latimes--2020-03-20--Drive-through coronavirus testing site to open at stadium in Lake Elsinore

A drive-through facility for coronavirus testing will open at a baseball stadium in Lake Elsinore this weekend .
Testing at the Lake Elsinore Diamond stadium will take place from 9:30 a.m. to 3 p.m. Saturday and Sunday in parking lot C , Riverside County health officials announced in a news release .
Those who want to be tested must have symptoms or a risk of exposure and must make an appointment by calling ( 800 ) 945-6171 .
“ This is going to take extreme measures , and it is our turn to step in and offer our support to @ @ @ @ @ @ @ best serve and protect all of Riverside County , ” Lake Elsinore Mayor Brian Tisdale said in a statement .
Lake Elsinore ’ s city manager declared a public emergency Tuesday .
The testing site is modeled after a drive-through facility for Coachella Valley residents that was set up at Southwest Church in Indian Wells starting Wednesday .
Testing there is available from 9:30 a.m. to 3 p.m. through Saturday , though officials are considering adding more days , said Shane Reichardt , spokesman for the county Emergency Management Department .
“ It @ @ @ @ @ @ @ which has been somewhat good , ” Reichardt said .
“ It has allowed the staff to improve their process .
The first cars that came through took about 15 minutes , and now they ’ ve got it down to about 10 minutes.
” The testing operations are being coordinated by Riverside University Health System Public Health , which is the county ’ s public health department , in cooperation with local healthcare providers Desert Care Network , Desert Oasis Healthcare and Desert Healthcare District .
They are staffed by a mixture @ @ @ @ @ @ @ personnel from the healthcare partners .
Initially , people needed a doctor ’ s referral to get an appointment , but they can now call the 800 number to request one directly , Reichardt said .
Still , potential patients will be asked a series of questions , and only those who fit certain criteria will receive an appointment to be tested , he said .
The sites join a growing list of drive-through testing facilities in California , including in the Bay Area and in Orange County .
To access them , @ @ @ @ @ @ @ contact their doctor , who must make an appointment .
Four people have died from the coronavirus in Riverside County .
Among the dead are two men and one woman from the Coachella Valley who were all older than 70 .
Two had underlying health problems , including the woman , who had spent time at a Rancho Mirage skilled nursing facility before she was hospitalized .
A vendor who performed work at the facility , the Rancho Mirage Health and Rehabilitation Center , also contracted the virus , and test results for @ @ @ @ @ @ @ were continuing to come in , officials said Thursday .
A total of 22 cases of the coronavirus had been reported in Riverside County as of 10 a.m. Friday .
Thirteen of the cases were in the Coachella Valley , four were in western Riverside County and three were in the southwestern portion of the county , officials said .
Four of them are believed to be associated with travel , and 18 are believed to have been locally acquired .

A drive-through facility for coronavirus testing will open at a baseball stadium in Lake Elsinore this weekend.
Testing at the Lake Elsinore Diamond stadium will take place from 9:30 a.m. to 3 p.m. Saturday and Sunday in parking lot C, Riverside County health officials announced in a news release. Those who want to be tested must have symptoms or a risk of exposure and must make an appointment by calling (800) 945-6171.
“This is going to take extreme measures, and it is our turn to step in and offer our support to ensure a coordinated and collaborative approach to best serve and protect all of Riverside County,” Lake Elsinore Mayor Brian Tisdale said in a statement. Lake Elsinore’s city manager declared a public emergency Tuesday.
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The testing site is modeled after a drive-through facility for Coachella Valley residents that was set up at Southwest Church in Indian Wells starting Wednesday. Testing there is available from 9:30 a.m. to 3 p.m. through Saturday, though officials are considering adding more days, said Shane Reichardt, spokesman for the county Emergency Management Department.
“It hasn’t been a rush, which has been somewhat good,” Reichardt said. “It has allowed the staff to improve their process. The first cars that came through took about 15 minutes, and now they’ve got it down to about 10 minutes.”
The testing operations are being coordinated by Riverside University Health System Public Health, which is the county’s public health department, in cooperation with local healthcare providers Desert Care Network, Desert Oasis Healthcare and Desert Healthcare District. They are staffed by a mixture of county public health officials and medical personnel from the healthcare partners.
Initially, people needed a doctor’s referral to get an appointment, but they can now call the 800 number to request one directly, Reichardt said. Still, potential patients will be asked a series of questions, and only those who fit certain criteria will receive an appointment to be tested, he said.
The sites join a growing list of drive-through testing facilities in California, including in the Bay Area and in Orange County. To access them, people must either make an appointment or contact their doctor, who must make an appointment.
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Four people have died from the coronavirus in Riverside County. Among the dead are two men and one woman from the Coachella Valley who were all older than 70. Two had underlying health problems, including the woman, who had spent time at a Rancho Mirage skilled nursing facility before she was hospitalized.
A vendor who performed work at the facility, the Rancho Mirage Health and Rehabilitation Center, also contracted the virus, and test results for 140 employees and vendors and 94 residents were continuing to come in, officials said Thursday.
A total of 22 cases of the coronavirus had been reported in Riverside County as of 10 a.m. Friday. Thirteen of the cases were in the Coachella Valley, four were in western Riverside County and three were in the southwestern portion of the county, officials said. Four of them are believed to be associated with travel, and 18 are believed to have been locally acquired.


latimes--2020-03-20--What if I get sick? Coronavirus adds new anxieties for pregnant women

But there I was — 17 weeks pregnant with my first child — with tears streaming down my face as I stood among a crowd of anxious shoppers in a Long Beach Target .
I had tried to push down that all-too-familiar lump that rises in my throat before the tears began , but a mix of hormones and coronavirus-induced anxiety proved too much .
My colleagues at The Times have written extensively about the apprehension surrounding the outbreak , including people flocking to stores to stockpile food and other essentials .
So when my husband and I walked into @ @ @ @ @ @ @ certain aisles would be empty .
I didn ’ t anticipate nearly all the infant Tylenol would be gone .
In a complete panic , but still months away from my due date , I picked up one of the last boxes on the shelf in an attempt to find some sense of control .
My husband looked at me with confusion as I unleashed a string of irrational fears .
He countered , kindly , that perhaps the medicine should be saved for a family with a sick baby at home .
@ @ @ @ @ @ @ I pictured a panicked new mother searching for medication for her child and finding none among the sea of empty shelves .
I put the box back .
That ’ s when the tears started .
Pregnancy in the time of coronavirus seems especially cruel .
Pregnancy , though joyous , is filled with so much unspoken anxiety in the best of times .
Am I eating the right food ?
Am I drinking too much caffeine ?
Will my baby be healthy ?
Will I be a good mother ?
Coronavirus adds @ @ @ @ @ @ @ happens if I get sick ?
Dr. Neil Silverman , a clinical professor of obstetrics and gynecology at the David Geffen School of Medicine at UCLA , has heard similar questions at his practice from many worried mothers-to-be .
“ It ’ s all about the fact that there ’ s so many things in the setting of a pregnancy that women have no control over , ” Silverman said during a recent phone interview .
“ Women , especially in their first pregnancy , are understandably concerned in general about all the @ @ @ @ @ @ @ plan.
” There is little data available on how the coronavirus , which causes a respiratory illness known as COVID-19 , affects pregnant women .
Women experience physiological changes during pregnancy that can weaken their immune systems and place them at higher risk for severe complications if exposed to viruses , especially if they have underlying heath conditions .
Past studies have shown that pregnant women who contract influenza are at higher risk for severe complications , and in 2009 , women who contracted H1N1 — the swine flu — during pregnancy also @ @ @ @ @ @ @ to Dr. Denise Jamieson , chair of the department of gynecology and obstetrics at the Emory University School of Medicine in Georgia .
Still , doctors said that researchers have not seen early signals suggesting an increased risk of complications or birth defects associated with pregnant women and fetuses exposed to the coronavirus .
“ Pregnant women can become severely ill , but I think pregnant women should be reassured as there doesn ’ t seem to be related birth defects like we saw with Zika , ” Jamieson said during a phone @ @ @ @ @ @ @ scary times , and I think a lot of people , including pregnant women , are afraid .
Luckily this is not a virus that seems to disproportionately affect pregnant women .
They can take solace in that.
” In a recent study published in the Lancet , researchers followed nine pregnant women who had tested positive for the novel coronavirus in Wuhan , China — the epicenter of the outbreak — during their third trimester .
Researchers found that none of the infants , all delivered via caesarean , had the virus @ @ @ @ @ @ @ evidence of the virus in the mothers ’ breast milk , cord blood or amniotic fluid , according to the study .
The new mothers had experienced the same symptoms as nonpregnant women , the study showed , with fever in seven , cough in four , myalgia in three and sore throat and malaise in two .
They developed pneumonia , but none of the cases were considered severe .
Researchers suggest these data indicate that mothers diagnosed with COVID-19 do not pass along the virus to their unborn babies through the @ @ @ @ @ @ @ for mothers to pass the virus to infants after birth from respiratory droplets or particles that leave the mouth or nose when a sick person coughs , sneezes or talks .
While the virus has not been detected in breast milk , the Centers for Disease Control and Prevention said it ’ s still not clear whether the virus can be transmitted to infants during feedings .
The CDC recommends infected mothers wash their hands before touching their babies and wearing a face mask , if possible , while breastfeeding .
Another option @ @ @ @ @ @ @ breast milk to the infant .
Health officials are urging pregnant women , along with the elderly and others with weakened immune systems , to do their best to avoid exposure to the coronavirus .
Doctors suggest staying home as much as possible , avoiding crowds — including long lines at supermarkets and other stores — and staying away from emergency rooms .
And , of course , frequent hand washing .
Dr. Karin Nielsen-Saines , professor of clinical pediatrics in the Division of Infectious Diseases at UCLA Children ’ s Hospital , @ @ @ @ @ @ @ to see if routine labs or physical assessments can be done without a visit to clinics or hospitals to limit their risk of exposure .
Some doctors , including mine , have already instituted this practice .
The Kaiser Permanente in Gardena was nearly empty when I arrived Wednesday afternoon for a monthly exam and ultrasound .
Medical staff wearing paper gowns , masks and gloves screened patients for symptoms of the virus before they walked in the front door .
I was one of a few people that day who had to @ @ @ @ @ @ @ to have blood drawn .
“ Get in and out quickly , ” a nurse told me as she placed a sticker allowing my entry into the building on my blouse .
Another woman who was having an ultrasound was video-chatting with her husband , who was stuck in the lobby , during the exam .
The medical center has stopped allowing visitors in exam rooms in an effort to help protect patients and staff members from the spread of the illness .
A similar visitor policy also extends to hospitals when women @ @ @ @ @ @ @ one visitor , typically a spouse or partner , for the duration of a woman ’ s hospital stay .
But family and friends are being asked to wait until the new parents are at home to meet their bundle of joy .
Hoag Hospital in Orange County has also instituted the one-visitor policy .
Despite the new restrictions and disappointments — especially for women whose baby shower plans and “ babymoon ” trips have been thwarted by the virus — Nielsen-Saines emphasized the importance of keeping to a routine , even during @ @ @ @ @ @ @ talk with friends , try to keep a sense of normalcy , ” she told me .
“ This feeling of impending doom doesn ’ t help anyone .
It ’ s important to keep it all in perspective.
” At least we can all try .

I hate crying in public.
But there I was — 17 weeks pregnant with my first child — with tears streaming down my face as I stood among a crowd of anxious shoppers in a Long Beach Target. I had tried to push down that all-too-familiar lump that rises in my throat before the tears began, but a mix of hormones and coronavirus-induced anxiety proved too much.
My colleagues at The Times have written extensively about the apprehension surrounding the outbreak, including people flocking to stores to stockpile food and other essentials. So when my husband and I walked into the store that day, we expected certain aisles would be empty. I didn’t anticipate nearly all the infant Tylenol would be gone.
In a complete panic, but still months away from my due date, I picked up one of the last boxes on the shelf in an attempt to find some sense of control.
Advertisement
My husband looked at me with confusion as I unleashed a string of irrational fears. He countered, kindly, that perhaps the medicine should be saved for a family with a sick baby at home. Of course, he was right. I pictured a panicked new mother searching for medication for her child and finding none among the sea of empty shelves. I put the box back.
That’s when the tears started. Pregnancy in the time of coronavirus seems especially cruel.
Pregnancy, though joyous, is filled with so much unspoken anxiety in the best of times. Am I eating the right food? Am I drinking too much caffeine? Will my baby be healthy? Will I be a good mother?
Coronavirus adds another question into the mix: What happens if I get sick?
Dr. Neil Silverman, a clinical professor of obstetrics and gynecology at the David Geffen School of Medicine at UCLA, has heard similar questions at his practice from many worried mothers-to-be.
“It’s all about the fact that there’s so many things in the setting of a pregnancy that women have no control over,” Silverman said during a recent phone interview. “Women, especially in their first pregnancy, are understandably concerned in general about all the things that cannot go according to plan.”
Advertisement
There is little data available on how the coronavirus, which causes a respiratory illness known as COVID-19, affects pregnant women. Women experience physiological changes during pregnancy that can weaken their immune systems and place them at higher risk for severe complications if exposed to viruses, especially if they have underlying heath conditions.
Past studies have shown that pregnant women who contract influenza are at higher risk for severe complications, and in 2009, women who contracted H1N1 — the swine flu — during pregnancy also became sicker than non-pregnant women, according to Dr. Denise Jamieson, chair of the department of gynecology and obstetrics at the Emory University School of Medicine in Georgia.
Still, doctors said that researchers have not seen early signals suggesting an increased risk of complications or birth defects associated with pregnant women and fetuses exposed to the coronavirus.
“Pregnant women can become severely ill, but I think pregnant women should be reassured as there doesn’t seem to be related birth defects like we saw with Zika,” Jamieson said during a phone call last week. “These are scary times, and I think a lot of people, including pregnant women, are afraid. Luckily this is not a virus that seems to disproportionately affect pregnant women. They can take solace in that.”
In a recent study published in the Lancet, researchers followed nine pregnant women who had tested positive for the novel coronavirus in Wuhan, China — the epicenter of the outbreak — during their third trimester. Researchers found that none of the infants, all delivered via caesarean, had the virus at birth. There also was no evidence of the virus in the mothers’ breast milk, cord blood or amniotic fluid, according to the study.
The new mothers had experienced the same symptoms as nonpregnant women, the study showed, with fever in seven, cough in four, myalgia in three and sore throat and malaise in two. They developed pneumonia, but none of the cases were considered severe.
Researchers suggest these data indicate that mothers diagnosed with COVID-19 do not pass along the virus to their unborn babies through the placenta. However, it is possible for mothers to pass the virus to infants after birth from respiratory droplets or particles that leave the mouth or nose when a sick person coughs, sneezes or talks.
While the virus has not been detected in breast milk, the Centers for Disease Control and Prevention said it’s still not clear whether the virus can be transmitted to infants during feedings. The CDC recommends infected mothers wash their hands before touching their babies and wearing a face mask, if possible, while breastfeeding. Another option is having a healthy person feed expressed breast milk to the infant.
Health officials are urging pregnant women, along with the elderly and others with weakened immune systems, to do their best to avoid exposure to the coronavirus. Doctors suggest staying home as much as possible, avoiding crowds — including long lines at supermarkets and other stores — and staying away from emergency rooms. And, of course, frequent hand washing.
Dr. Karin Nielsen-Saines, professor of clinical pediatrics in the Division of Infectious Diseases at UCLA Children’s Hospital, suggests women reach out to their doctors to see if routine labs or physical assessments can be done without a visit to clinics or hospitals to limit their risk of exposure.
Some doctors, including mine, have already instituted this practice. The Kaiser Permanente in Gardena was nearly empty when I arrived Wednesday afternoon for a monthly exam and ultrasound. Medical staff wearing paper gowns, masks and gloves screened patients for symptoms of the virus before they walked in the front door.
I was one of a few people that day who had to physically visit the office because I had to have blood drawn.
“Get in and out quickly,” a nurse told me as she placed a sticker allowing my entry into the building on my blouse.
Another woman who was having an ultrasound was video-chatting with her husband, who was stuck in the lobby, during the exam. The medical center has stopped allowing visitors in exam rooms in an effort to help protect patients and staff members from the spread of the illness.
A similar visitor policy also extends to hospitals when women are giving birth. Kaiser will allow one visitor, typically a spouse or partner, for the duration of a woman’s hospital stay. But family and friends are being asked to wait until the new parents are at home to meet their bundle of joy. Hoag Hospital in Orange County has also instituted the one-visitor policy.
Despite the new restrictions and disappointments — especially for women whose baby shower plans and “babymoon” trips have been thwarted by the virus — Nielsen-Saines emphasized the importance of keeping to a routine, even during times of uncertainty.
“Exercise, talk with friends, try to keep a sense of normalcy,” she told me. “This feeling of impending doom doesn’t help anyone. It’s important to keep it all in perspective.”
At least we can all try.


latimes--2020-03-20--The surreal scenes of 40 million Californians staying at home

Gov .
Gavin Newsom has ordered Californians to stay at home , the first mandatory restrictions placed on all 40 @ @ @ @ @ s residents in the fight against the novel coronavirus .
With businesses and popular destinations @ @ @ @ @ Los Angeles Times visual journalist Luis Sinco documented the surreal scenes .

Gov. Gavin Newsom has ordered Californians to stay at home, the first mandatory restrictions placed on all 40 million of the state’s residents in the fight against the novel coronavirus.
With businesses and popular destinations throughout the Southland closed, Los Angeles Times visual journalist Luis Sinco documented the surreal scenes.
Take a look.
A handful of visitors walk on a largely deserted Santa Monica Beach. (Luis Sinco / Los Angeles Times)
Visitors pose for pictures at the Urban Light sculpture at the Los Angeles County of Museum of Art in Mid-Wilshire. (Luis Sinco / Los Angeles Times)
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The lights are on but the Santa Monica Pier is closed to the public. (Luis Sinco / Los Angeles Times)
Shuttered shops line Windward Avenue in Venice. (Luis Sinco / Los Angeles Times)
The streets of Santa Monica are largely empty. (Luis Sinco / Los Angeles Times)
A lone vendor sits along the empty boardwalk at Venice Beach. (Luis Sinco / Los Angeles Times)
A lone commuter waits on the platform of the Metro Hollywood/Highland Station in Hollywood. (Luis Sinco / Los Angeles Times)
Walt Disney Concert Hall in downtown L.A. is also shut down. (Luis Sinco / Los Angeles Times)
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The famed Sunset Strip in West Hollywood is largely devoid of motor and pedestrian traffic. (Luis Sinco / Los Angeles Times)


latimes--2020-03-20--Here are the L.A. County communities with coronavirus cases

Health officials Thursday reported the county ’ s second death , with the total number of confirmed cases rising by @ @ @ @ @ A 34-year-old man who tested positive for the coronavirus after visiting the Walt Disney World @ @ @ @ @ through Los Angeles International Airport this month died Thursday at a hospital in Pasadena , @ @ @ @ @ sources .
County and city officials also announced steep restrictions on movements designed to slow @ @ @ @ @ must slow the number of new cases we have — we must , ” said @ @ @ @ @ the L.A. County Department of Public Health .
“ Without slowing the number of new @ @ @ @ @ sure overwhelm not only our healthcare system but many other essential services as workers who @ @ @ @ @ fall ill. ” Here are the latest numbers of coronavirus cases in L.A. County communities @

At Chi Spacca, Nancy Silverton and her staff distributed 300 free meals and other supplies to those in the restaurant industry who have been effected by closures due to the coronavirus outbreak.
Health officials Thursday reported the county’s second death, with the total number of confirmed cases rising by 40 overnight to 230.
A 34-year-old man who tested positive for the coronavirus after visiting the Walt Disney World Resort in Florida and traveling through Los Angeles International Airport this month died Thursday at a hospital in Pasadena, according to medical and government sources.
County and city officials also announced steep restrictions on movements designed to slow the virus.
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“We must slow the number of new cases we have — we must,” said Barbara Ferrer, director of the L.A. County Department of Public Health. “Without slowing the number of new cases, we will for sure overwhelm not only our healthcare system but many other essential services as workers who are doing those essential services fall ill.”
Here are the latest numbers of coronavirus cases in L.A. County communities:


latimes--2020-03-20--Doctors and nurses brace for coronavirus onslaught: 'What happens if I end up on a ventilator?'

As hospitals prepare for a possibly overwhelming number of COVID-19 patients in the coming weeks , doctors and nurses in all departments are being told they may have to start working in emergency rooms and intensive care units , a directive that has sent shock waves through the medical community .
Health workers say they are concerned about their ability to perform duties they haven ’ t done in decades , or perhaps ever , as well as for their own health and safety .
“ Anxiety is an understatement .
I ’ d be terrified , ” said a @ @ @ @ @ @ @ in San Francisco .
There , a looming staff shortage caused by COVID-19 could mean a labor pool to redistribute nurses to the intensive care unit , she said .
“ No reasonable person would ever expect me to do that under normal circumstances , ” said the nurse , who , like others interviewed for this article , spoke on condition of anonymity because she was not authorized to speak to the media .
But the expected surge of COVID-19 cases has forced hospital leaders to consider calling in reinforcements from all @ @ @ @ @ @ @ their staffs to not talk to journalists about the desperate preparations underway .
Doctors , nurses and other hospital workers say their anxiety levels are rising as they hear not just about medical workers in Italy and China falling sick , but now an increasing number of U.S. health workers as well .
This week , two emergency room physicians , one in Washington state and one in New Jersey , were infected with the coronavirus and admitted to hospitals in critical condition .
Several health workers in Seattle , now an epicenter @ @ @ @ @ @ @ with the disease as well .
A UC San Francisco emergency medicine doctor reported this week that he had COVID-19 and that he may have infected others while at a recent medical conference .
For medical workers during this pandemic , a grim reality is emerging : Those who don ’ t contract COVID-19 could be redistributed to care for patients who do , thereby making them more likely to become infected .
“ We ’ re going to start dropping like flies , ” said a nurse in an urgent care clinic @ @ @ @ @ @ @ seen several patients with COVID-19 symptoms .
“ I ’ m a single mom ; I ’ m supporting my son through college .
I don ’ t have a choice — I ’ m going to work.
” As cases begin to mount within the United States , American health workers say they are haunted by stories from other countries where COVID-19 cases have already exploded .
In China , an estimated 3,000 healthcare workers have become infected with the virus , and at least 22 have died .
In Italy , @ @ @ @ @ @ @ , an estimated 20 % of healthcare professionals working on the front lines of the outbreak have become infected with COVID-19 , according to one study .
“ Everyone knows we ’ re going to be at the level of China and Italy within a week or two , ” said a doctor at a major L.A. hospital .
“ There ’ s a huge sense of anxiety amongst medical professionals because we see how poorly prepared the U.S. is.
” One of the emergency room physicians hospitalized in the U.S. is in @ @ @ @ @ @ @ to be at lower risk of serious infection .
In uneasy conversations , many providers bring up Dr. Li Wenliang , the 34-year-old Chinese physician who rang the alarm bells about the new virus and then succumbed to it .
“ What I ’ m hearing about colleagues — physicians who are younger than me who are dying of this — it ’ s scary , ” said Dr. Nick Mark , a critical care physician in Seattle who has been treating COVID-19 patients .
Mark said he and his wife , who @ @ @ @ @ @ @ worst-case scenarios , he said .
“ What happens if I end up on a ventilator ?
What are we going to do ?
” he said .
“ We have friends who are doctors — we ’ ve basically said , ‘ If you guys get sick , we ’ ll take care of the kids , and you do the same for us.
’ ” Mark posted to Twitter a guide to managing severely ill COVID-19 patients that has been widely circulated among physicians .
He created it for doctors in @ @ @ @ @ @ @ be asked to help , as has happened in other countries .
He noted that Li , who worked on the front lines in Wuhan , China , was an ophthalmologist .
In Seattle , hospital staff members are already straining under the number of patients they have now , he said .
“ That makes me nervous , because this is a marathon , not a sprint , ” he said .
“ The peak of it is likely weeks away , if not months away.
” At other hospitals , specialists @ @ @ @ @ @ @ be willing to lead intensive care units , departments they haven ’ t worked on in decades .
“ The residents could help guide you , ” one hospital ’ s email to a group of surgeons read last week .
Dr. Wally Ghurabi , ER medical director at UCLA Medical Center in Santa Monica , said the hospital team preparing for a surge in COVID-19 patients meets more than once a day to discuss staffing needs .
If needed , nurses who don ’ t typically treat patients , such as those @ @ @ @ @ @ @ could be asked to help out , he said .
“ I ’ ve been through so many disasters , ” he said , citing the Northridge earthquake and the market crash .
“ What we ’ re doing now is way , way more than those days , as far as preparation , working hard to make sure we ’ re ready.
” The idea that doctors of all specialties will be called to help has even become a joke , albeit a dark one , in medical circles .
“ Stay @ @ @ @ @ @ @ to be intubated by a gynecologist , ” reads a meme shared by providers on Twitter .
“ Stay home if you don ’ t want an orthopaedic surgeon treating your pneumonia , ” reads another .
Dr. Folasade May , a gastroenterologist at UCLA , said she is reviewing notes and manuals from colleagues on how to run ventilators and take care of patients in the ICU , just in case it comes to that .
“ Those are little pearls that we ’ re putting in our pockets , ” May @ @ @ @ @ @ @ a toll on the local health system .
In California , at least 300 nurses and other health workers at hospitals in Riverside , Santa Rosa and L.A. have been sent home because of coming into contact with COVID-19 patients .
Such furloughs , however , reduce how many people a hospital can treat , a major problem during a pandemic .
So the Centers for Disease Control and Prevention recently changed its guidelines so that some health workers who have treated COVID-19 patients can continue working until they begin showing symptoms of @ @ @ @ @ @ @ .
It ’ s that simple , ” said one emergency room nurse in the Bay Area .
The nurse said he worked the weekend alongside a doctor who subsequently tested positive for COVID-19 .
Per hospital policy , the nurse will return to work to care for patients , and will not quarantine at home unless he develops symptoms , despite the fact that the virus can be transmitted before symptoms appear .
The nurse is diligently washing his hands and wearing protective gear , but he interacts with vulnerable patients — @ @ @ @ @ @ @ with a rib fracture .
The elderly man didn ’ t have any signs of COVID-19 — yet .
“ This is not in the back of my mind , it ’ s in the front — it ’ s right in the passenger ’ s seat.
” One physician at a major L.A. hospital said she has started to strip naked when she gets home , throw her clothes in the laundry and jump in the shower , to avoid contaminating her home or infecting her partner .
Another said his wife @ @ @ @ @ @ @ garage .
Some staffers ’ parents have called their kids ’ bosses to ask about safety precautions .
“ I ’ ve talked a few moms off the ledge , ” said Dr. James Keany , an ER physician at Providence Mission Hospital in Mission Viejo .
Workers ’ fears are exacerbated by a shortage of protective gear , they say .
A nurse in an emergency room said her colleagues had begun filing requests to the federal Occupational Safety and Health Administration after hospital administrators called their safety concerns “ hysteric.
” @ @ @ @ @ @ @ currently out of N-95 masks , and it is a ‘ tough luck ’ kind of situation , ” she said .
Meanwhile , “ the hospital administrators are working from home.
” Still , for many healthcare providers , the trepidation surrounding the pandemic seems mixed with a call to duty .
Some physicians have volunteered to work the front lines , seeing their youth as an advantage .
“ We ’ re using a lot of war metaphors , ” said an internal medicine doctor at a major L.A. hospital .
@ @ @ @ @ @ @ this is going to be the defining moment in medical history for our generation .
”

Tents have been erected at the Saperstein Emergency Center entrance to the Ronald Reagan UCLA Medical Center on the Westwood campus as hospitals anticipate a big wave of coronavirus patients.
As hospitals prepare for a possibly overwhelming number of COVID-19 patients in the coming weeks, doctors and nurses in all departments are being told they may have to start working in emergency rooms and intensive care units, a directive that has sent shock waves through the medical community.
Health workers say they are concerned about their ability to perform duties they haven’t done in decades, or perhaps ever, as well as for their own health and safety.
“Anxiety is an understatement. I’d be terrified,” said a surgical nurse at California Pacific Medical Center in San Francisco. There, a looming staff shortage caused by COVID-19 could mean a labor pool to redistribute nurses to the intensive care unit, she said.
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“No reasonable person would ever expect me to do that under normal circumstances,” said the nurse, who, like others interviewed for this article, spoke on condition of anonymity because she was not authorized to speak to the media.
But the expected surge of COVID-19 cases has forced hospital leaders to consider calling in reinforcements from all departments, ration protective gear and advise their staffs to not talk to journalists about the desperate preparations underway.
Doctors, nurses and other hospital workers say their anxiety levels are rising as they hear not just about medical workers in Italy and China falling sick, but now an increasing number of U.S. health workers as well.
This week, two emergency room physicians, one in Washington state and one in New Jersey, were infected with the coronavirus and admitted to hospitals in critical condition. Several health workers in Seattle, now an epicenter for the virus, have fallen ill with the disease as well. A UC San Francisco emergency medicine doctor reported this week that he had COVID-19 and that he may have infected others while at a recent medical conference.
For medical workers during this pandemic, a grim reality is emerging: Those who don’t contract COVID-19 could be redistributed to care for patients who do, thereby making them more likely to become infected.
“We’re going to start dropping like flies,” said a nurse in an urgent care clinic in Los Angeles County, who has seen several patients with COVID-19 symptoms. “I’m a single mom; I’m supporting my son through college. I don’t have a choice — I’m going to work.”
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As cases begin to mount within the United States, American health workers say they are haunted by stories from other countries where COVID-19 cases have already exploded.
In China, an estimated 3,000 healthcare workers have become infected with the virus, and at least 22 have died. In Italy, currently a hot spot for the virus, an estimated 20% of healthcare professionals working on the front lines of the outbreak have become infected with COVID-19, according to one study.
“Everyone knows we’re going to be at the level of China and Italy within a week or two,” said a doctor at a major L.A. hospital. “There’s a huge sense of anxiety amongst medical professionals because we see how poorly prepared the U.S. is.”
One of the emergency room physicians hospitalized in the U.S. is in his 40s, an age group thought to be at lower risk of serious infection. In uneasy conversations, many providers bring up Dr. Li Wenliang, the 34-year-old Chinese physician who rang the alarm bells about the new virus and then succumbed to it.
“What I’m hearing about colleagues — physicians who are younger than me who are dying of this — it’s scary,” said Dr. Nick Mark, a critical care physician in Seattle who has been treating COVID-19 patients.
Mark said he and his wife, who is also a doctor, have discussed worst-case scenarios, he said.
“What happens if I end up on a ventilator? What are we going to do?” he said. “We have friends who are doctors — we’ve basically said, ‘If you guys get sick, we’ll take care of the kids, and you do the same for us.’”
Mark posted to Twitter a guide to managing severely ill COVID-19 patients that has been widely circulated among physicians. He created it for doctors in other specialties who he anticipates will eventually be asked to help, as has happened in other countries.
He noted that Li, who worked on the front lines in Wuhan, China, was an ophthalmologist. In Seattle, hospital staff members are already straining under the number of patients they have now, he said.
“That makes me nervous, because this is a marathon, not a sprint,” he said. “The peak of it is likely weeks away, if not months away.”
At other hospitals, specialists have received surveys about whether they would be willing to lead intensive care units, departments they haven’t worked on in decades. “The residents could help guide you,” one hospital’s email to a group of surgeons read last week.
Dr. Wally Ghurabi, ER medical director at UCLA Medical Center in Santa Monica, said the hospital team preparing for a surge in COVID-19 patients meets more than once a day to discuss staffing needs. If needed, nurses who don’t typically treat patients, such as those who teach or work in administration, could be asked to help out, he said.
“I’ve been through so many disasters,” he said, citing the Northridge earthquake and the market crash. “What we’re doing now is way, way more than those days, as far as preparation, working hard to make sure we’re ready.”
The idea that doctors of all specialties will be called to help has even become a joke, albeit a dark one, in medical circles.
“Stay home if you don’t want to be intubated by a gynecologist,” reads a meme shared by providers on Twitter. “Stay home if you don’t want an orthopaedic surgeon treating your pneumonia,” reads another.
Dr. Folasade May, a gastroenterologist at UCLA, said she is reviewing notes and manuals from colleagues on how to run ventilators and take care of patients in the ICU, just in case it comes to that. “Those are little pearls that we’re putting in our pockets,” May said.
The virus has already taken a toll on the local health system. In California, at least 300 nurses and other health workers at hospitals in Riverside, Santa Rosa and L.A. have been sent home because of coming into contact with COVID-19 patients.
Such furloughs, however, reduce how many people a hospital can treat, a major problem during a pandemic. So the Centers for Disease Control and Prevention recently changed its guidelines so that some health workers who have treated COVID-19 patients can continue working until they begin showing symptoms of the disease.
“We need bodies. It’s that simple,” said one emergency room nurse in the Bay Area.
The nurse said he worked the weekend alongside a doctor who subsequently tested positive for COVID-19. Per hospital policy, the nurse will return to work to care for patients, and will not quarantine at home unless he develops symptoms, despite the fact that the virus can be transmitted before symptoms appear.
The nurse is diligently washing his hands and wearing protective gear, but he interacts with vulnerable patients — like a 90-year-old man who came in with a rib fracture. The elderly man didn’t have any signs of COVID-19 — yet. “This is not in the back of my mind, it’s in the front — it’s right in the passenger’s seat.”
One physician at a major L.A. hospital said she has started to strip naked when she gets home, throw her clothes in the laundry and jump in the shower, to avoid contaminating her home or infecting her partner. Another said his wife makes him leave his scrubs in the garage. Some staffers’ parents have called their kids’ bosses to ask about safety precautions.
“I’ve talked a few moms off the ledge,” said Dr. James Keany, an ER physician at Providence Mission Hospital in Mission Viejo.
Workers’ fears are exacerbated by a shortage of protective gear, they say. A nurse in an emergency room said her colleagues had begun filing requests to the federal Occupational Safety and Health Administration after hospital administrators called their safety concerns “hysteric.”
“The hospital I work for is currently out of N-95 masks, and it is a ‘tough luck’ kind of situation,” she said. Meanwhile, “the hospital administrators are working from home.”
Still, for many healthcare providers, the trepidation surrounding the pandemic seems mixed with a call to duty. Some physicians have volunteered to work the front lines, seeing their youth as an advantage.
“We’re using a lot of war metaphors,” said an internal medicine doctor at a major L.A. hospital. “A lot of us are realizing this is going to be the defining moment in medical history for our generation.”


latimes--2020-03-19--Is SAT test going down at UC? Several regents express deep skepticism over use in admissions

Several University of California regents expressed deep skepticism Thursday about the use of SAT and ACT tests in admissions decisions , signaling the standardized exams may be headed for elimination as an application requirement .
Regents , meeting remotely because of the coronavirus outbreak , honed in on the test ’ s impact on underserved students .
Opponents of the tests argue that it discriminates on the basis of race , income and parent education levels .
In their first substantive discussion of the testing issue since UC President Janet Napolitano asked faculty leaders to review it in 2018 , @ @ @ @ @ @ @ and role of the exams in the university system .
“ A system designed to oppress does the thing that it is designed to do , ” Regent Laphonza Butler said .
“ And if we are thinking about how we move forward , the freedom associated with the unburdening of California families ... is incredibly important.
” Regents will not vote on whether to keep or drop the tests until at least May .
But powerful forces on both sides , including testing industry officials and civil rights activists , are scrambling @ @ @ @ @ @ @ stakes were not lost on the regents , whose actions will play an outsized role in the future of standardized testing in America because of the public research university system ’ s size , stature and influence .
“ Among all the many issues that come before the board , I would rank this at the very top , ” Napolitano told regents Thursday .
The UC system , by adopting a SAT testing requirement for admissions a half-century ago , propelled what had been an assessment mainly used by smaller East Coast @ @ @ @ @ @ @ .
Four-fifths of UC ’ s 172,000 freshmen applicants submit SAT scores , making the university system the largest customer of the College Board , which owns the test .
“ In many ways , the University of California is the history maker in this area , ” said Regent Eloy Ortiz Oakley .
College Board and ACT Inc. officials argue that their tests offer a uniform yardstick to assess students from different schools and states and , along with high school grades , help predict college success .
They also assert that @ @ @ @ @ @ @ only reflect the effects of inequitable educational systems .
Such arguments , however , seem unlikely to move many regents .
Several expressed concern about not only the inequitable outcomes of the tests but also about the stress they cause students and parents .
Two decades ago , then-UC President Richard Atkinson considered eliminating the SAT testing requirement in part because of the “ devastating impact on the self-esteem and aspirations of young people , ” said Provost Michael Brown , who has voiced support for dropping the tests .
Regent Richard Leib @ @ @ @ @ @ @ prep and asked UC officials to provide research about it at the May meeting .
He said his own children hit higher scores on their second attempts after undertaking test prep and practice tests .
“ It makes it very difficult for me to support using this tool when there ’ s such a disparity there , ” Leib said .
Some regents , however , noted that UC campuses consider test scores as just one of 14 factors in a comprehensive review process and don ’ t use them at face value @ @ @ @ @ @ @ a student ’ s school and family background .
The most competitive UC campuses — UCLA , Berkeley , San Diego , Irvine and Davis — do not assign a fixed weight to test scores .
They are weighted at 43 % at UC Santa Barbara , 41 % at UC Riverside and 20 % at UC Merced in an applicant ’ s academic index , which also includes high school grades and comprises just part of the overall evaluation .
A UC Academic Senate task force found in a preliminary review of @ @ @ @ @ @ @ bias by admitting underserved students with lower scores compared to more advantaged peers .
Several regents asked that admissions officers appear at the May meeting to explain the comprehensive review process , including the role of test scores .
UC officials said test scores also help campuses compare nonresident students to Californians and calculate how many admission offers to extend based on estimates of how many will accept them .
“ We don ’ t want to take away tools they need to make important decisions , ” said Regent Charlene Zettel .
@ @ @ @ @ @ @ that UC has sought to use various measures to compensate for testing bias for decades .
“ One asks how many mitigating tools are needed to compensate for something that creates inequitable outcomes.
” he said .
Pérez also asserted the board ’ s authority over the decision .
Under UC ’ s system of “ shared governance , ” the Academic Senate is responsible for setting admissions policies and some faculty members have expressed concern about a “ constitutional crisis ” if the regents overturn their ultimate recommendation on standardized testing .
@ @ @ @ @ @ @ task force has recommended that UC keep the tests while faculty continue research into making them optional — which more than 1,000 other colleges and universities have done — or develop its own assessment .
But Pérez made clear the regents would not necessarily follow the faculty view .
“ We take input and we ask everybody to engage , but it ’ s ultimately the board ’ s responsibility , ” he said .
At the showdown in May , regents have asked to hear from both critics and supporters of the @ @ @ @ @ @ @ They also have asked for a rundown of the myriad potential impacts of dropping the testing requirement .

The University of California is considering whether to drop the SAT and ACT tests as an admission requirement.
Several University of California regents expressed deep skepticism Thursday about the use of SAT and ACT tests in admissions decisions, signaling the standardized exams may be headed for elimination as an application requirement.
Regents, meeting remotely because of the coronavirus outbreak, honed in on the test’s impact on underserved students. Opponents of the tests argue that it discriminates on the basis of race, income and parent education levels.
In their first substantive discussion of the testing issue since UC President Janet Napolitano asked faculty leaders to review it in 2018, regents also sought to understand the history and role of the exams in the university system.
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“A system designed to oppress does the thing that it is designed to do,” Regent Laphonza Butler said. “And if we are thinking about how we move forward, the freedom associated with the unburdening of California families...is incredibly important.”
Regents will not vote on whether to keep or drop the tests until at least May. But powerful forces on both sides, including testing industry officials and civil rights activists, are scrambling to influence the decision. The enormous stakes were not lost on the regents, whose actions will play an outsized role in the future of standardized testing in America because of the public research university system’s size, stature and influence.
“Among all the many issues that come before the board, I would rank this at the very top,” Napolitano told regents Thursday.
The UC system, by adopting a SAT testing requirement for admissions a half-century ago, propelled what had been an assessment mainly used by smaller East Coast campuses into a place of national prominence. Four-fifths of UC’s 172,000 freshmen applicants submit SAT scores, making the university system the largest customer of the College Board, which owns the test.
“In many ways, the University of California is the history maker in this area,” said Regent Eloy Ortiz Oakley.
College Board and ACT Inc. officials argue that their tests offer a uniform yardstick to assess students from different schools and states and, along with high school grades, help predict college success. They also assert that their tests don’t discriminate but only reflect the effects of inequitable educational systems.
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Such arguments, however, seem unlikely to move many regents. Several expressed concern about not only the inequitable outcomes of the tests but also about the stress they cause students and parents.
Two decades ago, then-UC President Richard Atkinson considered eliminating the SAT testing requirement in part because of the “devastating impact on the self-esteem and aspirations of young people,” said Provost Michael Brown, who has voiced support for dropping the tests.
Regent Richard Leib expressed concern about unequal access to test prep and asked UC officials to provide research about it at the May meeting. He said his own children hit higher scores on their second attempts after undertaking test prep and practice tests.
“It makes it very difficult for me to support using this tool when there’s such a disparity there,” Leib said.
Some regents, however, noted that UC campuses consider test scores as just one of 14 factors in a comprehensive review process and don’t use them at face value but place them in the context of a student’s school and family background.
The most competitive UC campuses — UCLA, Berkeley, San Diego, Irvine and Davis — do not assign a fixed weight to test scores. They are weighted at 43% at UC Santa Barbara, 41% at UC Riverside and 20% at UC Merced in an applicant’s academic index, which also includes high school grades and comprises just part of the overall evaluation.
A UC Academic Senate task force found in a preliminary review of the issue that campuses compensate for testing bias by admitting underserved students with lower scores compared to more advantaged peers.
Several regents asked that admissions officers appear at the May meeting to explain the comprehensive review process, including the role of test scores. UC officials said test scores also help campuses compare nonresident students to Californians and calculate how many admission offers to extend based on estimates of how many will accept them.
“We don’t want to take away tools they need to make important decisions,” said Regent Charlene Zettel.
But board Chair John A. Pérez noted that UC has sought to use various measures to compensate for testing bias for decades. “One asks how many mitigating tools are needed to compensate for something that creates inequitable outcomes.” he said.
Pérez also asserted the board’s authority over the decision. Under UC’s system of “shared governance,” the Academic Senate is responsible for setting admissions policies and some faculty members have expressed concern about a “constitutional crisis” if the regents overturn their ultimate recommendation on standardized testing.
In its preliminary report, the Senate task force has recommended that UC keep the tests while faculty continue research into making them optional — which more than 1,000 other colleges and universities have done — or develop its own assessment.
But Pérez made clear the regents would not necessarily follow the faculty view. “We take input and we ask everybody to engage, but it’s ultimately the board’s responsibility,” he said.
At the showdown in May, regents have asked to hear from both critics and supporters of the tests, along with admissions officers. They also have asked for a rundown of the myriad potential impacts of dropping the testing requirement.


latimes--2020-03-20--Officials long warned funding cuts would leave California vulnerable to pandemic. No one listened

California public health officials have repeatedly warned over the last decade that federal budget cuts were weakening their ability to respond to a widespread health crisis like the current coronavirus pandemic .
Despite the warnings , elected leaders cut millions of dollars in federal grants and other funding to California state and county health agencies , reducing the number of medical workers , including epidemiologists , and jeopardizing the ability to do lab tests and quickly set up mobile hospitals , according to interviews and records reviewed by The Times .
The budget woes have left California desperate for more @ @ @ @ @ @ @ beds .
A year ago , Riverside County Public Health Director Kim Saruwatari warned state lawmakers at a public hearing that the staff and budget cuts would be a serious problem in the face of an emergency such as a pandemic .
Now her fears have come to fruition .
The funding cuts , particularly to federal grants meant to bolster local preparations , have left Riverside County with “ fewer trained staff to conduct case investigations and contact tracing , fewer epidemiologists to assist with analysis , fewer lab staff ( public @ @ @ @ @ @ @ updated laboratory equipment , ” Saruwatari told The Times .
Budget cuts also played a role in the closure of 11 local public health laboratories over the last 15 years , said Kat DeBurgh , executive director of the Health Officers Assn .
of California .
Local health agencies need more staff to expand testing , operate alternative care sites for infected patients , expand call centers for the anxious public and conduct contact tracing to limit the spread of the virus that causes COVID-19 , DeBurgh said .
“ We can definitely @ @ @ @ @ @ @ drastically shrunk and never recovered , ” DeBurgh said .
“ That really shows at a time like today.
” Heavy cuts began during the 2007-09 recession as governments struggled with budget shortfalls .
Nationwide , local public health agencies cut 55,000 jobs between 2008 and 2017 , according to an estimate by the advocacy group Trust for America ’ s Health .
“ These cuts reduced the capacity for these health departments to prevent illness and loss of life , ” said John Auerbach , the organization ’ s president and chief @ @ @ @ @ @ @ illuminated in an all too real fashion by the novel coronavirus.
” The two main programs that fund local health preparedness are administered by the Centers for Disease Control and Prevention and its parent agency , the Department of Health and Human Services .
Both programs also have seen significant reductions .
In California , the annual allocations from those programs to the state and all but one of its 58 counties dropped from $ 81 million in 2010 to $ 65 million last year .
Los Angeles County health officials did not @ @ @ @ @ @ @ but said cuts left them short-staffed and “ in some cases , activities took longer.
” Still , they said they weren ’ t hampered as much as smaller jurisdictions around the country .
A Health and Human Services spokeswoman declined to address cuts to local health agencies but said in a statement that the Trump administration worked with Congress to boost overall funding for federal agencies involved with pandemic preparedness .
Adriane Casalotti , chief of government and public affairs for the National Assn .
of County and City Health Officials , @ @ @ @ @ @ @ recommended additional cuts but was rebuffed by Congress , though the funding remains far short of what it was a decade ago .
She said local and state health departments across the country have lost nearly a quarter of their workforce since 2008 .
The CDC did not respond to requests for comment .
Dr. Tom Frieden , who was director of the CDC from 2009 to 2017 , said in a statement that the “ U.S .
has under-invested in preparedness.
” “ It ’ s crucial that funding support not only @ @ @ @ @ @ @ , but what health departments do every day to keep people safe , ” said Frieden , now president and CEO of Resolve to Save Lives , whose goals include making the world safer from epidemics .
“ Robust systems that can be scaled up in an emergency are the most effective way to reduce risk.
” His statement did not address cuts during his tenure .
A Times review of state legislative hearings shows that warnings about the consequences of the cuts were repeatedly made in Sacramento .
In 2013 , the @ @ @ @ @ @ @ called “ Are We Prepared ?
Assessing the Status of California ’ s Emergency Response Capabilities.
” There , a top California Department of Public Health official told lawmakers that local health budgets had been slashed by 30 % to 40 % in the previous few years .
State Sen. Richard Pan ( D-Sacramento ) , a physician who now chairs the state Senate Health Committee , recalled at the same hearing how his home county had struggled to respond in 2009 to the H1N1 flu pandemic that killed an estimated 12,500 people @ @ @ @ @ @ @ the CDC .
He said Sacramento County public health officials told him at the time that many of the health workers who deployed to combat the flu crisis did so shortly after they were given pink slips notifying them that they would soon lose their jobs .
State Sen. Hannah-Beth Jackson ( D-Santa Barbara ) was particularly upset to hear in 2013 that state budget cuts could delay setting up of some of the state ’ s mobile hospitals in the event of an emergency .
“ This to me is a violation @ @ @ @ @ @ @ the people , ” Jackson told health officials at the hearing .
Last year , Dr. Karen Smith , then California ’ s public health officer , told lawmakers she remained concerned about the years-long reduction in the number of public health nurses , epidemiologists and communicable disease investigators working for public health agencies in California .
“ It ’ s this very infrastructure of trained , skilled people that has been significantly eroded over the past decade , ” Smith told the Senate Health Committee .
“ The loss of our experienced @ @ @ @ @ @ @ actually represents a very real threat to the health of California.
” Gov .
Gavin Newsom responded to concerns by allocating $ 40 million last year to assist county public health agencies in fighting infectious disease , which local officials said was a good start .
But the consequences of more than a decade in cuts have become even clearer in recent weeks .
In 2011 , the state eliminated the $ 1.7-million budget for its Mobile Field Hospital Program .
Two mobile shelters have been kept in storage , and a third @ @ @ @ @ @ @ emergency agencies .
The state could still deploy its mobile structures to assist with the COVID-19 pandemic , but officials said they have not yet decided whether to do so .
Pan acknowledged again last week that preparedness in California has suffered .
“ Unfortunately , while the Congress has tried to sustain funding to agencies like the CDC , they have also cut back on funds that get allocated to state and local health departments , and we need to change that , ” Pan said during a legislative hearing March 12 @ @ @ @ @ @ @ for lost time , state officials this week approved an emergency infusion of $ 1 billion in state funds for various programs to fight the coronavirus outbreak .
Federal officials are also dipping into their treasury to get money to the states .
“ We are reassured that resources are not the issue here , ” state Public Health Officer Dr. Sonia Angell said last week .
On Thursday , Newsom told congressional leaders in a letter that $ 1 billion is needed from Washington to help California and its counties deploy mobile @ @ @ @ @ @ @ ventilators , tents , cots and sheltering supplies .
But some public health officials say money was needed sooner to react promptly to the crisis .
Dr. Jonathan Fielding , who led the L.A. County Department of Public Health from 1998 to 2014 , said there was a significant nationwide reduction in staff and resources at health departments during his tenure .
That ’ s making it harder for authorities to respond to the coronavirus outbreak , said Fielding , now a professor at the School of Public Health at UCLA .
The @ @ @ @ @ @ @ the lack of tests for COVID-19 , he said .
But another , less obvious way the manpower shortage could be hampering the response is in tracking the origins of new cases .
“ That was one of the first things we needed to do , and it can make a huge difference , ” Fielding said .
“ It ’ s very disappointing how slow we were in the United States .
”

Travelers wearing masks make their way through the Tom Bradley International Terminal at Los Angeles International Airport this month.
California public health officials have repeatedly warned over the last decade that federal budget cuts were weakening their ability to respond to a widespread health crisis like the current coronavirus pandemic.
Despite the warnings, elected leaders cut millions of dollars in federal grants and other funding to California state and county health agencies, reducing the number of medical workers, including epidemiologists, and jeopardizing the ability to do lab tests and quickly set up mobile hospitals, according to interviews and records reviewed by The Times.
The budget woes have left California desperate for more resources, including test kits and hospital beds.
A year ago, Riverside County Public Health Director Kim Saruwatari warned state lawmakers at a public hearing that the staff and budget cuts would be a serious problem in the face of an emergency such as a pandemic.
Now her fears have come to fruition.
The funding cuts, particularly to federal grants meant to bolster local preparations, have left Riverside County with “fewer trained staff to conduct case investigations and contact tracing, fewer epidemiologists to assist with analysis, fewer lab staff (public health microbiologists) and less funding for updated laboratory equipment,” Saruwatari told The Times.
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Budget cuts also played a role in the closure of 11 local public health laboratories over the last 15 years, said Kat DeBurgh, executive director of the Health Officers Assn. of California.
Local health agencies need more staff to expand testing, operate alternative care sites for infected patients, expand call centers for the anxious public and conduct contact tracing to limit the spread of the virus that causes COVID-19, DeBurgh said.
“We can definitely see that the public health workforce has drastically shrunk and never recovered,” DeBurgh said. “That really shows at a time like today.”
Heavy cuts began during the 2007-09 recession as governments struggled with budget shortfalls. Nationwide, local public health agencies cut 55,000 jobs between 2008 and 2017, according to an estimate by the advocacy group Trust for America’s Health.
1 / 44 The City of Santa Monica closed the Santa Monica Pier in an attempt to prevent the further spread of the Coronavirus. Very few people were on the beach in Santa Monica as the epidemic continues. (Carolyn Cole/Los Angeles Times) 2 / 44 Volunteer Nagma Shakur, 16, left, hugs her “Grannie” as she helps senior shoppers with their carts at the Grocery Outlet Bargain Market in Altadena. (Al Seib/Los Angeles Times) 3 / 44 People walk up the ramp, exiting the secure area at the Tom Bradley International Terminal at LAX. (Kent Nishimura/Los Angeles Times) 4 / 44 David Barker, 56, is visiting with his friend living in a tent on skidrow in Los Angeles. Barker, who is not homeless, works in the area. (Francine Orr/Los Angeles Times) 5 / 44 Dr. Dallas Weaver, 79, and his wife, Janet Weaver, 75, of Huntington Beach, walk on the Huntington pier. (Allen J. Schaben/Los Angeles Times) 6 / 44 Seniors, including Eileen Oda Leaf, 67, left, and her husband Dave Leaf, 67, right, both wearing protective masks, line up outside Gelson’s Market in Manhattan Beach early on Wednesday, March 18, 2020. (Christina House/Los Angeles Times) 7 / 44 Roberta Tabor, 66, of Hermosa Beach, has her ID checked by store director Dennis Sullivan at Gelson’s Market in Manhattan Beach on Wednesday. The store is doing a “seniors shopping hour” where seniors 65+ can go grocery shopping before anybody else. (Christina House/Los Angeles Times) 8 / 44 Seniors shop at Gelson’s Market in Manhattan Beach on Wednesday. The store is doing a “seniors shopping hour” where seniors can go grocery shopping before the store opens to the general public. (Christina House/Los Angeles Times) 9 / 44 Dr. Mark V. Morocco oversees testing at UCLA Medical Center where people can drive up and get tested if they have the symptoms. Morocco listens to a female patient’s lungs through the car window. (Carolyn Cole/Los Angeles Times) 10 / 44 HOPICS outreach worker Ralph Gomez tosses a clipboard for a signature to homeless client Davis Soto, right, taking care to stay at least six feet away during outreach in Los Angeles. (Brian van der Brug/Los Angeles Times) 11 / 44 Medical personnel screen patients outside the emergency room at Loma Linda University Health during the coronavirus pandemic. (Gina Ferazzi/Los Angeles Times) 12 / 44 A nurse takes the vital signs of a woman in a medical tent outside the hospital on Catalina. (Francine Orr/Francine Orr/Los Angeles Times) 13 / 44 An employee of the Trader Joe’s store in Monrovia tells customers waiting in line that it would open doors to everyone at 9 a.m., not just seniors, who arrived believing doors would open earlier to older residents, as some of the people were told by employees and it was reported. Some grocery outlets were offering special morning hours of shopping to accommodate older residents. (Al Seib/Los Angeles Times) 14 / 44 Kevin Ezeh, protected with face mask and gloves, addresses the Los Angeles City Council meeting standing under a tent erected outside City Hall. A television livestreamed video of the meeting and the public offered comments remotely. (Irfan Khan/Los Angeles Times) 15 / 44 Orange County Undersheriff Bob Peterson listens during a board of supervisors discussion on combating the coronavirus in Santa Ana. (Allen J. Schaben/Los Angeles Times) 16 / 44 Dr. Mark V. Morocco oversees the testing at UCLA Medical Center. Testing for Covid-19 is going on at UCLA Medical Center, where people can drive up and get tested if they have the symptoms. (Carolyn Cole/Los Angeles Times) 17 / 44 A large tent is installed for public attendance at Tuesday’s Los Angeles City Council meeting. The public was not allowed in the council chamber. (Irfan Khan/Los Angeles Times) 18 / 44 Shoppers queue up ahead of the Los Feliz Costco opening for business on Tuesday, March 17, 2020 in Los Angeles. (Kent Nishimura/Los Angeles Times) 19 / 44 Muhammad Faruq, an Uber driver, picks his ride Sotero Reyes, left, and Cristian Eguia, visitors from Houston, all in protective masks, from downtown Los Angeles. (Irfan Khan/Los Angeles Times) 20 / 44 Volunteer Rachel Figueroa, serves a free lunch to go to Destiny Mendez, with her mother, Estefany, at the Dream Center in Los Angeles. LAUSD students can get free breakfast, lunch and dinner at the Dream Center, Monday through Friday. (Mel Melcon/Los Angeles Times) 21 / 44 Emma Bradley, left, and her husband, Samuel Bradley, of Palmdale are walking up the ramp to catch the Metrolink in Union Sation in Los Angeles. (Francine Orr/Los Angeles Times) 22 / 44 Medical personnel surround a car that is going through a coronavirus drive-thru test clinic at the San Mateo County Event Center. Drive-thru test clinics for COVID-19 are popping up across the country as more tests become available. (Justin Sullivan/Getty Images) 23 / 44 From left, Josh Akamine, of Oahu, Hawaii; Madison Shine of Oahu; Matthew Valencia of Los Altos and Dani Ikeda visit L.A. Live in downtown Los Angeles. (Mel Melcon/Los Angeles Times) 24 / 44 Normally bustling Grand Central Market in downtown L.A. is open only for take out. (Irfan Khan/Los Angeles Times) 25 / 44 L.A. has banned restaurants from offering seating at places such as Grand Central Market. (Irfan Khan/Los Angeles Times) 26 / 44 Carlos Perez, a worker at Wolfgang Puck Bar & Grill at L.A. Live in downtown Los Angeles sits in the empty restaurant. (Mel Melcon/Los Angeles Times) 27 / 44 A line at the Martin B. Retting gun store in Culver City on Sunday extends out the door and around the corner. (Francine Orr / The Times) 28 / 44 A guest wears a mask in front of the Sleeping Beauty Castle at Disneyland on Thursday. (Allen J. Schaben / Los Angeles Times) 29 / 44 Students hug as they are let out of school at Hamilton High School in Los Angeles, Calif., on March 13, 2020. The school has 2,623 students who live in 94 different zip codes, some of whom travel upwards of 30 miles to school on 24 different school bus routes. 221 school staff live in 88 zip codes. Los Angeles Unified School District Superintendent Austin Beutner announced that schools will be closed due to the coronavirus. (Gary Coronado / Los Angeles Times) (Gary Coronado/Los Angeles Times) 30 / 44 Blake Anderson, left, a freshman, walks with his father Oree Anderson, as school is let out at Hamilton High School in Los Angeles. LAUSD announced that schools will be closed due to the Coronavirus. (Gary Coronado/Los Angeles Times) 31 / 44 Students leave John C. Fremont High School in Los Angeles at the end of the school day on Friday, Mar. 13, 2020. LAUSD announced it will shut down beginning Monday. (Luis Sinco/Los Angeles Times ) 32 / 44 Alexandria Casserly crosses the street while looking for toilet paper in downtown Los Angeles. (Gabriella Angotti-Jones / Los Angeles Times) 33 / 44 A crew member stands on the stern of a cruise ship docked at the Port of Los Angeles. (Luis Sinco/Los Angeles Times) 34 / 44 Two children look at movie posters in the lobby of the Arclight theater Thursday in Manhattan Beach. (Jay L. Clendenin / Los Angeles Times) 35 / 44 Disneyland guests wearing ponchos pass the Marketplace inside Star Wars: Galaxy’s Edge on Thursday. Disneyland and California Adventure will temporarily close in response to the coronavirus pandemic. (Allen J. Schaben / Los Angeles Times) 36 / 44 People shop at the Del Amo Fashion Center in Torrance. (Luis Sinco/Los Angeles Times) 37 / 44 Disneyland guests take photos in front of the Millennium Falcon: Smugglers Run at Star Wars: Galaxy’s Edge. (Allen J. Schaben / Los Angeles Times) 38 / 44 Airline workers take precautions at Tom Bradley International Terminal in Los Angeles on Thursday. (Christina House / Los Angeles Times) 39 / 44 An airport worker cleans a railing at Tom Bradley International Terminal. (Christina House / Los Angeles Times) 40 / 44 Two people arrive at Knott’s Berry Farm on Thursday in Buena Park. (Gina Ferazzi / Los Angeles Times) 41 / 44 Cab drivers wait for riders at the Long Beach Airport. (Luis Sinco/Los Angeles Times) 42 / 44 The Del Amo Fashion Center in Torrance. (Luis Sinco/Los Angeles Times) 43 / 44 A woman claims her luggage at he Long Beach Airport. (Luis Sinco/Los Angeles Times) 44 / 44 The Del Amo Fashion Center in Torrance. (Luis Sinco/Los Angeles Times)
“These cuts reduced the capacity for these health departments to prevent illness and loss of life,” said John Auerbach, the organization’s president and chief executive. “Their impact is being illuminated in an all too real fashion by the novel coronavirus.”
The two main programs that fund local health preparedness are administered by the Centers for Disease Control and Prevention and its parent agency, the Department of Health and Human Services. Both programs also have seen significant reductions.
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In California, the annual allocations from those programs to the state and all but one of its 58 counties dropped from $81 million in 2010 to $65 million last year.
Los Angeles County health officials did not say how much funding they have received but said cuts left them short-staffed and “in some cases, activities took longer.” Still, they said they weren’t hampered as much as smaller jurisdictions around the country.
A Health and Human Services spokeswoman declined to address cuts to local health agencies but said in a statement that the Trump administration worked with Congress to boost overall funding for federal agencies involved with pandemic preparedness.
Adriane Casalotti, chief of government and public affairs for the National Assn. of County and City Health Officials, said the Trump administration in recent years recommended additional cuts but was rebuffed by Congress, though the funding remains far short of what it was a decade ago. She said local and state health departments across the country have lost nearly a quarter of their workforce since 2008.
The CDC did not respond to requests for comment.
Dr. Tom Frieden, who was director of the CDC from 2009 to 2017, said in a statement that the “U.S. has under-invested in preparedness.”
“It’s crucial that funding support not only what would be done in an emergency, but what health departments do every day to keep people safe,” said Frieden, now president and CEO of Resolve to Save Lives, whose goals include making the world safer from epidemics. “Robust systems that can be scaled up in an emergency are the most effective way to reduce risk.”
His statement did not address cuts during his tenure.
A Times review of state legislative hearings shows that warnings about the consequences of the cuts were repeatedly made in Sacramento.
In 2013, the Assembly and Senate held a joint hearing called “Are We Prepared? Assessing the Status of California’s Emergency Response Capabilities.”
There, a top California Department of Public Health official told lawmakers that local health budgets had been slashed by 30% to 40% in the previous few years.
State Sen. Richard Pan (D-Sacramento), a physician who now chairs the state Senate Health Committee, recalled at the same hearing how his home county had struggled to respond in 2009 to the H1N1 flu pandemic that killed an estimated 12,500 people in the United States, according to the CDC.
He said Sacramento County public health officials told him at the time that many of the health workers who deployed to combat the flu crisis did so shortly after they were given pink slips notifying them that they would soon lose their jobs.
State Sen. Hannah-Beth Jackson (D-Santa Barbara) was particularly upset to hear in 2013 that state budget cuts could delay setting up of some of the state’s mobile hospitals in the event of an emergency.
“This to me is a violation of our responsibilities as a government to the people,” Jackson told health officials at the hearing.
Last year, Dr. Karen Smith, then California’s public health officer, told lawmakers she remained concerned about the years-long reduction in the number of public health nurses, epidemiologists and communicable disease investigators working for public health agencies in California.
“It’s this very infrastructure of trained, skilled people that has been significantly eroded over the past decade,” Smith told the Senate Health Committee. “The loss of our experienced public health workforce at the local level actually represents a very real threat to the health of California.”
Gov. Gavin Newsom responded to concerns by allocating $40 million last year to assist county public health agencies in fighting infectious disease, which local officials said was a good start.
But the consequences of more than a decade in cuts have become even clearer in recent weeks.
In 2011, the state eliminated the $1.7-million budget for its Mobile Field Hospital Program. Two mobile shelters have been kept in storage, and a third was divided and parceled out to local emergency agencies.
The state could still deploy its mobile structures to assist with the COVID-19 pandemic, but officials said they have not yet decided whether to do so.
Pan acknowledged again last week that preparedness in California has suffered.
“Unfortunately, while the Congress has tried to sustain funding to agencies like the CDC, they have also cut back on funds that get allocated to state and local health departments, and we need to change that,” Pan said during a legislative hearing March 12.
In the scramble to make up for lost time, state officials this week approved an emergency infusion of $1 billion in state funds for various programs to fight the coronavirus outbreak. Federal officials are also dipping into their treasury to get money to the states.
“We are reassured that resources are not the issue here,” state Public Health Officer Dr. Sonia Angell said last week.
On Thursday, Newsom told congressional leaders in a letter that $1 billion is needed from Washington to help California and its counties deploy mobile hospitals and procure more protective equipment, ventilators, tents, cots and sheltering supplies.
But some public health officials say money was needed sooner to react promptly to the crisis.
Dr. Jonathan Fielding, who led the L.A. County Department of Public Health from 1998 to 2014, said there was a significant nationwide reduction in staff and resources at health departments during his tenure.
That’s making it harder for authorities to respond to the coronavirus outbreak, said Fielding, now a professor at the School of Public Health at UCLA.
The biggest obstacle U.S. health officials face is the lack of tests for COVID-19, he said. But another, less obvious way the manpower shortage could be hampering the response is in tracking the origins of new cases.
“That was one of the first things we needed to do, and it can make a huge difference,” Fielding said. “It’s very disappointing how slow we were in the United States.”


latimes--2020-03-20--Californians ordered to stay at home: Here are the new rules

Gov .
Gavin Newsom ’ s sweeping order for Californians to stay home to slow the spread of the coronavirus outbreak will dramatically restrict public movement .
The governor ’ s office provided a list of how the order will play out : • Essential state and local government functions including law enforcement and offices that provide government programs and services .
What is behind this ?
Officials hope telling people to stay homes and restrict social interactions will slow the spread of the virus and ultimately prevent hospitals from being overrun with sick patients .
Newsom asked Californians to @ @ @ @ @ @ @ necessary activities.
” “ We ’ re going to keep the grocery stores open , ” Newsom said .
“ We ’ re going to make sure that you ’ re getting critical medical supplies .
You can still take your kids outside , practicing common sense and social distancing .
You can still walk your dog.
” No time frame was set for when the order would end .
What are exemptions from the order ?
Newsom ’ s action orders “ all individuals living in the state of California to stay @ @ @ @ @ @ @ , except as needed to maintain continuity of operation of the federal critical infrastructure sectors.
” The government order links to a Department of Homeland Security document that lists 16 “ critical infrastructure sectors whose assets , systems , and networks , whether physical or virtual , are considered so vital to the United States that their incapacitation or destruction would have a debilitating effect on security , national economic security , national public health or safety , or any combination thereof.
” The city of Los Angeles issued a restrictive order , @ @ @ @ @ @ @ with companies able to operate only through work-at-home arrangements .
The order also bans all public gatherings of any size outside homes .
Under the city ’ s new order , officials said residents are permitted to : • Go to the grocery store ; • Go to the pharmacy to pick up medications and other healthcare necessities ; • Go to medical appointments ( check with your doctor or provider first ) ; • Take a walk , ride your bike and be in nature for exercise — just keep at least @ @ @ @ @ @ @ the community ; • Walk your pets and take them to the veterinarian if necessary ; • Help someone to get necessary supplies .
• Go to work unless providing essential services as defined by the order ; • Visit friends and family if there is no urgent need ; • Maintain less than six feet of distance from others when you go out ; • Travel to or from a job outside the city , unless to perform essential activities ; • Travel to or from a vacation home outside the city @ @ @ @ @ @ @ hospital , nursing home , skilled nursing facility or other residential care facility .
• Plumbers , electricians , exterminators , custodial/janitorial workers , handyman services , funeral home workers and morticians , moving services , HVAC installers , carpenters , landscapers , gardeners , property managers , private security personnel and others who provide services to maintain the safety , sanitation and essential operation of properties and other essential activities • Organizations and businesses that provide food , shelter , social services and other necessities of life for economically disadvantaged or otherwise @ @ @ @ @ @ @ intervention and domestic violence agencies ) • Educational institutions , including public and private K-12 schools , colleges , and universities — for purposes of facilitating distance learning or performing essential functions provided that social distancing of six feet per person is maintained to the greatest extent possible

During the coronavirus epidemic people continue to walk, ride thier bikes, and play basketball at Junipero Beach in Long Beach. (Francine Orr/Los Angeles Times)
People walk the beach, but maintain “social distancing” during the coronavirus outbreak at Crystal Cove in Newport Beach. (Gina Ferazzi/Gina Ferazzi/Los Angeles Times)
With all the stores closed, Fashion Island is a ghost town except for an occasional customer getting food for take-out Newport Beach. (Gina Ferazzi/Los Angeles Times)
The Apple store is among all the stores which have closed during the coronavirus outbreak in Newport Beach. (Gina Ferazzi/Los Angeles Times)
Popular shopping destination Rodeo Drive is all but deserted as retail shops are shuttered in Beverly Hills. (Brian van der Brug/Los Angeles Times)
Salvation Army volunteer Christina Cuevas sets up cots for homeless at Westwood Recreation Center in Westwood. (Brian van der Brug/Brian van der Brug/Brian van der Brug/Los Angeles Times)
Commuter protect themselves with a face mask while riding a bus at El Monte Metro Station. (Irfan Khan/Los Angeles Times)
Union Station was restricted to only ticketed passenger and main entrance closed. (Irfan Khan/Los Angeles Times)
The main entrance to Union Station is closed. (Irfan Khan/Los Angeles Times)
On the first day of L.A.’s ‘Safer at Home,” most major avenues and streets in downtown Los Angeles have very little traffic. (Irfan Khan/Los Angeles Times)
Hollywood Blvd. is devoid of the usual crowds as most shops are closed. (Brian van der Brug/Los Angeles Times)
Hollywood Blvd. is devoid of the usual crowds as most shops are closed. (Brian van der Brug/Los Angeles Times)
The intersection of the 101 and 110 freeways in downtown Los Angeles. (Carolyn Cole/Los Angeles Times)
Shops are shuttered on historic Olvera Street in downtown Los Angeles. (Irfan Khan/Los Angeles Times)
The city of Santa Monica has closed the Santa Monica Pier, and few people were on the beach Friday. (Carolyn Cole / Los Angeles Times)
Vehicles flow smoothly along Interstate 5 and the 110 Freeway in Los Angeles in this drone image. (Brian van der Brug / Los Angeles Times)
In this drone image, the Westfield Topanga mall parking lot sits empty, as new regulations have closed all indoor shopping centers in Canoga Park. (Brian van der Brug / Los Angeles Times)
School buses sit idle since all schools have been closed in Los Angeles County. The image was taken by drone. (Carolyn Cole / Los Angeles Times)
The sparsely trafficked intersection of the 101 and 110 freeways in downtown Los Angeles is seen in a drone image. (Carolyn Cole / Los Angeles Times)
Spooked by coronavirus fears, people from nearby Inland Empire cities lined-up to buy eggs at Maust’s California Poultry in Chino. (Irfan Khan/Los Angeles Times)
Xiao Ping, holding a tray of eggs, looks back at the long line of egg buyers on Saturda morning in Chino. Spooked by coronavirus people from nearby Inland Empire cities started lining up early morning at Maust’s California Poultry in Chino. (Irfan Khan/Los Angeles Times)
Drivers line-up to get a coronavirus test administered by Riverside County medical personnel at a drive-though testing facility at Diamond Stadium in Lake Elsinore. Those tested have symptoms or have had a risk of exposure. (Gina Ferazzi/Los Angeles Times)
Riverside County medical personnel administer a coronavirus test to a driver at a drive-though testing facility at Diamond Stadium in Lake Elsinore. (Gina Ferazzi/Los Angeles Times)
Jesus Mendoza sells roses on the sidewalk in downtown Los Angeles. Mendoza said his business was overwhelmed by hundred of boxes of roses they could not sell. (Francine Orr/Los Angeles Times)
People run and walk on the Veterans Parkway in Manhattan Beach even with signage saying the space is closed to help minimize the spread of the coronavirus. (Dania Maxwell/Dania Maxwell/Los Angeles Times)
During the coronavirus pandemic, people continue to walk and ride their bikes along the path at Junipero Beach in Long Beach. (Francine Orr/Los Angeles Times)
At Echo Park Lake, friends gather with their dogs and enjoy a Sunday afternoon in the park. Social distancing and home isolation remain in effect due to the coronavirus. (Carolyn Cole/Carolyn Cole/Los Angeles Times)
Workers at the Ralphs grocery store in Westchester measure out social distancing guidelines for its customers with markers every six feet and limiting the number of customers it allows in to shop. (Jason Armond/Los Angeles Times)
Gov. Gavin Newsom’s sweeping order for Californians to stay home to slow the spread of the coronavirus outbreak will dramatically restrict public movement.
The governor’s office provided a list of how the order will play out:
What stays open:
Pharmacies
Food: Grocery stores, farmers markets, food banks, convenience stores, takeout and delivery restaurants
Banks
Gas stations
Laundromats/laundry services
Essential state and local government functions including law enforcement and offices that provide government programs and services.
What is closed:
Bars and nightclubs
Entertainment venues
Gyms and fitness studios
Public events and gatherings
Convention Centers
Dine-in restaurants
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What is behind this?
Officials hope telling people to stay homes and restrict social interactions will slow the spread of the virus and ultimately prevent hospitals from being overrun with sick patients.
Newsom asked Californians to practice social distancing when performing such “necessary activities.”
“We’re going to keep the grocery stores open,” Newsom said. “We’re going to make sure that you’re getting critical medical supplies. You can still take your kids outside, practicing common sense and social distancing. You can still walk your dog.”
No time frame was set for when the order would end.
What are exemptions from the order?
Newsom’s action orders “all individuals living in the state of California to stay home or at their place of residence, except as needed to maintain continuity of operation of the federal critical infrastructure sectors.”
The government order links to a Department of Homeland Security document that lists 16 “critical infrastructure sectors whose assets, systems, and networks, whether physical or virtual, are considered so vital to the United States that their incapacitation or destruction would have a debilitating effect on security, national economic security, national public health or safety, or any combination thereof.”
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Chemical Sector
Commercial Facilities Sector
Communications Sector
Critical Manufacturing Sector
Dams Sector
Defense Industrial Base Sector
Emergency Services Sector
Energy Sector
Financial Services Sector
Food and Agriculture Sector
Government Facilities Sector
Healthcare and Public Health Sector
Information Technology Sector
Nuclear Reactors, Materials, and Waste Sector
Transportation Systems Sector
Water and Wastewater Systems Sector
Los Angeles
The city of Los Angeles issued a restrictive order, requiring all nonessential businesses to close, with companies able to operate only through work-at-home arrangements. The order also bans all public gatherings of any size outside homes.
Under the city’s new order, officials said residents are permitted to:
Go to the grocery store;
Go to the pharmacy to pick up medications and other healthcare necessities;
Go to medical appointments (check with your doctor or provider first);
Take a walk, ride your bike and be in nature for exercise — just keep at least six feet between you and others in the community;
Walk your pets and take them to the veterinarian if necessary;
Help someone to get necessary supplies.
Residents are not allowed to:
Go to work unless providing essential services as defined by the order;
Visit friends and family if there is no urgent need;
Maintain less than six feet of distance from others when you go out;
Travel to or from a job outside the city, unless to perform essential activities;
Travel to or from a vacation home outside the city;
Visit loved ones in a hospital, nursing home, skilled nursing facility or other residential care facility.
These are considered essential services:
City/county government services
Healthcare providers
Food and grocery service
Hardware stores and nurseries
Plumbers, electricians, exterminators, custodial/janitorial workers, handyman services, funeral home workers and morticians, moving services, HVAC installers, carpenters, landscapers, gardeners, property managers, private security personnel and others who provide services to maintain the safety, sanitation and essential operation of properties and other essential activities
Banks
Organizations and businesses that provide food, shelter, social services and other necessities of life for economically disadvantaged or otherwise needy individuals (including gang prevention and intervention and domestic violence agencies)
Laundromats/laundry service
Newspapers, magazines, television, radio, podcasts and other media services


latimes--2020-03-19--'Complete chaos' as Orange County courts reopen amid coronavirus panic

Orange County ’ s first attempt to hold court hearings after a brief closure due to concerns over the spread of the coronavirus descended into “ complete chaos ” Thursday , with packed courtrooms seeming to fly in the face of recent guidance offered by health officials , some of the county ’ s top legal officials said .
On Monday , the Orange County Superior Court system announced the closure of all courthouses until March 27 , with exceptions for emergency matters .
But an attempt to use five courtrooms in Santa Ana to hold arraignments and other proceedings @ @ @ @ @ @ @ .
“ We were not following the state guidelines for public health .
We were not following the federal guidelines for public health , ” Orange County Public Defender Sharon Petrosino said .
“ It was wall-to-wall people , everywhere you looked.
” Dist .
Atty .
Todd Spitzer said a system that would have allowed hearings to be conducted by video malfunctioned for half the day .
Poor communication from court officials , who Spitzer said attempted to pack too much onto Thursday ’ s court calendar , led to long delays @ @ @ @ @ @ @ when health officials have urged people to limit contact with one another .
“ They got ahead of themselves .
They didn ’ t communicate well with the private defense bar .
They didn ’ t have instructions up on their website … so today was complete chaos , ” he said .
“ Social distancing ?
” Spitzer quipped later .
“ It was actually social consolidation.
” Petrosino called the situation a “ catastrophe ” and faulted court officials for trying to mash “ three days ” worth of cases into @ @ @ @ @ @ @ defendants in custody , saying at least 140 county inmates were held in close quarters in the building while waiting hours to appear .
“ I worry about two things .
I worry about my clients … and I worry about my staff , ” Petrosino said .
“ None of those people were protected today by the court system.
” A Sheriff ’ s Department spokeswoman did not immediately respond to Petrosino ’ s claim about the treatment of in-custody defendants .
Court spokesman Kostas Kalaitzidis declined to address specific allegations of @ @ @ @ @ @ @ an email said officials were scrambling to deal with an unprecedented situation .
“ We are working very hard to provide access to justice , preserve everyone ’ s constitutional rights and do our part to provide safety and security to all residents of Orange County , ” he said .
Photos taken in the Santa Ana courthouse showed attorneys wearing masks and filling hallways in crowds , at a time when California leaders are urging people to stay home and the Centers for Disease Control and Prevention is advising people to avoid @ @ @ @ @ @ @ to limit the spread of the virus .
Staycie Sena , a criminal defense lawyer , said private attorneys were not notified that hearings would be taking place in Santa Ana until 4 p.m. Wednesday .
The lack of communication from court officials and heavy backlog of cases created an unnecessary and dangerous situation , she said .
“ It ’ s not just the clients and the court personnel who are being put at risk , ” she said .
“ You have to choose between your bar card and the safety @ @ @ @ @ @ @ it puts us in an impossible position.
” The fiasco in Orange County comes as law enforcement officials continue to try and balance public safety and the scheduling of necessary court hearings with statewide and national efforts to limit the spread of the virus , which has killed 19 people in California and infected nearly 1,000 people .
Earlier this week , the Los Angeles County Superior Court announced it would shut down for three days and effectively halt criminal trials for a month .
The nation ’ s largest court system is @ @ @ @ @ @ @ Friday , and some attorneys fear similar chaos .

Orange County Dist. Atty. Todd Spitzer said the county’s court system devolved into “complete chaos” on Thursday as courtrooms partially reopened after a brief closure due to fears of the spread of the coronavirus.
Orange County’s first attempt to hold court hearings after a brief closure due to concerns over the spread of the coronavirus descended into “complete chaos” Thursday, with packed courtrooms seeming to fly in the face of recent guidance offered by health officials, some of the county’s top legal officials said.
On Monday, the Orange County Superior Court system announced the closure of all courthouses until March 27, with exceptions for emergency matters. But an attempt to use five courtrooms in Santa Ana to hold arraignments and other proceedings quickly overwhelmed the system, officials said.
“We were not following the state guidelines for public health. We were not following the federal guidelines for public health,” Orange County Public Defender Sharon Petrosino said. “It was wall-to-wall people, everywhere you looked.”
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Dist. Atty. Todd Spitzer said a system that would have allowed hearings to be conducted by video malfunctioned for half the day. Poor communication from court officials, who Spitzer said attempted to pack too much onto Thursday’s court calendar, led to long delays and heavy foot traffic at a time when health officials have urged people to limit contact with one another.
“They got ahead of themselves. They didn’t communicate well with the private defense bar. They didn’t have instructions up on their website … so today was complete chaos,” he said.
“Social distancing?” Spitzer quipped later. “It was actually social consolidation.”
Petrosino called the situation a “catastrophe” and faulted court officials for trying to mash “three days” worth of cases into one. She also expressed concern for defendants in custody, saying at least 140 county inmates were held in close quarters in the building while waiting hours to appear.
“I worry about two things. I worry about my clients … and I worry about my staff,” Petrosino said. “None of those people were protected today by the court system.”
A Sheriff’s Department spokeswoman did not immediately respond to Petrosino’s claim about the treatment of in-custody defendants.
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Court spokesman Kostas Kalaitzidis declined to address specific allegations of poor planning or conditions, but in an email said officials were scrambling to deal with an unprecedented situation.
“We are working very hard to provide access to justice, preserve everyone’s constitutional rights and do our part to provide safety and security to all residents of Orange County,” he said.
Photos taken in the Santa Ana courthouse showed attorneys wearing masks and filling hallways in crowds, at a time when California leaders are urging people to stay home and the Centers for Disease Control and Prevention is advising people to avoid gathering in groups of more than 10 to limit the spread of the virus.
Staycie Sena, a criminal defense lawyer, said private attorneys were not notified that hearings would be taking place in Santa Ana until 4 p.m. Wednesday. The lack of communication from court officials and heavy backlog of cases created an unnecessary and dangerous situation, she said.
“It’s not just the clients and the court personnel who are being put at risk,” she said. “You have to choose between your bar card and the safety and health of your family. So it puts us in an impossible position.”
The fiasco in Orange County comes as law enforcement officials continue to try and balance public safety and the scheduling of necessary court hearings with statewide and national efforts to limit the spread of the virus, which has killed 19 people in California and infected nearly 1,000 people.
Earlier this week, the Los Angeles County Superior Court announced it would shut down for three days and effectively halt criminal trials for a month. The nation’s largest court system is scheduled to reopen for limited matters on Friday, and some attorneys fear similar chaos.