Italy’s new coronavirus cases are slowing. How soon will normal life return?

are many uncertainties that could influence when to begin easing restrictions, including whether the virus will wane during hotter and more humid months. Even the size of Italy’s outbreak is unknown. Government officials and experts have said that because of limitations on testing, the spread of the virus could be significantly larger than the official data suggests. Andrea Crisanti, a virologist advising the Veneto region, said the country would have to conduct granular testing for the virus — in several geographic areas — to better gauge the true size of the outbreak and then determine more accurately how it is changing. “You aggressively sample a big part of the population in a few infected areas” before you can consider changing the lockdown, Crisanti said. “Then, you maybe start to open some factories, test all people. I don’t think the lifting of the quarantine will be in one go.” In the 4½ weeks since Italy detected the first signs of the outbreak, the country has lost more than 8,000 people to the virus. The rate of spread has appeared to slow, with cases growing day-on-day this week at about 8 percent, compared with 20 percent two weeks ago. But the daily toll remains staggering. The Italian government on Thursday reported that 662 people had died in the previous 24 hours. The Reuters news agency suggested that the government had omitted 50 deaths in one region and that the count should be higher. Although most of those deaths have taken place in the north, a nationwide sense of horror has helped with the enforcement of the restrictions. The lockdown has had widespread support: Between 76 and 90 percent approve of the measures, according to various polls. And although some Italian politicians, such as the mayor of Milan, encouraged people in the early days of the outbreak to stay calm and socialize responsibly, that messaging has stopped cold. Italian politicians have not embraced Trump’s argument that the economic price of fighting the virus may be worse than the virus itself. The main opposition, the far-right League, has its stronghold in the north, the area hit hardest by the virus. League regional governors in the north have accused Conte of ordering the lockdown too late and of initially allowing too many loopholes. Politically, that means Conte does not face much pressure to relieve the restrictions prematurely. But Italians, under de facto house arrest for


America has a moral imperative to combat the coronavirus worldwide

maintain only 40 intensive care beds. Several dozen more cases have been recorded in the nearby West Bank. Cases also have been reported in perpetually war-ravaged Somalia and Congo. Aid workers worry even more about the sprawling refugee camps that now contain millions of people around the world, including the 1 million Rohingya who fled Myanmar for neighboring Bangladesh. In the northwestern Syrian province of Idlib are more than 1 million people who have been driven from their homes in recent months by Russian and Syrian government bombing, much of which has been deliberately aimed at hospitals. In northeastern Syria, the al-Hol camp contains 70,000 people, most of them women and children who fled the Islamic State and who lack adequate food and water, not to mention medical services. “These are places where people who have been forced to flee their homes because of bombs, violence or floods are living under plastic sheets in fields or crammed into refugee camps or informal settlements,” U.N. Secretary General António Guterres said Wednesday. “They do not have homes in which to socially distance or self-isolate. They lack clean water and soap with which to do that most basic act of self-protection against the virus — washing their hands. And should they become critically ill, they have no way of accessing a health care system that can provide a hospital bed and a ventilator.” Preoccupied with fighting the virus at home, the United States and other rich nations have done little to head off these potential covid-19 disaster zones. But as Mr. Guterres pointed out, doing so is not only a moral imperative; it is also crucial to ending the pandemic. Without action, he said, “the virus will establish a foothold in the most fragile countries, leaving the whole world vulnerable as it continues to circle the planet.” Inevitably, too, an uncontrolled outbreak in these areas will propel new waves of desperate refugees northward. Mr. Guterres unveiled a response plan put together by the World Health Organization and U.N. humanitarian agencies as well as nongovernment groups. The $2 billion in funding they are seeking would provide tests, supplies for medical workers, and water and sanitation to places that now lack it. The requested resources, the secretary general pointed out, are a drop in the bucket compared with what Western governments are spending on their own citizens. But they are critical to defeating the disease.


Washington-area jobless claims spike dramatically as virus cases surge

At least 102,000 D.C.-area residents have lost their jobs amid the coronavirus-related shutdowns, a worrisome glimpse of the economic damage being wrought as the area’s caseload continues to surge. Nearly 42,000 people in Maryland filed unemployment claims last week, an 11-fold increase from the previous week, Labor Department figures released Thursday showed. In Virginia, nearly 47,000 were newly unemployed last week, 17 times more than the week before. The District, which had more recent figures available, said its claims have gone up 18-fold during the past two weeks, to nearly 25,000. The data mirrors a spike in jobless claims nationwide as restaurants, movie theaters and other businesses are closed by government officials desperate to contain the virus. “This battle is going to be much harder, take much longer, and be much worse than almost anyone comprehends,” Maryland Gov. Larry Hogan (R) said on social media after his state reported 157 new cases of infection — another record single-day tally that more than doubled Maryland’s previous record on Wednesday. The region had 1,313 known cases of infection, with 22 deaths, as of Thursday evening. Maryland’s total was 581. Virginia reported 69 new cases of covid-19, the disease caused by the virus, for a total of 461. The District reported 36 new cases, for a total of 271. “We are only at the beginning of this crisis, in our state, in the National Capital Region, and in America. As I have repeatedly stressed, we should continue to expect the number of cases to dramatically and rapidly rise,” Hogan said in his statement. Hogan, Virginia Gov. Ralph Northam (D) and D.C. Mayor Muriel E. Bowser (D) have implemented measures that have left the local economy at a near-standstill. Virginia schools are closed through the end of the school year, while in Maryland and the District, they are closed until at least late April. Nonessential businesses The Library of Congress closed all of its buildings to the public Thursday. Metro, which has seen sharp drops in ridership, had closed 19 train stations as of Wednesday night, and shut down two more Thursday — Van Ness and Tenleytown on the Red Line — after learning that a contractor working in those stations had tested positive for the virus. The contractor worked overnight, when Metro was closed and not carrying passengers. Interviewed Thursday night on MSNBC’s “Meet the Press,” Bowser acknowledged that the efforts to contain


for a total of 461. The District reported 36 new cases, for a total of 271. “We are only at the beginning of this crisis, in our state, in the National Capital Region, and in America. As I have repeatedly stressed, we should continue to expect the number of cases to dramatically and rapidly rise,” Hogan said in his statement. Hogan, Virginia Gov. Ralph Northam (D) and D.C. Mayor Muriel E. Bowser (D) have implemented measures that have left the local economy at a near-standstill. Virginia schools are closed through the end of the school year, while in Maryland and the District, they are closed until at least late April. Nonessential businesses The Library of Congress closed all of its buildings to the public Thursday. Metro, which has seen sharp drops in ridership, had closed 19 train stations as of Wednesday night, and shut down two more Thursday — Van Ness and Tenleytown on the Red Line — after learning that a contractor working in those stations had tested positive for the virus. The contractor worked overnight, when Metro was closed and not carrying passengers. Interviewed Thursday night on MSNBC’s “Meet the Press,” Bowser acknowledged that the efforts to contain the coronavirus has “shut down our economy and put millions of people across our country and thousands in Washington, D.C., out of work.” “But we believe, as all the experts say, that it will get us to the other side much faster,” the mayor said. In another attempt to slow the virus, Maryland State Superintendent of Schools Karen B. Salmon ordered most child-care centers in the state to shut down at the end of this week. Salmon said that if licensed facilities are willing to care for children of essential employees — such as health-care workers or firefighters — they may reopen March 30, provided that they thoroughly clean their sites and do not take in other children. Bowser slammed Congress for not sending enough economic aid to the nation’s capital in a $2 trillion federal stimulus package, which passed the Senate and is set to be voted on by the House. The bill treats the District as if it were a U.S. territory and would steer about $500 million to local relief efforts — about $750 million less than what each state is guaranteed. Normally, the city is treated like a state in terms of federal funding. “It’s infuriating,


virus Thursday, while more residents and staff tested positive. Over the past 12 days, 17 Canterbury patients and six workers have tested positive for the virus, representing the largest known outbreak in a long-term-care facility in the greater Washington region. Two residents remained hospitalized, and workers are caring for the rest in a wing separate from other patients. An undisclosed number of suspected cases have been separately isolated. A top local health official said Wednesday that Canterbury does not have enough protective gear for employees working with other patients in the facility, who are not showing symptoms of the virus but still could have been exposed. Seven other Virginia communities reported their first cases Thursday: Fauquier County, Amelia County, Pittsylvania County, the cities of Lynchburg, Hampton and Poquoson, and the town of Washington. Health officials in Alexandria — which had reported 14 cases as of Thursday afternoon — said a patron had tested positive and they are searching for people who spent time in the popular Murphy’s Irish Pub in Old Town on three dates earlier this month, when that patron was there. Health officials said anyone who was at the pub on March 10 between 6 p.m. and 2 a.m., on March 14 between 11 a.m. and 6 p.m., and on March 15 between 10 a.m. and 6 p.m., should self-quarantine at home, avoid visitors, stay at least six feet from other household members and call the city’s covid-19 information line at 703-746-4988. Loudoun County, which had 28 known cases, reported the death of a county schools employee. The woman died Wednesday night, according to an email sent to families and staffers by Loudoun Superintendent Eric Williams. The woman, whose name was not released, was in her 70s, the county Health Department said. She is among at least six employees within the 84,000-student system who have tested positive for covid-19 and the first reported death from within a Virginia school system. Williams said the school system would refrain from any “specific remembrances,” because he believes the woman would not have wanted that. But, in his email, he echoed the grief being felt by a widening group of area residents as the number of fatalities climbs. “She is someone who loved and was loved,” Williams wrote. “She is someone who felt joy and sorrow. She is someone who poured her whole self into contributing to our community.” antonio.olivo@washpost.com fenit.nirappil@washpost.com laura.vozzella@washpost.com


What coronavirus? With indictment of Venezeula’s Maduro and sanctions on Iran, U.S. doubles down on ‘maximum pressure’

maximum pressure campaign on the Maduro regime,” said Eric Lorber of the Foundation for Defense of Democracies. “Justice Department indictments and other legal actions beyond sanctions have played a very important part in a number of ways.” Thursday’s criminal indictment is only the second the United States has brought against a foreign head of state. But it’s not clear whether the previous example holds any clues for future U.S. moves against Maduro. In February 1988, federal prosecutors in Miami indicted Panamanian strongman Manuel Antonio Noriega on drug dealing and conspiracy charges. In December 1989, President George H.W. Bush ordered troops into Panama to oust him from power; Noriega surrendered on Jan. 3, 1990. Noriega was convicted of drug and racketeering charges in Miami federal court and sentenced to 40 years in prison. He was eventually enmeshed in a prolonged legal tussle that saw him released early by the United States, extradited to France and then extradited back to Panama, where he died in 2017. Maduro and Noriega were both Latin American strongmen and adversaries of the United States accused in large-scale drug trafficking conspiracies. But Venezuela is a far larger country than Panama, with a more formidable military, and Russian backing. If the charges don’t immediately result in Maduro’s capture, they could be used to add further economic pressure on the country. The evidence compiled by the Justice Department could be used in new sanctions, including possibly the State Department designation of Venezuela as a state sponsor of terrorism — a rare move currently applied to only North Korea, Iran, Sudan and Syria. Lorber, a former undersecretary for terrorism and financial intelligence at the Treasury Department, said it was unclear how the administration could do this when it doesn’t consider Maduro legitimate. The United States recognizes opposition leader Juan Guaidó, head of Venezuela’s National Assembly, as the nation’s rightful president. “The United States would both be recognizing Guaidó’s government as the legitimate government while simultaneously calling the country a state sponsor of terrorism,” Lorber said. Venezuela isn’t the only nation facing growing U.S. pressure while also battling covid-19. Over the past month, the Treasury also has announced new sanctions designations related to Iran, North Korea and Syria. “The administration’s tactic of choice toward adversaries is all pressure, all the time,” said Suzanne DiMaggio, a senior fellow at the Carnegie Endowment for International Peace. The government of Iran has complained that


The history and mystery of Purell, the most sacred goo of our new era

the United States. In gyms and yoga studios, before the gyms and yoga studios closed, communal bottles were padlocked to prevent theft, like engagement rings at Zales. In Tennessee, a former Air Force technical sergeant hoarded nearly 18,000 bottles from dollar stores across two states, hocking them for up to $70 apiece on Amazon until the retailer pulled the plug. When the New York Times reported what he had been doing, he received death threats and said he would donate his stockpile to churches. And earlier this month, the metaphor of our times — for our panic and obliviousness, our desperation and our delusion, for how much we crave safety and how little we are willing to give up in order to get it — arrived in the form of an Instagram video. It was an advertisement for a strip club in Times Square. It opened on a dimly lit stage. Women in thongs gyrated and twerked and rubbed sexy oil on each other’s butts. Only it wasn’t sexy oil. It was Purell. “The cleanest place in New York,” read the tagline, as a dancer ran her hand suggestively up an economy-size bottle. My God, what are we all doing, and how long will Purell make us feel okay doing it? In 1946, a curly-haired brunette Gojo, as they eventually named their company, spent the next several decades growing and expanding and innovating the art of hand-washing until, in the late 1980s, Gojo developed a clear, alcohol-based, emollient-enriched, disinfecting substance that was dispensed by a pump bottle and required no water at all. First sold mostly to medical professionals, it hit the public nearly a decade later, in two-ounce bottles and scents like Magic Mint. The rollout coincided with the 1996 presidential campaign. Both the Bill Clinton and Bob Dole camps received early samples. Tipper Gore was a fan. Purell is “just the thing for people who have to shake hands with lots of people,” Gore said, “and don’t have time to wash up between shakes.” Then came SARS, MERS, bird flu, swine flu, Ebola. Every few years, there was a scary outbreak, and every few years we recommitted to the sacrament of Purelling. Gojo Industries’ phones in Akron, Ohio, rang off the hook during the 2003 epidemic of severe acute respiratory syndrome, when people wanted to know, Will this protect us? Gojo tripled production in 2009, when swine flu


Expectant mothers stare down the prospect of giving birth alone, as coronavirus upends hospitals

responsible for my parents’ deaths because they wanted to see their grandchild,” said Vastola, a 37-year-old reporter for Defense News who lives in Arlington. That led Vastola to a difficult realization: Her husband will watch the toddler, and she will deliver their second child alone. “It just seemed safer to us,” Vastola said. Aasta Mehta, women’s health policy adviser for the Philadelphia Department of Health, said many providers are worried that women may respond to the new restrictions by opting for a home birth. If there are complications, a woman probably would be transported to the hospital in an ambulance and risk going through the emergency room. “We want to emphasize that we are open for business and still consider hospitals to be the safest place to have babies,” Mehta said. Covid-19, the disease caused by the novel coronavirus, does not appear to have a serious impact on pregnant women, unlike severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), diseases caused by two other coronaviruses that are known to be responsible for severe complications during pregnancy. But scientists aren’t sure why. The dearth of available data led a team at the University of California at San Francisco to this week launch a nationwide study of pregnant and recently pregnant women who are either suspected or confirmed to have the novel coronavirus. Eighty women were referred from across the country within the first 48 hours, said obstetrician and co-principal investigator Vanessa Jacoby, who expects that enrollment will exponentially increase. Because of the urgency of the mission, the project is being supported through crowdfunding rather than waiting for a research grant, which typically takes months to secure. During flu outbreaks, pregnant women have been shown to be at greater risk of severe illness because of changes in their immune system, heart and lungs. Researchers at the Johns Hopkins Bloomberg School of Public Health are also providing guidance on including pregnant and lactating women in clinical trials for a vaccine against covid-19. One of the most worrisome takeaways from recent studies has been that the coronavirus may impact infants differently than other children, most of whom are believed to be either asymptomatic or have mild symptoms such as a runny nose, cough and fever. A paper in the journal Pediatrics published this month found that 33 infants out of the 378 studied had severe illness. An additional seven progressed to


Warm, humid weather could slow coronavirus, new research finds

are appearing as they go into their winter season. And if, in fact, they have a substantial outbreak, it will be inevitable that we need to be prepared, that we’ll get a cycle around the second time.” The anecdotal evidence suggesting a possible connection between the rate of spread of covid-19, the illness the novel coronavirus causes, and temperature emerged early on. One of the most puzzling things about the unfolding pandemic in Asia is why many countries and territories in the region have apparently been spared major, rapidly growing outbreaks, despite close contacts with China, where the outbreak began. The success of places like Taiwan, Singapore and Hong Kong in tamping down the epidemic could be ascribed to quick and decisive action by their governments as well as effective precautions by local residents to enforce social distancing. But that doesn’t fully explain why Cambodia, Thailand, Vietnam and the Philippines have largely been spared mass outbreaks of the disease, at least not on the scale that has been seen in Western Europe and the United States. All had huge numbers of Chinese visitors at the start of the year, have crowded cities and relatively simple health-care systems. Cambodia was criticized early in the epidemic for failing to close its borders with China and even failing to promote the wearing of masks, with Prime Minister Hun Sen accused of putting his relationship with his strongest foreign backer ahead of the needs of his people. Nearly two months since its first case, the country has recorded only 91 cases of the coronavirus, according to a Johns Hopkins University database, with almost all the infected people thought to have contracted the virus abroad. Compare that to the United States, which added more than 10,000 cases during each of the past three days. In recent weeks, there has been a rise in cases in many hotter countries as testing has expanded, although many of the cases have been imported from Europe or the United States. In the Southern Hemisphere, Australia has seen a sharp rise in cases, but most are thought to have been acquired abroad — while a large number remain under investigation. There are countless examples where the virus has been transmitted between people within warmer and more humid places, and several examples of infection clusters within hotter countries. One of the biggest clusters was a four-day religious gathering at a mosque


Fed rate cut delivers more financial pain for retirees and other savers

below 1 percent. Kimball was content when CD rates finally began to climb again, and she celebrated when yields surpassed 2 percent. On April 1, 2010, the average five-year CD was paying 2.12 percent, according to Bankrate.com. A year ago, if you put $2,000 in a one-year CD, the average interest rate was a measly 0.98 percent, earning just $19.60. If you wanted to lock in your money for five years, you could get about 1.5 percent. As of last week, the average rate for a 12-month CD had fallen to 0.57 percent, with a payout on $2,000 of $11.40, Bankrate.com found. The rate for a five-year CD was 0.86 percent. Now compare those rates with the annual inflation rate, which in February was 2.3 percent. “CD yields are in a full-on retreat, given how the Fed has been aggressively cutting interest rates since the beginning of March,” said Greg McBride, chief financial analyst at Bankrate.com. “Yields are falling, and they’re going to continue to fall.” McBride recommends that if you’re trying to eke out every bit of interest on a deposit account, shop around for the best rates. Look at institutions that may have only an online presence but are still backed by the FDIC. I’m hearing from so many people who are either already retired or are close to retirement. These folks are worried that they don’t have the time to wait for a recovery in the stock market. They’re stuck between a rock (low deposit rates) and a hard place (a bear market). Kimball and her husband acknowledge that they’re in better shape than many of their peers to weather the current economic storm: ● They don’t have a mortgage. ●They don’t have credit card debt. ●They still have a bit of their money in the stock market, recognizing that they could live three or four decades in retirement, and their future financial needs would require that they still invest for some growth. Kimball’s husband, Bob, has about 20 percent of his own TSP savings in the stock market. “My hope is that this will be a one- or two-year blip and that the economy will ultimately recover,” he said. They lived well below their means and saved as much as they could, Sharon Kimball said, adding, “Although I’m scared to death because I’m old, we were saving for something horrible. And Holy Toledo, here it is.”


What to know about the Defense Production Act

recently in 2018. Although the law was geared initially toward U.S. military capabilities, its provisions in more recent decades also have been used for natural hazards or terrorist attacks, among other emergency scenarios. “The Federal Emergency Management Agency used the authority extensively during the 2017 disaster season, including prioritizing contracts for manufactured housing units, food and bottled water, and the restoration of electrical transmission and distribution systems in Puerto Rico,” according to the nonpartisan Congressional Research Service (CRS). The act has different parts, and sometimes it’s hard to keep track of which one public officials are discussing. Here’s a breakdown of the main provisions: In response to the pandemic, Trump has signed two executive orders citing provisions of the Defense Production Act. The first delegates the president’s powers to prioritize contracts and allocate resources to Health and Human Services Secretary Alex Azar. The second includes measures to prevent people from hoarding health and medical resources. But Azar and the Trump administration have not used the Defense Production Act to direct industries. FEMA Administrator Peter T. Gaynor said Tuesday on CNN that the administration was using the law for the first time since the outbreak to commission 60,000 testing kits, but an agency spokeswoman later in the day said that “at the last minute we were able to procure the test kits from the private market” without relying on the law. Spokespeople for the Department of Health and Human Services referred us to Trump’s comments on the issue and to a March 18 statement from Azar, which does not mention (or rule out) the possibility of directing private-sector manufacturing. “HHS has been working since January with American manufacturers to prepare for responding to the COVID-19 outbreak,” Azar said. “We are coordinating closely with private suppliers, healthcare purchasers, and our federal partners like the Commerce Department to ensure that resources are going where they’re needed. President Trump’s bold invocation of the Defense Production Act gives his administration the necessary power to allocate healthcare supplies in the event that such a step is necessary.” A shortage of ventilators and personal protective gear poses a challenge for the places hit by covid-19. In theory, Trump could use the Defense Production Act to compel manufacturers to fill the gaps. But the window of opportunity may be closing too quickly. In practice, repurposing an auto factory, for example, into a medical-respirator facility could take months, longer


How the coronavirus is igniting riots, releases and crackdowns in world’s prisons

now under quarantine. Turkey’s government is seeking to fast-track a plan to release as many as 100,000 inmates from its overcrowded facilities, joining Iran and other countries that have freed some of their prisoners in response to the pandemic. Elsewhere, anger over restrictive measures and anxiety about the coronavirus have led to violence. In Colombia last weekend, nearly two dozen people died in riots that swept the prison system as inmates protested what they called inadequate safeguards against the virus. In Italy, riots erupted in almost 50 prisons this month, leaving 13 inmates dead and 59 guards injured. Authorities said the inmates died of drug overdoses after raiding a prison infirmary. In the Middle East, where hundreds of thousands of people have been rounded up in recent years in response to political uprisings, terrorism and the growth of conservative Islam, many prisoners are held in densely populated facilities that lack hygienic conditions and sunlight, leaving them susceptible to disease and infections. The majority of these prisons are in Egypt, Syria and Iran. Human rights groups and U.N. officials are urging Middle Eastern governments to release prisoners from overcrowded facilities. “Generally, if you are in prison in the Middle East, you are in a pretty worse case than other parts of the world,” said Philippe Nassif, the advocacy director for the Middle East and North Africa at Amnesty International USA, referring to the threats posed by the coronavirus. Such concerns prompted Seif, her mother, aunt and a family friend to stage a rare protest in Cairo last week in front of the government’s cabinet building. Seif’s activist brother, Alaa Abdel Fattah, has been imprisoned since September, when small anti-government protests erupted in Cairo and other cities. The women clutched a placard that read: “Underestimating coronavirus in prisons puts the lives of inmates, police officers, conscripts and all who work in prisons and their families in danger. Release the prisoners.” Security forces detained the women overnight at a police station before releasing them on bail. They were charged with inciting a protest, disseminating false news and possession of material disseminating false news. Some countries are responding aggressively to the threat the virus poses inside their prisons. After about a dozen cases were reported among inmates and staff members at South Korean correctional facilities, health authorities swiftly quarantined the patients and tested other inmates. A South Korean court released two infected inmates on


riots in Colombia depicted hellish scenes, with inmates lighting fires and screams echoing across courtyards. At least 23 people were killed and more than 80 injured across 10 prisons. Two weeks ago, as many as 1,000 inmates escaped in the Brazilian state of Sao Paulo after prison furloughs were suspended in an effort to contain the spread of the virus. Five inmates in Venezuela were fatally shot last week while trying to escape. Riots have also upended prisons in Peru and Chile. Since the violence, Colombian officials have voiced increasing concern about the deterioration of conditions in the prison system. Brazilian authorities, meanwhile, have mandated the use of surgical masks during inmate transfers and the isolation of potentially infected people. But critics say such measures will almost certainly be insufficient on a continent that has seen decades of mass incarcerations, with long-neglected prison systems that are afflicted by a lack of sanitation, poor health facilities, mismanagement and gang activity. Robert Muggah, research director at the Rio de Janeiro-based Igarapé Institute, which tracks violence in Latin America, said the coronavirus “is a ticking time bomb for Latin America’s prisons.” “Even if steps are taken immediately to improve conditions and secure facilities, we can expect a surge in violent protests in Mexico, Central and South American jails, as well as an uptick in breakouts,” he added. “Short-term palliative measures, while necessary, will not repair years of prison . . . mismanagement.” Some Middle Eastern governments have selectively released prisoners in the face of the pandemic. These include Iran, which is reeling from the region’s deadliest coronavirus outbreak. The country’s judiciary has granted temporary release for 85,000 prisoners and ruled that 10,000 of them be granted amnesty, including some political prisoners. Bahrain has released nearly 1,500 prisoners, but activists have declared the action insufficient, as large numbers of political leaders and human rights defenders remain behind bars. In Israel, the issue of releasing prisoners is unusually complicated because about 4,500 Palestinians are being held in Israeli jails, all on security or terrorism-related charges. Israel is considering transferring 500 jailed criminals to house arrest, but such a furlough would not be extended to Palestinian prisoners. Two of the biggest jailers in the Middle East — Egypt and Syria — have so far made little apparent effort to prevent the virus from spreading in prisons. In Egyptian prisons, where as many as 60,000 people are


What it’s like to be infected with coronavirus

Ritchie Torres, 32, a New York City councilman from the Bronx, first had nothing more than a “general sickly feeling.” Then came a bad headache. He felt terrible. But for Torres, the worst effects of covid-19 so far have been mental: “It is psychologically unsettling to know I am carrying a virus that could harm my loved ones.” The Rev. Jadon Hartsuff, 42, an Episcopal priest in Washington, D.C., felt drained after a Sunday service on Feb. 23. He took a nap. No big deal — the service can be tiring. The next day at the gym, his muscles ached. He became fatigued, feverish, slightly dizzy. “I kept telling people I felt spongy,” he recalls. “Like a kitchen sponge.” Mike Saag, 64, an infectious disease doctor in Alabama, developed a cough, like a smoker’s hack. He was bone-tired, his mind foggy. About five days in, the misery intensified. “This is not something anybody wants to go through,” he said Saturday. “I implore everyone to stay at home!” These stories were offered in recent days by people in the United States who now know the new coronavirus and the disease it causes intimately. In sharing their experiences, they are helping to demystify this alarming contagion. Covid-19 can be a severe illness, even deadly. But it varies from person to person, and most people with a confirmed infection do not require hospitalization. It can induce intense fatigue and trigger a recurring cough and intermittent fever. This is a slow-developing illness, and it lingers, the whole process typically playing out in weeks rather than days. Patients with covid-19 report a psychological toll. This disease is unfamiliar. It’s a pandemic virus that has alarmed the entire planet. A natural reaction is anxiety. Jim, a 34-year-old from Long Island who asked that his full name be withheld, had mild symptoms for several days and then abruptly developed shortness of breath, fever and chest pains. “The fear is real,” he said. “It’s impossible not to be scared at times that it’s just going to take this insane turn into uncontrollably bad.” Saag, the doctor, teaches at the University of Alabama at Birmingham and fully understands the biological processes that take place when a virus invades the body. He knows, for example, that his immune system generates the symptoms — things like fever. He became sick after a long drive from the Northeast back to Alabama, and


Men are getting sicker, dying more often of covid-19, Spain data shows

MADRID — Cristian Guaman Benítez, a 33-year-old electrician who moved to Spain from Ecuador, had been sick for a week with a cough, a terrible headache and a fever as high as 104 degrees. He saw three doctors who treated his illness like a cold, prescribing medicines and sending him back to work. Finally, he called the number for covid-19 information, and a doctor came to his home to examine him — and sent him by ambulance to Madrid’s 12 de Octubre Hospital. Which was where he discovered he was an outlier. “I looked around and all I saw [were] very old people,” Benítez remembered. Struggling to breathe by that point, he ended up in the intensive care unit, and only then, fortunately, was he able to recover. Benítez’s story, of an ICU admission for covid-19 at age 33, remains rare. However, based on detailed epidemiological data from the advancing epidemic in Spain, even young men are not risk-free. And the older that men in Spain are, their cases of severe disease, including pneumonia, trips to the ICU and deaths become far more numerous than those for women. The data arriving from Spain, combined with similar findings from other countries with large outbreaks, such as Italy, China and France, are increasingly suggesting that the top risk group for the novel coronavirus is not simply older adults, but older men. A Washington Post analysis of U.S. deaths so far also found that nearly 60 percent of deaths, in cases where a gender could be identified, were male. The Spain data, based on an analysis of 20,648 cases so far and 722 deaths by the country’s Institute of Health Carlos III, a national public health agency, delivers a new level of detail. It shows that men are faring worse on multiple metrics for the disease. Among gender-identified disease cases, men make up 60 percent of those that progress to the dangerous pneumonia stage. They make up 59 percent of the hospitalizations, 72 percent of the intensive care unit admissions and 65 percent of the deaths. The gender divide shows up early, according to Spanish health officials. Men exhibit more of the initial symptoms: fever, cough and trouble breathing. And that carries through the course of sickness: Men progress more often to pneumonia, and have more cases of acute respiratory distress syndrome and more kidney failures. One prominent hypothesis to explain higher male


deaths from the disease in other countries is that men tend to smoke more. And yet in Spain, the gender-based smoking gap is small. Thirty-one percent of males ages 15 and older smoke in the country, according to the World Health Organization, and so do 27 percent of women. So it seems unlikely that smoking alone would explain the disparities above. “The discrepancy between rates of smoking in men and women are less pronounced in Spain and Italy than in China, yet the sex difference in covid-19 outcomes are more pronounced in Spain and Italy than in China,” said Sabra Klein, an expert on how men and women experience disease, especially viral infections, at the Johns Hopkins Bloomberg School of Public Health. “Smoking cannot be the primary cause.” That’s true of Benítez. He doesn’t smoke or have any health issues, and he was stunned that he could get so sick. “It was strange,” he said of his hospitalization, “because I was so much younger than everyone else. When I left, the doctor told me I was very strong because I had been very sick and a lot of people wouldn’t have made it.” Experts trying to parse the meaning of the gender-based data out there say that, while behaviors play some role, it’s also hard to rule out biological explanations. That’s especially true because the additional X chromosome that women have plays a role in immune response, so much so that one recent study asserted that “it is clear that sex-specific effects contribute to infectious disease susceptibility and females have a major immunological advantage over males.” “The data from Spain and Italy supports the hypothesis that there is a biological basis for the sex bias observed in covid-19 disease severity,” said Angela Rasmussen, a virologist at Columbia University. “As the data continues to be analyzed, it’s possible we may find a behavioral or cultural basis for these disparities, but this is now emerging as a global trend, suggesting that this is rooted in the biological underpinnings of sex.” Klein agrees. At the same time, she also suspects a role for behavioral differences, such as less of a tendency toward hand-washing and less willingness to go to the doctor. “I realize that everyone wants answers for the question of ‘why,’ but the truth is that we don’t know and will not likely know until controlled research studies can be conducted to


Thousands are crowding into free national parks. And workers are terrified of coronavirus.

loss of his job. Stone said his colleagues at Klondike Gold Rush grumbled when the park supervisor said he had authority to close portions of the park. Many wanted it to close entirely, he said. “The National Park Service needs to recognize that the way they’ve been behaving is irresponsible and send everyone home but security,” Stone said. “Not all parks are going to be a problem, and not all areas in a park are going to be a problem. But working out a nuance like that takes time, and we don’t have time.” Those who live near national parks — and normally like seeing out-of-towners arrive in droves to boost the local economy — are also worried about an influx of visitors seeking to “socially distance” themselves from others by retreating to wilderness. “Look to your backyard and recreate there,” said Emily Niehaus, mayor of Moab, Utah, who on Wednesday called on nearby Arches and Canyonlands national parks to close down. “Moab will be here when this pandemic is over.” Near some parks, there are already signs of strain. Outside of Death Valley National Park in the unincorporated town of Beatty, Nev. — population 1,010 — toilet paper and other essentials were picked over at the local Family Dollar. Campgrounds and other attractions there had been closed over the weekend, but visitors still flowed into the area to erect tents and park campers in the adjacent Amargosa Valley to the east of the park. “It’s a higher density than we’ve ever seen outside the park,” said Laura Cunningham, who is worried about the virus taking hold in her town, 70 miles from the nearest hospital. Last week, officials at Joshua Tree in California had initially indicated the park’s roads would be opened to motorists. Hundreds drove from Los Angeles and elsewhere Saturday only to find the gates shut after a last-minute announcement from the park. Park goers instead packed the sides of the road going to Joshua Tree’s western gate, leading locals to text the park superintendent and vent on Facebook and Instagram. “Nobody has ever seen it like that,” said Cody Hanford, who lives just outside the park. “It looked like a musical festival for a second.” The local rural hospital outside Yellowstone was built to meet the needs of a small community of 21,000 that explodes to 75,000 in Teton County’s peak season. “Our health-care system is


Demand for online ordering leaves grocery stores scrambling, customers waiting

workers to fill and deliver additional online orders. Andrew Whelan, a spokesman for Albertsons, Safeway’s parent company, said the grocery giant plans to hire 30,000 workers and is partnering with companies in the service industry, such as Hilton and MGM Resorts, that have laid off workers to find them. Whelan said the new hires will boost the timeliness of online deliveries. “As you can imagine, we are experiencing high demand. We appreciate our customers’ patience on this,” he said. “Certainly, as you know, these are unprecedented times.” Other companies are making similar moves. Instacart is planning to hire 300,000 personal shoppers. A Giant spokesperson said the company is hiring store clerks, pharmacy technicians, delivery drivers and warehouse workers — and suggested customers use Instacart as well as Giant’s own drivers. A Whole Foods Market spokesperson said the company is seeing an increase in online orders and is “working around the clock to continue to deliver grocery orders to customers as quickly as possible.” The company declined to release details about grocery delivery demand but referred to Amazon’s companywide announcement of plans to hire 100,000 full- and part-time workers. (Whole Foods is an Amazon subsidiary, and Amazon CEO Jeff Bezos owns The Washington Post.) There seemed to be a bottleneck Friday in the delivery process from grocers in the Washington region. Safeway’s earliest delivery time was noon Tuesday. Peapod, Giant’s delivery service, had no delivery available through April 3. Amazon, which delivers for Whole Foods, had a delivery slot at 9 p.m. Friday but none Saturday, the only other day listed. Toilet paper was unavailable at all three. Seeking to keep shoppers safe in a period of social distancing, several grocers have introduced special hours reserved for older shoppers and those with compromised immune systems, an effort to reduce their risk of infection. Some shoppers are finding plexiglass shields for cashiers and marked floors so shoppers can stand six feet apart to maintain social distancing. At least one grocery store in the Washington region is switching to curbside pickup, worried that shopping inside isn’t safe. The Takoma Park Silver Spring Co-op closed this week to transition to an online ordering system. Mike Houston, the store’s general manager, said he hopes to reopen Saturday to complete orders filed with the Web-based system, which was built from scratch. The co-op has operated “massively beyond capacity” since the coronavirus outbreak hit, Houston said. Worried


The Washington Post.) There seemed to be a bottleneck Friday in the delivery process from grocers in the Washington region. Safeway’s earliest delivery time was noon Tuesday. Peapod, Giant’s delivery service, had no delivery available through April 3. Amazon, which delivers for Whole Foods, had a delivery slot at 9 p.m. Friday but none Saturday, the only other day listed. Toilet paper was unavailable at all three. Seeking to keep shoppers safe in a period of social distancing, several grocers have introduced special hours reserved for older shoppers and those with compromised immune systems, an effort to reduce their risk of infection. Some shoppers are finding plexiglass shields for cashiers and marked floors so shoppers can stand six feet apart to maintain social distancing. At least one grocery store in the Washington region is switching to curbside pickup, worried that shopping inside isn’t safe. The Takoma Park Silver Spring Co-op closed this week to transition to an online ordering system. Mike Houston, the store’s general manager, said he hopes to reopen Saturday to complete orders filed with the Web-based system, which was built from scratch. The co-op has operated “massively beyond capacity” since the coronavirus outbreak hit, Houston said. Worried about risks to shoppers and employees in a 4,200-square-foot store — and skeptical that special hours for older guests will prevent infection — he decided “the only safe way to protect our employees and the public is to close the store off entirely.” “It’s unbelievably hard,” he said. “I’ve been in natural foods for a long time. Closing your door to people that purchase food goes against my DNA.” At least two small co-ops, in Minneapolis and Seattle, have had to temporarily close after employees tested positive for the coronavirus. From small grocers to national chains, some stores have boosted worker pay by $2 an hour amid the outbreak. Houston said his store’s brief closure might preserve business in the long run. He said he’s “a week ahead of a bunch of other stores in coming to this conclusion.” “I would love to think we can sanitize our way out of this,” he said, “but I don’t think it’s safe for people to crowd into a grocery store to shop.” In Northwest Washington, the Broad Branch Market’s newest delivery method removes the possibility of human-to-human coronavirus spread: Deliveries are being made with robots. The small, six-wheeled computer-controlled vehicles resemble large


From unfazed to unprecedented: Inside the decision to postpone the Olympics

postponement of the Tokyo Games. In Rio, American swimmers had collected more medals than any other individual team. USA Swimming was the first prominent governing body to call for such a drastic measure. “There’s always anxiousness when you decide to stick your neck out and say something you believe in — and not knowing what the world is going to think,” Hinchey said. “It was really important the tone of the letter be humble and respectful because the USOPC are phenomenal partners for us, the IOC, FINA — all these great partners. So you hope they take it for what it’s worth, which is just prioritizing the athletes.” The next day, March 21, USA Track & Field joined USA Swimming in calling on the USOPC to request the Games be postponed. On March 22, a Sunday morning, Bach’s outlook shifted. He awoke to news of a coronavirus outbreak starting in Africa and read reports of the accelerating growth of cases in the United States and South America. He called an emergency meeting of the IOC’s executive board. Bach then called Yoshiro Mori, president of Tokyo 2020’s organizing committee. Bach said he told Mori to be prepared not only to discuss potential scenarios but to talk with Abe and come up with specific plans for a postponement. “Cancellation was discussed and considered like all the options on the table,” Bach said. But while the executive board quickly decided postponement was the only option, the IOC also recognized it could not confront the logistical challenges of postponement without Japan on board. As the endgame neared, Abe felt he needed to project control, according to Japanese news accounts. After Sunday’s emergency executive board call, Bach announced for the first time the IOC was considering postponement. Still, he said a decision would be “premature” and placed a self-imposed deadline of four weeks to make a decision. The half-measure — announcing postponement may happen but that it could take a month — was a result of Bach trying to help Abe save face. Japan wanted to clear all of the logistical hurdles first, to roll out the new version of the Games as the 2020 version was postponed. But the IOC realized the rest of the world, especially athletes forced to continue training, would not accept it. “The IOC went from immediately announcing postponement talks were underway but at same time recognizing there is no


Virginia, Maryland governors warn that hospitals soon may be overwhelmed by surge in coronavirus cases

to us, we will literally see more cases. We’ll see our hospitals overwhelmed.” Maryland added 194 cases Friday morning, its third consecutive day reporting record numbers of confirmed infections. In the past three days, the caseload in Maryland has more than doubled, to 775, with the state on Friday reporting its fifth death, a resident of Anne Arundel County. Virginia announced 144 new cases, bringing the state’s total to 605.The state added five deaths Friday. Among them: two more residents at the Canterbury Rehabilitation & Healthcare Center just outside Richmond — bringing that facility’s total to six deaths in the largest-known coronavirus outbreak in a long-term-care facility in the greater Washington region. The District reported 37 new cases Friday night, bringing its total to 308. On Friday, Mayor Muriel E. Bowser (D) said the city had recorded its fourth coronavirus death: George Valentine, deputy director of the mayor’s office of legal counsel. Bowser said Valentine was admitted to a hospital on Wednesday after testing positive for the virus and died Friday morning. Bowser said the nation’s capital is preparing for when community spread and infections require more people to be hospitalized. “We’re all using pretty sophisticated models to put inputs in to get our best guess of when that’s going to happen and what the level of impact on our system will be,” she said. Bowser, Northam and Hogan have all shut down schools and most businesses and banned group gatherings in an effort to slow the spread of the virus. Looking toward May, the Vietnam Veterans Memorial Fund said Friday that its annual Memorial Day commemoration will be webcast and will not held on the Mall or at the Vietnam Veterans Memorial. D.C. officials announced that the city will curtail most in-person voting for the June 2 primary elections, which include the presidential nominating contest and several city council races. Just 20 precincts in the city will be open for voting, with at least two operating on Election Day in each of the city’s eight wards, officials said. But election officials are encouraging voters instead to request mail-in ballots, either over the phone or by visiting the election office. The city may try to stagger in-person voting throughout the day based on last name but said these measures are voluntary. “No voter will ever be turned away,” said Michael Bennett, the chair of the D.C. Board of Elections. As


How the coronavirus pandemic affected workers around the worldPhotos: A day in the life during a pandemic

has Type 1 diabetes and has chosen to stay in Canada despite the U.S.-Canada boarder closing to nonessential travel. Essert believes the Canadian health-care system is superior and is less likely to be overwhelmed by coronavirus cases. But Essert is two months shy of the 12 months of continuous work in a specific field required to allow him to apply for the next step to becoming a permanent citizen of Canada. The mill is hoping to bring Essert back on after the crisis, but there is no timetable for when that could happen. Essert noted how the virus has separated him from his loved ones and shifted his lifestyle to a reclusive one. “Covid 19 has separated me from my family and friends, and forced my girlfriend and I out of her university housing situation," Essert wrote in an email. "My girlfriend returned to her home in Oregon and now that the borders between BC and USA have closed indefinitely I don’t know when the next time I will see her, my parents, my brother, grandparents, niece, and friends living in the United States.” Tobi Ewing, 27, is a painter, and yoga and meditation guide. She said her world was all about personal contact and interaction, calling herself an artist involved in the “practice of play, exploration and well-being.” It all has been reinvented in the time of social distancing. The phrase is written in red on her wall calendar. Her yoga classes now appear on the video app Zoom. With her partner, she ran what she called a “The Self Care cafe.” Ewing is now at home waiting for the crisis to ease. “I genuinely love what I do. I am employed by yoga and painting, but those are things that I wanted my daily lifestyle to be cultivated with,” Ewing said. “It is what I am employed by, but It helps keep me sane.” (name changed to protect photographer’s identity) There is a new job for officials in registry bureaus in China: keeping tabs on travelers’ journeys at train stations as coronavirus restrictions ease. At the train platforms in Dazhou — about 300 miles west of Wuhan, where the virus was first detected — health workers are on stand by in case they find someone who needs care or is infected. This is another job created during the crisis. No one knows how long it may be needed.


Covid-19 is harshly testing our capacities as physicians and medical staffers

the nation focuses — understandably — on our hospitals’ ability to care for the coming surge of severely ill covid-19 patients, much of the pandemic response is playing out in primary care offices (and phones and computers) across the country as doctors and nurses triage precious resources such as tests and emergency care and recalibrate anxieties fueled by politicians’ mixed messages. The pandemic is testing the capacity of a primary care system that is already short on doctors and long showing signs of wear. But it is also a time when primary care is needed to do what it does best: offer trusted advice in the face of uncertainty, tend to our patients’ physical and mental health, and help them stay out of emergency rooms and hospitals that are becoming overwhelmed. We are seeing more than the infectious symptoms of coronavirus. Like the 37-year-old ICU nurse who has been caring for covid-19 patients wearing reused protective equipment and coming home to her infant, a husband whose business is now failing and a disabled mother at high risk of the disease. She is reaching out now because her once manageable postpartum anxiety has become severe. We decide to start her on medication and weekly phone check-ins to get her through. Melissa, a 66-year-old woman with a finger infection, is wrapping up a course of antibiotics another doctor gave her. She tells me that her finger looks better, but not yet normal. Rather than the usual watch and wait, we have her pick up a second, just-in-case antibiotic while she still feels safe to leave her house. For patients with urgent problems such as rectal bleeding or with chronic conditions such as diabetes and heart failure, we weigh the need for in-person care against the risk of covid-19. These trade-offs will grow increasingly difficult when we are further along in a pandemic that will be a marathon rather than a sprint. At the same time, we worry about patients — often the most vulnerable — who will not seek help for these problems during the pandemic. And when our best advice is often to stay at home, we worry about those who do not have this luxury. Primary care practices are scrambling to address this swell of medical needs caused or complicated by covid-19, and to adapt to the reality that the virus, enabled by test and mask shortages, has rendered office


go to their PCP to be tested,” Greiner said. In response, many practices like ours are canceling most in-person visits (which is still how most doctors are paid) or shifting them to video and telephone. As of March 23, 40 percent were offering video visits in some form, while 91 percent offered phone visits. If there is any good news to come out of the pandemic, it is that it has compelled some policy changes to support this virtual care that we should have had for a long time. For example, Medicare just loosened restrictions on the video platforms we can use to talk with older patients (FaceTime and Skype are now in play). Massachusetts now requires insurance companies to pay equally for in-person, telephone and video visits; when these visits are covid-related, patients cannot be asked to pay. But especially for smaller primary care practices, telemedicine is still complicated and costly to set up, and the financial losses from dropped visits will be severe. Rebecca Etz, associate professor of family medicine at Virginia Commonwealth University and co-director of the Larry A. Green Center that co-led the survey, said she was most struck by the written-in comments she read. Many doctors did not know whether they would be able to keep their practice doors open, she told me. One wrote, simply, “please help us.” Complicating matters further is the worrisome number of health care workers who are under quarantine (for covid-19 exposure) or isolation (for symptoms or confirmed infection). In mid-March, 20 percent of survey respondents said that doctors, physician assistants or nurse practitioners in their practice were quarantined. As of March 23, it was nearly 50 percent. In my own unscientific Twitter survey of U.S. doctors on March 20, nearly one-tenth of the 143 who responded were home with symptoms or exposure to covid-19 (8 percent) or with confirmed infection (1 percent). A few weeks ago, a mild sore throat, headache and chills that I’d have usually ignored prompted my own, first-ever sick day from the clinic followed by self-isolation. A camera-enabled laptop and an oversized armchair became my makeshift exam room. But like so many others, I still felt stuck between the need to limit spread to colleagues and patients and the desire to report for duty. I’ll be glad — if nervous — when I return to work as normal, especially because it is anything but. health-science@washpost.com


Immigrant doctors want to help the Army fight the coronavirus. The Pentagon won’t let them.

civilian hospitals but signed up to serve part-time with the Army. Now, they are desperate to serve in uniform as they wait for background checks to complete. An internal medicine specialist, a doctor from India with a specialty in respiratory illnesses, said he has treated at least 40 patients with the coronavirus in a civilian hospital in New York City. He enlisted in the Army in 2015 and has mostly sat around while on reservist duty as a low-ranking soldier with little to do. “I love to help people,” he told The Post. “But these hurdles are unnecessary. I’m wasting years of my medical experience in the Army.” Like the other five recruits interviewed for this story, he declined to provide his name and some identifying details for fear of retribution from the U.S. government. Those six recruits combined have spent 25 years on limited reserve duty as junior soldiers unable to use any of their medical skills in uniform. The Pentagon did not return a request for comment, and the Army did not say how many immigrant physicians are still waiting to muster into the service. The physicians enlisted in an immigrant recruitment program that traded fast-tracked citizenship for language and medical skills that the Pentagon identified as both vital to national security but in short supply among U.S.-born troops. More than 10,000 skilled immigrants entered the military in the last decade, mostly for their linguistic skills. The program shuttered in 2017 amid security concerns and heightened background checks that stalled the process for years. At least several dozen physicians are still waiting for their checks to finish. They busy themselves with menial tasks at their reserve units, where they have limited duties, said retired Army officer Margaret Stock, the architect of the program and an immigration attorney who has represented physician recruits. The military has consistent physician shortages, a 2018 Government Accountability Office report found. “The nation is facing a crisis when we need these people,” Stock said. “It was the point of recruiting them in the first place.” The Military Accessions Vital to National Interest program was championed by Special Operations Command for its stream of language and cultural experts who could aid them in unconventional missions, a Pentagon overview of the program said. It also helped the Army Reserve fill many dental jobs, a vital task because dentists must be available to clear soldiers for combat


Inside a major New York City hospital system battling coronavirus

Adam Bernheim got a good, hard look at the enemy well before it invaded his own hospital. The white, round-shaped spots he saw clinging to the edges of people’s lungs formed a pattern unlike any he had seen in patients suffering tuberculosis or any other respiratory disease. This was January, and Bernheim, a cardiothoracic radiologist with the Mount Sinai Health System, was studying CT scans sent from China with a researcher’s dispassionate eye. “It was very unusual,” said Bernheim, whose long-standing partnership with West China Hospital in Chengdu and three other hospitals in different provinces gave him early access to their images, the first glimpse of the coronavirus now rampant in New York. Nothing that Bernheim saw in those scans could have prepared him or other doctors for the onslaught of patients a few months later as New York City became the epicenter of the U.S. outbreak, with more than 29,000 cases and 517 deaths as of Saturday evening. In hospitals across the city, emergency rooms are swelling, beds are filling, and intensive care units are becoming overwhelmed, with the projected peak still seven to 21 days away. On Tuesday night, emergency medical services workers received 6,406 medical 911 calls in the previous 24 hours, surpassing the total from Sept. 11, 2001, and the numbers keep mounting, said Oren Barzilay, president of Local 2507, which represents emergency medical technicians and paramedics of the New York City Fire Department. Now Bernheim is seeing those distinctive patterns again, this time as a clinician on scans taken in his own emergency department. “One after another after another after another,” he said. “Yesterday more than the day before. In all ages. Men and women.” The Mount Sinai Health System is better positioned than most to weather the storm sweeping the city. It is a well-funded, world-renowned research and academic center. It has invested in data modeling to plan for how many beds and intensive care units hospitals need. But it, too, may be nearing a tipping point as the disease consumes unprecedented resources and puts relentless pressure on nursing staff who sweat under layers of protective equipment. “This is a fluid situation,” said Ugo Ezenkwele, chief of emergency medicine at Mount Sinai Hospital in Queens. “In a week or two, who knows? . . . This is unique in my experience, and I’ve been doing emergency management since 2002.” Hospital leaders had anxiously watched


the abdominal scans — and there Bernheim saw the distinctive pattern of white spots, clinging to the periphery. He does not know what the future holds or exactly when the cases will peak. If the situation worsens, radiologists like him could be called to work on the front lines, perhaps in the ICU. “There’s been discussion,” Bernheim said, “but it hasn’t reached that point yet.” None of this comes as a surprise to doctors treating people in emergency rooms. “We have seen a surge of sicker patients,” Ezenkwele said. A week and a half ago, some showed up to the ER with symptoms mild enough they could be sent home to rest, he said. But now, nearly all the patients are running fevers and are short of breath. When Ezenkwele measures the oxygen levels in their blood, they are alarmingly low. “They require oxygen — now,” he said. “They can’t go home.” For the moment, the hospital is managing. Employees have enough masks and other protective equipment, Ezenkwele said. There are enough ventilators for patients who need them. But as patients keep coming, Ezenkwele can see the ER under strain. The first patients suspected of having covid-19 were sequestered to keep the virus from spreading. But now, staff members must place two patients in some rooms. “Once those are at capacity, we’ll put patients in open bays, with curtains separating them,” Ezenkwele said. “There will be a point where it’s a moot discussion, and anyone in the ER with respiratory problems is presumed to be a covid patient.” The virus is confronting doctors in unexpected ways. “You have to be ready to reorient at any moment,” said gastroenterologist Ryan Ungaro, who is seeing patients with GI symptoms who turn out to be suffering from covid-19. Some specialists are preparing to adjust to a new schedule of 12-hour shifts. “You almost have to assume everyone is positive now,” he said, describing how colleagues are ramping up their research even as they treat patients. Looking back, some can see that the wave cresting over them now was already forming at their feet weeks ago. “I get the sense that we were starting to see infections way back, even in January, but we just didn’t realize it,” said Kamal Kalsi, an emergency room doctor. “It was people that were coming in with coughs and symptoms for two weeks.” “Once we got our first


keep the virus from spreading. But now, staff members must place two patients in some rooms. “Once those are at capacity, we’ll put patients in open bays, with curtains separating them,” Ezenkwele said. “There will be a point where it’s a moot discussion, and anyone in the ER with respiratory problems is presumed to be a covid patient.” The virus is confronting doctors in unexpected ways. “You have to be ready to reorient at any moment,” said gastroenterologist Ryan Ungaro, who is seeing patients with GI symptoms who turn out to be suffering from covid-19. Some specialists are preparing to adjust to a new schedule of 12-hour shifts. “You almost have to assume everyone is positive now,” he said, describing how colleagues are ramping up their research even as they treat patients. Looking back, some can see that the wave cresting over them now was already forming at their feet weeks ago. “I get the sense that we were starting to see infections way back, even in January, but we just didn’t realize it,” said Kamal Kalsi, an emergency room doctor. “It was people that were coming in with coughs and symptoms for two weeks.” “Once we got our first diagnosed cases, we started to lose staff, because initially, if you had contact with these covid patients, you had to be sent home for a two-week quarantine,” Kalsi said. “We were initially just hemorrhaging all types of staff.” Heart surgeon John Puskas has repurposed a cardiovascular care facility consisting of an ICU with 26 beds and a ward with 31 beds into a new unit — 98 percent of it now packed with covid-19 patients. “It’s like saying Ford makes great cars. But from now on, don’t make cars, make submarines — it’s the same team doing very different things,” said Puskas, who had just come off a Zoom call pooling information on treatment and strategies with 24 other doctors, including infectious disease experts and anesthesiologists. Although covid-19 is largely a respiratory disease, it has in a few instances caused a dangerous form of myocarditis, or inflammation of the heart muscle. It is rapid — and fortunately rare so far. Puskas has one such patient, an 83-year-old woman, on his floor. “To my knowledge, I don’t know of a survivor. It seems to be a terminal event,” he said. The challenges he is looking at going forward are immense, with


Elderly Asian elephant is euthanized at the National Zoo

for us was not hugging each other,” because of the virus restrictions. Ambika was a cautious elephant and not a matriarch. But she “was very wise,” Galloway said. “She knew a lot about how to be an elephant. . . . She was able to teach by example.” Her roughly 6,500-pound remains were removed from the zoo late Friday night with a front end loader and a truck and taken to a facility where a necropsy, an autopsy for an animal, was underway Saturday. The remains were to be “disarticulated” and incinerated. “It’s a huge job,” Amaral said. No ashes will be kept for sentimental reasons. It was the second euthanization of an animal at the zoo this month. An American bison named Zora had to be put down March 3 after she thrashed in a stall and broke her left hind leg. She was 7 and had been at the zoo for six years. Ambika, one of seven elephants the zoo had, had been ailing in recent months. She had been treated for osteoarthritis a decade ago, but the staff was able to ease her pain and slow the progression of the disease, the zoo said. She received anti-inflammatory drugs, analgesics and joint supplements. But she also began to develop lesions on her footpads and nails. For those, she got foot baths, pedicures and antibiotics. But the lesions could not be controlled and got worse, the zoo said. “Last week, her keepers noticed that her right-front leg, which bore the brunt of her weight, developed a curve that weakened her ability to stand,” the zoo said in a statement. Given those factors, as well as her age, physical and social decline, and poor quality of life, the staff decided to euthanize her, the zoo said. “We were at a point where we knew this was the best option for her,” Amaral said. Ambika was captured in India at 8 and worked for years as a logging elephant. She came to the zoo in 1961, during the administration of President John F. Kennedy. “It’s sad in a lot of ways,” Amaral said. “They don’t get much sweeter than she was. . . . It’s the end of an era, 59 years at the National Zoo. . . . Seventy-two years for an elephant is a pretty good run. “We did good by her, and she did good by us.” michael.ruane@washpost.com


Three months into the pandemic, here’s how likely the coronavirus is to infect people

Three months into this pandemic, scientists are coming to understand the novel coronavirus. They know, for example, that as horrible as this virus is, it is not the worst, most apocalyptic virus imaginable. Covid-19, the disease caused by the virus, is not as contagious as measles, and although it is very dangerous, it is not as likely to kill an infected person as, say, Ebola. But there is one critically important, calamitous feature of SARS-CoV-2: the novelty. When it jumped from an animal host into the human population sometime late last year, no one had immunity to it. That is one reason the new coronavirus is not comparable to a harsh strain of the flu going around. The first cluster of mysterious, pneumonia-like respiratory illnesses was reported in Wuhan, China, at the end of December, and in the days that followed, it spread explosively. With astonishing speed, this submicroscopic pathogen has contaminated the planet, infecting more than 600,000 as of Saturday and killing at least 28,000, grinding global commerce to a near standstill and rattling the nerves of everyone brave enough to be following the news. “This is a new virus that has landed in the human community. We are a brand-new, naive population. We’re kind of sitting ducks, right?” said Ilhem Messaoudi, a virologist at the University of California at Irvine. Most viral contagions in circulation face obstacles in the form of people with at least partial immunity. But this coronavirus is a bulldozer. It can flatten everyone in its path. When the virus infects people, they don’t get sick right away. Researchers believe the incubation period before symptoms is roughly five days on average. In studying the pattern of illness, epidemiologists have made the dismaying discovery that people start shedding the virus — potentially making others sick — in advance of symptoms. Thus, the virus has a gift for stealth transmission. It seeds itself in communities far and wide, where vulnerable human beings represent endless fertile terrain. At the genetic level, the new virus is not terribly different from the SARS virus that emerged in China in 2002 — which is why the new one has the derivative name SARS-CoV-2. SARS killed nearly 1 in 10 patients. But people with SARS infections did not shed the virus until they were already quite sick, and victims were typically hospitalized. SARS was snuffed out after causing about 8,000 infections and


a brand-new, naive population. We’re kind of sitting ducks, right?” said Ilhem Messaoudi, a virologist at the University of California at Irvine. Most viral contagions in circulation face obstacles in the form of people with at least partial immunity. But this coronavirus is a bulldozer. It can flatten everyone in its path. When the virus infects people, they don’t get sick right away. Researchers believe the incubation period before symptoms is roughly five days on average. In studying the pattern of illness, epidemiologists have made the dismaying discovery that people start shedding the virus — potentially making others sick — in advance of symptoms. Thus, the virus has a gift for stealth transmission. It seeds itself in communities far and wide, where vulnerable human beings represent endless fertile terrain. At the genetic level, the new virus is not terribly different from the SARS virus that emerged in China in 2002 — which is why the new one has the derivative name SARS-CoV-2. SARS killed nearly 1 in 10 patients. But people with SARS infections did not shed the virus until they were already quite sick, and victims were typically hospitalized. SARS was snuffed out after causing about 8,000 infections and 774 deaths worldwide. That successful fight may have led to some complacency; researchers say funding for SARS research dried up in recent years. “We thought we cured it. We thought the virus disappeared. Well, the virus didn’t disappear, did it?” said Michael Buchmeier, a UC Irvine virologist who has studied coronaviruses for three decades. Because this is such a contagious virus, a large percentage of the world’s population, potentially billions of people, could become infected within the next couple of years. Frantic efforts to develop a safe and effective vaccine are likely to take a year or more. President Trump and others have repeatedly downplayed the threat of covid-19 by comparing its lethality to seasonal influenza, which claims tens of thousands of lives in the United States every year. But covid-19 may be many times as lethal for an infected person as seasonal flu. Messaoudi noted that the health system is set up to deal with the seasonal flu, but not with a new, pandemic disease. “We have a vaccine for the flu. And antivirals. It’s seasonal, we prepare for it, we try to get vaccination coverage; this is already what our system is dealing with,” she said. “This is


774 deaths worldwide. That successful fight may have led to some complacency; researchers say funding for SARS research dried up in recent years. “We thought we cured it. We thought the virus disappeared. Well, the virus didn’t disappear, did it?” said Michael Buchmeier, a UC Irvine virologist who has studied coronaviruses for three decades. Because this is such a contagious virus, a large percentage of the world’s population, potentially billions of people, could become infected within the next couple of years. Frantic efforts to develop a safe and effective vaccine are likely to take a year or more. President Trump and others have repeatedly downplayed the threat of covid-19 by comparing its lethality to seasonal influenza, which claims tens of thousands of lives in the United States every year. But covid-19 may be many times as lethal for an infected person as seasonal flu. Messaoudi noted that the health system is set up to deal with the seasonal flu, but not with a new, pandemic disease. “We have a vaccine for the flu. And antivirals. It’s seasonal, we prepare for it, we try to get vaccination coverage; this is already what our system is dealing with,” she said. “This is the wrong time to deal with another surge of a respiratory disease that causes a lot of morbidity and potentially mortality.” The bulldozer nature of coronavirus means widespread severe illnesses and deaths from covid-19 can happen with terrifying speed. This happened in northern Italy, where hospitals become overwhelmed and many patients couldn’t get standard lifesaving treatment. The pandemic appears to be largely driven by direct, human-to-human transmission. That is why public health officials have told people to engage in social distancing, a simple but effective way to drive down virus’s reproductive number — known as R0, pronounced “R naught.” That is the average number of new infections generated by each infected person. The R0 is not an intrinsic feature of the virus. It can be lowered through containment, mitigation and ultimately “herd immunity,” as people who have recovered become less susceptible to infections or serious illnesses. For the epidemic to begin to end, the reproduction rate has to drop below 1. In the early days in China, before the government imposed extreme travel restrictions in Wuhan and nearby areas, and before everyone realized exactly how bad the epidemic might be, the R0 was 2.38, according to a study published in


D.C.-area forecast: Cool and rather dreary today, then briefly much warmer tomorrow

A somewhat subjective rating of the day’s weather, on a scale of 0 to 10. 3/10: After a few classic springtime days, we get sent a marine air mass through early Sunday. Low clouds and a wind off the ocean portend cool weather around here. If you’ve been in the area awhile, you know these air masses can be tricky to dislodge once they come into town. A strong front will help tomorrow, and it should send us some briefly toasty air for March. Going into next week, things are looking mostly good in what can be a tumultuous time of year with the weather. We’ll take all the breaks we can get. Get our daily forecasts Today (Saturday): Tonight: Follow us on Tomorrow (Sunday): Tomorrow night: If everyone wasn’t already at home, I’d suggest Monday might be a day to play hookie. Hopefully you can still find a moment to take it in, with proper social distancing of course. Skies are largely clear as highs reach the mid-60s to near 70. Winds are out of the west. Confidence: Medium It starts off sunny Tuesday, but clouds should tend to increase with time. I do believe we’ll stay dry. Just need to keep an eye on the storm speed in closing to be sure. Highs in a near 60 to mid-60s zone are pleasant for the date. A storm system approaching could try to throw us some wintry mix after dark and into the night. While it might be cold enough aloft, it’ll probably be too warm at the ground for anything more than conversational snowflakes or the like. Confidence: Medium Read more about Capital Weather Gang’s confidence rating


These ‘mission critical’ federal employees and contractors are still reporting to the office. They’re terrified they’ll get sick.

“mission critical,” a State Department spokesperson said. Colleagues across the government are asking why they’ve been designated mission critical, and finding few answers. “It’s not that we’re unimportant,” said a compliance officer in a West Coast field office of the National Labor Relations Board, which adjudicates private-sector labor disputes. The 1,630-person agency, with 26 field offices, has shortened its hours to 10 a.m. to 2 p.m., when a skeletal staff is required to come to work to open the mail. “But we’re not paramedics,” said the employee. “We’re not saving lives. Given what’s going on, I just don’t think we’re essential.” Many offices waited until this week to send employees home, a week after the administration released its 15-day recommendations on March 16 to close schools, avoid groups of more than 10 and stay home. Leaders in the Washington, D.C., area have told residents to leave home only for essential activities. Federal government leaders have struggled to strike a balance between protecting their staffs and serving the public. This has led to political sensitivities. Interior Secretary David Bernhardt at first left it to national park superintendents to decide whether to stay open or close. But that quickly changed, as pressure built to keep parks open as the administration did during last year’s government shutdown. “They’re approaching this with the shutdown mind-set, even though a pandemic is completely different,” said one superintendent at a national monument in the Midwest who closed his visitor center but is keeping the monument open. A Park Service spokesperson said the agency will “evaluate and reassess operations on a park-by-park basis.” The government is hampered by aging technology, an aversion to telework among some Trump political appointees, and a reliance on paper-based systems in many offices. “The logistics of this are hard,” said Chris Lu, who oversaw Cabinet Affairs for the Obama White House. “Even if you send people home, do they have the technology to do all of these jobs? The government is not yet built to telework.” Health and Human Services and the Veterans Health Administration, with front-line medical staffs responding directly to the pandemic, have restricted many others from working from home. Richard Stone, the VA health system’s executive in charge, told his staff in mid-March that the agency’s strained computer networks had to be saved for vital telehealth services. He later eased his directive and advised employees to telework, but many feared


Several participants test positive for coronavirus after Maryland curling event

people tested positive for covid-19 while the rest are presumed positive. When contacted by The Washington Post on Friday evening, Plush referred to the organization’s statement. The day after the event’s conclusion, Potomac Curling Club announced it was canceling the rest of the 2019-2020 curling season and shutting down ice operations. The club said it will experience “$14,500 of lost revenue” but “will likely still end the year in positive financial territory.” Sara Shuster, who participated in the event, told Minnesota’s Fox 21 this week that she experienced shortness of breath and lost her sense of smell or taste within days of returning home from Maryland. Shuster works as a pharmacist and therefore had access to early testing. Shuster’s husband, John, a gold medalist for the men’s Olympic curling team, said the family is in self-quarantine. Shuster said in a since-removed Facebook post that four days after returning home from the Club National Championships she felt “excruciating back pain.” She also experienced shortness of breath walking up the stairs and couldn’t stand for extended periods of time without losing her breath. Shuster added that “there are almost 20 confirmed curlers from the club nationals to have [covid-19]” and there “are just as many who are awaiting test results or cannot get tested.” Athena Dalrymple, whose husband worked the event as a volunteer, told Fox 5 that they were both told by their doctor not to get tested and to assume they would test positive for covid-19. “There’s absolutely a level of fear,” Dalrymple said. “There’s no question. It’s a deadly disease. You don’t know whether you’re going to be in that percentage that dies or that percentage that lives. That’s not a real comfortable place to be sitting.” A Prince George’s County Health Department spokeswoman told Fox 5 on Thursday that the county doesn’t believe any of Maryland’s confirmed covid-19 cases are linked to the curling event. USA Curling also announced Friday it had canceled the 2020 Arena National Championships, which were set to take place April 27 to May 2 in Gillette, Wyo. Read more: Postponing the Tokyo Games was the right call, even if it is heartbreaking now Some sports owners are stepping up during this crisis. It’s what they should do. What would NCAA eligibility relief for spring sport athletes entail? Athletic directors explain. Sports apparel company stops making MLB jerseys to manufacture protective masks and gowns


For the sports-entertainment business, coronavirus is taking a huge toll

You lose marketing value, you lose exposure value," Rishe said. “Just look at Duke,” he added, noting a small top-tier academic school that has become far more well-known thanks to its run of five men’s basketball titles under coach Mike Krzyzewski. (Actual payouts come in the form of nearly $2 million per tournament win, paid to the conference to which the team belongs.) “March Madness benefits a lot of parties,” Rishe said. “So when it doesn’t happen it costs a lot of parties.” Also lost: the opportunity for advertisers to promote their brands. A slew of companies — they include Capital One, Coke and Turner parent AT&T — use the tournament to launch and sell products. March Madness isn’t the only realm that will feel a major promotional impact because of the virus. If the Olympics this summer fall victim to the pandemic — so far they remain on, despite widespread calls for their postponement — it would be disastrous for NBC. The network is already taking a hit with the postponement or cancellation of the Kentucky Derby, Stanley Cup finals and French Open. Yet it is the Olympics that are massively essential to NBC, which paid about $1.1 billion for the U.S. broadcast rights for the Tokyo Games. That’s in part because the high viewership means high ad rates — an average of well over 25 million people were watching many nights four years ago, plus many more on streaming, pushing ad rates up. But it’s NBC’s ability to promote off the Games that truly makes them so valuable. The company not only plans to publicize its upcoming shows there, as it does every Summer and Winter Games, it plans to launch a new business off these Games: The Olympics will be the kickoff event for Peacock, the new streaming service executives hope can compete with Netflix, Disney Plus and HBO Max. At an investor presentation in January, the company said that it would feature opening and closing ceremonies live exclusively on the platform along with three daily Olympics shows. Its TV viewership would also provide the kind of launchpad to attract subscribers that other streaming services only dream about. Asked to discuss the impact, an NBC Sports spokesperson said only that “The safety of our employees is always our top priority, but our preparations continue full steam ahead for the Tokyo Olympics on July 24” and referred to


Even if the NCAA grants spring sports seniors another season, there are tough decisions to make

bit of unfinished business,” White said. “But there’s just so many things you have to consider.” “It’s kind of hard to process all of that,” Doherty said. “I’ve been trying not to think about it, because then I’d just overthink it.” The NCAA and its schools, though, are giving it thought. It goes without saying that there are more pressing, more important issues than whether Reilly White ever rows again for her Cavaliers or Meghan Doherty ever scoops up another groundball for her Terrapins. Each is highly aware of that. “The rowing being canceled was everything to me,” White said. “But now, if you look at the world, it was so small in the grand scheme of things.” But they also know what it felt like to be in the midst of their final seasons, only to have them screech to a halt. The lives of college athletes are built on routine and balance. Now those commodities are among those in short supply. The pandemic is bigger than us all. That doesn’t mean the pain of losing a season wasn’t raw. “We almost knew in the back of our head it was going to happen, but no one was ready to admit it,” White said. “And then when we heard, it was just devastating. Completely devastating.” “We’re performing on such a high level, at the top platform that we can reach,” Doherty said. “It was definitely heartbreaking for us athletes.” Take those emotions and apply them to thousands of athletes across all the spring sports whose seasons were canceled because of the spread of the coronavirus. The most recent NCAA data shows that 5,472 women were members of Division I rowing teams in 2018-19, and another 3,661 women played lacrosse. Back-of-the-envelope math would show that, if those numbers were roughly steady this year and a quarter of those students were in their final year of eligibility, nearly 2,300 athletes from those two sports alone would be wondering whether they might have another season ahead next spring. And that doesn’t address the men’s versions of those sports or baseball and softball, track and field and all the other athletes in all the other divisions across all the other spring sports. On Monday, an NCAA group called the Division I Council will meet, remotely, to discuss and vote on what it is calling “eligibility relief” for students whose careers ended prematurely. “In


Russia claims it has covid-19 under control. The facade is cracking.

Garry Kasparov is the chairman of the With most of Europe and the United States shutting down to slow the coronavirus pandemic’s advance, it was surprising in recent weeks to hear that Russia had apparently dodged covid-19 almost entirely. Maps of the outbreak drew a suspiciously tidy ring around the largest nation on Earth, as if Russian dictator Vladimir Putin had simply banned the virus like he has free speech and opposition candidates. It seemed an unlikely miracle. Russia’s risk factors include a health-care system that is creaky at best outside of the affluent city centers; countless international travelers; a large migrant labor force; and a 2,600-mile border with China, where the virus originated. While covid-19 was filling European hospitals, Russia was still filling soccer stadiums with fans and, in one case, the opening ceremony of a chess event in a theater with more than a thousand people. Yet the official Kremlin line, parroted to varying degrees by every Russian news outlet, was that rapid testing and travel restrictions had turned the country into a citadel. Reports on Russia’s success were also spread by the international media with only marginally greater skepticism — despite having spent the past three years reporting on Moscow’s ability to blanket the world with lies. The Kremlin could fudge the coronavirus numbers, tout its response on state-run media and censor social media posts exposing a mounting crisis, but ultimately — just as China discovered — the government could not spin a relentless virus. In the past few days, the Russian facade has begun to crack. Reports of overloaded hospitals are emerging, Moscow’s mayor said the official numbers were wrong, and Putin made one of his ritual photo-ops at a hospital in full protective gear, finally acknowledging the crisis. If the Trump administration’s example is anything to go by, months of ignoring and distorting reality will almost certainly make the consequences in Russia far worse. It is remarkable that anyone ever took Russia’s coronavirus numbers at face value. Like most dictatorships, Putin’s regime lies constantly, even when it doesn’t have to. Authoritarian regimes are obsessed with information control, especially when there is news that could make them look weak. No appearance of vulnerability can be permitted, otherwise the people might start getting dangerous ideas. Then there is Putin’s track record in the specific realm of health and epidemics. HIV officially barely exists in Russia, where it


Experts converge on plans for easing coronavirus restrictions safely

locking down,” he said at a recent news briefing. Proposals from many experts for a U.S. strategy have similarly stressed the importance of large-scale contact tracing — a cornerstone for successful efforts in countries including South Korea and Singapore. In the past, some epidemiologists viewed contact tracing on a large scale both impractical and unhelpful once an outbreak has become widespread in a community. But as countries have shown its success against this coronavirus, that thinking has changed. In a paper last week and interviews, Marc Lipsitch, an epidemiologist at Harvard University, suggested while contact tracing is “impractical now in many places,” it could become practical once the numbers have gone down and testing has gone up. He said it also “could alleviate the need for stringent social distancing to maintain control of the epidemic.” South Korea had already honed this ability during an 2015 outbreak of the deadly MERS coronavirus. Singapore deployed its police force to do the work, drawing on digital footprints with security camera footage and credit card records. In the United States, however, that task falls to county health departments, which have been weakened by decades of budget cuts and lack the staffing and ability to mount such a response. Rapidly building up that capacity — either with community volunteers or short-term hires — will be crucial in coming months, said Rivers, of Johns Hopkins. “If you build capacity up and bring cases down, it starts looking a lot more possible.” Many proposals are also tackling the problem of the tanking economy. The Gottlieb-Johns Hopkins plan, for example, calls for widespread use of blood tests to identify people who have had the infection and now are immune — called serology testing. People who are immune could return to work, or take on high-risk roles in the health care system and help people, especially the elderly, who are in quarantine. Serology tests have not been deployed on such a large scale, although in Africa, during the Ebola outbreaks, survivors often were the ones who provided care, watched over the children of sick patients and buried the dead. But the one looming challenge unaddressed by most proposals and op-eds is how to get such detailed plans adopted by the White House, whose response has been weighed down by infighting and leadership ping-ponging among Trump, Pence and health advisers including Anthony S. Fauci and Deborah Birx. Pence said Saturday


A beloved school counselor, an inspirational basketball coach and now — a coronavirus victim

Hasani Hill was a sophomore when he was cut from the basketball team at Northwestern High in Maryland, not quite good enough to make the squad. But when he showed up to the gym to watch the team practice, the coach, Terrance Burke, recognized him, and decided to give him another shot. He struck the young man a deal: outdo his teammates at practice, and he had a spot. It was an encounter that would change the trajectory for Hill, who said he frequently got into trouble. Burke would give him guidance, structure and even a pair of basketball shoes from his own closet when he could not afford his own. “I was nobody important,” Hill said, “and he still looked out for me.” Burke, a well-known school counselor and basketball coach at the Hyattsville, Md., high school, succumbed Friday to complications of covid-19, one of 10 people in the state whose deaths have been linked to the coronavirus. He was 54. Burke’s death came as a shock to his family, who said the Navy veteran had asthma but was physically fit and ate a healthy diet. When he fell ill about two weeks ago, he told his daughter Chanel Parker that he planned to vacation in Jamaica once he felt better. “He was strong. He was healthy. He worked out every day,” said his son Sydne Burke, a teacher and entrepreneur in New York. On Saturday, Northwestern High Principal E. Carlene Murray sent a letter to the school community saying that Burke had passed away from the coronavirus. He died the same day the school system announced that an English teacher at High Point High in Beltsville, Md., had tested positive for the virus. The man, 39-year-old Jason Flanagan, was in a medically induced coma Friday. Burke, a Brooklyn native, was known for his broad smile, sense of humor and Brooklyn accent, qualities that endeared him to students at Northwestern High. He had a knack for seeing potential in young people who had been written off by others and pushing those around him to be their best. He valued hustle over talent. “Hard work beats talent if talent fails to work hard,” Sydne Burke said his father told him. His youngest daughter, Arnetha Burke, said she saw his effect on students and decided to follow in his footsteps. Now a kindergarten teacher at Gladys Noon Spellman Elementary in Prince