In Lebanon, coronavirus outbreak prompts a quarantine for mountain town

BSHARRI, Lebanon — When Lebanon reported its first coronavirus infection in February, the case was a woman who had come from the Muslim holy city of Qom in Iran, which was rapidly becoming the epicenter of the epidemic in the Middle East. Iran has long been a factor in Lebanon’s highly sectarian politics, and many Lebanese were quick to cast blame on Iran and local Shiite Muslims for Lebanon’s widening outbreak. Avoid Shiite villages and areas, some urged. So when, weeks later, it emerged that the largest cluster of coronavirus cases in the country was actually in the insular Christian hamlet of Bsharri in the mountains above Beirut, the irony was not lost on many in Lebanon. Bsharri is known for its devout Maronite Christian inhabitants and as a bastion of right-wing Christian militiamen during the country’s long civil war. Bsharri is also famous for being beautiful. It is widely celebrated for its cedar trees, some of the oldest in the world — called the “Cedars of God” — and the national emblem of Lebanon. Below the town’s newly inaugurated government hospital perched atop a hill extends a lush valley. Streams, waterfalls and water springs abound, filling the silence with a permanent gurgling. Mountains, both green and snow-capped, encircle the town, giving an impression of nature-mandated isolation. Today, however, the isolation is government imposed. Bsharri is the only town in Lebanon to have been placed under complete quarantine, after 24 cases of the coronavirus were recorded in a 24-hour period early this month. About 70 of the town’s 5,500 residents have now contracted the virus, around 10 percent of all the cases in the country. The government has closed off the surrounding Bsharri district, which includes 22 towns and villages, allowing only supplies and police and other official personnel in and out. The emptied streets in the picturesque town look like an abandoned Hollywood set. Residents are not permitted out of their homes except individually to go shopping. A rotation has been set for restaurants so one is open each day to feed hospital staff and policemen. Policemen are stationed outside markets to limit crowding. “You either wear the mask or quit,” one growled at a grocer. Lebanon continues to struggle with the religious differences that have long divided it, at times violently, and religious affiliations that define so much of the country’s politics. The mountains extending north of the


Q&A: Keeping yourself and others safe as states reopen

cases of covid-19 have mild or moderate symptoms, and a spouse probably will be able to take care of himself or herself. If possible, the ill spouse should move into an extra bedroom, use a different bathroom and wear a mask to protect others in the household. If you are living with someone who needs help, you should wear a mask and gloves while providing care. If you are removing a dinner plate, for example, grab it with a dishrag or wear gloves, doctors say. Even at a distance, however, it’s important to monitor a person with covid-19. Doctors are finding that covid-19 can appear with blood clots, strokes and other serious conditions that require immediate medical care. Recommended reading: Months into the crisis, In rare cases, children and young adults are falling ill with a Kawasaki-like inflammatory illness that doctors call MIS-C. Some doctors report brain inflammation and pinkeye in patients. It’s not clear, physicians say, whether some of the varied symptoms are caused by covid-19 or just occurring at the same time. The CDC has added several new symptoms to its list for covid-19, including chills, repeated shaking with chills, muscle pain, headache, sore throat and loss of taste and smell. The symptoms could appear two to 14 days after infection. Recommended reading: Consult your primary care doctor, if you have one. Don’t go to the physician’s office or the emergency room without calling ahead. The coronavirus is highly contagious, and doctors want to protect themselves and other patients from infection. You’ll probably be advised to self-quarantine and, because there is no effective treatment for the disease, take over-the-counter pain medicines such as Tylenol. If symptoms worsen, and you have trouble breathing, persistent chest pain or pressure, confusion or have underlying medical conditions, seek immediate medical care. Recommended reading: Norman “Ned” Sharpless, director of the National Cancer Institute, has warned that delayed screenings and treatments could lead to an estimated 10,000 excess deaths from breast and colorectal cancer over the next decade. He urged doctors to make patients comfortable with coming in for screenings and treatment. As with other appointments, talk with your doctor’s office about their procedures, and the possibility of a telemedicine visit, before showing up in person. When you visit, wear a mask, keep yourself apart from other people and wash your hands or use hand sanitizer between points of contact. If you think you


Killing of Ethiopian protest singer triggers unrest in leader’s ethnic heartland

cities protested the killing of a popular singer, unrest that jeopardizes Prime Minister Abiy Ahmed's power base in his ethnic heartland. Abiy called for calm after the killing of Hachalu Hundessa, a musician whose political songs were the soundtrack of the protest movement that propelled Abiy to power two years ago. In a tweet, Abiy promised an investigation. The medical director of the main hospital in the town of Adama said the facility had received about 80 wounded patients. Most had been shot. Six died en route to the hospital, and two died in intensive care. The prime minister and the slain singer are both from the Oromo ethnic group, Ethiopia’s largest, which has long complained of being marginalized by national leaders from other communities. A television station owned by a prominent Oromo opponent of Abiy, media tycoon Jawar Mohammed, said police had arrested Jawar after his bodyguards refused to disarm. Bekele Gerba, a leader of an opposition Oromo party, also was arrested, the station said. Federal forces had not arrested Jawar or Bekele, a federal police spokesman said. Last week, Hachalu gave an interview to Jawar’s media network in which he criticized Ethiopia’s leadership. The killing appeared well-planned, police told state media Tuesday. The Addis Ababa police commissioner said a day earlier that arrests had been made. The normally busy streets of Addis Ababa were eerily empty Tuesday as protesters lit fires and chanted slogans. Internet access was shut down, a step the authorities have taken in the past at times of political unrest. Telephone service worked intermittently. Hachalu, a former political prisoner, rose to prominence during anti-government demonstrations that began in the Oromo heartland and led to Abiy taking power in 2018, ending decades of dominance of the ruling coalition by ethnic Tigray leaders. Abiy’s rule ushered in greater political and economic freedoms in what had long been one of Africa’s most repressive states. He won the 2019 Nobel Peace Prize for ending conflict with neighboring Eritrea. But the rise in political activism has also led to an increase in unrest in a country with more than 80 ethnic groups. Abiy’s rule has been frequently challenged by local power brokers demanding more access to land and resources. His emphasis on pan-Ethiopian politics sparked a backlash from some elements of his Oromo base, spearheaded by Jawar. Clashes between police and Jawar’s backers killed at least 78 people in October.


With no path forward amid coronavirus pandemic, Minor League Baseball cancels 2020 season

With no players to fill rosters, no major television contracts to generate revenue and no way to put fans in seats, Minor League Baseball bowed to the inevitable Tuesday and canceled its 2020 season, which had already been delayed by nearly three months by the novel coronavirus pandemic. The cancellation, first reported by Baseball America, came following a meeting of Minor League Baseball’s board of trustees. The organization released a statement confirming the decision Tuesday afternoon. “We are in dire straits,” Minor League Baseball President Pat O’Conner said on a conference call with reporters following the announcement. The future of the organization and its individual franchises, he said, is “extremely difficult for us to project, because there is no end in sight [to the crisis] in the immediate future. … I have grave concerns.” The move has been expected for months, because the business model for minor league teams — which lack the lucrative television contracts that major league teams have — isn’t built to withstand the financial pressures created by games played without fans. In addition, because of the national emergency, Major League Baseball suspended the agreement covering the assignment of players to minor league affiliates and decided to adopt a “taxi squad” model to supply its teams with extra players — who will train together at one location per team — during a truncated, 60-game season. In other words, to survive, minor league teams would have had to find and pay their own players in 2020. “It was an insurmountable list of challenges,” O’Conner said. “We were unable to find a path” to play this year. The long-term financial implications for the industry are dire, O’Connor said, with “north of half” of all minor league franchises facing solvency issues without government assistance. Many, he said, have already been through two, three or even four rounds of furloughs of team employees. “The coronavirus has cut into many clubs’ ability to make it,” he said. “ … We need a lifeline to get to the other side.” While big league teams are permitted to start the 2020 season with 30-man rosters and can keep taxi squads of up to another 30 extra players in reserve, the lack of a minor league season still dooms hundreds of farmhands to a year without organized baseball. Some could latch on with independent league teams or seek winter league spots in foreign countries. Minor


Kids are healthier when they can go to school. Even during the pandemic.

that children returning to school at full capacity will lead to increases in infection, though there are disagreements about to what degree kids present risk of spread. Some estimates suggest the effects of children in school are minimal compared to other social distancing efforts, with closures preventing as little as 2-4 percent of deaths. There are also indications children are half as likely to become infected as adults and are much less likely to spread the coronavirus than adults. Children who do become infected are at very low risk of significant morbidity and mortality from infection. As of June 24, 28 children aged 14 years and younger have died with presumed or confirmed covid-19 diagnoses (whether or not covid-19 was the cause of death). In that same period, 9,622 children age 14 and under have died of all causes. Accidents, suicides, assaults and homicides remain the most common sources of preventable death for young people. Meanwhile, keeping kids out of school puts them at significant risk of a wide range of negative health outcomes. A huge body of research before the pandemic showed when children are out of school for summer or holidays, they are less physically active, less cardiovascularly fit, have irregular sleep patterns — which can lead to a range of other health issues — and have worse nutrition, a particular issue for children who rely on schools for food. The negative outcomes of excessive screen time are well documented. Depression and anxiety have increased among young people during social isolation, and may be worse for children of color. We have every reason to believe children who are socially isolated during a pandemic are at even greater health risk, particularly as sports leagues, swimming pools, summer camps and other recreational facilities remain closed, and interaction with peers is unavailable. What is also clear is reports of child maltreatment have dropped significantly since kids have been out of school, in large part because teachers, counselors, coaches, bus drivers, and other mandated reporters aren’t seeing them. Given that unemployment, family stress, and even natural disasters increase domestic violence, it is probably the case that many children are much worse off at home than they are at school, even during a pandemic. As parents return to work, there are no plans for how children who are home from school will receive care or supervision. This could lead to increased risk of


Nationals granted D.C. approval to open ballpark for spring training reboot

This story has been updated. One day before training camp is scheduled to begin at their ballpark in Southeast, the Washington Nationals were granted approval from the D.C. government for a waiver to conduct practices and play games at Nationals Park. The World Series champions had submitted their request for a waiver early last week when Major League Baseball and the players’ union finalized an agreement to play the 2020 season, with a modified spring training, or “summer camp,” to resume this week. “I think that we will be approving their waiver today,” District Mayor Muriel E. Bowser (D) said Tuesday afternoon during her weekly news conference updating the city’s plans amid the novel coronavirus pandemic. “We will waive them for training and games, [with] no spectators.” The franchise is required to apply for a waiver based on Bowser’s order that temporarily shuttered on-site operation of nonessential businesses in the nation’s capital to stem the spread of the virus that put sports around the country on hold. The Nationals, according to Christopher Rodriguez, head of the District’s Homeland Security and Emergency Management Agency, initially had applied for a waiver for training only, then submitted a plan to seek approval for games, which are slated to begin July 23 or 24. The 2020 regular season is scheduled for 60 games over 66 days, with the Nationals reportedly hosting the New York Yankees on Opening Day. Approval for resumption of operations at Nationals Park probably would mandate compliance to guidelines similar to those outlined for Monumental Sports and Entertainment as well as D.C. United, both of which received the green light from D.C. HSEMA to resume operations. Letters of approval sent to Monumental and D.C. United requested contact information for each organization’s medical staff and that any laboratory-confirmed positive tests for covid-19, the disease caused by the coronavirus, be reported immediately to D.C.’s department of health. Monumental Sports and D.C. United were approved for waivers to operate as the District entered Phase Two of reopening June 22, allowing for, among other facilities, gyms and public pools to operate at limited capacity and with certain restrictions. The NBA’s Wizards and WNBA’s Mystics operate under the umbrella of Monumental Sports and practice at Entertainment and Sports Arena in Congress Heights. Both teams are scheduled to resume their seasons in July in “bubble” settings in Florida. MLS’s D.C. United, which resumed regular training June 15,


There is no safe way to reopen colleges this fall

estimates of the fatality rate of covid-19 are still being refined, some reliable studies place the age-adjusted case fatality rate at 0.5 percent, five times that of seasonal influenza. The risk of death among young adults falls unequally, being 5 to 9 times higher among Black, Hispanic, and indigenous young adults. Death isn’t the only worry: Clinicians are documenting heart, kidney, and neurological problems from coronavirus infection, and a recent analysis of patient experiences shows some cases continue experiencing symptoms for 50 days or longer. We still don’t reliably know what risk factors lead to these severe outcomes, but activities like vaping — which is on the rise among college students — may increase risk, and health conditions such as obesity, which occurs in 16 percent of college students, are believed to increase the need for hospital admission and critical care from covid-19. Without a well-defined risk rubric, cocooning the most vulnerable students, staff, and faculty while reopening is infeasible. If acquiring covid-19 remains risky, the question becomes whether universities can stop transmission on campus. The cardinal rule of a dangerous respiratory epidemic is to avoid unnecessary congregation. But campuses are a dense network of highly connected, clustered settings with intense social contact; students meet in dorms, classrooms and other common spaces. Diminishing connectivity through physical distancing can’t eliminate long chains of transmission. Cutting a select few environments from the college experience as a “compromise” (e.g., distanced on-campus housing or repurposing dining halls as carryout) might distance students from each other, but probably not enough to stop the spread. A recent study on data from Cornell University showed even without the effect of dormitories, shared food facilities, and extracurricular activities, physical classes create fertile conditions for disease transmission on their own. Another risk is that most interactions occur indoors. One experimental study showed SARS-CoV-2 viral particles can remain in the air for at least three hours and recirculate without significant airflow. Most traceable covid-19 transmissions happened indoors: All 318 clusters of three or more covid-19 cases in Chinese cities occurred in an indoor environment, and among eleven clusters of cases in Japanese cities, the chances of covid-19 transmission were 19 times greater in a closed environment. An investigation of large-scale outbreaks at a church and a choir practice and recent experiments also suggest situations with widespread voice projection — such as a physically distanced classroom — may increase transmission risk.


While face coverings can meaningfully reduce the risk of respiratory transmission from the wearer to others, incorrect use or lack of perfect adherence can render surgical masks ineffective at stopping transmission. The popularity of bandannas and simple cloth masks — as medical masks are prioritized for front-line responders and essential workers — makes the efficacy of these interventions less certain or reliable. Moving outside can also reduce transmission compared to poorly ventilated space, but trying to teach and learn wearing masks in a spaced-out, outdoor setting will be more disruptive than the now-familiar setting of online classrooms. Even with every evidence-backed mitigation option, there is no way to transmission-proof a physical classroom — let alone a dense, highly socially connected miniature city, interconnected with its host community. When outbreaks do happen, most public health experts agree the best covid-19 response is to test widely and identify infected cases, isolate and treat them, trace the close contacts whom they might have infected and then quarantine those contacts. But covid-19 is by nature resistant to this intervention in highly dense settings; the virus is highly infectious, with a relatively long period during which a person may be infectious but not yet showing symptoms. University administrators should be prepared for several roadblocks that could make “test-trace-isolate” a gamble. It is not clear how available or accurate tests that will be most readily available are. Testing during the presymptomatic stage currently fails to identify a large fraction of cases: Recent meta-analysis showed four days before symptoms start the false-negative rate of testing is 100 percent (meaning you would miss all cases), reducing only to 38 percent on the day symptoms start. This means approximately a third of cases would be missed. Given that so much transmission happens in the presymptomatic stage, relying on testing for case confirmation would allow significant transmission. The success or failure of the test-trace-isolate strategy depends on high frequency and high capacity; most universities will be unprepared for that monumental effort, and without regular (e.g. weekly) testing of all students and faculty, cases will undoubtedly slip through the cracks. Fever or symptom screening has been proposed by some organizations as a key for safe return. However, a large proportion of covid-19 cases occur without infectious individuals showing symptoms. As a result, relying on symptoms to detect cases would allow significant transmission to continue. Covid-19 can be transmitted before a person


Use of military contractors shrouds true costs of war. Washington wants it that way, study says.

the Costs of War project at Boston University and Brown University. “It hides the human cost and makes war more politically palatable,” Peltier told The Washington Post. The reliance on defense contractors, once touted as a way to reduce costs and improve quality of services for the military, has instead led to a glut of spending, the study concluded. More than half of the defense budget last year — $370 billion — was spent on all contractor efforts, from weapons to services, according to the study. There is also a concern that the reliance on private military contractors has blunted the public’s understanding of the human cost of America’s unprecedented long-term deployments. “You don’t see yellow ribbons around trees for contractors,” said Mark Cancian, a defense budget expert for the Center for Strategic and International Studies. “All these touching scenes of the military service member coming home and scooping his kids up at the airport, you never see that for contractors.” The Pentagon did not return a request for comment. Analysts say the reliance on private military contractors started during the Clinton administration, when U.S.-based companies played a prominent role in training and equipping the Croatian military. But the contractor economy expanded drastically after the Sept. 11 terrorist attacks, as companies found a lucrative business on sprawling bases in Iraq, Afghanistan, Kuwait and other nations. The George W. Bush administration relied heavily on private military corporations to support a fast scale-up in the U.S. military presence in Iraq as the security situation worsened there. Reports of abuses perpetrated by armed private security forces working for companies like Blackwater created a public perception of contractors as irresponsible mercenaries, stirring a broader conversation about oversight and authorities. But most contractors deployed to war zones have been engaged in the mundane yet often dangerous work of logistics and supply. U.S. contracting companies such as DynCorp and Triple Canopy have handled laundry, run dining facilities, operated bus lines, built tents and housing units, transported fuel and water, provided base security officers, and carried out other duties. Many conservative think tanks and corporations pushed the idea of contractors absorbing duties the military historically performed for itself to lower costs and improve quality, the study concluded. But often the opposite occurred, according to the study. Companies driven by no-competition bids have little incentive to cut costs. Companies further boosted profits by hiring host country citizens or


U.S. airlines will ask travelers to submit to covid- 19 health questionnaires at check-in

U.S. airlines will require passengers to answer a series of health questions before boarding, including whether they have experienced covid-19 symptoms or have been exposed to someone that tested positive for the virus, the industry’s leading trade group said Monday. Major U.S. carriers, including American, Delta and United are implementing the new health acknowledgment policy as an “additional level of protection during the pandemic,” Airlines for America said. Travelers should expect to be asked to fill out the new health questionnaire when they check-in, the airline trade group said. Besides questions about their health, passengers are asked to commit to wearing a face covering at the airport and on their flight. “Passengers who fail or refuse to complete the health acknowledgment may be deemed unfit to travel and each carrier will resolve the matter in accordance with its own policies,” A4A said. The new measure is expected to remain in place through the public health crisis. A4A President and chief executive Nicholas E. Calio said in a statement that the health assessments are one more measure in a “multilayered approach to help mitigate risk and prioritize the well-being of passengers and employees.” Airlines and airports in recent months have adopted new strategies for combating the coronavirus. In some airports, travelers have their temperatures checked upon arrival, while all major airlines are enforcing the use of face coverings. With the health questionnaires, airlines seek assurance from passengers that they are not experiencing covid-19 symptoms such as fever, shortness of breath and others such as a cough, loss of taste or smell, chills, muscle pain and sore throat. Passengers will also be asked to acknowledge if they have been exposed to someone who tested positive or had symptoms of covid-19 in the last 14 days. Other airlines enforcing the new health acknowledgment policies are Alaska Airlines, Hawaiian Airlines, JetBlue Airways and Southwest Airlines.


El coronavirus en Colombia. Los hispanos, ¿un modelo para EE UU? La condena a Fillon en Francia

Hablamos con Gina Tambini, representante de la OMS en Bogotá; con Nicholas Kristof, columnista de The New York Times, y con Andreína Flores, periodista venezolana en París


Treating coronavirus is brutal. But our hunt for better medicine keeps us going.

“Mrs. Croft, I truly regret that I’m calling you about a covid-19 research program only an hour after your husband, John, died of his coronavirus infection. None of us know what you are feeling, and we want you to know how immensely sorry we are for all that you and your family are going through. It’s just that the whole world is trying to grapple with this pandemic, and we are trying to understand what the virus is doing to the brain, since so many people are presenting with an inability to smell, confusion and strokes. I am calling to see if you might consider a priceless gift to the world so we can learn and hopefully help others: We are studying the brain in those who die of covid, and I’d like to talk with you about the possibility of donating John’s brain to our NIH-funded scientific research program.” As a physician-scientist, I have spent 30 years at the bedside of my patients and their families. There is no place I’d rather be, but I wouldn’t have stayed here for so long without the research part. Alongside 90 others in Vanderbilt’s Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, I now study covid-19, the disease caused by the novel coronavirus. The pandemic is different: tough, inspiring and exasperating all at once. Answering questions to help reduce human suffering is what we do. Attempts to flatten the curve have shuttered our existing projects and catapulted us into new work and international collaborations in what seemed like one day. And then almost as quickly this month, we were immersed in disparities. The pandemic has amplified elements of the everyday disadvantages that millions face, and it’s obvious to all of us that it’s not fair or just. Every covid-19 doctor has patients we will never forget, especially those of us who work in the ICU and specialize in mechanical ventilation. In my mind’s eye, I see faces of triumph and tragedy. Julio, a young agricultural laborer, represents both. He’d come in with horrendous shortness of breath that got worse fast. Despite this, he always greeted me with a smile, “Hola Doctor! Buenos días y gracias por cuidarme y ayudarme a recuperarme.” (Hi, Doctor. Good day, and thank you for taking care of me and helping me recover.) After 10 days on the ventilator, he seemed to be getting better. One morning, he


I now study covid-19, the disease caused by the novel coronavirus. The pandemic is different: tough, inspiring and exasperating all at once. Answering questions to help reduce human suffering is what we do. Attempts to flatten the curve have shuttered our existing projects and catapulted us into new work and international collaborations in what seemed like one day. And then almost as quickly this month, we were immersed in disparities. The pandemic has amplified elements of the everyday disadvantages that millions face, and it’s obvious to all of us that it’s not fair or just. Every covid-19 doctor has patients we will never forget, especially those of us who work in the ICU and specialize in mechanical ventilation. In my mind’s eye, I see faces of triumph and tragedy. Julio, a young agricultural laborer, represents both. He’d come in with horrendous shortness of breath that got worse fast. Despite this, he always greeted me with a smile, “Hola Doctor! Buenos días y gracias por cuidarme y ayudarme a recuperarme.” (Hi, Doctor. Good day, and thank you for taking care of me and helping me recover.) After 10 days on the ventilator, he seemed to be getting better. One morning, he was extubated and just on nasal cannula oxygen. I sat at Julio’s bedside celebrating with him, talking in my “poquito” Spanish. He stuck out his arms and gave me a hug over my personal protective equipment — a huge, strong bear hug I can still feel. That night, though, he got quiet — too quiet. Within hours, he’d suffered a massive stroke, as too many covid-19 patients do. Cayce Strength, one of our most experienced ICU research nurses, called his wife, whom none of us had met in person since she wasn’t allowed to visit, and got a consent through tears to receive Julio’s brain into our BRAIN-ICU-2 research program. I’m devastated, yet thankful at the same time. It feels weird and right. How can that be? Doing our best to provide great clinical care is getting us through the days, but it will only be through great research that we get through the years. Why did Julio have that stroke when everything else about his infection was getting better, while he was safely on prophylactic blood thinners and as markers of his blood flow indicated steady improvement? Yet just at the time we need our best research, we are


90 percent or higher. After a short treatment, his read 97. The only change we’d made was proning him onto his stomach, then angling his bed upward to make his position a bit more comfortable. Will this help John survive? The truth is we don’t know the answer to these day-to-day questions about covid-19 — yet. But all over the world, with their prior studies shut down, researchers are rapidly designing new investigations related to the pandemic to help answer important questions that will affect your life and millions of lives. Not just patients and families, but all of us in society. How does this research work, and why? Primum non nocere. Harm comes in many shapes and sizes. What about extreme social isolation during the pandemic? We hypothesize that it’s hurting not only patients, but also families, friends and health-care professionals. We know about PTSD and depression after critical illness, but is post-intensive care syndrome (PICS) going to be worse in the covid-19 era? In the past week, our center pondered these questions, gathered ourselves together, recruited other national experts and designed a study about it. We’ll get some answers quickly using a national registry and figure out the best way to mitigate harm. What about the acute brain problems we are seeing in covid-19 patients? Doctors in Spain running the Humanizing-the-ICU project wrote to me that 75 percent of their coronavirus patients have delirium. They asked, “Can we study this with you and determine risk factors for brain injury in covid and how to treat patients better?” You bet. In less than a week, we had worked with investigators throughout the world to launch a study, enrolling more than 2,000 coronavirus-infected ICU patients in a dozen countries over two weeks via my new Twitter feed. We are analyzing the data now. Will covid-19 delirium leave survivors with an acquired dementia? We already know that delirium duration is the most robust predictor of a prolonged Alzheimer’s-like dementia after critical illness. We designed an investigation to measure the long-term neuropsychological outcomes of covid-19 survivors from across the United States, and it’s going to help you learn if that confusion you saw during your wife’s coronavirus infection will leave her with memory problems that cause her trouble going back to work and organizing daily life, or shame in forgetting friends’ names at long-awaited post-pandemic parties. (If so, we will enroll her


All the ways the coronavirus will make this school year harder than the last, even if campuses reopen

the lights on" if it is forced to cut its 2020-2021 budget by 25 percent, a possibility depending on several factors. Michael Leachman, a vice president for state fiscal policy at the Center on Budget and Policy Priorities, told Congress: “The covid-19 pandemic has caused state revenues to fall off the table, creating a fiscal crisis unlike anything states have faced since the Great Depression of the 1930s. Without significant federal aid, soon, states and localities will lay off teachers and other workers and take additional steps that worsen the recession, delay the recovery, and weaken students’ education." Hundreds of thousands of teachers and other school personnel have already been laid off as a result of the coronavirus, he said. Recently, Sen. Lamar Alexander (R-Tenn), chairman of the Senate’s education committee, said he would support spending $50 billion to $75 billion to help schools, along with extra money for busing, but a spokesman in his office said it is unclear whether that would be solely for K-12 schools or would include colleges as well. He would consider the issue in the “next work cycle,” the spokesman said, but did not clarify when that would be. And a Democratic-led House bill passed recently calls for $58 billion in new funding for K-12 schools. But the Council of Chief State School Officers recently sent a letter to Congress estimating that the cost of safely reopening schools this fall is estimated to be between $158.1 billion and $244.6 billion. Many districts still don’t know how much money they will have for the new school, which in some places could open as soon as in a month. There has been much written about the pandemic causing a generation of students that could be academically lost, socially stunted and emotionally scarred. The American Academy of Pediatrics wrote in its clinical guidance on reopening schools: But exactly how students will be affected by all of this is simply not known — at least not in long-term impacts. “We currently have no way of predicting the long-term effects of the pandemic on children," Sanja Gupta, a neurosurgeon at Emory University Hospital in Atlanta and a CNN medical correspondent, wrote recently. "Covid-19 is an unprecedented natural experiment in and of itself. Some kids may come out the other end with increased resilience. Others may experience the type of long-term trauma that impairs their development and keeps them overly


Republican lawmakers confirm intelligence reports on Russian operation to target U.S. troops but say material needs further review

it?” “When people at Liberty Crossing go to get coffee today, what are they saying to one another?” Hayden said, referring to the headquarters building of the Office of the Director of National Intelligence, in Virginia. Nada Bakos, a former CIA officer who handled intelligence obtained from detainees, which appears to be a source of at least some of the information on the Russian bounty program, said she could not understand why it would not be shared with the president. Bakos said that fragmentary intelligence will at times be included in the President’s Daily Brief, “especially if it’s about something fast-moving, like in a war zone.” “Not everything that goes to the president is sure and solid — that’s not what intel is,” Bakos said. “Especially if it’s a threat.” U.S. officials presented a “low-key” briefing on the matter to NATO member countries in Brussels on Thursday, “including asking questions” about whether their own military and intelligence services had any information to add, a senior European official said. The official said the briefing took place on the “professional” level and did not rise to high-ranking officials involved in policymaking. Nearly every NATO member has some presence in the Afghanistan coalition, most of them in relatively low numbers. According to NATO figures for June, those with the highest number of troops are Germany, with 1,300; Italy, with 895; Romania, with 738; and Turkey, with 600. The United States has about 8,600 troops in Afghanistan, down from about 13,000 before withdrawals during the spring under the U.S.-Taliban agreement signed in February. Afghanistan experts have questioned whether the mainline Taliban group would be involved in any plan to attack U.S. forces, particularly as it moves closer to implementing an agreement with the United States that would achieve its overall goal of removing all foreign troops from Afghanistan. Although implementation has been slow, the deal, signed in February, calls for the last U.S. forces to leave the country by May 2021. There are, however, thought to be a number of splinter Taliban groups opposed to the peace agreement. U.S. negotiators think Russia, after spending years trying to create obstacles for the NATO effort in Afghanistan, has been cooperative, and even helpful, since serious American talks with the Taliban began last summer. It is unclear whether the bounty program, allegedly launched before that time, was part of a high-level Russian strategy that is ongoing. karen.deyoung@washpost.com


Nationals awaiting D.C. government approval to use ballpark for training camp

Days before training camp is scheduled to begin at their stadium in Southeast Washington, the Washington Nationals continue to await approval from the District government to resume operations at Nationals Park amid the novel coronavirus pandemic. The reigning World Series champions submitted their request for a waiver, according to the team, around the time early last week when Major League Baseball and the players’ union finalized an agreement to play the 2020 season, with a modified spring training to resume Wednesday. “The Nationals can’t just go into their stadium and start training,” a spokesperson for the office of D.C. Mayor Muriel E. Bowser (D) said. “They have to get a waiver. They’ve submitted a request for a waiver, but it hasn’t been approved yet.” The Nationals opened spring training at their regular facility in West Palm Beach, Fla., and left in mid-March when all such venues closed because of the coronavirus outbreak. The plan was to return to complete spring training, but the Nationals never did because of a surge of reported cases in Florida. The team is required to apply for a waiver based on Bowser’s order that temporarily closed on-site operation of nonessential businesses in the nation’s capital to stem the spread of the coronavirus. Two other local sports entities in the District — Monumental Sports and Entertainment, and D.C. United — were approved for waivers to operate. The District entered Phase 2 of reopening June 22, allowing for, among other facilities, gyms and public pools to operate with certain restrictions. The NBA’s Washington Wizards and WNBA’s Washington Mystics operate under the umbrella of Monumental Sports and practice at Entertainment and Sports Arena in Congress Heights. Both teams are scheduled to resume their seasons in July in separate “bubble” settings in Florida. MLS’s D.C. United, which resumed regular training June 15, plays at Audi Field, located a half-mile from Nationals Park. Approval for resumption of operations at Nationals Park, meanwhile, probably would mandate compliance to guidelines similar to those outlined for Monumental Sports and D.C. United, based on letters of approval each received from the mayor’s office and the District’s Homeland Security and Emergency Management Agency. Those letters request contact information for each organization’s medical staff be provided and that any laboratory-confirmed positive tests for the coronavirus be reported immediately to D.C.’s Department of Health. “One further condition of this waiver is that you consent to allow inspectors


All masked up and ready to gamble as Maryland’s casinos reopen

to stay home, avoid congregating indoors, refrain from unessential activity and keep from touching things other people have touched. But when Maryland Gov. Larry Hogan (R) moved the state into Phase 2 of its reopening plan earlier this month, casinos were given the green light to welcome customers who are now in a position to do many of those things that were once off-limits. There are firm rules in place, of course. Everyone must wear masks. Capacity is limited to 50 percent. Temperatures are checked. Hand sanitizer is everywhere. But will the gamblers come back? In Maryland, it’s a billion-dollar-plus question. Casino operators at MGM National Harbor in Prince George’s County and Live Casino and Hotel in Anne Arundel County hope there are lots of others like Hashimi out there ready to return. The state’s two top revenue-producing casinos, as well as Horseshoe Casino in Baltimore, which reopened Sunday, spent much of the shutdown retrofitting their casino floors and developing new plans to protect customers and employees as the card dealing, dice throwing and slot spinning returns. The state’s three other smaller casinos opened earlier this month. First, visitors must walk past thermal scanners that look like radar guns for a temperature check before entering the casinos. Once inside, steps have been taken to minimize contact between gamblers. The number of chairs at all game tables have been reduced. Plexiglas shields have been installed to separate players from dealers and one another. And in the banks of slot machines some have been disabled to keep distance between players. Chairs, counters, slot machines and other high-touch areas will be wiped down again and again and again, casino operators say. In addition to changes to casino floors, most of the Maryland venues have halted valet service and limited seating in restaurants and bars to ensure social distancing. Theaters at the casinos remain closed. The new safety measures are the only reason Juliana and Joseph Billiams said they were comfortable visiting the casino. The Staunton, Va., couple, who wore matching gambling-themed masks they bought on Etsy, have been making recent road trips to casinos in Connecticut, West Virginia and North Carolina to play slots. The precautions in place at MGM were better than most of the other casinos they had visited, said Joseph Billiams, 40. The couple arrived early Monday to avoid any crowds, said Juliana Billiams, 35, who works as a traveling


On his first U.S. visit as president, Mexico’s Lopez Obrador to fly commercial

tested for the novel coronavirus, even as many people in the country’s government have fallen ill. In his decision to lead a delegation on an indirect commercial flight to Washington, many here see yet another sign of an irresponsible response to the pandemic. As of Monday, Mexico had reported more than 216,000 cases and 26,648 deaths, seventh in the world. Analysts see other problems. “Sure, for a head of state to fly commercial is a challenge — to say the least — in this covid era,” said Arturo Sarukhan, a former Mexican ambassador to the United States. “But more importantly, it raises concerns about the security of the president and the apparatus — both human and technological — which is needed to ensure a security bubble so that his [communications] and conversations in transit and on-site are secure and not vulnerable before a bilateral meeting with his U.S. counterpart.” As López Obrador has crisscrossed Mexico on commercial flights, Mexicans have had the surreal experience of bumping into the president in departure terminals or at metal detectors. Videos frequently circulate on social media of crowds of travelers approaching the president, some shouting questions or criticisms, others standing in long lines for selfies. Some passengers have complained of the frenzy that ensues when the president boards their flight — with fellow travelers crowding around to take photos. In one case that drew attention this year, a family refused to travel on the same flight as López Obrador because they were worried the plane could be targeted by his political opponents. Francisco Javier Quiroz Sandoval asked that Aeromexico allow him and his family to disembark and reschedule his flight from Mexico City to the city of Villahermosa. “It seems to me irresponsible to put citizens on commercial flights in a vulnerable position with regards to security,” he said. López Obrador travels with a small team of assistants and escorts, but none of them are armed, he has said. He has continued to defend his choice to fly on commercial airlines. The president has questioned repeatedly how he can board the presidential plane while poverty remains an issue in Mexico. The former presidential plane has been available to potential buyers at about $130 million. The Mexican government has been paying fees for its maintenance and storage. López Obrador suggested this year it could be raffled off, but the idea has not come to fruition.


Republicans once again face questions about why Trump isn’t tougher on Russia

on the condition of anonymity to discuss a national security matter. Schumer suggested that lawmakers should use the national defense authorization bill, the annual legislation detailing policy priorities for the Pentagon that senators are working on this week, to punish the Russian government. “President Trump, you lose either way,” Schumer said Monday during a speech on the Senate floor. “If you weren’t briefed on this important report, how can you run an administration where something this important is not brought to your level? “If you were told about the report and did nothing, that’s even worse.” Some of the president’s closest allies in the House GOP ranks took a different stance after a briefing at the White House, with at least one emerging from the closed-door session and accusing journalists of damaging an ongoing intelligence investigation. Rep. Jim Banks (R-Ind.) lashed out at the New York Times, which first published the report, by accusing the newspaper of compromising a national security probe. “The blood is on their hands,” Banks tweeted. “Having served in Afghanistan during the time the alleged bounties were placed, no one is angrier about this than me. Now it’s impossible to finish the investigation.” But two Republicans who received the briefing — Reps. Michael McCaul (Tex.) and Adam Kinzinger (Ill.) — called for the administration to take “swift and serious action” against Putin should the intelligence bear out to be true. Senior Senate Republican leaders and heads of key committees did not disclose how much, if at all, they were aware of the intelligence. Senate Majority Leader Mitch McConnell (R-Ky.) declined to respond when asked whether he had been briefed on the matter. Sen. Marco Rubio (R-Fla.), the acting chairman of the Senate Intelligence Committee, declined to comment on specifics but said that the “targeting of our troops by foreign adversaries via proxies is a well-established threat.” Senate Armed Services Committee Chairman James M. Inhofe (R-Okla.) signaled that he was unaware of the intelligence, saying Monday that he had “asked the administration to share what it knows” and that he expected to have more information in the coming days. “We’ve known for a long time that Putin is a thug and a murderer, and if the allegations reported in the New York Times are true, I will work with President Trump on a strong response,” Inhofe said. “My number one priority is the safety of our troops.”


Millions track the pandemic on Johns Hopkins’s dashboard. Those who built it say some miss the real story.

She found herself listening for the sirens all the time. Before, they had been just background noise, ambulances regularly blasting through Beth Blauer’s neighborhood in Baltimore to or from a nearby critical-care facility for the elderly. Now she knew every emergency trip from the nursing home could turn up later as a statistic on her computer screen. The novel coronavirus was working its way through the United States, and Blauer — along with dozens of colleagues at Johns Hopkins University — was actively tracking its path. “The sirens now feel different,” she said recently. “They come with a different flood of emotions.” The noise outside her window was a tangible reminder of the human lives hidden in the maze of anonymous data that had come to dominate her days. Since launching in January, the university’s Coronavirus Resource Center has exploded in scope and popularity, garnering millions of page views and popping up in news coverage and daily conversation. Through numbers, the tracker has told the story of what the virus is doing while the story is still unfolding, offering a nearly real-time picture of its silent march across the globe. But even as data has jumped to the forefront of international discussions about the virus, the Johns Hopkins team wrestles with doubts about whether the numbers can truly capture the scope of the pandemic, and whether the public and policymakers are failing to absorb the big picture. They know what they are producing is not a high-resolution snapshot of the pandemic but a constantly shifting Etch a Sketch of the trail of covid-19, the disease caused by the virus. Case counts are consistently inconsistent. Reporting practices differ from country to country, state to state, even county to county. If authorities fail to contextualize the virus with other factors — such as Zip codes, race or Medicaid usage — the hardest-hit communities can go unseen. “Numbers in some ways instill this sense of comfort. But then on the other hand, they can be wrong,” said Lauren Gardner, the associate professor at Johns Hopkins’s Whiting School of Engineering who has spearheaded the global tracker since Day 1. “And they can be wrong for lots of different reasons.” For those looking closely, the Hopkins project does lay out a clearly legible story about American life today, one involving economic inequality, racial disparities and poor access to health care. Many of the same issues


suggesting that local health officials include probable deaths and probable infections in their counts. Some states did. Some didn’t. Sometimes some counties within a state would follow it and others would chart a different course. “It’s one thing that this is not consistent globally, that Spain presents data differently from Indonesia, and Indonesia reports differently from the U.S.,” Gardner said. “The thing that’s crazy to me is how different the reporting is within a state in the United States, let alone state to state.” By then, Johns Hopkins, like the rest of the county, was shut down. The tracker team — which now comprises dozens of professors, experts and students from multiple departments — coordinated via long Zoom meetings, emails and phone calls. “The first 6 1/2 weeks, we were building the plane as it flew, and we were flying at supersonic speeds,” said Sheri Lewis, a member of Hopkins’s Applied Physics Laboratory working on the tracker. The U.S. map soon illustrated what anecdotal reports were suggesting: Minority communities were being hit hardest by the disease. In Washington, D.C., African Americans accounted for 46 percent of the city’s population but 74 percent of deaths. In Arizona, Native Americans — who make up about 5 percent of the population — accounted for 18 percent of deaths. And in South Dakota, where African Americans are less than 3 percent of the population, they represented 17 percent of coronavirus cases; other minority populations totaling around 16 percent of the population, including Latinos and Native Americans, made up 70 percent of cases. For Gardner, the U.S. map put a spotlight on inequalities that made the pandemic more heartbreaking. “When you actually start looking at the affected populations, the breakdown of race and age and ethnicity and socioeconomic demographics, it becomes so much more human,” she said. Even Blauer, who has spent her career teasing out the social ills hidden inside strings of numbers, felt frustration and resignation as she watched the virus’s path. “We’ve known for generations that populations that are poor and living in highly dense areas have these co-morbidities that are presenting for risk for covid-19,” she said. “But the reality of the situation is we don’t do anything about it. If you are born black in this country, it’s harder for you to get a job, harder for you to keep a job and also harder for you to stay alive.”


The way these older amateur athletes are staying fit despite the pandemic offers lessons for all ages

When I talked with 76-year-old Sylvia Okala for an article about thriving older tennis players last August, she said that though she prefers to sleep late, she would get up at 5:30 a.m. to prepare for a match. Then the pandemic hit, and the U.S. Tennis Association suspended all activities in March. Okala can sleep in as much as she wants, but, “Oh my God, I miss it,” she said. The Washington, D.C., resident was used to playing four times per week. “Without competitive tennis, there’s no goal to make me practice and stay in shape,” she said. Although the media has heavily covered the interruptions to the Olympics, and to collegiate and professional sports, older amateur athletes might be even more affected, because the Centers for Disease Control and Prevention is urging that seniors take extra precautions. Asked how they’re maintaining their well-being despite the disruption of their leagues and routines, several seniors revealed strategies for overcoming adversity, regardless of one’s age or athletic ability. A prolonged gap in exercise is a blow to anyone’s fitness, but particularly for seniors, who may see a rapid falloff. “A decrease in type two, fast-twitch muscle fibers [involved in sprinting and power] can begin to be observed after three to four weeks,” said Robert Mazzeo, a professor of integrative physiology at the University of Colorado at Boulder. The “detraining effect” for aerobic endurance is even faster than for musculature. “If [older] people haven’t been keeping up, they lose ground, and we often see they can’t quite get it back,” added Louise Aronson, a geriatrician and professor at the University of California at San Francisco. Okala has had this going for her: a live-in tennis partner, her husband. They played when possible, but when the courts were closed, she resorted to hitting the ball against a utility building near her home. “Just anything to keep a racket in my hand,” she said. “We were so desperate.” Late in May, public courts reopened. Although the USTA recommends that the elderly continue to avoid tennis, Okala returned, practicing social distancing for safety. But she had another concern: “I worried I wouldn’t be able to get back.” Her movement has gradually improved over several matches — the payoff for a lifetime of investing in physical activity, Mazzeo said. He noted that the resilience of very active seniors to layoffs is comparable to that of much younger


America’s pandemic response doesn’t bode well for a potential cyberattack

America’s botched response to the coronavirus pandemic is a warning that, unless our broken political and administrative systems are fixed, the country could experience a similar breakdown in future national crises, such as a massive cyberattack. This stark message was contained in a little-noticed white paper recently released by the bipartisan Cyberspace Solarium Commission, titled “Cybersecurity Lessons From the Pandemic.” As the paper highlighted, the covid-19 outbreak has been a stress test for our national crisis-management system — and that system has, to a frightening extent, failed. The challenges of a cyberattack would be even greater. Sen. Angus King (I-Maine) and Rep. Mike Gallagher (R-Wis.), the panel’s co-chairs, describe the disorganized response to covid-19 this way: “The pandemic produces cascading effects and high levels of uncertainty. It has undermined normal policymaking processes and, in the absence of the requisite preparedness, has forced decision makers to craft hasty and ad hoc emergency responses.” President Trump’s chaotic and sometimes counterproductive personal management of the covid-19 crisis has underlined the need for clear executive authority that can coordinate different federal agencies and state and local responders. Trump dismantled or disdained the management tools that might have been useful — and seemed to develop a love-hate relationship with experts who could have helped frame a coherent response, such as Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases. This problem of coordinating the executive branch in a national crisis was the centerpiece of a report issued in March by the Cyberspace Solarium Commission. The group brought together Congress, the executive branch and private experts to recommend how to cope with the threat of a crippling cyberattack. As the report was released, covid-19 was beginning to spread in the United States, and I wrote that the pandemic was a foretaste of what we’d experience in a debilitating cyberattack. Now, after three months of White House missteps, the commission’s findings are even more relevant. The commission’s marquee proposal was to create a national cyber director as the president’s chief adviser on cybersecurity and related issues. This cyber czar, confirmed by the Senate, could pull together a coherent, whole-of-government response, which has so far been lacking with covid-19. The commission’s recent white paper amplified this recommendation: “In confronting COVID-19 and other catastrophes, it is imperative that the executive branch be guided by strong leadership, including subject matter experts who are sufficiently empowered


CDC says colleges should not give covid-19 tests to everybody returning to campus this fall. Here’s why.

In May, I published detailed guidance from the U.S. Center for Diseases Control and Prevention (CDC) about how colleges and universities can safely reopen — and now, the agency has released some updated guidance on when and who to test for covid-19. You can read it below. Hundreds of colleges and universities have announced they will reopen campus this fall, with protective measures to try to prevent an outbreak of covid-19, the disease caused by the novel coronavirus. Many have said they will limit the number of students allowed on campus. Some are allowing students to live in the dorms but take most or even all of their courses online. Schools are trying to figure out who to test for the coronavirus and when. According to the CDC, some colleges and universities are planning to test everybody returning to campus, but the agency is now advising against it. It says: A recent story in Inside Higher Ed Here’s the new guidance, with all of the CDC links, from the agency’s website. The boldface is in the original document: These interim considerations are based on what is currently known about SARS-CoV-2 and COVID-19 as of the date of posting, June 30, 2020. The U.S. Centers for Disease Control and Prevention (CDC) will update these considerations as needed and as additional information becomes available. Please check the As some institutions of higher education (IHEs) open in the United States, CDC offers considerations for ways in which IHEs can help protect students, faculty, and staff and slow the spread of the coronavirus disease 2019 (covid-19). Testing to diagnose covid-19 is one component of a comprehensive strategy and should be used in conjunction with promoting behaviors that reduce spread, maintaining healthy environments, maintaining healthy operations, and preparing for when someone gets sick. These CDC considerations are meant to supplement — not replace — any federal, state, local, territorial, or tribal health and safety laws, rules, and regulations with which IHEs must comply. Implementation should be guided by what is feasible, practical, and acceptable, as well as tailored to the needs of each community. IHEs vary considerably in geographic location, size, and structure. As such, IHE officials should determine, in collaboration with state and local health officials, whether to implement any testing strategy, and if so, how to best do so. Symptom screening and testing are strategies to identify individuals with covid-19. In addition to


screening and testing, covid-19 contact tracing is an effective disease control strategy that involves identifying individuals and their contacts. Screening, testing, and contact tracing are actions that can be taken to slow and stop the spread of covid-19. These strategies must be carried out in a way that protects individuals’ privacy and confidentiality and is consistent with applicable laws and regulations. In addition to state and local laws, IHE administrators should follow guidance from the Equal Employment Opportunity Commission when offering testing to faculty, staff, and students who are employed by the IHE. IHEs also should follow guidance from the U.S. Department of Education on the Family Educational Rights and Privacy Act (FERPA) and the Health Insurance Portability and Accountability Act (HIPAA) and their applicability to students and covid-19 contact tracing and testing. Types of tests to identify SARS-CoV-2, the virus that causes covid-19 Viral tests Antibody tests CDC recommendations for SARS-CoV-2 testing are based on what is currently known about the virus. SARS-CoV-2 is new and what is known about it continues to change rapidly. Information on testing for SARS-CoV-2 will be updated as more information becomes available. When testing might be needed This document describes scenarios when IHEs may need to conduct SARS-CoV-2 viral testing for students, faculty, or staff, though ultimate determinations for such a test rest with IHEs in consultation with local health officials: Testing individuals with signs or symptoms consistent with covid-19 Consistent with CDC’s recommendations, individuals with covid-19 signs or symptoms should be referred to a health-care provider for evaluation on whether testing is needed. In some locations, individuals can also visit their state or local health department’s website to look for the latest local information on testing. One strategy to identify individuals with covid-19 signs or symptoms is to conduct daily symptom screening such as temperature screening and/or symptom checking for students, faculty, and staff. These screenings are one of many strategies IHEs can use to help lower the risk of covid-19 transmission. However, because symptom screenings are not helpful for identification of individuals with covid-19 who may be asymptomatic or pre-symptomatic, symptom screening alone will not prevent all individuals with covid-19 from entering the IHE. Screenings should be conducted safely and respectfully and in accordance with any applicable privacy laws and regulations. IHEs may use examples of screening methods found in CDC’s General Business FAQs. IHE administrators and health-care providers should immediately


As MLB players report to summer camps, the sport braces for more positive tests

person in question chooses otherwise. In doing so, according to an MLB spokesman, the sport would be deferring to the wishes of the union and adhering to privacy guidelines under the federal Health Insurance Portability and Accountability Act (HIPAA) and baseball’s collective bargaining agreement — the latter of which states: “For public relations purposes, a Club may disclose the following general information about employment-related injuries: (a) the nature of a Player’s injury, (b) the prognosis and the anticipated length of recovery from the injury, and (c) the treatment and surgical procedures undertaken or anticipated in regard to the injury. For any other medical condition … a Club may disclose only the fact that a medical condition is preventing the Player from rendering services to the Club and the anticipated length of the Player’s absence from the Club.” Procedurally speaking, a player who tests positive would be placed on a specially created “COVID-19 Related Injured List,” which will be separate from the standard injured list. (Notably, it would not require a positive test for a player to be placed on the covid-19 list; a player with confirmed exposure to the coronavirus or who shows symptoms can also be placed there.) Publicly, however, a team would reveal only that the player was placed on the injured list. Team officials, of course, would know about the diagnosis and would be required under the terms of the operating manual to initiate contact tracing with people, including teammates, “who had close contact with the infected individual, while maintaining the confidentiality of the infected individual to the extent possible.” From a practical standpoint, names will almost certainly become public. If, for example, a manager is asked by reporters about the whereabouts of a player who is suddenly absent on a given day, and the manager declines to reveal why the player is missing, the reason would be obvious. And, of course, an individual player can choose on his own to make public his coronavirus diagnosis. “Somebody would not be available … but we might not be able to speak to why,” Cashman said. “It would be a speculating circumstance.” The Philadelphia Phillies, who already suffered an outbreak at their Clearwater, Fla., spring training headquarters in which at least seven players tested positive, are expecting some players — “a handful, at minimum,” according to GM Matt Klentak — to open camp on the covid-19 list. Baseball officials


In Emily Temple’s ‘The Lightness,’ troubled teens fall hard for the promise of spirituality

Confession: I read “The Secret History,” by Donna Tartt, and enjoyed it, but it did not change my life. Nor did it make me long for new versions of its plot about a cabal of college students who take part in a crime they spend years hiding. But Tartt’s 1992 novel appears to have made an impression on debut novelist Emily Temple. (Full disclosure: Temple is an editor at Literary Hub, where I am a contributing editor, but we have neither met nor corresponded.) Temple’s book, “The Lightness,” places a group of wounded and ornery teenage girls at “a panspiritual contemplative community” retreat in the mountains, where the gardener is a man-bun-sporting slice of heaven named Luke. What could go wrong? Despite my lukewarm memories of “The Secret History,” I rode along happily for much of Temple’s book. The narrator, Olivia, arrives at the Levitation Center for its annual summer program aimed at young women whose families despair of their behavior — or, as is Olivia’s case, just want to unload their daughters for a month or two. After her father disappears, Olivia runs away, “if you can really call it running away when you leave plain tracks and credit card receipts and no one bothers to come after you.” As it happens, Olivia’s father is a dedicated Buddhist and devotee of the Center who believes it is one of the only places in the United States where meditation-induced levitation is possible. Luke has supposedly achieved levitation, and so Olivia and the friends to whom she becomes attached — Laurel, Serena, Janet — circle around him, at first cautiously, then with abandon. Temple makes this melodramatic trope work thanks to her unusual, clipped and very funny style. “Men are always comparing naked women to other things,” Temple writes, “as if our exposed flesh is too bright to be experienced without simile. As if bare breasts won’t blind you if they’re cans, cantaloupes.” She’s a gifted writer and storyteller with an unwavering command of her plot. The plot she’s chosen remains melodramatic, however: Hormone-drunk adolescents fall for something part-spiritual, part-magical, and go too far — way, way too far. The four friends constantly touch and stroke and lounge on one another in what might be a realistic view of young female sexuality if it weren’t combined with all their scheming and manipulation to have Luke teach them the secrets of levitation,


Ivy League plans ‘final decision’ on fall sports next week

The Ivy League will make a decision next week on whether athletes at its schools can play sports this fall amid overall uncertainty about whether the novel coronavirus pandemic will jeopardize on-campus classes and the return of students. “With return to campus protocols still being developed and introduced by Ivy League institutions, the Council of Ivy League presidents intends to announce a final decision regarding the status of intercollegiate athletic activity for the fall term 2020 on July 8,” it said in a statement Wednesday. “That decision will be communicated first to Ivy League directors of athletics, coaches and student-athletes, followed by the wider Ivy League campus community, media, alumni and the public.” Last week, TMG Sports reported the league was considering two possibilities for the football season, including skipping fall competition in favor of a seven-game, conference-only spring season from April to mid-May. The other option under consideration was pushing the season to a late September start with a seven-game schedule against conference opponents only. The Ivy League normally plays a 10-game schedule; this year’s is set to begin Sept. 19. Forbes reported Ivy League schools don’t compete in the Football Bowl Subdivision, but the conference is influential, just as it was in the spring when March Madness was canceled. On March 10, it was the first college sports body to cancel its basketball conference tournament, making a decision that was initially seen as an overreaction. Four weeks before the NCAA men’s basketball national championship game was scheduled to take place, Robin Harris, executive director of the league, held conference calls with league presidents, who were listening to their schools’ medical experts, and other sports quickly followed suit. “As the situation changed daily, if not more often than daily, and as the situation became worse very much consistent with what all these medical experts were predicting and as our schools were implementing their own policies for campuses, that’s what influenced our decision about athletics,” Harris told The Washington Post’s Adam Kilgore in April. “We went from, in the span of a few days, the presidents trying to come up with a policy for limited attendance so we could still have the basketball tournaments. That was seriously considered on Monday morning, March 9. By Tuesday, we had canceled the tournaments. We had limited attendance for spring sports. And then Wednesday canceled everything. That’s how quickly things were changing.” Harris said


Ethiopia protests spark Internet shutdown and fears of high death toll after popular singer killed

said six people were killed by security forces in Ambo on Wednesday. Roads across Oromia were closed, many blocked by protesters chanting "Abiy is our enemy," according to witnesses. The demonstrations in Oromia as well as the capital were the latest indication of seething ethnic grievances that have repeatedly threatened to derail Ethiopia's transition to multiparty democracy. The government shut down the country's Internet on Tuesday — a common tactic during unrest — and has not yet restored the service. Hachalu, 34, belonged to the Oromo ethnic group, the country’s largest, and was shot in his car on the outskirts of Addis Ababa on Monday night. He died hours later in a hospital. Police said his assailants and their motives are unknown. His songs had galvanized a movement that succeeded in pushing Ethiopia’s previous prime minister to step down and opening the way for democratic reforms. Abiy, himself an Oromo, has released political prisoners, allowed greater freedom of speech and lifted a ban on several opposition groups, but many Oromos say they continue to be marginalized in the nation-building process. Abiy won last year’s Nobel Peace Prize for his efforts in brokering an end to a decades-long standoff with Ethiopia’s northern neighbor, Eritrea. Domestic conflicts have proved harder to smooth over, and millions of Ethiopians remain internally displaced. “This is an act committed and inspired by domestic and foreign enemies in order to destabilize our peace and to stop us from achieving things that we started,” Abiy said Tuesday, in reference to Hachalu’s killing, without providing evidence. Long before the pandemic delayed parliamentary elections, which were scheduled for August, analysts had warned that simmering discontent in Oromia ahead of the vote could lead to large-scale bloodshed. A prominent Oromo media outlet reported that its founder, Jawar Mohammed, and Bekele Gerba, two of the country’s most prominent Oromo politicians, were arrested in connection with an argument over the burial of Hachalu’s body. Dozens of others were also arrested, the outlet said on Facebook. In a Facebook post just before the Internet was shut off, Jawar posted an impassioned tribute to Hachalu. “They did not just kill Hachalu. They shot at the heart of the Oromo Nation, once again !! . . . You can kill us, all of us, you can never ever stop us!! NEVER !!” he wrote. In October, Jawar warned on social media about government moves against him,


The Technology 202: IBM and Notre Dame team up on new tech ethics lab

more ethics resources on campus could change that. “Rather than following the ‘ready, fire, aim’ approach sometimes used in developing new technologies, we hope to provide resources that allow developers and industry to create better, more responsible technologies that positively benefit society,” said Mark McKenna, acting director of the Technology Ethics Center at Notre Dame. The accelerating development of artificial intelligence, quantum computing and other technologies is also putting pressure on universities to think about these issues at earlier stages. The new lab is housed within Notre Dame’s Technology Ethics Center, which launched in fall 2019 to bring together people from different academic disciplines who are interested in the dilemmas confronting the industry. The center was founded on the belief that many tech ethics discussions are lacking from expertise of people in the social sciences, particularly from philosophy. “A lot of technology ethics problems are really ethical problems that have existed a very long time, but they just have new applications because of the nature of technology,” McKenna said in an interview. “You can’t really make progress on them if you’re just looking at them from within technical disciplines.” IBM began discussing launching the new lab with Notre Dame in the fall. The lab also plans to tackle problems related to artificial intelligence, in hopes that improving ethics and transparency will allow people to trust it more. Right now many of the algorithms are a black box, and people might not know why they are making sensitive decisions related to hiring or receiving a mortgage. Colleges across the country are shaking up the way they teach ethics to computer science students. In the heart of Silicon Valley, Stanford’s Center for Ethics in Society launched a large course two years ago that integrates computer science, public policy and ethics. About 250 students took the course at launch, and the university continues to offer it. The center is also working to embed ethicists within the faculty to develop assignments that would be included in the core curriculum for computer science students. Robert Reich, the director of that center, said these efforts date back to 2015, but the recent problems in the industry have given the work greater urgency. “Stanford is the site for many of the innovations of Silicon Valley; it also has responsibilities to invest in research and teaching on the ethical and societal dimensions of technological innovation,” he told me


Local Digest: Two men killed in shootings in Northeast and Southeast D.C.

THE DISTRICT Two men were fatally shot early Wednesday in Northeast and Southeast Washington, according to D.C. police. One shooting occurred about 1:20 a.m. in the 4000 block of Grant Street NE, across from the Minnesota Avenue Metro Station. Police said a man was pronounced dead at the scene. Police identified the victim as Dennis Dykes, 34, of Southeast. A police report says he had been shot several times in the body. A second shooting occurred about two minutes later and three miles away, in the 1800 block of Q Street SE, near Anacostia Park. Police said a man was found unconscious and was later pronounced dead at a hospital. Police identified the victim as Kelvin Goggins, 18, of Southeast. A police report says he had been shot in the face. Six more people were shot in the District on Tuesday night into Wednesday morning, according to police, in Southeast and Northwest Washington. None of their injuries were believed to be life-threatening. Homicides in the District — Peter Hermann The operator of a motor scooter was killed Tuesday in a crash in Southeast Washington, D.C. police said. The gasoline-powered scooter was going south about 1:55 p.m. in the 1700 block of 25th Street SE, police said, when it went around vehicles stopped at a stop sign and entered the intersection with Naylor Road. It was struck by an SUV, police said. The scooter operator died at a hospital, police said. His name was not immediately available. — Martin Weil MARYLAND A body was found in a lake in Charles County on Tuesday, a few hours after a woman living nearby heard a cry of distress in the early-morning darkness, according to authorities. The woman heard a man yelling for help about 4:40 a.m. near a lake behind her house on Fountain Head Court in the Waldorf area, the county sheriff’s office said. Emergency personnel, including a dive team, arrived and began searching, the sheriff’s office said. Divers recovered the body of a man about 8:45 a.m. The man was identified as Raymond Anthony Savoy Jr., 31, of Waldorf, according to the sheriff’s office. An autopsy is to be conducted to determine the cause of death. No obvious signs of trauma were found, the sheriff’s office said. — Martin Weil


Mexico has few reasons to celebrate the USMCA as violence flares in alarming ways

As the U.S.-Mexico-Canada Agreement comes into effect on Wednesday, Mexican President Andrés Manuel López Obrador is preparing to defy criticism at home to travel to Washington to celebrate the deal along with President Trump, who is eager to tout the agreement as a meaningful accomplishment to bolster his reelection case. For Mexico, the positive gains from the deal are far less certain. For one, López Obrador’s erratic management of the Mexican economy amid a growing number of covid-19 cases has dimmed the country’s potential as a promising investment destination in the short and longer term. But the Mexican president’s populist economic policies could soon be eclipsed by a more urgent crisis: Violence in the country is flaring up in alarming ways. Last week, on Friday morning in Mexico City’s affluent Lomas de Chapultepec neighborhood, a large group of heavily armed men ambushed Omar García Harfuch, the Mexican capital’s chief of police, in an unprecedented brutal and brazen attack. As García Harfuch’s armored SUV approached an intersection, a large pick-up truck full of hired assassins blocked its way. Another vehicle advanced from behind, making escape impossible. Then came three minutes of hell. The attackers shot at least 400 rounds at close range. Two of García Harfuch’s bodyguards died in the attack (one took 38 bullets). A woman who was caught in the crossfire along with her family was also killed. García Harfuch survived but was badly wounded. As they fled, the killers left behind a cache of weapons of war, including grenades, a grenade launcher and molotov cocktails. The plan, according to Mexican journalist Héctor de Mauleón, was to kill García Harfuch and then torch his remains inside the vehicle. That they failed is nothing short of a miracle. But who were the attackers exactly? A few minutes after he was extracted from the demolished shell of his SUV, García Harfuch himself took to Twitter to identify the group responsible for the unprecedented attempt to assassinate a high-profile figure on the streets of Mexico City. “This morning we were cowardly attacked by the CJNG,” he posted. Over the past 10 years, the Cartel Jalisco Nueva Generación, or CJNG, has become Mexico’s most violent drug organization. “It has made extreme violence a kind of business card,” de Mauleón, who has been documenting the rise of CJNG for years, told me recently. “Videos of rivals being dismembered are their favorite method of propaganda.”


Boeing minimized to FAA the importance of flight control system implicated in 737 Max crashes, new report says

a consequence, neither Boeing nor the FAA called for installing key safety redundancies, which experts say could have saved the planes. An FAA spokesman declined to respond directly, referring instead to a response from a key deputy to Transportation Secretary Elaine Chao. The report points to “some strengths in FAA’s aircraft certification process, as well as areas for improvement,” General Counsel Steven G. Bradbury told the inspector general in a letter last month. Bradbury said the “FAA anticipates strengthening coordination” among agency officials responsible for certification, “as well as enhancing its human factors, flight controls, and system safety expertise to address weaknesses that led to an incomplete understanding of MCAS prior to certification.” Sen. Roger Wicker (Miss.), the Republican chairman of the Senate Commerce Committee, which oversees aviation, and his Democratic counterpart, Sen. Maria Cantwell (Wash.), have jointly introduced legislation that would strengthen the FAA’s oversight of Boeing employees who conduct safety work on behalf of the agency and ensure that government and company employees are free to communicate with one another. The bill would also require the FAA to rethink its approach to evaluating the risks posed when automated flight systems and human pilots have to work together. Previous reviews of the Max crashes have concluded that the agency and Boeing did not anticipate the difficulty some pilots would have overriding the MCAS if it failed. House Democrats also are expected to introduce legislation following an extensive investigation into Boeing and the FAA. An interim report they released branded the agency as “grossly insufficient” in its initial review of the Max and blamed Boeing for having a “culture of concealment.” FAA Administrator Steve Dickson has said that the coronavirus pandemic has not slowed the agency’s work in reviewing the Max. But he told members of Congress recently that convening a panel involving pilots from around the world, another important step in the process, could be challenging. Dickson has said he will personally fly a Max before signing off on ungrounding it. “The report reinforces concerns that have been raised by the Commerce Committee, including Boeing’s lack of candor during the certification process, FAA’s questionable oversight of critical safety systems, and the FAA’s response after the Lion Air crash,” Wicker said. “Although the IG report does not include recommendations, it does provide a factual basis for further consideration of bipartisan aviation safety legislation that Senator Cantwell and I have introduced.”


For athletes, decision to opt out is fraught with health concerns and pull of social activism

and its players’ union announced 16 players from a pool of 302 tested positive in the first round of mandatory tests last week. The Denver Nuggets shut down their training facility Saturday after two members of their traveling party tested positive. The Philadelphia Phillies announced an outbreak among players and staff at their spring training headquarters in Clearwater, Fla. The Tampa Bay Lightning closed its facilities after three players and other staff members tested positive. The WNBA, so far, has had the most prominent players deciding to stay home. Cloud and LaToya Sanders are starters on the defending champion Mystics. Maya Moore (Minnesota Lynx), Jonquel Jones (Connecticut Sun), Renee Montgomery (Atlanta Dream), Tiffany Hayes (Dream), Kristi Toliver (Los Angeles Sparks), Chiney Ogwumike (Sparks), Cecilia Zandalasini (Lynx) and Rebecca Allen (New York Liberty) have chosen to sit, either for medical reasons or to focus on social activism. Montgomery was already a self-described germaphobe before the global pandemic. She would wear masks on planes and took blankets to sit on at the movie theater, but her decision to opt out came a few days after Floyd’s death. She said she needed to take action. Since then, she has hosted a Juneteenth block party in Atlanta and is now focused on the educational aspect of social justice. “I couldn’t stop thinking about [Floyd]. … It was almost like a reoccurring nightmare,” Montgomery said. “I’m jumping off of a cliff in a sense of, I took a leap and I don’t necessarily know where I’m going to land with it. … But I feel like when you’re doing stuff for the right reasons and your heart’s in the right place, it’ll work out. “I didn’t go back and forth. I know myself and … I’m a passionate player. When I play, I’m passionate. So, I need to have that passion to play and, right now, my passion is here with this movement.” That passion can also be exhausting. People of color, African Americans in particular, have been physically challenged during the past several months. The coronavirus has disproportionately affected black communities, and watching video after video of black people being killed can be mentally draining. Cloud said she sometimes feels exhausted before she even starts the day, but she’s encouraged by the support she receives and has had in-depth conversations with Irving, the Wizards’ Bradley Beal and others. Addressing voting issues is the next


New evidence that Trump’s handling of the coronavirus pandemic is pushing his support lower

country has collapsed. That month, 31 percent felt satisfied with how things are going in the country compared with 68 percent who said they were dissatisfied, a net minus-37 view of the nation. That gap has grown to minus-75 points, thanks largely to a collapse in satisfaction among Republicans. Only about a fifth of Republicans still express satisfaction about how things are going. Again, strongly suggestive of why Trump’s fortunes are eroding. But then there is Pew’s more direct examination of how views of Trump have changed, measured in shifts in opinions of his performance as president among a consistent panel of poll respondents. Three months ago, Pew asked a group of people whether they approved of Trump’s performance as president. On net, they didn’t, with 45 percent approving and 52 percent disapproving. This month, Pew asked the same people — a group statistically representative of the country as a whole — how they viewed Trump. Eight percent jumped from the “approve” to “disapprove” columns, totaling one out of every six people who approved of Trump in March. Now, nearly 6 in 10 disapprove of Trump’s performance as president. Who are those people whose opinions of Trump deteriorated? Pew’s analysis indicates that they are more likely to be under the age of 30 than those who approved of Trump in both March and June. They are also likely to be in a lower income bracket, a trait that tends to correlate with age to some extent. Perhaps most indicatively, though, 45 percent of those whose opinions of Trump sagged live in areas hit hardest by the pandemic. In other words, there’s a significant link between living in places where the effects of the pandemic have been worse and views of Trump heading south. What constitutes an area hit harder by the pandemic? Pew looked at deaths per 100,000 residents, assigning each county to a high, medium or low designation. It’s worth noting that the data used for this analysis looks at deaths as of June 17, meaning that the recent resurgence of the virus in heavily red states (Texas, Florida and Arizona, among them) isn’t entirely captured in the categorizations. Respondents were asked specifically how much confidence they had in Trump or Biden to address the pandemic. Forty-one percent expressed at least some confidence in Trump. More than half said the same of Biden. While Pew’s use of a panel


Protests probably didn’t lead to coronavirus spikes, but it’s hard to know for sure

has not tracked data about whether new cases there are tied to the protests. Meanwhile, data from other cities suggests protests have not been followed by an increase in cases of covid-19, the disease caused by the novel coronavirus. Minneapolis, where Floyd was killed and where the protests began, has registered a steady decrease in case numbers this month. According to Minneapolis Department of Health spokesman Doug Schultz, more than 15,000 people were tested at centers the city set up in communities affected by the protests, and 1.7 percent of tests came back positive — below the statewide average of about 3.6 percent. Health systems in the area that tested thousands of people who attended the demonstrations returned positivity rates of less than 1 percent. Schultz said officials believe the low infection rates reflect that the protests were outside, that most people wore masks and that people spent most of their time in motion, circulating through the crowd. Officials in New York and Philadelphia have drawn similar conclusions and say they see no evidence of cases accumulating because of the protests. In Seattle; Portland, Ore.; and Oakland, Calif. — cities experiencing a coronavirus resurgence — officials have asked people testing positive whether they attended protests, and few said they had. Neetu Balram, a spokeswoman for Alameda County, which includes Oakland, said officials there figured they would have identified signs of a demonstration-related outbreak by now but haven’t. The same is true in Seattle. Out of more than 1,000 positive tests in recent weeks, 34 of the people testing positive said they attended a protest or mass gathering since late May, according to King County Health Officer Jeff Duchin. Nearly 3,000 people who said they were at protests have been tested by the city, and fewer than 1 percent were positive, Duchin said. “The data may be imperfect, but we certainly don’t have any evidence that those gatherings outdoors are triggering this increase we’re seeing,” Duchin said. In other places, the impact of the protests is less clear. Brent Andrew, spokesman for San Francisco’s Department of Public Health, said the city is still monitoring potential ties between a recent surge in cases and protests. In Houston, at the epicenter of a covid-19 crisis in Texas, officials attribute rising case loads to a variety of factors — and say protests could be one. Houston Health Department spokesman Porfirio Villarreal said rising cases


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Russia misses World Athletics payments, jeopardizing track athletes’ eligibility

The eligibility of Russia’s top athletes to compete at global track and field events is in question after the sport’s governing body announced Thursday that the Russian Athletic Federation failed to make a fine payment of more than $6 million due Wednesday. World Athletics said in a news release that it has not received any money from the Russian federation or any assurance of when or if the money will be paid despite “reminders and correspondence with the federation.” World Athletics will temporarily shutter its Russian Taskforce and Doping Review Board, the departments that allow for the program that permits Russian athletes to compete under a neutral flag while Russia remains suspended for widespread doping offenses. World Athletics said it will revisit the matter at its next council meeting, which is scheduled for July 29-30. Russian athletic officials had indicated they would be unable to make fine payments to World Athletics. Russia owed World Athletics a $5 million fine and $1.31 million in fees, including legal costs and money spent on investigating high jumper Danil Lysenko, whom Russian track officials protected from doping tests using forged documents, the Athletics Integrity Unit found. World Athletics announced the fines in early March, shortly before the Tokyo 2020 Olympics were rescheduled for 2021. The Russian Athletic Federation asked World Athletics in writing for more time to pay, Russian Sports Minister Oleg Matytsin told state news agencies Wednesday, according to the Associated Press. Matytsin also asked that any punishment not include sidelining independent athletes from Russia. “The money, unfortunately, has not been found,” Russian track federation president Yevgeny Yurchenko told the Tass state news agency Wednesday, according to the AP. Yurchenko also told Tass that Russia should receive leniency from World Athletics because of the economic problems produced by the novel coronavirus pandemic. “We recognize these are difficult times, but we are very disappointed by the lack of progress made by RusAF in terms of the requirements set in March,” World Athletics President Sebastian Coe said in a statement. “The serious allegations of breaching the anti-doping rules resulted in a new RusAF administration and we had assurances and hoped that change was on its way. … RusAF is letting its athletes down badly.”


Heart conditions drove spike in deaths beyond those attributed to covid-19, analysis shows

are recorded on some death certificates mean some covid-19 deaths could be included in the analysis of other causes; however, the number is small and does not account for the dramatic increase in excess deaths from heart disease and other causes, said Robert N. Anderson, chief of the Mortality Statistics Branch of the National Center for Health Statistics. Piazza said he was not surprised to see across-the-board increases in diabetes deaths given that the pandemic has drastically altered routines, making it more difficult for people to stick to regular diets and exercise crucial for glucose control. Some diabetics may be reluctant to go to the pharmacy and could be more likely to run out of medication, he said. The Post analysis estimated there were more than 1,300 excess deaths from diabetes. “Diabetes is the kind of illness that requires, for good control, a reasonable amount of monitoring from both patient and provider,” Piazza said. The Post analysis also estimated there were 1,300 more deaths attributed to Alzheimer’s disease than would have been expected, adding to the pandemic’s devastating toll on the country’s elderly. The coronavirus has made nursing homes some of the deadliest places, and responding to the crisis probably affected care across the board, Bhadelia said. Facilities may also have been reluctant to send uninfected residents to hospitals for fear of exposure, she said. “They just didn’t get timely care,” Bhadelia said. And as with other diseases, experts said, some of those Alzheimer’s deaths may have been missed cases of covid-19. The Post’s analysis found that cerebrovascular diseases — stroke and other conditions that involve blood flow to the brain — accounted for more than 170 excess deaths in New York City and more than 120 in New Jersey. In New York state and Illinois, the numbers were smaller, well below 100 each. Massachusetts and Michigan saw about the same or fewer deaths from strokes than would have been expected over the same period. Though covid-19 was originally believed to be primarily a respiratory illness, Eriksson noted its ability to attack blood vessels and form blood clots. That virus-related complication could have created stroke symptoms in some patients, he said, but there also almost certainly were patients who delayed stroke treatment out of fear of exposure to the virus. Analyzing deaths by cause underscores the severity of the pandemic, its cascading effects and the deadliness of the novel coronavirus,