vox--2020-03-12--Coronavirus is already here. Blocking travelers won’t prevent its spread.

Despite President Donald Trump ’ s sweeping ban on non-US citizen travelers from Europe , the consensus among public health experts is clear : At this point , restricting travel can ’ t prevent the spread of the coronavirus .
Epidemiologists have long observed the failure of travel restrictions to contain other infectious diseases , such as influenza .
It also seems to be true in the case of the coronavirus outbreak so far : China and Italy both adopted stringent restrictions on domestic and international travel but were unable to avert a pandemic .
It ’ s true that @ @ @ @ @ @ @ China , but as epidemiologist Bruce Aylward told my colleague Julia Belluz , that can mostly be attributed to efforts to educate the public , identifying cases , and rapidly isolating them .
At this point , it ’ s hard to tell what containment strategies have been effective ; we ’ ll know more in the months to come after various countries ’ real-time experimentation has played out .
Preliminary research suggests that travel restrictions could be effective in temporarily delaying the spread of coronavirus by a few days , if not @ @ @ @ @ @ @ be valuable in terms of buying time for governments and communities to prepare .
But there ’ s only a small window in which the restrictions can be effective , and for the US , that opportunity passed weeks ago .
The Centers for Disease Control and Prevention reported 1,215 cases nationwide as of Thursday , but due to insufficient testing , there are likely many more cases that have gone unidentified .
Congress ’ s in-house doctor told staffers on Wednesday that 70 million to 150 million people in the US could @ @ @ @ @ @ @ , there ’ s just too much community transmission for travel restrictions to make much of a difference .
“ Border closures have not stopped the spread of this virus or prevented it from becoming a pandemic , ” Jennifer Nuzzo , a senior scholar at the Johns Hopkins Center for Health Security , told Vox .
“ Now that we have local transmission within the United States , looking outward to control the virus makes even less sense.
” Even Thomas Bossert , a former adviser on the Trump administration ’ s @ @ @ @ @ @ @ US pandemic is past the stage at which a ban on international travelers from Europe would help insulate the public from the virus : How the travel bans played out in China and Italy Joshua Michaud , associate director for global health policy at the Kaiser Family Foundation , said that what happened in China suggests that there is a window when restricting travel can have an impact on the spread of a disease .
China ’ s decision to lock down domestic transportation in the Hubei province , where the virus originated @ @ @ @ @ @ @ led to a delay both in the spread of the epidemic internally and in other countries — one paper estimates by about 2.9 days .
Another paper recently published in Science that has yet to be peer-reviewed determined that the combination of those approaches produced a “ much larger synergistic effect ” than either of them would have alone .
“ It bought other countries some time , ” Thomas Bollyky , director of the global health program at the Council on Foreign Relations , told Vox .
But those policies still couldn @ @ @ @ @ @ @ in part because a large number of infected people from mainland China went undetected and could have dispersed across the globe , the researchers write .
Since people can be infected without exhibiting symptoms , it ’ s all the more difficult to identify sick people and prevent them from traveling .
It ’ s not yet clear whether travel restrictions in Italy had a similar impact .
Italy was the first European Union country to ban flights to and from China on account of coronavirus , going against the recommendations of the @ @ @ @ @ @ @ which is suffering from the worst coronavirus epidemic in Europe , remains on total lockdown .
But the US , which in January blocked foreigners who had recently visited China , may have consequently been able to delay the spread of the virus for some time .
Anthony Fauci , the head of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health , and other public health officials “ knew that they couldn ’ t hermetically seal off the US , but they could slow the spread , @ @ @ @ @ @ @ testified before Congress backing Trump ’ s latest ban on Europeans and calling for even more travel bans as necessary .
“ If , in fact , the dynamics of the outbreak mandates that , I think they would seriously consider that , ” Fauci told lawmakers on Thursday .
“ I can tell you it would be seriously considered.
” The new restrictions Trump announced on Wednesday night bar all travel from Europe to the US for 30 days starting Friday at midnight , though citizens of the UK and Americans who @ @ @ @ @ @ @ move blindsided European leaders and caused mass panic at European airports , where the cost of last-minute flights to the US skyrocketed to as much as $ 20,000 .
But only a fraction of coronavirus cases in the US are coming from Europe at this point : Trevor Bedford , a scientist who studies viruses at the Fred Hutchinson Cancer Research Center , estimates that the number of new infections generated within the US is higher than the number of new infections introduced by Europeans daily by a factor of about 18 to @ @ @ @ @ @ @ does little to blunt the epidemic that we already have here , ” Michaud said .
“ It misplaces emphasis on a relatively small risk.
” Even if there were a pressing threat from Europe that could be averted by instituting travel restrictions , Irwin Redlener , director of the National Center for Disaster Preparedness at Columbia University , told Vox that it ’ s not clear that Trump ’ s ban as it is designed would prevent people from coming to the US .
Nothing seems to be stopping Europeans from rerouting @ @ @ @ @ @ @ through another country .
And there appears to be no scientific justification for exempting the UK , which has a higher number of coronavirus cases than other countries in Europe .
“ This is an extraordinarily inept statement of policy , ” he said .
Experts instead recommend focusing the US ’ s response on ways to reduce domestic transmission of the virus .
Investing in increasing testing would help identify hotspots of infection and inform how officials can most effectively allocate resources in order to prepare for increased pressure on hospitals and @ @ @ @ @ @ @ Redlener said the federal government needs to also issue guidance to states and localities to develop public health protocols and educate the public on best practices because , so far , the response has been “ too little , too late.
” “ Coronavirus knows no borders but borders are the only thing that President Trump knows with regard to Covid-19 , ” Bollyky said .

Despite President Donald Trump’s sweeping ban on non-US-citizen travelers from Europe and now the UK, the consensus among public health experts is clear: At this point, restricting travel can’t prevent the spread of the coronavirus.
Epidemiologists have long observed the failure of travel restrictions to contain other infectious diseases, such as influenza. It also seems to be true in the case of the coronavirus outbreak so far: China and Italy both adopted stringent restrictions on domestic and international travel but were unable to avert a pandemic. It’s true that case numbers finally started dropping recently in China, but as epidemiologist Bruce Aylward told Vox’s Julia Belluz, that can mostly be attributed to efforts to educate the public, identify cases, and rapidly isolate them.
At this point, it’s hard to tell what containment strategies have been effective; we’ll know more in the months to come after various countries’ real-time experimentation has played out. Preliminary research suggests travel restrictions could be effective in temporarily delaying the spread of coronavirus by a few days, if not in stopping it entirely, and that could be valuable in terms of buying time for governments and communities to prepare.
But there’s only a small window in which the restrictions can be effective, and for the US, that opportunity passed weeks ago.
The Centers for Disease Control and Prevention reported more than 1,600 cases nationwide as of March 13, but due to insufficient testing, there are likely many more cases that have gone unidentified. Congress’s in-house doctor told staffers on Wednesday that 70 million to 150 million people in the US could eventually be infected. At this point, there’s just too much community transmission for travel restrictions to make much of a difference.
“Border closures have not stopped the spread of this virus or prevented it from becoming a pandemic,” Jennifer Nuzzo, a senior scholar at the Johns Hopkins Center for Health Security, told Vox. “Now that we have local transmission within the United States, looking outward to control the virus makes even less sense.”
Tom Bossert, a former adviser on the Trump administration’s pandemic response team, argued that the US coronavirus pandemic is past the stage at which a ban on international travelers from Europe would help insulate the public from the virus:
There’s little value to European travel restrictions. Poor use of time & energy. Earlier, yes. Now, travel restrictions/screening are less useful. We have nearly as much disease here in the US as the countries in Europe. We MUST focus on layered community mitigation measures-Now! — Thomas P. Bossert (@TomBossert) March 12, 2020
How the travel bans played out in China and Italy
Joshua Michaud, associate director for global health policy at the Kaiser Family Foundation, said that what happened in China suggests there is a window when restricting travel can have an impact on the spread of a disease.
China’s decision to lock down domestic transportation in the Hubei province, where the virus originated, coupled with international travel restrictions, led to a delay both in the spread of the epidemic internally and in other countries — one paper estimates by about 2.9 days. Another paper recently published in Science that has yet to be peer-reviewed determined that the combination of those approaches produced a “much larger synergistic effect” than either of them would have alone.
“It bought other countries some time,” Thomas Bollyky, director of the global health program at the Council on Foreign Relations, told Vox.
But those policies still couldn’t fully contain the epidemic, in part because a large number of infected people from mainland China went undetected and could have dispersed across the globe, the researchers write. Since people can be infected without exhibiting symptoms, it’s all the more difficult to identify sick people and prevent them from traveling.
It’s not yet clear whether travel restrictions in Italy had a similar impact. Italy was the first European Union country to ban flights to and from China on account of coronavirus, going against the recommendations of the World Health Organization. The country, which is suffering from the worst coronavirus epidemic in Europe, remains on total lockdown.
But the US, which in January blocked foreigners who had recently visited China, may have consequently been able to delay the spread of the virus for some time. Anthony Fauci, the head of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, and other public health officials “knew that they couldn’t hermetically seal off the US, but they could slow the spread,” Michaud said.
Fauci has since testified before Congress backing Trump’s latest ban on Europeans and calling for even more travel bans as necessary.
“If, in fact, the dynamics of the outbreak mandates that, I think they would seriously consider that,” Fauci told lawmakers on Thursday. “I can tell you it would be seriously considered.”
Trump’s European ban makes no sense
Trump began barring entry for all travelers from Europe for 30 days on Friday. Americans returning from Europe who submitted to screenings and citizens of the UK and Ireland were initially exempt, however. The move blindsided European leaders and caused mass panic at European airports, where the cost of last-minute flights to the US skyrocketed to as much as $20,000.
He changed course on Saturday, announcing that the UK and Ireland would be subject to the European restrictions starting on Monday at midnight ET, based on the recommendations of his public health advisers.
But only a fraction of coronavirus cases in the US are coming from Europe at this point: Trevor Bedford, a scientist who studies viruses at the Fred Hutchinson Cancer Research Center, estimates that the number of new infections generated within the US is higher than the number of new infections introduced by Europeans daily by a factor of about 18 to one.
“Putting in border restrictions does little to blunt the epidemic that we already have here,” Michaud said. “It misplaces emphasis on a relatively small risk.”
Even if there were a pressing threat from Europe that could be averted by instituting travel restrictions, Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University, told Vox it’s not clear that Trump’s ban as it is designed would prevent people from coming to the US. Nothing seems to be stopping Europeans from rerouting their trips to fly to the US through another country.
And there appears to be no scientific justification for initially exempting the UK, which has a higher number of coronavirus cases than other countries in Europe.
“This is an extraordinarily inept statement of policy,” he said.
What could be more effective is something Trump hinted at, and a practice that aided China: domestic travel restrictions. Trump didn’t elaborate on what areas of the US could face domestic travel restrictions, but he did recommend that the public avoid nonessential travel domestically. As of Saturday, hotspots of transmission that would seem likely targets for such a ban include Washington state, where there are 510 confirmed cases and 37 deaths, and New York state, where there are 524 confirmed cases and one death. There is already a containment zone in the city of New Rochelle, New York, and the Pentagon has restricted service members’ domestic travel.
”If you don’t have to travel I wouldn’t do it ... we want this thing to end,” Trump said Saturday.
Experts also recommend focusing the US response on ways to reduce domestic transmission of the virus. Investing in increasing testing would help identify hotspots of infection and inform how officials can most effectively allocate resources in order to prepare for increased pressure on hospitals and the health care system more broadly.
Redlener said the federal government also needs to issue guidance to states and localities to develop public health protocols and educate the public on best practices because, so far, the response has been “too little, too late.”
“Coronavirus knows no borders but borders are the only thing that President Trump knows with regard to Covid-19,” Bollyky said.


vox--2020-03-12--Why Covid-19 is so dangerous for older adults

Even before the Covid-19 coronavirus reached more than 100 countries around the world , early data from China — where the outbreak started — suggested that older adults were the most vulnerable to the worst effects of the disease .
Now , that data , along with emerging research from Italy — the second-most affected country in the world — are showing just how dangerous Covid-19 is for older people , particularly for those with heart , lung , and immunological conditions .
In Italy , a country with one of the world ’ s oldest populations , a March @ @ @ @ @ @ @ found that , of the 105 patients who died from the virus , the average age was 81 .
This put a 20-year gap between the average age of people who tested positive for the virus and the deceased , the institute said .
This finding squared with some of the other best data on the risks of the new respiratory disease , from the Center for Disease Control in China .
In a late February report , researchers looked at the first 72,314 patients with confirmed or suspected Covid-19 and discovered a @ @ @ @ @ @ @ by age group .
In short , the disease appears to be deadlier in people with each passing decade .
In a new but not-yet-peer-reviewed preprint out of Switzerland ’ s University of Bern , researchers used the China CDC data to model how the risk of death — or case fatality rate — increases with age .
They estimated a wide variation in death risk across the age spectrum : Less than 1 percent of people in their 20s die from the virus , they estimated , while the rate shoots up @ @ @ @ @ @ @ You can see the trend in the chart above . )
Age , however , doesn ’ t tell the whole story about who is at risk of severe disease .
In fact , it reveals the underlying vulnerabilities in the wider population to an illness like Covid-19 .
Many of these factors are concentrated among older adults , but younger people with certain underlying health problems are also at risk .
The lessons we learn from older patients could help us treat and prevent the spread .
That makes it all the @ @ @ @ @ @ @ put older adults at greatest risk so we can develop a strategy to protect society as a whole .
Immune function declines with age .
That makes us more susceptible to more severe illness .
As we age , the systems our bodies use to fight disease wear down .
Not only does the body have a harder time fighting off new infections like Covid-19 ; it ’ s also more likely to be afflicted by chronic diseases that make the immune system weaker .
Let ’ s walk through the first part @ @ @ @ @ @ @ fighting foreign invaders , including viruses like SARS-Cov-2 , which causes Covid-19 .
In older adults , the number of white blood cells that find and help eliminate infections can decline .
The cells also become less adept at identifying new pathogens to fight .
In the case of Covid-19 , the virus can also damage the immune cells that might otherwise overcome the virus .
If there are fewer of these cells to begin with , and they ’ re also weaker than they once were , an illness can do more @ @ @ @ @ @ @ as robust as it is in younger people , ” said Sean Leng , a geriatrician and a professor of medicine at the Johns Hopkins University School of Medicine .
“ Studies over the years have shown that in most people , their immune function is pretty OK in their 60s , or even in their 70s .
The immune functions go down rather quickly after age 75 or 80.
” When a response to infection kicks in , an older person ’ s immune system faces a higher chance of a dangerous @ @ @ @ @ @ @ Cytokines are proteins that serve as signals to the body to ramp up its infection-fighting machinery .
But during a storm , these cytokines are overproduced , which causes severe inflammation , high fever , and organ failure .
In other words , it ’ s not just a sluggish response to infections that can harm older adults ; the immune system ’ s overreaction to an invader can also kill , Leng said .
“ The cause of death of this virus is , No .
1 , respiratory failure , and @ @ @ @ @ @ @ cytokine storm.
” The good news , as two doctors at the University of Alabama at Birmingham wrote for Vox , is that we have treatments for cytokine storm syndromes , which could help save a significant number of lives in this outbreak .
Older people also have a higher prevalence of chronic disease The longer we live , the more likely our cells are to replicate in dangerous ways , the more damage they accumulate , and the more likely our organs are to stop functioning normally .
This puts us at @ @ @ @ @ @ @ , like cancer or diabetes .
Along with already weakened immune systems , these underlying diseases can also make it harder for the body to ward off infections .
The takeaway : It ’ s not just age alone that endangers people ; it ’ s being older with one or more chronic diseases .
Among the 105 patients who had died in Italy as of March 4 , two-thirds had three or more preexisting conditions .
The most common was hypertension , followed by ischemic heart disease and diabetes mellitus .
These @ @ @ @ @ @ @ more vulnerable to infection .
Additionally , the treatments for these conditions can suppress the immune system , leaving the body susceptible to pathogens .
In a World Health Organization report on China ’ s outbreak , the case fatality rate in people who reported no chronic diseases was 1.4 % but it shot up in groups with these conditions : “ 13.2 % for those with cardiovascular disease , 9.2 % for diabetes , 8.4 % for hypertension , 8.0 % for chronic respiratory disease , and 7.6 % for cancer.
” @ @ @ @ @ @ @ in The Lancet , found that nearly half of the 191 hospitalized patients in the sample had another underlying illness .
“ These people are dying of an inflammatory process in their lungs .
It ’ s not an infectious process , like a bacterial or viral infection .
It ’ s inflammatory , like we see with SARS , ” said Bruce Aylward .
who led the WHO mission to China that produced the report .
The Chinese data echoed the Italian findings .
It showed , Aylward said , “ the @ @ @ @ @ @ @ cancer was half compared to hypertension and cardiovascular disease .
Diabetes is a little bit lower than those two , and cancer lower again.
” It ’ s not clear why Covid-19 is especially risky for people with these diseases .
But in general , respiratory diseases can be especially dangerous in people with cardiovascular disease .
When the lungs don ’ t function properly , the heart has to work even harder .
Researchers have also known that diabetes can cause damage to the nervous system and impair the body ’ s @ @ @ @ @ @ @ Meanwhile , conditions like high blood sugar associated with diabetes can also suppress immune cells .
There are other problems associated with aging that play a role here as well .
Older people may be less efficient at coughing and sneezing , making it harder for them to clear the Covid-19 virus , which infects the airways .
Accumulated lung damage in older adults from habits like smoking or breathing polluted air can further increase vulnerability so when Covid-19 strikes , it can lead to problems like severe pneumonia .
On the other @ @ @ @ @ @ @ a minority of older adults who are facing the most severe consequences of Covid-19 .
Many have recovered , and older people in otherwise good health will likely survive the infection , Leng said .
“ If you have a strong immune system to begin with , you can most likely fight against the virus.
” Beyond physiology , how society treats older adults plays a big role in their risk from diseases like Covid-19 .
At the same time , measures like social distancing and quarantines remain our most effective tactics for @ @ @ @ @ @ @ .
“ Right now there isn ’ t a vaccine , so we have to start thinking about other ways that people can be protected , ” said Julie Masters , chair of the department of gerontology at the University of Nebraska Omaha .
( Geriatrics is the clinical specialty for treating the elderly ; gerontology is the scientific study of aging . )
But there are trade-offs with distancing tactics , particularly for isolated older adults , as Vox ’ s Ezra Klein observed about a major National Academies of Sciences report @ @ @ @ @ @ @ : Conversely , researchers have found that robust social networks and interactions improve health for older adults .
“ We know that when people are more integrated socially , when they have people in their life , when they have a sense of meaning and purpose , that ’ s good for their overall well-being , their overall health , ” Masters said .
That ’ s creating a difficult situation for older people who need protection from diseases like Covid-19 but may already be quite isolated .
So the concern here isn @ @ @ @ @ @ @ get sick ; it ’ s people who will experience a drop in their quality of life in response to the outbreak .
Another issue is how older adults interact with the health care system .
As noted earlier , age tends to bring more chronic illnesses , which in turn demand more frequent health interventions or ongoing treatment in places like nursing homes .
“ With our most frail , most ill older adults , it ’ s not just that they ’ re older and they have a compromised immune system @ @ @ @ @ @ @ times they are in situation that put them at risk , in terms of congregate living , ” said Elaine Eshbaugh , a professor of gerontology at the University of Northern Iowa .
“ They [ may ] live in a nursing home where if something like [ Covid-19 ] happens , it takes off like wildfire.
” We saw this happen at the Life Care Center in Kirkland , Washington , where Covid-19 infected 50 residents and killed 23 patients .
The Centers for Disease Control and Prevention has now put out @ @ @ @ @ @ @ care facilities to deal with the outbreak .
“ Given their congregate nature and residents served ( e.g.
, older adults often with underlying chronic medical conditions ) , nursing home populations are at the highest risk of being affected by COVID-19 , ” according to the CDC ’ s website .
“ If infected with SARS-CoV-2 , the virus that causes COVID-19 , residents are at increased risk of serious illness.
” But these measures to limit the spread of Covid-19 can also hamper care for other chronic illnesses among older adults @ @ @ @ @ @ @ care start to keep their distance .
“ As a virus like this becomes prevalent , it may not be that [ older adults ] get sick , it may be that the person who comes into their home to care for them every day has a cough and stays home , ” Eshbaugh said .
Older adults may face the greatest risks , but the Covid-19 outbreak affects everyone While the majority of the people infected by Covid-19 will survive , there will be significant ripple effects if large numbers of older @ @ @ @ @ @ @ the disease .
That ’ s particularly true in the United States , where the population as a whole is getting older : There are almost 50 million Americans over the age of 65 and their ranks are rapidly growing .
These people are our co-workers , employers , friends , family , caretakers , and educators .
They are major contributors to our economy and our social fabric , providing value beyond what ’ s captured by economic metrics like GDP .
Only about 5 percent of seniors in the US live @ @ @ @ @ @ @ the vast majority , even those with chronic illnesses , are living on their own or with family while going about their normal lives .
And right now , the leading contenders for the White House are all in their 70s .
That means that everyone has to work together to control the spread of Covid-19 , and we all stand to suffer if we don ’ t .
Younger people can limit the infection ’ s spread to the more vulnerable with good hygiene , self-isolating when they ’ re sick , @ @ @ @ @ @ @ can avoid getting the virus and passing it along to their older family members .
This is particularly important for Covid-19 since people can transmit the virus before experiencing any symptoms .
And we ’ re still learning about the dangers of this disease and how quickly it ’ s spreading , so there may be other groups at risk that we don ’ t yet understand .
Some of the factors that put older adults at greatest risk are not unique to them .
Whether you ’ re 75 or 35 , @ @ @ @ @ @ @ the new coronavirus .
Younger people have already fallen ill and have died from Covid-19 , though they make up a much smaller share of the afflicted .
However , the potential damage from this virus could be immense : More than 10 million Americans are immunocompromised , and more than 100 million US adults have diabetes or pre-diabetes .
So the measures we use to protect older adults , both physically and mentally , can help younger people in similar situations .
“ There are young people ... they ’ ve got @ @ @ @ @ @ @ s what puts them at risk ” from Covid-19 , Masters said .
This outbreak is also an opportunity to rethink and strengthen our personal health and social infrastructure .
“ This may be a wake-up call to us to think about our own aging and what can I do to make sure I ’ m in the best health possible , ” Masters said .
“ Meaning , am I getting a good diet ?
Am I exercising ?
Do I have people in my life ?
Do I have social connections @ @ @ @ @ @ @ healthy.
” But at a time when people are being forced apart — with offices closing , conferences being canceled , students staying home , gyms shutting down , and individuals isolating themselves — those social connections are becoming harder to maintain.We ’ ll need to make active efforts to stay in touch , for our own health , and for those around us .

Even before the Covid-19 coronavirus reached more than 100 countries around the world, early data from China — where the outbreak started — suggested that older adults were the most vulnerable to the worst effects of the disease.
Now, that data, along with emerging research from Italy — the second-most-affected country in the world — is showing just how dangerous Covid-19 is for older people, and others with with heart, lung, and immunological conditions.
In Italy, a country with one of the world’s oldest populations, a March 4 analysis by the national health institute found that of the 105 patients who died from the virus, the average age was 81. This put a 20-year gap between the average age of people who tested positive for the virus and the deceased, the institute said. On Friday, an ICU physician in Lombardy — the epicenter of Italy’s outbreak — told JAMA there have been only two deaths of people under the age of 50.
This finding squared with some of the other best data on the risks of the new respiratory disease, from China’s Center for Disease Control. In a late February report, researchers looked at the first 72,314 patients with confirmed or suspected Covid-19 and discovered a huge variation in the case fatality rate by age group. In short, the disease appears to be deadlier in people with each passing decade.
Age, however, doesn’t tell the whole story about who is at risk of severe disease. In fact, it reveals the underlying vulnerabilities in the wider population to an illness like Covid-19. Many of these factors are concentrated among older adults, but younger people with certain underlying health problems are also at risk. (Sixty percent of Americans have at least one chronic condition; 40 percent have more than one.)
The lessons we learn from older patients could help us treat and prevent the spread. That makes it all the more important to understand the variables that put older adults at greatest risk so we can develop a strategy to protect society as a whole.
Immune function declines with age. That makes us more susceptible to more severe illness.
As we age, the systems our bodies use to fight disease wear down. Not only does the body have a harder time fighting off new infections like Covid-19; it’s also more likely to be afflicted by chronic diseases that make the immune system weaker.
Let’s walk through the first part: how our bodies get worse at fighting foreign invaders, including viruses like SARS-CoV-2, which causes Covid-19.
In older adults, the number of white blood cells that find and help eliminate infections can decline. The cells also become less adept at identifying new pathogens to fight. In the case of Covid-19, the virus can also damage the immune cells that might otherwise overcome the virus. If there are fewer of these cells to begin with, and they’re also weaker than they once were, an illness can do more damage.
“Immune function is not as robust as it is in younger people,” said Sean Leng, a geriatrician and a professor of medicine at the Johns Hopkins University School of Medicine. “Studies over the years have shown that in most people, their immune function is pretty okay in their 60s, or even in their 70s. The immune functions go down rather quickly after age 75 or 80.”
When a response to infection kicks in, an older person’s immune system faces a higher chance of a dangerous overreaction known as a cytokine storm. Cytokines are proteins that serve as signals to the body to ramp up its infection-fighting machinery.
But during a storm, these cytokines are overproduced, which causes severe inflammation, high fever, and organ failure. In other words, it’s not just a sluggish response to infections that can harm older adults; the immune system’s overreaction to an invader can also kill, Leng said. “The cause of death of this virus is, No. 1, respiratory failure, and then No. 2, probably the cytokine storm.” The good news, as two doctors at the University of Alabama Birmingham wrote for Vox, is that we have treatments for cytokine storm syndrome, which could help save a significant number of lives in this outbreak.
Older people also have a higher prevalence of chronic disease
The longer we live, the more likely our cells are to replicate in dangerous ways, the more damage they accumulate, and the more likely our organs are to stop functioning normally. This puts us at a heightened risk of chronic health conditions, like cancer or diabetes. Along with already weakened immune systems, these underlying diseases can make it harder for the body to ward off infections. The takeaway: It’s not just age alone that endangers people; it’s being older with one or more chronic diseases.
Among the 105 patients who had died in Italy as of March 4, two-thirds had three or more preexisting conditions. The most common was hypertension, followed by ischemic heart disease and diabetes mellitus. These chronic illnesses can leave organs degraded and more vulnerable to infection. Additionally, the treatments for these conditions can suppress the immune system, leaving the body susceptible to pathogens.
In a World Health Organization report on China’s outbreak, the case fatality rate in people who reported no chronic diseases was 1.4 percent, but it shot up in groups with these conditions: “13.2% for those with cardiovascular disease, 9.2% for diabetes, 8.4% for hypertension, 8.0% for chronic respiratory disease, and 7.6% for cancer.”
Another study on China, newly published in The Lancet, found that nearly half of the 191 hospitalized patients in the sample had another underlying illness.
“These people are dying of an inflammatory process in their lungs. It’s not an infectious process, like a bacterial or viral infection. It’s inflammatory, like we see with SARS,” said Bruce Aylward, who led the WHO mission to China that produced the report. He was referring to the fact that SARS — like the new coronavirus — drove some people’s immune systems into overdrive, leading to cytokine storm.
But that immune response seems to be worse in people with underlying health conditions, the Chinese data showed. Aylward said, “the proportion of people who die who had cancer was half compared to hypertension and cardiovascular disease. Diabetes is a little bit lower than those two, and cancer lower again.”
The CDC and the WHO recommend several basic measures to help prevent the spread of Covid-19: Wash your hands often for at least 20 seconds.
Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
Clean and disinfect frequently touched objects.
Practice social distancing, and stay home when you are sick.
Contact a health worker if you have symptoms; fever and a dry cough are most common. Guidance may change. Stay informed, and stay safe, with Vox’s coronavirus coverage hub.
It’s not clear why Covid-19 is especially risky for people with these diseases. But in general, respiratory diseases can be especially dangerous for people with cardiovascular disease.
When the lungs don’t function properly, the heart has to work even harder. Researchers have also known that diabetes can damage the nervous system and impair the body’s efforts to clear infections from lungs. Conditions like high blood sugar associated with diabetes can also suppress immune cells.
There are other problems associated with aging that play a role here as well. Older people may be less efficient at coughing and sneezing, making it harder for them to clear the Covid-19 virus, which infects the airways. Accumulated lung damage in older adults from habits like smoking or breathing polluted air can further increase vulnerability, so when Covid-19 strikes, it can lead to problems like severe pneumonia.
On the other hand, it’s still only a minority of older adults who are facing the most severe consequences of Covid-19. Many have recovered, and older people in otherwise good health will likely survive the infection, Leng said. “If you have a strong immune system to begin with, you can most likely fight against the virus.”
Social factors play a major role in vulnerability to disease
Beyond physiology, how society treats older adults plays a big role in their risk from diseases like Covid-19. At the same time, measures like social distancing and quarantines remain our most effective tactics for shielding the most vulnerable during this outbreak.
“Right now there isn’t a vaccine, so we have to start thinking about other ways that people can be protected,” said Julie Masters, chair of the department of gerontology at the University of Nebraska Omaha. (Geriatrics is the clinical specialty for treating the elderly; gerontology is the scientific study of aging.)
But there are trade-offs with distancing tactics, particularly for isolated older adults, as Vox’s Ezra Klein observed about a major National Academies of Sciences report looking at the health consequences of isolation:
The researchers found that even before the coronavirus, about a quarter of older adults fit the definition of socially isolated — which measures routine social contact — and 43 percent said they felt lonely. You can be socially isolated without reporting feelings of loneliness, and you can be lonely without being socially isolated. But both conditions seem to inflict harm on physical and mental health.
Conversely, researchers have found that robust social networks and interactions improve health for older adults. “We know that when people are more integrated socially, when they have people in their life, when they have a sense of meaning and purpose, that’s good for their overall well-being, their overall health,” Masters said.
That’s creating a difficult situation for older people who need protection from diseases like Covid-19 but may already be quite isolated. So the concern here isn’t just older people who may get sick; it’s people who will experience a drop in their quality of life in response to the outbreak.
Another issue is how older adults interact with the health care system. As noted earlier, age tends to bring more chronic illnesses, which in turn demand more frequent health interventions or ongoing treatment in places like nursing homes.
“With our most frail, most ill older adults, it’s not just that they’re older and they have a compromised immune system, it’s also that many times they are in situations that put them at risk, in terms of congregate living,” said Elaine Eshbaugh, a professor of gerontology at the University of Northern Iowa. “They [may] live in a nursing home where if something like [Covid-19] happens, it takes off like wildfire.”
We saw this happen at the Life Care Center in Kirkland, Washington, where Covid-19 infected 50 residents and killed 23 patients. The Centers for Disease Control and Prevention has now put out additional guidance for nursing homes and long-term care facilities to deal with the outbreak.
“Given their congregate nature and residents served (e.g., older adults often with underlying chronic medical conditions), nursing home populations are at the highest risk of being affected by COVID-19,” according to the CDC’s website. “If infected with SARS-CoV-2, the virus that causes COVID-19, residents are at increased risk of serious illness.”
But these measures to limit the spread of Covid-19 can also hamper care for other chronic illnesses among older adults, particularly as the people providing the care start to keep their distance. “As a virus like this becomes prevalent, it may not be that [older adults] get sick, it may be that the person who comes into their home to care for them every day has a cough and stays home,” Eshbaugh said.
Older adults may face the greatest risks, but the Covid-19 outbreak affects everyone
While the majority of the people infected by Covid-19 will survive, there will be significant ripple effects if large numbers of older adults get very ill or die from the disease.
That’s particularly true in the United States, where the population as a whole is getting older: There are almost 50 million Americans over the age of 65, and their ranks are growing rapidly. These people are our coworkers, employers, friends, family, caretakers, and educators. They are major contributors to our economy and our social fabric, providing value beyond what’s captured by economic metrics like GDP.
Only about 5 percent of seniors in the US live in assisted care facilities, which means the vast majority, even those with chronic illnesses, are living on their own or with family while going about their normal lives. And right now, the leading contenders for the White House are all in their 70s.
That means that everyone has to work together to control the spread of Covid-19, and we all stand to suffer if we don’t. Younger people can limit the infection’s spread to the more vulnerable with good hygiene, self-isolating when they’re sick, and practicing social distancing measures so they can avoid getting the virus and passing it along to their older family members. This is particularly important for Covid-19 since people can transmit the virus before experiencing any symptoms. And we’re still learning about the dangers of this disease and how quickly it’s spreading, so there may be other groups at risk that we don’t yet understand.
Some of the factors that put older adults at greatest risk are not unique to them. Whether you’re 75 or 35, chronic illnesses worsen outcomes from infections like the new coronavirus. Younger people have already fallen ill and have died from Covid-19, though they make up a much smaller share of the afflicted.
However, the potential damage from this virus could be immense: More than 10 million Americans are immunocompromised, and more than 100 million US adults have diabetes or prediabetes. So the measures we use to protect older adults, both physically and mentally, can help younger people in similar situations. “There are young people ... they’ve got those underlying conditions, and that’s what puts them at risk” from Covid-19, Masters said.
This outbreak is also an opportunity to rethink and strengthen our personal health and social infrastructure. “This may be a wake-up call to us to think about our own aging and what can I do to make sure I’m in the best health possible,” Masters said. “Meaning, am I getting a good diet? Am I exercising? Do I have people in my life? Do I have social connections? All those things can keep us healthy.”
But at a time when people are being forced apart — with offices closing, conferences being canceled, students staying home, gyms shutting down, and individuals isolating themselves — those social connections are becoming harder to maintain. We’ll need to make active efforts to stay in touch, for our own health, and for those around us.


vox--2020-03-12--Democrats have a new coronavirus relief package. Here’s what’s in it.

House Democrats released their coronavirus economic relief bill late Wednesday night , as layoffs related to the outbreak were reported .
But the timing of when they ’ ll vote on it is still up in the air nearly 24 hours later .
House Speaker Nancy Pelosi had been negotiating the text of the bill with Treasury Secretary Steven Mnuchin throughout the day on Thursday .
The two had their fifth phone call shortly before 4 pm , her spokesperson said .
( This piece will be updated as negotiations on the bill continue . )
The new multibillion-dollar bill @ @ @ @ @ @ @ designed to assist working people and families dealing with the virus — including free coronavirus testing , paid sick leave , and expanded unemployment benefits for those laid off related to the virus .
Provisions in the bill expanding food assistance alone would cost $ 1 billion ; a Congressional Budget Office score is expected .
“ It will be in the billions , and I won ’ t go beyond that , but it will be costly , ” House Majority Leader Steny Hoyer ( D-MD ) told reporters of the bill @ @ @ @ @ @ @ this : It will be much more costly if we don ’ t provide relief.
” ( For context , the federal government ’ s discretionary spending was well over $ 1 trillion last year . )
The impasse between Republicans and Democrats on the bill centers on two things ; Republicans don ’ t like a provision in the relief bill that would establish a permanent paid sick leave program , and Democrats are pushing back on Republicans wanting to add language referencing the Hyde amendment , which bans federal funds being @ @ @ @ @ @ @ the House was initially planning to vote on the bill Thursday , it ’ s unclear whether a vote will happen Thursday night or get pushed to Friday .
The Senate has canceled its planned recess to stay in Washington and work on the legislation .
“ I think it ’ s possible tonight .
If we can ’ t get it done tonight , we ’ ll get it done tomorrow , ” Hoyer told reporters after leaving Pelosi ’ s office Thursday afternoon .
“ I think everybody feels a sense @ @ @ @ @ @ @ ’ t make it was President Donald Trump ’ s big ask : a payroll tax cut , which Hoyer called a “ nonstarter ” Wednesday .
There was near-universal Democratic opposition to the payroll tax cut , which would likely benefit only companies and a subset of workers .
Even members of Trump ’ s party expressed skepticism about the president ’ s idea , saying they ’ re not sure it would be effective .
House Democrats are also putting on the pressure on paid sick leave .
Senate Democrats released @ @ @ @ @ @ @ Wednesday ( something that ’ s in the House bill as well ) .
Both proposals stand at odds with the White House plan to target economic relief like low interest rates toward specific industries , including travel and hotel industries as well as oil and gas companies , the Washington Post ’ s Jeff Stein reported .
Getting the bill over the finish line will mean a sorting of priorities .
Democrats want to make sure cost doesn ’ t impede workers from getting the health care they need and that taking @ @ @ @ @ @ @ ’ t a problem .
Republicans seem more preoccupied with stabilizing the economy , and Senate Majority Leader Mitch McConnell panned the bill as “ an ideological wish list that was not closely tailored to the circumstances , ” according to New York Times reporter Carl Hulse .
The growing coronavirus threat could be a good motivator for bipartisan cooperation , especially as the stock market had another precipitous drop Thursday .
Unlike a lot of partisan fights , this one could be more about when — not if — this bill will @ @ @ @ @ @ @ passed an $ 8.3 billion supplemental bill designed to boost the US public health response to the coronavirus .
While this one is focused on shoring up the economy , it has a serious public health component as well .
“ We ’ ll have to worry about the costs at some point in time , ” Hoyer said Wednesday .
“ This is an emergency ; we need to get this done.
” Even though this is an economy-focused bill , Democrats have been clear it ’ s also about public health @ @ @ @ @ @ @ are no cost barriers to getting tested if families are uninsured or underinsured , and that workers who might have contracted the coronavirus don ’ t feel the need to keep working , thereby spreading the disease to others .
Pelosi and Senate Minority Leader Chuck Schumer blasted Trump for not mentioning coronavirus testing in his Wednesday night address announcing a partial travel ban for European nationals coming to the US , which contained multiple errors .
“ Alarmingly , the president did not say how the administration will address the lack of @ @ @ @ @ @ @ , ” Pelosi and Schumer said in their joint statement .
“ We urge Republicans in the House and Senate to help immediately pass the Families First Coronavirus Response Act.
” • Emergency paid sick days : The bill would require all employers to accrue seven days of paid sick leave , and provide an additional 14 days to be available immediately during the coronavirus ( many employers are asking employees to work from home for that amount of time ) .
It ensures sick leave to those impacted by quarantine orders , @ @ @ @ @ @ @ care for their children .
The bill reimburses small businesses ( those with 50 or fewer employees ) for the cost of the 14 additional days of leave .
• Emergency paid leave : The bill would create a new federal emergency paid leave program for those unable to work because they either have Covid-19 , are quarantined , are caring for someone with the disease , or are caring for a child due to coronavirus-related school closings .
Eligible workers would receive benefits for a month ( the program goes up to @ @ @ @ @ @ @ amount would be two-thirds of the individual ’ s average monthly earnings .
Those receiving pay or unemployment compensation directly through their employers aren ’ t eligible .
There is some precedent for this : Congress expanded unemployment benefits for up to 99 weeks for Americans left unemployed by the 2008 financial crisis .
• Expanding food security : The bill would direct $ 1 billion to expanding access to programs like WIC and the emergency food assistance program throughout the coronavirus pandemic .
Progressive economists have long believed that expanding existing safety @ @ @ @ @ @ @ of stimulating the economy because the low-income people who benefit from them are highly likely to immediately spend any extra money they get — helping stabilize economy-wide demand .
The 2009 stimulus bill featured many provisions along these lines .
Conservatives , who are critical of those programs in general , tend to be highly skeptical of putting more money into them .
• Free coronavirus testing : Democratic leaders propose making coronavirus testing free to increase access by requiring private health insurers ( plus government programs like Medicare and Medicaid ) to @ @ @ @ @ @ @ emergency room visits and doctor fees in the process .
Free testing is being offered in a number of states , but there ’ s no federal regulation mandating it so far .
• Increasing the capacity of the US medical system and ensuring affordable treatment : The bill also calls on insurance providers to reimburse coronavirus patients for any non-covered costs related to Covid-19 .
Again , they ’ re hoping this gets more people treated and makes it so people don ’ t put off going to the doctor because they @ @ @ @ @ @ @ next House members were supposed to vote on the bill Thursday before flying out for a previously scheduled district work period ; as of right now , the recess is still on , though potentially delayed until Friday morning or afternoon .
Once the House passes the bill , the Senate could vote on it soon after .
McConnell announced the Senate would cancel its recess next week , but it needs to act fast for another reason — Sens .
Lindsey Graham ( R-SC ) and Rick Scott ( R-FL ) — @ @ @ @ @ @ @ to the coronavirus .
With reports of new coronavirus-related layoffs and a rising number of cases , there ’ s increased incentive for Senate Republicans to vote for the bill .
But whether they support it will likely come down to whether President Trump does , McConnell said Monday .
“ The secretary of the Treasury is going to have control for the administration , and I expect that will speak for us as well , ” McConnell said .
“ We ’ re hoping he and the speaker pull this together so @ @ @ @ @ @ @ games at a time which seems to me to cry out for bipartisan , bicameral agreement.
” Though early reports suggested Trump would go along with the House bill , Republicans registered their opposition to it Thursday morning .
However , negotiations on the bill between Pelosi and Mnuchin are ongoing , and Pelosi sounded optimistic that a deal would happen at her press conference Thursday morning .
There ’ s plenty of incentive to act as fast as possible .
Congress realizes they have a fast-growing national crisis on their hands , @ @ @ @ @ @ @ some assurance from the government .

House Democrats released their coronavirus economic relief bill late Wednesday night, as layoffs related to the outbreak were reported. But the timing of when they’ll vote on it is still up in the air nearly 24 hours later.
House Speaker Nancy Pelosi had been negotiating the text of the bill with Treasury Secretary Steven Mnuchin throughout the day on Thursday. The two had their fifth phone call shortly before 4 pm, her spokesperson said. (This piece will be updated as negotiations on the bill continue.)
The new multibillion-dollar bill contains a number of emergency economic measures designed to assist working people and families dealing with the virus — including free coronavirus testing, paid sick leave, and expanded unemployment benefits for those laid off related to the virus. Provisions in the bill expanding food assistance alone would cost $1 billion; a Congressional Budget Office score is expected.
“It will be in the billions, and I won’t go beyond that, but it will be costly,” House Majority Leader Steny Hoyer (D-MD) told reporters of the bill. “But I will tell you this: It will be much more costly if we don’t provide relief.” (For context, the federal government’s discretionary spending was well over $1 trillion last year.)
The impasse between Republicans and Democrats on the bill centers on two things; Republicans don’t like a provision in the relief bill that would establish a permanent paid sick leave program, and Democrats are pushing back on Republicans wanting to add language referencing the Hyde amendment, which bans federal funds being used to pay for abortions.
Though the House was initially planning to vote on the bill Thursday, it’s unclear whether a vote will happen Thursday night or get pushed to Friday. The Senate has canceled its planned recess to stay in Washington and work on the legislation.
“I think it’s possible tonight. If we can’t get it done tonight, we’ll get it done tomorrow,” Hoyer told reporters after leaving Pelosi’s office Thursday afternoon. “I think everybody feels a sense of urgency.”
One thing that didn’t make it was President Donald Trump’s big ask: a payroll tax cut, which Hoyer called a “nonstarter” Wednesday. There was near-universal Democratic opposition to the payroll tax cut, which would likely benefit only companies and a subset of workers. Even members of Trump’s party expressed skepticism about the president’s idea, saying they’re not sure it would be effective. House Democrats are also putting on the pressure on paid sick leave.
Senate Democrats released their own plan for paid sick leave Wednesday (something that’s in the House bill as well). Both proposals stand at odds with the White House plan to target economic relief like low interest rates toward specific industries, including travel and hotel industries as well as oil and gas companies, the Washington Post’s Jeff Stein reported.
Getting the bill over the finish line will mean a sorting of priorities. Democrats want to make sure cost doesn’t impede workers from getting the health care they need and that taking time off from work to quarantine isn’t a problem. Republicans seem more preoccupied with stabilizing the economy, and Senate Majority Leader Mitch McConnell panned the bill as “an ideological wish list that was not closely tailored to the circumstances,” according to New York Times reporter Carl Hulse.
The growing coronavirus threat could be a good motivator for bipartisan cooperation, especially as the stock market had another precipitous drop Thursday. Unlike a lot of partisan fights, this one could be more about when — not if — this bill will be worked out.
Congress last week passed an $8.3 billion supplemental bill designed to boost the US public health response to the coronavirus. While this one is focused on shoring up the economy, it has a serious public health component as well.
“We’ll have to worry about the costs at some point in time,” Hoyer said Wednesday. “This is an emergency; we need to get this done.”
The Democrats’ stimulus bill, explained
Even though this is an economy-focused bill, Democrats have been clear it’s also about public health. They especially want to ensure there are no cost barriers to getting tested if families are uninsured or underinsured, and that workers who might have contracted the coronavirus don’t feel the need to keep working, thereby spreading the disease to others.
Pelosi and Senate Minority Leader Chuck Schumer blasted Trump for not mentioning coronavirus testing in his Wednesday night address announcing a partial travel ban for European nationals coming to the US, which contained multiple errors.
“Alarmingly, the president did not say how the administration will address the lack of coronavirus testing kits throughout the United States,” Pelosi and Schumer said in their joint statement. “We urge Republicans in the House and Senate to help immediately pass the Families First Coronavirus Response Act.”
Here’s what’s in Democrats’ proposal.
Emergency paid sick days: The bill would require all employers to accrue seven days of paid sick leave, and provide an additional 14 days to be available immediately during the coronavirus (many employers are asking employees to work from home for that amount of time). It ensures sick leave to those impacted by quarantine orders, or those who must stay home to care for their children. The bill reimburses small businesses (those with 50 or fewer employees) for the cost of the 14 additional days of leave.
The bill would require all employers to accrue seven days of paid sick leave, and provide an additional 14 days to be available immediately during the coronavirus (many employers are asking employees to work from home for that amount of time). It ensures sick leave to those impacted by quarantine orders, or those who must stay home to care for their children. The bill reimburses small businesses (those with 50 or fewer employees) for the cost of the 14 additional days of leave. Emergency paid leave: The bill would create a new federal emergency paid leave program for those unable to work because they either have Covid-19, are quarantined, are caring for someone with the disease, or are caring for a child due to coronavirus-related school closings. Eligible workers would receive benefits for a month (the program goes up to three months), and the benefit amount would be two-thirds of the individual’s average monthly earnings. Those receiving pay or unemployment compensation directly through their employers aren’t eligible. There is some precedent for this: Congress expanded unemployment benefits for up to 99 weeks for Americans left unemployed by the 2008 financial crisis.
The bill would create a new federal emergency paid leave program for those unable to work because they either have Covid-19, are quarantined, are caring for someone with the disease, or are caring for a child due to coronavirus-related school closings. Eligible workers would receive benefits for a month (the program goes up to three months), and the benefit amount would be two-thirds of the individual’s average monthly earnings. Those receiving pay or unemployment compensation directly through their employers aren’t eligible. There is some precedent for this: Congress expanded unemployment benefits for up to 99 weeks for Americans left unemployed by the 2008 financial crisis. Expanding food security: The bill would direct $1 billion to expanding access to programs like WIC and the emergency food assistance program throughout the coronavirus pandemic. Progressive economists have long believed that expanding existing safety net programs is a highly effective way of stimulating the economy because the low-income people who benefit from them are highly likely to immediately spend any extra money they get — helping stabilize economy-wide demand. The 2009 stimulus bill featured many provisions along these lines. Conservatives, who are critical of those programs in general, tend to be highly skeptical of putting more money into them.
The bill would direct $1 billion to expanding access to programs like WIC and the emergency food assistance program throughout the coronavirus pandemic. Progressive economists have long believed that expanding existing safety net programs is a highly effective way of stimulating the economy because the low-income people who benefit from them are highly likely to immediately spend any extra money they get — helping stabilize economy-wide demand. The 2009 stimulus bill featured many provisions along these lines. Conservatives, who are critical of those programs in general, tend to be highly skeptical of putting more money into them. Free coronavirus testing: Democratic leaders propose making coronavirus testing free to increase access by requiring private health insurers (plus government programs like Medicare and Medicaid) to cover the cost of testing, including emergency room visits and doctor fees in the process. Free testing is being offered in a number of states, but there’s no federal regulation mandating it so far.
Democratic leaders propose making coronavirus testing free to increase access by requiring private health insurers (plus government programs like Medicare and Medicaid) to cover the cost of testing, including emergency room visits and doctor fees in the process. Free testing is being offered in a number of states, but there’s no federal regulation mandating it so far. Increasing the capacity of the US medical system and ensuring affordable treatment: The bill also calls on insurance providers to reimburse coronavirus patients for any non-covered costs related to Covid-19. Again, they’re hoping this gets more people treated and makes it so people don’t put off going to the doctor because they are worried about costs.
What happens next
House members were supposed to vote on the bill Thursday before flying out for a previously scheduled district work period; as of right now, the recess is still on, though potentially delayed until Friday morning or afternoon. Once the House passes the bill, the Senate could vote on it soon after.
McConnell announced the Senate would cancel its recess next week, but it needs to act fast for another reason — Sens. Lindsey Graham (R-SC) and Rick Scott (R-FL) — are in self-quarantine after potentially being exposed to the coronavirus.
With reports of new coronavirus-related layoffs and a rising number of cases, there’s increased incentive for Senate Republicans to vote for the bill. But whether they support it will likely come down to whether President Trump does, McConnell said Monday.
“The secretary of the Treasury is going to have control for the administration, and I expect that will speak for us as well,” McConnell said. “We’re hoping he and the speaker pull this together so that we’re not playing partisan games at a time which seems to me to cry out for bipartisan, bicameral agreement.”
Though early reports suggested Trump would go along with the House bill, Republicans registered their opposition to it Thursday morning. However, negotiations on the bill between Pelosi and Mnuchin are ongoing, and Pelosi sounded optimistic that a deal would happen at her press conference Thursday morning.
There’s plenty of incentive to act as fast as possible. Congress realizes they have a fast-growing national crisis on their hands, and panicked stock markets are looking for some assurance from the government.


vox--2020-03-12--Watch: Delhi’s deadly riots, explained by an expert

On December 11 , 2019 , India ’ s parliament passed a controversial new law : the Citizenship Amendment Act .
The law fast-tracks citizenship for migrants from three neighboring countries , specifically if they are Hindus , Sikhs , Buddhists , Jains , Parsis , or Christians .
It conspicuously leaves out Muslims .
Since the law was passed , it ’ s drawn widespread opposition and protests , and not only because it discriminates against Muslims .
The law is also closely linked to another controversial initiative : the National Registry of Citizens , a citizenship list that @ @ @ @ @ @ @ primarily Muslims , stateless .
So far , only the northeastern state of Assam has implemented the NRC .
In August 2019 , the government of Assam published a citizenship list that left off nearly 2 million residents .
And without the citizenship fast-track that the Citizenship Amendment Act grants other religions , the Muslims left off that list are at risk of losing their citizenship entirely .
To understand the law , the national registry of citizens , the controversy they ’ ve ignited , and what might happen next , watch @ @ @ @ @ @ @ director of the South Asia Program at Carnegie Endowment for International Peace .
You can find this video and all of Vox ’ s videos on YouTube .
And if you ’ re interested in supporting our video journalism , you can become a member of the Vox Video Lab on YouTube .
Correction : An earlier version of this story misstated the number of Muslims left off the National Register of Citizens in Assam .
The nearly 2 million people left off the NRC included people of all religions .

On December 11, 2019, India’s parliament passed a controversial new law: the Citizenship Amendment Act. The law fast-tracks citizenship for migrants from three neighboring countries, specifically if they are Hindus, Sikhs, Buddhists, Jains, Parsis, or Christians. It conspicuously leaves out Muslims.
Since the law was passed, it’s drawn widespread opposition and protests, and not only because it discriminates against Muslims. The law is also closely linked to another controversial initiative: the National Registry of Citizens, a citizenship list that could potentially leave millions of people, primarily Muslims, stateless.
So far, only the northeastern state of Assam has implemented the NRC. In August 2019, the government of Assam published a citizenship list that left off nearly 2 million residents. And without the citizenship fast-track that the Citizenship Amendment Act grants other religions, the Muslims left off that list are at risk of losing their citizenship entirely.
To understand the law, the national registry of citizens, the controversy they’ve ignited, and what might happen next, watch the video above featuring Milan Vaishnav, director of the South Asia Program at Carnegie Endowment for International Peace.
You can find this video and all of Vox’s videos on YouTube. And if you’re interested in supporting our video journalism, you can become a member of the Vox Video Lab on YouTube.
Correction: An earlier version of this story misstated the number of Muslims left off the National Register of Citizens in Assam. The nearly 2 million people left off the NRC included people of all religions.


vox--2020-03-12--A conservative activist is under fire for calling out Republicans on coronavirus spread

During the last week of February , a man attended the annual Conservative Political Action Conference in National Harbor , Maryland , a yearly get together of conservative media figures and Republican officials — including Donald Trump , Mike Pence and other senior administration members .
The man held a gold-level ticket to the event that gave him access to private areas and receptions with Republican Congress members and high-level guests .
Just days later , the man alerted organizers of the conference that he had tested positive for the novel coronavirus , leading multiple members of Congress to self-quarantine @ @ @ @ @ @ @ of Congress were informed about potential exposure to the virus almost immediately , attendees of the conference more generally were not .
That led Raheem Kassam , a conservative writer and former Breitbart editor who began feeling ill at the event , to begin tweeting about his own potential exposure to coronavirus and raising the concerns of other CPAC attendees .
In response , Matt Schlapp , chair of the American Conservative Union ( which puts on CPAC ) , told Yahoo News that Kassam was causing “ a near panic ” and @ @ @ @ @ @ @ ’ t selected as a speaker at the conference .
“ I ’ m sorry that Raheem was not included on our speaker schedule , and I ’ m sorry that he has a bone to pick with us .
But using a health care moment where people are worried , to use that to try to stick a stake in my heart , was a mistake .
... And I think the conservatives who have acted irresponsibly here , I hold them in the same contempt as I hold reporters who are @ @ @ @ @ @ @ political deal.
” Schlapp ’ s view of both the potential exposure of thousands of CPAC attendees to coronavirus and Kassam ’ s decision to tweet about his concerns reflects a greater tension — one between conservatives who believe the pandemic is overblown ( or an effort to subvert Trump ’ s presidency ) and others who think that politics is being permitted to shape messaging on the virus and its potential impact .
I spoke with Kassam on Thursday as he waits for the results of his coronavirus test .
This interview @ @ @ @ @ @ @ .
How are you feeling ?
I ’ m more or less recovered .
I mean , it ’ s been now , what , 11 days , which is ridiculous .
They still don ’ t know what it is .
I mean , I tested negative for flu and for H1N1 and other stuff .
The Covid-19 test is still out .
They ’ re now telling me there may even be a delay , another day delay , to get the results , so now I ’ m just quarantined @ @ @ @ @ @ @ you were at CPAC , were there people who were taking precautions [ regarding coronavirus ] with handshaking or anything like that that you saw ?
Yeah , a lot of people were sort of cognizant of that .
A lot of people were doing fist bumps and elbow bumps .
To the American Conservative Union ( ACU ) ’ s credit , not that I should be giving them much credit after the way they ’ d been treating me , but there was hand sanitizer absolutely everywhere , and people were @ @ @ @ @ @ @ many people as I would have liked to have been using them , by the way , and I was using them nonstop , but people were using them .
And by the way , that ’ s pretty new to CPAC .
I ’ ve been going to CPAC for 10 years .
I ’ ve never seen that before .
So yeah , there were precautions being taken .
But at the same time , Jane , especially after the day ’ s events , you might be good during the @ @ @ @ @ @ @ around networking or whatever .
[ But ] you go down to the pub and you have a couple of drinks , people soon forget , you know ?
And people are hugging and they ’ re kissing and high-fiving , your typical revelry , right ?
I mean , that ’ s just anecdotal , but it is a thing .
And when did you start coming down with symptoms of something flu-like or just feeling unwell ?
On the Monday I was at CPAC .
I was at a dinner , @ @ @ @ @ @ @ on the Monday evening , and I arrived early and I sat down at the bar waiting , and I just developed this extraordinary headache .
And I ’ m not a headache guy .
I ’ m always hydrated , I ’ ve never had migraines or anything like that .
I quickly realized that something was wrong .
I got myself through dinner , went home as quickly as possible , and basically just got in bed .
Over the course of that night and into the morning , I developed @ @ @ @ @ @ @ the morning , I had full body aches , bunged-up sinuses , congestion , all of that and it felt like a flu .
Then I started to get a fever .
Thursday was especially rough .
I was having to wash my sheets twice a day because of being bedridden , but also just sweating through your sheets all the time .
I ’ ve never really had anything like that , so I really started to sort of question what the heck was going on .
Really ramped up my medications @ @ @ @ @ @ @ Friday , Saturday , the stories [ about a CPAC attendee testing positive for coronavirus ] started to come out .
And I was like , “ Well , hold on a minute .
We ’ re now a week out of CPAC , how didn ’ t we know about this immediately ?
” When did you start asking questions about your own potential exposure to coronavirus ?
I think the gentleman was hospitalized on Wednesday or Thursday , and so we didn ’ t hear about it until Saturday .
So @ @ @ @ @ @ @ What was going on ?
Who was in touch with him ?
Who was he ?
Where was he ?
” And it just became abundantly clear that nobody could get answers out of the ACU .
That Sen. Ted Cruz and Rep. Paul Gosar and Rep. Kevin McCarthy were being given information , but the rest of us , including people who were in the green areas , in the backstage areas , were not being given information .
So a bunch of us , which includes current CPAC speakers from this @ @ @ @ @ @ @ all had long phone calls over the weekend .
And then we finally pieced together a timeline and areas in which the guy looks like he would have been , where he would have had to have been for it to make sense that CPAC were putting out certain information about certain speakers , and that only certain speakers were self-quarantining .
And so I tweeted all of that .
Obviously , [ ACU chair ] Matt Schlapp and his gang lost their shit .
But I turned out to be right about @ @ @ @ @ @ @ I decided to start to seek a test , Rep. Matt Gaetz and all these others , who were originally told that they didn ’ t have a problem , and that they didn ’ t meet this guy , they were then told afterwards , “ Actually , yeah , you did.
” The guy was at the congressional reception with all the congressmen , and was there all of the Thursday and at the [ CPAC ] Shabbat dinner , and so on and so forth .
He was all over @ @ @ @ @ @ @ So I spent all day on Tuesday on the phone trying to get a test , DOH , CDC , CDC National , all the local urgent care clinics , hospitals , etc.
, etc.
, and everybody was just sending me round and round in circles .
So eventually , what I did , I got a phone call that evening from a friend of mine and he said , “ Look , I ’ ve been following your struggles to get tests .
I ’ ve made some calls to some @ @ @ @ @ @ @ the best bet is to walk into an emergency room with a mask on and just immediately tell somebody , ‘ Hey , I may have had community exposure .
I want to get a test.
’ ” So that ’ s why I did the next morning .
Early morning , I went to Georgetown University Hospital ’ s emergency room .
I walked in in my mask .
I told them in two sentences exactly why I was there .
They immediately ushered me into a side room , closed door @ @ @ @ @ @ @ the tests over the course of the next five hours .
They said I did the right thing in going in I was also the first person that this doctor on call had tested and now I ’ m just awaiting the test results .
They told me to go home , quarantine , drink lots of fluids and take lots of Tylenol .
So the response from the ACU , from both Matt Schlapp and from [ ACU spokesperson ] Ian Walters has been “ Parlor games and trafficking in rumors is @ @ @ @ @ @ @ a little bit about your thoughts of how the ACU responded when you first had these concerns and how that response has changed over the last few days ?
Well , at first , it was minimal information to a minimal number of people .
And as it became clear that actually a lot of these people had then gone on to interact with the president , had [ been ] on Air Force One , [ were ] at Mar-a-Lago on the weekend , I think they started to realize that , @ @ @ @ @ @ @ bit more forthcoming with information .
Now look , I don ’ t know what was happening internally with them .
Information may not have been flowing them from the sick man and the family of the sick man in good time .
But that should have been communicated with people .
I mean , you have 10,000 people in a conference area like that , and given what we know about the virus now and its proclivity to last on surfaces for hours and hours ... Look , what I don ’ @ @ @ @ @ @ @ Saturday when they found out , they didn ’ t just send out an email to every single person who attended CPAC to say , “ Look , we ’ ve had a report about a person who ’ s been tested positive .
It ’ s not a reason to panic .
It ’ s not a reason for alarm .
Here are the areas in which that person spent most of their time .
We ’ re trying to track down any further information .
We ’ ll keep you updated @ @ @ @ @ @ @ day if we have to .
Make sure we ’ re not in your spam list on your email so you get consistent updates from us and we ’ ll furnish you with information as it comes through.
” Instead , what they basically said is , “ Hey , guys , coronavirus ?
Don ’ t worry !
” Like , what ?
And that , especially given how sick I was at the time , that really , really ... Their way of approaching this really panicked me , and I @ @ @ @ @ @ @ lot of other people .
They ’ re claiming that my intervention led to panic , where actually , look at where we are now as a result of my intervention .
It ’ s actually where people are less afraid because we ’ ve got more information , and we can , as adults , take a view as to whether or not we want to get tested , whether or not our symptoms are bad enough .
One lady had symptoms and she wasn ’ t going to get tested originally @ @ @ @ @ @ @ “ Nothing to worry about.
” Then she saw my tweet thread and said , “ Okay , I ’ m going to get tested.
” She went to get tested and she came back positive for a different strain of coronavirus .
Now , I know those aren ’ t as deadly , but it ’ s a good thing she got that test and she got checked .
And I just think it ’ s so irresponsible to tell people , “ Yeah , you ’ re good .
Don ’ @ @ @ @ @ @ @ playbook for [ coronavirus ] .
They can ’ t be expected to know how to deal with these things .
But the last thing they should start doing is hurling accusations at me and telling the attendees that they ’ re being too panicky or anything like this .
This is an international public health crisis we ’ re talking about .
People will forgive an overreaction .
They won ’ t forgive an underreaction .

During the last week of February, a man attended the annual Conservative Political Action Conference in National Harbor, Maryland, a yearly get together of conservative media figures and Republican officials — including Donald Trump, Mike Pence and other senior administration members. The man held a gold-level ticket to the event that gave him access to private areas and receptions with Republican Congress members and high-level guests.
Just days later, the man alerted organizers of the conference that he had tested positive for the novel coronavirus, leading multiple members of Congress to self-quarantine in response.
While the Congressman is not experiencing symptoms, he received testing today and expects results soon.
Under doctor's usual precautionary recommendations, he'll remain self-quarantined until the 14-day period expires this week. — Rep. Matt Gaetz (@RepMattGaetz) March 9, 2020
However, while members of Congress were informed about potential exposure to the virus almost immediately, attendees of the conference more generally were not. That led Raheem Kassam, a conservative writer and former Breitbart editor who began feeling ill at the event, to begin tweeting about his own potential exposure to coronavirus and raising the concerns of other CPAC attendees.
I have now spoken to a number of people who were in/around the green room at CPAC when the attendee with coronavirus was there.
People are apoplectic about how they have not been better informed of what happened.
The attendee was there for much of Thursday at LEAST... — Raheem Kassam (@RaheemKassam) March 9, 2020
In response, Matt Schlapp, chair of the American Conservative Union (which puts on CPAC), told Yahoo News that Kassam was causing “a near panic” and was only speaking out because he wasn’t selected as a speaker at the conference.
“I’m sorry that Raheem was not included on our speaker schedule, and I’m sorry that he has a bone to pick with us. But using a health care moment where people are worried, to use that to try to stick a stake in my heart, was a mistake. ... And I think the conservatives who have acted irresponsibly here, I hold them in the same contempt as I hold reporters who are simply trying to make this a big political deal.”
Schlapp’s view of both the potential exposure of thousands of CPAC attendees to coronavirus and Kassam’s decision to tweet about his concerns reflects a greater tension — one between conservatives who believe the pandemic is overblown (or an effort to subvert Trump’s presidency) and others who think that politics is being permitted to shape messaging on the virus and its potential impact.
I spoke with Kassam on Thursday as he waits for the results of his coronavirus test. This interview has been edited for length and clarity.
Jane Coaston
How are you feeling?
Raheem Kassam
I’m more or less recovered. I mean, it’s been now, what, 11 days, which is ridiculous. They still don’t know what it is. I mean, I tested negative for flu and for H1N1 and other stuff. The Covid-19 test is still out. They’re now telling me there may even be a delay, another day delay, to get the results, so now I’m just quarantined until I get any results.
Jane Coaston
When you were at CPAC, were there people who were taking precautions [regarding coronavirus] with handshaking or anything like that that you saw?
Raheem Kassam
Yeah, a lot of people were sort of cognizant of that. A lot of people were doing fist bumps and elbow bumps. To the American Conservative Union (ACU)’s credit, not that I should be giving them much credit after the way they’d been treating me, but there was hand sanitizer absolutely everywhere, and people were using [it]. Not as many people as I would have liked to have been using them, by the way, and I was using them nonstop, but people were using them.
And by the way, that’s pretty new to CPAC. I’ve been going to CPAC for 10 years. I’ve never seen that before. So yeah, there were precautions being taken.
But at the same time, Jane, especially after the day’s events, you might be good during the sessions and while you’re walking around networking or whatever. [But] you go down to the pub and you have a couple of drinks, people soon forget, you know? And people are hugging and they’re kissing and high-fiving, your typical revelry, right? I mean, that’s just anecdotal, but it is a thing.
Jane Coaston
And when did you start coming down with symptoms of something flu-like or just feeling unwell?
Raheem Kassam
On the Monday I was at CPAC. I was at a dinner, or due to get to a dinner on the Monday evening, and I arrived early and I sat down at the bar waiting, and I just developed this extraordinary headache. And I’m not a headache guy. I’m always hydrated, I’ve never had migraines or anything like that. I quickly realized that something was wrong. I got myself through dinner, went home as quickly as possible, and basically just got in bed.
Over the course of that night and into the morning, I developed chills. When I woke up in the morning, I had full body aches, bunged-up sinuses, congestion, all of that and it felt like a flu. Then I started to get a fever. Thursday was especially rough. I was having to wash my sheets twice a day because of being bedridden, but also just sweating through your sheets all the time.
I’ve never really had anything like that, so I really started to sort of question what the heck was going on. Really ramped up my medications and everything. And then on the Friday, Saturday, the stories [about a CPAC attendee testing positive for coronavirus] started to come out. And I was like, “Well, hold on a minute. We’re now a week out of CPAC, how didn’t we know about this immediately?”
Jane Coaston
When did you start asking questions about your own potential exposure to coronavirus?
Raheem Kassam
I think the gentleman was hospitalized on Wednesday or Thursday, and so we didn’t hear about it until Saturday. So I started to make inquiries. “What was going on? Who was in touch with him? Who was he? Where was he?” And it just became abundantly clear that nobody could get answers out of the ACU. That Sen. Ted Cruz and Rep. Paul Gosar and Rep. Kevin McCarthy were being given information, but the rest of us, including people who were in the green areas, in the backstage areas, were not being given information.
So a bunch of us, which includes current CPAC speakers from this year as well as others, we all had long phone calls over the weekend. And then we finally pieced together a timeline and areas in which the guy looks like he would have been, where he would have had to have been for it to make sense that CPAC were putting out certain information about certain speakers, and that only certain speakers were self-quarantining. And so I tweeted all of that.
Obviously, [ACU chair] Matt Schlapp and his gang lost their shit.
I now know that Rep. Gosar met the person and within the next hour I was shaking Gosar's hand across the street.
GREAT.
(I've been down with the "flu" for the past week). — Raheem Kassam (@RaheemKassam) March 9, 2020
But I turned out to be right about it all, and at that point I decided to start to seek a test, Rep. Matt Gaetz and all these others, who were originally told that they didn’t have a problem, and that they didn’t meet this guy, they were then told afterwards, “Actually, yeah, you did.” The guy was at the congressional reception with all the congressmen, and was there all of the Thursday and at the [CPAC] Shabbat dinner, and so on and so forth. He was all over CPAC. Put it that way.
So I spent all day on Tuesday on the phone trying to get a test, DOH, CDC, CDC National, all the local urgent care clinics, hospitals, etc., etc., and everybody was just sending me round and round in circles. So eventually, what I did, I got a phone call that evening from a friend of mine and he said, “Look, I’ve been following your struggles to get tests. I’ve made some calls to some doctor friends of mine. They said the best bet is to walk into an emergency room with a mask on and just immediately tell somebody, ‘Hey, I may have had community exposure. I want to get a test.’”
So that’s why I did the next morning. Early morning, I went to Georgetown University Hospital’s emergency room. I walked in in my mask. I told them in two sentences exactly why I was there. They immediately ushered me into a side room, closed door behind me, and basically ran all the tests over the course of the next five hours. They said I did the right thing in going in I was also the first person that this doctor on call had tested and now I’m just awaiting the test results. They told me to go home, quarantine, drink lots of fluids and take lots of Tylenol.
Jane Coaston
So the response from the ACU, from both Matt Schlapp and from [ACU spokesperson] Ian Walters has been “Parlor games and trafficking in rumors is not helpful.” Can you tell me a little bit about your thoughts of how the ACU responded when you first had these concerns and how that response has changed over the last few days?
Raheem Kassam
Well, at first, it was minimal information to a minimal number of people. And as it became clear that actually a lot of these people had then gone on to interact with the president, had [been] on Air Force One, [were] at Mar-a-Lago on the weekend, I think they started to realize that, oh, we better be a little bit more forthcoming with information.
Now look, I don’t know what was happening internally with them. Information may not have been flowing them from the sick man and the family of the sick man in good time. But that should have been communicated with people. I mean, you have 10,000 people in a conference area like that, and given what we know about the virus now and its proclivity to last on surfaces for hours and hours ...
Look, what I don’t understand is why, on that Saturday when they found out, they didn’t just send out an email to every single person who attended CPAC to say, “Look, we’ve had a report about a person who’s been tested positive. It’s not a reason to panic. It’s not a reason for alarm. Here are the areas in which that person spent most of their time. We’re trying to track down any further information. We’ll keep you updated twice a day, three times a day if we have to. Make sure we’re not in your spam list on your email so you get consistent updates from us and we’ll furnish you with information as it comes through.”
Instead, what they basically said is, “Hey, guys, coronavirus? Don’t worry!” Like, what? And that, especially given how sick I was at the time, that really, really ... Their way of approaching this really panicked me, and I know it panicked a hell of a lot of other people. They’re claiming that my intervention led to panic, where actually, look at where we are now as a result of my intervention. It’s actually where people are less afraid because we’ve got more information, and we can, as adults, take a view as to whether or not we want to get tested, whether or not our symptoms are bad enough.
One lady had symptoms and she wasn’t going to get tested originally because the ACU had basically said, “Nothing to worry about.” Then she saw my tweet thread and said, “Okay, I’m going to get tested.” She went to get tested and she came back positive for a different strain of coronavirus. Now, I know those aren’t as deadly, but it’s a good thing she got that test and she got checked. And I just think it’s so irresponsible to tell people, “Yeah, you’re good. Don’t worry.”
There’s no playbook for [coronavirus]. They can’t be expected to know how to deal with these things. But the last thing they should start doing is hurling accusations at me and telling the attendees that they’re being too panicky or anything like this. This is an international public health crisis we’re talking about. People will forgive an overreaction. They won’t forgive an underreaction.