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| Fresh From Iran’s Coronavirus Zone, Now Moving Across Afghanistan | Fresh From Iran’s Coronavirus Zone, Now Moving Across Afghanistan |
| (3 days later) | |
| HERAT, Afghanistan — Afghanistan has already imported its epidemic. And each day it adds to it, as thousands more displaced Afghans continue to flow across the border from Iran, which has reported among the world’s highest numbers of Covid-19 cases and deaths. | HERAT, Afghanistan — Afghanistan has already imported its epidemic. And each day it adds to it, as thousands more displaced Afghans continue to flow across the border from Iran, which has reported among the world’s highest numbers of Covid-19 cases and deaths. |
| The returnees, some surely infected with the coronavirus when in Iran, cluster shoulder to shoulder in massive crowds on both sides of the crossing, where toilet facilities are primitive and soap and potable water are scarce. | The returnees, some surely infected with the coronavirus when in Iran, cluster shoulder to shoulder in massive crowds on both sides of the crossing, where toilet facilities are primitive and soap and potable water are scarce. |
| Later, they climb aboard overloaded taxis, buses and minivans for the two-hour trip to Herat city, the sprawling and crowded hub of western Afghanistan, where they sleep in packed hostels and cramped rooms behind restaurants. | Later, they climb aboard overloaded taxis, buses and minivans for the two-hour trip to Herat city, the sprawling and crowded hub of western Afghanistan, where they sleep in packed hostels and cramped rooms behind restaurants. |
| From Herat, tens of thousands of the new arrivals have boarded more overloaded buses and vans en route to Kabul, the capital. From there, they have returned to crowded homes in Kabul or traveled onward to outlying provinces — potential vectors for spreading the virus nationwide. | From Herat, tens of thousands of the new arrivals have boarded more overloaded buses and vans en route to Kabul, the capital. From there, they have returned to crowded homes in Kabul or traveled onward to outlying provinces — potential vectors for spreading the virus nationwide. |
| More than 115,000 Afghans returned from Iran just between March 8 and 21, according to the International Organization for Migration. The agency said that even if the border crossing were to be closed, Afghans who wanted to get home could easily find a way, given how porous the border is. | More than 115,000 Afghans returned from Iran just between March 8 and 21, according to the International Organization for Migration. The agency said that even if the border crossing were to be closed, Afghans who wanted to get home could easily find a way, given how porous the border is. |
| Many of the migrants are returning because they lost their jobs in Iran’s collapsing economy. Some others have said they were trying to escape the coronavirus, or were pushed out. Most returnees received rudimentary health screenings at the border crossing, where a small team of overwhelmed health workers struggled to cope with the influx. | Many of the migrants are returning because they lost their jobs in Iran’s collapsing economy. Some others have said they were trying to escape the coronavirus, or were pushed out. Most returnees received rudimentary health screenings at the border crossing, where a small team of overwhelmed health workers struggled to cope with the influx. |
| On some days, only about 10 percent of arrivals had their temperatures taken, said Abdul Qayoum Rahimi, the governor of Herat Province. Only a handful were tested for the virus, he said. The province does not have enough health workers, gloves, masks or thermometers to handle the daily crush. | On some days, only about 10 percent of arrivals had their temperatures taken, said Abdul Qayoum Rahimi, the governor of Herat Province. Only a handful were tested for the virus, he said. The province does not have enough health workers, gloves, masks or thermometers to handle the daily crush. |
| “This is a massive, massive return — simply overwhelming,” said Nick Bishop, who is leading the International Organization for Migration’s response to Covid-19 in Afghanistan. | “This is a massive, massive return — simply overwhelming,” said Nick Bishop, who is leading the International Organization for Migration’s response to Covid-19 in Afghanistan. |
| The city of Herat, with 1.5 million people, is the epicenter of the virus in Afghanistan, but life continued as normal this week. People congregated in teeming markets and in mosques and parks, greeting one another with traditional hugs and kisses on the cheek. Some returnees have not been in Afghanistan for 10 or 15 years, so they wandered through the city in large groups, sightseeing in parks and markets. | The city of Herat, with 1.5 million people, is the epicenter of the virus in Afghanistan, but life continued as normal this week. People congregated in teeming markets and in mosques and parks, greeting one another with traditional hugs and kisses on the cheek. Some returnees have not been in Afghanistan for 10 or 15 years, so they wandered through the city in large groups, sightseeing in parks and markets. |
| “We fear that Herat will turn into another Wuhan,” Afghanistan’s minister of public health, Ferozuddin Feroz, said Tuesday, referring to the Chinese metropolis where the virus was first detected. | “We fear that Herat will turn into another Wuhan,” Afghanistan’s minister of public health, Ferozuddin Feroz, said Tuesday, referring to the Chinese metropolis where the virus was first detected. |
| Mr. Rahimi, the Herat provincial governor, imposed a lockdown on Herat city beginning on Wednesday. He asked residents to cooperate with security forces and said exceptions would be made for people seeking food or medical treatment | Mr. Rahimi, the Herat provincial governor, imposed a lockdown on Herat city beginning on Wednesday. He asked residents to cooperate with security forces and said exceptions would be made for people seeking food or medical treatment |
| But during the Nowruz Persian new year, Friday through Sunday, thousands of Herat residents defied an order by President Ashraf Ghani banning all holiday gatherings. They celebrated in large crowds and held family picnics in public — an indication that the governor’s recent stay-at-home order would face public resistance. | But during the Nowruz Persian new year, Friday through Sunday, thousands of Herat residents defied an order by President Ashraf Ghani banning all holiday gatherings. They celebrated in large crowds and held family picnics in public — an indication that the governor’s recent stay-at-home order would face public resistance. |
| “The nature of this society is a very close physical one,” said Mr. Bishop, the migration official. “People touch one another a lot; they live in multigenerational families.” | “The nature of this society is a very close physical one,” said Mr. Bishop, the migration official. “People touch one another a lot; they live in multigenerational families.” |
| He added, “Many people may pass away before people change their behavior to reflect the new reality.” | He added, “Many people may pass away before people change their behavior to reflect the new reality.” |
| At the Herat hospital, where people thought to have Covid-19 were kept in isolation wards, Dr. Asif Rahmani said Afghans who had survived 40 years of war, and almost daily car bombs and roadside explosions, assumed they would survive the virus as well. | At the Herat hospital, where people thought to have Covid-19 were kept in isolation wards, Dr. Asif Rahmani said Afghans who had survived 40 years of war, and almost daily car bombs and roadside explosions, assumed they would survive the virus as well. |
| “People don’t take it seriously,” Dr. Rahmani said. “Because we are Muslims and we believe that God is great, he will decide. Good or bad, everything comes from God.” | “People don’t take it seriously,” Dr. Rahmani said. “Because we are Muslims and we believe that God is great, he will decide. Good or bad, everything comes from God.” |
| Mr. Feroz, the national health minister, complained Tuesday that Afghans continued to ride in crowded buses, attend sporting events, gather at family picnics and in wedding celebrations sometimes attended by thousands. | Mr. Feroz, the national health minister, complained Tuesday that Afghans continued to ride in crowded buses, attend sporting events, gather at family picnics and in wedding celebrations sometimes attended by thousands. |
| “This is a crisis,” he said. | “This is a crisis,” he said. |
| Toby Lanzer, the United Nations humanitarian coordinator for Afghanistan, said during a visit to Herat that his organization was assisting Afghan health officials as they struggled to prevent the virus from spreading to a majority of the population. | Toby Lanzer, the United Nations humanitarian coordinator for Afghanistan, said during a visit to Herat that his organization was assisting Afghan health officials as they struggled to prevent the virus from spreading to a majority of the population. |
| “Covid-19 is the new front line in a country where health services can only be described as fragile,” Mr. Lanzer said. | “Covid-19 is the new front line in a country where health services can only be described as fragile,” Mr. Lanzer said. |
| Herat has reported 65 of the 88 confirmed virus cases in Afghanistan, the health ministry said. Only two deaths from Covid-19 have been reported nationwide, with three patients reported to have recovered from the virus. But health professionals say the number of cases is probably far higher because of minimal testing. | Herat has reported 65 of the 88 confirmed virus cases in Afghanistan, the health ministry said. Only two deaths from Covid-19 have been reported nationwide, with three patients reported to have recovered from the virus. But health professionals say the number of cases is probably far higher because of minimal testing. |
| The Afghan health ministry projects that half of Afghanistan’s estimated 32 to 34 million people will contract the virus, and that more than 110,000 will probably die unless strict social distancing measures are imposed, Mr. Feroz said. | The Afghan health ministry projects that half of Afghanistan’s estimated 32 to 34 million people will contract the virus, and that more than 110,000 will probably die unless strict social distancing measures are imposed, Mr. Feroz said. |
| According to Herat health officials, one of the very first Covid-19 patients in the city was Wahidullah, 32, a father of four who returned from Iran in late February. He spent four days in the city, living with his family and moving through crowds in the streets, before he became the city’s first person to test positive for the virus, he said. | According to Herat health officials, one of the very first Covid-19 patients in the city was Wahidullah, 32, a father of four who returned from Iran in late February. He spent four days in the city, living with his family and moving through crowds in the streets, before he became the city’s first person to test positive for the virus, he said. |
| After three weeks in a Herat hospital, Mr. Wahidullah, who goes by one name, was declared recovered and was released, he said. He celebrated last weekend by attending a Nowruz picnic with family and friends. | After three weeks in a Herat hospital, Mr. Wahidullah, who goes by one name, was declared recovered and was released, he said. He celebrated last weekend by attending a Nowruz picnic with family and friends. |
| Updated June 12, 2020 | |
| 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. | |
| 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. |
| 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. |
| “I panicked, I was so scared” after testing positive, Mr. Wahidullah said. “But the doctors told me it’s like the flu and doesn’t kill everyone. We are Muslims, and God looks after us.” | “I panicked, I was so scared” after testing positive, Mr. Wahidullah said. “But the doctors told me it’s like the flu and doesn’t kill everyone. We are Muslims, and God looks after us.” |
| In Herat, health officials hired untrained residents of an internal displacement camp next to the city’s designated coronavirus treatment hospital for three days to clean rooms and help patients who had flulike systems as well as patients who tested positive. | In Herat, health officials hired untrained residents of an internal displacement camp next to the city’s designated coronavirus treatment hospital for three days to clean rooms and help patients who had flulike systems as well as patients who tested positive. |
| Mohammad Osman, 56, a camp resident, said he was paid 300 afghanis (about $4) a day for three days to clean, make patients’ beds and help them move around the 150-bed hospital. He said he had not been provided with gloves or a mask. | Mohammad Osman, 56, a camp resident, said he was paid 300 afghanis (about $4) a day for three days to clean, make patients’ beds and help them move around the 150-bed hospital. He said he had not been provided with gloves or a mask. |
| “I had no idea what kind of disease these patients had,” Mr. Osman said. | “I had no idea what kind of disease these patients had,” Mr. Osman said. |
| Another camp resident, Ghulam Yahya, 56, said he had also worked at the hospital for three days. He said he worried that he might have contracted the virus and transmitted it to the nine family members who live with him. | Another camp resident, Ghulam Yahya, 56, said he had also worked at the hospital for three days. He said he worried that he might have contracted the virus and transmitted it to the nine family members who live with him. |
| “All they gave me was gloves; I had no mask and no gown,” Mr. Yahya said. | “All they gave me was gloves; I had no mask and no gown,” Mr. Yahya said. |
| The police have since told residents of the camp to stay away from the hospital. | The police have since told residents of the camp to stay away from the hospital. |
| Last week, 38 patients who had exhibited symptoms and were awaiting test results attacked hospital staff and fled the facility as police officers stood by, said Dr. Abdul Hakim Tamana, the director of public health for Herat Province. Other patients complained of inadequate medical treatment and unsanitary conditions. | Last week, 38 patients who had exhibited symptoms and were awaiting test results attacked hospital staff and fled the facility as police officers stood by, said Dr. Abdul Hakim Tamana, the director of public health for Herat Province. Other patients complained of inadequate medical treatment and unsanitary conditions. |
| Moeedullhaq Fakhri, a doctor at the hospital, said staff members did not receive masks until March 15. He said he ignored a directive from provincial health officials instructing him not to accept people who might be infected from the border unless they paid hospital fees in advance. | Moeedullhaq Fakhri, a doctor at the hospital, said staff members did not receive masks until March 15. He said he ignored a directive from provincial health officials instructing him not to accept people who might be infected from the border unless they paid hospital fees in advance. |
| “These are poor people who don’t have anything, and they need to be hospitalized,” Dr. Fakhri said. | “These are poor people who don’t have anything, and they need to be hospitalized,” Dr. Fakhri said. |
| When he complained to health officials about shortages of trained staff and medical equipment, he said he was told: “If you want to keep your job, keep working. If not, please resign.” | When he complained to health officials about shortages of trained staff and medical equipment, he said he was told: “If you want to keep your job, keep working. If not, please resign.” |
| At the border crossing, Roya Mohammadi, 19, said she worked 12 hours a day helping screen the thousands of Afghans returning from Iran. She said that she feared some had Covid-19, but that she needed the income to support her extended family in Herat. | At the border crossing, Roya Mohammadi, 19, said she worked 12 hours a day helping screen the thousands of Afghans returning from Iran. She said that she feared some had Covid-19, but that she needed the income to support her extended family in Herat. |
| “I’m afraid of getting sick, of course,” Ms. Mohammadi said. “But I prefer to die with a full stomach rather than die of hunger.” | “I’m afraid of getting sick, of course,” Ms. Mohammadi said. “But I prefer to die with a full stomach rather than die of hunger.” |
| Reporting was contributed by Asad Timory and Jim Huylebroek from Herat, and Najim Rahim and Fahim Abed from Kabul, Afghanistan. | Reporting was contributed by Asad Timory and Jim Huylebroek from Herat, and Najim Rahim and Fahim Abed from Kabul, Afghanistan. |