vox--2020-03-09--How Congress is preparing for the coronavirus

Members of both chambers began returning to the Capitol for this week ’ s session on Monday , even as concerns about new coronavirus cases continued to grow .
Sen. Ted Cruz ( R-TX ) and Reps. Paul Gosar ( R-AZ ) , Matt Gaetz ( R-FL ) , and Doug Collins ( R-GA ) have all announced plans to “ self-quarantine , ” or stay home in the coming days , after being exposed to an individual who tested positive for coronavirus at the Conservative Political Action Conference .
Rep. Julia Brownley ( D-CA ) also announced Thursday she @ @ @ @ @ @ @ week who has since tested positive for coronavirus .
Brownley said she would be working remotely this week , along with her staff .
The unique role of the Capitol as a hub for visitors and a workplace for lawmakers ( many of whom are older ) has further compounded concerns .
Capitol Hill is an extremely busy place ; in addition to being an office for lawmakers flying in from all over the country , it ’ s also a destination for many tourists .
The Architect of the Capitol estimates 3 @ @ @ @ @ @ @ Capitol each year .
Given their older average age , members of the Senate and House are also among the groups that could be most at risk for severe coronavirus symptoms .
“ Sixty-six senators are over 60 — two-thirds of the body — with more than a quarter over 70 , ” NBC News reports .
“ The average age of House members is 57.6 years , according to the Congressional Research Service.
” At this point , the Hill feels a bit like it ’ s in a “ holding pattern @ @ @ @ @ @ @ .
While staffers have been receiving intermittent alerts about the latest coronavirus developments , individual offices have also been prepping to ensure that teams can more easily telecommute and work remotely .
No decisions have been announced yet about any type of extended leave or recess , and House Speaker Nancy Pelosi told reporters Monday there ’ s no reason yet to close the Capitol temporarily .
“ Obviously members are concerned about what ’ s happening with coronavirus and its impact , ” another Democratic aide told Vox .
Teleworking is one @ @ @ @ @ @ @ lawmakers need to be present to vote .
The House and Senate have already approved $ 8.3 billion in coronavirus aid , but committee chairs are meeting with Pelosi Monday night to discuss additional measures Congress may need to take for Americans impacted by the virus , as well as the US economy .
“ We can ’ t vote from home , however , ” Pelosi told reporters last Thursday .
“ So it ’ s about security ; it ’ s not about testing everybody who comes into the building .
@ @ @ @ @ @ @ Congress does will send a message Congress is far from the only place where concerns about coronavirus are growing — and what lawmakers do in response is likely to send a strong message to the broader public .
If lawmakers were to head on recess , it could set an alarming precedent , according to one former Senate aide .
“ I think it would send a terrible signal to the American people if Congress decided to go on recess for a few weeks while the virus works its way through the country @ @ @ @ @ @ @ was a staffer for former Senate Majority Leader Harry Reid .
Manley also worked on the Hill during the anthrax scare lawmakers faced in 2001 , and he noted that the ongoing operations in Congress helped demonstrate the government ’ s ability to continue functioning during a crisis .
It ’ s worth noting the anthrax scare had key differences with coronavirus , which is highly contagious and is affecting the country on a broader scale .
Additionally , technological advances have changed significantly since 2001 , making potential remote work more accessible @ @ @ @ @ @ @ severely curbing its operations , is also not the only course of action in the near term .
To reduce potential exposure to coronavirus , lawmakers could cut back on the number of meetings they conduct , the travel they do , and the events they take part in .
Some offices are already beginning to take such measures .
There ’ s not a ton of recent precedent for Congress to physically shutter , though there ’ s been at least one case when the Capitol closed , in part .
“ @ @ @ @ @ @ @ the Capitol was actually closed for health reasons , ” Senate Rules Committee Chair Roy Blunt told CNN in an allusion to the Spanish flu pandemic that took place at the time .
Back then , the House and Senate closed their public galleries and held intermittent pro forma sessions .
The question on the minds of multiple members of Congress and their staff is if and when they ’ ll get the green light from leadership to work remotely , especially if the coronavirus threat worsens in the United States .
“ @ @ @ @ @ @ @ continuity of operations plans , ensuring offices have the resources they need to telework , ” a Democratic aide told Vox , adding that members of Congress have offered a number of ideas on that front .
Members who have reported being exposed to individuals with coronavirus are working from home , but it ’ s been on a case-by-case basis .
Though Pelosi has said House members and other offices are updating their technology to be able to work remotely , there has been no decision made thus far on whether lawmakers @ @ @ @ @ @ @ will simply hold a recess to allow members and staff to stay home .
“ In case , god forbid , but in case there is a need for people to work from home , all of the offices — not only congressional offices but offices that serve the purpose of the Capitol — will have the technology up to date in order to do that , ” Pelosi said Thursday .
Working remotely is one thing , but voting remotely is another thing entirely .
Voting is a huge part of the @ @ @ @ @ @ @ especially during a massive public health crisis if more new funding or economic stimulus needs to be approved .
Pelosi said last week that members can ’ t vote from home , and House rules state : Despite a push for the ability to vote remotely in the past , those who have argued against it have long said that such tactics don ’ t allow for ample debate and discussion to take place .
Rep. Eric Swalwell ( D-CA ) previously proposed a bill that would enable lawmakers to take certain procedural @ @ @ @ @ @ @ though it hasn ’ t gained enough traction to advance .
The emerging challenges posed by the coronavirus , however , could prompt lawmakers to give it — and measures like it — another look .

Coronavirus anxiety is mounting on Capitol Hill.
Members of both chambers began returning to the Capitol for this week’s session on Monday, even as concerns about new coronavirus cases continued to grow. Sen. Ted Cruz (R-TX) and Reps. Paul Gosar (R-AZ), Matt Gaetz (R-FL), and Doug Collins (R-GA) have all announced plans to “self-quarantine,” or stay home in the coming days, after being exposed to an individual who tested positive for coronavirus at the Conservative Political Action Conference.
Rep. Julia Brownley (D-CA) also announced Thursday she had met with a separate individual last week who has since tested positive for coronavirus. Brownley said she would be working remotely this week, along with her staff.
The unique role of the Capitol as a hub for visitors and a workplace for lawmakers (many of whom are older) has further compounded concerns. Capitol Hill is an extremely busy place; in addition to being an office for lawmakers flying in from all over the country, it’s also a destination for many tourists. The Architect of the Capitol estimates 3 million to 5 million people visit the Capitol each year.
Given their older average age, members of the Senate and House are also among the groups that could be most at risk for severe coronavirus symptoms. “Sixty-six senators are over 60 — two-thirds of the body — with more than a quarter over 70,” NBC News reports. “The average age of House members is 57.6 years, according to the Congressional Research Service.”
At this point, the Hill feels a bit like it’s in a “holding pattern,” one Democratic aide told Vox. While staffers have been receiving intermittent alerts about the latest coronavirus developments, individual offices have also been prepping to ensure that teams can more easily telecommute and work remotely. No decisions have been announced yet about any type of extended leave or recess, and House Speaker Nancy Pelosi told reporters Monday there’s no reason yet to close the Capitol temporarily.
“Obviously members are concerned about what’s happening with coronavirus and its impact,” another Democratic aide told Vox.
Teleworking is one thing, but the fact remains that lawmakers need to be present to vote. The House and Senate have already approved $8.3 billion in coronavirus aid, but committee chairs are meeting with Pelosi Monday night to discuss additional measures Congress may need to take for Americans impacted by the virus, as well as the US economy.
“We can’t vote from home, however,” Pelosi told reporters last Thursday. “So it’s about security; it’s not about testing everybody who comes into the building. That’s not realistic.”
What Congress does will send a message
Congress is far from the only place where concerns about coronavirus are growing — and what lawmakers do in response is likely to send a strong message to the broader public.
If lawmakers were to head on recess, it could set an alarming precedent, according to one former Senate aide.
“I think it would send a terrible signal to the American people if Congress decided to go on recess for a few weeks while the virus works its way through the country,” said Jim Manley, who was a staffer for former Senate Majority Leader Harry Reid. Manley also worked on the Hill during the anthrax scare lawmakers faced in 2001, and he noted that the ongoing operations in Congress helped demonstrate the government’s ability to continue functioning during a crisis.
It’s worth noting the anthrax scare had key differences with coronavirus, which is highly contagious and is affecting the country on a broader scale. Additionally, technological advances have changed significantly since 2001, making potential remote work more accessible.
Closing down the Capitol, or severely curbing its operations, is also not the only course of action in the near term. To reduce potential exposure to coronavirus, lawmakers could cut back on the number of meetings they conduct, the travel they do, and the events they take part in. Some offices are already beginning to take such measures.
There’s not a ton of recent precedent for Congress to physically shutter, though there’s been at least one case when the Capitol closed, in part. “I think it was actually 1918 that the Capitol was actually closed for health reasons,” Senate Rules Committee Chair Roy Blunt told CNN in an allusion to the Spanish flu pandemic that took place at the time. Back then, the House and Senate closed their public galleries and held intermittent pro forma sessions.
Will Congress start working from home?
The question on the minds of multiple members of Congress and their staff is if and when they’ll get the green light from leadership to work remotely, especially if the coronavirus threat worsens in the United States.
“There has been guidance sent out on continuity of operations plans, ensuring offices have the resources they need to telework,” a Democratic aide told Vox, adding that members of Congress have offered a number of ideas on that front.
Members who have reported being exposed to individuals with coronavirus are working from home, but it’s been on a case-by-case basis. Though Pelosi has said House members and other offices are updating their technology to be able to work remotely, there has been no decision made thus far on whether lawmakers will actually work remotely or if Congress will simply hold a recess to allow members and staff to stay home.
“In case, god forbid, but in case there is a need for people to work from home, all of the offices — not only congressional offices but offices that serve the purpose of the Capitol — will have the technology up to date in order to do that,” Pelosi said Thursday.
Working remotely is one thing, but voting remotely is another thing entirely. Voting is a huge part of the job of a member of Congress, especially during a massive public health crisis if more new funding or economic stimulus needs to be approved.
Pelosi said last week that members can’t vote from home, and House rules state:
Every Member shall be present within the Hall of the House during its sittings, unless excused or necessarily prevented, and shall vote on each question put, unless having a direct personal or pecuniary interest in the event of such question.
Despite a push for the ability to vote remotely in the past, those who have argued against it have long said that such tactics don’t allow for ample debate and discussion to take place. Rep. Eric Swalwell (D-CA) previously proposed a bill that would enable lawmakers to take certain procedural votes remotely and videoconference during hearings, though it hasn’t gained enough traction to advance.
The emerging challenges posed by the coronavirus, however, could prompt lawmakers to give it — and measures like it — another look.


vox--2020-03-09--11 questions about the Covid-19 coronavirus outbreak, answered

The coronavirus outbreak , which began in China , keeps evolving at a dizzying speed .
With the case toll rising steeply ( reaching over 113,000 on March 9 ) , face masks flying off store shelves , borders around the world closing , and meetings , cruise itineraries , and the global economy upended by the virus , it ’ s no wonder questions and fears are swirling about Covid-19 , as the disease is known .
The likelihood that we ’ re in a pandemic , a new disease that spreads around the world — or that we @ @ @ @ @ @ @ much higher than just a few weeks ago .
That means more countries are likely to see a spread of the virus within their borders very soon — and that includes the US .
“ The spread in other countries has raised our level of concern and our level of expectation we ’ re going to have community spread here , ” said Nancy Messonnier , director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention ( CDC ) , on February 25 .
“ @ @ @ @ @ @ @ if this will happen , but when this will happen , and how many people in this country will have severe illnesses.
” By February 26 , California announced a new Covid-19 case involving a person who had not traveled to any of the affected countries nor been in contact with anyone who had .
There are now more than 600 cases , and more than 20 deaths , across the country .
Meanwhile , outbreaks have been surging outside of China , as far and wide as South Korea , Italy , @ @ @ @ @ @ @ continuing its tour around the world , here are answers to your most burning questions .
1 ) What is this new coronavirus , and where did it come from ?
Coronaviruses are a large family of viruses that typically attack the respiratory system .
The name comes from the Latin word corona , for crown , and the ancient Greek korōnè , meaning garland or wreath , because of the spiky fringe encircling these viruses .
Most coronaviruses infect animals , such as bats , cats , and birds .
Only seven @ @ @ @ @ @ @ MERS , are known to infect humans .
SARS is thought to have evolved from infecting bats to civet cats to humans in China ; MERS evolved from bats to camels to humans in the Middle East .
No one knows precisely where Covid-19 came from , though a leading hypothesis is that bats were once again the original source : They spread the virus to pangolins , and pangolins to humans .
2 ) What are the symptoms ?
Two of the seven coronaviruses that infect humans , SARS and MERS , @ @ @ @ @ @ @ in 10 and more than 30 percent of cases , respectively .
But others lead to milder symptoms , like a common cold .
At the moment , we know Covid-19 can cause pneumonia and that it too can kill — but while it seems to be less deadly than SARS and MERS , it ’ s not yet clear by precisely how much .
Some of the best evidence on the question comes from a February 16 China Center for Disease Control report looking at the outcomes of the first 72,314 patients @ @ @ @ @ @ @ China .
It ’ s the largest such analysis to date , and it found an overall case fatality rate of 2.3 percent — lower than both SARS and MERS .
( The case fatality rate , or CFR , is the proportion of deaths a disease causes within a group of people who have the disease . )
The researchers also discovered a huge variation in the case fatality rate by age group .
In short , the virus appears to be deadlier in people with each passing decade .
You can @ @ @ @ @ @ @ Overall , the researchers characterized 81 percent of the cases as mild and 19 percent as severe or critical .
One major caveat , though : This data comes from mainland China , where most of the 2,012 deaths have occurred .
And the case fatality rate has been different outside of China .
At the same time , there ’ s also evidence of asymptomatic cases .
And it ’ s possible that as we discover more of these cases , Covid-19 will seem more like seasonal flu than like SARS .
@ @ @ @ @ @ @ look more severe when they ’ re first discovered since the people showing up in hospitals tend to be the sickest .
Disease modelers who account for this under-counting of cases currently estimate an overall case fatality rate of 1.6 percent .
As for symptoms : Fever and a dry cough are most common , while mucus , shortness of breath , sore throat , and headache are less common , according to China ’ s data .
But the picture might change as data on symptoms emerge from other countries .
For @ @ @ @ @ @ @ looked at nine of the country ’ s earliest confirmed Covid-19 patients .
Researchers found symptoms for many people resembled a cold .
So only two of the nine had a fever , and seven had a cough , but just as common were symptoms like stuffy nose , runny nose , and sneezing .
No one knows the precise incubation period for the virus but symptoms can show up anywhere from one day to two weeks after exposure , according to a WHO report on China ’ s response .
We don @ @ @ @ @ @ @ — the virus that causes the Covid-19 disease — spreads , but we do have a lot of data on how MERS , SARS , and other respiratory viruses move from person to person .
And that ’ s mainly through exposure to droplets from coughing or sneezing .
So when an infected person coughs or sneezes , they let out a spray , and if these droplets reach the nose , eyes , or mouth of another person , they can pass on the virus , said Jennifer Nuzzo , an infectious @ @ @ @ @ @ @ Johns Hopkins Center for Health Security .
In rarer cases , a person might catch a respiratory disease indirectly , “ via touching droplets on surfaces — and then touching mucosal membranes ” in the mouth , eyes , and nose , she added .
There ’ s also emerging evidence showing that SARS-CoV-2 may spread through poop — known as the “ fecal-oral ” route of disease transmission .
Researchers are on the lookout for potential airborne transmission , too , and there ’ s a lot of speculation about whether inanimate @ @ @ @ @ @ @ pass on the virus .
In the case of airborne transmission , a person would get infected by directly inhaling droplets suspended in the air from an infected individual .
With “ fomites ” — objects that can transmit infections — droplets from an infected person would end up on surfaces another person touches .
“ So far , there is no conclusive evidence of that , ” wrote Megan Murray , a Harvard Infectious Disease specialist , in a coronavirus explainer , “ although that is challenging to prove one way or @ @ @ @ @ @ @ : More and more research is piling up to suggest people who have only mild symptoms , or no symptoms at all , can test positive for Covid-19 disease .
The virus also appears to be present in the body at very high levels early on in an illness .
“ We still don ’ t know to what extent people without symptoms can infect , ” Nuzzo cautioned .
And Isaac Bogoch , a professor at the University of Toronto told Vox , “ even if there have been cases of asymptomatic @ @ @ @ @ @ @ be typically rare cases , and with just about every other respiratory tract infection known to humankind , those are not the people who are driving an epidemic.
” Even so , if this virus can spread from people with no or mild symptoms , it might help explain why it ’ s so contagious .
Researchers currently believe one person with Covid-19 generally infects two to more than three others , which would make the new coronavirus more transmissible than seasonal flu , SARS , and MERS .
4 ) Are there @ @ @ @ @ @ @ during this outbreak ?
The CDC has issued its highest-level travel alerts for Italy , Iran , South Korea , and China , advising Americans to avoid traveling in these places for the moment .
These are the countries with the largest known coronavirus outbreaks .
But just because a country you plan to visit isn ’ t on the list right now doesn ’ t mean it won ’ t be there tomorrow .
The outbreak is evolving rapidly , and these advisories are likely to change in the coming days , @ @ @ @ @ @ @ .
This map and list of travel restrictions from the Council on Foreign Relations is another good resource .
Also keep in mind : The travel warnings are not entirely driven by the risk of catching this new virus .
Airlines have been canceling or scaling back flights , trains have been halted , and countries have been imposing sometimes arbitrary quarantines on travelers and citizens .
As Nuzzo told Vox : “ I ’ m more concerned about the unpredictability of the [ outbreak ] response at this point .
It would @ @ @ @ @ @ @ and get stuck there somehow .
And coming back , you ’ ll be subject to additional screening ” or quarantines .
What if you decide to travel and you ’ re seated near someone who is coughing or sneezing ?
That ’ s not very reassuring , but it ’ s not time to panic , either .
“ The risk of acquiring a respiratory infection through air travel is still extraordinarily low , ” Bogoch , who studies how air travel influences the dynamics of outbreaks — including the new coronavirus @ @ @ @ @ @ @ if you happen to be seated within six feet of a person with a respiratory infection .
But even there , simple proximity doesn ’ t necessarily mean you ’ ll catch anything .
Instead , the more infectious the person is , and the longer you sit near them , the higher your risk .
If you ’ re not near the person for very long or they ’ re not very infectious , the risk is lower .
5 ) I ’ m still worried about the new coronavirus .
What @ @ @ @ @ @ @ Buy a face mask ?
In the US , just about every health expert Vox has spoken to has said there ’ s little evidence to support the use of face masks for preventing disease in the general population .
Masks are only useful if you have a respiratory infection already and want to minimize the risk of spread to others , or if you ’ re caring for someone who is sick or working in a hospital in direct contact with people who have respiratory illnesses .
( Plus , there are @ @ @ @ @ @ @ supplies that health workers need to stay safe .
If they can ’ t get them and start walking off the job , we ’ re all in trouble . )
That ’ s why the CDC advises against the use of masks for regular Americans .
The best thing you can do to prevent all sorts of illnesses , CDC ’ s Messonnier said , is “ wash your hands , cover your cough , take care of yourself , and keep alert to the information that we ’ re providing.
” @ @ @ @ @ @ @ severe disease — the elderly , people with underlying health conditions — should take additional precautions : avoiding crowds and contact with people who are sick , and stocking up on medicines and groceries , Messonnier said .
6 ) What should I do if I think I have Covid-19 ?
If you ’ re in a high-risk group — over the age of 60 with an underlying health condition — seek medical treatment immediately , and let your hospital or health care provider know you suspect Covid-19 .
Otherwise , stay at @ @ @ @ @ @ @ Vox ’ s Umair Irfan explained .
“ They will work with your local health department and figure out whether you need to get tested or get treatment .
Doctors and health officials advise not to go to the emergency room if your symptoms do not appear to be life-threatening.
” There ’ s a good chance you ’ ll recover with nothing more than rest and fluids .
The CDC and WHO are still calling this an outbreak or epidemic .
But with the disease in more than 100 countries and major @ @ @ @ @ @ @ , health experts told Vox we ’ re on the brink of a pandemic — or we ’ re already in one .
That means containing the virus — fully halting its spread — may no longer be possible .
“ I don ’ t think the answer is shutting down the world to stop this virus .
It ’ s already out , ” said Michael Osterholm , director of the University of Minnesota ’ s Center for Infectious Disease Research and Policy .
“ We must prepare for the foreseeable possibility @ @ @ @ @ @ @ soon become a pandemic affecting countries on virtually all continents , ” said Lawrence Gostin , a global health law professor at Georgetown University .
Keep in mind , the p-word doesn ’ t say anything about the severity of Covid-19 .
A disease can spread widely and become a pandemic without being particularly severe .
And no one knows yet what a Covid-19 pandemic would look like — mostly because we don ’ t yet know precisely how lethal this disease is .
8 ) Is my city at risk of an @ @ @ @ @ @ @ on that question comes from researchers at the University of Oxford , University of Toronto , and the London School of Medicine and Tropical Hygiene .
They published studies a few weeks ago on the places most vulnerable to novel coronavirus infections .
The big takeaway then was that cities in East Asia and Southeast Asia were most at immediate risk .
Here are 15 of the top destinations where they predicted we ’ d see outbreaks next .
( You should also pay attention to the IDVI , or Infectious Disease Vulnerability @ @ @ @ @ @ @ a measure of a country ’ s ability to manage infectious disease .
Scores closer to zero mean they ’ re less prepared . )
Note that cities in Japan , Singapore , and South Korea were among the places that topped the list — and as we ’ re seeing now , some of the biggest outbreaks outside of China are playing out in these countries .
Iran and Italy are also on the list , and large outbreaks have emerged in these countries , too .
With the scope of this @ @ @ @ @ @ @ updated their models in a yet-to-be-published study focused on how the coronavirus disease will likely spread from Iran .
They found that Iran probably has thousands more cases within its borders than we currently know .
And they predict that we can expect outbreaks with links back to Iran in Turkey , the United Arab Emirates , Iraq , Qatar , and Georgia , among other countries .
In Europe , they predict Germany , France , and Italy are also at higher risk of imported cases from Iran .
This is a @ @ @ @ @ @ @ be at immediate risk , according to some of the best guesses available .
9 ) How does this end ?
There was a time when it seemed possible that China might contain the virus and the outbreaks outside of China would fizzle out , spelling the end of this public health emergency .
But there are now so many around the world , and the very real possibility that the virus is circulating , undetected , in even more countries — especially those with weak health systems — that containment appears impossible @ @ @ @ @ @ @ to see more sickness and death not only in China but also in other countries as cases grow from one-off travelers or small clusters to full-blown outbreaks .
In this scenario , Tony Fauci , the head of the National Institute of Allergy and Infectious Diseases , said , “ you don ’ t try to control [ the virus ] because it ’ s already everywhere.
” Health officials will begin to move into a new mitigation phase in their response strategy .
This involves a focus on reducing the spread and @ @ @ @ @ @ @ hospitals need to be ready with Covid-19 protocols , health care workers need to be protected with access to protective equipment such as face masks , and countries need plans in place for maintaining supply chains and carrying on with travel and trade .
But again , even if this virus moves around the world , it may not do much harm .
In the best-case scenario , this outbreak might look more like H1N1 swine flu .
When H1N1 was first recognized in 2009 and spread around the world , there were @ @ @ @ @ @ @ schools closed , people from North America were quarantined when they arrived in other countries , flights were canceled .
Not only did those measures fail to contain the virus , Nuzzo said , but it also turned out H1N1 wasn ’ t all that deadly .
“ Now we ’ re still living with that virus — it ’ s one that circulates with every flu season , ” Nuzzo explained .
10 ) How is the world responding to this crisis ?
On January 30 , the WHO declared the outbreak @ @ @ @ @ @ @ most dramatic — and unprecedented — response is currently playing out in China , the country with the most Covid-19 cases .
“ China has implemented the most extensive cordon sanitaire [ or quarantine ] in the history of humankind , ” Gostin told Vox .
“ They ’ ve restricted movements , caused fear and panic .
They ’ ve violated human rights.
” Authorities there have also censored information and silenced the whistleblowers who tried to sound the alarm sooner than Chinese authorities were willing , and kicked out foreign journalists @ @ @ @ @ @ @ .
Italy has adopted quarantine measures that are similar to China — first locking down some 16 million people in the country ’ s north , where the virus has been spreading , and then extending restrictions on movement to the entire country .
In recent weeks , the US government dramatically escalated its response : issuing its highest-level travel advisories , quarantining citizens evacuated from China , and banning foreign nationals who have recently been to China from coming in , as well as travelers from Iran .
On February 25 , @ @ @ @ @ @ @ lot more to come ; “ disruption to everyday life might be severe.
” This means Americans can expect more cancellations , quarantines , and social distancing efforts .
( To read more about those , see this explainer . )
The severe measures can be explained by the fact that there ’ s still a lot we don ’ t know about this new virus and health officials are taking drastic actions .
There ’ s also no enforceable international law governing outbreak responses , so countries can basically do what they @ @ @ @ @ @ @ getting penalized , even if those actions are proportional or science-based , and the WHO is advising against them .
11 ) How might this end ?
There are a few ways this outbreak could end , as Vox ’ s Brian Resnick explained .
Perhaps public health measures — identifying cases fast , putting infected people in isolation — will slow the spread of this coronavirus .
( That ’ s what stopped the spread of SARS in 2003 . )
“ If we slow it so that infections happen over 10 @ @ @ @ @ @ @ month , that ’ s going to make a big difference as far as how many people seriously infected , how many people may end up hospitalized , and how many they end up dying , ” said Tara Smith , a Kent State University epidemiologist .
“ We talk about it as ‘ flattening the epidemic curve ’ — so that it ’ s not a big , sudden peak in cases , but it ’ s a more moderate plateau over time.
” Because this is a zoonotic disease , meaning @ @ @ @ @ @ @ and eliminating that source would also help .
Or maybe a vaccine or antiviral will be invented quickly to curb a broader epidemic ( though that ’ ll take time ) .
The coming seasons of warmer weather could also play a role in at least slowing down the virus .
“ Coronaviruses are winter viruses , ” Fauci said .
“ When the weather is warm and moist , these viruses don ’ t spread as well as when the weather is cold and dry.
” “ I think that it ’ @ @ @ @ @ @ @ the 2009 H1N1 [ flu ] pandemic ended , which is that shortly after it ’ s over , people will lose memory of it and not worry about it , ” Angela Rasmussen , a Columbia virologist , told Vox .
“ But it ’ s going to have tremendous — really negative and lasting effects — for the most vulnerable people who are either medically or economically vulnerable in our society.
” Correction March 3 : A graphic in this piece previously misstated the percentage of cases in China that were @ @ @ @ @ @ @ .
The graphic has been updated with the correct figure , 14 percent .
What else do you want to know about the coronavirus outbreak and the surrounding news ?
Fill out the survey below ( or head over to this Google form ) to let us know .

Editor’s note, April 2: There have been significant developments in the coronavirus pandemic since this story was last updated. Here is our latest information on the big questions about the coronavirus, as of this writing. For our most up-to-date coverage, visit our coronavirus hub.
The coronavirus outbreak, which began in China, keeps evolving at a dizzying speed. With the global case toll rising steeply, face masks flying off store shelves, borders around the world closing, and meetings, cruise itineraries, and the global economy upended by the virus, it’s no wonder questions and fears are swirling about Covid-19, as the disease is known.
On March 11, the WHO declared the outbreak a pandemic, a new disease that has spread around the world. Many countries have seen reported cases of the virus rise within their borders — and that includes the US.
“We will see more cases, and things will get worse,” Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told members of the House Oversight Committee on March 11. “How much worse … will depend on our ability to do two things: to contain the influx in people who are infected coming from the outside and the ability to contain and mitigate within our own country.”
Spread of the virus and the slow rollout of testing mean reported case numbers are changing quickly. Meanwhile, outbreaks have been surging in South Korea, Italy, and Iran. With the new virus continuing its tour around the world, here are answers to your most burning questions.
1) What is this new coronavirus, and where did it come from?
Coronaviruses are a large family of viruses that typically attack the respiratory system. The name comes from the Latin word corona, for crown, and the ancient Greek korōnè, meaning garland or wreath, because of the spiky fringe encircling these viruses. Most coronaviruses infect animals, such as bats, cats, and birds. Only seven, including Covid-19, SARS, and MERS, are known to infect humans.
SARS is thought to have evolved from infecting bats to civet cats to humans in China; MERS evolved from bats to camels to humans in the Middle East. No one knows precisely where Covid-19 came from, though a leading hypothesis is that bats were once again the original source: They spread the virus to another animal species, possibly a pangolin, where it jumped to humans.
2) What are the symptoms and death rate?
Two of the seven coronaviruses that infect humans, SARS and MERS, can cause severe pneumonia and even death in 10 and more than 30 percent of cases, respectively. But others lead to milder symptoms, like a common cold. The most common symptoms of Covid-19 are fever and dry cough.
No one knows the precise incubation period for the virus, but symptoms can show up anywhere from one day to two weeks after exposure, according to a WHO report on China’s response.
At the moment, we know Covid-19 can cause pneumonia and that it too can kill — but while it seems to be less deadly than SARS and MERS, it’s not yet clear by precisely how much.
Some of the best evidence on the question comes from a February 16 China Center for Disease Control report looking at the outcomes of the first 72,314 patients with confirmed or suspected Covid-19 in mainland China. It’s the largest such analysis to date, and it found an overall case fatality rate of 2.3 percent — lower than both SARS and MERS. (The case fatality rate, or CFR, is the proportion of deaths a disease causes within a group of people who have the disease.)
The researchers also discovered a huge variation in the case fatality rate by age group. In short, the virus appears to be deadlier in people with each passing decade. You can see the trend in this graph:
Overall, the researchers characterized 81 percent of the cases as mild and 19 percent as severe or critical.
One major caveat, though: This data comes from mainland China. And the case fatality rate has been different outside of China.
At the same time, there’s also evidence of asymptomatic cases. And it’s possible that as we discover more of these cases, Covid-19 will look less deadly. That’s because infectious diseases typically look more severe when they’re first discovered since the people showing up in hospitals tend to be the sickest. Disease modelers who account for this under-counting of cases currently estimate an overall case fatality rate of just over 1 percent.
As for symptoms: Fever, dry cough, and fatigue are more common, while thick mucus from coughs, shortness of breath, sore throat, and headache are less common, according to China’s data.
But the picture might change as data on symptoms emerge from other countries. For example, a yet-to-be published German paper looked at some of the country’s earliest confirmed Covid-19 patients. Researchers found symptoms in this small sample often resembled a cold. So only two of the nine patients had a fever, and seven had a cough, but just as common were symptoms like stuffy nose, runny nose, and sneezing.
3) What should I do if I think I have Covid-19?
If you’re in a high-risk group — over the age of 60 with an underlying health condition — seek medical treatment immediately, and let your hospital or health care provider know you suspect Covid-19 before showing up.
Otherwise, stay at home and call a health professional, Vox’s Umair Irfan explained: “They will work with your local health department and figure out whether you need to get tested or get treatment. Doctors and health officials advise not to go to the emergency room if your symptoms do not appear to be life-threatening.” There’s a good chance you’ll recover with nothing more than rest and fluids. But you will need to self-isolate while sick to avoid spreading the disease to others, including any people in your home. Here’s how to do it.
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.
And if you are healthy, here are some ways you can help vulnerable people in your community.
4) How do coronaviruses spread?
We don’t yet know exactly how SARS-CoV-2 — the virus that causes the Covid-19 disease — spreads, but we do have a lot of data on how MERS, SARS, and other respiratory viruses move from person to person. And that’s mainly through exposure to droplets from coughing or sneezing.
So when an infected person coughs or sneezes, they let out a spray, and if these droplets reach the nose, eyes, or mouth of another person, they can pass on the virus, said Jennifer Nuzzo, an infectious disease expert and senior scholar at the Johns Hopkins Center for Health Security. In rarer cases, a person might catch a respiratory disease indirectly, “via touching droplets on surfaces — and then touching mucosal membranes” in the mouth, eyes, and nose, she added.
There’s also emerging evidence showing that SARS-CoV-2 may spread through poop — known as the “fecal-oral” route of disease transmission. Researchers are on the lookout for potential airborne transmission, too, and there’s a lot of speculation about whether inanimate objects — like door handles — can pass on the virus.
In the case of airborne transmission, a person would get infected by directly inhaling droplets suspended in the air from an infected individual. With “fomites” — objects that can transmit infections — droplets from an infected person would end up on surfaces another person touches. “So far, there is no conclusive evidence of that,” wrote Megan Murray, a Harvard Infectious Disease specialist, in a coronavirus explainer, “although that is challenging to prove one way or the other.”
What we do know: More and more research is piling up to suggest people who have only mild symptoms, or no symptoms at all, can test positive for Covid-19 disease. The virus also appears to be present in the body at very high levels early on in an illness, when people are still going to work or traveling.
“We still don’t know to what extent people without symptoms can infect,” Nuzzo cautioned. And Isaac Bogoch, a professor at the University of Toronto told Vox, “even if there have been cases of asymptomatic transmission of this infection, those will be typically rare cases, and with just about every other respiratory tract infection known to humankind, those are not the people who are driving an epidemic.”
Even so, if this virus can spread from people with no or mild symptoms, it might help explain why it’s so contagious. Researchers currently believe one person with Covid-19 generally infects two to more than three others, which would make the new coronavirus more transmissible than seasonal flu, SARS, and MERS. That’s why social distancing measures are so important.
5) What should I do to protect myself? Buy a face mask?
In the US, just about every health expert Vox has spoken to has said there’s little evidence to support the use of face masks for preventing disease in the general population.
Masks are only useful if you have a respiratory infection already and want to minimize the risk of spread to others, or if you’re caring for someone who is sick or working in a hospital in direct contact with people who have respiratory illnesses. (Plus, there are reports of runs on masks and other supplies that health workers need to stay safe. If they can’t get them and start walking off the job, we’re all in trouble.)
Related How soap absolutely annihilates the coronavirus
That’s why the CDC advises against the use of masks for regular Americans. The best thing you can do to prevent all sorts of illnesses, CDC’s Nancy Messonnier said, is “wash your hands, cover your cough, take care of yourself, and keep alert to the information that we’re providing.”
Individuals at a higher risk of developing severe disease — the elderly, people with underlying health conditions — should take additional precautions: avoiding crowds and contact with people who are sick, and stocking up on medicines and groceries, Messonnier said.
6) Is this a deadly pandemic?
The WHO has officially declared the outbreak a pandemic, with the disease in more than 100 countries and major epidemics in several regions of the world.
That means containing the virus — fully halting its spread — is no longer the goal but rather mitigation of fast spread and harm reduction.
Keep in mind, the p-word doesn’t say anything about the severity of Covid-19. A disease can spread widely and become a pandemic without being particularly severe. And no one knows yet what the ultimate effects of this pandemic will look like — mostly because we don’t yet know precisely how lethal the disease is.
There was a time when it seemed possible that China might contain the virus and the outbreaks outside of China would fizzle out, spelling the end of this public health emergency.
But there are now so many around the world, and the very real possibility that the virus is circulating, undetected, in even more countries — especially those with weak health systems — that containment appears out of reach.
This means we’re likely to see more sickness and death in many countries as cases grow from one-off travelers or small clusters to full-blown outbreaks.
In this scenario, the NIH’s Fauci said, “you don’t try to control [the virus] because it’s already everywhere.”
Health officials are now in the mitigation phase of the response strategy. This involves a focus on social distancing to slow the speed of the outbreak and avoid overwhelming health systems. It also involves ramping up public health communications to inform the public about the disease, testing of potential cases to find sick people and their contacts, and capacity in hospitals.
So hospitals need to be ready with Covid-19 protocols so the disease doesn’t spread from them, and health care workers need to be protected with access to protective equipment such as face masks so they can keep doing their jobs. Countries also need plans in place for maintaining supply chains and carrying on with travel and trade.
The slow rollout of testing in the US, in particular, has made slowing the spread of the virus more difficult.
An investigation led by the Atlantic and independent researchers found that a little more than 7,000 people in the US had been tested as of March 11 — putting the US far behind other developed countries. (The Covid Tracking Project team is now gathering test counts daily.)
Slowing epidemics is critical in preventing more deaths, as it reduces stress on hospitals and health centers, which can only treat a certain number of patients at a time. That’s why “flattening the curve” of the pandemic through social distancing measures is so important.
As Eliza Barclay and Dylan Scott wrote for Vox: “A disastrous inundation of hospitals can likely be averted with protective measures we’re now seeing more of — closing schools, canceling mass gatherings, working from home, self-quarantine, self-isolation, avoiding crowds — to keep the virus from spreading fast.”
In the best-case scenario, which has become less likely, this outbreak might look more like H1N1 swine flu. When H1N1 was first recognized in 2009 and spread around the world, there were major concerns about its lethality. US schools closed, people from North America were quarantined when they arrived in other countries, flights were canceled. Not only did those measures fail to contain the virus, Nuzzo said, but it also turned out H1N1 wasn’t all that deadly.
“Now we’re still living with that virus — it’s one that circulates with every flu season,” Nuzzo explained.
7) Are there any places I shouldn’t go during this outbreak?
The CDC has issued its highest-level travel alerts for Italy, Iran, South Korea, and China, advising Americans to avoid traveling in these places for the moment. These are the countries with the largest known coronavirus outbreaks. On March 11, President Donald Trump issued a ban on travel from most of Europe for 30 days.
But just because a country you plan to visit isn’t on the list right now doesn’t mean it won’t be there tomorrow. The outbreak is evolving rapidly, and these advisories are likely to change in the coming days, so keep checking in with the CDC. This map and list of travel restrictions from the Council on Foreign Relations is another good resource.
As Nuzzo told Vox: “I’m more concerned about the unpredictability of the [outbreak] response at this point. It would not be fun to go to China and get stuck there somehow. And coming back, you’ll be subject to additional screening” or quarantines.
What if you decide to travel and you’re seated near someone who is coughing or sneezing? That’s not very reassuring, but it’s not time to panic, either. “The risk of acquiring a respiratory infection through air travel is still extraordinarily low,” Bogoch, who studies how air travel influences the dynamics of outbreaks — including the new coronavirus infection.
The risk does go up if you happen to be seated within six feet of a person with a respiratory infection. But even there, simple proximity doesn’t necessarily mean you’ll catch anything. Instead, the more infectious the person is, and the longer you sit near them, the higher your risk. If you’re not near the person for very long or they’re not very infectious, the risk is lower.
Also keep in mind: The travel warnings are not entirely driven by the risk of catching this new virus. Airlines have been canceling or scaling back flights, trains have been halted, and countries have been imposing quarantines on travelers and citizens.
8) How is the world responding to this crisis?
On January 30, the WHO declared the outbreak a global public health emergency, and about a month later said it had become a pandemic.
A dramatic — and unprecedented — response played out in China, the country with the most Covid-19 cases. “China has implemented the most extensive cordon sanitaire [or quarantine] in the history of humankind,” Gostin told Vox. “They’ve restricted movements, caused fear and panic. They’ve violated human rights.” But they also managed to get more control over the outbreak, and cases are now declining.
Italy has adopted quarantine measures that are similar to China — first locking down some 16 million people in the country’s north, where the virus has been spreading, and then extending restrictions on movement to the entire country.
Some governments have so far been able to halt the spread of coronavirus within their borders, seemingly through quick action. In Taiwan, a small island close to mainland China, testing for Covid-19 began in late December, even as China was just beginning to discover cases and ramp up its response. The Taiwanese government also emphasized public education about curbing the disease’s spread. Taiwan has only reported one death from the virus, as of March 11.
In recent weeks, the US government dramatically escalated its response: issuing its highest-level travel advisories, quarantining citizens evacuated from China, and banning foreign nationals who have recently been to China from coming in, as well as travelers from Iran. On March 11, Trump announced a 30-day travel ban from most of Europe to the US (excluding the UK).
The CDC warned, on February 25, there may be a lot more to come; “disruption to everyday life might be severe.” This means Americans can expect more cancellations, quarantines, and social distancing efforts. (To read more about those, see this explainer.)
The severe measures can be explained by the fact that there’s still a lot we don’t know about this new virus and health officials are taking drastic actions. There’s also no enforceable international law governing outbreak responses, so countries can basically do what they want in response to pandemic threats without getting penalized, even if those actions are proportional or science-based, and the WHO is advising against them.
9) How might this end?
There are a few ways this outbreak could end, as Vox’s Brian Resnick explained. Perhaps public health measures — identifying cases fast, putting infected people in isolation — will slow the spread of this coronavirus. (That’s what stopped the spread of SARS in 2003.)
“If we slow it so that infections happen over 10 or 12 months instead of over one month, that’s going to make a big difference as far as how many people seriously infected, how many people may end up hospitalized, and how many they end up dying,” said Tara Smith, a Kent State University epidemiologist. “We talk about it as ‘flattening the epidemic curve’ — so that it’s not a big, sudden peak in cases, but it’s a more moderate plateau over time.”
Because this is a zoonotic disease, meaning it came from an animal, finding and eliminating that source would also help.
Or maybe a vaccine or antiviral will be invented quickly to curb a broader epidemic (though a vaccine is expected to take at least a year).
Related A simple guide to the vaccines and drugs that could fight coronavirus
The coming seasons of warmer weather could also play a role in at least slowing down the virus. “Coronaviruses are winter viruses,” Fauci said. “When the weather is warm and moist, these viruses don’t spread as well as when the weather is cold and dry.”
Covid-19 could also keep spreading at a high rate and become endemic — regularly infecting humans, like the common cold.
Either way, “it’s going to have tremendous — really negative and lasting effects — for the most vulnerable people who are either medically or economically vulnerable in our society,” Angela Rasmussen, a Columbia virologist, told Vox.
Correction March 3: A graphic in this piece previously misstated the percentage of cases in China that were not linked back to the Wuhan area. The graphic has been updated with the correct figure, 14 percent.
Ask Vox
What else do you want to know about the coronavirus outbreak and the surrounding news? Fill out the survey below (or head over to this Google form) to let us know.


vox--2020-03-09--Could the coronavirus spark drug shortages in the US?

Share All sharing options for : Could the coronavirus spark drug shortages in the US ?
Some prescription drugs Americans rely on every day , including antibiotics , come from China or depend on ingredients that are made there .
The coronavirus outbreak and measures to prevent its spread have disrupted manufacturing in China , taking factories offline that are only now slowly ramping back up .
That ’ s all increased fears of potential drug shortages in the United States .
But how worried should we be ?
Experts say the answer largely depends on how long these disruptions @ @ @ @ @ @ @ becomes widespread in other countries critical to the drug supply chain , including India .
Drug shortages might not be felt immediately , as many companies stockpile ingredients or supplies to protect against unexpected stoppages , or have redundancies — meaning they rely on factories in different places — built into their supply chains .
And the reality is , with or without the coronavirus , drug shortages are a perennial problem in the United States .
But an acute emergency like a virus outbreak , but also a natural disaster or a @ @ @ @ @ @ @ can threaten to make things worse .
“ It does fit a kind of scenario we have worried about in the field for a while now , ” Cornelius Clancy , an associate professor of medicine and director of the XOR pathogen lab at the University of Pittsburgh , told me .
“ It wouldn ’ t take much to expose the vulnerabilities in the supply chain.
” The FDA is monitoring for coronavirus-related shortages The Food and Drug Administration ( FDA ) , the US federal agency that regulates medicines among other @ @ @ @ @ @ @ last week that a drug manufacturer had alerted the agency of a drug shortage related to the novel coronavirus outbreak in China .
The FDA won ’ t disclose the name of the drug but said that it was recently added to the drug shortages list , and that patients would be able to find an alternative .
The agency also said that , since January , it has communicated with more than 180 drug manufacturers about potential disruptions because of the coronavirus and identified 20 drugs that might be vulnerable because they @ @ @ @ @ @ @ or finished drug products from China.
” “ We have been in contact with those firms to assess whether they face any drug shortage risks due to the outbreak , ” FDA Commissioner Steven Hahn said in the statement .
“ None of these firms have reported any shortage to date .
Also , these drugs are considered non-critical drugs.
” But fears of potential shortages emerged again when India announced that it would limit the export of some two dozen drugs or drug ingredients to make sure it had enough supply for @ @ @ @ @ @ @ of drugs , especially generics , to the United States and Europe , India also relies on China to help make those medicines — particularly those active pharmaceutical ingredients , or APIs .
In a statement , Jeremy Kahn , a spokesperson for the FDA , told Vox that the agency is “ currently conducting a supply chain analysis of the APIs mentioned in the India news report to determine where other API facilities around the world are located that supply the US market .
This will help to identify any potential drug @ @ @ @ @ @ @ FDA , he added , “ will work to evaluate identified products for any shortage concerns.
” In other words : The FDA says it is on it .
Again , drug shortages are not unusual in the United States .
The FDA currently lists dozens of drugs in shortage .
But the coronavirus could exploit some of these already present vulnerabilities depending on how the outbreak unfolds over the next weeks and months .
Fears of drug shortages are partially driven by a lack of transparency A lot goes into manufacturing medicines @ @ @ @ @ @ @ , which are the things that make an antibiotic effective in treating a bacterial infection .
Then there are other raw materials needed for manufacturing .
So a particular drug you buy at your pharmacy may contain active pharmaceutical ingredients that come from one place — say , China — but the actual pill or cream or whatever the finished product is might actually be manufactured in India or any number of other countries , including the United States .
The number of facilities overseas , including in China , that manufacture active @ @ @ @ @ @ @ , of course , for many of the same reasons other manufactured goods have moved overseas : It is cheaper to make those products overseas , and some of the environmental regulations may be less stringent .
“ The supply chain is much more globalized today than it was in the past , ” Rachel Sachs , an associate professor of law who studies food and drug policy at Washington University in St. Louis , told me , “ and that poses concerns in any international global health crisis like this one.
” @ @ @ @ @ @ @ know exactly how dependent the US is on places like China and India for its drugs .
Janet Woodcock , the director of the FDA ’ s Center for Drug Evaluation and Research , told a House committee in August 2019 that , based on the data available , the FDA “ can not determine with any precision the volume of API that China is actually producing , or the volume of APIs manufactured in China that is entering the US market , either directly or indirectly by incorporation into finished dosages manufactured @ @ @ @ @ @ @ world.
” In other words , the FDA knows the number of facilities in China or Ireland or Mexico that are producing ingredients that go into drugs , but not what percentage of those overseas-manufactured ingredients ends up in an average American ’ s medicine cabinet .
What we do know , according to a 2019 paper from the National Bureau of Economic Research , is that almost 90 percent of the factories that make active pharmaceutical ingredients for the US market are located outside of the United States .
And about 60 @ @ @ @ @ @ @ final products are outside the US .
Again , this is not a percentage of US drugs made abroad , or the percentage that rely on ingredients from abroad .
It is merely noting the location of the factories .
What makes this even more complicated is the lack of transparency , at least for the public .
The FDA has said that the 20 drugs it is monitoring because of coronavirus are “ non-critical ” but won ’ t say what they are .
And , as mentioned above , the FDA @ @ @ @ @ @ @ currently facing a shortage due to the coronavirus actually is .
FDA Commissioner Hahn said at a Senate hearing last week that the FDA could not make it public because of “ confidential commercial information.
” This is frustrating in its own way because if you ’ re someone who relies on medication , not knowing what ’ s in shortage can create its own type of panic .
Erin Fox , a University of Utah expert on drug shortages , told me that under the law , US drug companies have to @ @ @ @ @ @ @ drug shortage at least six months ahead of the shortage , or as soon as possible if for some reason they can ’ t meet that standard .
However , Fox explained that companies aren ’ t obligated to say the reason for the shortage .
But all of this means it ’ s actually pretty hard for you , as an American consumer , to know whether the medication you ’ ve been prescribed is reliant in some way on materials made in China or made in a factory in India or @ @ @ @ @ @ @ just literally the one thing that we buy in the US that we have literally no information about , ” Fox told me .
“ You know more about your water bottle that you ’ re going to buy or your clothing or your food than you know about purchasing a drug.
” Okay , so what ’ s the bottom line here ?
How worried should I be ?
As with all things related to the coronavirus , don ’ t panic .
But overall , experts said that , yes , @ @ @ @ @ @ @ especially if the coronavirus outbreak continues to affect manufacturing in China , and even more so if the outbreak goes farther afield , particularly if it threatens India ’ s drug production .
“ If the coronavirus spread to India in a large way , and you started having Indian pharmaceutical facilities go down at the same time you had Chinese pharmaceutical facilities go down , that would cause significant shortages in the US , ” Howard Sklamberg , a partner at the global law firm Akim Gump and a former deputy commissioner @ @ @ @ @ @ @ “ In other industries , ” Sklamberg explained , “ companies can try to shift their supply chains ” elsewhere if there ’ s a disruption in one country .
“ With drugs , that ’ s just more difficult.
” It takes effort , no matter what , to shift an industry ’ s supply chain .
But drugs go through a critical extra layer of approval , which slows things down .
And while the FDA can absolutely expedite those applications and inspect new facilities , “ That ’ s just @ @ @ @ @ @ @ ” Sklamberg said .
Now for the good news .
Rena Conti , a health economist at Boston University , told me that because drug supply chains are so diffuse and complex , pharmaceutical companies are aware of the potential vulnerabilities .
That includes quality issues , contamination issues , weather events , or natural disasters .
And , especially recently , vulnerabilities related to tariffs or trade policies .
Many drug companies have backups in place .
For instance , they may have separate suppliers , or they may stockpile extra inventory @ @ @ @ @ @ @ means shortages may never happen , even if facilities face coronavirus-related snafus .
And even for those drugs that are at risk of a shortage because of an event like coronavirus , it is likely to take some time for these backlogs to work their way through the system — and , if this crisis is short-lived , consumers may never experience them .
The federal government also has backups in case of an emergency .
The US keeps a Strategic National Stockpile of some critical drugs and medical supplies , from vaccines @ @ @ @ @ @ @ established in case of a bioterrorism event and doesn ’ t have enough supplies for every citizen , it ’ s there .
Many local and state governments also stockpile vital drugs .
All this is for worst-case scenarios , and drug shortages can cause problems for patients and people long before there .
But the US and the rest of the world is still a long way from the most dire situation .
“ Yes , we ’ re vulnerable , ” Conti told me .
“ But we ’ re not @ @ @ @ @ @ @ ”

Share All sharing options for: Could the coronavirus spark drug shortages in the US?
Some prescription drugs Americans rely on every day, including antibiotics, come from China or depend on ingredients that are made there. The coronavirus outbreak and measures to prevent its spread have disrupted manufacturing in China, taking factories offline that are only now slowly ramping back up. That’s all increased fears of potential drug shortages in the United States.
But how worried should we be? Experts say the answer largely depends on how long these disruptions continue in China and whether the outbreak becomes widespread in other countries critical to the drug supply chain, including India.
Drug shortages might not be felt immediately, as many companies stockpile ingredients or supplies to protect against unexpected stoppages, or have redundancies — meaning they rely on factories in different places — built into their supply chains.
And the reality is, with or without the coronavirus, drug shortages are a perennial problem in the United States. But an acute emergency like a virus outbreak, but also a natural disaster or a geopolitical event like a trade war, can threaten to make things worse.
“It does fit a kind of scenario we have worried about in the field for a while now,” Cornelius Clancy, an associate professor of medicine and director of the XOR pathogen lab at the University of Pittsburgh, told me. “It wouldn’t take much to expose the vulnerabilities in the supply chain.”
The FDA is monitoring for coronavirus-related shortages
The Food and Drug Administration (FDA), the US federal agency that regulates medicines among other things related to public health, announced last week that a drug manufacturer had alerted the agency of a drug shortage related to the novel coronavirus outbreak in China.
The FDA won’t disclose the name of the drug but said that it was recently added to the drug shortages list, and that patients would be able to find an alternative.
The agency also said that, since January, it has communicated with more than 180 drug manufacturers about potential disruptions because of the coronavirus and identified 20 drugs that might be vulnerable because they “solely source their active pharmaceutical ingredients or finished drug products from China.”
“We have been in contact with those firms to assess whether they face any drug shortage risks due to the outbreak,” FDA Commissioner Steven Hahn said in the statement. “None of these firms have reported any shortage to date. Also, these drugs are considered non-critical drugs.”
But fears of potential shortages emerged again when India announced that it would limit the export of some two dozen drugs or drug ingredients to make sure it had enough supply for its domestic population. A major exporter of drugs, especially generics, to the United States and Europe, India also relies on China to help make those medicines — particularly those active pharmaceutical ingredients, or APIs.
In a statement, Jeremy Kahn, a spokesperson for the FDA, told Vox that the agency is “currently conducting a supply chain analysis of the APIs mentioned in the India news report to determine where other API facilities around the world are located that supply the US market. This will help to identify any potential drug shortage concerns for these APIs.”
The FDA, he added, “will work to evaluate identified products for any shortage concerns.”
In other words: The FDA says it is on it.
Again, drug shortages are not unusual in the United States. The FDA currently lists dozens of drugs in shortage. But the coronavirus could exploit some of these already present vulnerabilities depending on how the outbreak unfolds over the next weeks and months.
Fears of drug shortages are partially driven by a lack of transparency
A lot goes into manufacturing medicines. There are the active pharmaceutical ingredients, which are the things that make an antibiotic effective in treating a bacterial infection. Then there are other raw materials needed for manufacturing.
So a particular drug you buy at your pharmacy may contain active pharmaceutical ingredients that come from one place — say, China — but the actual pill or cream or whatever the finished product is might actually be manufactured in India or any number of other countries, including the United States.
The number of facilities overseas, including in China, that manufacture active ingredients has increased. This has happened, of course, for many of the same reasons other manufactured goods have moved overseas: It is cheaper to make those products overseas, and some of the environmental regulations may be less stringent.
“The supply chain is much more globalized today than it was in the past,” Rachel Sachs, an associate professor of law who studies food and drug policy at Washington University in St. Louis, told me, “and that poses concerns in any international global health crisis like this one.”
But it’s still hard to know exactly how dependent the US is on places like China and India for its drugs.
Janet Woodcock, the director of the FDA’s Center for Drug Evaluation and Research, told a House committee in August 2019 that, based on the data available, the FDA “cannot determine with any precision the volume of API that China is actually producing, or the volume of APIs manufactured in China that is entering the US market, either directly or indirectly by incorporation into finished dosages manufactured in China or other parts of the world.”
In other words, the FDA knows the number of facilities in China or Ireland or Mexico that are producing ingredients that go into drugs, but not what percentage of those overseas-manufactured ingredients ends up in an average American’s medicine cabinet.
What we do know, according to a 2019 paper from the National Bureau of Economic Research, is that almost 90 percent of the factories that make active pharmaceutical ingredients for the US market are located outside of the United States. And about 60 percent of the factories that manufacture the final products are outside the US. Again, this is not a percentage of US drugs made abroad, or the percentage that rely on ingredients from abroad. It is merely noting the location of the factories.
What makes this even more complicated is the lack of transparency, at least for the public. The FDA has said that the 20 drugs it is monitoring because of coronavirus are “non-critical” but won’t say what they are. And, as mentioned above, the FDA won’t say what the drug currently facing a shortage due to the coronavirus actually is. FDA Commissioner Hahn said at a Senate hearing last week that the FDA could not make it public because of “confidential commercial information.”
This is frustrating in its own way because if you’re someone who relies on medication, not knowing what’s in shortage can create its own type of panic.
Erin Fox, a University of Utah expert on drug shortages, told me that under the law, US drug companies have to tell the FDA when they anticipate a drug shortage at least six months ahead of the shortage, or as soon as possible if for some reason they can’t meet that standard. However, Fox explained that companies aren’t obligated to say the reason for the shortage.
But all of this means it’s actually pretty hard for you, as an American consumer, to know whether the medication you’ve been prescribed is reliant in some way on materials made in China or made in a factory in India or anywhere else.
“It’s just literally the one thing that we buy in the US that we have literally no information about,” Fox told me. “You know more about your water bottle that you’re going to buy or your clothing or your food than you know about purchasing a drug.”
Okay, so what’s the bottom line here? How worried should I be?
As with all things related to the coronavirus, don’t panic.
But overall, experts said that, yes, potential drug shortages are a concern, especially if the coronavirus outbreak continues to affect manufacturing in China, and even more so if the outbreak goes farther afield, particularly if it threatens India’s drug production.
“If the coronavirus spread to India in a large way, and you started having Indian pharmaceutical facilities go down at the same time you had Chinese pharmaceutical facilities go down, that would cause significant shortages in the US,” Howard Sklamberg, a partner at the global law firm Akim Gump and a former deputy commissioner at the FDA, told me.
“In other industries,” Sklamberg explained, “companies can try to shift their supply chains” elsewhere if there’s a disruption in one country. “With drugs, that’s just more difficult.”
It takes effort, no matter what, to shift an industry’s supply chain. But drugs go through a critical extra layer of approval, which slows things down. And while the FDA can absolutely expedite those applications and inspect new facilities, “That’s just not something you can do overnight,” Sklamberg said.
Now for the good news.
Rena Conti, a health economist at Boston University, told me that because drug supply chains are so diffuse and complex, pharmaceutical companies are aware of the potential vulnerabilities. That includes quality issues, contamination issues, weather events, or natural disasters. And, especially recently, vulnerabilities related to tariffs or trade policies.
Many drug companies have backups in place. For instance, they may have separate suppliers, or they may stockpile extra inventory. So for some drugs, it means shortages may never happen, even if facilities face coronavirus-related snafus.
And even for those drugs that are at risk of a shortage because of an event like coronavirus, it is likely to take some time for these backlogs to work their way through the system — and, if this crisis is short-lived, consumers may never experience them.
The federal government also has backups in case of an emergency. The US keeps a Strategic National Stockpile of some critical drugs and medical supplies, from vaccines to face masks. Though it was established in case of a bioterrorism event and doesn’t have enough supplies for every citizen, it’s there. Many local and state governments also stockpile vital drugs.
All this is for worst-case scenarios, and drug shortages can cause problems for patients and people long before there. But the US and the rest of the world is still a long way from the most dire situation. “Yes, we’re vulnerable,” Conti told me. “But we’re not as vulnerable as some people expect.”