An outbreak would demand peak performance from America’s medical professionals — especially in hospitals. But many of the facilities that may be on the front lines have well-documented histories of failing to prevent the spread of infectious diseases.
A stark contrast in the coronavirus mortality rates in South Korea and Iran shows how critical a government’s response can be in determining whether the disease is stymied or spread. Public health experts say they want to ensure the U.S. outcome turns out more like the former.
“Will we take the tough actions to mitigate spread, or will we let this spread like the flu?†said Scott Gottlieb, former head of the Food and Drug Administration. “I think we will end up somewhere in between: not helpless like Iran, but not as aggressive and swift as South Korea.â€
South Korea managed to dramatically arrest the spread. It’s conducting more tests per person than any other country in the world, with about 15,000 people getting tested every day. The government has set up dozens of drive-through testing centers. South Korean officials aggressively informed the public about how to respond, including with cellphone alerts notifying people of new cases near them.
The country has reported 7,800 cases, but just 66 deaths — a relatively low mortality rate under 1 percent. Its daily growth in new cases also appears to be slowing. But it’s a different story in Iran, a country with 80 million people where cases are surging and several top officials — including two dozen members of parliament and a vice president — have been infected.
As neighboring countries canceled flights and alerted medical personnel, Iranian officials said little in public about the virus. They didn’t announce the disease’s arrival in the country until Feb. 19, when officials said two people had already died.
The country’s Health Ministry claims that about 10,000 have been infected and 429 have died. But mass graves — confirmed by videos, satellite images and other open-source data — could mean Iran has suffered more deaths than its government has let on.
During an interview on “CBS This Morning,†Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said the widespread disruption to everyday American life from the coronavirus is unlike anything the nation has experienced in his 36 years on the job.
“There have been an awful lot of challenges,†Fauci said, noting the HIV/AIDS crisis in the 1980s and the H1N1 influenza pandemic in 2009. “With regard to disruption of everyday life, we have not seen that before, but we’ve not had this kind of a situation before.”
With H1N1, also known as the swine flu, Fauci said there was less mass panic because unlike the new coronavirus, it was an influenza virus.
“We were familiar with what influenza does. We were familiar with its seasonal capability,” Fauci said. “Right now there are a lot of unknowns and I think that’s the thing that’s frightening people.â€
Scientists studying the novel coronavirus are quickly uncovering features that allow it to infect and sicken human beings.
The coronavirus can be shed by people even before they develop symptoms. That pre-symptomatic transmission has helped it become a stealth contagion. The coronavirus may take many days — up to 14 — before an infection flares into symptoms, and although most people recover without a serious illness, this is not a bug that comes and goes quickly.
The virus lurks in the body even after people feel better. A new study in the Lancet, based on research in China, found that the median length of time the virus remains in the respiratory tract of a patient after symptoms begin is 20 days. Among patients who survived the disease, the virus continued to be shed for between eight and 37 days.
This coronavirus can establish itself in the upper respiratory tract, said Vincent Munster, chief of the Virus Ecology Section of Rocky Mountain Laboratories, a facility in Hamilton, Mont., that is part of the National Institute of Allergy and Infectious Diseases. That enables the virus to spread more easily through coughing and sneezing, and stands in contrast to another coronavirus that Munster’s laboratory has studied — MERS, which tends to infect cells in the lower respiratory tract, he said.
Munster and his colleagues have conducted experiments showing that at least some coronavirus can potentially remain viable — capable of infecting a person — for up to 24 hours on cardboard and up to three days on plastic and stainless steel.
During a CNN town hall program on the coronavirus Thursday night, Anthony Fauci, the longtime director of the National Institute of Allergy and Infectious Diseases, addressed whether it is safe to open a package delivered by mail: “I think if you start thinking about money and mail and things like that, you can almost sort of immobilize yourself, which I don’t think is a good idea.â€
Read more here.
As coronavirus infections mount, the federal government is preparing for an unprecedented experiment in remote working that brings with it a slew of digital dangers.
The Trump administration is ordering hundreds of thousands of federal employees to be prepared to telework full time if the virus spread worsens, as my colleague Lisa Rein reports. And it’s far from clear government technologists are prepared to handle that strain.
If U.S. adversaries, such as Russia or Iran, creep inside government computer networks, they could disrupt efforts to mitigate the virus by stopping or slowing down communications. They could also sow chaos by sending phony alerts about the virus to the government workforce or the public.
Federal agencies are trying to get ahead of any problems as telework is being encouraged, though not mandated at this point. The Department of Homeland Security’s Cybersecurity and Infrastructure Security Agency is working entirely remotely today to stress-test whether the agency will be up to the job “if CISA-wide telework becomes necessary in response to the outbreak,†spokeswoman Sara Sendek said.
But the government has never attempted to work remotely on anywhere near this scale before. At DHS alone, as many as 240,000 workers could be asked to work remotely; the CISA test alone involves 3,500 people.
Read more here.
But to understand why experts are so alarmed and what may be coming next, the public needs to start paying attention to a whole other set of numbers: How many ventilators do we have in this country? How many hospital beds? How many doctors and nurses? And most importantly, how many sick people can they all treat at the same time?
Consider the ventilators. For those severely ill with a respiratory disease like Covid-19, ventilators are a matter of life and death because they allow patients to breathe when they cannot on their own. In a report, last month, the Center for Health Security at Johns Hopkins estimated American has a total of 160,000 ventilators available for patient care.
A planning study run by the federal government in 2005 estimated that if America were struck with a moderate pandemic like the 1957 influenza, the country would need more than 64,000 ventilators. If we were struck with a severe pandemic like the 1918 Spanish flu, we would need more than 740,000 ventilators — many times more than are available.
South Korea, which has seen success mitigating its large outbreak, has more than 12 hospital beds per 1,000 people. China, where hospitals in Hubei were quickly overrun, has 4.3 beds per 1,000. Italy, a developed country with a reasonably decent health system, has seen its hospitals overwhelmed and has 3.2 beds per 1,000.
Read more here.
At a time when U.S. fatalities from the virus have risen, there remain limited numbers of tests and the capacity of laboratories is under strain.
The constraints are squeezing outpatients who don’t meet rigid government eligibility criteria, even if their doctors want them tested, according to dozens of interviews with doctors and patients this week.
The gap between real-life obstacles to testing and President Trump’s sweeping assurances that “anybody that needs a test gets a test†has sown frustration, uncertainty, and anxiety among patients who have symptoms consistent with covid-19, the disease caused by the virus, but have been unable to find out whether they are infected.
“It’s really been unbelievably infuriating,†said Remy Coeytaux, a North Carolina physician with a doctorate in epidemiology who tried to get tested for Covid-19 but was turned down by the state public health department. He had not traveled abroad, was not sick enough to be hospitalized and had no known contact with an infected person.
At the time Coeytaux tried to get tested, there was only one confirmed case of covid-19 in the state. “It’s out there,†he said. “But we just haven’t been testing.â€
The federal government’s handling of testing erupted as a political issue Thursday, with even members of the president’s party venting about not being able to get answers on when the nation would see more commercial tests, faster testing and more widely available tests.
Sen. James Lankford (R-Okla.) acknowledged that Trump’s recent statement about tests for anyone who wants them is “not consistent right now†with what is actually happening.
Since mid-January, the Centers for Disease Control and Prevention and other public health laboratories have tested about 11,000 specimens for the disease. The number of people who have been tested is likely far lower than that tally, however, because labs usually test at least two specimens per person, experts said. In contrast, South Korea has been running 10,000 tests per day.
“The system is not really geared to what we need right now, to what you are asking for. That is a failing,†Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases and a member of Trump’s coronavirus task force, said Thursday, testifying before the House Oversight Committee. “The idea of anybody getting it easily the way people in other countries are doing it, we’re not set up for that. Do I think we should be? Yes.â€
States determine who is eligible for public Covid-19 testing in accordance with CDC guidelines. In the early weeks of the outbreak, as the CDC struggled to roll out tests, the agency strictly limited testing to those most likely to be infected and most in need of acute care. Even a person with a fever and a cough who had traveled to a country with widespread community transmissions — such as China, Iran or Italy — could not get tested unless they were sick enough to be hospitalized.
Amid mounting criticism, Vice President Pence declared last week that with a doctor’s orders, “any American can be tested.†Trump took that message a step further after a tour of the CDC last Friday, calling the tests “beautiful†and twice declaring anybody needing a test would get it.
The number of medical professionals and patients who are denied access to tests is not tracked nationally. But in interviews, people from states as varied as Wisconsin, North Carolina, Washington, Indiana and New York said their doctors sought but were unable to get testing approval from local or state health officials.
Coeytaux, a 56-year-old family doctor and professor at Wake Forest School of Medicine in Winston-Salem, N.C., came down with a fever, shortness of breath, a dry cough and a deep ache in his lungs last Tuesday, he said. Two days later, he tested negative for flu and 15 other common respiratory viruses. He believed he was probably infected with the new coronavirus.
A county public health nurse agreed and called the state health department. She handed over her cellphone to Coeytaux, and he explained his situation. “They wouldn’t test me,†he said because he didn’t meet the eligibility criteria.
Kelly Haight Connor, a spokeswoman for the North Carolina Department of Health and Human Services, said the state is following CDC guidance and sent Web links to state documents that seemed to offer conflicting descriptions of who would be eligible for testing. She did not respond to a request for clarification.
“It’s very infuriating for us who work in this world,†said Amy Schabel, a public health worker in Milwaukee. “The messaging out there is completely inaccurate and inconsistent with what’s happening.â€
Schabel, 32, returned last week from a vacation to Spain and northern Africa that included a trans-Mediterranean ferry ride with passengers who were noticeably ill, she said. Over the weekend, she developed a high fever, difficulty breathing and other symptoms consistent with the virus, she said.
“Unfortunately, he wasn’t able to get a response from them,†she said Tuesday, sick and self-quarantined in her home.
By Wednesday, her condition had deteriorated. She went back to the urgent-care center, and this time, she was able to get a test. It would take at least 24 hours to get a result, she was told, and still was waiting as of midday Thursday.
A spokeswoman for the Wisconsin Department of Health Services called the situation “unfortunate.†On the same day, Schabel has turned away, the state instructed doctors they no longer needed government approval to order tests, Jennifer Miller said. A spokesman for the hospital did not respond to requests for comment.
Experts say public health laboratories are generally not designed to do high-volume testing. Commercial and academic laboratories — which can test people who don’t meet CDC criteria — have begun processing samples only in the past few days and are still ramping up their capacity. The federal government does not have a way to count the tests that those labs are running, which means federal officials do not know how many Americans have been tested.
Limited testing in the early days of disease transmission not only increases the risk of the disease being spread by people who don’t realize they have it but also affects the ability of public health officials and hospitals to plan for a prolonged outbreak.
It is not just positive results that matter, but negative results, too. The negatives help researchers understand whether increasing numbers of covid-19 cases are a result of an epidemic or arise simply because testing expanded.
“When we monitor the flu, one of the indicators is the proportion of people who test positive versus negative. That positive proportion gives a very important number in terms of tracking how the epidemic is moving,†said Justin Lessler, an associate professor of epidemiology at Johns Hopkins and lead writer on a recent study estimating the incubation period of the coronavirus.
Administration officials have tried to reassure the public they’re rapidly expanding access to tests. Last Friday officials said they had shipped 1.1 million tests to labs across the country.
But nationwide, as of Wednesday, the nation’s public health, academic and commercial laboratories had the ability to process only about 16,530 patients per day, according to an estimate compiled by former Food and Drug Administration Commissioner Scott Gottlieb and researchers at the American Enterprise Institute. That figure is growing as labs bolster efforts and are expected to reach 20,000 per day by the end of the week, according to Gottlieb.
In the meantime, some large research hospitals are trying to bypass the bureaucratic logjam.
“Our access to testing was entirely based on what the state would allow,†said Daniel Varga, chief physician executive at Hackensack Meridian Health in northern New Jersey.
Researchers at the hospital began developing an in-house test several weeks ago. The hospital planned to start using it this week.
Varga estimated that “a handful†of patients exhibiting signs of the virus had been turned down for testing by the state because they did not meet the criteria.
In Indiana, an emergency-room doctor at a community hospital said she had tried to get three patients tested, two of those after the CDC liberalized its guidelines.
Both patients had flu-like symptoms and CT scans that showed lung problems consistent with covid-19, and both were in severe enough distress that they needed to be admitted to the hospital. Both also tested negative for a panel of 20 common respiratory viruses.
But neither had a history of travel or been in contact with a confirmed infected person. In the two cases after the loosened guidelines, when the doctor called the state health department to request testing, the request still was denied.
“Since I watched all three cases get denied, it made me realize that they weren’t testing anyone,†said the doctor, who spoke on the condition of anonymity because she did not have permission from her employer to speak to a reporter.
In early March, Marcy Klein of New Rochelle, N.Y., came down with a fever and a dry cough, just as a coronavirus cluster transformed her Westchester County town into the nation’s first containment zone.
A week later, still hacking and taking Tylenol to keep her temperature down, she sought a test for the coronavirus. Though her symptoms were mild, the Â64-year-old worried about her husband, a 71-year-old physician with diabetes.
On Wednesday, a hospital nurse told her she didn’t meet the testing criteria: She hadn’t traveled outside the country recently and she hadn’t had any known contact with someone who tested positive.
The uncertainty has left Klein feeling paralyzed.
“I don’t want to feel like I’m giving the virus to anybody,†she said.â€
A spokeswoman from Westchester County declined to comment on Klein’s experience.
A spokeswoman for Montefiore Health System, Laura Ruocco, said the hospital has had to prioritize patients given the limited access to testing.
In Washington, D.C., doctors repeatedly declined to test a woman who got sick after spending three days with a delegation visiting from her company’s home office in northern Italy.
“I realize health care is an imperfect process, but this is just kind of ridiculous,†said David Johnson, whose wife has been sick for 1½ weeks with symptoms akin to covid-19.
He spoke on the condition that his wife, an Italian living in Washington, not be identified to avoid complicating her application for a green card.
On March 2, days after the visit, his wife came down with a fever, body aches, congestion, and a cough. Since then, she has gone three times to an emergency room at MedStar Georgetown University Hospital. She has been unable to persuade anyone there to test her for the virus because she had not traveled to Italy and could not confirm she had been in close contact with anyone who had tested positive, her husband said — though she later learned that an unidentified person from the home office had.
She tested positive for a trace amount of the H1N1 virus — a form of flu. But when the couple asked whether that meant she could not have covid-19, they said they did not get an answer.
Told of the woman’s attempts, a MedStar Georgetown spokeswoman, Debbie Asrate, said Thursday that the facility “has been working closely†with the CDC and the District’s health department and following their guidelines.
In the District, people can be tested by the public health laboratory when they are showing symptoms and have a known exposure to a laboratory-confirmed case of covid-19, or have traveled to one of several countries with the widespread transmission, or are living in long-term care facilities, said D.C. Health Director LaQuandra Nesbitt at a news conference Wednesday. She said health-care providers can get other people tested by sending their samples to commercial labs.
“From an epidemiological risk perspective, she absolutely should have been tested,†said Jeanne Marrazzo, director of the Division of Infectious Diseases at the University of Alabama at Birmingham. “She was in close contact with visitors from the epicenter of the epidemic.â€
On Wednesday, 10 days after she fell ill, she was finally able to get tested at a D.C. urgent-care clinic. She was told it would take about four days to learn the results.
FOOTNOTE: Andrew Ba Tran and Fenit Nirappil contributed to this report.
University of Southern Indiana women’s tennis team defeated the Royals of Warner University at the Cocoa Beach Racket Club Thursday evening in a tightly contested match.
In the doubles, after USI dropped the doubles match the sophomore duo Shelby Braselton and Kylie Skepnek quickly defeated their opponents, 6-2. The Screaming Eagles picked up a crucial point after the tandem of junior Lauryn Thompson and freshman Chole McIsaac notched a 6-2 victory in No. 2 play.
Skepnek continued her success in singles by kicking it off with a 6-3, 6-0 win and another point. Sophomore Lindsey McCord was the next in line for a win in the No. 6 match, taking it 6-4, 6-0. After dropping the next two matches, it came down to No. 5 play where Braselton outlasted her opponent in a tiebreaker set, 6-2, 2-6, 6-2 clinching the win for USI.
Up Next: USI Women’s Tennis will make a little road trip as take on the Wheaton Thunder March 13 at the United States Tennis Association Center in Orlando, Florida. Play is scheduled to start at 11:30 a.m.
  The Evansville Police Department is asking for help in identifying the vehicle involved in a hit and run accident that happened on March 10 at the intersection of Englewood and Taylor around 4pm. The suspect vehicle appears to be a tan Chevy S-10 truck. The truck should have heavy front end damage.Â
  If anyone recognizes this vehicle, they are asked to contact the Evansville Police Department’s Hit and Run Unit at 812-436-7941.
There Is a ‘Tipping Point’ Before Coronavirus Kills
By Jason Gale,
BLOOMBERG
March 13, 2020
The new coronavirus causes little more than a cough if it stays in the nose and throat, which it does for the majority of people unlucky enough to be infected. Danger starts when it reaches the lungs.
One in seven patients develops difficulty breathing and other severe complications, while 6% become critical. These patients typically suffer failure of the respiratory and other vital systems and sometimes develop septic shock, according to a report by last month’s joint World Health Organization-China mission.
The progression from mild or moderate to severe can occur “very, very quickly,†said Bruce Aylward, a WHO assistant director-general who co-led a mission in China that reviewed data from 56,000 cases. Understanding the course of the disease and identifying individuals at greatest risk are critical for optimizing care for a global contagion that’s killed more than 3,500 people since emerging in central China in December.
About 10-15% of mild-to-moderate patients progress to severe and of those, 15-20% progress to critical. Patients at the highest risk include people age 60 and older and those with pre-existing conditions such as hypertension, diabetes, and cardiovascular disease.
“The clinical picture suggests a pattern of disease that’s not dissimilar to what we might see in influenza,†said Jeffery K. Taubenberger, who studied the infection in Spanish flu victims, including one exhumed more than 20 years ago from permafrost in northwestern Alaska.
Covid-19 most likely spreads via contact with virus-laden droplets expelled from an infected person’s cough, sneeze or breath.
Can I Get It? What’s Known About Virus Transmission: QuickTake
Infection generally starts in the nose. Once inside the body, the coronavirus invades the epithelial cells that line and protect the respiratory tract, said Taubenberger, who heads the viral pathogenesis and evolution section of the National Institute of Allergy and Infectious Diseases in Bethesda, Maryland. If it’s contained in the upper airway, it usually results in less severe disease.
But if the virus treks down the windpipe to the peripheral branches of the respiratory tree and lung tissue, it can trigger a more severe phase of the disease. That’s due to the pneumonia-causing damage inflicted directly by the virus plus secondary damage caused by the body’s immune response to the infection.
“Your body is immediately trying to repair the damage in the lung as soon as it’s happening,†Taubenberger said. Various white blood cells that consume pathogens and help heal damaged tissue act as first-responders. “Normally, if this goes well, you can clear up your infection in just a few days.â€
In some more-severe coronavirus infections, the body’s effort to heal itself may be too robust, leading to the destruction of not just virus-infected cells, but healthy tissue, Taubenberger said. Damage to the epithelium lining the trachea and bronchi can result in the loss of protective mucus-producing cells as well as the tiny hairs, or cilia, that sweep dirt and respiratory secretions out of the lungs.
“You have no ability to keep stuff out of the lower respiratory tract,†Taubenberger said. As a result, the lungs are vulnerable to an invasive secondary bacterial infection. Potential culprits include the germs normally harbored in the nose and throat, and the antibiotic-resistant bacteria that thrive in hospitals, especially the moist environments of mechanical ventilators.
What You Need to Know About the Spreading Coronavirus: QuickTake
Secondary bacterial infections represent an especially pernicious threat because they can kill critical respiratory tract stem cells that enable tissue to rejuvenate. Without them, “you just can’t physically repair your lungs,†Taubenberger said. Damaged lungs can starve vital organs of oxygen, impairing the kidneys, liver, brain and heart.
“When you get a bad, overwhelming infection, everything starts to fall apart in a cascade,†said David Morens, senior scientific adviser to the director of the National Institute of Allergy and Infectious Diseases. “You pass the tipping point where everything is going downhill and, at some point, you can’t get it back.â€
That tipping point probably also occurs earlier in older people, as it does in experiments with older mice, said Stanley Perlman, a professor of microbiology and immunology at the University of Iowa in Iowa City, who has studied coronaviruses for 38 years.
Still, even healthy younger adults have succumbed to the illness. Li Wenliang, the 34-year-old ophthalmologist who was one of the first to warn about the coronavirus in Wuhan, died last month after receiving antibodies, antivirals, antibiotics, oxygen and having his blood pumped through an artificial lung.
Some people may be more genetically susceptible, possibly because they have a greater abundance of the distinctly shaped protein receptors in their respiratory epithelial cells that the virus targets, Taubenberger said. It’s also possible certain individuals have some minor immunodeficiency or other host factors that relate to underlying illnesses.
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