'‘Hospital Needs to Be Quarantined,’ but Works On in Country at War' diff viewer (5/6)

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‘Hospital Needs to Be Quarantined,’ but Works On in Country at War	‘Hospital Needs to Be Quarantined,’ but Works On in Country at War
2020-06-08 21:10:35 UTC	2020-06-10 03:09:44 UTC (1 day later)
KABUL, Afghanistan — Even when their city was repeatedly overrun by the Taliban and fighting reached their doorsteps, the doctors and nurses in the northern Afghan city of Kunduz kept working. They dressed wounds and saved lives at the main government hospital even as a nearby trauma center was bombed, killing more than 40 people.	KABUL, Afghanistan — Even when their city was repeatedly overrun by the Taliban and fighting reached their doorsteps, the doctors and nurses in the northern Afghan city of Kunduz kept working. They dressed wounds and saved lives at the main government hospital even as a nearby trauma center was bombed, killing more than 40 people.
Now, about 70 doctors and nurses out of a staff of 361 at Kunduz Regional Hospital — the main health facility for several restive provinces in northeastern Afghanistan — are either infected with the coronavirus or in quarantine on suspicion of infection.	Now, about 70 doctors and nurses out of a staff of 361 at Kunduz Regional Hospital — the main health facility for several restive provinces in northeastern Afghanistan — are either infected with the coronavirus or in quarantine on suspicion of infection.
Yet there is no choice but to keep the doors open, said Dr. Naeem Mangal, the hospital director. The doctors cannot reject the dozens of war wounded who continue to arrive each day, as fighting rages every night within earshot of the hospital.	Yet there is no choice but to keep the doors open, said Dr. Naeem Mangal, the hospital director. The doctors cannot reject the dozens of war wounded who continue to arrive each day, as fighting rages every night within earshot of the hospital.
“The hospital needs to be quarantined, but what alternative do we have?” Dr. Mangal said. “It has made us so concerned that we are all scared of each other at the hospital because we don’t know who is infected and who isn’t.”	“The hospital needs to be quarantined, but what alternative do we have?” Dr. Mangal said. “It has made us so concerned that we are all scared of each other at the hospital because we don’t know who is infected and who isn’t.”
Afghanistan’s feeble health system is dependent on foreign donations even for the $5 per head the country spends annually on health, and reliant on nongovernmental organizations for the delivery of its most basic services. Now it is being tested by the spread of the pandemic at a time when war with the Taliban continues to rage nationwide.	Afghanistan’s feeble health system is dependent on foreign donations even for the $5 per head the country spends annually on health, and reliant on nongovernmental organizations for the delivery of its most basic services. Now it is being tested by the spread of the pandemic at a time when war with the Taliban continues to rage nationwide.
Testing remains extremely limited, but as of Friday, the country had recorded just over 2,300 cases, with at least 228 among medical workers, and 68 recorded deaths. There is a risk that hospital visits could be fueling the spread of the virus.	Testing remains extremely limited, but as of Friday, the country had recorded just over 2,300 cases, with at least 228 among medical workers, and 68 recorded deaths. There is a risk that hospital visits could be fueling the spread of the virus.
Officials from several provinces said infections probably had not peaked. But the number of confirmed cases, together with concern about undetected ones, is already straining health facilities and forcing hospitals to improvise protocols and ration care between war-wounded patients and virus-infected ones.	Officials from several provinces said infections probably had not peaked. But the number of confirmed cases, together with concern about undetected ones, is already straining health facilities and forcing hospitals to improvise protocols and ration care between war-wounded patients and virus-infected ones.
Dr. Mangal said his hospital in Kunduz, where 23 of 37 confirmed cases are medical workers, had pleaded with people to visit the hospital only for severe emergencies.	Dr. Mangal said his hospital in Kunduz, where 23 of 37 confirmed cases are medical workers, had pleaded with people to visit the hospital only for severe emergencies.
Fighting rages every night within two to three miles of the Kunduz city center, and the hospital cannot refuse those wounded. For other patients, the hospital is turning away roughly half. Between 100 to 150 new patients are still being treated each day, with about half of them hurt by violence, Dr. Mangal said.	Fighting rages every night within two to three miles of the Kunduz city center, and the hospital cannot refuse those wounded. For other patients, the hospital is turning away roughly half. Between 100 to 150 new patients are still being treated each day, with about half of them hurt by violence, Dr. Mangal said.
On Thursday, Afghanistan’s health minister, Dr. Ferozuddin Feroz, said the spread of the virus had continued as predicted by World Health Organization models, which suggest that more than half of the population could become infected.	On Thursday, Afghanistan’s health minister, Dr. Ferozuddin Feroz, said the spread of the virus had continued as predicted by World Health Organization models, which suggest that more than half of the population could become infected.
“Yesterday, we had 500 tests and about 232 turned out positive,” said Dr. Feroz, a trauma surgeon during the country’s bloody civil war in the 1990s. “That would suggest the infection is truly circulating in society.”	“Yesterday, we had 500 tests and about 232 turned out positive,” said Dr. Feroz, a trauma surgeon during the country’s bloody civil war in the 1990s. “That would suggest the infection is truly circulating in society.”
Citing the Spanish flu, which lasted three years, Dr. Feroz said he feared an impoverished place like Afghanistan could be grappling with the coronavirus not for months but years.	Citing the Spanish flu, which lasted three years, Dr. Feroz said he feared an impoverished place like Afghanistan could be grappling with the coronavirus not for months but years.
The government’s ban on large gatherings and enforcement of some level of lockdown in major cities slowed the spread, he said, but too many people flouted those measures.	The government’s ban on large gatherings and enforcement of some level of lockdown in major cities slowed the spread, he said, but too many people flouted those measures.
Some Afghans have been swayed by religious leaders who are disregarding advisories and continuing to hold prayers involving hundreds and sometimes thousands of people. Even the country’s Senate is refusing pleas to call off sessions and respect the government ban on large indoor gatherings.	Some Afghans have been swayed by religious leaders who are disregarding advisories and continuing to hold prayers involving hundreds and sometimes thousands of people. Even the country’s Senate is refusing pleas to call off sessions and respect the government ban on large indoor gatherings.
More widely, deep poverty in Afghanistan, where people depend day to day on wages they earn, has made any strict enforcement of lockdowns impossible. One Western official, speaking on condition of anonymity to brief a reporter, estimated that 80 percent of the population already lived on less than $1.25 a day — just 25 cents more than the poverty line.	More widely, deep poverty in Afghanistan, where people depend day to day on wages they earn, has made any strict enforcement of lockdowns impossible. One Western official, speaking on condition of anonymity to brief a reporter, estimated that 80 percent of the population already lived on less than $1.25 a day — just 25 cents more than the poverty line.
There are already widespread food shortages across the country. In Kabul, the government started distributing bread on Wednesday to about 250,000 families through 1,200 bakeries across the city, each family getting between four to 10 loaves once a day, depending on the number in the household.	There are already widespread food shortages across the country. In Kabul, the government started distributing bread on Wednesday to about 250,000 families through 1,200 bakeries across the city, each family getting between four to 10 loaves once a day, depending on the number in the household.
It is an emergency measure to prevent deaths from hunger, and it will be extended to other cities in coming days. But crowds outside bakeries on the first day of distribution raised concerns that the measure would also fuel the spread of the virus.	It is an emergency measure to prevent deaths from hunger, and it will be extended to other cities in coming days. But crowds outside bakeries on the first day of distribution raised concerns that the measure would also fuel the spread of the virus.
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.
In several provinces, medical workers and hospitals are bearing the brunt of the virus.	In several provinces, medical workers and hospitals are bearing the brunt of the virus.
A hospital in northern Faryab Province, where fighting continues in several districts, may be forced to quarantine the I.C.U. section of its only hospital, said the governor, Naqibullah Faiq. He said it “has turned into a source for spreading the virus,” after a nurse there tested positive and another patient died of the virus.	A hospital in northern Faryab Province, where fighting continues in several districts, may be forced to quarantine the I.C.U. section of its only hospital, said the governor, Naqibullah Faiq. He said it “has turned into a source for spreading the virus,” after a nurse there tested positive and another patient died of the virus.
In Kandahar, the public health director, Dr. Tawus Naderi, said the main regional hospital, which serves several neighboring provinces, planned to hire 300 new health workers. But until then, with 41 doctors and nurses down with the coronavirus, the mildly ill are helping to care for the seriously ill.	In Kandahar, the public health director, Dr. Tawus Naderi, said the main regional hospital, which serves several neighboring provinces, planned to hire 300 new health workers. But until then, with 41 doctors and nurses down with the coronavirus, the mildly ill are helping to care for the seriously ill.
“We have admitted the infected health workers to the hospital allocated for Covid-19 and have created a mechanism where healthier patients are serving the more severe patients of Covid-19 to cover the gap,” Dr. Naderi said.	“We have admitted the infected health workers to the hospital allocated for Covid-19 and have created a mechanism where healthier patients are serving the more severe patients of Covid-19 to cover the gap,” Dr. Naderi said.
A major factor limiting the country’s response to the virus is the raging war.	A major factor limiting the country’s response to the virus is the raging war.
The Taliban have refused a call for a cease-fire on humanitarian grounds, even as they have highlighted the threat from the virus by demanding their prisoners be released immediately from jails where the virus has started spreading.	The Taliban have refused a call for a cease-fire on humanitarian grounds, even as they have highlighted the threat from the virus by demanding their prisoners be released immediately from jails where the virus has started spreading.
The head of the Taliban’s health commission in Kunduz Province has also been infected and is self-isolating, local insurgency members confirmed.	The head of the Taliban’s health commission in Kunduz Province has also been infected and is self-isolating, local insurgency members confirmed.