Category Archives: Covid-19

Lara Sowers has had experience dealing with highly infectious diseases even before the emergence of the coronavirus.

A nurse at Penn State Milton S. Hershey Medical Center, Sowers has been part of the special pathogens team since 2014. For the last several weeks, shes been working with coronavirus patients.

She described how COVID-19 is much different than the Ebola virus, an infectious disease that can be fatal.

Its a lot less viral than Ebola. Ebola is scary in that it moves so quickly. Luckily, COVID isnt on that level," Sowers said.

Whats scary about COVID-19 is its more insidious," she said. "People know when they have Ebola. Whats scary with this (COVID-19) is people dont know. They dont have symptoms.

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Penn State Health nurses

In the course of the coronavirus pandemic, she said some people have had surgery and were swabbed for a virus as a precaution and the tests have come back positive.

Weve had some really sick people and others feel rundown and dont feel like themselves, and get swabbed, and they come in and theyre positive, Sowers said.

Since COVID-19 is a novel virus, theres not volumes of research doctors and nurses can review to get a handle on it. So she appreciates that fact that the Hershey Medical Center is engaged in studies of the virus.

Its crazy in that sense," Sowers said. "Its neat to be at an institution thats creating the research too. Thats been pretty neat to see in action.

Very little is easy right now. Even donning - and removing - the protective gear is an arduous, time-consuming process.

In our normal operations, its rip it off and go, she said. Here, its step by step and making sure were doing it as safe as possible. Its a lot more intentional.

Sowers is a pediatric nurse so working in the coronavirus unit has given her the chance to work with adults. The medical center has seen a few pediatric patients with the virus but theyve been treated at Penn State Childrens Hospital.

For me, Ive been learning how to take care of a whole new population of patients Ive never cared for, she said. I give a lot of credit to the adult nurses who have taken me under their wings. Thats been definitely a huge challenge.

Sowers, who works the night shift, has bonded with the nurses in the coronavirus unit. The coronavirus team has nurses from various departments throughout the hospital.

Were experiencing some crazy things, she said. "We get so crazy. You look awful, you feel terrible, you kind of have to laugh with each other.

Its all hands on deck and its incredible to see everybody work together," she said. "It really is a family.

In the first weeks of the pandemic, Sowers said it was a non-stop adrenaline rush. Now, she said, "Were out of that intensity and into the longevity phase.

This is not going away, Sowers said. "Even as life gets to normal outside the hospital, its not normal in the COVID unit. This is going to be an ongoing fight for us.

Sowers said she understands the frustrations of those seeking a return to normalcy, particularly as so many have lost jobs. But she said it can be frustrating seeing people online who arent social distancing.

Its heartbreaking to see the reality of this disease and how it affects families. You have the heartbreaking stories of people who arent working," she said. I get it from both sides. I dont know the right answer."

This illness is so scary, she said. "I wouldnt want anyone to have to go through this.

Like some other nurses, Sowers has been avoiding contact with her family during the pandemic so she doesnt risk passing on the virus to her loved ones.

Theyre very much a part of my normal everyday life," she said. "Not having that has been challenging for sure.

On the plus side, shes heard from friends she hasnt heard from in years. And the medical center has had donations of food from area restaurants.

Little gestures from the community go a long way," she said.

Note: As part of National Nurses Week, PennLive is spotlighting nurses who are treating coronavirus patients. Look for more features in the coming days.

More from PennLive

UPMC nurses describe the challenge of battling coronavirus: National Nurses Week

Geisinger Holy Spirit nurses describe their rewarding work: National Nurses Week

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Even for a nurse who has dealt with infectious diseases, COVID-19 is scary; National Nurses Week - PennLive

Construction at the COVID-19 field hospital at McCormick Place in Chicago on April 10. The city pared back plans for a 3,000-bed temporary hospital at the nation's largest convention center as infection numbers decreased. Nam Y. Huh/AP hide caption

Construction at the COVID-19 field hospital at McCormick Place in Chicago on April 10. The city pared back plans for a 3,000-bed temporary hospital at the nation's largest convention center as infection numbers decreased.

As hospitals were overrun by coronavirus patients in other parts of the world, the Army Corps of Engineers mobilized in the U.S., hiring private contractors to build emergency field hospitals around the country.

The endeavor cost more than $660 million, according to an NPR analysis of federal spending records.

But nearly four months into the pandemic, most of these facilities haven't treated a single patient.

Don't see the graphic above? Click here.

Public health experts said this episode exposes how ill-prepared the U.S. is for a pandemic. They praised the Army Corps for quickly providing thousands of extra beds, but experts said there wasn't enough planning to make sure these field hospitals could be put to use once they were finished.

"It's so painful because what it's showing is that the plans we have in place, they don't work," said Robyn Gershon, a professor at New York University's School of Global Public Health. "We have to go back to the drawing board and redo it."

But the nation's governors who requested the Army Corps projects and, in some cases, contributed state funding said they're relieved these facilities didn't get more use. They said early models predicted a catastrophic shortage of hospital beds, and no one knew for sure when or if stay-at-home orders would reduce the spread of the coronavirus.

"All those field hospitals and available beds sit empty today," Florida Gov. Ron DeSantis, a Republican, said last month. "And that's a very, very good thing."

Michigan Gov. Gretchen Whitmer, a Democrat, said: "These 1,000-bed alternate care sites are not necessary; they're not filled. Thank God."

Senior military leaders also said the effort was a success even if the beds sit empty. Gen. John Hyten, vice chairman of the Joint Chiefs of Staff, was asked at a news conference if it bothered him to see the field hospitals go unused.

"For gosh sakes, no," Hyten said. "If you see beds full, that means the local capacity of the local hospitals to handle this [has] been overwhelmed. And now we're into an emergency situation."

The Army Corps started building more than 30 field hospitals, retrofitting convention centers and erecting climate-controlled tents, in mid-March. Agency officials pushed to get these facilities done fast limiting the bidding process and often negotiating directly with contractors they knew could deliver on time.

"I tell our guys, you have three weeks," Lt. Gen. Todd Semonite, commander of the Army Corps of Engineers, said at a Pentagon news briefing in March. "You get as much as you can [get] done in three weeks. And then the mission is complete. We have a narrow window of opportunity. If we don't leverage that window of opportunity, we're gonna miss it."

At Chicago's McCormick Place, workers scrambled in April to transform the convention center into a massive temporary hospital with 3,000 beds more than the biggest hospital in Illinois.

"This was an empty convention hall," Illinois Gov. J.B. Pritzker said during a news conference while flanked by construction workers in hard hats and bright yellow vests. "Monumental, round-the-clock dedication is what got this done before we need it, preparing for saving lives in the event that things become as bad as some have predicted."

But just as construction got underway, states were issuing stay-at-home orders. And the spread of the coronavirus eventually began to slow.

Work on the field hospitals continued, though some projects were scaled back including McCormick Place. The field hospital opened with one-third of the beds originally planned, and it closed its doors a few weeks later after treating fewer than 40 patients.

The same story is playing out across the country. In fact, most Army Corps field hospitals haven't seen a single patient.

In many parts of the U.S., hospitals were able to expand their capacity to keep up with the surge of coronavirus patients. But in New York, hospitals were overwhelmed, and local officials pleaded with the public to save hospital beds for people who needed them most.

"The mantra was, 'Don't come to the hospital, don't go to the doctor, stay home, stay home till your lips turn blue,' " said Gershon of NYU's School of Global Public Health. "Well, we now know that was a crazy set of advice."

Gershon said she worries that a lot of people followed that advice and that some may have died because of it including a cousin of hers on Long Island. He stayed at home as he got sicker, Gershon said, and later died on a ventilator in the hospital.

Contractors built two field hospitals on Long Island, on the campuses of the State University of New York at Stony Brook and SUNY Old Westbury, at a total cost of more than $270 million.

The Army Corps limited the competition in awarding the projects to speed the process, which usually takes six to nine months, according to agency documents. Officials noted they were able to complete the contract award for the Stony Brook project in a "little more than three days."

"This time savings was critical in order for construction to begin as quickly as possible, supporting the unusual and compelling nature of the urgency of this procurement and the national emergency," the document said.

The two Long Island field hospitals were completed in late April. They never opened to the public and didn't treat any patients.

"That's outrageous," Gershon said. "That's completely crazy. I hope they didn't take them down."

The temporary hospitals in New York haven't been taken down. They're on hold in case they need to be reopened in the future, according to a state health department spokesman.

New York has "so far avoided the worst-case scenario we were preparing for," the spokesman said in a statement. "There has been a reduced need for hospital beds, and as of now we are not moving forward on purchasing supplies and equipment or securing staff for these sites."

Even in New York City, where the Army Corps field hospital did treat COVID-19 patients, it never reached full capacity.

"There are a lot of losers in it and not a lot of winners," said Dario Gonzalez, an emergency doctor with the New York City Fire Department who helped lead the medical response at the temporary hospital at the Javits Center in Manhattan.

"It was very disappointing," Gonzalez said. "Everybody was here, ready to work, ready to get patients in."

Medical supplies are viewed inside the Javits Center in March in New York City. The Javits field hospital treated about 1,100 patients while it was open for three weeks. Bryan R. Smith/AFP via Getty Images hide caption

Medical supplies are viewed inside the Javits Center in March in New York City. The Javits field hospital treated about 1,100 patients while it was open for three weeks.

The plan was for the Javits Center to take patients from overwhelmed hospitals in the city. But in practice it wasn't that easy. Some hospitals complained that the intake process was too complicated. And they sent few patients to Javits even as they resorted to treating patients in the hallways.

During the three weeks it was open, the Javits field hospital treated about 1,100 patients. Gonzales said it could have handled a lot more.

"We all could have done a much better job," Gonzalez says. "And we've got to really get it together to get that right the next time."

Officials in other states such as Illinois and Michigan also said field hospitals can be quickly reopened if there's an increase in coronavirus cases.

"We really wanted to make sure that we were maintaining some of the physical infrastructure that has been built there. So that should we need it, it doesn't take us a long time to potentially turn that back on," said Allison Arwady, the public health commissioner in Chicago.

She said officials there are keeping a close eye on the number of COVID-19 patients in local hospitals.

"We watch it really closely every day," Arwady said. "And certainly if we start to see any direction that things are not going the right way, we stand ready in case that needs to be reassessed."

National Desk Senior Producer Walter Watson and intern Brooklyn Riepma contributed to this report.

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U.S. Field Hospitals Stand Down, Most Without Treating Any COVID-19 Patients - NPR

If theres one thing my kids miss most during quarantine, its buffets. In stark contrast to highly regimented meals of the past two months, buffets have no rules. Zev would enjoy combining sushi and pizza. Hal has been known to sneak dessert first. Leos plate was often piled so high it looked like hed taken one of everything. The lack of dining rules suffused the entire outing and it required effort to keep them from running wild through the restaurant.

While high-end buffets do a nice job of hiding the disorder cleaning up spilled shrimp cocktail sauce the lack of rules is most evident at more affordable venues. Zev has celebrated several birthday dinners at the Legoland California Hotel buffet, but my only memory is of an obese bearded man passed out on the floor next to the soft serve machine, shirt riding high on his belly a buffet omen if there ever was one.

In addition to hosting many actual Legoland-quality buffets (including at least one in a revolving restaurant), colleges and universities market themselves as buffets for the mind. For many of us, scrolling through a colleges courses and programs of study can be even more exhilarating than strolling into a buffet on an empty stomach. Universities are also buffets in that students consume cognitive skills, non-cognitive skills, and maybe even technical skills in a single (albeit lengthy) sitting. Finally, while many buffets have installed chocolate fountains with no clear nutritional purpose, universities have lazy rivers.

Welcome to college!

So what happens to the college buffet now that COVID crisis has turned to coping? In the absence of a resurgence of the virus or scary new research about aerosol transmission, nearly all campuses will reopen this fall with a significant portion of learning conducted online in order to maintain social distancing via reduced classroom density. The stated reason for inviting students back to campus will be along the lines of what Mitch Daniels conveyed two weeks ago: Purdue University [is] sober about the certain problems that the COVID-19 virus represents, but determined not to surrender helplessly to those difficulties but to tackle and manage them aggressively and creatively. Copycat messages have already begun (see e.g., Radford University: We will overcome this unprecedented challenge together as one Radford family). The unstated reason will be financial: no college or university wants to find out what happens to enrollment following an announcement of continued remote learning. This is why the first institution to signal further online instruction Cal State Fullerton quickly walked it back.

Nevertheless, on the heels of a lost spring when students learned that remote learning is like a buffet where you cant smell or taste the food, many wont be buying in this fall. International students are already out the door kicked out of dorms and mostly back home. In a global public health and economic crisis, relatively few are likely to return to study in a country where the only thing worse than the Presidents historic bungling of the COVID crisis is pencil neck henchman Stephen Millers un-American message that we no longer welcome foreign talent. Domestic students also appear willing to press pause, many signaling theyll be staying close to home regardless of how enthusiastically their (former) college of choice echoes Mitch Daniels. An ACE survey predicted up to 17% of currently enrolled students wont continue. Another poll found that 12% of entering students who have already paid deposits no longer plan on attending, while a much higher proportion of students than normal havent paid deposits. A survey of surveys estimated a potential overall shortfall of as much as 20%.

While we await the first survey of survey of surveys, we know one thing for certain: the impact of a national enrollment shortfall anywhere in this vicinity will be unevenly distributed. Our most selective colleges and universities are top buffets like the Bacchanal Buffet at Caesars Palace: a combination of incredible choice and quality that will continue to attract long lines. For these schools, which continue to strictly limit the number of seats for no good reason, COVID-19 wont mark the end of the buffet; well still be wondering where the buffet line ends.

The story will be very different for non-selective institutions that predominantly enroll students from outside their metropolitan areas, or that operate outside major metropolitan areas. At these schools, far too many current and prospective students will stay home and enrollment declines may be devastating. On top of this, expect a decline in state funding of higher education of as much as 20%. So revenue at some public institutions could fall 30%. The question these colleges and universities will face is one a friend who teaches at a liberal arts institution recently posed: If someone burned down 1/3 of your house, would you rebuild exactly as it was? Would you put up plywood sheets to separate the charred part? Or would you completely redesign your house?

In 1937, Texas oil tycoon Sid Richardson decided to toughen up his nephew, recent Yale grad Perry Bass, by hiring him to manage the construction of his new estate on St. Joes, a barrier island in the Gulf. Richardson told Bass he had a $35k construction budget. Once Bass reached the island, Richardson called Bass and took it back, saying he needed the money for a lease in West Texas. Any son-of-a-bitch can build a house for $35k, said Richardson. It takes a genius to build it with nothing.

COVID-19 is a Sid Richardson test for hundreds of non-selective colleges and universities. As finances turn upside-down, presidents, provosts, and deans will find themselves in an unfamiliar and highly uncomfortable position. Bass passed Richardsons test by rethinking construction, making his own building material out of a mixture of sand, oyster shells, and cement (which he bought on credit). To pass their test, college and university leaders must do nothing less than redesign higher education.

As Pennsylvania State System Chancellor Dan Greenstein correctly notes, redesigning higher education means more than closing campuses. Greenstein is considering moving less popular programs and courses online so a single campus in the system can achieve scale in delivery. Similarly, Southern New Hampshire University one of the few non-selective institutions with nothing to worry about by dint of its online scale proactively announced freshman year coursework would be completed online, reset freshman tuition at $10k, and awarded full scholarships to all entering students. According to President Paul LeBlanc, we're trying to unbundle these two jobs we get asked to do. New students will have the clubs, organizations, all of that which we associate with residential campuses. But their academic program will look quite different, and there will be aspects of the residential experience that will likely look different as well. SNHU promptly set a record for most deposits in a single day.

Assuming few at-risk schools take similar action this fall, watch for at least one state to make a SNHU-like move, helping public institutions manage an unprecedented budget reduction by migrating all lower division instruction online and sourcing programs from providers like Coursera. Multiple data points suggest general education at non-selective colleges and universities may be a casualty of COVID-19. Beyond gen ed, in the coming months expect to hear a lot more about zero-based budgeting, upside-down degrees that start with industry-recognized certifications (or at least marketable certificates), and new linear faster + cheaper pathways to good jobs. The wild disconnect between a higher education buffet with no rules and a labor market with too many surprising and unfair rules cannot continue indefinitely.

Most of these changes will have the effect of limiting student choice and therefore will be anathema to prior generations who benefited from choice and discovery. The trope of discovery is powerful in higher education. Whod want to be against discovery? (Whos against bigger buffets?) But COVID-19 will force colleges and universities to distinguish between choosing a pathway and choosing elements of that pathway. The former is critical. But at too many institutions, the latter directly contributes to crises of completion, affordability, and employability.

The biggest challenge to rethinking higher education is that faculty and administrators are captive to their educational backgrounds and nostalgia. But just because that model still works at our most selective universities or worked 20, 30, or 40 years ago where you went to school as Michael Sorrell, savior of Paul Quinn College argues, we can no longer sit around and be held hostage to traditional wisdom or tradition. We have to stop being more in love with our traditions than we are with our students. Passing the Sid Richardson test and redesigning higher education will require taking advantage of the COVID-19 crisis to overcome the numerous internal obstacles to necessary change.

All buffets are NOT created equal. As demonstrated by Yelp reviews, theres a wide gap between the paroxysms of pleasure for the Bacchanal Buffet and the nearby Las Vegas Golden Corral where a complete lack of rules seems to frustrate the dining experience:

The cook is cooking me a steak holding his phone. Next hes putting food in a container holding a towel in the food. Just completely nasty.

Our server was on her phone texting. We needed refills and our plates needed to be picked up they kept piling she just kept walking passed them then she disappeared. We ended up finding her outside with management smoking marijuana.

If you feel like pulling up to a feeding trough this is the place for you.

Golden Corrals traditions are clearly not worth maintaining (who wants to eat in a corral anyway?). Although non-selective colleges and universities are certainly prettier and nicer places to work than Golden Corral (and contribute more to the store of human knowledge than the above comments), from the standpoint of student outcomes, hundreds of schools with low completion rates and indebted, underemployed graduates are in the same category; if Yelp permitted education reviews, they would be just as depressing.

One higher education tradition worth upholding is harnessing social turbulence or transformation to advance the mission. During the Great Depression, many colleges took advantage of record low construction costs to build iconic campuses. Passage of the GI Bill resulted in a 2.5x increase in the number of college graduates over the course of the 1940s. The Civil Rights era led to much needed diversity and social justice on campus. The COVID question for trustees, presidents, provosts, and deans at non-selective institutions is how to harness financial disruption to jettison traditions and rethink how to achieve better student outcomes. The coming fiscal crunch is a crisis that cannot go to waste. Because if theres one thing that will never be the same after quarantine, its buffets.

Read more:

COVID-19 Is The End Of The Higher Education Buffet - Forbes

"I'm not new to this game, I'm true to the game," the blues singer told CNN. "I've been doing it for a long time. You really have a lot of ups and downs in this crazy situation."

Cohen is part of a community of musicians trying to keep the blues alive in a landscape where live music is on hold and the artists dedicated to the genre are particularly vulnerable to Covid-19.

"It shut a lot of us down," Cohen said. "The ones that were doing the clubs, they don't have the clubs [to perform in] anymore. They don't have the regular gigs anymore. They don't have anything."

Musician and singer Sam Frazier, Jr. recently rose to the top of the kidney transplant list, but he is now unsure when he might receive one because of the pandemic.

He told CNN he's working hard to protect himself and stay healthy, but misses performing -- even locally in Alabama where he lives.

"I'm an entertainer," he said. "I'm a singer. I play the harmonica, guitar and I can play the [bass] drum using my feet. I sing blues and I sing country. That's what I do."

Already in a crisis situation

The group helps book members for performances and also provides financial assistance to artists.

Timothy Duffy, founder and executive director of the foundation, told CNN that many of the artists they assist are most susceptible to falling critically ill were they to contract Covid-19.

"Almost all our partners are elderly, so that makes them extremely vulnerable to the virus," Duffy said. "The majority, over 80% of the artists we work with, are African Americans over the age of 55."

Duffy said most of them were already making do with annual incomes of less than $18,000 a year. Any work they used to get from playing bars and restaurants is now gone.

"They're already in a crisis situation," said Duffy, whose organization gave out 85 grants to struggling artists in April and helped set up grocery and medicine deliveries for some. "They're already marginalized, so our staff has a dedicated social worker that is working to ensure that our artists are safe and informed."

Still singing

Cohen said she appreciates the help as she waits things out in the new normal and finds strength in what she's already overcome.

"I lost everything in Katrina," said Cohen, who added she relies on the power of positive thinking and consuming inspirational content. "I haven't lost everything because of this pandemic."

She definitely hasn't lost her ability to entertain.

Lately she takes her audio equipment to a nursing home where her brother resides. With current health precautions preventing her from entering, Cohen performs for residents from the parking lot.

"I wanted to make sure that my brother got some entertainment," she said. "They said the only way that we could see them is to go to their windows outside and you know, wave to them and talk to them through the windows with the windows closed. But they can still hear you."

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Covid-19 taking toll on blues community - CNN

A man wearing a face mask travels on a ferry to cross the Yangtze River in Wuhan in April. Chinese officials are working to silence people suspected of challenging the narrative that authorities in Wuhan and Beijing acted swiftly and efficiently to contain the coronavirus outbreak. Hector Retamal/AFP via Getty Images hide caption

A man wearing a face mask travels on a ferry to cross the Yangtze River in Wuhan in April. Chinese officials are working to silence people suspected of challenging the narrative that authorities in Wuhan and Beijing acted swiftly and efficiently to contain the coronavirus outbreak.

China's leaders have declared the coronavirus outbreak largely under control within its borders. Now, the authorities are working to control the narrative of how the country contained the virus by questioning and even detaining people who might possess information that challenges the official line.

Those being questioned include Internet-savvy archivists; families and their legal counsel suing the state for damages from the coronavirus epidemic; and even lauded volunteers who staffed critical emergency services from the epicenter city of Wuhan.

In February, during the peak of the outbreak in Wuhan, where the virus is believed to have originated, thousands of volunteers delivered supplies to hospitals, drove medical workers around the city and staffed online mental health services.

But now public security agents are questioning these volunteers over suspicions they provided foreign organizations with documentation that has led to accusations that China intentionally covered up the full extent of its coronavirus epidemic, according to two people familiar with the matter. They requested anonymity because those questioned were told by security agents to keep the matter confidential.

Some of the volunteers questioned ran a telephone hotline that became a well-known resource offering both counseling services and help finding open hospital beds as Wuhan's health care system became overwhelmed with COVID-19 patients.

Hotline volunteers kept active counts of hospital beds and emergency cases of the coronavirus across Wuhan information that could be used for estimating fatalities.

"The police say they have been investigating whether different Chinese volunteer groups provided U.S. intelligence agencies with the real death number of COVID-19 in China," said a person familiar with the police questioning who declined to be named for fear of retribution.

Another Shanghai-based volunteer group said a prominent organizer of theirs had also been questioned by public security agents in connection with possibly leaking information to foreign agencies and was asked to provide a list of names of other volunteers. The group, which denies leaking any information, said the organizer refused to identify the volunteers.

Official messaging from China's Communist Party insists the authorities in Wuhan and Beijing acted swiftly and efficiently to implement lockdown measures and contain the outbreak.

This effort to silence those who might provide information contradicting the official Chinese narrative comes as U.S. intelligence officials have been warning the White House that China vastly undercounted its coronavirus death toll, according to various U.S. news reports. The stakes are high: Missouri and Mississippi are suing China over damages from the coronavirus pandemic, and U.S. citizens have filed several related class-action lawsuits alleging China covered up the scope of the initial outbreak in Wuhan.

"A whitewash"

China has strenuously denied the allegations. "The sole purpose for some U.S. politicians trying to fool others with their obvious lies is to shift the blame of their own incompetence," a foreign ministry spokesperson said last month. A day later, China's state broadcaster ran a segment on its widely watched evening news program that featured footage of U.S. Secretary of State Mike Pompeo with "liar" stamped in red letters across his visage, in response to unfounded allegations from Pompeo that the coronavirus was leaked from a Wuhan lab.

Current efforts to conceal unfavorable information contrast with Chinese leaders' transparency pledge following the 2003 SARS epidemic, which health officials initially tried to hide, according to Susan Shirk, an expert on Chinese politics at the University of California, San Diego.

That year, Shirk points out, Chinese leadership changed hands Hu Jintao and Wen Jiabao took over as president and premier and promised to do things differently. "It was the new broom sweeping out the old ways of doing things and made a point of creating a new image emphasizing transparency," Shirk said.

But China's handling of the COVID-19 outbreak seems to revert to old ways. "[Chinese leaders] decided to not go with transparency but to go with a whitewash," Shirk says. "That's very different from SARS."

In several cases over the past month, China has outright detained those suspected of challenging the official version of how the outbreak was quickly brought to heel.

Eyes on GitHub

For the past three months, Beijing tech worker Chen Mei and more than a dozen other tech-savvy volunteers used GitHub, the open-source programming platform, to archive copies of nearly four dozen, often critical, journalistic reports and essays put together by Chinese writers, journalists, freelance bloggers and writers deleted by China's Internet censors.

Among the articles Chen and others archived was a widely read profile of Ai Fen, a Wuhan doctor who first forwarded a medical report in early January nearly three weeks before Chinese leader Xi Jinping warned the public about the epidemic to other doctors describing a mysterious SARS-like pneumonia arising in hospitals. GitHub, which is not blocked in China, is widely used by programmers and companies to collaborate on writing software.

Beijing tech worker Chen Mei and more than a dozen other tech-savvy volunteers used GitHub, the open-source programming platform, to archive copies of nearly four dozen, often critical, journalistic reports and essays put together by Chinese writers, journalists, freelance bloggers and writers deleted by China's Internet censors. Family of Chen Mei hide caption

Beijing tech worker Chen Mei and more than a dozen other tech-savvy volunteers used GitHub, the open-source programming platform, to archive copies of nearly four dozen, often critical, journalistic reports and essays put together by Chinese writers, journalists, freelance bloggers and writers deleted by China's Internet censors.

Then on April 19, Chen was suddenly detained, say three people close to him. Two friends Cai Wei, who helped update the GitHub archive, and Cai's girlfriend Xiaotang were also detained in Beijing on the same day as Chen for "picking quarrels and provoking trouble," according to a police notice seen by NPR. Lawyers for both Cai and Xiaotang say they have been unable to meet or communicate with their clients.

"Chen Mei used his personal ID on GitHub, so I sent him a message saying his ID was public and to be careful," said Lucy Qiu, a friend of Chen's. "That was our last contact."

NPR's calls to Beijing's Changping district police department, near where Chen lives, and calls and texts to the Chaoyang district police department, where the three are reportedly being held, were not answered.

Suing the city

Families demanding justice from the state have also been subject to sustained pressure from China's security apparatus.

"It is all part of social stability management," said a lawyer who has been providing legal aid to Wuhan residents. He requested anonymity because of the sensitivity of the topic. "They made a mistake, and they will not allow people to take them to court."

He is part of a group of about 20 lawyers who helped Wuhan residents seeking to sue the city and provincial government for allegedly mishandling the outbreak. They say that local officials failed to notify the public early enough about the virus' contagiousness and the extent of the outbreak in Wuhan.

In mid-April, several of the lawyers were called in by Chinese justice ministry officials and were told to stop their pro bono work. They were also asked to name the other lawyers in the group and plaintiffs. At least three plaintiffs have since dropped their cases after being coerced by police, according to those who were providing them legal assistance.

But a handful of Wuhan residents say they are pressing ahead with their lawsuits despite the danger in doing so. "What happened in Wuhan was a warning for the entire country. Leaders here created havoc for the entire country," one of the plaintiffs, whose mother died in February from the coronavirus, told NPR by phone. He vowed to continue with his lawsuit, saying it was his responsibility to push for an accurate accounting of human suffering during the lockdown.

Then he hung up abruptly, saying his phone was being monitored.

Originally posted here:

China Says It Contained COVID-19. Now It Fights To Control The Story - NPR

Fever, cough and shortness of breath were early on identified as symptoms of COVID-19, but additional symptoms are emerging. megamix/Getty Images hide caption

Fever, cough and shortness of breath were early on identified as symptoms of COVID-19, but additional symptoms are emerging.

When the coronavirus pandemic first emerged, public health officials told the world to watch out for its telltale symptoms: fever, dry cough and shortness of breath. But as the virus has spread across the globe, researchers have developed a more nuanced picture of how symptoms of infection can manifest themselves, especially in milder cases.

We're getting a "better understanding of how these symptoms express in the general population and not necessarily in hospitalized patients," which is whom most of the earlier studies from China looked at. "So it's a bit of a bigger picture," says Charitini Stavropoulou, an associate professor in health services research at City, University of London in the U.K., who led an analysis of known symptoms in milder cases as part of a collaboration with Oxford University.

Some of these symptoms, such as loss of smell or taste, are highly distinctive and a strong indicator of infection. Others, like headaches, chills or sore throat, are common to lots of illnesses. So how do you know when a symptom is cause to seek medical advice or testing? We asked doctors and public health and infectious disease researchers for their insights.

THE STANDARD 3

Fever: Some patients can experience fevers that last for days, while others might see their temperature go up and down, with peaks often occurring in the evening, says Dr. David Aronoff, chief of the Division of Infectious Diseases at Vanderbilt University Medical Center. "I think if someone has a fever, regardless of how long it's lasting, unless they can clearly attribute it to something else, that's a very reasonable symptom to seek an evaluation for," he says.

Stavropoulou's systematic review of the medical literature found that fever was reported in 82% to 87% of mild to moderate cases.

Dry cough: Cough was the second most common symptom after fever, though "coughing was not always there," Stavropoulou notes. "So while we think it's a main symptom, it appears only two out of three times for patients with COVID-19."

That said, cough remains a "very, very common symptom of the pneumonia that the virus can cause," says Aronoff. Given this fact, "if someone has a new cough or a new shortness of breath that's cropped up in the last three days or so, they should definitely get tested."

Shortness of breath: Stavropoulou's review found that this symptom occurs more frequently in severe cases "and indeed, in some studies, was a marker of severe disease." The two largest studies she looked at found that shortness of breath occurred in fewer than 8% of milder cases.

THE NEW 6 FROM THE CDC:

Chills/repeated shaking with chills: The chills generally precede a fever, though people don't always perceive when their temperature has spiked, Aronoff says. Sometimes, those chills can be accompanied by shaking, since shivering is our bodies' way of generating heat and raising our temperature, he says.

Muscle pain: Nearly 15% of COVID-19 patients experience muscle pain, according to a report published by the World Health Organization in February that analyzed nearly 56,000 confirmed cases in China. But that's hardly unique to this disease: Lots of viral infections can cause muscle aches and pains, which can result from an inflammatory response to a virus.

"I think all of us who have had the winter cold or flu have had experience with muscle pain, headache, sore throat," notes Aronoff. Given that we're no longer in the typical cold and flu season, if you're experiencing muscle pains and other flu-like symptoms, "we know that those can be associated with COVID-19," he says. "And it is very reasonable to get people thinking, you know, maybe I should get tested."

He added: "I would also include new-onset fatigue, out of proportion to what a patient would expect to be experiencing under whatever circumstances they are [in]," as a symptom.

However, fatigue on its own is not very predictive of disease, because it is also frequently reported by people who don't test positive, says Claire Steves, a geriatrician and senior lecturer at King's College London. She's one of the lead researchers on the COVID Symptom Tracker, an app-based project that has so far recruited 3 million people across the U.K. to log any symptoms even if they are not feeling sick. Researchers can use data from those who are eventually diagnosed with COVID-19 as an early radar on how symptoms develop in the population. (The COVID Symptom Tracker is now recruiting people in the U.S. to sign up as well.)

Steves' research is finding that certain symptoms tend to cluster together in people who test positive. For instance, fitter people in the 20-70 age range who experience loss of smell often also experience fatigue, and they tend to have a milder course of the disease, she says.

Headache: Headaches are a common experience for many adults. On its own, a headache should probably not be cause for alarm, especially if it behaves like other headaches you've experienced, says Aronoff.

"If somebody is only going to use headache as a trigger to go get tested for COVID[-19], that headache should be something that either is a headache that's new for them or that is sticking around a bit longer than they are used to," he says. "Or it's associated with another symptom that may also be subtle, like fatigue or feeling kind of worn out" especially if there's no good reason for the tiredness.

In fact, Steves says research out of the COVID Symptom Tracker suggests that headache "is an important symptom" seen early on in the course of the disease and it commonly occurs alongside other symptoms.

Sore throat: "We're seeing sore throat in COVID-19 patients," says Aronoff. "But it's what I would say [is] a minor symptom" one that's common to lots of other ailments.

Loss of taste or smell: This symptom has emerged as a strong indicator of infection one distinctive enough that it alone should be cause to seek testing, says Dr. Carol Yan, an otolaryngologist and head and neck surgeon at UC San Diego Health.

If someone is experiencing this symptom, "I would tell them that they should consider self-quarantining themselves and contacting their health care providers," says Yan. Most people who experience loss of smell or taste also have other symptoms, commonly fever, fatigue and malaise, she says. "But there's certainly a subset of people that we know have only smell and taste loss and no other symptoms" who ultimately test positive.

Yan's research has found that about 7 out of 10 patients reported an acute loss of sense of smell or taste at the time of their diagnosis.

Similar findings have emerged from the COVID Symptom Tracker. Among fit and healthy people ages 20 to 70, "the loss of sense of smell is a really good marker" of infection, Steves says.

In fact, this symptom is seen as such a strong indicator of infection that patients at UC San Diego Health are now routinely asked not just if they have a cough or fever but also if they're experiencing a loss of smell or taste, says Yan. "It's really being used as a good screening question and in helping triage patients."

The good news is that both Yan and Steves have found that people who lose their sense of smell or taste tend to experience a milder course of the disease. Yan says patients generally recover these senses in two to four weeks on average.

OTHER POTENTIAL RED FLAGS

Confusion and gastrointestinal issues: Stavropoulou's review of the medical literature found that, in most studies, gastrointestinal issues were reported in fewer than 10% of mild cases of COVID-19.

But Steves says emerging data from the COVID Symptom Tracker suggest that problems like diarrhea, nausea and abdominal pain tend to be more prominent in the frail elderly people who are over 70 and need help to get around. Acute confusion also seems to be an important symptom in this group, she says.

"Older and frailer and more co-morbid people" those with underlying conditions such as heart disease, diabetes or obesity "tend to be getting this cluster of abdominal symptoms and delirium symptoms and headache as well," Steves says.

She says it's important for caregivers to recognize that these symptoms in the frail elderly could be indicative of COVID-19, particularly in situations like nursing homes, "because that's where spread could occur."

AND THEN THERE'S THIS ...

Chilblains (pictured) are itchy, red, pink or purple inflammations of the skin's small blood vessels that can develop in body parts such as toes and fingers from exposure to colder temperatures or wet conditions. A similar-looking inflammation of the toes is an emerging symptom of COVID-19 and is being referred to as "COVID toes." Science Source hide caption

"COVID toes" and other skin manifestations: Dermatologists are now reporting that certain skin conditions appear to be emerging as symptoms of infection in milder cases. Among the most common and striking is "COVID toes," a condition resembling chilblains, or pernio, on the feet or toes, says Dr. Esther Freeman, director of global health dermatology at Massachusetts General Hospital and director of the international Dermatology COVID-19 Registry. The registry has received more than 400 reports from dermatologists in 21 countries, and a little under half are cases of COVID toes, she says.

Normally with chilblains, "you would see pink, red or purple lesions on the toes or sometimes on the hands," Freeman says. "That's often accompanied by swelling and can also be accompanied by a burning, itching or tender sensation," she says.

Chilblains are caused by inflammation in the small blood vessels of the skin, usually in reaction to colder temperatures or damp weather, Freeman says. "So, for example, spending a lot of time outside in wet socks could do it."

What's unusual is that during the coronavirus pandemic, "we're seeing patients who are living in warm climates or patients who have been sheltering inside and staying warm developing these lesions for the first time," she says.

"I have seen more toe consults in the past two weeks than I have in my entire prior career combined," Freeman says.

She says some patients develop COVID toes early on, along with other symptoms such as fever or cough. Others develop the condition well after their other symptoms have passed, almost like a post-viral response. And a third category of patients seems to develop COVID toes as the sole symptom.

Other skin conditions reported include hives and morbilliform, a measles-like rash on the chest, back, arms or legs. Freeman notes that viruses for example, those that cause measles or chickenpox often cause rashes, so dermatologists were expecting that with the coronavirus. But the toe manifestations were surprising.

While data are still emerging, Freeman says that in her opinion, dermatologic symptoms, such as COVID toes, should be considered as criteria for testing. But if you're having these symptoms, she says, "Please don't panic. Most of our patients who are developing these COVID toes are doing extremely well and are able to recover fully at home."

"I think it's also important to know that the purple lesions will go away on their own," she adds.

Read more:

Is It COVID-19 Or Something Else? What Experts Are Learning About Symptoms : Goats and Soda - NPR

SEATTLE Amid growing impatience over stay-at-home orders and rising unemployment, public health experts have worried that some people may try to expose themselves to the coronavirus in a risky bid to gain immunity.

County health officials in southeastern Washington State reported this week that they had evidence that one or more such gatherings had been linked to at least two new coronavirus cases. But on Wednesday night, the officials retracted those comments and said the so-called Covid-19 parties may have been more innocent gatherings.

Meghan DeBolt, the director of community health for Walla Walla County, said county officials were learning more about the cases that have emerged from the recent social gatherings. She said they were still hearing reports of parties where infected people were present but do not have evidence that the people who became ill after the gatherings had attended out of a desire to be exposed.

The county had said in a news release on Monday that the authorities were receiving reports of Covid-19 parties occurring in our community, where non-infected people mingle with an infected person in an effort to catch the virus. Officials later elaborated on those reports in interviews, saying the parties were discovered after tracing the paths of people who were found to be infected after the gatherings.

Officials in Walla Walla have been working in recent weeks to contain a large outbreak at a meat processing facility in the area. Ms. DeBolt said the county was not close to halting the rise in infections, and health officials are concerned that more people are engaging in ill-advised social interactions despite stay-at-home requirements.

We know that people are exhausted from isolation and quarantine, Ms. DeBolt said. We want to be able to reopen, too. We want to be able to go to restaurants and socialize with friends and family members. We need our communitys help to be diligent for a little bit longer so that we can get ahead of this.

The prospect of infection parties for people who wish to quickly contract the disease in the hope of gaining immunity has been a fear among some health experts because the country has a long history of people choosing purposeful infection.

Visit link:

Covid-19 Parties Probably Didnt Involve Intentional Spread - The New York Times

PIERRE, S.D. (KELO) The death toll from COVID-19 in South Dakota increased by two on Thursday, according to the latest update from the state department of health.

Total deaths reported is now at 31 in South Dakota. The two new deaths were listed as females over the age of 80-years-old in Minnehaha County.

Active cases of COVID-19 went to 846, up 73 from Wednesday (773).

Theres 2,905 total positive cases, up 126 from Wednesday (2,779). Recoveries went over 2,000 to 2,028, 51 more than Wednesday (1,977).

Current hospitalizations are at 70, down from Wednesday (72). Total hospitalizations are at 236, up from Wednesday (230).

Negative tests at at 17,209, up from Wednesday (16,637).

The amount of new tests reported was 698 on Thursday. 101 of the 126 new positive cases were Minnehaha County, where mass testing has been taking place this week for Smithfield employees and families.

Stay with KELOLAND News for more coverage online and on-air.

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COVID-19 update: South Dakota death toll up to 31, active cases at 846 as 698 new test results announced - KELOLAND.com

A mobile morgue at the Brooklyn Hospital Center, April 20, 2020. Photo: Ben Fractenberg/THE CITY

Need to know more about coronavirus in New York? Sign up for THE CITYsdaily morning newsletter.

The disparities in the COVID-19 deaths ravaging New York City extend to who is publicly memorialized.

Fewer than 5% of the nearly 20,000 New Yorkers killed by coronavirus so far have been remembered with a paid or staff-written news outlet obituary or other death notice, an analysis by THE CITY and Columbia Journalism Investigations found.

The team examined English-language media, as well as news sources in a number of other languages, among them Spanish and Korean.

The publicized deaths defined as accompanied by a victims name and other identifying information, such as age, home borough and next of kin skew male and younger. They also disproportionately come from wealthier enclaves of the city than the general population felled by the virus.

The result: The deaths of some groups hardest hit by coronavirus including black and Hispanic residents and recent immigrants living in poorer and more densely populated neighborhoods in The Bronx and Queens often go unnoticed by anyone other than their families, coworkers and friends.

Were hoping to change that but we need your help.

If someone you know a relative, a friend, a coworker, a neighbor, a client, etc. lived and died in New York City, and was a victim of coronavirus, tell us about them by filling out this short form.

Were looking for some basic information the persons age, where they lived, when they died and more.

Bronx Community Board 9 member Sharan Fernandez, 63, died April 10 from coronavirus complications. She didnt receive a formal public obituary, but her death was announced on Twitter by the community board. Photo: Courtesy of the Fernandez Family

But we also want you to tell us whats the one thing you most remember about the person what, in your eyes, made them a unique New Yorker.

Were encouraging people to share pictures, prayer cards, old news clippings anything that helps us show their life in the city. Well also need to know a little about you so we can follow-up as needed, to verify details.

This, to say the least, is a huge undertaking. We cant promise full-scale obituaries of thousands of people.

Were still figuring out how we will present the information we receive and are able to verify. We cant say how long it will take, though we suspect this project will build in stages.

Our goal, though, is clear: to put as many names, faces and details to the numbers as possible.

Were striving to give a sense of the unimaginable loss our city is experiencing while sharing both the burden of grief and the comfort of memories as we forge ahead together, as New Yorkers.

Keith Cousins is a reporting fellow for Columbia Journalism Investigations, an investigative reporting unit at the Columbia Journalism School. Funding for CJI is provided by the schools Investigative Reporting Resource.

The work of Derek Kravitz and Anjali Tsui is funded as part of Columbia Journalism Schools Brown Institute for Media Innovation.

Want to republish this story? See ourrepublication guidelines.

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Tell the Stories of the New Yorkers Lost to COVID-19 - THE CITY

In the past two weeks, one Covid-19 patient died following what several staff physicians described as gross mismanagement by healthcare workers at Rehoboth McKinley Christian hospital. Another patient suffered severe brain damage when a ventilator was improperly adjusted, according to those same physicians. And the hospitals critical care doctor, the only critical care physician in McKinley county, resigned, citing patient safety concerns.

On 5 May, an ad-hoc group of staff providers at the hospital, formally known as Rehoboth McKinley Christian Health Care Services, unanimously voted to submit a declaration of no confidence in Rehoboths CEO, David Conejo. The group, which formed this spring to protest conditions, followed up with a warning letter to the hospital board.

The letter charged Conejo with failing to effectively communicate, promoting a lack of transparency and poor fiscal management, and creating unsafe working conditions.

The rebelling staff accused Gallups second largest hospital of questionable leadership decision-making that led to severe staff shortages, a Searchlight New Mexico investigation found. Interviews with six doctors, three nurses and other caregivers, and a review of internal emails and written complaints, reveal a hospital in disarray.

Three physicians contacted by Searchlight agreed to go on the record in tandem. They are Chris Hoover, a urologist now directing the allocation of ventilators; Neil Jackson, a family medicine doctor now working in intensive care; and Andrea Walker, chief of obstetrics and gynecology.

Our hospital has not been safe in recent weeks, they said in a collective interview. And to not be transparent about this is medically unethical. Were working incredibly hard on the frontlines but due to managements poor choices, were left without the tools we need to fulfill our obligations to the community.

Critically understaffed for weeks while treating between 15 and 20 patients sick with Covid-19 the private non-profit hospital is faltering just as Gallup weathers a surge in coronavirus cases.

A 60-bed hospital with an eight-bed intensive care unit, Rehoboth has been operating far below minimum standards on nurse-patient ratios, Searchlight found. National nursing guidelines recommend that hospitals maintain one nurse to every three patients in most settings, with acute care units requiring a one-to-one or one-to-two ratio.

In recent weeks, Rehoboth has assigned one nurse to every two or three critical care patients and one nurse to up to seven patients in other units, said Val Wangler, the hospitals chief medical officer. One nurse, who asked for anonymity, told Searchlight that she was alone during one shift in late April.

Others had similar concerns. A labor and delivery nurse said in an email to staff physicians that she was overwhelmed and unable to respond to nonstop call lights.

I can say that I have never before in my career walked past a call light or intentionally ignored call lights in order to get through my day, wrote the nurse, who asked to remain anonymous. I did this all day on Wednesday.

She added: I am seeing images of helpless, desperate elderly patients tangled up in their beds and looking at me begging for help I have this feeling that I will enter a room and find a patient dead.

Conejo declined requests for comment. Responding on his behalf, Rehoboths public information officer wrote: Covid-19 is a new challenge for everyone. We are learning every day and our staff is working very hard to provide the best care possible for our Covid-19 patients.

Located at the edge of the Navajo Nation where the coronavirus infection rate is one of the highest in the US Gallup has become a center for the scourge. The city serves as a major shopping and medical hub for Navajo, Zuni and surrounding tribal communities, increasing the potential for widespread transmission. As of 6 May, the Navajo Nation had reported 2,654 confirmed coronavirus cases and 85 deaths.

On 1 May, the governor, Michelle Lujan Grisham, invoked an emergency declaration that closed all roads in and out of Gallup.

Private rural hospitals everywhere are struggling to maintain staff while losing revenue. They rely on privately insured patients and elective surgery to stay financially afloat. Rehoboth relies heavily on elective surgery for hospital revenues.

That all came to a stop on 25 March, when the governor temporarily ordered a halt to all elective surgery in New Mexico.

That same week, the hospital terminated the contracts of 17 nurses, most of them working in the emergency room and operating room. On 1 April, four hospital physicians delivered a letter to the administration, demanding to know what steps it would take to maintain patient care standards and safe staffing levels.

Conejo responded with his own series of letters and emails, arguing that because the hospital could no longer depend on elective surgery, the cuts had become financially necessary.

During one communication with staff, Conejo emailed a budget document that listed his annual salary of $674,481. In an accompanying document he wrote that he plans to give at least $50k in this current effort and that he generously gives of personal time and money to feed and clothe the poor.

Nine days later, on 15 April , Conejo again emailed staff, this time to say that the hospital had received nearly $3m in federal aid and expected to receive at least another $11m in federal loans.

He did not mention any plans to use those funds to address staffing shortages. By then, Rehoboth had lost even more workers 30 employees had tested positive for Covid-19, including 10 nurses.

There were errors happening that should never occur in any medical setting

The medical staff was outraged by what they called a lack of foresight by the CEO. At that point, management left us dangerously short-staffed and expected our nurses and medical assistants to work harder and for longer in areas outside of their expertise, said Hoover, Jackson and Walker. There were errors happening that should never occur in any medical setting.

According to two physicians who spoke to Searchlight, a Covid-positive patient spent the night of 26 April on a maladjusted ventilator. The equipment, which pushes oxygen to the lungs, had slipped out of the trachea and was resting in the patients mouth, rendering it useless for hours. The patient died in the following days.

A 27 April email from a doctor called for a peer review of the case and indicated that the medical staff had grossly mismanaged the ventilator.

Many of the nurses and doctors on duty were unprepared to care for such patients suffering from acute respiratory distress, according to several staff physicians. They blamed system inefficiencies, outdated equipment and a poorly trained support staff for negligence in failing to recognize the severity of the problems.

Many of the physicians and nurses had been hired by the hospital through remote staffing agencies, doctors said.

Rajiv Patel, the hospitals only critical care doctor, said he had become disillusioned with the inexperience of temporary staff and safety issues by late April.

It became clear to me that I could not safely keep and take care of critically ill, and especially ventilated Covid-19 patients, said Patel, who worked extended shifts almost every day for more than a month.

By 28 April, Patel and numerous colleagues had fashioned an agreement requiring that all ventilated patients at Rehoboth be transferred to better-equipped facilities around the state. Once that was finalized, Patel told the staff he was quitting Rehoboth. He said he remains committed to serving the communities of north-west New Mexico.

Since the end of March, when the hospital terminated the 17 nurses, it has hired only one new nurse and brought on no additional physicians, said Wangler. Across the street, Gallup Indian medical center has brought on seven physicians and 14 nurses on month-long voluntary assignments.

Nursing supervisors at Rehoboth are struggling to find more than three nurses a shift. For now, nurses describe an untenable and soul-crushing workload.

We need help, one nurse said. We deserve better.

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How a New Mexico hospital rebelled against its bosses as Covid-19 hit - The Guardian