How to Make this Moment the Turning Point for Real Change
Current guidelines from the Centers for Disease Control and Prevention give priority first to hospitalized patients and symptomatic health-care workers, then to high-risk patients, specifically those over 65 and those suffering from other serious health conditions, with COVID-19 symptoms. Under this system, asymptomatic individuals are not tested, even if they had contact with people who tested positive.
This is an enormous mistake. If we want to control the spread of COVID-19, the United States must adopt a new testing policy that prioritizes people who, although asymptomatic, may have the virus and infect many others.
San Francisco had yet to confirm a single case of the coronavirus when London Breed, the city’s 45-year-old first-term mayor, declared a state of emergency in late February. Two weeks later, Breed’s decision to ban gatherings of more than 1,000 people forced the hand of the Bay Area’s beloved Golden State Warriors, who this year moved into San Francisco’s Chase Center after nearly a half century in Oakland. Her decision, along with the NBA’s first positive case of the coronavirus, set in motion a chain of events that effectively shut down all of the nation’s major sports leagues. At the time, Breed heard criticism that she was moving too quickly.
Concerns about false negatives arise from a mix of factors: quickly created tests from dozens of labs and manufacturers that haven't been extensively vetted by federal health regulators; a shortage of supplies and material for the tests that may impact results, long incubation times for the infection, and the challenge of getting an adequate sample from a patient.
Most tests rely on a nasal swab that penetrates deep into the pharynx, the mucous membrane behind the nose and mouth. Even for a trained health worker, it can be difficult: It’s an invasive procedure that often causes patients to squirm. With a shortage of staff to conduct such widespread testing, in many cases people not typically trained to do so are collecting samples.
Ryan Stanton, an emergency medicine physician in Lexington, Kentucky, said that most people likely aren't swabbing patients correctly. “They're not getting far enough back there to get a good sample,” he said.
the Centers for Disease Control and Prevention developed and distributed a faulty test in February. Independent labs created alternatives, but were mired in bureaucracy from the FDA. In a crucial month when the American caseload shot into the tens of thousands, only hundreds of people were tested. That a biomedical powerhouse like the U.S. should so thoroughly fail to create a very simple diagnostic test was, quite literally, unimaginable. “I’m not aware of any simulations that I or others have run where we [considered] a failure of testing,” says Alexandra Phelan of Georgetown University, who works on legal and policy issues related to infectious diseases.
In several hours on Tuesday, Dr. Ashley Bray performed chest compressions at Elmhurst Hospital Center on a woman in her 80s, a man in his 60s and a 38-year-old who reminded the doctor of her fiancé. All had tested positive for the coronavirus and had gone into cardiac arrest. All eventually died.
Elmhurst, a 545-bed public hospital in Queens, has begun transferring patients not suffering from coronavirus to other facilities as it moves toward becoming a facility dedicated entirely to the outbreak. Doctors and nurses have struggled to make do with a few dozen ventilators. Calls over a loudspeaker of “Team 700,” the code for when a patient is on the verge of death, come several times a shift. Some have died inside the emergency room while waiting for a bed.
A refrigerated truck has been stationed outside to hold the bodies of the dead. Over the past 24 hours, New York City’s public hospital system said in a statement, 13 people at Elmhurst had died.
“It’s apocalyptic,” said Dr. Bray, a general medicine resident at the hospital.
Absolutely terrifying account of how COVID-19 impacts lungs of the infected.
Over the next several days, Askini saw her temperature spike and drop dangerously, and she developed a cough that gurgled because of all the liquid in her lungs. After two more trips to the ER that week, Askini was given a final test on the seventh day of her illness, and once doctors helped manage her flu and pneumonia symptoms, they again sent her home to recover. She waited another three days for a lab to process her test, and at last she had a diagnosis: COVID-19.
A few days later, Askini got the bills for her testing and treatment: $34,927.43. “I was pretty sticker-shocked,” she says. “I personally don’t know anybody who has that kind of money.”
The pictures you may have seen only begin to capture the chaos. There was no attempt to enable social distancing; we were packed closely together. Two giant queues of people — one for U.S. citizens and green-card holders and one for foreign nationals — wound their way through the cavernous hall. I counted and came up with approximately 450 people in each section, for a total of just under a thousand. Many were coughing, sneezing and looking unwell.
Long lines at airports worldwide as coronavirus spurs cancellations and travel bans
When I inched closer to the front, I could see that a scant six immigration desks were in service. Two additional desks to the left had less traffic. These are ordinarily for people in wheelchairs; now, the wheelchairs were mixed in with the rest. When I asked a security guard about the other lines, he told me they were for people with a confirmed corona diagnosis. There was no separation for this group — no plastic sheets, not even a bit of distance. When your line snaked to the left, you were inches away from the infected.
The flu kills less than 1% of infected people who are over age 65. By comparison, in China, COVID-19 killed 8% of those infected who were 70-79 and almost 15% of those infected who were age 80 or older. That’s a staggering difference.
Even for younger people, the difference was striking. Flu killed .02% of infected patients age 18-49. It’s 10 times that for COVID-19.
In other countries, such as South Korea, the death rate has been far lower.
But if 1 in 12 people age 70-79 who get the virus and 1 in 7 people age 80 or older who get the virus die, and the virus spreads to 20%, 40% or 70% of the population, we’re talking massive death tolls, the likes of which we have never seen before in our lives.
“I mean, people always say, well, the flu does this, the flu does that,” Fauci said Wednesday during congressional testimony. “The flu has a mortality of 0.1%. This has a mortality rate of 10 times that. That’s the reason I want to emphasize we have to stay ahead of the game in preventing this.”
Between 160 million and 214 million people in the U.S. could be infected over the course of the epidemic, according to one projection. That could last months or even over a year, with infections concentrated in shorter periods, staggered across time in different communities, experts said. As many as 200,000 to 1.7 million people could die
Without it, to simply tell people to “stay at home if you’re sick” will be inadequate. Most cases of COVID-19 are reportedly “mild,” but that term can be misleading. As the World Health Organization adviser Bruce Aylward clarified last week, a “mild” case of COVID-19 is not equivalent to a mild cold. Expect it to be much worse: fever and coughing, sometimes pneumonia—anything short of requiring oxygen. “Severe” cases require supplemental oxygen, sometimes via a breathing tube and a ventilator. “Critical” cases involve “respiratory failure or multi-organ failure.”
All of this could have been avoided if the media and the electorate were less blinded by cynicism, sexism and fear and more willing to see Warren for who she was – the most capable, competent and kindest candidate in the race.
The I.O.C. is adamant that the Games will go on, as they always have except in times of war. John Coates, the organization’s Tokyo event coördinator, told reporters, “There is no case for any contingency plans or cancelling the Games or moving the Games.” That may seem the height of hubris—or, perhaps, greed, considering the organization’s undistinguished record on ethics. But there is a lot at stake even beyond the billions in sponsorships and television money: many people orient their entire lives toward those two brief weeks.
Through interviews with dozens of public-health officials and a survey of local data from across the country, The Atlantic could only verify that 1,895 people have been tested for the coronavirus in the United States, about 10 percent of whom have tested positive. And while the American capacity to test for the coronavirus has ramped up significantly over the past few days, local officials can still test only several thousand people a day, not the tens or hundreds of thousands indicated by the White House’s promises.
A quick look at how designers and engineers should work together
The New York Times reported last year that McKinsey ultimately did more than $20 million in consulting work for ICE, a commitment to one of the Trump administration’s most controversial endeavors that raised concerns among some of McKinsey’s employees and former partners. The firm’s global managing partner, Kevin Sneader, assured them in a 2018 email that the firm had never focused on developing, advising or implementing immigration policies. He said McKinsey “will not, under any circumstances, engage in work, anywhere in the world, that advances or assists policies that are at odds with our values.”
Shortly after Donald Trump took office, the administration rescinded a $400,000 grant to Life After Hate, a group dedicated to stopping right-wing extremism in America. The Department of Homeland Security also backed out of a $867,000 grant promised to researchers at the University of North Carolina who were developing a program to stop young people from embracing ideologies like jihadism and white supremacy.
“The American people rightly should expect more from their public servants than merely avoiding criminal liability,” Kris said.
"A warning light that would’ve alerted the crew to the disagreement wasn’t part of the added-cost optional package of equipment on Lion Air’s 737 Max aircraft. A guardrail wasn’t in place."
“As a general rule, showing vulnerability and humanness is powerful in that it builds connection,” says Nino-Murcia. “There’s one important caveat, though. If you’re showcasing vulnerability in the exact core competency that people expect of you, it actually tends to be more unsettling for those around you.”