'Coronavirus Outbreak Has America’s Homeless at Risk of ‘Disaster’' diff viewer (17/18)

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Coronavirus Outbreak Has America’s Homeless at Risk of ‘Disaster’	Coronavirus Outbreak Has America’s Homeless at Risk of ‘Disaster’
2020-06-24 11:14:34 UTC	2020-06-24 11:46:27 UTC (32 minutes later)
SAN DIEGO — As the head of a homeless shelter in San Diego, Bob McElroy knows firsthand how epidemics can turn deadly for people living on the streets. Three years ago an outbreak of hepatitis A, an otherwise preventable and treatable disease, killed 20 people in San Diego County alone, most of them homeless.	SAN DIEGO — As the head of a homeless shelter in San Diego, Bob McElroy knows firsthand how epidemics can turn deadly for people living on the streets. Three years ago an outbreak of hepatitis A, an otherwise preventable and treatable disease, killed 20 people in San Diego County alone, most of them homeless.
Now as the coronavirus spreads across the country, Mr. McElroy is faced with a new threat, one that he can only hope to ward off with a stockpile of hand sanitizer. Under a single tent in downtown San Diego, his shelter sleeps more than 300 people, a majority of them over 50 years old, a warehouse of human beings arrayed like cadets in military barracks. Numbered bunk beds are spaced just two feet apart.	Now as the coronavirus spreads across the country, Mr. McElroy is faced with a new threat, one that he can only hope to ward off with a stockpile of hand sanitizer. Under a single tent in downtown San Diego, his shelter sleeps more than 300 people, a majority of them over 50 years old, a warehouse of human beings arrayed like cadets in military barracks. Numbered bunk beds are spaced just two feet apart.
“We’re just saying our prayers,” Mr. McElroy said. “If it gets in here it would be a disaster.”	“We’re just saying our prayers,” Mr. McElroy said. “If it gets in here it would be a disaster.”
Medical researchers say the 550,000 people currently homeless across the United States have a double vulnerability to the coronavirus. They are more susceptible to contracting the disease caused by the virus because of the cramped quarters in shelters, the sharing of utensils and the lack of hand-washing stations on the streets.	Medical researchers say the 550,000 people currently homeless across the United States have a double vulnerability to the coronavirus. They are more susceptible to contracting the disease caused by the virus because of the cramped quarters in shelters, the sharing of utensils and the lack of hand-washing stations on the streets.
Once infected the chronically homeless are more likely to get much sicker or die because of underlying medical conditions and a lack of reliable health care. One study last year found that 30 percent of homeless people had chronic lung disease.	Once infected the chronically homeless are more likely to get much sicker or die because of underlying medical conditions and a lack of reliable health care. One study last year found that 30 percent of homeless people had chronic lung disease.
Phoenix; Portland, Ore.; Washington, D.C.; Austin, Texas; and many cities across California have large homeless populations that are vulnerable to an outbreak. New York City, which has the largest homeless population in the country, issued an 11-page document instructing shelters to screen people for symptoms and quickly identify and isolate those who have contracted the virus in a separate room “as much as possible.”	Phoenix; Portland, Ore.; Washington, D.C.; Austin, Texas; and many cities across California have large homeless populations that are vulnerable to an outbreak. New York City, which has the largest homeless population in the country, issued an 11-page document instructing shelters to screen people for symptoms and quickly identify and isolate those who have contracted the virus in a separate room “as much as possible.”
“We should be very worried,” said Helen Chu, an infectious disease doctor in Seattle, a metropolitan area with one of the highest rates of homelessness in the nation and the current center of America’s coronavirus outbreak. So far, none of the more than 100 confirmed cases in Washington State have been among the homeless population.	“We should be very worried,” said Helen Chu, an infectious disease doctor in Seattle, a metropolitan area with one of the highest rates of homelessness in the nation and the current center of America’s coronavirus outbreak. So far, none of the more than 100 confirmed cases in Washington State have been among the homeless population.
Over the past several years Dr. Chu has conducted studies of diseases at homeless shelters in Seattle where mattresses, she said, are less than one foot apart from each other. Homeless people are “extremely vulnerable” to the coronavirus, she said.	Over the past several years Dr. Chu has conducted studies of diseases at homeless shelters in Seattle where mattresses, she said, are less than one foot apart from each other. Homeless people are “extremely vulnerable” to the coronavirus, she said.
Dr. Chu has argued for urgent steps to test homeless people in shelters for the coronavirus to stop the chain of transmission. But she and other experts acknowledged how difficult halting an outbreak would be.	Dr. Chu has argued for urgent steps to test homeless people in shelters for the coronavirus to stop the chain of transmission. But she and other experts acknowledged how difficult halting an outbreak would be.
The global response to coronavirus outbreaks has been to order people to self-quarantine. Homeless people, by definition, have nowhere to go.	The global response to coronavirus outbreaks has been to order people to self-quarantine. Homeless people, by definition, have nowhere to go.
There are also concerns for employees at shelters — nurses, administrators, charitable workers — who, like health care workers at hospitals, could find themselves exposed multiple times if the virus were to spread among the homeless community.	There are also concerns for employees at shelters — nurses, administrators, charitable workers — who, like health care workers at hospitals, could find themselves exposed multiple times if the virus were to spread among the homeless community.
In some cases it was illness that sent many of those living on the street there in the first place. Tracy Semrow, who was a school psychologist earning a six-figure salary working with children with disabilities, learned two years ago that she had a degenerative connective tissue disorder. The costs of medical care have drained her savings.	In some cases it was illness that sent many of those living on the street there in the first place. Tracy Semrow, who was a school psychologist earning a six-figure salary working with children with disabilities, learned two years ago that she had a degenerative connective tissue disorder. The costs of medical care have drained her savings.
Since August her home has been one of the bunk beds in the shelter run by Mr. McElroy’s charity, Alpha Project. She is frequently sick and sometimes cannot get out of bed.	Since August her home has been one of the bunk beds in the shelter run by Mr. McElroy’s charity, Alpha Project. She is frequently sick and sometimes cannot get out of bed.
“My immune system has gone haywire,” Ms. Semrow said.	“My immune system has gone haywire,” Ms. Semrow said.
The breadth of the homelessness problem in San Diego County, where by last count more than 8,000 people were without homes, shows the challenges that a coronavirus outbreak would pose.	The breadth of the homelessness problem in San Diego County, where by last count more than 8,000 people were without homes, shows the challenges that a coronavirus outbreak would pose.
Homeless people sleep in rows on sidewalks in downtown San Diego, huddling in half-mile-long drainage tunnels filled with rats. And they have erected makeshift homes in the canyons that run through the county.	Homeless people sleep in rows on sidewalks in downtown San Diego, huddling in half-mile-long drainage tunnels filled with rats. And they have erected makeshift homes in the canyons that run through the county.
Doctors say that when homeless people arrive at emergency rooms, they are often already very sick.	Doctors say that when homeless people arrive at emergency rooms, they are often already very sick.
Homeless people have rates of respiratory infections far greater than in the general population. At one hospital in Seattle, 32 percent of people who had a common respiratory illness were homeless, compared with 7 percent of all patients hospitalized, according to a study published last year that was written by Dr. Chu and others.	Homeless people have rates of respiratory infections far greater than in the general population. At one hospital in Seattle, 32 percent of people who had a common respiratory illness were homeless, compared with 7 percent of all patients hospitalized, according to a study published last year that was written by Dr. Chu and others.
Norbert Alarcon, a former janitor, has been homeless for two years and sleeps in a tent made from plastic sheeting in a forested area of National City, near San Diego. When police officers and outreach workers approached him last week he had a severely swollen hand from a deep cut he sustained in a bicycle accident. The officers urged him to seek treatment but Mr. Alarcon insisted his hand was fine. “It has color now,” he said of his hand, which was bandaged with postal packing tape. “Before it didn’t have any color.”	Norbert Alarcon, a former janitor, has been homeless for two years and sleeps in a tent made from plastic sheeting in a forested area of National City, near San Diego. When police officers and outreach workers approached him last week he had a severely swollen hand from a deep cut he sustained in a bicycle accident. The officers urged him to seek treatment but Mr. Alarcon insisted his hand was fine. “It has color now,” he said of his hand, which was bandaged with postal packing tape. “Before it didn’t have any color.”
The hepatitis A outbreak of 2017-18 infected approximately 600 people in San Diego County, according to Natasha Martin, a specialist in infectious diseases at the University of California, San Diego. Hepatitis A is transmitted through fecal matter, sometimes by people who prepare food with unwashed hands.	The hepatitis A outbreak of 2017-18 infected approximately 600 people in San Diego County, according to Natasha Martin, a specialist in infectious diseases at the University of California, San Diego. Hepatitis A is transmitted through fecal matter, sometimes by people who prepare food with unwashed hands.
The authorities and charitable organizations fought the spread of that disease aggressively with a vaccination campaign, street cleaning and the placement of hand-washing stations on sidewalks. But the measures did not arrive in time to prevent the 20 deaths.	The authorities and charitable organizations fought the spread of that disease aggressively with a vaccination campaign, street cleaning and the placement of hand-washing stations on sidewalks. But the measures did not arrive in time to prevent the 20 deaths.
“Had the emergency campaign occurred earlier, it would have had an even greater impact on preventing transmission,” Dr. Martin said.	“Had the emergency campaign occurred earlier, it would have had an even greater impact on preventing transmission,” Dr. Martin said.
Doctors say the threat of coronavirus is analogous to that of hepatitis but with at least one key difference.	Doctors say the threat of coronavirus is analogous to that of hepatitis but with at least one key difference.
~~“Obviously we don’t have a vaccine for coronavirus,” said Dr. Robert T. Schooley, an infectious disease expert who advised the San Diego city government during the hepatitis outbreak.~~
Updated June 22, 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.	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.
	“Obviously we don’t have a vaccine for coronavirus,” said Dr. Robert T. Schooley, an infectious disease expert who advised the San Diego city government during the hepatitis outbreak.