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Huge Shelters for Coronavirus Patients Pose New Risks, Experts Fear Huge Shelters for Coronavirus Patients Pose New Risks, Experts Fear
(about 8 hours later)
As the new coronavirus continued to spread unabated within the city of Wuhan, China, government officials last week imposed draconian measures.As the new coronavirus continued to spread unabated within the city of Wuhan, China, government officials last week imposed draconian measures.
Workers in protective gear were instructed to go to every home in the city, removing infected residents to immense isolation wards built hastily in a sports stadium, an exhibition center and a building complex.Workers in protective gear were instructed to go to every home in the city, removing infected residents to immense isolation wards built hastily in a sports stadium, an exhibition center and a building complex.
“There must be no deserters, or they will be nailed to the pillar of historical shame forever,” said Vice Premier Sun Chunlan, who is leading the government’s response to the virus.“There must be no deserters, or they will be nailed to the pillar of historical shame forever,” said Vice Premier Sun Chunlan, who is leading the government’s response to the virus.
Many experts are skeptical that isolating thousands of patients in shelters can stanch the spread of the coronavirus. There are more than 40,000 cases in China now, in every province, although the wide majority are in Hubei Province.Many experts are skeptical that isolating thousands of patients in shelters can stanch the spread of the coronavirus. There are more than 40,000 cases in China now, in every province, although the wide majority are in Hubei Province.
“This is a bit like closing the barn door after the horses are already out,” said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center in Nashville.“This is a bit like closing the barn door after the horses are already out,” said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center in Nashville.
And the shelters, so reminiscent of those erected in the United States during the Spanish flu pandemic, raise other concerns.And the shelters, so reminiscent of those erected in the United States during the Spanish flu pandemic, raise other concerns.
Chinese authorities have said that only residents with confirmed coronavirus are being sent to shelter, but have not fully explained how they are being screened, raising the possibility that many patients may actually be infected with flu or something else.Chinese authorities have said that only residents with confirmed coronavirus are being sent to shelter, but have not fully explained how they are being screened, raising the possibility that many patients may actually be infected with flu or something else.
Inside, narrow beds are laid side by side, or stacked in bunks, in wards separated by temporary walls — perfect for the transmission of respiratory viruses. Little is known about the treatments patients are to receive, or how long they will be kept.Inside, narrow beds are laid side by side, or stacked in bunks, in wards separated by temporary walls — perfect for the transmission of respiratory viruses. Little is known about the treatments patients are to receive, or how long they will be kept.
The containment measures in Wuhan are reminiscent of steps taken in 1918 in the United States to halt the Spanish flu. But they are being put in place on a far grander scale: Wuhan is a city of 11 million.The containment measures in Wuhan are reminiscent of steps taken in 1918 in the United States to halt the Spanish flu. But they are being put in place on a far grander scale: Wuhan is a city of 11 million.
In New York City in August 1918, after reports that an arriving Norwegian ship was carrying sailors and passengers infected with the Spanish flu, health officials dispatched ambulances to transport 11 patients directly to hospitals.In New York City in August 1918, after reports that an arriving Norwegian ship was carrying sailors and passengers infected with the Spanish flu, health officials dispatched ambulances to transport 11 patients directly to hospitals.
The city’s health commissioner, Dr. Royal S. Copeland, eventually put the entire port under quarantine, according to the Influenza Encyclopedia, produced by the University of Michigan Center for the History of Medicine.The city’s health commissioner, Dr. Royal S. Copeland, eventually put the entire port under quarantine, according to the Influenza Encyclopedia, produced by the University of Michigan Center for the History of Medicine.
As the epidemic spread that fall, cities across the country prohibited public gatherings. Officials in Los Angeles closed the schools in October and banned funerals, theaters, pool rooms — and the filming of mob scenes for movies. Baltimore ordered churches and schools closed, but not saloons, citing the putative “medicinal” uses of alcohol.As the epidemic spread that fall, cities across the country prohibited public gatherings. Officials in Los Angeles closed the schools in October and banned funerals, theaters, pool rooms — and the filming of mob scenes for movies. Baltimore ordered churches and schools closed, but not saloons, citing the putative “medicinal” uses of alcohol.
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Many cities left the ill to recover at home, in quarantine. In New York, families were instructed to keep sick members in their rooms and limit contact with them; patients living in cramped tenements were isolated in city hospitals.Many cities left the ill to recover at home, in quarantine. In New York, families were instructed to keep sick members in their rooms and limit contact with them; patients living in cramped tenements were isolated in city hospitals.
In Richmond, Va., there were 10,000 influenza cases by early October 1918 after efforts to contain an outbreak at a large military base nearby failed. City officials converted an unused high school into a 500-bed emergency hospital and began filling it with patients.In Richmond, Va., there were 10,000 influenza cases by early October 1918 after efforts to contain an outbreak at a large military base nearby failed. City officials converted an unused high school into a 500-bed emergency hospital and began filling it with patients.
Though there were nurses providing care at shelters like these, the conditions were grim, said Dr. Howard Markel, professor of the history of medicine at the University of Michigan and author of the book “Quarantine.”Though there were nurses providing care at shelters like these, the conditions were grim, said Dr. Howard Markel, professor of the history of medicine at the University of Michigan and author of the book “Quarantine.”
Patients were essentially warehoused, and those who survived recalled poor or even hostile treatment from health care workers, and inadequate food and bathing facilities, Dr. Markel said. Patients became delusional; fights often broke out.Patients were essentially warehoused, and those who survived recalled poor or even hostile treatment from health care workers, and inadequate food and bathing facilities, Dr. Markel said. Patients became delusional; fights often broke out.
“It was not the Four Seasons,” he said.“It was not the Four Seasons,” he said.
The makeshift shelters in Wuhan do not have adequate heating and have suffered power failures, according to early reports. Staffing is inadequate, and medical equipment is in short supply.The makeshift shelters in Wuhan do not have adequate heating and have suffered power failures, according to early reports. Staffing is inadequate, and medical equipment is in short supply.
“This is taking us back to the 19th century,” Dr. Markel said. “It’s an old-fashioned approach to an epidemic, because you care more about the healthy than the people who are sick.”“This is taking us back to the 19th century,” Dr. Markel said. “It’s an old-fashioned approach to an epidemic, because you care more about the healthy than the people who are sick.”
Wuhan’s makeshift shelters may yet become breeding grounds for infection, especially if patients are not properly screened, Dr. Markel and other experts said.Wuhan’s makeshift shelters may yet become breeding grounds for infection, especially if patients are not properly screened, Dr. Markel and other experts said.
The patients already are in a weakened state, and facilities like these make it easy for viruses and bacteria to travel — not just the coronavirus, but also any of the dozens of pathogens that may thrive when people gather in tight quarters.The patients already are in a weakened state, and facilities like these make it easy for viruses and bacteria to travel — not just the coronavirus, but also any of the dozens of pathogens that may thrive when people gather in tight quarters.
“Whenever we put people in facilities together, even during a hurricane, we are concerned about them getting infectious diseases,” said Nicole A. Errett, a researcher at the University of Washington who is a co-director of the Collaborative on Extreme Event Resilience.“Whenever we put people in facilities together, even during a hurricane, we are concerned about them getting infectious diseases,” said Nicole A. Errett, a researcher at the University of Washington who is a co-director of the Collaborative on Extreme Event Resilience.
People in a shelter who may have a misdiagnosis of coronavirus infection — when in fact they had, say, the flu — are in a particularly paradoxical situation. They would have been far safer from coronavirus at home than in a large open ward, cheek by jowl with the infected.People in a shelter who may have a misdiagnosis of coronavirus infection — when in fact they had, say, the flu — are in a particularly paradoxical situation. They would have been far safer from coronavirus at home than in a large open ward, cheek by jowl with the infected.
And there are intangible benefits to isolation at home. Removing patients from a supportive environment, where they are cared for by relatives, and placing them in a shelter can be stigmatizing and deprives them of emotional support at a critical time, Dr. Errett said.And there are intangible benefits to isolation at home. Removing patients from a supportive environment, where they are cared for by relatives, and placing them in a shelter can be stigmatizing and deprives them of emotional support at a critical time, Dr. Errett said.
Whether patients in warehouselike settings will receive appropriate medical care is often uncertain, as these shelters historically have opened when local hospitals were already overburdened.Whether patients in warehouselike settings will receive appropriate medical care is often uncertain, as these shelters historically have opened when local hospitals were already overburdened.
In the past, it often has been unclear how long the isolation should last.
During the influenza pandemic of 1918, officials in Richmond, Va., lifted many restrictions in November, allowing churches to hold services and schools to reopen.
By early December, hospitals were near capacity again, and the flu had returned to near-epidemic levels.
Updated June 22, 2020Updated June 22, 2020
A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
In the past, it often has been unclear how long the isolation should last.
During the influenza pandemic of 1918, officials in Richmond, Va., lifted many restrictions in November, allowing churches to hold services and schools to reopen.
By early December, hospitals were near capacity again, and the flu had returned to near-epidemic levels.
Yet it is possible the sequestration of patients in Wuhan could succeed in stemming further spread of the coronavirus, Dr. Markel said.Yet it is possible the sequestration of patients in Wuhan could succeed in stemming further spread of the coronavirus, Dr. Markel said.
“In the best of all circumstances, by warehousing the sick and potentially sick and keeping them away from the healthy, it could prevent further spread,” he said.“In the best of all circumstances, by warehousing the sick and potentially sick and keeping them away from the healthy, it could prevent further spread,” he said.
“But it will probably come at the expense of the medical attention that’s needed by those in the warehouses. That’s what I worry about.”“But it will probably come at the expense of the medical attention that’s needed by those in the warehouses. That’s what I worry about.”
Other scientists believe it would be preferable to let sick people remain in their homes, with family members trained to provide care and to protect themselves from infection.Other scientists believe it would be preferable to let sick people remain in their homes, with family members trained to provide care and to protect themselves from infection.
Instead of providing shelters, officials might distribute food and hygiene kits, including personal protective equipment for caregivers, and set up a telephone hotline to dispense information.Instead of providing shelters, officials might distribute food and hygiene kits, including personal protective equipment for caregivers, and set up a telephone hotline to dispense information.
Making hospital facilities available for the most severely ill patients instead of spending health care resources on the less ill is critical, said Jennifer B. Nuzzo of the Johns Hopkins Center for Health Security.Making hospital facilities available for the most severely ill patients instead of spending health care resources on the less ill is critical, said Jennifer B. Nuzzo of the Johns Hopkins Center for Health Security.
“Attempting to stop the spread of the virus at this point is the wrong goal,” she said.“Attempting to stop the spread of the virus at this point is the wrong goal,” she said.
“I don’t think there’s evidence that we can stop a respiratory virus moving as quickly and silently as this one is.”“I don’t think there’s evidence that we can stop a respiratory virus moving as quickly and silently as this one is.”