President Charles Scharf told lawmakers Tuesday that the scandal-plagued bank he now leads "had a flawed business model" and a structure and culture that "were problematic."
He said that while he is confident that reform plans he's implementing will work, such efforts will likely continue until at least 2021.
Scharf, who was named the bank's top executive in September, was peppered with questions from members of the House Financial Services Committee for more than four hours.
Lawmakers wanted to know how he plans to steer Wells Fargo back into the public's good graces after years of cascading consumer abuse scandals. They also pressed him on how the public could trust the financial institution, especially now, as many of its customers fear devastating economic impacts as a result of the spread of the coronavirus in the United States.
"I took this job because I believe that our country and communities benefit from a strong Wells Fargo," Scharf said in his opening statement to the committee.
He vowed to move the company in a "significantly improved direction" but also admitted: "We have not done what's necessary to address our shortcomings."
Wells Fargo has been engulfed in scandals in recent years, including a $3 billion settlement last month connected to illegal sales practices. The company is still entangled in legal and financial woes stemming from a scandal that started in 2016, in which investigators found that millions of accounts were opened without customers' knowledge.
Enlarge this image toggle caption Alex Brandon/AP Alex Brandon/AP
Scharf's appearance on Capitol Hill comes a day after Wells Fargo announced the resignations of two board members, including the now-former chairwoman Elizabeth Duke. She and another board member, James Quigley, said they were stepping down to "avoid distraction" and allow Scharf the "ability to turn the page."
Duke and Quigley are scheduled to testify before the same committee on Wednesday. A spokesperson for Wells Fargo's board told NPR both Quigley and Duke plan to appear.
The committee's Democratic majority released a report last week accusing bank executives of failing to correct deficiencies of its infrastructure and exposing customers to "countless abuses" including wrongful foreclosure.
Rep. Maxine Waters, D-Calif., who chairs the committee, started the hearing by acknowledging to Scharf that the company has faced tumult in recent years.
"He is now the third Wells Fargo CEO to testify before this committee in less than three and a half years," Waters said. "I will note that each time a Wells Fargo CEO has testified before this committee he has soon resigned thereafter."
After the hearing concluded, Waters sent a letter to the Department of Justice alleging previous Wells Fargo CEO Tim Sloan "willfully" gave false statements to the committee last year.
Waters said the matter involves "a potential violation of a criminal statue" and urged the Justice Department to review Sloan's testimony "and take such action as the DOJ deems appropriate."
Both the Justice Department and Wells Fargo declined comment to NPR regarding the letter.
As NPR has reported, Sloan, Scharf's predecessor, resigned in March 2019, weeks after he appeared before the committee. John Stumpf, the previous CEO, stepped down in October 2016 in the fallout over the accounts scandal.
Waters pressed Scharf about whether customers who were harmed by Wells Fargo would be identified to receive payment and have their credit reporting fixed within 30 days.
Scharf said the company is in the process of trying to "remediate everything we possibly can" without giving a specific timeline. But he later added, "As of now, our plans take us into 2021 to ensure that all the payments are made appropriately."
The hearing also took place as the Trump administration is attempting to sway lawmakers in favor of a plan to stabilize the economy amid fears of a widening coronavirus outbreak.
Enlarge this image toggle caption Alex Brandon/AP Alex Brandon/AP
Wells Fargo announced earlier this week that it would make $6.25 million in donations to support the domestic and global public health response to the coronavirus.
The bank's announcement did not specify whether it would provide relief for its customers if an outbreak should force workers to miss paychecks leading to late mortgage, credit card and other consumer debt payments.
"As we think about what we could be doing relative to late fees, missed payments and things like that, we want our customers to believe that we're a source of strength for them," Scharf told lawmakers.
Waters fired back, "I know that you understand we'll be looking for a lot more specificity than you have just described."
Other committee members, like Rep. Patrick McHenry, R-N.C., the ranking member on the committee, lamented that lawmakers don't have the luxury to conduct "politically motivated ideological hearings on Wells Fargo right now."
"There are serious things happening in the world while we're having this hearing," McHenry said, adding that investors fear the spread of coronavirus is impacting the financial services industry, the economy and the markets.
"Our constituents have real concerns and they expect us to put aside politics and focus on the urgent matter at hand," McHenry said.


npr--2020-03-10--Federal Court Sides With House In Fight Over Mueller Grand Jury Materials

Federal Court Sides With House In Fight Over Mueller Grand Jury Materials A federal appeals court ruled Tuesday that the Justice Department must give House lawmakers secret grand jury materials from former special counsel Robert Mueller 's Russia investigation .
The 2-1 decision from a three-judge panel on the U.S. Court of Appeals for the D.C .
Circuit upholds a district court ruling from last year and gives House Democrats a victory in their ongoing legal battles with the Trump administration .
The ruling , which can be appealed , comes two weeks after a different three-judge panel on the @ @ @ @ @ @ @ House Democrats ' efforts to pry information out of the administration .
In the previous case , the court ruled that the House did not have standing to sue to enforce a subpoena for former White House counsel Don McGahn 's testimony .
The battle over the Mueller grand jury materials dates back to July , when the House Judiciary Committee filed an application to force the Justice Department to turn them over to the committee .
Grand jury materials are typically kept secret , although there are certain exceptions under which a @ @ @ @ @ @ @ of those exceptions is a `` judicial proceeding '' in which someone seeking their release has shown a `` particularized need . ''
In her written opinion Tuesday , federal Judge Judith Rogers said that the committee was indeed engaged in a legal proceeding and that the committee also has demonstrated a `` particularized need '' for the materials .
`` The committee has repeatedly stated that if the grand jury materials reveal new evidence of impeachable offenses , the committee may recommend new articles of impeachment , '' she wrote .
The @ @ @ @ @ @ @ President Trump was impeached in connection with allegations that he improperly held up aid and White House access from Ukraine while pushing for a political investigation .
Rogers ' ruling alluded to the prospect of an impeachment connected directly with Mueller 's investigation into Russian interference in the 2016 election .
In addition , Rogers said the district court controls access to grand jury records — not the executive branch or the Justice Department .
In other words , the material in question is n't the government 's to control or conceal .
@ @ @ @ @ @ @ of the redacted grand jury materials , but the department has no interest in objecting to the release of these materials outside of the general purposes and policies of grand jury secrecy , which as discussed , do not outweigh the committee 's compelling need for disclosure , '' she wrote .
`` Even if the department had not objected to disclosure , the district court would still need to authorize disclosure . ''
That would be up to the judge who presided over the grand jury that worked with Mueller , federal @ @ @ @ @ @ @ , the third judge on the panel that ruled on Tuesday , filed a dissent .

Federal Court Sides With House In Fight Over Mueller Grand Jury Materials
Enlarge this image toggle caption Susan Walsh/AP Susan Walsh/AP
A federal appeals court ruled Tuesday that the Justice Department must give House lawmakers secret grand jury materials from former special counsel Robert Mueller's Russia investigation.
The 2-1 decision from a three-judge panel on the U.S. Court of Appeals for the D.C. Circuit upholds a district court ruling from last year and gives House Democrats a victory in their ongoing legal battles with the Trump administration.
The ruling, which can be appealed, comes two weeks after a different three-judge panel on the same court dealt a significant blow to House Democrats' efforts to pry information out of the administration.
In the previous case, the court ruled that the House did not have standing to sue to enforce a subpoena for former White House counsel Don McGahn's testimony.
The Mueller materials
The battle over the Mueller grand jury materials dates back to July, when the House Judiciary Committee filed an application to force the Justice Department to turn them over to the committee.
Grand jury materials are typically kept secret, although there are certain exceptions under which a court can authorize their disclosure. One of those exceptions is a "judicial proceeding" in which someone seeking their release has shown a "particularized need."
In her written opinion Tuesday, federal Judge Judith Rogers said that the committee was indeed engaged in a legal proceeding and that the committee also has demonstrated a "particularized need" for the materials.
"The committee has repeatedly stated that if the grand jury materials reveal new evidence of impeachable offenses, the committee may recommend new articles of impeachment," she wrote.
The Judiciary Committee drafted the articles under which President Trump was impeached in connection with allegations that he improperly held up aid and White House access from Ukraine while pushing for a political investigation. Rogers' ruling alluded to the prospect of an impeachment connected directly with Mueller's investigation into Russian interference in the 2016 election.
In addition, Rogers said the district court controls access to grand jury records — not the executive branch or the Justice Department. In other words, the material in question isn't the government's to control or conceal.
"The department has objected to disclosure of the redacted grand jury materials, but the department has no interest in objecting to the release of these materials outside of the general purposes and policies of grand jury secrecy, which as discussed, do not outweigh the committee's compelling need for disclosure," she wrote.
"Even if the department had not objected to disclosure, the district court would still need to authorize disclosure."
That would be up to the judge who presided over the grand jury that worked with Mueller, federal Judge Beryl Howell.
Judge Neomi Rao, the third judge on the panel that ruled on Tuesday, filed a dissent.
NPR legal affairs correspondent Nina Totenberg contributed to this report.


npr--2020-03-10--Coronavirus: New York Creates 'Containment Area' Around Cluster In New Rochelle

Coronavirus : New York Creates 'Containment Area ' Around Cluster In New Rochelle New York is creating a `` containment area '' around a community in New Rochelle , in an attempt to limit the spread of coronavirus in an area that quickly became the state 's largest source of COVID-19 infections , Gov .
Andrew Cuomo announced Tuesday .
Residents would still be allowed to move around — but the new policy effectively blocks any large public gatherings in the area , to prevent further transmission of the virus .
`` It is a dramatic action , but it @ @ @ @ @ @ @ , '' Cuomo said .
`` And this is literally a matter of life and death . ''
`` New Rochelle is a particular problem , '' Cuomo said .
`` The numbers have been going up , the numbers continue to go up , the numbers are going up unabated — and we do need a special public health strategy for New Rochelle . ''
A synagogue in the city has become the epicenter of an outbreak in Westchester County — which accounts for 108 of New York state 's 173 coronavirus @ @ @ @ @ @ @ Young Israel congregation have already been under a voluntary quarantine order that was issued last week .
The congregation 's rabbi has confirmed that he is among those who have tested positive for the virus .
As of Tuesday , that synagogue is also at the center of a circle that extends for a 1-mile radius , marking the state 's containment area .
The governor is calling on the National Guard to help support the containment area .
Cuomo said the troops will be deployed `` to deliver food to homes , @ @ @ @ @ @ @ spaces . ''
At a news conference and in a statement posted online , New Rochelle Mayor Noah Bramson stressed that the National Guard would play only a limited role , saying , `` The Guard will not be engaged in military or policing functions . ''
Bramson also said several public and private schools are in the containment area .
Schools and large gathering places will be closed for two weeks inside the containment area , Cuomo said .
Officials will use that time to clean the schools , he added .
@ @ @ @ @ @ @ and remain in place through March 25 .
To reduce contacts between the containment area and the outside world , a new coronavirus testing facility will also be placed inside the area in New Rochelle .
`` This is an evolving situation , '' New York Health Commissioner Dr. Howard Zucker said .
`` We have moved from a containment strategy to more of a mitigation strategy . ''
People will still be allowed to go in and out of the containment zone , Cuomo said .
But any facilities that would bring @ @ @ @ @ @ @ schools and synagogues , will be closed .
`` This will be a period of disruption for the local community , I understand that .
Local shop owners do n't like the disruption ; nobody does .
Local politicians do n't like the disruption .
I get it , '' Cuomo said .
He added , `` This ca n't be a political decision .
This is a public health decision . ''
Saying that the decision reflects a recommendation of Dr. Zucker , Cuomo added , `` In a situation like this @ @ @ @ @ @ @ , or governor , let the experts decide .
And let the science drive the decision .
When you politically interfere in science , that 's when you tend to make a mistake . ''

Coronavirus: New York Creates 'Containment Area' Around Cluster In New Rochelle
Enlarge this image toggle caption New York Governor's Office New York Governor's Office
Updated at 9:15 p.m. ET
New York is creating a "containment area" around a community in New Rochelle, in an attempt to limit the spread of coronavirus in an area that quickly became the state's largest source of COVID-19 infections, Gov. Andrew Cuomo announced Tuesday.
"It is a dramatic action, but it is the largest cluster in the country," Cuomo said. "And this is literally a matter of life and death."
A synagogue in the city has become the epicenter of an outbreak in Westchester County — which accounts for 108 of New York state's 173 coronavirus cases. Hundreds of people in the Young Israel congregation have already been under a voluntary quarantine order that was issued last week. The congregation's rabbi has confirmed that he is among those who have tested positive for the virus.
As of Tuesday, that synagogue is also at the center of a circle that extends for a 1-mile radius, marking the state's containment area. Residents would still be allowed to move around — but the new policy effectively blocks any large public gatherings in the area, to prevent further transmission of the virus.
"New Rochelle is a particular problem," Cuomo said. "The numbers have been going up, the numbers continue to go up, the numbers are going up unabated — and we do need a special public health strategy for New Rochelle."
The governor is calling on the National Guard to help support the containment area. Cuomo said the troops will be deployed "to deliver food to homes, to help with the cleaning of public spaces."
At a news conference and in a statement posted online, New Rochelle Mayor Noam Bramson stressed that the National Guard would play only a limited role, saying, "The Guard will not be engaged in military or policing functions."
Enlarge this image toggle caption John Minchillo/AP John Minchillo/AP
Bramson also said several public and private schools are in the containment area.
Schools and large gathering places inside the containment area will be closed for two weeks, Cuomo said. Officials will use that time to clean the schools, he added. The new policy will take effect Thursday and remain in place through March 25.
To reduce contacts between the containment area and the outside world, a new coronavirus testing facility will also be placed inside the area in New Rochelle.
"This is an evolving situation," New York Health Commissioner Dr. Howard Zucker said. "We have moved from a containment strategy to more of a mitigation strategy."
People will still be allowed to go in and out of the containment zone, Cuomo said. But any facilities that would bring large gatherings of people, such as schools and synagogues, will be closed.
"This will be a period of disruption for the local community, I understand that. Local shop owners don't like the disruption; nobody does. Local politicians don't like the disruption. I get it," Cuomo said, adding, "This can't be a political decision. This is a public health decision."
The governor also said the decision reflects a recommendation from Zucker. "In a situation like this, whether you're president, mayor, or governor, let the experts decide," Cuomo said. "And let the science drive the decision. When you politically interfere in science, that's when you tend to make a mistake."


npr--2020-03-10--Putin Could Stay President Until 2036 Under New Proposal

Putin Could Stay President Until 2036 Under New Proposal A new proposal to change Russian presidential term limits could pave the way for Russian President Vladimir Putin to stay in power until 2036 .
The constitutional amendment proposed by lawmaker and former cosmonaut Valentina Tereshkova would reset the current term limits , which limit Russian presidents to two consecutive six-year terms .
Putin is already the longest-serving leader of the country since Josef Stalin .
Russians are scheduled to vote on the proposed amendment on April 22 in a nationwide constitutional referendum .
Putin spoke to lawmakers at the Kremlin-controlled @ @ @ @ @ @ @ a change would mean for the future of presidential power in Russia .
It 's important , he said , for a president to ensure the country 's `` evolutionary development . ''
For now , he said , it 's important to not move too quickly to change how Russian state power operates : `` We have had enough revolutions . ''
`` I have no doubt that the day will come when the supreme , presidential power in Russia will not be so personified , if I may say so , @ @ @ @ @ @ @ a certain individual , '' Putin added .
`` But this is exactly how it was in our previous history , and we must take this into account . ''
Putin told lawmakers on Tuesday that he did not endorse completely eliminating presidential term limits , one element of Tereshkova 's proposal .
But he strongly backed the idea of resetting the number of terms he could run .
Putin told lawmakers that he thought amending Russia 's constitution would be possible as long as the country 's Constitutional Court approved it .
@ @ @ @ @ @ @ have no restrictions on presidential terms .
Even in the United States , he said , the two-term limit has only been in place since the 22nd Amendment was ratified in 1951 .
The Great Depression , economic uncertainty , unemployment and World War II all called for persistent leadership in the U.S. , Putin said .
As Russia is also undergoing upheaval and difficulty , `` stability may be more important and must be given priority , '' he said , especially `` when a country still has many problems . ''
@ @ @ @ @ @ @ of parliament , overwhelmingly endorsed the proposal .
Russia watchers , who have long been wondering how Putin would maintain power once his term ran out , have been anticipating a move like this for some time .
`` The Russian system has been existing under this perpetual question mark of 'what is Putin going to do ? '
`` Fiona Hill , President Trump 's former top Russia adviser , told NPR 's Mary Louise Kelly .
Many observers thought Putin might take on a different role that would let him maintain @ @ @ @ @ @ @ Ali Khamenei or Kazakhstan 's first president , Nursultan Nazarbayev , who now chairs the country 's security council and holds the title `` leader of the nation . ''
There was talk of having Putin lead the country 's State Council , which would be strengthened with the presidency becoming more of a symbolic position .
Ultimately , the Kremlin decided to simply change the presidential term limits so that Putin could maintain control , Loyola University Chicago professor Michael Dhorokovsky told NPR .
`` The Kremlin is searching for ways to @ @ @ @ @ @ @ said .
`` Putin and his inner circle seem to have decided that the way to do it is to eliminate term limits and allow Putin to run again .
It would be inconceivable for Putin to lose . ''
The 67-year-old Putin has maintained power in some form or another for more than 20 years , serving as both president and prime minister .
His current term is set to expire in 2024 ; should he run again , Putin could be 83 when the next term limit runs out in 2036 @ @ @ @ @ @ @ said Dhorokovsky , `` is that Putin wants to beat Stalin , who ruled for almost 30 years . ''
`` Putin will stay in power and in his present position for life , '' said Dmitri Trenin , director of the Carnegie Moscow Center .
`` As for the future of Russian democracy , we will need to wait till after Putin passes from the stage . ''
`` Putin has become the wild card in his own system , '' Hill said .
`` If he goes , it seems destabilizing @ @ @ @ @ @ @ to kind of put off the inevitable .
He surely wo n't live forever . ''

Russian Parliament Allows Putin 2 More Terms As President
Enlarge this image toggle caption Alexei Nikolsky/AP Alexei Nikolsky/AP
Updated at 6:25 a.m. ET Wednesday
Russia's lower house of parliament on Wednesday approved a constitutional amendment to allow President Vladimir Putin — already the country's longest-serving leader since Josef Stalin — to extend his rule until 2036.
Lawmakers in the State Duma voted 383 to 0 in favor of the amendment, with 43 abstentions. Putin said on Tuesday that Russia's Constitutional Court would have to rule on whether the move would contradict Russian law. Putin's critics have said approval by the court is all-but certain.
The constitutional amendment proposed by lawmaker and former cosmonaut Valentina Tereshkova — who gained fame in 1963 as the first woman in space — resets the current term limits, which limit Russian presidents to two consecutive six-year terms. Russians are scheduled to vote on the proposed amendment on April 22 in a nationwide constitutional referendum.
Putin spoke to lawmakers at the State Duma on Tuesday about what such a change would mean for the future of presidential power in Russia.
It's important, he said, for a president to ensure the country's "evolutionary development." Now, he said, is not the time to move too quickly to change how Russian state power operates: "We have had enough revolutions."
"I have no doubt that the day will come when the supreme, presidential power in Russia will not be so personified, if I may say so, that it will not be connected to a certain individual," Putin added. "But this is exactly how it was in our previous history, and we must take this into account."
Putin told lawmakers on Tuesday that he did not endorse completely eliminating presidential term limits, one element of the proposal by Tereshkova. But he strongly backed the idea of resetting the number of terms for which he could run.
In his appeal to parliament, Putin also pointed to other countries that have no restrictions on presidential terms. Even in the United States, he said, the two-term limit has only been in place since the 22nd Amendment was ratified in 1951.
The Great Depression, economic uncertainty, unemployment and World War II all called for persistent leadership in the U.S., Putin said, referring to President Franklin Roosevelt's four terms. As Russia is also undergoing upheaval and difficulty, "stability may be more important and must be given priority," he said, especially "when a country still has many problems."
Russia watchers, who have long assumed Putin would seek to retain power after his current term expires in 2024, were not surprised.
"The Russian system has been existing under this perpetual question mark of 'what is Putin going to do?' " Fiona Hill, President Trump's former top Russia adviser, told NPR's Mary Louise Kelly.
Many observers thought Putin might take on a different role that would let him maintain influence – like Iranian Supreme Leader Ayatollah Ali Khamenei or Kazakhstan's first president, Nursultan Nazarbayev, who now chairs the country's security council and holds the title "leader of the nation." There was talk of having Putin lead the country's State Council, which would be strengthened, with the presidency becoming more of a symbolic position.
Ultimately, the Kremlin decided to simply change the presidential term limits so that Putin could maintain control, Loyola University Chicago professor Michael Khodarkovsky told NPR.
"The Kremlin is searching for ways to keep Putin in power," Khodarkovsky said. "Putin and his inner circle seem to have decided that the way to do it is to eliminate term limits and allow Putin to run again. It would be inconceivable for Putin to lose."
The 67-year-old Putin has ruled Russia for more than 20 years, serving as both president and prime minister. His current presidential term is set to expire in 2024; should he run again, Putin would be 83 when the next term limit runs out in 2036. "My own feeling," said Khodarkovsky, "is that Putin wants to beat Stalin, who ruled for almost 30 years."
"Putin will stay in power and in his present position for life," said Dmitri Trenin, director of the Carnegie Moscow Center. "As for the future of Russian democracy, we will need to wait till after Putin passes from the stage."
"Putin has become the wild card in his own system," Hill said. "If he goes, it seems destabilizing. And this seems like an effort to kind of put off the inevitable. He surely won't live forever."


npr--2020-03-10--Coronavirus: Sacramento County Gives Up On Automatic 14-Day Quarantines

Coronavirus : Sacramento County Gives Up On Automatic 14-Day Quarantines California 's Sacramento County is calling off automatic 14-day quarantines that have been implemented for the coronavirus , saying it will focus instead on mitigating the impact of COVID-19 .
The change is an acknowledgement that the county can not effectively manage the quarantines while its health system copes with coronavirus cases .
It also reflects problems with the U.S. government 's coronavirus testing program — issues that slowed efforts to identify people with the deadly virus and to contain COVID-19 .
`` With the shift from containment to mitigation @ @ @ @ @ @ @ someone who has been in contact with someone with COVID-19 to quarantine for 14 days , '' the county says .
Effective immediately , people in Sacramento County should not quarantine themselves if they 've been exposed to the COVID-19 .
Instead , they should go into isolation only if they begin to show symptoms of the respiratory virus , the county 's health department says .
Sacramento County has at least 10 coronavirus cases , including one person who recovered .
Decisions on how to try to contain and control the coronavirus @ @ @ @ @ @ @ local officials , rather than those at the federal level .
`` The decision of what steps to implement will be local , '' Dr. Nancy Messonnier , director of the CDC 's National Center for Immunization and Respiratory Diseases , said last week .
She added , `` CDC 's role is to provide technical advice to states and counties . ''
Sacramento 's new policy is similar to the approach in King County , Wash. , which now has 116 coronavirus cases and 20 COVID-19 deaths .
The county health department @ @ @ @ @ @ @ the virus does n't mention quarantines at all .
Instead , it advises people to stay at home if they 're sick and to limit chances for the virus to spread by taking precautions such as teleworking and practicing excellent hygiene .
`` Once you get a certain number of cases , it 's hard to continue to contact-trace back the way you tried originally , '' Dr. Peter Beilenson , head of Sacramento County 's Department of Health Services , told The Sacramento Bee .
`` So we move to mitigation , @ @ @ @ @ @ @ risk to those who are most at risk : the elderly and those with chronic underlying conditions . ''
Such policies can also reduce the toll on health care providers and first responders who might otherwise be compelled to self-quarantine if they have been exposed to someone who has been diagnosed with the coronavirus .
Without those medical workers on the front lines , the broader response could be hobbled .
California and Washington state emerged as the first hot spots for the coronavirus in the U.S. , which currently has more than @ @ @ @ @ @ @ cases of community spread , in which an infected person has no history of travel to affected areas or exposure to someone known to have the COVID-19 illness .
Sacramento County includes the University of California , Davis Medical Center , the facility that housed the first U.S. case of novel coronavirus infection through community spread .
The patient was left undiagnosed for days because , according to the hospital , a request for testing was n't granted on the grounds that the person did n't fit official criteria , which at the @ @ @ @ @ @ @ was quickly revised — but 36 nurses and a total of roughly 188 other workers at UC Davis Medical Center and another area hospital were sent into self-quarantine for 14 days .
Messionier and other CDC officials say the U.S. response to the coronavirus wo n't be one-size-fits-all , with varying methods used in different parts of the country .
In large part , they say , that 's because the effort must adapt in areas where there has been community spread .
Even when an agency emphasizes mitigation over containment , Messionier @ @ @ @ @ @ @ there 's no `` on-off switch . ''
In many cases , she added , the local response will be a hybrid of the two .
`` In Seattle and in California , they have n't stopped entirely contact tracing , but they have started mitigation , '' Messionier noted .
`` And I think that you will likely see local health departments deciding when there is community spread to start turning on more of the mitigation measures , even while they 're still doing some level of contact tracing . ''
Messionier @ @ @ @ @ @ @ adopt similar approaches .
`` You will see , I think , lots more communities starting to implement some kind of mitigation measures when they 're seeing community spread .
It will look different in different places .
And that 's why it 's really important for folks to stay informed of what 's going on in their local area and to follow their advice of the local health department . ''
To prevent the coronavirus from spreading , the CDC recommends washing hands with soap and water for at least 20 seconds @ @ @ @ @ @ @ sink is n't available .
The World Health Organization says people should wear face masks only if they 're sick or caring for someone who is .
`` For most people , COVID-19 infection will cause mild illness ; however , it can make some people very ill and , in some people , it can be fatal , '' the WHO says .
`` Older people , and those with pre-existing medical conditions ( such as cardiovascular disease , chronic respiratory disease or diabetes ) are at risk for severe disease .
@ @ @ @ @ @ @ , according to a recent WHO report that draws on more than 70,000 cases in China : fever ( in 88 % of cases ) ; dry cough ( 68 % ) ; fatigue ( 38 % ) ; sputum/phlegm production ( 33 % ) .
Shortness of breath occurred in nearly 20 % of cases , and about 13 % had a sore throat or headache , the WHO said .

Coronavirus: Sacramento County Gives Up On Automatic 14-Day Quarantines
Enlarge this image toggle caption Patrick Mouzawak/Bloomberg via Getty Images Patrick Mouzawak/Bloomberg via Getty Images
Updated at 3 p.m. ET
California's Sacramento County is calling off automatic 14-day quarantines that have been implemented for the coronavirus, saying it will focus instead on mitigating the impact of COVID-19.
The change is an acknowledgement that the county cannot effectively manage the quarantines while its health system copes with coronavirus cases. It also reflects problems with the U.S. government's coronavirus testing program — issues that slowed efforts to identify people with the deadly virus and to contain COVID-19.
"With the shift from containment to mitigation, it is no longer necessary for someone who has been in contact with someone with COVID-19 to quarantine for 14 days," the county says.
Effective immediately, people in Sacramento County should not quarantine themselves if they've been exposed to the COVID-19. Instead, they should go into isolation only if they begin to show symptoms of the respiratory virus, the county's health department says.
Sacramento County has at least 10 coronavirus cases, including one person who recovered.
Decisions on how to try to contain and control the coronavirus have largely been left to state and local officials, rather than those at the federal level.
"The decision of what steps to implement will be local," Dr. Nancy Messonnier, director of the CDC's National Center for Immunization and Respiratory Diseases, said last week. She added, "CDC's role is to provide technical advice to states and counties."
Sacramento's new policy is similar to the approach in King County, Wash., which now has 116 coronavirus cases and 20 COVID-19 deaths. The county health department's page of recommendations for dealing with the virus doesn't mention quarantines at all. Instead, it advises people to stay at home if they're sick and to limit chances for the virus to spread by taking precautions such as teleworking and practicing excellent hygiene.
"Once you get a certain number of cases, it's hard to continue to contact-trace back the way you tried originally," Dr. Peter Beilenson, head of Sacramento County's Department of Health Services, told The Sacramento Bee. "So we move to mitigation, which is basically trying to mitigate the risk to those who are most at risk: the elderly and those with chronic underlying conditions."
Such policies can also reduce the toll on health care providers and first responders who might otherwise be compelled to self-quarantine if they have been exposed to someone who has been diagnosed with the coronavirus. Without those medical workers on the front lines, the broader response could be hobbled.
California and Washington state emerged as the first hot spots for the coronavirus in the U.S., which currently has more than 760 cases. Both states have reported cases of community spread, in which an infected person has no history of travel to affected areas or exposure to someone known to have the COVID-19 illness.
Sacramento County includes the University of California, Davis Medical Center, the facility that housed the first U.S. case of novel coronavirus infection through community spread. The patient was left undiagnosed for days because, according to the hospital, a request for testing wasn't granted on the grounds that the person didn't fit official criteria, which at the time included international travel. That criteria was quickly revised — but 36 nurses and a total of roughly 188 other workers at UC Davis Medical Center and another area hospital were sent into self-quarantine for 14 days.
Messionier and other CDC officials say the U.S. response to the coronavirus won't be one-size-fits-all, with varying methods used in different parts of the country. In large part, they say, that's because the effort must adapt in areas where there has been community spread.
Even when an agency emphasizes mitigation over containment, Messionier said during a briefing on Monday, there's no "on-off switch." In many cases, she added, the local response will be a hybrid of the two.
"In Seattle and in California, they haven't stopped entirely contact tracing, but they have started mitigation," Messionier noted. "And I think that you will likely see local health departments deciding when there is community spread to start turning on more of the mitigation measures, even while they're still doing some level of contact tracing."
Messionier said she expects to see more agencies adopt similar approaches.
"You will see, I think, lots more communities starting to implement some kind of mitigation measures when they're seeing community spread. It will look different in different places. And that's why it's really important for folks to stay informed of what's going on in their local area and to follow their advice of the local health department."
Coronavirus symptoms and prevention
To prevent the coronavirus from spreading, the CDC recommends washing hands with soap and water for at least 20 seconds or using a hand sanitizer if a sink isn't available. The World Health Organization says people should wear face masks only if they're sick or caring for someone who is.
"For most people, COVID-19 infection will cause mild illness; however, it can make some people very ill and, in some people, it can be fatal," the WHO says. "Older people, and those with pre-existing medical conditions (such as cardiovascular disease, chronic respiratory disease or diabetes) are at risk for severe disease."
The most common symptoms of COVID-19, according to a recent WHO report that draws on more than 70,000 cases in China: fever (in 88% of cases); dry cough (68%); fatigue (38%); sputum/phlegm production (33%).
Shortness of breath occurred in nearly 20% of cases, and about 13% had a sore throat or headache, the WHO said.


npr--2020-03-10--How A South Korean City Is Changing Tactics To Tamp Down Its COVID-19 Surge

How A South Korean City Is Changing Tactics To Tamp Down Its COVID-19 Surge The city of Daegu , about 150 miles southeast of Seoul , has long been a bustling industrial center and transport hub , home to 2.5 million South Koreans .
But lately Daegu has become a shadow of its usual self .
`` It actually looks like a scene from a disaster movie , '' says Dr. Lee Jun-yeup , communications director for the Daegu Medical Association .
`` Streets are empty , restaurants and shops closed .
People stock up on instant noodles because they @ @ @ @ @ @ @ Daegu has so far been the main battleground of the coronavirus outbreak in South Korea , accounting for 75 % of the country 's 7,513 cases as of Tuesday .
The country has one of the highest number of infections outside of China .
Despite a national system that has a reputation for providing affordable , good-quality health care , the city 's hospitals have been overwhelmed with infected patients , necessitating a shift in tactics .
The past couple of days saw the smallest daily increases in new cases in South Korea @ @ @ @ @ @ @ Jae-In said Monday it was too soon for anyone to be optimistic .
Daegu 's first known coronavirus case was confirmed on Feb. 18 .
A 61-year-old woman was South Korea 's 31st case .
Epidemiological investigators believe she came into contact with more than 1,100 people .
Most are fellow members of the Shincheonji Church of Jesus , a religious group that accounts for most of the cases in Daegu .
The disease 's rapid spread through Daegu is due in part to the way patients transmit or `` shed '' the @ @ @ @ @ @ @ symptoms are mild in the early phase , even though viral shedding is high , '' explains Dr. Choi Sung Ho of Chung-Ang University College of Medicine in Seoul .
`` Patients may not realize they are infected and so go about their everyday lives . ''
As the virus spread in the early days of the outbreak , a slow trickle of patients entered Daegu 's hospitals , which were equipped to handle it , Lee says .
`` Daegu city 's policy , at first , was to put every patient @ @ @ @ @ @ @ of the severity of their symptoms , '' he says .
Negative pressure rooms isolate infected patients by preventing contaminated air from escaping the room .
The trickle soon turned into a deluge of hundreds of patients , and by Feb. 23 , when the increase in new cases in Daegu exceeded 100 per day , the city 's hospitals became clogged with patients with mild symptoms .
As of Friday , some 1,800 of Daegu 's coronavirus patients were at home awaiting hospital beds .
Two of them died waiting .
`` @ @ @ @ @ @ @ nationwide , '' Dr. Kim Dong-hyun , a professor at the Hallym University College of Medicine in Chuncheon city , referring to infections that have been traced to the region in South Korea where the infection was reported .
This represents a new phase of the outbreak , Kim argues , and authorities must adapt their response to it .
At first they were focused on tracking suspected cases and quarantining them .
But , Kim says , `` at this point , tracing how the infection spread is meaningless . ''
Tracing @ @ @ @ @ @ @ says .
He adds that the city does n't have enough epidemiological investigators and that the virus is so widespread that investigators can no longer sort out who infected whom in Daegu .
Kim Hyeonggab , president of the Korean Association of Public Health Doctors and a medical volunteer in Daegu , says he 's seeing a shift in tactics from health authorities from trying to contain and trace the virus to trying to mitigate its impact and prevent deaths .
This has been done nationwide and involves a range of actions , @ @ @ @ @ @ @ concerts .
`` Since last Saturday , I 've seen government efforts shift to securing more hospital beds and building a triaging system , '' says Kim — prioritizing patients with severe symptoms at health facilities .
But , he adds , it 's not happening fast enough .
`` We should 've been preparing mitigation strategies even while we were in the containment phase . ''
Currently , the goal of the mitigation efforts is to delay the inevitable peak of infections — the point at which Daegu reaches the maximum number @ @ @ @ @ @ @ time for the authorities to marshal resources and deploy medical personnel to Daegu , Kim says .
Despite these advances , halting the virus ' spread in South Korea could require tougher measures .
`` I believe the surest way is to stop people 's activities and movements , '' says Dr. Choi Sung Ho , of Chung-Ang University 's College of Medicine in Seoul .
`` And I personally suspect that the government understands this and wants to impose stricter limits on social activities . ''
But domestic travel bans — lockdowns @ @ @ @ @ @ @ could be politically unpopular .
One of the most common criticisms is that President Moon should have banned all travelers from China .
If a domestic ban is enforced , it could look like the government is showing more deference to China than to South Korean citizens .
And the bans could be reminiscent of North Korea , where freedom of movement is tightly controlled even when there are no epidemics .
So far , Seoul has not even suggested them .

How A South Korean City Is Changing Tactics To Tamp Down Its COVID-19 Surge
Enlarge this image toggle caption Chung Sung-Jun/Getty Images Chung Sung-Jun/Getty Images
The city of Daegu, about 150 miles southeast of Seoul, has long been a bustling industrial center and transport hub, home to 2.5 million South Koreans. But lately Daegu has become a shadow of its usual self. "It actually looks like a scene from a disaster movie," says Dr. Lee Jun-yeup, communications director for the Daegu Medical Association. "Streets are empty, restaurants and shops closed. People stock up on instant noodles because they want to avoid going out."
Daegu has so far been the main battleground of the coronavirus outbreak in South Korea, accounting for 75% of the country's 7,513 cases as of Tuesday. The country has one of the highest number of infections outside of China.
Despite a national system that has a reputation for providing affordable, good-quality health care, the city's hospitals have been overwhelmed with infected patients, necessitating a shift in tactics.
The past couple of days saw the smallest daily increases in new cases in South Korea since Feb. 26. But President Moon Jae-In said Monday it was too soon for anyone to be optimistic.
Daegu's first known coronavirus case was confirmed on Feb. 18. A 61-year-old woman was South Korea's 31st case. Epidemiological investigators believe she came into contact with more than 1,100 people.
Most are fellow members of the Shincheonji Church of Jesus, a religious group that accounts for most of the cases in Daegu.
The disease's rapid spread through Daegu is due in part to the way patients transmit or "shed" the virus. "With this virus, symptoms are mild in the early phase, even though viral shedding is high," explains Dr. Choi Sung Ho of Chung-Ang University College of Medicine in Seoul. "Patients may not realize they are infected and so go about their everyday lives."
As the virus spread in the early days of the outbreak, a slow trickle of patients entered Daegu's hospitals, which were equipped to handle it, Lee says. "Daegu city's policy, at first, was to put every patient in a negative pressure room, regardless of the severity of their symptoms," he says. Negative pressure rooms isolate infected patients by preventing contaminated air from escaping the room.
The trickle soon turned into a deluge of hundreds of patients, and by Feb. 23, when the increase in new cases in Daegu exceeded 100 per day, the city's hospitals became clogged with patients with mild symptoms. As of Friday, some 1,800 of Daegu's coronavirus patients were at home awaiting hospital beds. Two of them died waiting.
"We're now seeing all-out local transmissions nationwide," Dr. Kim Dong-hyun, a professor at the Hallym University College of Medicine in Chuncheon city, referring to infections that have been traced to the region in South Korea where the infection was reported.
This represents a new phase of the outbreak, Kim argues, and authorities must adapt their response to it. At first they were focused on tracking suspected cases and quarantining them. But, Kim says, "at this point, tracing how the infection spread is meaningless." Tracing takes up too many resources, he says. He adds that the city doesn't have enough epidemiological investigators and that the virus is so widespread that investigators can no longer sort out who infected whom in Daegu.
Kim Hyeonggab, president of the Korean Association of Public Health Doctors and a medical volunteer in Daegu, says he's seeing a shift in tactics from health authorities from trying to contain and trace the virus to trying to mitigate its impact and prevent deaths. This has been done nationwide and involves a range of actions, from canceling schools to calling off K-pop concerts.
"Since last Saturday, I've seen government efforts shift to securing more hospital beds and building a triaging system," says Kim — prioritizing patients with severe symptoms at health facilities.
But, he adds, it's not happening fast enough. "We should've been preparing mitigation strategies even while we were in the containment phase."
Currently, the goal of the mitigation efforts is to delay the inevitable peak of infections — the point at which Daegu reaches the maximum number of coronavirus cases. It will buy time for the authorities to marshal resources and deploy medical personnel to Daegu, Kim says.
Despite these advances, halting the virus' spread in South Korea could require tougher measures. "I believe the surest way is to stop people's activities and movements," says Dr. Choi Sung Ho, of Chung-Ang University's College of Medicine in Seoul. "And I personally suspect that the government understands this and wants to impose stricter limits on social activities."
But domestic travel bans — lockdowns similar to China's Hubei province — could be politically unpopular. One of the most common criticisms is that President Moon should have banned all travelers from China. If a domestic ban is enforced, it could look like the government is showing more deference to China than to South Korean citizens.
And the bans could be reminiscent of North Korea, where freedom of movement is tightly controlled even when there are no epidemics. So far, Seoul has not even suggested them.


npr--2020-03-10--Trump Urges Calm, Vows To Help Cruise, Airline Industries Amid Coronavirus Concerns

President Trump said Tuesday his administration was working with the cruise and airline industries that have been battered by the coronavirus outbreak as he traveled to Capitol Hill to meet with Senate Republicans to talk about plans to stimulate the economy in the midst of the health crisis .
`` It will go away , '' Trump said of the coronavirus after meeting with GOP senators .
`` Stay calm . ''
Trump again compared the coronavirus to the flu , which he said has killed 8,000 Americans compared with 26 deaths attributed to the coronavirus .
`` So you @ @ @ @ @ @ @ time — with all of that being said , we 're taking this unbelievably seriously and I think were doing a very good job , '' Trump said .
The latest figures indicate 28 Americans and 4,000 people worldwide have died in the outbreak .
Trump did not announce any economic proposals on Capitol Hill , but said `` a lot of good things are going to happen . ''
Senate Majority Leader Mitch McConnell indicated that Treasury Secretary Steven Mnuchin would represent the White House and Senate Republicans and handle negotiations over @ @ @ @ @ @ @ Nancy Pelosi , D-Calif. '' We 're hoping that he ( Mnuchin ) and the speaker can pull this together so that we end up not playing partisan games at a time , which seems to me to cry out for bipartisan , bicameral agreement , '' McConnell said shortly after the meeting with Trump .
Responding to a question about whether the President would be amenable to steps backed by Pelosi , including an extension of unemployment insurance , McConnell said : `` I think the package needs to be negotiated .
@ @ @ @ @ @ @ most prominent Democrat here on Capitol Hill , and anything to get on the president 's desk has to be agreed to between the administration and the speaker of the House . ''
Earlier , at a White House meeting with hospital CEOs and executives from the insurance industry , Trump said `` We are working very , very closely with the cruise industry . ''
He added of the airline industry : `` We 'll be helping them through this patch . ''
Travel stocks have been hit hard by the uncertainty @ @ @ @ @ @ @ conferences to be canceled , universities to close and travel to some nations restricted or barred .
On Monday , the president said he 'd unveil unspecified `` dramatic '' policies to counter the economic effects of the outbreak that has sent shivers through the global economy as entire national regions and nations have enforced lockdowns to stem the spread of the disease .
`` We are going to take care of and have been taking care of the American public and the American economy , '' Trump said Monday .
Among the @ @ @ @ @ @ @ is a cut in the payroll taxes American workers have deducted from their paychecks to pay for Social Security and Medicare .
Trump also called on the Federal Reserve Board to further cut interest rates .
In a tweet , he said the `` pathetic , slow moving '' Federal Reserve `` should get our Fed Rate down to the levels of our competitor nations .
They now have as much as a two point advantage , with even bigger currency help .
Also , stimulate ! ''
The Fed cut interest rates @ @ @ @ @ @ @ in an emergency .
At the time , Fed Chair Jerome Powell said the coronavirus `` and the measures that are being taken to contain it will surely weigh on economic activity , both here and abroad , for some time . ''
The Fed , he said , is `` prepared to use our tools and act appropriately , depending on the flow of events . ''
The action on both ends of Pennsylvania Avenue comes a day after the stock market dropped precipitously .
The S & P 500 was down @ @ @ @ @ @ @ somewhat on Tuesday as expectations for a payroll tax cut rose .

NIH Official Urges Vigilance On Coronavirus As White House Floats Economic Proposals
Enlarge this image toggle caption Alex Brandon/AP Alex Brandon/AP
Updated at 7:44 p.m. ET
One of the nation's leading infectious disease experts issued a stern warning on Tuesday: If you think you have escaped the spread of the coronavirus, do not become complacent.
"As a nation, we can't be doing the kinds of things we were doing a few months ago," said Dr. Anthony Fauci, the head of infectious diseases at the National Institutes of Health. "It doesn't matter if you're in a state that has no cases or one case, you have to start taking seriously what you can do now."
The briefing on Tuesday comes as the White House is beginning outreach to lawmakers about possible measures to protect workers and small businesses affected by the virus. While President Trump has promised action, officials have not yet announced any specific agreements.
The U.S. has counted at least 712 cases and 27 deaths from the novel coronavirus so far. Fauci told reporters Tuesday that both the number of new cases and fatalities from the virus in the U.S. are expected to rise.
Fauci said as the nation grapples with the spread of the respiratory disease, "everything is on the table for consideration," but he noted that the Trump administration is searching for the right balance between preventing future outbreaks while also not taking steps that are too extreme.
"For the country right now to say, 'We're going to close all the schools in the country,' I don't think would be appropriate," Fauci said, adding that the country should, however, "do real mitigation some time before you think you really need it."
Exactly what those measures might look like were not disclosed. Fauci said federal officials are working to get ahead of the virus as its spread continues, saying, "If and when the infections will come, sorry to say, sad to say, they will."
At the same Tuesday briefing, Vice President Pence said Trump had talked to Senate Republicans and asked for payroll tax relief and measures for hourly workers and small businesses who may not have sick leave plans.
The yet-to-be-unveiled fiscal stimulus package, including any kind of payroll tax cut, would need the support of House Democrats, who have their own proposals to combat economic problems caused by coronavirus.
Pence said White House officials would "fan out" and talk to lawmakers to move the economic relief package forward.
Other questions continue to swirl on Capitol Hill about how exactly the administration plans to pay for expensive measures like a suspension of payroll taxes.
The Centers for Disease Control and Prevention is working with Washington state, California, New York and Florida to develop community-specific recommendations to address the spread of coronavirus in those states and will publish recommendations in the next 24 hours, Pence said.
"The risk to the average American of contracting the coronavirus remains low," Pence said. "The risk to senior citizens with serious underlying chronic health conditions is very significant."
White House economic adviser Larry Kudlow said it may be possible to work around Congress by using administrative authority to fund unpaid sick leave, but he declined to elaborate on any specifics, saying a deal is still being hammered out.
"We're checking with the leaders of both parties and both houses to see what is doable and where the tough nuts are going to be," Kudlow said. "In the near future we will outline a more detailed package for you."
Trump said earlier Tuesday his administration was working with the cruise and airline industries that have been battered by the coronavirus outbreak as he traveled to Capitol Hill.
Trump did not announce any economic proposals after his meetings, but said "a lot of good things are going to happen."
Senate Majority Leader Mitch McConnell indicated that Treasury Secretary Steven Mnuchin would represent the White House and Senate Republicans and handle negotiations over a final stimulus plan with House Speaker Nancy Pelosi, D-Calif.
"We're hoping that he [Mnuchin] and the speaker can pull this together so that we end up not playing partisan games at a time, which seems to me to cry out for bipartisan, bicameral agreement," McConnell said shortly after the meeting with Trump.
Responding to a question about whether the president would be amenable to steps backed by Pelosi, including an extension of unemployment insurance, McConnell said: "I think the package needs to be negotiated. I think the speaker is obviously the most prominent Democrat here on Capitol Hill, and anything to get on the president's desk has to be agreed to between the administration and the speaker of the House."
Travel stocks have been hit hard by the uncertainty over the coronavirus, which has led conferences to be canceled, universities to close and travel to some nations restricted or barred.
On Monday, the president said he'd unveil unspecified "dramatic" policies to counter the economic effects of the outbreak that has sent shivers through the global economy as entire national regions and nations have enforced lockdowns to stem the spread of the disease.
"We are going to take care of and have been taking care of the American public and the American economy," Trump said Monday.
The action on both ends of Pennsylvania Avenue comes a day after the stock market dropped precipitously. The S&P 500 was down nearly 8%. Markets bounced back somewhat on Tuesday as the prospect of a payroll tax cut rose.


npr--2020-03-10--Sanders' Army Of Volunteers Tries To Rally Support In Missouri

Sanders ' Army Of Volunteers Tries To Rally Support In Missouri Ricardo Flores ca n't vote on Tuesday .
He 's not a citizen .
But Flores wants to play a role now .
He figures if he can convince a few people , especially members of his own Latino community in Kansas City , Mo.
, to cast a ballot for his candidate — that 's a close second .
`` I 'm going to become a citizen of this country , '' he says .
`` And I 'm going to be able to vote and I have @ @ @ @ @ @ @ to see things better . ''
Flores , 31 , is a member of the enthusiastic army of political volunteers who have given up their weekends and put jobs on hold to visit new neighborhoods and corner strangers in hopes of persuading them to support Bernie Sanders for president .
Voters from six states are going to the polls Tuesday in what many are calling Big Tuesday .
The race for the Democratic primary is now largely a two-man competition .
While the Democratic establishment coalesces around former Vice President Joe Biden , @ @ @ @ @ @ @ a big push in what may be his last opportunity to regain a foothold in the race .
And Sanders is depending on the strength of his volunteers to make that happen .
Sanders was in St. Louis on Monday rallying support a day before Missourians go to the polls .
An Emerson College/Nexstar Media poll shows him trailing Biden by 4 points in the state , where 68 of Tuesday 's 352 delegates are at stake .
Tessa Sheehan , 49 , is part of a core group of supporters from Kansas @ @ @ @ @ @ @ team since 2015 .
Sheehan recognizes the `` old guard '' is behind Biden , but she says her crew of volunteers wo n't be discouraged .
Since February , the team has knocked on more than 45,000 doors , including nearly 10,000 on Saturday , during Biden 's swing through the state .
`` It 's we the people , '' Sheehan says .
`` The other campaigns do n't have that .
You know , they 've got the bells and whistles and the media and the money .
We have @ @ @ @ @ @ @ lot of us .
There 's a lot more of us than there are with them . ''
Enthusiasm at the Kansas City headquarters was high on Sunday morning .
Before dispatching to their assigned `` turf '' across the city and surrounding suburbs , Abril Negrete , 26 , led a circle of volunteers in a chant to get them ready for the day .
`` We are human beings , '' Negrete , a labor organizer , calls out as the crowd repeats .
`` And we deserve full equality .
@ @ @ @ @ @ @ But some volunteers were feeling the pressure ahead of Tuesday 's primary as endorsements for Biden continued to pour in .
The news on Sunday that Kamala Harris , the California senator and former presidential candidate , was backing Biden had made its way around the office .
`` It 's just unbelievable that people are rallying behind Biden , '' says Mahra Seward , 51 , a life coach who took the train from Chicago to help knock on doors in Kansas City .
She began to tear up as she talked @ @ @ @ @ @ @ 's heartbreaking — especially progressives , '' she says .
`` If you turn on the news , it 's hard to get out of bed , but despair is not an option . ''
On her second day canvassing , Essence Jewel , a 19-year-old junior at the University of Missouri , Kansas City , is hopeful .
She teamed up with Bill Drummond , 66 , a longtime supporter of Sanders who says his punk rock roots draw him to the senator 's brand of politics .
At their first door @ @ @ @ @ @ @ neighborhood in southern Kansas City , Drummond gives Jewel a quick lesson on his knocking strategy .
`` You knock three times with escalating volume and enthusiasm , '' he says .
`` You want it to telegraph , ' I would like to speak to you very , very , very much , but you do n't want it to be the knock of doom , as in , 'Open up or we 'll kick the door in . '
`` Jewel tells those who answer the door about her mounting student @ @ @ @ @ @ @ .
She says she fears she wo n't be able to afford having children of her own when she 's older .
`` I feel trapped right now and I feel like [ Sanders ] is the only person right now that is fighting for a future that is really livable .
One day I want to own a house , '' she tells them .
`` How can I do that if I already have tens of thousands of dollars in debt ? ''
Around the same time in North Kansas City @ @ @ @ @ @ @ a mixed community that includes Latino , African and Vietnamese immigrants .
`` Me nombre es Ricardo Flores , '' he says .
`` Vengo de hablarles un poquito de Bernie Sanders . ''
Maria Perez , 30 , hugs the door and listens as Flores asks to speak about Sanders ' candidacy .
Three of her five children cling to her legs , and their eyes fixate on the colorful campaign flyers he hands her .
Perez admits being unfamiliar with Sanders but promises to discuss his campaign with her husband .
@ @ @ @ @ @ @ person from any campaign who has knocked on her door .
Flores shakes his head .
He says it 's `` crazy '' that other candidates have n't visited the neighborhood .
But he also sees it as a sign that his work for Sanders can make a difference .
`` I kind of feel that if I get some people to vote that would n't have voted otherwise , '' Flores says , `` you know , I kind of voted in a way . ''

Sanders' Army Of Volunteers Tries To Rally Support In Missouri
Enlarge this image toggle caption Franco Ordoñez/NPR Franco Ordoñez/NPR
Ricardo Flores can't vote on Tuesday. He's not a citizen.
But Flores wants to play a role now. He figures if he can convince a few people, especially members of his own Latino community in Kansas City, Mo., to cast a ballot for his candidate — that's a close second.
"I'm going to become a citizen of this country," he says. "And I'm going to be able to vote and I have my life here now, I want to see things better."
Flores, 31, is a member of the enthusiastic army of political volunteers who have given up their weekends and put jobs on hold to visit new neighborhoods and corner strangers in hopes of persuading them to support Bernie Sanders for president.
Voters from six states are going to the polls Tuesday in what many are calling Big Tuesday. The race for the Democratic primary is now largely a two-man competition.
Politics 6 States Will Vote Tuesday For A Democratic Presidential Nominee 6 States Will Vote Tuesday For A Democratic Presidential Nominee Listen · 3:23 3:23
While the Democratic establishment coalesces around former Vice President Joe Biden, Sanders' army of volunteers is making a big push in what may be his last opportunity to regain a foothold in the race. And Sanders is depending on the strength of his volunteers to make that happen.
Sanders was in St. Louis on Monday rallying support a day before Missourians go to the polls. An Emerson College/Nexstar Media poll shows him trailing Biden by 4 points in the state, where 68 of Tuesday's 352 delegates are at stake.
Tessa Sheehan, 49, is part of a core group of supporters from Kansas City who has volunteered for the Sanders team since 2015. Sheehan recognizes the "old guard" is behind Biden, but she says her crew of volunteers won't be discouraged.
Since February, the team has knocked on more than 45,000 doors, including nearly 10,000 on Saturday, during Biden's swing through the state.
"It's we the people," Sheehan says. "The other campaigns don't have that. You know, they've got the bells and whistles and the media and the money. We have each other. And there's a lot of us. There's a lot more of us than there are with them."
Enthusiasm at the Kansas City headquarters was high on Sunday morning.
Before dispatching to their assigned "turf" across the city and surrounding suburbs, Abril Negrete, 26, led a circle of volunteers in a chant to get them ready for the day.
"We are human beings," Negrete, a labor organizer, calls out as the crowd repeats. "And we deserve full equality. Right here, right now!"
But some volunteers were feeling the pressure ahead of Tuesday's primary as endorsements for Biden continued to pour in. The news on Sunday that Kamala Harris, the California senator and former presidential candidate, was backing Biden had made its way around the office.
"It's just unbelievable that people are rallying behind Biden," says Mahra Seward, 51, a life coach who took the train from Chicago to help knock on doors in Kansas City.
She began to tear up as she talked about the recent endorsements.
"It's heartbreaking — especially progressives," she says. "If you turn on the news, it's hard to get out of bed, but despair is not an option."
Enlarge this image toggle caption Chloee Weiner/NPR Chloee Weiner/NPR
On her second day canvassing, Essence Jewel, a 19-year-old junior at the University of Missouri, Kansas City, is hopeful.
She teamed up with Bill Drummond, 66, a longtime supporter of Sanders who says his punk rock roots draw him to the senator's brand of politics.
At their first door in Manheim Park, a rapidly changing neighborhood in southern Kansas City, Drummond gives Jewel a quick lesson on his knocking strategy.
"You knock three times with escalating volume and enthusiasm," he says. "You want it to telegraph, 'I would like to speak to you very, very, very much, but you don't want it to be the knock of doom, as in, 'Open up or we'll kick the door in.' "
Jewel tells those who answer the door about her mounting student debt and family members without health care. She says she fears she won't be able to afford having children of her own when she's older.
"I feel trapped right now and I feel like [Sanders] is the only person right now that is fighting for a future that is really livable. One day I want to own a house," she tells them. "How can I do that if I already have tens of thousands of dollars in debt?"
Around the same time in North Kansas City, Flores knocks on the doors of a mixed community that includes Latino, African and Vietnamese immigrants.
"Me nombre es Ricardo Flores," he says. "Vengo de hablarles un poquito de Bernie Sanders."
Maria Perez, 30, hugs the door and listens as Flores asks to speak about Sanders' candidacy. Three of her five children cling to her legs, and their eyes fixate on the colorful campaign flyers he hands her.
Perez admits being unfamiliar with Sanders but promises to discuss his campaign with her husband. She tells Flores he's the only person from any campaign who has knocked on her door.
Flores shakes his head. He says it's "crazy" that other candidates haven't visited the neighborhood. But he also sees it as a sign that his work for Sanders can make a difference.
"I kind of feel that if I get some people to vote that wouldn't have voted otherwise," Flores says, "you know, I kind of voted in a way."