'‘It’s Totally Ad Hoc’: Why America’s Virus Response Looks Like a Patchwork' diff viewer (17/18)

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‘It’s Totally Ad Hoc’: Why America’s Virus Response Looks Like a Patchwork	‘It’s Totally Ad Hoc’: Why America’s Virus Response Looks Like a Patchwork
2020-06-24 17:21:20 UTC	2020-07-01 13:00:24 UTC (7 days later)
PAWTUCKET, R.I. — David Norton, who helps to run a community center in this small Rhode Island city, is not a scientist. Neither were the board members who gathered for an emergency meeting last week, to decide whether the risk of contagion meant they should cancel their upcoming events.	PAWTUCKET, R.I. — David Norton, who helps to run a community center in this small Rhode Island city, is not a scientist. Neither were the board members who gathered for an emergency meeting last week, to decide whether the risk of contagion meant they should cancel their upcoming events.
They sat together — a nurse, a civil servant, a therapist, an insurance executive — and tried to decode the guidance given by state and federal authorities.	They sat together — a nurse, a civil servant, a therapist, an insurance executive — and tried to decode the guidance given by state and federal authorities.
Rhode Island’s governor, Gina Raimondo, had urged community leaders to cancel gatherings larger than 250. On the other hand, Pawtucket’s public schools were still open. Then again, a private school nearby, the site of the state’s first coronavirus outbreak, had closed for two weeks.	Rhode Island’s governor, Gina Raimondo, had urged community leaders to cancel gatherings larger than 250. On the other hand, Pawtucket’s public schools were still open. Then again, a private school nearby, the site of the state’s first coronavirus outbreak, had closed for two weeks.
Boston had canceled its St. Patrick’s Day parade, but Newport had not. Movie theaters and malls were open. But Disney World was closing. In the end, members threw up their hands and canceled most everything through the end of April.	Boston had canceled its St. Patrick’s Day parade, but Newport had not. Movie theaters and malls were open. But Disney World was closing. In the end, members threw up their hands and canceled most everything through the end of April.
“It’s totally ad hoc,” Mr. Norton said. “There’s no science behind it, or reasoning. It’s not like we were following someone’s instructions.”	“It’s totally ad hoc,” Mr. Norton said. “There’s no science behind it, or reasoning. It’s not like we were following someone’s instructions.”
Without clear guidance from the government, “it feels like we’ve been left on our own to decide what would be best,” he said. “There’s a lot of room for error. In Singapore or Japan, if it’s canceled, it’s canceled.”	Without clear guidance from the government, “it feels like we’ve been left on our own to decide what would be best,” he said. “There’s a lot of room for error. In Singapore or Japan, if it’s canceled, it’s canceled.”
Welcome to public health, American style.	Welcome to public health, American style.
The United States, a nation founded on the notion of individual rights and limited federal power, vests key decisions on public health in state and local government. The last week laid bare a dizzying patchwork of local decision-making, as the largest quarantine in recent American history occurred in a juddering, piecemeal fashion.	The United States, a nation founded on the notion of individual rights and limited federal power, vests key decisions on public health in state and local government. The last week laid bare a dizzying patchwork of local decision-making, as the largest quarantine in recent American history occurred in a juddering, piecemeal fashion.
Limits on public gatherings are being decided by individual states and counties, school closures by individual school districts. Testing practices vary widely, with some states introducing curbside testing and private testing firms. Although this country has a central public authority for handling infectious disease — the Centers for Disease Control and Prevention — the federal agency cannot get involved on the ground unless invited by states or municipalities.	Limits on public gatherings are being decided by individual states and counties, school closures by individual school districts. Testing practices vary widely, with some states introducing curbside testing and private testing firms. Although this country has a central public authority for handling infectious disease — the Centers for Disease Control and Prevention — the federal agency cannot get involved on the ground unless invited by states or municipalities.
“We have a completely decentralized public health system,” said Michele Barry, senior associate dean for global health at Stanford University. “It is difficult to mobilize a large containment strategy. That’s what Singapore did, or what China did. We don’t even work from the states up. We work from the counties up.”	“We have a completely decentralized public health system,” said Michele Barry, senior associate dean for global health at Stanford University. “It is difficult to mobilize a large containment strategy. That’s what Singapore did, or what China did. We don’t even work from the states up. We work from the counties up.”
She said she worried that this has kept the nation from acting swiftly, to enact aggressive controls on social distancing.	She said she worried that this has kept the nation from acting swiftly, to enact aggressive controls on social distancing.
“I’m just worried we’re going to follow the Italy course, rather than the Singapore course or Hong Kong course, because we’re decentralized,” she said.	“I’m just worried we’re going to follow the Italy course, rather than the Singapore course or Hong Kong course, because we’re decentralized,” she said.
In interviews from all over the country last week, Americans questioned why the government’s handling of the coronavirus varied so widely depending on where they lived.	In interviews from all over the country last week, Americans questioned why the government’s handling of the coronavirus varied so widely depending on where they lived.
“Every state has their own little different rules,” said Linda Dunn, 64, an Uber driver and retired teacher in Orlando, Fla. That morning, she had read in the news that Minnesota had introduced curbside testing for the virus. It made no sense, she said, that Floridians could not get the same service.	“Every state has their own little different rules,” said Linda Dunn, 64, an Uber driver and retired teacher in Orlando, Fla. That morning, she had read in the news that Minnesota had introduced curbside testing for the virus. It made no sense, she said, that Floridians could not get the same service.
“We’ve got a wildfire on our hands. The way to control it is the testing. Get it out there and get it done,” she said. If states could not keep up with one another, she said, the job should be done by the federal government.	“We’ve got a wildfire on our hands. The way to control it is the testing. Get it out there and get it done,” she said. If states could not keep up with one another, she said, the job should be done by the federal government.
“That’s one of the reasons we have a federal government,” she said. “This is an emergency.”	“That’s one of the reasons we have a federal government,” she said. “This is an emergency.”
For many parents, school closings sent a message of confusion and chaos.	For many parents, school closings sent a message of confusion and chaos.
Tracy Stettner, 44, of Hillsborough, Calif., said it was difficult to explain to her two children why the younger son’s school — which is private — had suspended in-school classes, to guard against spreading infection, while her older son left every morning, spent the day in close quarters with 1,200 other teenagers, and returned home.	Tracy Stettner, 44, of Hillsborough, Calif., said it was difficult to explain to her two children why the younger son’s school — which is private — had suspended in-school classes, to guard against spreading infection, while her older son left every morning, spent the day in close quarters with 1,200 other teenagers, and returned home.
“It needs to be all or nothing, or else how do we stop the spread?” said Ms. Stettler. “The most confusing thing to my kids is, why is the N.B.A. canceling, and Disneyland, but my school is still open? It doesn’t make sense.”	“It needs to be all or nothing, or else how do we stop the spread?” said Ms. Stettler. “The most confusing thing to my kids is, why is the N.B.A. canceling, and Disneyland, but my school is still open? It doesn’t make sense.”
She, too, was eager for a higher level of government to step in — in her case, Gov. Gavin Newsom.	She, too, was eager for a higher level of government to step in — in her case, Gov. Gavin Newsom.
“Our public schools are waiting for him to say something,” she said. “They need him to say, ‘any kid that’s pulled out is an excused absence.’ And even more, they need him to say, ‘no mass gatherings,’” which would trigger the closings of schools.	“Our public schools are waiting for him to say something,” she said. “They need him to say, ‘any kid that’s pulled out is an excused absence.’ And even more, they need him to say, ‘no mass gatherings,’” which would trigger the closings of schools.
In Bellevue, Wash., Geng Tan, 48, wondered why her children’s schools remained open, when the schools in the next county over had already closed as a precaution.	In Bellevue, Wash., Geng Tan, 48, wondered why her children’s schools remained open, when the schools in the next county over had already closed as a precaution.
Ms. Tan, an architect who grew up in China, concluded that the hesitation was “really related to the American social structure.”	Ms. Tan, an architect who grew up in China, concluded that the hesitation was “really related to the American social structure.”
“I think, under special circumstances, we do need a higher level to make dramatic decisions,” she said. “Basically, the school hesitated to make that hard decision themselves.”	“I think, under special circumstances, we do need a higher level to make dramatic decisions,” she said. “Basically, the school hesitated to make that hard decision themselves.”
The country’s localized approach to public health is no accident: It was built this way.	The country’s localized approach to public health is no accident: It was built this way.
The system’s infrastructure was shaped by the 1892 cholera pandemic, which reached this country with the arrival of infected passengers sent on steamships from Europe, said Howard Markel, a professor of the history of medicine at the University of Michigan.	The system’s infrastructure was shaped by the 1892 cholera pandemic, which reached this country with the arrival of infected passengers sent on steamships from Europe, said Howard Markel, a professor of the history of medicine at the University of Michigan.
There was logic to policing the issue locally, since three-quarters of all imported goods entered the country through New York Harbor. After that, sweeping powers were controlled by the state and municipality; New York City’s health department had its own police force, and an island used to quarantine infected people.	There was logic to policing the issue locally, since three-quarters of all imported goods entered the country through New York Harbor. After that, sweeping powers were controlled by the state and municipality; New York City’s health department had its own police force, and an island used to quarantine infected people.
~~Updated June ~~24,~~ 2020~~	Updated June 30, 2020
	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.
Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles.	Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles.
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.
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.