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In a Province No Stranger to War, Preparing to Battle a New Enemy In a Province No Stranger to War, Preparing to Battle a New Enemy
(6 days later)
An activist who has supported the democracy protests against Syria’s authoritarian president since they began nine years ago knows a thing or two about battling adversity. But Hosam al-Ali, 35, is more than a little worried about his new adversary: the coronavirus.An activist who has supported the democracy protests against Syria’s authoritarian president since they began nine years ago knows a thing or two about battling adversity. But Hosam al-Ali, 35, is more than a little worried about his new adversary: the coronavirus.
A pharmacist in Idlib, the last province still in the hands of Syrian opposition groups, Mr. al-Ali volunteered to be the main virus-response coordinator in his region.A pharmacist in Idlib, the last province still in the hands of Syrian opposition groups, Mr. al-Ali volunteered to be the main virus-response coordinator in his region.
An estimated 3.5 million people are crammed into the northern half of the province, at least half of them displaced, many in makeshift homes and tents. The lack of basic services, aid groups warn, makes Idlib particularly vulnerable to the virus.An estimated 3.5 million people are crammed into the northern half of the province, at least half of them displaced, many in makeshift homes and tents. The lack of basic services, aid groups warn, makes Idlib particularly vulnerable to the virus.
As he set to work, Mr. al-Ali began keeping an audio diary, which he shared day by day with Carlotta Gall, the Istanbul bureau chief for The New York Times. His entries have been condensed, and edited for clarity.As he set to work, Mr. al-Ali began keeping an audio diary, which he shared day by day with Carlotta Gall, the Istanbul bureau chief for The New York Times. His entries have been condensed, and edited for clarity.
April 1, 2020April 1, 2020
Today there was an announcement from the Minister of Health of the temporary government. We had concerns about 20 patients, and the results were negative. Thanks be to God.Today there was an announcement from the Minister of Health of the temporary government. We had concerns about 20 patients, and the results were negative. Thanks be to God.
April 3April 3
It was a holiday, and a day off for me.It was a holiday, and a day off for me.
Like most Syrians who, on Friday, wake up and buy breakfast outside, I went to the center of Al-Atareb, which is very close to the front line and badly destroyed. There was only one breakfast shop open. It was very crowded and I had to wait.Like most Syrians who, on Friday, wake up and buy breakfast outside, I went to the center of Al-Atareb, which is very close to the front line and badly destroyed. There was only one breakfast shop open. It was very crowded and I had to wait.
I returned home to my wife and kids, and then I was fixing up solar panels and a battery. It was a very normal day.I returned home to my wife and kids, and then I was fixing up solar panels and a battery. It was a very normal day.
Of course, I have coronavirus work, but I did this from home. There were a lot of communications, because I am on several WhatsApp chat groups.Of course, I have coronavirus work, but I did this from home. There were a lot of communications, because I am on several WhatsApp chat groups.
The most important thing is training and social awareness, and how people should stay at home for safety. But society is disregarding that — that is the biggest problem we are facing.The most important thing is training and social awareness, and how people should stay at home for safety. But society is disregarding that — that is the biggest problem we are facing.
Today they decided to cancel one of the new quarantine camps and make it a center for burning medical waste.Today they decided to cancel one of the new quarantine camps and make it a center for burning medical waste.
I have to prepare a lecture for midwife students at a university in Azaz on pharmacology. I have been teaching there for the last two years, but the whole university is going online because of the virus.I have to prepare a lecture for midwife students at a university in Azaz on pharmacology. I have been teaching there for the last two years, but the whole university is going online because of the virus.
April 4April 4
We went to the Directorate of Health today and were trained on how to take a sample from a person suspected of being infected.We went to the Directorate of Health today and were trained on how to take a sample from a person suspected of being infected.
Then they brought us a patient.Then they brought us a patient.
He had a high temperature, and was ill with flulike symptoms. Of course, this patient had been one week under quarantine at home, not in a health center, and he came in for the test. The trainer carried it out.He had a high temperature, and was ill with flulike symptoms. Of course, this patient had been one week under quarantine at home, not in a health center, and he came in for the test. The trainer carried it out.
April 5April 5
Today I conducted training for the White Helmets [a Syrian civil defense group].Today I conducted training for the White Helmets [a Syrian civil defense group].
There were two teams, each with 10 people. We did two sessions to avoid crowding.There were two teams, each with 10 people. We did two sessions to avoid crowding.
The next morning, I woke at 5 a.m., and we modified slides for the lecture. The slides outline the criteria for sending people to health facilities. They also tell people how to handle dead bodies.The next morning, I woke at 5 a.m., and we modified slides for the lecture. The slides outline the criteria for sending people to health facilities. They also tell people how to handle dead bodies.
The trainees from the White Helmets are very interested. Their motto, I learned, is from the Quran: “Whoever saves the life of one, it is as if he saves the life of all mankind.”The trainees from the White Helmets are very interested. Their motto, I learned, is from the Quran: “Whoever saves the life of one, it is as if he saves the life of all mankind.”
The whole day my mood was very bad, because my tooth infection had moved from my mouth to my eye, and it was very painful. I started to look like a teddy bear.The whole day my mood was very bad, because my tooth infection had moved from my mouth to my eye, and it was very painful. I started to look like a teddy bear.
So I finished my training early and went to Ad Dana, a village 15 kilometers away from my house where a dentist treated the infection. I cried from the pain.So I finished my training early and went to Ad Dana, a village 15 kilometers away from my house where a dentist treated the infection. I cried from the pain.
The dentist gave me some medicine, I went back home, ate a little bit and then went to sleep.The dentist gave me some medicine, I went back home, ate a little bit and then went to sleep.
See you soon, or maybe not.See you soon, or maybe not.
April 8April 8
Yesterday we trained 20 people. The day before, also. We reached 62 trainees in three days, all White Helmets. Afterward, we posted the training material to the WhatsApp group.Yesterday we trained 20 people. The day before, also. We reached 62 trainees in three days, all White Helmets. Afterward, we posted the training material to the WhatsApp group.
The White Helmets will be responsible for burying the bodies. This requires special procedures, and then the car needs to be sterilized after the burial. That is what I spoke about.The White Helmets will be responsible for burying the bodies. This requires special procedures, and then the car needs to be sterilized after the burial. That is what I spoke about.
I also gave a lecture to students of the Institute for Midwives and the Institute of Pediatric Nurses. It was a good lecture, but a little bit harder than an in-person one. I could not understand the body language of the students. I tried shouting and repeating again and again.I also gave a lecture to students of the Institute for Midwives and the Institute of Pediatric Nurses. It was a good lecture, but a little bit harder than an in-person one. I could not understand the body language of the students. I tried shouting and repeating again and again.
Then I took my family out for 10 minutes outside. We drank coffee and the children drank juice and then we returned home.Then I took my family out for 10 minutes outside. We drank coffee and the children drank juice and then we returned home.
God willing, Monday we will do another training session.God willing, Monday we will do another training session.
April 12April 12
Today I had a planning meeting on Zoom. Everyone had good ideas. Everyone would like to work. But in the end, the main problems are weakness of coordination and lack of financial means. It is because of that we are moving forward very, very slowly.Today I had a planning meeting on Zoom. Everyone had good ideas. Everyone would like to work. But in the end, the main problems are weakness of coordination and lack of financial means. It is because of that we are moving forward very, very slowly.
Yesterday a friend called me. He was looking for an incubator for his new born baby.Yesterday a friend called me. He was looking for an incubator for his new born baby.
I found an incubator, but actually he needed a ventilator.I found an incubator, but actually he needed a ventilator.
After we understood that we started looking for a ventilator, but unfortunately we could not find one. All the hospital ventilators were busy — and still we don’t have a single coronavirus case.After we understood that we started looking for a ventilator, but unfortunately we could not find one. All the hospital ventilators were busy — and still we don’t have a single coronavirus case.
If that is happening, it means the medical capacity is very poor.If that is happening, it means the medical capacity is very poor.
Today I felt depressed: I heard the baby died.Today I felt depressed: I heard the baby died.
April 23April 23
Last week we trained a lot of teams on how to run a quarantine center. We found acceptance from a lot of organizations, and these organizations have some money which they could put toward this.Last week we trained a lot of teams on how to run a quarantine center. We found acceptance from a lot of organizations, and these organizations have some money which they could put toward this.
We divided the session into two parts: Before the virus appears in our area, and after.We divided the session into two parts: Before the virus appears in our area, and after.
In the first part it is about health awareness.In the first part it is about health awareness.
We will supply soap and clean water in the market and two tents for the center: one for isolation, and one for testing.We will supply soap and clean water in the market and two tents for the center: one for isolation, and one for testing.
Updated June 16, 2020 Updated June 22, 2020
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.
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.
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.
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.
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.
We will raise awareness of the people not to bring their children to the clinic, and only to come in an emergency.We will raise awareness of the people not to bring their children to the clinic, and only to come in an emergency.
And we will spray-paint health messages on the town walls.And we will spray-paint health messages on the town walls.
All that is before the virus appears.All that is before the virus appears.
After it is here, there will be more serious coordination with the White Helmets, the local council and civil society organizations.After it is here, there will be more serious coordination with the White Helmets, the local council and civil society organizations.
The plan is to put tents at the entrance of Al-Atareb. People will pass through the tents and be registered. If we have any doubts about someone who is trying to come into Al-Atareb, we will take them to the quarantine center.The plan is to put tents at the entrance of Al-Atareb. People will pass through the tents and be registered. If we have any doubts about someone who is trying to come into Al-Atareb, we will take them to the quarantine center.
There will also be a kind of home isolation for everybody, and there is a team of women who volunteered to teach people how to make homemade masks.There will also be a kind of home isolation for everybody, and there is a team of women who volunteered to teach people how to make homemade masks.
The White Helmets will start using their vehicles to disinfect the public areas.The White Helmets will start using their vehicles to disinfect the public areas.
The situation of the health authority is very, very bad. The Health Directorate laid off some employees and gave others unpaid leave because of the financial situation.The situation of the health authority is very, very bad. The Health Directorate laid off some employees and gave others unpaid leave because of the financial situation.
The rest of the employees will be paid $100 a month.The rest of the employees will be paid $100 a month.
You know: $100 is nothing. I will pay $50 for my rent and $50 for fuel for my car. How will I deal for the rest of the month?You know: $100 is nothing. I will pay $50 for my rent and $50 for fuel for my car. How will I deal for the rest of the month?
Soon, Ramadan is coming and the market will be crowded.Soon, Ramadan is coming and the market will be crowded.
But I think the sickness will not spread too much in our area if we apply the plan. Each village should do social management. We need to spread awareness to the people to do self-isolation and social distancing, and then we will be in good shape.But I think the sickness will not spread too much in our area if we apply the plan. Each village should do social management. We need to spread awareness to the people to do self-isolation and social distancing, and then we will be in good shape.
Happy Ramadan — and I hope this year will be good for all the world.Happy Ramadan — and I hope this year will be good for all the world.
May 3May 3
Greetings.Greetings.
It is really hard with Ramadan. We have a lot of work and it makes me tired.It is really hard with Ramadan. We have a lot of work and it makes me tired.
The Kafr Karmin quarantine center has begun its work. This center is receiving people who are coming from Turkey. The border authorities are taking them to the center and isolating them for 14 days.The Kafr Karmin quarantine center has begun its work. This center is receiving people who are coming from Turkey. The border authorities are taking them to the center and isolating them for 14 days.
I also have a bad situation at home. My wife started crying.I also have a bad situation at home. My wife started crying.
Our fridge is not working and every day I say I will get a new one or fix it and I did not do it. And some of the windows are broken and I did not fix them. I am really busy, and when I am busy I forget.Our fridge is not working and every day I say I will get a new one or fix it and I did not do it. And some of the windows are broken and I did not fix them. I am really busy, and when I am busy I forget.
May 5May 5
There is something very important going on these days. It is not about coronavirus.There is something very important going on these days. It is not about coronavirus.
It is about the people.It is about the people.
They are in a very difficult situation. Everything is super-expensive now. The dollar is rising and the Syrian pound is on the floor. The rate of one dollar is 1,500 Syrian pounds.They are in a very difficult situation. Everything is super-expensive now. The dollar is rising and the Syrian pound is on the floor. The rate of one dollar is 1,500 Syrian pounds.
People are going crazy. God help the people with Ramadan, coronavirus and high prices. God help the people.People are going crazy. God help the people with Ramadan, coronavirus and high prices. God help the people.
**
Update: As of this week, Idlib has had no reported cases of infection.Update: As of this week, Idlib has had no reported cases of infection.
Saad al-Nassife contributed reporting from Gaziantep, Turkey.Saad al-Nassife contributed reporting from Gaziantep, Turkey.