Your COVID-19 questions, answered

There is a lot of misinformation circulating about the coronavirus, so we took to Instagram, Twitter and Reddit to see what questions have been bugging you, our readers.Below are answers from several healthcare experts who have been following the outbreak. Please note that there is much we still don’t know about the new virus, and you should reach out to your own healthcare provider with any personal health concerns.

LIVING UNDER LOCKDOWN

What are good ways to maintain your mental health?

I would recommend the following:

1. Maintain a normal schedule if possible

2. Exercise (go for walk or run, do an online video)

3. Maintain social connections via FaceTime, Skype or phone calls

4. Limit time spent on the Internet and connected to the news

5. Have “virtual” dates with family and friends.

— Dr. Krutika Kuppalli, infectious disease researcher

Here’s how it’s affecting young minds  and how millennials are adjusting to isolation.

How long will the U.S. really have to be on lockdown to successfully flatten the curve?

We’re still learning on a daily basis what the case count looks like in the U.S. We also need to consider that there could be a resurgence of cases once public health measures are loosened up.

— Dr. Krutika Kuppalli, infectious disease researcher

I defer to the epidemiologists here, but National Institute of Allergy and Infectious Diseases Director Anthony Fauci recently said that he’s confident in a range of four to six weeks to 3 months.

— Dr. Angela Rasmussen, virologist at Columbia University

Do I actually need to wear a mask?

The WHO advises that if you’re healthy, you need to wear a mask only when caring for an infected person or if you’re coughing, sneezing or showing symptoms. More here

TRANSMISSION

Is it fair to assume every American will be exposed to the coronavirus this year?

No, which is one of the reasons we have these current public health measures in place. We are trying to prevent further onward transmission of the disease.

— Dr. Krutika Kuppalli, infectious disease researcher

Almost 100,000 cases have been reported in the U.S. and its territories, according to a Reuters tally of state and local government sources, mapped .

Is the coronavirus airborne in normal settings and if so, for how long?

According to our knowledge, it does not stay in the air in normal settings. Most evidence directs us to droplet transmission. Airborne precautions are required only for healthcare workers when undertaking aerosol producing procedures such as bronchoscopy/intubation.

— Dr. Muge Cevik, infectious diseases researcher at the University of St. Andrews

Is there potential exposure in elevators?

Coronavirus guidelines by the CDC are based on the fact that the virus is transmitted primarily via respiratory droplets, like a cough or sneeze. In droplet form, it’s airborne for a few seconds, but is only able to travel a short distance. In elevators, social distancing measures should be implemented with a max number of people inside at a time.

— Infectious Diseases Society of America

How worried should we be about fomite transmission?

We are still learning about fomite transmission. We know from an article in the New England Journal of Medicine that the virus is viable up to four hours on copper, 24 hours on cardboard, and two to three days on plastic and stainless steel.

— Dr. Krutika Kuppalli, infectious disease researcher

Can you spread the virus if you’re asymptomatic?

Yes, but it isn’t the main driver of transmission. This is also why it is extremely important to ensure you have washed hands before touching your face.

— Dr. Krutika Kuppalli, infectious disease researcher

What’s the typical timeline of symptoms?

From the time of exposure to symptoms it may take on average three to six days, which may be longer/shorter in some patients. Typically it starts with fever, dry cough, myalgia and flu-like illness, then progresses to shortness of breath and pneumonia in some patients.

— Dr. Muge Cevik, infectious diseases researcher at the University of St. Andrews

Is it possible that an infected person only has a mild cold before recovering?

Yes. The most common symptoms a person will have are fever, dry cough and muscle aches/fatigue.

— Dr. Krutika Kuppalli, infectious disease researcher

Should people be more concerned about eye protection?

We certainly use face shields to protect our eyes when in contact with patients.

— Dr. Isaac Bogoch, infectious disease researcher and scientist

Does getting vaccines increase your risk?

Getting any vaccines would not increase your risk for COVID-19. We’re recommending getting needed vaccines. We want people to get their influenza vaccines so they don’t end up with the flu and in the hospital.

— Dr. Krutika Kuppalli, infectious disease researcher

Do people have a natural immunity to this virus?

I am not aware of “natural immunity” since it is a new virus. We might find as serology testing is rolled out that people have been exposed and developed antibodies without having symptoms.

— Dr. Krutika Kuppalli, infectious disease researcher

Is it possible to get reinfected?

We’re not sure how immunity works or how long it lasts. The best guess is that people who are infected are likely to be protected over the short-to-medium term. We don’t know about longer yet.

— Dr. Eric Rubin, editor-in-chief, New England Journal of Medicine

There are a handful of cases of possible “reinfection” in recovered patients. But most scientists believe those are more likely to have been relapses.

TREATMENT

Is there a team working on an antibody test for the virus? If so, when might it be ready?

There are teams working on serological tests. Rolling out on a population scale will be an essential part of the long-term answer, but we need to get through the next month.

— Bill Hanage, associate professor at the Harvard T. H. Chan School of Public Health

When will a vaccine be ready?

Vaccine trials may take as long as 12 months. There are multiple clinical trials looking at different treatment options, but we currently don’t know whether this combination is effective and safe for patients.

— Dr. Muge Cevik, infectious diseases researcher at the University of St. Andrews

Scientists in Singapore are trying to fast-track the process.

What impact will warmer weather have on the spread?

I have yet to see convincing evidence on this, one way or the other. We are all hoping transmission will slow down with warmer weather in the northern hemisphere, and that warmer countries will be spared the worst. Not enough data yet to conclude.

— Dr. Suerie Moon, director of research at the Global Health Centre

Here’s what we know about seasonal features of disease outbreaks.

I’ve seen several news sources report that experts from Johns Hopkins and other medical colleges are saying the virus can become less deadly as it spreads. Can you explain this phenomenon?

Yes, one theory for why many viruses become weaker over time is that viruses that kill their host don’t get very far. This pattern of weakening is seen with flu viruses, and many others, but not all. We’re not there yet with the current outbreak. Whether it’s weaker three or 10 years from now doesn’t change anything about today’s situation.

— Christine Soares, medical editor at Reuters

(Reporting by Lauren Young, Jenna Zucker, Beatrix Lockwood, Nancy Lapid, Christine Soares)

Italy coronavirus deaths rise by 756, lifting total death toll to 10,779

ROME (Reuters) – The death toll from an outbreak of coronavirus in Italy climbed by 756 to 10,779, the Civil Protection Agency said on Sunday, the second successive fall in the daily rate.

The number of fatalities, by far the highest of any country in the world, account for more than a third of all deaths from the infectious virus worldwide.

Italy’s largest daily toll was registered on Friday, when 919 people died. There were 889 deaths on Saturday.

The total number of confirmed cases in Italy rose on Sunday to 97,689 from a previous 92,472, the lowest daily rise in new cases since Wednesday.

Of those infected nationwide, 13,030 had fully recovered on Sunday, compared to 12,384 the day before. There were 3,906 people in intensive care, up from the previous 3,856.

Lombardy, the hardest hit Italian region, reported a rise in deaths of around 416 on Sunday.

More than 662,700 people have been infected by the novel coronavirus across the world and 30,751 have died, according to a Reuters tally.

(Reporting by Giulia Segreti)

Race for space to house vulnerable in coronavirus

By Zoe Tabary

LONDON (Thomson Reuters Foundation) – “Stay home” – that’s the message stretching from Italy to Iran as the world tries to contain coronavirus. But what if you’ve got no place to call home, or your house is out of bounds in the pandemic?

Some 1.8 billion people worldwide are homeless or live in inadequate housing, experts say, calling for urgent measures to ensure the most vulnerable get sanctuary in the outbreak.

Thousands more need a temporary place to live, either to stay close to crisis centres at the core of the coronavirus fightback or to keep housemates infection-free during weeks of lockdown.

Worldwide, the respiratory disease – which emerged last year in China – has infected more than 490,000 people and the death toll tops 22,000, according to Johns Hopkins University.

“Housing has become the front line defence against the coronavirus, said Leilani Farha, the U.N. Special Rapporteur on the right to adequate housing. “Home has rarely been more of a life or death situation.”

To that end, officials are scouring cities for vacant spaces or disused buildings to turn into makeshift homes.

From empty motels to festival halls, conference centres to cottages – buildings are being repurposed at breakneck speed, with the homeless a top priority.

“Housing, not handcuffs or forced congregate sheltering, for those experiencing homelessness, is the way to best ensure we all remain safer,” Eric Tars, of the U.S. National Law Center on Homelessness & Poverty, said in a statement.

SHELTER

In Italy, which has registered more than 7,500 deaths from the virus – it is the world’s worst hit country – some rail stations are doubling up as centres offering shelter and wash rooms.

Alessandro Radicchi, who runs the Binario 95 shelter in Rome’s central train station, said police were now routinely stopping homeless people, saying they could pay a fine for wandering the streets without proof of residence.

“You can imagine how a homeless person who feels alone during an ordinary time, now really feels there is no one,” Radicchi told the Thomson Reuters Foundation by phone.

The centre supports about 70 people daily but can only sleep 12, Radicchi said, adding that the Italian capital has more than 40,000 people living without adequate housing but only 1,000 beds in homeless shelters.

“We cannot host all of them. But we tell them, ‘when you go in the street, remember these things like keep the mask and don’t touch anything if you don’t have to’,” he explained.

Officials expect the crisis to have an outsized impact on the homeless, who often make do without sanitation or food, bed down in close quarters and suffer more underlying illnesses.

For the millions of poor and daily wage workers in India, the threat of hunger and a lack of shelter looms larger than that of the deadly coronavirus, which has prompted the government to lock down the country until mid-April.

Since the shutdown began on Wednesday night, homeless shelters have filled with migrant workers and labourers who have lost their livelihoods and so cannot afford food or a bed.

ISOLATION

In the Canadian city of Montreal, a former hospital is this week being transformed into an isolation facility for homeless people exhibiting symptoms of coronavirus.

Patients will be kept in individual rooms in a building that sits at the top of a hill, tested for the virus and quarantined should they test positive, said a spokesman for the regional health agency, with capacity that can go up to 150 beds.

In London, the government will open a temporary hospital at the cavernous ExCel exhibition centre in east London, installing ventilators and beds in what was once an Olympic sporting venue.

U.S. communities have taken things into their own hands.

In California, a collective of homeless people and others whose housing is insecure have occupied six vacant, state-owned homes in the Los Angeles area.

“Letting hundreds of homes sit empty during a pandemic poses a health hazard to those like us — those who lack stable housing,” the Reclaiming Our Homes collective wrote on Facebook.

JUST A BED

Cities are also scrambling to help hard-pressed healthcare staff – working flat out and often without transport networks – with well-placed home owners opening up their flats for free.

As the virus decimates tourism, hotels and holiday lets are also sitting empty, prompting rental company Airbnb to open pages in Italy and France to connect medics with hosts.

“Doctors and nurses were requested to move from one city to another to support hospitals with exploding intensive care units. It was our desire to support … these heroes,” said Airbnb’s general manager in Italy, Giacomo Trovato.

He said the firm would pay hosts a minimum rate of about 10 euros a night and cover cleaning and fees for up to two months.

More than 2,000 homeowners and 180 doctors and nurses signed up within days of the launch, he said by phone.

Europe’s largest hotel group Accor said on Tuesday it had created a platform to offer housing to medical staff, and would offer up to 2,000 beds in 40 hotels for the homeless.

Such measures will be even more pressing as the virus digs into poorer countries where densely populated slum neighbourhoods create ideal conditions for disease transmission.

“COVID-19 is likely to spread at an even faster rate in informal settlements than elsewhere and with more disastrous consequences,” Farha said via WhatsApp.

“A ‘stay at home’ policy fails to recognise the conditions in informal settlements that make staying at home just as deadly, if not more, than no policy at all,” she said.

(Reporting by Zoe Tabary @zoetabary in London, Thin Lei Win @thinkink in Rome, Umberto Bacchi @UmbertoBacchi in Tbilisi, Annie Banerji @anniebanerji in Delhi and Jillian Kestler-D’Amours @jkdamours in Montreal, editing by Lyndsay Griffiths. Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers the lives of people around the world who struggle to live freely or fairly. Visit http://news.trust.org)

Coronavirus tag: How the pandemic can affect young minds

By Kate Kelland

LONDON (Reuters) – It’s a bit like tag, except that you get tagged when someone coughs on you and that means you have the virus and have to go into isolation. If you come out and get tagged again, you die.

Child psychotherapists say playground games in the time of COVID-19 are becoming infused with words that many of the children playing them had never heard before: pandemic, isolation, lockdown.

So while the disease caused by the new coronavirus appears to produce relatively mild symptoms in many children, doctors and psychologists warn the impact of the outbreak and its anxiety-inducing spread may be far more traumatic.

“I’m worried we could develop a generation of children with health anxiety,” said Nikhil Chopra, a family doctor and father of two girls, aged 2 and 4, living in southern England.

His 4-year-old, normally playful and worry-free, he said, was coming home from school last week saying: “If we don’t wash our hands we could die.”

A psychotherapist who works with children in London said the games and playground talk among young children sharply reflect the new world.

Describing the coronavirus tag game, where “if you’re tagged you have to stand at one end of the playground in isolation, and if you come out and get tagged again, you die”, the therapist said fear and confusion were leading some kids to lash out.

“There’s quite a lot of ethnic diversity in the school I work in, and the Chinese children are being victimized and bullied – they are being told they’re “unclean” and “revolting” because “they eat dogs and snakes”. It’s so sad. The children are not bad, but their fear is so great that the only thing they can do is project it onto others to gain a sense of control.”

NERVOUS AND BRAVE

Across the Atlantic, 4-year-old Asher Henkoff says he’s fine when asked how the pandemic is affecting him: “I have my stuffed animals to keep me company, and I get to watch TV,” the Houston, Texas boy said, adding he feels “nerv-brave” – a mix of nervous and brave.

His mother, Alexandra Wax, says Asher has become uncharacteristically clingy, is asking non-stop questions about the new virus and has begun having accidents during the night – something he hasn’t done in years.

While some young minds will be resilient and enable those children to bounce back after the crisis, the risk for others, psychotherapists say, is that the anxiety they see around them now will impact their mental growth and future lives.

“Adults panicking is going to mean children panicking because they will be feeling very unsafe,” said Lucy Russell, a clinical psychologist in southern England and author of an online child mental health blog called “They are the Future”.

“I’m most worried not because of the distress I’m seeing in children right at this moment, but because of the distress I’m seeing in adults and how that will be transmitted to children.”

Russell and other mental health specialists such as Mary Calabrese, a Cambridge, Massachusetts-based child psychologist, say traumas like the global coronavirus pandemic can affect children particularly strongly.

Because their brains are still forming, trauma can cause the amygdala – the emotional part of the brain linked to fear and anxiety – to over-react at a time when its link to the frontal cortex – the thinking and more rational part of the brain – is not fully developed.

“The connections aren’t strong,” Russell said. “So young children tend to react emotionally to things – and the thinking, rational part of the brain can’t calm them down.”

Calming becomes a job for adults – parents, neighbors, teachers and friends – said Russell and Calabrese.

Acknowledging how hard this can be for parents and carers whose own lives are filled with anxiety and uncertainty, the specialists advise creating as much structure and predictability as possible to help children feel secure and safe.

And because children’s minds are geared toward problem-solving, they might also respond well to reassurance that focuses on what can be done to control the spread of the virus – like washing hands and staying inside.

“Validate their fears without making it worse,” Calabrese said. “You might want to say: ‘Let’s find out together what this means’. Pull it away from them personally, and say: ‘This is why we all owe it to each other to socially distance’.”

(Reporting and writing by Kate Kelland in London. Additional reporting by Nick Brown in New York; Editing by Janet Lawrence)

A daughter learns in voicemails that coronavirus has killed her mother

By Tim Reid

(Reuters) – Debbie de los Angeles woke up on March 3 to two voicemails from nurses at the Seattle-area care home that housed her 85-year-old mother, Twilla Morin.

In the first one, left at 4:15 a.m., a nurse asked a troubling question – whether the “do not resuscitate” instructions for her mother’s end-of-life care were still in force.

“We anticipate that she, too, has coronavirus, and she’s running a fever of 104,” the woman on the recording said. “We do not anticipate her fighting, so we just want to make sure that your goal of care would be just to keep her here and comfortable.”

The nursing home in Kirkland, Washington was dealing with the beginnings of an outbreak that has since been linked to more than 30 deaths. De los Angeles had not yet fully grasped the grave threat; she comforted herself with the thought that her mother had made it through flu outbreaks at the center before.

Then she took in the next voicemail, left three hours after the first by a different nurse.

“Hi Debbie, my name is Chelsey … I need to talk to you about your Mom if you could give us a call. Her condition is declining, so if you can call us soon as possible that would be great. Thanks. Bye.”

De los Angeles called the home immediately. Her mom was comfortable, she was told. She did not change the “do not resuscitate” instruction. She wanted to visit, but held off: She is 65, and her husband Bob is 67; both have underlying medical conditions that pose serious risks if they contract coronavirus. She thought they had more time to find the best way to comfort her mother in what might be her final hours.

At 3 a.m. the next morning, Wednesday, March 4, de los Angeles woke up and reached for her phone. Life Care Center had called – leaving another voice message just a few minutes earlier, at 2:39 a.m.

“I know it’s early in the morning but Twilla did pass away at 2:10 because of the unique situation,” the nurse said. “The remains will be picked up from the coroner’s office. They’ve got your contact.”

The “unique situation” has of course become tragically common worldwide, as thousands of families have been separated from their loved ones in the last days before they died in isolation, often after deteriorating quickly. The three voicemails – eerily routine and matter-of-fact – would be de los Angeles’ final connection to her mother. She had gone from knowing relatively little about the threat of COVID-19 to becoming a bereaved daughter in the span of one day.

The hurried voicemails with such sensitive information were one sign of the chaos inside the facility at the time, as nurses worked feverishly to contain the outbreak while residents died from a virus that was just hitting the United States. One of the nurses who called de los Angeles, Chelsey Earnest, had been director of nursing at another Life Care facility and volunteered to come to Kirkland to care for patients through the outbreak. She never expected the disease would cause dozens of deaths and the mass infection of patients and staff.

Earnest worked the night shift, when patients with the disease seemed to struggle the most, and many, like Morin, succumbed to the disease. Infected patients developed a redness in and around their eyes. The center’s phones rang constantly as worried families called for updates. About a third of the center’s 180 staff members started showing symptoms of the disease; the rest started a triage operation.

“There were no protocols,” said Life Care spokesman Tim Killian, as nurses found themselves thrust into a situation more dire than any faced by an elderly care facility “in the history of this country.”

The center’s nurses, he said, would not normally leave such sensitive information about dying relatives in voicemails, but they had little time to do anything else – and did not want anyone to hear about a loved one’s condition in the news before the center could inform them. Outside the home, journalists and family members gathered for the latest scraps of information on the home’s fight against the virus. Many relatives, barred from going inside for safety reasons, stood outside the windows of their loved ones’ rooms, looking at them through the glass as they conversed over the phone.

Leaving the emergency voicemails, Killian said, made “the best of a difficult situation.”

From the outside, the messages appear abrupt and impersonal, but may well have been the best or only way to properly notify families in such a crisis, said Ruth Faden, professor of biomedical ethics at John Hopkins University’s Berman Institute of Bioethics. While medical professionals should normally aim to impart such urgent information in person, the circumstances – an overwhelmed staff, dealing with dozens of dying patients – likely made that impossible, she said.

“The way to find out is difficult, always,” Faden said. “What people remember is how much the nurse cared about the person.”

When de Los Angeles heard of her mother’s death in one of those voicemails, she immediately called one of the nurses back, looking for any bits of information about her mother’s final hours. The nurse sounded upset.

“She told me my Mom was one of her favorite people there; she was going to miss seeing my Mom going up and down the hallway in her wheelchair,” de los Angeles said.

They had given her mother morphine and Ativan to keep her calm and comfortable, the nurse told her.

“My Mom was asleep, and then she just went to sleep permanently,” de los Angeles said.

De los Angeles, an only child, aches over not having spoken to her mother before she died. Morin had been a bookkeeper for several companies. De los Angeles fondly remembers doing household chores with her mother on Saturday mornings, then going to the local mall or to Woolworth’s for lunch.

The separation continued even after her mother’s death. De los Angeles telephoned the crematorium where her mother had been taken, as Morin had arranged years earlier, to ask if she could view the body.

“Absolutely not,” the woman told her, out of concern de los Angeles could be infected.

Morin had been tested for coronavirus shortly after she died, on March 4. The results confirmed her coronavirus infection a week later. Soon afterwards, she was cremated.

“We picked up her ashes on Saturday,” she said. “I never saw or spoke to mom. It’s put off the closure.”

It’s also put off the funeral. De los Angeles had planned the ceremony for April 4 – the birthday of her father, who died ten years ago. Her ashes would be placed next to his. But the service will have to wait because Washington’s governor, Jay Inslee, has banned gatherings of 10 people or more.

In the meantime, de los Angeles has worked to make sure her mother’s death certificate records her as a causality of the pandemic. The doctor who signed it did not have confirmed test results showing a COVID-19 infection at the time of her death, de los Angeles said, and listed the cause as “a viral illness, coronary artery disease and a respiratory disorder.” But the doctor has since moved to include coronavirus as a cause, at de los Angeles’ request.

As she waits for the funeral, de los Angeles has put the urn holding her mother’s ashes behind some flowers on the mantle in her living room. She says she can’t bear to look at it.

(Reporting by Tim Reid; Editing by Brian Thevenot)

Washington considers actions to bolster U.S. economy as COVID-19 cases mount to over 1025

Reuters
By Steve Holland and Richard Cowan

WASHINGTON (Reuters) – As U.S. coronavirus cases rose steadily, the White House and Congress negotiated measures on Tuesday to bolster the U.S. economy and Americans’ paychecks against the outbreak’s impact, although there was no immediate sign of a deal.

The rise in the number of U.S. cases of COVID-19, a highly contagious and sometimes fatal respiratory illness, has concerned health officials and spurred calls within Congress for action to expand testing and avert an economic meltdown.

“We had a good reception on Capitol Hill. We’re going to be working with Republican and Democratic leadership to move a legislative package,” Vice President Mike Pence, who is leading the White House’s coronavirus task force, told a White House briefing.

Almost three-quarters of U.S. states have confirmed cases of COVID-19. A running national tally kept by the Johns Hopkins University center tracking the outbreak puts the number of cases at 1,025, with 28 deaths. Washington state’s governor warned of tens of thousands more cases without “real action,” and New York’s governor deployed National Guard troops as a containment measure in a hard-hit New York City suburb.

U.S. stocks rebounded in their largest daily gain since late 2018 on hopes that a government stimulus package was in the making. In Asia, though, on Wednesday, Asian shares and Wall Street futures fell as growing scepticism about Washington’s stimulus knocked the steam out of the rally.

A central feature of the administration’s legislative proposal is payroll tax relief, although the extent and duration of the proposal were unclear.

White House officials have also said the administration could undertake executive action to help small businesses and workers, including those who do not receive paid sick leave.

Trump is scheduled to meet with bank executives at the White House on Wednesday.

U.S. Treasury Secretary Steven Mnuchin, who is leading negotiations on behalf of Republican President Donald Trump, met with Democratic House Speaker Nancy Pelosi to discuss a possible deal.

“We’re going to work together on a bipartisan basis to figure out how we can get things done quickly that are going to help the Americans that are most impacted by this and small and medium-sized businesses that are impacted,” he said.

Pelosi said the meeting was aimed at seeing “where our common ground was” on a set of legislative proposals.

In remarks to reporters, she warned that any package should not contain “trickle-down solutions that only help a few.”

Democrats are challenging the Trump administration to tightly target new measures at people directly affected by the coronavirus. Any measure would need to pass the Democratic-controlled House as well as the Republican-controlled Senate before reaching Trump’s desk.

“I hope we don’t play politics with this. Mixing politics with a pandemic is not good. It’s terribly counterproductive,” said Republican Senator Pat Roberts.

‘MIXED REVIEWS’

All three major U.S. benchmark stock indexes on Tuesday rose nearly 5%, one day after suffering their largest losses since the 2008 financial crisis.

Prospects for a second day of gains on Wednesday dimmed as U.S. equity index futures slid 1% after the overnight trading session got under way.

Trump met with Republican lawmakers and again downplayed the risks from the coronavirus. “It will go away. Just stay calm. It will go away,” he said.

A senior Senate Republican aide said Trump’s payroll tax proposal got “mixed reviews” among Republican senators who attended.

Some Senate Republicans said a potential deal could include $300 billion in payroll tax relief that could help people make rent and mortgage payments, or pay medical bills if family members’ work hours are reduced during the outbreak.

Democrats accused Trump of being more focused on soothing Wall Street’s nerves than on protecting the public from the health and economic fallout of the fast-spreading epidemic. The White House has been accused of inadequate preparation for the outbreak and a slow rollout of coronavirus testing.

“President Trump and his administration should be putting people before corporations, and they should be focused on taking appropriate steps to keep the American people and their economic security safe,” Senate Democratic leader Chuck Schumer said.

Democrats are pushing for paid sick leave, expanded and free testing for the coronavirus and other measures.

OUTBREAK EXPANDS

More than 116,000 people have contracted the coronavirus worldwide since it surfaced in China late last year, according to the World Health Organization. More than 4,000 people have died.

Italy, which has the highest death toll outside of China, has put its entire population of 60 million on virtual lockdown.

At least 35 U.S. states and the District of Columbia have reported infections of COVID-19. New Jersey on Tuesday reported its first death.

New York Governor Andrew Cuomo said schools would be closed and public gatherings suspended in a coronavirus “hot zone” in New Rochelle, a New York City suburb, and deployed National Guard troops there.

The United Nations said it would be closing its headquarters in New York to the public until further notice.

As the outbreak spreads, daily life in the United States has been increasingly disrupted, with concerts and conferences canceled and universities telling students to stay home and take classes online.

Democratic presidential contenders Joe Biden and Bernie Sanders both canceled rallies in Ohio on Tuesday night, citing warnings from public health officials, as six states voted in the party’s nominating contests.

The Democratic National Committee said its presidential debate in Arizona on Sunday would be conducted without a live audience because of health concerns.

(Reporting by Richard Cowan, Susan Cornwell, Susan Heavey, Andrea Shalal, David Lawder and Lisa Lambert in Washington, Deborah Bloom in Olympia, Washington and Nathan Layne and Gabriella Borter in New York; Additional reporting by Brendan O’Brien, Eric Beech and Makini Brice, Rama Venkat in Bengaluru; Writing by Paul Simao and Lawrence Hurley; Editing by Bill Berkrot, Cynthia Osterman and Peter Cooney)

Homeless shelters, programs ill-equipped for coronavirus, U.S. cities warned

By Carey L. Biron

WASHINGTON (Thomson Reuters Foundation) – Homeless people in the United States are at particular risk of contracting coronavirus, and the systems that care for them are poorly equipped to handle a major outbreak, according to public health experts.

The United States had more than 750 confirmed cases of the respiratory virus – which emerged in China’s Hubei province late last year – as of Tuesday morning and 26 related deaths, as estimated by a national tally kept by Johns Hopkins University.

The count could rise sharply as testing increases this week. More than 110,000 people have been infected globally and about 4,000 people have died, according to a Reuters tally of government announcements.

Fears have been raised that the U.S. homeless population – nearly 600,000 people in 2019 – could be particularly vulnerable to the disease, which spreads primarily through tiny droplets coughed or sneezed from an infected person and inhaled by another.

“For the general public that contracts this virus, they’re told to quarantine, rest and recuperate at home,” said Barbara DiPietro, senior director of policy at the National Health Care for the Homeless Council (NHCHC), a nonprofit.

“What does that mean if you don’t have a home or a service provider who can accommodate them 24/7?,” she said.

Vigilant hygiene can prevent transmission, health experts say, in what could be a challenge for people living without homes.

Los Angeles lawmakers are considering setting up washing facilities in encampments, while county officials in Seattle have purchased a motel and set up modular housing, in part to quarantine homeless individuals who contract the disease.

There have been no reports of coronavirus among U.S. homeless populations.

The U.S. shelter system is ill-equipped to deal with a major outbreak, with most housing open only at night for sleeping and little room for quarantines, DiPietro said.

“We don’t have a homeless services infrastructure that is equipped, funded or staffed to be able to respond to a pandemic public health emergency,” she added.

Concerns about the potential for homeless populations to spread coronavirus have cropped up on social media and among conservative commentators who see homeless encampments ripe for spreading the disease.

But G. Robert Watts, an epidemiologist and head of the NHCHC, downplayed the concerns as “fearmongering”.

Because they often have weakened immune systems, “people experiencing homelessness are at greater risk of contracting this disease than of passing it on,” he told the Thomson Reuters Foundation.

Several of the U.S. coronavirus cases have been in the states of Washington and California, which have among the highest homeless populations in the country.

Last week the U.S. Department of Housing and Urban Development released extensive new guidance on dealing with infectious disease outbreaks in shelters, encampments and among homeless populations in general.

Also, President Donald Trump on Friday signed an $8.3 billion emergency bill to fight the virus, with $100 million for community health centers that NHCHC said could include homeless services.

Looking ahead to potential dangers, cities and homeless services providers are adopting a spectrum of new strategies for dealing with the outbreak.

“We are developing special protocols such as phone screening for patients calling into our primary care sites, education to prevent the spread of illness and support for our staff,” said Rachel Solotaroff, head of Central City Concern, a nonprofit in Portland, Oregon.

Some shelters are starting to assign people to sleep in the same beds every night to limit the potential for exposure, said Watts.

But homeless people get help from a host of service providers from shelters to food pantries, day centers and outreach teams, all of which are often pressed for resources and left out of response plans, DiPietro said.

A lack of resources could lead any of those to turn away anyone with potential symptoms that are not necessarily coronavirus, triggering a “vast increase” in homeless people with nowhere to go, she said.

(Reporting by Carey L. Biron @clbtea, Editing by Ellen Wulfhorst and Zoe Tabary. Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers the lives of people around the world who struggle to live freely or fairly. Visit http://news.trust.org)

Italy locks down millions as its coronavirus deaths jump

By James Mackenzie and Crispian Balmer

MILAN (Reuters) – Italy ordered a virtual lockdown across much of its wealthy north, including the financial capital Milan, in a drastic new attempt to try to contain a outbreak of coronavirus that saw the number of deaths leap again sharply on Sunday.

The unprecedented restrictions, which aim to limit gatherings and curb movement, will impact some 16 million people and stay in force until April 3. They were signed into law overnight by Prime Minister Giuseppe Conte.

The new measures say people should not enter or leave Lombardy, Italy’s richest region, as well as 14 provinces in four other regions, including the cities of Venice, Modena, Parma, Piacenza, Reggio Emilia and Rimini.

Only people with proven, work-related reasons, or health problems will be able to move in and out of the exclusion zones. Leave has been canceled for health workers.

A woman wears a protective face mask at Roma Termini railway station, after the Italian government imposed a virtual lockdown on the north of the country, in Rome, Italy, March 8, 2020. REUTERS/Yara Nardi

“We are facing a national emergency. We chose from the beginning to take the line of truth and transparency and now we’re moving with lucidity and courage, with firmness and determination,” said Conte.

“We have to limit the spread of the virus and prevent our hospitals from being overwhelmed,” he told a news conference called in the early hours of Sunday.

Italy has been hit harder by the crisis than anywhere else in Europe so far and Sunday’s latest figures showed that starkly.

The number of coronavirus cases jumped 25% in a 24-hour period to 7,375, while deaths climbed 57% to 366 deaths. It was the largest daily increase for both readings since the contagion came to light on Feb. 21.

Antonio Pesenti, head of the Lombardy regional crisis response unit, told the Corriere della Sera newspaper the health system in Lombardy was “a step away from collapse” as intensive care facilities came under growing strain from the new cases.

“We’re now being forced to set up intensive care treatment in corridors, in operating theaters, in recovery rooms. We’ve emptied entire hospital sections to make space for seriously sick people,” he said.

The Milan stock exchange, whose all-share index has plunged 17% since the crisis broke, was scheduled to open normally on Monday but one trader said he expected “a violent sell-off” as markets digested the lockdown of Italy’s economic heartland.

The World Health Organization said it fully supported the actions taken by Italy, which were in line with its guidelines for containing the spread of the virus.

But with the Italian economy already on the edge of recession, some local politicians pushed back against the measures, which leaked out before the regions were consulted.

The head of Veneto, Luca Zaia, complained he had not been properly consulted and was unhappy that three provinces in his region, including Venice, had been included in the clampdown.

“We do not understand the rationale of a measure that appears scientifically disproportionate to the epidemiological trend,” he wrote on Facebook.

CHURCHES, MUSEUMS, SPORTS EVENTS CLOSED

On Saturday, health officials had expressed alarm at the apparent lack of concern in the general public, as fine weekend weather attracted large crowds to the ski slopes outside Milan. But streets were notably quieter than normal as northern cities woke up to the news on Sunday.

“What is happening in my city is worrying me and it is also saddening, because Milan is a lively city and to see it like this today is almost a defeat for me,” said resident Lucia Navone. “I never would have thought this would happen.”

Public transport services were operating and train stations were still running as people caught away from home when the measures came into force were allowed to return.

But national carrier Alitalia said it would suspend international and domestic services from Milan’s main Malpensa airport from Monday and operate only domestic flights from the smaller Linate airport.

There was some confusion about what controls there would be from Monday on shops, offices and factories. Assolombarda, a business association that represents employers in Lombardy, said it understood the measures would not stop businesses from working or block deliveries of supplies of goods provided appropriate protective measures were adopted.

However, all museums, gyms, cultural centers, ski resorts and swimming pools in the targeted zones will have to close.

Top flight Serie A soccer matches were played behind closed doors despite a call from the country’s sports minister to stop the championship. The Italian Soccer Federation said it would meet on Tuesday to discuss the situation.

Restaurants and bars will be allowed to open from 6:00 a.m. to 6:00 p.m. (0500-1700 GMT) and only if they can guarantee that customers are at least one meter (yard) apart.

FIPE, a body representing restaurants and catering businesses, said the sector faced devastation and criticized measures that it called “incoherent and difficult to apply”.

Church services on Sunday were also canceled in the region.

Pope Francis delivered his Sunday blessing over the internet from inside the Vatican instead of from a window to stop crowds gathering in St Peter’s Square to see him.

On Sunday, the head of Piedmont region said he had tested positive for the virus despite having no symptoms — the second regional chief to be infected in 24 hours — while Army Chief of Staff General Salvatore Farina also contracted the illness.

As the alarm spread, Czech Prime Minister Andrej Babis said Italy should ban all its citizens from traveling to Europe. Austrian Chancellor Sebastian Kurz said it was only a matter of time until more European countries adopt the kind of aggressive steps that Italy is taking to combat the spread of the virus.

(Crispian Balmer reported for this story in Rome. Additional reporting by Silvia Aloisi, Eliza Anzolin, Francesca Landini, Valentina Za, Elvira Pollina, Giulio Piovaccari, Emilio Parodi, Gianluca Semeraro in Milan, and Angelo Amante and Gavin Jones in Rome; Editing by Frances Kerry)

U.S. pumps $8.3 billion into coronavirus battle as more states report cases

By Gabriella Borter

(Reuters) – A bill signed by U.S. President Donald Trump on Friday will provide $8.3 billion to bolster the country’s capacity to test for the fast-spreading new coronavirus and fund other measures to stem an outbreak that has now hit 21 states, with Pennsylvania and Indiana reporting their first cases.

The president signed the legislation, approved by the Senate on Thursday, at the end of a week in which the virus began to disrupt daily life for many Americans.

In Seattle, the epicenter of the nation’s outbreak, there were school closings and orders to work from home. In Miami and Baltimore, areas less affected by the outbreak, music festivals and sporting events were canceled or curtailed as a precaution.

The funds will partly go toward expanding testing capacity, which health officials say is a key slowing the spread of the respiratory illness in the United States.

The U.S. death toll reached 14 by Friday with more than 230 cases. Worldwide, about 100,000 people have been infected and more than 3,400 have died, most of them in China.

“We’re doing very well,” the president said after signing the bill. “But it’s an unforeseen problem … came out of nowhere but we’re taking care of it.”

Trump’s spokeswoman said he would travel to the U.S. Centers for Disease Control and Prevention (CDC) in Atlanta on Friday.

The planned trip had been called off because a CDC staff member was suspected to have the virus, but the person tested negative, White House spokeswoman Stephanie Grisham said.

Washington’s King County has been the hardest hit area in the United States with 12 of the deaths, at least six whom were people living at a nursing facility in the Seattle suburb of Kirkland.

The University of Washington announced on Friday that all classes would be held virtually for the rest of the winter term to limit contagion.

Alphabet Inc’s Google on Thursday joined Amazon.com Inc, Facebook Inc and Microsoft Corp in recommending employees in the Seattle area work from home after some contracted the virus, a policy affecting more than 100,000 people. Gap Inc on Friday closed its New York headquarters because one employee had tested positive.

In Florida, Miami officials canceled two music festivals on Friday – Ultra and Calle Ocho – because of potential risk that coronavirus could spread at events that bring large crowds into close proximity.

For similar reasons, the NCAA Division III men’s basketball tournament will go ahead at Johns Hopkins University in Baltimore this weekend but without spectators, the university said on Friday.

As new states report their first cases, others watched their tally grow. Cases in New York jumped to 33 from 22, Governor Andrew Cuomo said on Friday, adding that some 4,000 people in the state were under precautionary quarantine and 44 under mandatory quarantine.

But he also tried to stem any sense of panic by the public. “I think the anxiety and the fear is more of a problem than the virus,” Cuomo said.

GRAPHIC: Tracking the spread of the novel coronavirus – https://graphics.reuters.com/CHINA-HEALTH-MAP/0100B59S39E/index.html

INCREASED TESTING

Trump said he had spoken to California Governor Gavin Newsom about a cruise ship that was barred from docking in San Francisco after at least 35 people developed flu-like symptoms while on board. The ship has been linked to two confirmed cases of the illness caused by the virus called COVID-19.

“We’re doing testing on those people,” Trump said.

Test results of passengers were due on Friday, according to Mary Ellen Carroll, executive director of San Francisco’s Department of Emergency Management. State and local officials airlifted diagnostic kits to the vessel.

More than $3 billion included in the $8.3 billion spending bill is intended for test kits, research and development into vaccines and treatments. There are currently no approved vaccines or treatments for the illness, which began in China and has spread to about 90 countries and territories.

Health and Human Services Secretary Alex Azar, who was present at Trump’s bill signing, said the CDC had already sent tests for 75,000 people to public health labs around the country, amid widespread criticism of not enough tests available for states in need.

Azar said a private contractor was working with the CDC to send kits capable of testing 400,000 people to private hospitals and labs nationwide.

“The production and shipping of tests that we’ve talked about all week is completely on schedule,” Azar said.

Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, acknowledged issues that slowed distribution of coronavirus tests, but said the overall response was going well.

“There were certainly some missteps in the beginning,” he told NBC’s Today program. “In the next couple of weeks we should be ratcheted up to get many more out.”

U.S. Vice President Mike Pence, tasked by Trump to lead the coronavirus response, on Thursday noted there were not yet enough tests to meet demand going forward.

The deepening crisis has hit stocks hard. The benchmark S&P 500 was down nearly 3% on Friday after also falling by as much on Thursday.

The Trump administration may take targeted steps to stimulate the U.S. economy as the outbreak may temporarily drag down some sectors, White House economic adviser Larry Kudlow said on Friday.

“We’re worried about individuals at home who may lose paychecks. We’re worried about small business,” he said.

(Reporting by Susan Heavey, Lisa Lambert Timothy Ahmann and Steve Holland in Washington, D.C., Gabriella Borter, Peter Szekely and Nathan Layne in New York; Writing by Gabriella Borter; Editing by Frank McGurty and Bill Berkrot)

South Korea declares new ‘special care zone’ as coronavirus spreads

By Hyonhee Shin and Josh Smith

SEOUL (Reuters) – South Korea declared a “special care zone” on Thursday around a second city hit hard by the coronavirus and the U.S. military confirmed two new cases among relatives of its troops in the country, which is battling the biggest outbreak outside China.

Australia and Japan have joined the list of almost 100 nations now limiting arrivals of people from South Korea, which reported 760 coronavirus cases on Thursday for a total of 6,088.

Japanese Prime Minister Shinzo Abe said Japan will suspend existing visas for visitors from China and South Korea and quarantine them for two weeks in response to the widening outbreak of the flu-like virus.

The measures will go into effect on March 9.

Following the announcement, the South Korean Foreign Ministry summoned a Japanese diplomat to “hear Japan’s explanations regarding its announcement,” Yonhap news agency reported, citing a ministry official.

The South Korean government declared a “special care zone” around Gyeongsan, a city of about 275,000 people 250 km (150 miles) southeast of Seoul, promising extra resources such as face masks.

Gyeongsan has seen a spike in cases in recent days, many of them linked to a fringe Christian group at the center of South Korea’s outbreak. Similar zones have been declared around the neighboring city of Daegu and Cheongdo County.

About 75% of all cases in South Korea are in and around Daegu, its fourth-largest city, according to the Korea Centers for Disease Control and Prevention (KCDC).

“Every day is sad and tough like a war. But our Daegu citizens are showing surprise wisdom and courage,” Daegu Mayor Kwon Young-jin told reporters on Thursday.

About 2,120 patients were waiting for hospital beds in Daegu, city officials said. Dozens of newly commissioned military nurses were due to begin work in the city on Thursday, according to the health ministry.

The KCDC reported five more deaths from the virus, bringing the total to 37. The virus surfaced in China late last year and has infected more than 95,300 people and killed almost 3,300 worldwide, mostly in China, according to a Reuters tally.

South Korea also said it was banning the export of face masks, and would step up their production and ration them to limit individual purchases to two a week, in an attempt to ease shortages and curb hoarding.

People have flocked to supermarkets, pharmacies and online distributors to snap up masks and other supplies, with hundreds lining up at some stores every morning.

KCDC Deputy Director Kwon Jun-wook advised all South Koreans to stay home and avoid “any gatherings, especially those that take place in enclosed places with many people such as religious events”.

He also advised employers in Asia’s fourth-largest economy, highlighted by tech giants like Samsung Electronics Co Ltd, to allow staff to work from home.

‘DEEPLY REGRETTABLE’

U.S. Forces Korea (USFK) reported two new cases, for a total of six among soldiers, employees or people related to the roughly 28,500 U.S. troops stationed in South Korea.

Despite the new cases, USFK had resumed sending troops to bases in Daegu and surrounding areas, according to the military newspaper Stars and Stripes.

It said commanders believed the bases were protected from the outside population, and troop rotations were needed to maintain readiness in the face of threats from nuclear-armed North Korea.

Australia’s ban on the arrival of foreigners from South Korea is a blow to Seoul’s efforts to prevent the United States from imposing such restrictions.

“It is a deeply regrettable step, and we will closely consult Australian authorities for a swift revocation of the measure and to minimize inconvenience for our citizens,” Foreign Ministry spokesman Kim In-chul told reporters.

South Korean officials met the U.S. ambassador in Seoul on Wednesday to urge the United States not to limit travel. Similar talks would be held on Friday with diplomats from other nations, the Foreign Ministry said.

According to the U.S. State Department, anyone with a fever of 100.4 Fahrenheit (38 Celsius) is already banned from boarding direct flights from South Korea to the United States.

Korean Air Lines said it would screen all departing passengers for high temperatures and reject those deemed a risk.

South Korea also sent three “rapid response” teams to Vietnam on Thursday to help more than 270 citizens quarantined there over coronavirus concerns, the Foreign Ministry said.

(Reporting by Josh Smith and Hyonhee Shin in Seoul; Additional reporting by Ju-min Park and Heekyong Yang; Editing by Stephen Coates and Mark Heinrich)