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Coronavirus in N.Y.: Growing Anxiety as Doctors Prepare for an Epidemic Coronavirus in N.Y.: Growing Anxiety as Doctors Prepare for an Epidemic
(7 days later)
In recent weeks, some hospitals in New York City have begun safeguarding their stockpiles of masks and other protective gear amid suspicions that employees were taking them home.In recent weeks, some hospitals in New York City have begun safeguarding their stockpiles of masks and other protective gear amid suspicions that employees were taking them home.
Administrators at one hospital are allowing pregnant employees to opt out of caring for anyone thought to have the new coronavirus. At another hospital, radiologists have been studying CT scans of coronavirus patients from China.Administrators at one hospital are allowing pregnant employees to opt out of caring for anyone thought to have the new coronavirus. At another hospital, radiologists have been studying CT scans of coronavirus patients from China.
Although no one in New York has tested positive for the virus, doctors and public health officials in the city and state, amid growing anxiety, have been bracing for the possibility of an epidemic that could strain the health care system.Although no one in New York has tested positive for the virus, doctors and public health officials in the city and state, amid growing anxiety, have been bracing for the possibility of an epidemic that could strain the health care system.
The pace of the preparations may increase after federal officials urged Americans on Tuesday to prepare for the spread of the virus in the United States, with the possibility that containment strategies could soon give way to mitigation plans.The pace of the preparations may increase after federal officials urged Americans on Tuesday to prepare for the spread of the virus in the United States, with the possibility that containment strategies could soon give way to mitigation plans.
New York State officials say they are ready, with a huge store of supplies hidden in three locations around the state, including a soaring, temperature-controlled warehouse near Albany.New York State officials say they are ready, with a huge store of supplies hidden in three locations around the state, including a soaring, temperature-controlled warehouse near Albany.
The warehouse is stacked to its 40-foot ceilings with surgical masks, gowns and gloves, and more extreme protective gear like N95 respirators and enclosed Tyvek suits, which resemble hazmat suits. Officials have also stockpiled ventilators, a necessity for severe cases of this coronavirus, which causes high fever and respiratory problems.The warehouse is stacked to its 40-foot ceilings with surgical masks, gowns and gloves, and more extreme protective gear like N95 respirators and enclosed Tyvek suits, which resemble hazmat suits. Officials have also stockpiled ventilators, a necessity for severe cases of this coronavirus, which causes high fever and respiratory problems.
Officials are also consulting state and federal playbooks for potential plans, including measures like closing schools, day care centers and businesses; canceling mass gatherings and curtailing mass transit, although they caution that taking such steps is only being considered in worst-case scenarios.Officials are also consulting state and federal playbooks for potential plans, including measures like closing schools, day care centers and businesses; canceling mass gatherings and curtailing mass transit, although they caution that taking such steps is only being considered in worst-case scenarios.
New York law already provides for emergency powers for the governor and health officials, but state lawyers are examining whether changes might be necessary to address this threat, officials said. The state is also asking federal officials to allow testing for the virus at a basement-level laboratory adjacent to the State Capitol, and at laboratories in New York City and elsewhere. The tests are currently being sent via FedEx to the federal Centers for Disease Control in Atlanta.New York law already provides for emergency powers for the governor and health officials, but state lawyers are examining whether changes might be necessary to address this threat, officials said. The state is also asking federal officials to allow testing for the virus at a basement-level laboratory adjacent to the State Capitol, and at laboratories in New York City and elsewhere. The tests are currently being sent via FedEx to the federal Centers for Disease Control in Atlanta.
On Wednesday, Gov. Andrew M. Cuomo and Dr. Howard Zucker, the state health commissioner, announced a $40 million plan to fight the virus, promising the addition of more epidemiologists and other personnel to track potential patients, as well as more equipment to help treat the state’s first patients. New York City officials said on Wednesday that 1,200 hospital beds could be made available for coronavirus cases without affecting other patients.On Wednesday, Gov. Andrew M. Cuomo and Dr. Howard Zucker, the state health commissioner, announced a $40 million plan to fight the virus, promising the addition of more epidemiologists and other personnel to track potential patients, as well as more equipment to help treat the state’s first patients. New York City officials said on Wednesday that 1,200 hospital beds could be made available for coronavirus cases without affecting other patients.
Nobody knows quite what an outbreak in New York City or in the United States more broadly would look like.Nobody knows quite what an outbreak in New York City or in the United States more broadly would look like.
But the effect on daily life in America’s most populous city could be dramatic: Staggering or limiting public transportation; a shutdown of the country’s largest school system would leave 1.1 million children at home; and a sharp drop in the nearly 70 million tourists who visit the city each year could put a financial strain on local businesses. (Tourism from China has already been restricted.)But the effect on daily life in America’s most populous city could be dramatic: Staggering or limiting public transportation; a shutdown of the country’s largest school system would leave 1.1 million children at home; and a sharp drop in the nearly 70 million tourists who visit the city each year could put a financial strain on local businesses. (Tourism from China has already been restricted.)
Officials say that the virus’s arrival in New York seems inevitable, and on Thursday they identified a possible patient who was being tested for infection. Seven other people in New York City who were previously tested were found not to have the virus.Officials say that the virus’s arrival in New York seems inevitable, and on Thursday they identified a possible patient who was being tested for infection. Seven other people in New York City who were previously tested were found not to have the virus.
After originating in China, where entire cities were eventually placed on lockdown, the disease has spread to more than 40 countries. New hubs recently emerged in Iran, Italy, and South Korea. By Wednesday, nearly 3,000 people had been killed by the virus and more than 81,000 had been infected.After originating in China, where entire cities were eventually placed on lockdown, the disease has spread to more than 40 countries. New hubs recently emerged in Iran, Italy, and South Korea. By Wednesday, nearly 3,000 people had been killed by the virus and more than 81,000 had been infected.
Emergency planners in New York, both the city and the state, note that they have been quietly preparing for a pandemic for years. Their plans offer a rough sketch of what might happen in an outbreak of the coronavirus — technically known as Covid-19.Emergency planners in New York, both the city and the state, note that they have been quietly preparing for a pandemic for years. Their plans offer a rough sketch of what might happen in an outbreak of the coronavirus — technically known as Covid-19.
Yet in interviews, doctors at several hospitals in the city described growing concern about the new illness and whether New York’s health care system was prepared for it. The doctors expressed a worry that too few people were currently being tested. One doctor said that she was watching YouTube videos to learn how to use protective equipment. At some hospitals, two doctors said, surgical masks had begun to disappear in noticeable numbers, leading administrators to conclude that staff members were probably bringing them home.Yet in interviews, doctors at several hospitals in the city described growing concern about the new illness and whether New York’s health care system was prepared for it. The doctors expressed a worry that too few people were currently being tested. One doctor said that she was watching YouTube videos to learn how to use protective equipment. At some hospitals, two doctors said, surgical masks had begun to disappear in noticeable numbers, leading administrators to conclude that staff members were probably bringing them home.
The New York Department of Health has been asking hospitals “to dust off the pandemic flu plans,” according to Dr. Zucker, the state health commissioner. He noted that the coronavirus was similar to influenza in its transmission and in its nature as a respiratory illness.The New York Department of Health has been asking hospitals “to dust off the pandemic flu plans,” according to Dr. Zucker, the state health commissioner. He noted that the coronavirus was similar to influenza in its transmission and in its nature as a respiratory illness.
Dr. Zucker said the state planned to hold meetings with police and transit officials to work through various outbreak scenarios.Dr. Zucker said the state planned to hold meetings with police and transit officials to work through various outbreak scenarios.
“Day 2, Day 4, who calls who?” Dr. Zucker said of the planning sessions. “What’s the supply chain? What do you do with transportation, what do you do with mass gatherings?”“Day 2, Day 4, who calls who?” Dr. Zucker said of the planning sessions. “What’s the supply chain? What do you do with transportation, what do you do with mass gatherings?”
One planning document from November 2014 prepared by the city’s Emergency Management Department, which examined the effect of a flu pandemic, said that in a severe pandemic, as many as 41,000 people might die in each wave of possibly two or three.One planning document from November 2014 prepared by the city’s Emergency Management Department, which examined the effect of a flu pandemic, said that in a severe pandemic, as many as 41,000 people might die in each wave of possibly two or three.
Among the areas the report identified as most at risk included the Southwest Bronx, Morningside Heights in Manhattan and the Brooklyn neighborhoods of Bedford-Stuyvesant, East New York, Crown Heights and Coney Island.Among the areas the report identified as most at risk included the Southwest Bronx, Morningside Heights in Manhattan and the Brooklyn neighborhoods of Bedford-Stuyvesant, East New York, Crown Heights and Coney Island.
During the H1N1 “swine flu” pandemic in 2009, New York City closed a limited number of schools. Closing a large number of schools, or the entire school system, is not a move that public health officials would take lightly, and they are likely to wrestle with how aggressive their response should be.During the H1N1 “swine flu” pandemic in 2009, New York City closed a limited number of schools. Closing a large number of schools, or the entire school system, is not a move that public health officials would take lightly, and they are likely to wrestle with how aggressive their response should be.
If the first cases of infection in New York seem to be linked to a certain place, or if they are otherwise easily traced, the authorities would take limited steps: monitoring people who may have been exposed or asking some to quarantine at home. They could also close down a particular location associated with the virus’s spread.If the first cases of infection in New York seem to be linked to a certain place, or if they are otherwise easily traced, the authorities would take limited steps: monitoring people who may have been exposed or asking some to quarantine at home. They could also close down a particular location associated with the virus’s spread.
But if people began getting sick from the virus without an apparent connection to earlier cases, public health officials would most likely institute so-called social-distancing measures that were more aggressive.But if people began getting sick from the virus without an apparent connection to earlier cases, public health officials would most likely institute so-called social-distancing measures that were more aggressive.
Complicating matters is that so much remains unknown about the new coronavirus, including how infectious it is and the fatality rate.Complicating matters is that so much remains unknown about the new coronavirus, including how infectious it is and the fatality rate.
But there is danger in waiting too long before taking action and giving the virus time to spread unchecked, public health experts said. China did little initially to slow transmission. The government suppressed information about the virus and intimidated doctors who tried to raise concerns. After the illness began to spread widely, China imposed a quarantine on a scale that some public health officials deemed unprecedented.But there is danger in waiting too long before taking action and giving the virus time to spread unchecked, public health experts said. China did little initially to slow transmission. The government suppressed information about the virus and intimidated doctors who tried to raise concerns. After the illness began to spread widely, China imposed a quarantine on a scale that some public health officials deemed unprecedented.
Updated June 16, 2020 Updated 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.
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.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
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.)
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
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.
Some public health experts say that past pandemics — in particular the deadly Spanish flu pandemic of 1918, which killed approximately 675,000 people in the United States, offer lessons, including the importance of imposing strict social-distancing measures early and keeping them in place.Some public health experts say that past pandemics — in particular the deadly Spanish flu pandemic of 1918, which killed approximately 675,000 people in the United States, offer lessons, including the importance of imposing strict social-distancing measures early and keeping them in place.
In the 1918 pandemic, various cities took different tactics. Some continued to allow public gatherings in the weeks after the first cases appeared. Others acted more quickly.In the 1918 pandemic, various cities took different tactics. Some continued to allow public gatherings in the weeks after the first cases appeared. Others acted more quickly.
A study that examined 17 American cities’ responses to the 1918 pandemic found that “early implementation of certain interventions, including closure of schools, churches, and theaters, was associated with lower peak death rates.”A study that examined 17 American cities’ responses to the 1918 pandemic found that “early implementation of certain interventions, including closure of schools, churches, and theaters, was associated with lower peak death rates.”
In New York, there have been some recent efforts to plan for a pandemic on the scale of the one in 1918. The state, for instance, has been stockpiling ventilators, which are critical for treating coronavirus patients who have a severe form of the illness.In New York, there have been some recent efforts to plan for a pandemic on the scale of the one in 1918. The state, for instance, has been stockpiling ventilators, which are critical for treating coronavirus patients who have a severe form of the illness.
Across New York, there were 7,241 ventilators in acute care settings, and another 1,750 stockpiled for use in an emergency, according to a 2015 state report. The report noted that the supply of ventilators would be inadequate for a pandemic on the scale of the 1918 flu outbreak.Across New York, there were 7,241 ventilators in acute care settings, and another 1,750 stockpiled for use in an emergency, according to a 2015 state report. The report noted that the supply of ventilators would be inadequate for a pandemic on the scale of the 1918 flu outbreak.
The task force that issued the report devised a formula, relying partially on medical criteria, to help hospitals decide who would get ventilators and who would not. It also envisioned a lottery system in some instances. And age could play a role, with children being given preference over adults.The task force that issued the report devised a formula, relying partially on medical criteria, to help hospitals decide who would get ventilators and who would not. It also envisioned a lottery system in some instances. And age could play a role, with children being given preference over adults.
Most of the preparations in New York City over the past month have been focused on how to confront a smaller scale crisis.Most of the preparations in New York City over the past month have been focused on how to confront a smaller scale crisis.
Michael Phillips, the chief hospital epidemiologist for the NYU Langone Health System, listed numerous preparations that had been made, including plans to essentially split the main hospital between patients who have respiratory illness and those who do not. He said that alternative sites within the system had been identified where doctors could start treating patients if the number of cases spiked.Michael Phillips, the chief hospital epidemiologist for the NYU Langone Health System, listed numerous preparations that had been made, including plans to essentially split the main hospital between patients who have respiratory illness and those who do not. He said that alternative sites within the system had been identified where doctors could start treating patients if the number of cases spiked.
Still, Dr. Phillips wondered about the broader plan in the event that the illness spread beyond what hospitals could handle. “Where would those patients go?” he said. “We’re not China, and we can’t build an isolation hospital in 10 days.”Still, Dr. Phillips wondered about the broader plan in the event that the illness spread beyond what hospitals could handle. “Where would those patients go?” he said. “We’re not China, and we can’t build an isolation hospital in 10 days.”
It is a question that public health officials in New York City have so far been reluctant to address publicly.It is a question that public health officials in New York City have so far been reluctant to address publicly.
“We can really keep this thing contained,” Mr. de Blasio said at a news conference on Wednesday.“We can really keep this thing contained,” Mr. de Blasio said at a news conference on Wednesday.
Asked what would happen if the 1,200 hospital beds currently available for coronavirus patients filled up, he said, “We’ve got a long time to ramp up if we ever had anything like that.”Asked what would happen if the 1,200 hospital beds currently available for coronavirus patients filled up, he said, “We’ve got a long time to ramp up if we ever had anything like that.”
Christina Goldbaum contributed reporting.Christina Goldbaum contributed reporting.