'Treating Coronavirus in a Central Park ‘Hot Zone’' diff viewer (10/11)

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Treating Coronavirus in a Central Park ‘Hot Zone’	Treating Coronavirus in a Central Park ‘Hot Zone’
2020-06-24 10:54:49 UTC	2020-06-24 14:46:53 UTC (about 4 hours later)
Rubber boots hung from a tree of wooden pegs in soggy Central Park after being sterilized with chlorine. Workers observed a one-way flow into and out of what they referred to as “the hot zone” of patient treatment tents. Step by step, they removed their isolation suits in a designated area, as a monitor barked instructions.	Rubber boots hung from a tree of wooden pegs in soggy Central Park after being sterilized with chlorine. Workers observed a one-way flow into and out of what they referred to as “the hot zone” of patient treatment tents. Step by step, they removed their isolation suits in a designated area, as a monitor barked instructions.
“I like to liken it to a checklist that a pilot goes through before he starts the engine,” Dr. Elliott Tenpenny, the unit’s medical director, said on Monday. “You do it exactly the same way every single time.”	“I like to liken it to a checklist that a pilot goes through before he starts the engine,” Dr. Elliott Tenpenny, the unit’s medical director, said on Monday. “You do it exactly the same way every single time.”
The field hospital began treating patients on April 1 for Mount Sinai Health System and is directly across Fifth Avenue from one of its main hospitals. The tents, which are operated by the evangelical Christian relief group Samaritan’s Purse, have the look of an Ebola treatment unit in the Democratic Republic of Congo, where some of its staff have previously been deployed.	The field hospital began treating patients on April 1 for Mount Sinai Health System and is directly across Fifth Avenue from one of its main hospitals. The tents, which are operated by the evangelical Christian relief group Samaritan’s Purse, have the look of an Ebola treatment unit in the Democratic Republic of Congo, where some of its staff have previously been deployed.
The group has set up field hospitals in wartime Mosul, Iraq; after an earthquake in Ecuador; following a hurricane in the Bahamas; and during a diphtheria outbreak in Bangladesh, among others.	The group has set up field hospitals in wartime Mosul, Iraq; after an earthquake in Ecuador; following a hurricane in the Bahamas; and during a diphtheria outbreak in Bangladesh, among others.
The Central Park tent hospital, in America’s coronavirus epicenter, is the group’s first medical deployment in the United States. While Gov. Andrew M. Cuomo has said that the worst is over if residents remain vigilant, and that hospitalization figures continue to flatten, medical institutions in New York are still struggling to treat critically ill patients in numbers far exceeding typical capacity.	The Central Park tent hospital, in America’s coronavirus epicenter, is the group’s first medical deployment in the United States. While Gov. Andrew M. Cuomo has said that the worst is over if residents remain vigilant, and that hospitalization figures continue to flatten, medical institutions in New York are still struggling to treat critically ill patients in numbers far exceeding typical capacity.
“We will be here as long as we are meeting a need,” said Melissa Strickland, the organization’s communications director.	“We will be here as long as we are meeting a need,” said Melissa Strickland, the organization’s communications director.
The 68-bed field hospital in Central Park has 10 I.C.U. beds and ventilators, seven of which were being used at the beginning of this week. The facility had treated 130 patients as of Tuesday, according to the group — a similar number to the Navy hospital ship Comfort, which arrived March 30 and has space for as many as 500 severe coronavirus cases. As of Wednesday, six patients at the field hospital had died.	The 68-bed field hospital in Central Park has 10 I.C.U. beds and ventilators, seven of which were being used at the beginning of this week. The facility had treated 130 patients as of Tuesday, according to the group — a similar number to the Navy hospital ship Comfort, which arrived March 30 and has space for as many as 500 severe coronavirus cases. As of Wednesday, six patients at the field hospital had died.
The clinical staff — more than five dozen emergency response volunteers drawn from the organization’s nationwide roster — work 12-hour shifts. The infection control protocols they rigorously enforce are different and appear stricter than those being used to treat coronavirus patients in American hospitals, where protective equipment has run short, health workers are not always trained to use it, and many have contracted the coronavirus, with some dying. Thus far, Samaritan’s Purse leaders said, none of its workers have fallen ill at the New York field hospital or at a similar one in Cremona, Italy.	The clinical staff — more than five dozen emergency response volunteers drawn from the organization’s nationwide roster — work 12-hour shifts. The infection control protocols they rigorously enforce are different and appear stricter than those being used to treat coronavirus patients in American hospitals, where protective equipment has run short, health workers are not always trained to use it, and many have contracted the coronavirus, with some dying. Thus far, Samaritan’s Purse leaders said, none of its workers have fallen ill at the New York field hospital or at a similar one in Cremona, Italy.
While the virus that causes Covid-19 is spread differently from Ebola, and different protective equipment is needed, “the principles are similar,” Dr. Tenpenny said. “We just go over and above a little bit,” he added, having been able to design the hospital from scratch just over two weeks ago in a green field.	While the virus that causes Covid-19 is spread differently from Ebola, and different protective equipment is needed, “the principles are similar,” Dr. Tenpenny said. “We just go over and above a little bit,” he added, having been able to design the hospital from scratch just over two weeks ago in a green field.
“You have the privilege of being here in the middle of Central Park. We also want to take it as a burden on us not to allow anything to spread.”	“You have the privilege of being here in the middle of Central Park. We also want to take it as a burden on us not to allow anything to spread.”
The organization knows the cost of health worker infections. One of its doctors, Kent Brantly, was among the first Americans to contract Ebola in Liberia in 2014. Samaritan’s Purse arranged for a private flight back to the United States, and he was treated successfully at Emory University Hospital in Atlanta.	The organization knows the cost of health worker infections. One of its doctors, Kent Brantly, was among the first Americans to contract Ebola in Liberia in 2014. Samaritan’s Purse arranged for a private flight back to the United States, and he was treated successfully at Emory University Hospital in Atlanta.
For the New York field hospital, the group brought its own isolation suits, face shields, rubber boots and gloves, which workers wear in a double layer. Unlike other hospitals in the city, it has not had to ask for government assistance with these supplies or donations from the public. “We had stockpiled,” Dr. Tenpenny said. “We have enough.”	For the New York field hospital, the group brought its own isolation suits, face shields, rubber boots and gloves, which workers wear in a double layer. Unlike other hospitals in the city, it has not had to ask for government assistance with these supplies or donations from the public. “We had stockpiled,” Dr. Tenpenny said. “We have enough.”
While the field hospital maintains a laboratory and pharmacy and is able to perform X-rays and provide intensive care, about a tenth of its patients have had to be transferred to another facility for more specialized treatments. On Monday afternoon, one of the patients was being transferred out of the tents to an I.C.U. at Mt. Sinai. “They can provide a higher level so we’re back and forth all the time,” Dr. Tenpenny said. That higher-level care includes extracorporeal membrane oxygenation, or ECMO, which uses a machine to oxygenate a patient’s blood directly, temporarily replacing the function of the heart and lungs.	While the field hospital maintains a laboratory and pharmacy and is able to perform X-rays and provide intensive care, about a tenth of its patients have had to be transferred to another facility for more specialized treatments. On Monday afternoon, one of the patients was being transferred out of the tents to an I.C.U. at Mt. Sinai. “They can provide a higher level so we’re back and forth all the time,” Dr. Tenpenny said. That higher-level care includes extracorporeal membrane oxygenation, or ECMO, which uses a machine to oxygenate a patient’s blood directly, temporarily replacing the function of the heart and lungs.
On Monday morning, Dr. David L. Reich, president of Mount Sinai Hospital and Mount Sinai Queens, sang out a hello to Samaritan’s Purse workers in the Upper East Side hospital’s lobby, who were being trained to use the hospital’s glucose monitors. “Your team has been extraordinary,” he said, offering his elbow for a bump instead of a handshake. “We’re just delighted.”	On Monday morning, Dr. David L. Reich, president of Mount Sinai Hospital and Mount Sinai Queens, sang out a hello to Samaritan’s Purse workers in the Upper East Side hospital’s lobby, who were being trained to use the hospital’s glucose monitors. “Your team has been extraordinary,” he said, offering his elbow for a bump instead of a handshake. “We’re just delighted.”
“Pray for the tents,” he said that morning at a command team meeting, discussing the weather forecast and plans for potential evacuation. “We have stretchers ready to cross Fifth Avenue if necessary.”	“Pray for the tents,” he said that morning at a command team meeting, discussing the weather forecast and plans for potential evacuation. “We have stretchers ready to cross Fifth Avenue if necessary.”
Dr. Reich said the field hospital was considered an extension of Mount Sinai Hospital, which as of Tuesday evening was treating 669 people confirmed to have or suspected of having the virus. The severely ill were spread across newly created Covid-19 units throughout the hospital, which is also running studies to test potential treatments and a simulation laboratory with mannequins to develop new ventilator technologies.	Dr. Reich said the field hospital was considered an extension of Mount Sinai Hospital, which as of Tuesday evening was treating 669 people confirmed to have or suspected of having the virus. The severely ill were spread across newly created Covid-19 units throughout the hospital, which is also running studies to test potential treatments and a simulation laboratory with mannequins to develop new ventilator technologies.
The larger Mount Sinai health system has redistributed some patients from hard-hit areas of Queens, Brooklyn and South Nassau, on Long Island, where its hospitals have been overwhelmed. “They’re closer to nursing homes and socioeconomically depressed areas of New York,” he said.	The larger Mount Sinai health system has redistributed some patients from hard-hit areas of Queens, Brooklyn and South Nassau, on Long Island, where its hospitals have been overwhelmed. “They’re closer to nursing homes and socioeconomically depressed areas of New York,” he said.
~~Updated June ~~22,~~ 2020~~	Updated June 24, 2020
	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.
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.
A number of patients from those hospitals have been sent to the tents in Central Park, which on Tuesday had 47, according to the relief group.	A number of patients from those hospitals have been sent to the tents in Central Park, which on Tuesday had 47, according to the relief group.
“The beauty of the Samaritan’s Purse relationship is they come with staff,” Dr. Reich said, “and very good staff.” He added that doctors aim to assign patients to the tent who are “likely to have a stable course of care that does not involve I.C.U.-level care.”	“The beauty of the Samaritan’s Purse relationship is they come with staff,” Dr. Reich said, “and very good staff.” He added that doctors aim to assign patients to the tent who are “likely to have a stable course of care that does not involve I.C.U.-level care.”
Mount Sinai’s vice president for emergency management, Don R. Boyce, a former federal health official, was familiar with Samaritan’s Purse and its international aid efforts and made the initial connection between the institutions after the group offered a field hospital to the state.	Mount Sinai’s vice president for emergency management, Don R. Boyce, a former federal health official, was familiar with Samaritan’s Purse and its international aid efforts and made the initial connection between the institutions after the group offered a field hospital to the state.
Still, the group’s presence in New York City has drawn controversy. Samaritan’s Purse is led by the Rev. Franklin Graham, the son of the pastor Billy Graham. Its employees must endorse a Statement of Faith that opposes same-sex marriage. Mayor Bill de Blasio said at a news conference that Samaritan’s Purse had affirmed that it would not discriminate in providing treatment, and organization leaders made public statements to the same effect. On Tuesday, Mr. Graham accused elected officials and advocates of harassment, saying his organization had never discriminated against a patient.	Still, the group’s presence in New York City has drawn controversy. Samaritan’s Purse is led by the Rev. Franklin Graham, the son of the pastor Billy Graham. Its employees must endorse a Statement of Faith that opposes same-sex marriage. Mayor Bill de Blasio said at a news conference that Samaritan’s Purse had affirmed that it would not discriminate in providing treatment, and organization leaders made public statements to the same effect. On Tuesday, Mr. Graham accused elected officials and advocates of harassment, saying his organization had never discriminated against a patient.
The workers at the tents said New Yorkers had overwhelmingly been welcoming. A man who lives on Fifth Avenue and was walking his dog when the tents were being set up organized a team of volunteers to spread mulch. And staff members joked that eating all the baked goods and pizzas sent by the hospitals neighbor’s would make them gain “the Covid 20.”	The workers at the tents said New Yorkers had overwhelmingly been welcoming. A man who lives on Fifth Avenue and was walking his dog when the tents were being set up organized a team of volunteers to spread mulch. And staff members joked that eating all the baked goods and pizzas sent by the hospitals neighbor’s would make them gain “the Covid 20.”
Ken Isaacs, the organization’s vice president of programs and government relations, remarked on how friendly New Yorkers had been. “It sort of shocked me,” said Mr. Isaacs, who has worked in emergency response for over three decades and said the level of gratitude was unusual. The nightly practice of people beating pots and pans, clapping and waving to thank essential workers, brings him to the point of tears, he said. “It’s enormously affirming.”	Ken Isaacs, the organization’s vice president of programs and government relations, remarked on how friendly New Yorkers had been. “It sort of shocked me,” said Mr. Isaacs, who has worked in emergency response for over three decades and said the level of gratitude was unusual. The nightly practice of people beating pots and pans, clapping and waving to thank essential workers, brings him to the point of tears, he said. “It’s enormously affirming.”
He added, “Being in New York City, the hallowed ground of Central Park, deploying in the United States — these aren’t things we ever thought we would do.”	He added, “Being in New York City, the hallowed ground of Central Park, deploying in the United States — these aren’t things we ever thought we would do.”