'Coronavirus Cases, Concentrated on the Coasts, Now Threaten America’s Middle' diff viewer (2/3)

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Coronavirus Cases, Concentrated on the Coasts, Now Threaten America’s Middle	Coronavirus Cases, Concentrated on the Coasts, Now Threaten America’s Middle
2020-06-11 05:26:25 UTC	2020-06-11 05:58:09 UTC (32 minutes later)
CHICAGO — A second wave of coronavirus cases is charting a path far from coastal Washington State, California, New York and New Jersey, and threatening population centers in America’s middle. Emerging hot spots include smaller communities like Greenville, Miss., and Pine Bluff, Ark., and large cities like New Orleans, Milwaukee, Detroit and Chicago.	CHICAGO — A second wave of coronavirus cases is charting a path far from coastal Washington State, California, New York and New Jersey, and threatening population centers in America’s middle. Emerging hot spots include smaller communities like Greenville, Miss., and Pine Bluff, Ark., and large cities like New Orleans, Milwaukee, Detroit and Chicago.
Local and state leaders find themselves struggling to deal with the deadly onslaught, urgently issuing guidance to residents and sounding the alarm over a dearth of equipment in local clinics and hospitals.	Local and state leaders find themselves struggling to deal with the deadly onslaught, urgently issuing guidance to residents and sounding the alarm over a dearth of equipment in local clinics and hospitals.
As the threat expands, the orders from state and local officials have sometimes been a chaotic, confusing patchwork. With mixed signals from the federal authorities in Washington, D.C., local leaders have wrestled with complicated medical and economic choices. Mayors and governors in Oklahoma, Massachusetts, South Carolina and Texas have clashed over which restrictions to impose on residents, dispensing contradictory instructions, even as their communities are being ravaged by the virus.	As the threat expands, the orders from state and local officials have sometimes been a chaotic, confusing patchwork. With mixed signals from the federal authorities in Washington, D.C., local leaders have wrestled with complicated medical and economic choices. Mayors and governors in Oklahoma, Massachusetts, South Carolina and Texas have clashed over which restrictions to impose on residents, dispensing contradictory instructions, even as their communities are being ravaged by the virus.
This week, cities and states that had no known cases of coronavirus not long ago have seen the infection’s sudden, intense arrival. In Detroit, more than 850 cases have been identified and at least 15 people have died. In New Orleans, public health workers have identified more than 1,100 cases, including 57 people who have died. Eight deaths and nearly 400 cases have been reported in Milwaukee County, Wis. And in Chicago and its inner-ring suburbs, there have been nearly 2,000 cases, as of Friday morning.	This week, cities and states that had no known cases of coronavirus not long ago have seen the infection’s sudden, intense arrival. In Detroit, more than 850 cases have been identified and at least 15 people have died. In New Orleans, public health workers have identified more than 1,100 cases, including 57 people who have died. Eight deaths and nearly 400 cases have been reported in Milwaukee County, Wis. And in Chicago and its inner-ring suburbs, there have been nearly 2,000 cases, as of Friday morning.
“I look to New York to see what’s going on there, and I think, it’s a cautionary tale for the rest of us,” Mayor Lori Lightfoot of Chicago, a Democrat, said in an interview on Friday, a day when known cases in the United States rose above 100,000. “I look at New York and think, what do we do so that we are as prepared as possible as this begins to ramp up in a city like Chicago?”	“I look to New York to see what’s going on there, and I think, it’s a cautionary tale for the rest of us,” Mayor Lori Lightfoot of Chicago, a Democrat, said in an interview on Friday, a day when known cases in the United States rose above 100,000. “I look at New York and think, what do we do so that we are as prepared as possible as this begins to ramp up in a city like Chicago?”
A survey of cities conducted by the U.S. Conference of Mayors released on Friday found that despite assurances by the federal government that adequate medical supplies are available, cities say the equipment they need is not reaching them.	A survey of cities conducted by the U.S. Conference of Mayors released on Friday found that despite assurances by the federal government that adequate medical supplies are available, cities say the equipment they need is not reaching them.
Nearly every American city is lacking the most basic supplies. More than 90 percent of the nearly 200 cities that responded to the survey said they did not have a sufficient supply of face masks, and nearly 90 percent lacked an adequate amount of personal protective equipment. Detroit said it needed 18,000 surgical masks. Dayton, Ohio, needed 200,000 N95 masks, 150,000 pairs of gloves and 100,000 digital thermometers.	Nearly every American city is lacking the most basic supplies. More than 90 percent of the nearly 200 cities that responded to the survey said they did not have a sufficient supply of face masks, and nearly 90 percent lacked an adequate amount of personal protective equipment. Detroit said it needed 18,000 surgical masks. Dayton, Ohio, needed 200,000 N95 masks, 150,000 pairs of gloves and 100,000 digital thermometers.
Many local officials seeing a rise in cases have struggled to put in place robust restrictions that would help slow the spread of the outbreak. In Albany, Ga., a city of 73,000 where there have been 16 deaths and more than 160 confirmed cases of the virus, Mayor Bo Dorough imposed a stay-at-home order, similar to those enacted in New York, Illinois and California. But other than Albany and one nearby county, no other jurisdiction in southwest Georgia has restricted people’s movements or ordered businesses deemed nonessential to close.	Many local officials seeing a rise in cases have struggled to put in place robust restrictions that would help slow the spread of the outbreak. In Albany, Ga., a city of 73,000 where there have been 16 deaths and more than 160 confirmed cases of the virus, Mayor Bo Dorough imposed a stay-at-home order, similar to those enacted in New York, Illinois and California. But other than Albany and one nearby county, no other jurisdiction in southwest Georgia has restricted people’s movements or ordered businesses deemed nonessential to close.
“It’s not a natural disaster that’s confined to a certain geographic place,” Mr. Dorough said. “The county lines don’t mean anything to the virus.”	“It’s not a natural disaster that’s confined to a certain geographic place,” Mr. Dorough said. “The county lines don’t mean anything to the virus.”
In Mississippi, the state government had largely resisted calls to put in place regulations around the virus. That had led to a jumble of regulations, as mayors in Oxford, Jackson and Tupelo closed bars and restaurants and established shelter orders not much different than the rules in Houston, New Orleans, New York, Boston or San Francisco.	In Mississippi, the state government had largely resisted calls to put in place regulations around the virus. That had led to a jumble of regulations, as mayors in Oxford, Jackson and Tupelo closed bars and restaurants and established shelter orders not much different than the rules in Houston, New Orleans, New York, Boston or San Francisco.
“You can only go so far with leading from below,” said Mayor Chokwe Antar Lumumba of Jackson, the capital, which has more than 31 confirmed infections. “We need the state.”	“You can only go so far with leading from below,” said Mayor Chokwe Antar Lumumba of Jackson, the capital, which has more than 31 confirmed infections. “We need the state.”
In Utah, a standoff between Democratic government officials in Salt Lake City and the state’s Republican governor has heightened worries about spread of the coronavirus in the state’s most densely populated region.	In Utah, a standoff between Democratic government officials in Salt Lake City and the state’s Republican governor has heightened worries about spread of the coronavirus in the state’s most densely populated region.
Erin Mendenhall, Salt Lake City’s mayor, said in an interview that she had drafted — but not yet issued — an emergency order instructing residents to remain in their homes. The order allows people to shop for groceries, pick up medications and exercise, among other activities.	Erin Mendenhall, Salt Lake City’s mayor, said in an interview that she had drafted — but not yet issued — an emergency order instructing residents to remain in their homes. The order allows people to shop for groceries, pick up medications and exercise, among other activities.
But Ms. Mendenhall, a Democrat, said she had not invoked the order because Gov. Gary Herbert, a Republican, had not issued a similar statewide order.	But Ms. Mendenhall, a Democrat, said she had not invoked the order because Gov. Gary Herbert, a Republican, had not issued a similar statewide order.
“For a city to do it alone, particularly a city that’s the center for regional activities and business, it doesn’t do as much good as it would if we act as a county or region or even as a state,” she said.	“For a city to do it alone, particularly a city that’s the center for regional activities and business, it doesn’t do as much good as it would if we act as a county or region or even as a state,” she said.
Many of the new cases and deaths have been concentrated in the Midwest’s largest cities.	Many of the new cases and deaths have been concentrated in the Midwest’s largest cities.
Detroit has seen an explosion of coronavirus cases, with nearly 900 in total — including the city’s police chief, James Craig — and at least 19 deaths. Residents have a hard time comprehending why so many people in their city have become ill, especially because they viewed state and city leaders as having taken aggressive actions early on, said Tonya Allen, the president and chief executive of the Skillman Foundation, a philanthropic organization that focuses on Detroit youth.	Detroit has seen an explosion of coronavirus cases, with nearly 900 in total — including the city’s police chief, James Craig — and at least 19 deaths. Residents have a hard time comprehending why so many people in their city have become ill, especially because they viewed state and city leaders as having taken aggressive actions early on, said Tonya Allen, the president and chief executive of the Skillman Foundation, a philanthropic organization that focuses on Detroit youth.
“I think we’re all surprised by how fast and hard it’s hitting in Detroit,” she said. “You can imagine why it would hit in some large cities on the coast. But why it’s moving so quickly in Detroit, we have no idea.”	“I think we’re all surprised by how fast and hard it’s hitting in Detroit,” she said. “You can imagine why it would hit in some large cities on the coast. But why it’s moving so quickly in Detroit, we have no idea.”
Updated June 5, 2020	Updated 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.
The areas around Cleveland, St. Louis and Kansas City, Mo., have also seen spikes, leading officials to warn that medical facilities could be overwhelmed.	The areas around Cleveland, St. Louis and Kansas City, Mo., have also seen spikes, leading officials to warn that medical facilities could be overwhelmed.
“What we do now will determine if we overrun Ohio’s hospitals and get to a situation where our medical teams are making life-and-death decisions,” the state’s governor, Mike DeWine, said on Thursday. “We don’t want to be in that position. I worry about this every day.”	“What we do now will determine if we overrun Ohio’s hospitals and get to a situation where our medical teams are making life-and-death decisions,” the state’s governor, Mike DeWine, said on Thursday. “We don’t want to be in that position. I worry about this every day.”
The race to keep Americans at home has happened at astonishing speed. In just over a week, nearly half the states have issued orders or formal advisories for all residents to stay home, and others have strongly recommended it. As of Friday morning, at least 233 million people — or about seven in 10 Americans — were being told to stay home.	The race to keep Americans at home has happened at astonishing speed. In just over a week, nearly half the states have issued orders or formal advisories for all residents to stay home, and others have strongly recommended it. As of Friday morning, at least 233 million people — or about seven in 10 Americans — were being told to stay home.
Some governors who initially resisted such a sweeping measure quickly changed their minds. Gov. Chris Sununu of New Hampshire, a Republican, who initially described a stay-at-home order as “not a practical ask,” later put one in place.	Some governors who initially resisted such a sweeping measure quickly changed their minds. Gov. Chris Sununu of New Hampshire, a Republican, who initially described a stay-at-home order as “not a practical ask,” later put one in place.
In independent-minded Texas, where there is no statewide order, at least 20 million people — from the Rio Grande Valley to sprawling suburbs of Dallas — were under local instructions to stay home.	In independent-minded Texas, where there is no statewide order, at least 20 million people — from the Rio Grande Valley to sprawling suburbs of Dallas — were under local instructions to stay home.
Clay Jenkins, the Democratic judge of Dallas County, was the first county executive in Texas to shut down bars and restaurants and issue a stay-at-home order. He said he had been watching the outbreaks on the coasts with alarm, particularly in California and New York.	Clay Jenkins, the Democratic judge of Dallas County, was the first county executive in Texas to shut down bars and restaurants and issue a stay-at-home order. He said he had been watching the outbreaks on the coasts with alarm, particularly in California and New York.