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To Take On the Coronavirus, Go Medieval on It To Take On the Coronavirus, Go Medieval on It
(about 20 hours later)
There are two ways to fight epidemics: the medieval and the modern.There are two ways to fight epidemics: the medieval and the modern.
The modern way is to surrender to the power of the pathogens: Acknowledge that they are unstoppable and to try to soften the blow with 20th-century inventions, including new vaccines, antibiotics, hospital ventilators and thermal cameras searching for people with fevers.The modern way is to surrender to the power of the pathogens: Acknowledge that they are unstoppable and to try to soften the blow with 20th-century inventions, including new vaccines, antibiotics, hospital ventilators and thermal cameras searching for people with fevers.
The medieval way, inherited from the era of the Black Death, is brutal: Close the borders, quarantine the ships, pen terrified citizens up inside their poisoned cities.The medieval way, inherited from the era of the Black Death, is brutal: Close the borders, quarantine the ships, pen terrified citizens up inside their poisoned cities.
For the first time in more than a century, the world has chosen to confront a new and terrifying virus with the iron fist instead of the latex glove.For the first time in more than a century, the world has chosen to confront a new and terrifying virus with the iron fist instead of the latex glove.
At least for a while, it worked, and it might still serve a purpose.At least for a while, it worked, and it might still serve a purpose.
The Chinese leader, Xi Jinping, was able to seal off the city of Wuhan, where the Covid-19 outbreak began, because China is a place where a leader can ask himself, “What would Mao do?” and just do it. The bureaucracy will comply, right down to the neighborhood committees that bar anyone returning from Wuhan from entering their own homes, even if it means sleeping in the streets.The Chinese leader, Xi Jinping, was able to seal off the city of Wuhan, where the Covid-19 outbreak began, because China is a place where a leader can ask himself, “What would Mao do?” and just do it. The bureaucracy will comply, right down to the neighborhood committees that bar anyone returning from Wuhan from entering their own homes, even if it means sleeping in the streets.
The White House, in defiance of recent American history, also opted to go medieval by aggressive measures like barring entry to non-Americans who were recently in China and advising Americans not to go to China or South Korea.The White House, in defiance of recent American history, also opted to go medieval by aggressive measures like barring entry to non-Americans who were recently in China and advising Americans not to go to China or South Korea.
Over the years, states and cities have imposed local quarantines, but there have been no national restrictions on entry since 1892, according to Dr. Howard Markel, a medical historian and the author of “Quarantine!”Over the years, states and cities have imposed local quarantines, but there have been no national restrictions on entry since 1892, according to Dr. Howard Markel, a medical historian and the author of “Quarantine!”
In that year, President Benjamin Harrison ordered that all ships from Hamburg be kept offshore for 20 days because officials in that city, one of the world’s biggest ports, had lied about its cholera epidemic.In that year, President Benjamin Harrison ordered that all ships from Hamburg be kept offshore for 20 days because officials in that city, one of the world’s biggest ports, had lied about its cholera epidemic.
It apparently succeeded. The United States had cholera outbreaks in 1832, 1849, 1870 and 1910, but not in 1892.It apparently succeeded. The United States had cholera outbreaks in 1832, 1849, 1870 and 1910, but not in 1892.
Many public health figures consider shutting a nation’s doors to be an archaic tactic, and nearly impossible in the jet age.Many public health figures consider shutting a nation’s doors to be an archaic tactic, and nearly impossible in the jet age.
But for Mr. Trump, such a move is natural. He was elected on a Build-the-Wall platform and in 2014, when a few heroic American medical workers got infected fighting Ebola in West Africa, he advocated leaving them there to die. (They were flown back, and survived.)But for Mr. Trump, such a move is natural. He was elected on a Build-the-Wall platform and in 2014, when a few heroic American medical workers got infected fighting Ebola in West Africa, he advocated leaving them there to die. (They were flown back, and survived.)
Also, this virus’s speed and apparent lethality gave the experienced doctors in the White House Coronavirus Task Force reason to be nervous. It is spreading between nations very quickly. And, while data is still sketchy, some measurements indicate that its fatality rate might be close to that of the 1918 Spanish flu.Also, this virus’s speed and apparent lethality gave the experienced doctors in the White House Coronavirus Task Force reason to be nervous. It is spreading between nations very quickly. And, while data is still sketchy, some measurements indicate that its fatality rate might be close to that of the 1918 Spanish flu.
As a result, they endorsed dropping the portcullis and shutting off air links to China.As a result, they endorsed dropping the portcullis and shutting off air links to China.
They even created quarantine stations on military bases, the equivalent of Venice’s island lazarettos, where, in the time of the doges, the infected awaited their fate outside the city.They even created quarantine stations on military bases, the equivalent of Venice’s island lazarettos, where, in the time of the doges, the infected awaited their fate outside the city.
This has led to much consternation among other public health experts, who argue that travel restrictions can cause more panic, misery and death than they prevent. Crowds may besiege hospitals, supercharging the infection rate. Closed borders can cut off vital medications like insulin. Factory and shop closings mean lost wages, hardships and possibly recession.This has led to much consternation among other public health experts, who argue that travel restrictions can cause more panic, misery and death than they prevent. Crowds may besiege hospitals, supercharging the infection rate. Closed borders can cut off vital medications like insulin. Factory and shop closings mean lost wages, hardships and possibly recession.
Also, quarantines feed racism and stigma.Also, quarantines feed racism and stigma.
Officially, the World Health Organization opposes travel and trade restrictions. It reiterated that even as it declared the epidemic a global emergency on Jan. 30.Officially, the World Health Organization opposes travel and trade restrictions. It reiterated that even as it declared the epidemic a global emergency on Jan. 30.
But it now admits that they helped. The head of the W.H.O. team that visited China said this week that China “took one of the most ancient strategies and rolled out one of the most ambitious, agile and aggressive disease-containment efforts in history.”But it now admits that they helped. The head of the W.H.O. team that visited China said this week that China “took one of the most ancient strategies and rolled out one of the most ambitious, agile and aggressive disease-containment efforts in history.”
The W.H.O.’s epidemic-modeling teams concluded that travel restrictions had slowed the spread of the virus outside China by two to three weeks.The W.H.O.’s epidemic-modeling teams concluded that travel restrictions had slowed the spread of the virus outside China by two to three weeks.
For the United States, the delay was probably far greater. Air-traffic data shows that flights from China to the United States dropped much more than they did to Europe.For the United States, the delay was probably far greater. Air-traffic data shows that flights from China to the United States dropped much more than they did to Europe.
As of this writing, a single case not connected to any known transmission has turned up in California, but there are no indications of large outbreaks like those in Italy and Iran.As of this writing, a single case not connected to any known transmission has turned up in California, but there are no indications of large outbreaks like those in Italy and Iran.
Harsh measures horrify civil libertarians, but they often save lives, especially when they are imposed in the early days.Harsh measures horrify civil libertarians, but they often save lives, especially when they are imposed in the early days.
The best-known modern example is Cuba’s AIDS epidemic. In the 1980s, Cuba and the United States were both hit hard by the AIDS epidemic. In Cuba, the virus first infected thousands of soldiers, doctors and nurses who had served in Africa.The best-known modern example is Cuba’s AIDS epidemic. In the 1980s, Cuba and the United States were both hit hard by the AIDS epidemic. In Cuba, the virus first infected thousands of soldiers, doctors and nurses who had served in Africa.
The Castro regime’s response — roundly condemned by other countries — was to make H.I.V. tests mandatory, and to force everyone infected into quarantine camps. The camps were not hellholes: they had bungalows, gardens, theater troupes, medical care, more food than people outside often had, and less homophobia than gay men often faced in macho rural Cuba. But no one could leave, except for brief family visits with an escort whose main job was to make sure that no sex took place.The Castro regime’s response — roundly condemned by other countries — was to make H.I.V. tests mandatory, and to force everyone infected into quarantine camps. The camps were not hellholes: they had bungalows, gardens, theater troupes, medical care, more food than people outside often had, and less homophobia than gay men often faced in macho rural Cuba. But no one could leave, except for brief family visits with an escort whose main job was to make sure that no sex took place.
Meanwhile, the United States took a pro-legal-rights approach. Even offering an H.I.V. test was made illegal without a separate counseling session, which scared many away from testing. Although gay bathhouses were epicenters of transmission, there were long divisive fights over closing them.Meanwhile, the United States took a pro-legal-rights approach. Even offering an H.I.V. test was made illegal without a separate counseling session, which scared many away from testing. Although gay bathhouses were epicenters of transmission, there were long divisive fights over closing them.
Updated June 5, 2020Updated June 5, 2020
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.
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.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.
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
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.
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.
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.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.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.
After triple therapy was developed in the mid-1990s, most Cuban camps closed.After triple therapy was developed in the mid-1990s, most Cuban camps closed.
But the difference in lives saved by choosing brutality over freedom was stark: Cuba’s H.I.V. infection rate was for decades about one-sixth that of the American one. New York City and Cuba have roughly the same population. In the epidemic’s first 30 years, fewer than 2,500 Cubans died of AIDS. Over 78,000 New Yorkers — mostly gay men — did.But the difference in lives saved by choosing brutality over freedom was stark: Cuba’s H.I.V. infection rate was for decades about one-sixth that of the American one. New York City and Cuba have roughly the same population. In the epidemic’s first 30 years, fewer than 2,500 Cubans died of AIDS. Over 78,000 New Yorkers — mostly gay men — did.
As the virus creeps closer, stark choices will arise. The United States cannot shut out the whole world. Even if all air travel were stopped, the virus could reach Latin America or Canada and enter over our land borders.As the virus creeps closer, stark choices will arise. The United States cannot shut out the whole world. Even if all air travel were stopped, the virus could reach Latin America or Canada and enter over our land borders.
With luck, the extra time that China bought us by falling on its viral grenade will help produce a treatment or a vaccine. The threat will subside and reporters like me will be accused of alarmism.With luck, the extra time that China bought us by falling on its viral grenade will help produce a treatment or a vaccine. The threat will subside and reporters like me will be accused of alarmism.
Top American health officials now say “it is not a matter of if but when” the virus begins to spread here. But the American experience will not echo the Chinese one.Top American health officials now say “it is not a matter of if but when” the virus begins to spread here. But the American experience will not echo the Chinese one.
China has had imperial rule since 221 B.C. The United States, born of rebellion, prizes individual rights.China has had imperial rule since 221 B.C. The United States, born of rebellion, prizes individual rights.
There will be no national lockdown. No threats to have anyone “forever nailed to history’s pillar of shame,” as one of Mr. Xi’s underlings warned those who hid cases of infection.There will be no national lockdown. No threats to have anyone “forever nailed to history’s pillar of shame,” as one of Mr. Xi’s underlings warned those who hid cases of infection.
But local control — and the political factionalism that is endemic to democracy — can carry grave risks in the face of a crisis, Dr. Markel noted.But local control — and the political factionalism that is endemic to democracy — can carry grave risks in the face of a crisis, Dr. Markel noted.
In 1918 and 1919, as the Spanish influenza swept across the country in waves, various cities reacted in their own ways.In 1918 and 1919, as the Spanish influenza swept across the country in waves, various cities reacted in their own ways.
Cities like St. Louis that reacted quickly — canceling parades and ballgames, shutting schools, transit systems and government offices, ordering the sick to stay home — ultimately had fewer deaths.Cities like St. Louis that reacted quickly — canceling parades and ballgames, shutting schools, transit systems and government offices, ordering the sick to stay home — ultimately had fewer deaths.
In cities like Philadelphia and Pittsburgh, which were paralyzed by political feuds or pressure from local businesses to avoid shutdowns, many more ultimately died.In cities like Philadelphia and Pittsburgh, which were paralyzed by political feuds or pressure from local businesses to avoid shutdowns, many more ultimately died.
To overcome the divisiveness that would imperil a cohesive national response, Dr. Markel said, “you need leadership from the top — and there has to be trust. In an epidemic, the idea that ‘everyone is entitled to their own facts’ is really dangerous.”To overcome the divisiveness that would imperil a cohesive national response, Dr. Markel said, “you need leadership from the top — and there has to be trust. In an epidemic, the idea that ‘everyone is entitled to their own facts’ is really dangerous.”
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