Facing coronavirus pandemic, Trump suspends immigration laws and showcases vision for locked-down border

SAN ANTONIO — President Trump has used emergency powers during the coronavirus pandemic to implement the kind of strict enforcement regime at the U.S. southern border he has long wanted, suspending laws that protect minors and asylum seekers so that the U.S. government can immediately deport them or turn them away. Citing the threat of “mass, uncontrolled cross-border movement,” the president has shelved safeguards intended to protect trafficking victims and persecuted groups, implementing an expulsion order that sends migrants of all ages back to Mexico in an average of 96 minutes. U.S. Border Patrol agents do not perform medical checks when they encounter people crossing into the country. Homeland Security officials say the measures are necessary to protect U.S. agents, health-care workers and the general public from the coronavirus. Tightening controls at the border and preventing potentially infected populations from streaming into the United States minimizes the number of detainees in U.S. immigration jails and border holding cells. At a time when much of the nation is locked down, they say, strict border controls are an essential public health response, as each unmonitored crossing potentially exposes U.S. communities to what Trump has called an “invisible enemy.” “Our nation’s top health-care officials are extremely concerned about the grave public health consequences of mass uncontrolled cross-border movement,” Trump said last month in announcing new immigration restrictions. The border with Mexico and the huge steel barrier the president is building there — still under constant construction during the crisis — remain key campaign issues for the president. During White House briefings on the pandemic, Trump has repeatedly brought up his border wall project, unprompted, and has touted construction progress, overstating the number of miles crews have completed as he says he is fulfilling his 2016 campaign promise. Trump has for years assailed U.S. immigration laws as too lenient, and the global pandemic has allowed the president to drop many of the policies and legal protections he calls the “worst immigration laws ever.” In their place, he has created a pilot test for the impact of the more draconian measures he has long advocated. The most immediate impacts are that migrants who illegally cross the U.S. border are no longer taken to border stations where they would have the chance to file a claim for humanitarian protection and access to U.S. immigration courts, and some unaccompanied minors who typically would receive protection and shelter


the approval of their supervisors before taking an asylum seeker back to a Border Patrol facility, according to the new rules, dubbed “Operation Capio.” “This is an anomaly,” said one CBP official who was not authorized to speak publicly about the measures. “The norm is not applicable in this environment under these circumstances.” Selee said the administration might be slow to lift the emergency measures even after the pandemic subsides. Governments around the world that have struggled with a surge of asylum claims could use the pandemic as a “back door” to toughen immigration laws and implement other restrictions, he said, “because it’s harder to question a health rationale.” When he announced the new restrictions last month, Trump cited the threat of “mass global migration that would badly deplete the health-care resources needed for our people.” Mexico has confirmed fewer than 1,500 positive cases of the virus so far, less than 1 percent of the number in the United States, but testing there is not widely available. Many countries have seen major spikes in coronavirus cases just weeks after discovering their first few, as has happened in the United States. “Every week, our border agents encounter thousands of unscreened, unvetted and unauthorized entries from dozens of countries. And we’ve had this problem for decades,” Trump said. “In normal times, these massive flows place a vast burden on our health-care system, but during a global pandemic, they threaten to create a perfect storm that would spread the infection to our border agents, migrants and to the public at large. Left unchecked, this would cripple our immigration system, overwhelm our health-care system, and severely damage our national security.” Despite the recent drop in crossings, CBP officials and border agents say they fear a rush on the border if Mexican hospitals are overwhelmed, especially in the large border cities such as Ciudad Juárez and Tijuana that are home to millions of people, many of whom work in cramped assembly plants. The economic damage from the pandemic is likely to trigger millions of layoffs in Mexico and Central America, potentially creating new emigration pressures. U.S. and Mexican authorities say they are cooperating closely to secure the border. In an extraordinary step, Mexico is accepting the return of adults and families from Guatemala, Honduras and El Salvador who are “expelled.” The Mexican government said it will accept those returns on a case-by-case basis, but in


Love and medicine in the time of covid-19

Covid-19 changes everything — even, or especially, love. It demands that we love differently, and in new ways. For me, this is what #loveinthetimeofcovid19 looks like. My husband, Lunan, and I are both doctors. Lunan, a urologist, is completing his final year of training in New York, and I am a family-physician educator at a medical school in Miami. We are living separately this year — one of the many sacrifices we’ve made in pursuing our medical training over the past 12 years. Since August, he and I have been traveling back and forth to see each other two or three times per month. Now we’re not sure when we’ll be together again — and for us, that has been the most painful and personal part of the daily reality of covid-19. I love being a family physician and caring for my patients, but the mobile health center where I work was shut down as we transitioned to telehealth. Without personal protective equipment, we couldn’t safely care for our patients within our clinic’s tight confines. My patients are nearly all uninsured; the majority are immigrants, and they are usually hard to contact, given the uncertainty of their phone plans. A lot of my time is spent managing the social determinants of my patients’ health — giving them referrals for food assistance, social-work support and immigration counseling — and helping them with their anxiety and depression, which are exacerbated by their difficult lives. Over the past few weeks, many of my patients have suffered panic attacks brought on by the stress of the covid-19 pandemic. Their pain and fear are unimaginable. I wonder how, with their pay-by-the-minute cellphones, they will manage with telemedicine. I hope they don’t feel like I’m abandoning them. I also spend much of my time teaching medical students, and I love working with them as they get ready to be doctors. On a recent week, the medical school where I work celebrated Match Day — the culmination of years of education and hard work, when medical students across the country find out where they’ll be heading for their next stage of training. But this year, covid-19 meant we had to celebrate in a new way. This year, Match Day took place in a socially distanced parking lot, because we couldn’t let our students totally miss this rite of passage. The students’ cars snaked toward a tent, where


Bodies lie in the streets of Guayaquil, Ecuador, emerging epicenter of the coronavirus in Latin America

The body was wrapped in a plastic tarp, swollen, already attracting flies. He had been a neighbor, a man Rosangelys Valdiviezo passed while walking home from work, though they’d never exchanged words. Now he lay in front of his home, one of an untold number of bodies cast out in the streets of Guayaquil, Ecuador, a sweltering South American city being ravaged by the novel coronavirus. Valdiviezo, a 30-year-old seafood worker, said the body had been out in the tropical heat for six days. “I am very afraid,” Valdiviezo, a Venezuelan migrant who moved to Guayaquil, said by telephone. “I’m terrified of dying so far from home.” Ecuador’s largest city, a commercial center of nearly 3 million, is emerging as the epicenter of the novel coronavirus outbreak in Latin America. In local news accounts, videos shared on social media and telephone interviews, officials, aid workers and others in the poverty-stricken metropolis are reporting fly-covered bodies on sidewalks and corpses left inside homes for days. Ecuador confirmed its first case of covid-19, the disease caused by the coronavirus, on Feb. 29: a 71-year-old Ecuadoran woman who returned to Guayaquil from Spain on Valentine’s Day. Since then, the crisis in Guayaquil has ballooned, jumping to more than 2,200 cases, or roughly 70 percent of Ecuador’s total, far surpassing the numbers in Quito, the capital. The outbreak has struck faster than Guayaquil can cope. Hospitals were quickly overwhelmed. Mortuary workers couldn’t, or wouldn’t, collect the bodies — some dead from the virus, some apparently from other causes — from homes. With daytime temperatures topping 90 degrees in a city where many live with no air conditioning, some grieving families saw little option but to carry days-old corpses outside. The city’s struggle echoes those of other hard-hit spots around the globe where corpse control has become a grim daily struggle. The Italian army has mobilized to haul cadavers out of devastated Bergamo after the crematorium there was overwhelmed. Authorities in Iran have dug mass graves. The Spanish military found elderly patients in care homes abandoned and dead in their beds. Guayaquil could be a harbinger of things to come as the pandemic reaches deeper into the ill-prepared developing world. “The situation is dire in Guayaquil at this moment,” said Tati Bertolucci, director for Latin America and the Caribbean at the disaster relief organization CARE. “There are dead bodies in the streets, and the health


Retired police sergeant Jerry Manley, beloved for his generosity and wisecracking humor, dies of covid-19

say, ‘You got this, girl,’ and he’d open the door for me and help me in.” Manley, a married father of four, was hospitalized last week and died Tuesday at CalvertHealth Medical Center. He was one of more than 100 novel coronavirus fatalities in Maryland, Virginia and the District, a toll that keeps rising. Big Jerry’s network of friends, now mourners, was vast and varied, owing to his decades of charity work and to his outsize, boisterous personality, which was more than occasionally R-rated. “A gentle giant who’d give you the shirt off his back and not expect anything in return,” said his neighbor Kelly Brogan, 49, adding that Manley’s personal motto as the life of every party was “I like beer” — an understatement, as friends laughingly tell it. How did he catch this insidious illness advancing exponentially in all directions around the planet? His loved ones and others who were close to him, like disease-trackers and the bereaved worldwide, are left to ponder and agonize, plumbing memories, retracing steps, searching for nexuses. There was the annual seven-day family Caribbean cruise that he and 16 relatives embarked on in mid-February, by which time the disease had spread beyond China to other countries, though no cases had yet been reported in the United States. Then, on Feb. 23, the day after he got off the ship, he and his five siblings stood at their mother’s hospital bedside, clasping her frail hands as she died of respiratory failure, ending a weeks-long battle with pneumonia. None wore gloves or a mask. The first confirmed U.S. death from covid-19, in the Seattle area, was still five days away. And there was the big party at his brother Billy’s beach house in Ocean City, Md., in mid-March, on the weekend before St. Patrick’s Day, with about two dozen revelers packed indoors before all went out to a crowded Irish pub that Saturday night. Not until the following day, March 15, would the Centers for Disease Control and Prevention officially advise against gatherings of 50 or more people. “No one has any idea whether the party had anything to do with this, or whether some of those people were already sick and didn’t realize it,” said Billy Manley, 61. “Oh, my God, there would have been no Ocean City trip. But the information wasn’t getting out to us fast enough.” The only underlying medical issue


to other countries, though no cases had yet been reported in the United States. Then, on Feb. 23, the day after he got off the ship, he and his five siblings stood at their mother’s hospital bedside, clasping her frail hands as she died of respiratory failure, ending a weeks-long battle with pneumonia. None wore gloves or a mask. The first confirmed U.S. death from covid-19, in the Seattle area, was still five days away. And there was the big party at his brother Billy’s beach house in Ocean City, Md., in mid-March, on the weekend before St. Patrick’s Day, with about two dozen revelers packed indoors before all went out to a crowded Irish pub that Saturday night. Not until the following day, March 15, would the Centers for Disease Control and Prevention officially advise against gatherings of 50 or more people. “No one has any idea whether the party had anything to do with this, or whether some of those people were already sick and didn’t realize it,” said Billy Manley, 61. “Oh, my God, there would have been no Ocean City trip. But the information wasn’t getting out to us fast enough.” The only underlying medical issue Manley was known to have before he got sick was a blood pressure problem, his brother said. Jerry Manley, who retired after 33 years in law enforcement, with the Prince George’s County Sheriff's Office and later the police department, was an advocate and volunteer event staffer for Special Olympics Maryland. Among other charitable work, he helped organize and run the Maryland State Police Polar Bear Plunge into the Chesapeake Bay every January since 1997, when it began raising money for Special Olympics. What got him into the Olympics was his loving relationship with a former poster child, Jimmy Myrick Jr., born with Down syndrome. Myrick was a golfer, basketball player and swimmer, and the son of an old friend of Manley’s. “They’d never miss an opportunity to rag on each other,” Jimmy Myrick Sr., 63, said. “But there was an understanding, always, that Jerry had Jimmy’s back and Jimmy had Jerry’s.” When Jimmy Jr. died of leukemia in 2016, at age 33, it was as if a child of Manley’s had passed away. For 15 years, Manley also played a big part in putting together the annual Mickey Steele Celebrity Golf and Poker Tournament — named for a deceased friend.


Mexican factories boost production of medical supplies for U.S. hospitals while country struggles with its own coronavirus outbreak

and local politicians have protested the call for factory work in the midst of the outbreak. “If we want to avoid a massive spread of coronavirus, it is necessary that the worker stay at home with his family,” said the mayor of Matamoros, Mario López Hernández. But the calls keep coming. Haemotronic, an Italian company with a factory in Reynosa, Mexico, received a request this week for 1.5 million IV tubing extensions specifically crafted for the treatment of the coronavirus, allowing nurses to keep more distance from infectious patients. The company says it has implemented measures, including providing private transportation, to protect its workers. “I don’t think finding people will be a problem unless the virus surges in Mexico,” said Ettore Ravizza, manager of the Reynosa plant. “The covid situation just highlighted how strategic or essential we are for the well-being of our fellow humans.” Mexico has reported 1,510 cases of the virus. Officials acknowledge that actual case numbers are almost certainly higher because testing is limited. As the world races to increase production of ventilators, many parts of those, too, will come from Mexico. Supply chains for ventilators straddle the border, with components pieced together in both countries. Integer of Plano, Tex., operates factories in Tijuana and Ciudad Juárez, where it produces batteries for ventilators that are completed in the United States. Hillrom, based in Batesville, Ind., makes some ventilator components in its Tijuana factory and plans to begin producing the Life2000 noninvasive ventilator there in the coming months. Hillrom has seen U.S. demand surge for its other products. It’s making 500 million probe covers, used to protect thermometers, every three months. Demand for stretchers has doubled. “It’s very likely the first things that a patient needs or comes into contact with, will have been produced in Mexico,” said Howard Karesh, a Hillrom spokesperson. Among the company’s 1,300 employees in the country, Karesh said, coronavirus cases were “extremely limited.” Becton Dickinson, based in Franklin Lakes, N.J., employs 15,000 people in Mexico who produce “multiple billions of products and components” every year, company spokesman Troy Kirkpatrick said. They include catheters and IV sets now being used to treat coronavirus patients in the United States. “We have been in contact with the governor’s offices in the states in which we have operations to explain the critical nature of our manufacturing to maintain a functioning global health-care system and the precautions we


The next pandemic is already coming, unless humans change how we interact with wildlife, scientists say

The new coronavirus, which has traversed the globe to infect more than 1 million people, began like so many pandemics and outbreaks before: inside an animal. The virus’s original host was almost certainly a bat, scientists have said, as was the case with Ebola, SARS, MERS and lesser-known viruses such as Nipah and Marburg. HIV migrated to humans more than a century ago from a chimpanzee. Influenza A has jumped from wild birds to pigs to people. Rodents spread Lassa fever in West Africa. But the problem is not the animals, according to scientists who study the zoonotic diseases that pass between animals and humans. It’s us. Wild animals have always had viruses coursing through their bodies. But a global wildlife trade worth billions of dollars, agricultural intensification, deforestation and urbanization are bringing people closer to animals, giving their viruses more of what they need to infect us: opportunity. Most fail. Some succeed on small scales. Very few, like SARS-CoV-2, the novel coronavirus, triumph, aided by a supremely interconnected human population that can transport a pathogen around the world on a jet in mere hours. As the world scrambles to cope with an unprecedented public health and economic crisis, many disease researchers say the coronavirus pandemic must be taken as a deadly warning. That means thinking of animals as partners whose health and habitats should be protected to stave off the next global outbreak. “Pandemics as a whole are increasing in frequency,” said Peter Daszak, a disease ecologist who is president of EcoHealth Alliance, a public health organization that studies emerging diseases. “It’s not a random act of God. It’s caused by what we do to the environment. We need to start connecting that chain and say we need to do these things in a less risky way.” Some 70 percent of emerging infectious diseases in humans are of zoonotic origin, scientists say, and nearly 1.7 million undiscovered viruses may exist in wildlife. Many researchers are searching for the ones that could cause the next animal-to-human spillover. The likeliest hot spots have three things in common, Daszak said: lots of people, diverse plants and animals, and rapid environmental changes. They also are home to many of the likeliest zoonotic disease hosts: rodents and bats. About half of mammal species are rodents, and about a quarter are bats. But bats make up about 50 percent of mammals in the most biodiverse


Violence imperils coronavirus response in conflict zones around the world

the warring parties on a video call in the coming days to work out a plan to halt all air, ground and sea attacks, Reuters reported Thursday. The five-year conflict in the Middle East’s poorest nation has pitted Shiite Muslim rebels known as Houthis against a United States-backed coalition of Sunni Muslim nations, which is led by Saudi Arabia and the United Arab Emirates. Regular attacks also imperil prospects for peace in Afghanistan, where the government and the Taliban keep clashing as the country counts a steady uptick of coronavirus cases. Fighting picked up after the United States signed a peace deal with the Taliban in February, with militants attacking government outposts in the country’s north. “We can’t completely stop our attacks,” Taliban spokesman Zabiullah Mujahid said, blaming the government for “compelling” them. But if the situation worsens, the Taliban may stand down. “God forbid,” Mujahid said, “if the virus spreads in the country, then we could stop fighting to control the situation.” Both the Afghan government and the Taliban have launched efforts to curb the virus. Police in Kabul are enforcing a lockdown, and the Taliban has dispatched teams around the territory it controls to pass out masks, gloves and soap. Millions of lives are at risk if the warring sides don’t find a way to work together during the pandemic, Human Rights Watched warned Monday in a statement. The risk is similar in Libya, where hostilities are surging despite calls from the United Nations, the United States and a number of European and Arab countries for combatants to engage in a “humanitarian pause.” Khalifa Hifter’s year-long offensive on the Libyan capital, Tripoli, has triggered the worst violence the North African oil producer has seen since 2011, killing more than 350 civilians. His forces fired rockets at several residential areas this past week, analysts say, and social media in Libya is full of grief. “Nobody could sleep last night,” wrote Montaha Nattah, who lives in Tripoli. “I’ve never felt so close to death as I am now.” The conflict has decimated Libya’s health system. Health facilities and ambulances have endured more than 60 attacks over the past year. A lack of specialized medical staff and medical equipment hinders the country’s ability to address disease — let alone the coronavirus outbreak. Fighters on both sides appear to be taking advantage of the international community’s gaze on the pandemic, said Jalel


and soap. Millions of lives are at risk if the warring sides don’t find a way to work together during the pandemic, Human Rights Watched warned Monday in a statement. The risk is similar in Libya, where hostilities are surging despite calls from the United Nations, the United States and a number of European and Arab countries for combatants to engage in a “humanitarian pause.” Khalifa Hifter’s year-long offensive on the Libyan capital, Tripoli, has triggered the worst violence the North African oil producer has seen since 2011, killing more than 350 civilians. His forces fired rockets at several residential areas this past week, analysts say, and social media in Libya is full of grief. “Nobody could sleep last night,” wrote Montaha Nattah, who lives in Tripoli. “I’ve never felt so close to death as I am now.” The conflict has decimated Libya’s health system. Health facilities and ambulances have endured more than 60 attacks over the past year. A lack of specialized medical staff and medical equipment hinders the country’s ability to address disease — let alone the coronavirus outbreak. Fighters on both sides appear to be taking advantage of the international community’s gaze on the pandemic, said Jalel Harchaoui, a Libya analyst at the Clingendael Institute in The Hague. “Right now, because the world is indeed being consumed with the whole covid-19 pandemic,” he said, “the behaviors we see in Libya are even more unhinged and more cynical.” As the pandemic grips the world’s attention, eastern Ukraine’s six-year war, which broke out when Russian-backed separatists declared independence, injures and kills those on the front lines at its usual clip. One big difference these days: Ukrainian armed forces are wearing face masks in the trenches, according to local media. Civilians and combatants are wounded practically every day in sprays of bullets and shells. A soldier died this past week. The Ukrainian president has vowed to end the war, and encouraging developments have surfaced, including prisoner exchanges. But progress drags on the thorniest issues at the heart of the conflict. The pandemic has encouraged some combatants to hold fire — if only for a few weeks. In parts of the Philippines, concerns for public health appear to have motivated a temporary truce: The Communist Party of the Philippines has ordered its armed branch, the New People’s Army, to halt fighting rebel groups until April 15. “The cease-fire is a “gesture


FIFA extends men’s age limit for the Tokyo Olympics

FIFA extended the age limit for the men’s soccer tournament at next year’s Tokyo Olympics, ensuring that players who would have been able to compete in the Games this summer retain their eligibility in 2021. The criteria for the rescheduled Tokyo Games remains the same: All players born on or after Jan. 1, 1997, will have the opportunity to suit up for their countries, essentially turning what has been under-23 tournament since 1992 into an under-24 event. As usual, each of the 16 teams in the field may select three players over the age limit for their rosters. There is no age limit for the women’s tournament. FIFA also confirmed that no international games for men or women will be played in June. A pair of women’s World Cup tournaments — the under-20 World Cup set for Central America in August and September, and the under-17 World Cup scheduled to be played in India in November — were postponed. The 2020 European Championship, second only to the World Cup in international soccer prestige, already had been postponed for one year. According to the Associated Press, UEFA had hoped to have playoff games in June to determine the final four places in a 24-team field. For the Tokyo Games, 14 of 16 nations already have secured their spots: Argentina, Australia, Brazil, Egypt, France, Germany, Ivory Coast, New Zealand, Japan, Romania, Saudi Arabia, Spain, South Africa and South Korea will compete. The final two spots in the field will be filled by nations in Concacaf, which is the only federation that has not completed its Olympic qualifying tournament. Should the United States qualify a men’s team for the first time since 2008, its biggest star will be eligible to play. Christian Pulisic — as is the case with another surefire Olympic draw, France’s Kylian Mbappé — was born in 1998 and would have been under the age limit anyway, though it is still up to both players’ private clubs to release them for the Games. Read more soccer: Q&A with Robbie Russell, MLS defender turned ER doctor Brazil opens stadiums, including the Maracanã, for coronavirus victims ‘A biological bomb’: Match in Italy linked to epicenter of deadly outbreak


Yellow fever led half of Philadelphians to flee the city. Ten percent of the residents still died.

teams. What was destroying them, scientists say, was the first virus found to cause human disease. It was yellow fever. In Philadelphia that year, it killed roughly 5,000 people, about one-tenth of the population. (The deaths of one-tenth of Washington’s population today would mean a toll of 70,000 people.) Thousands more were infected but either had no symptoms or only a mild version of the disease, said J. Erin Staples, head of a surveillance and epidemiology team at the Centers for Disease Control and Prevention. “For every death, there’s about 21 other infections,” she said modeling showed. So most of Philadelphia’s 50,000 people probably were infected. “They were either lucky that they didn’t develop disease or had mild disease compared to those that were unlucky and died.” Yellow fever is one of more than 200 known human viruses, according to the National Institutes of Health. They include those that cause HIV/AIDS, Ebola, polio, smallpox, measles, mumps, rabies, the common cold and now the novel coronavirus. In the late 1800s, scientists were just starting to realize that strange microbes smaller than bacteria were causing disorders in plants and animals. Bacteria, which had been discovered in the 1670s, had been associated with human illnesses such as typhoid fever, cholera and tuberculosis. At first, yellow fever was thought to be caused by bacteria, too. But that theory was discounted when famous U.S. Army physician Walter Reed reported in 1900 that the leading suspect bacteria was not found in the blood of fever cases he studied in Cuba. There was an alien “parasite” at work, he believed. “At the time they didn’t even call it a virus,” Staples said. “They didn’t know really what a virus was.” Yellow fever, in the worst cases, attacks the liver, inhibiting the ability of blood to clot. That can cause bleeding in the stomach and the dark vomit, Staples said. “People were also described as having blood coming from other places … out of different orifices,” she said. The liver damage also turned the skin yellow and gave the disease its name. None of this was known in Philadelphia in 1793. The cause of the “bilious remitting Yellow Fever” was thought to be a load of rotting coffee left on a wharf on the Delaware River, “corrupting” the air. So believed Benjamin Rush, the prominent 47-year-old Philadelphia physician, civic leader and signer of the Declaration of Independence. (A


IT manager who loved trivia and once appeared on ‘Jeopardy!’ dies of covid-19

From her hotel room under quarantine, Anne Starkweather emailed her husband letters for the nurses to read to him daily as Chad Capule lay in an intensive care hospital bed suffering from covid-19. She wrote that she loved him, and they would celebrate his 50th birthday in July. Starkweather also called, and the nurses placed the phone on Capule’s chest so he could listen as she played ’80s music and his favorite Broadway show tunes. But after more than two weeks in a Wisconsin hospital, the IT project manager from Cheverly, Md., died on March 29 of complications from covid-19. He had arrived in Wisconsin earlier that month to oversee the installation of a computer system at St. Agnes Hospital in Fond du Lac, where he died. It’s unclear if he worked on-site. Capule’s family remembered him as a cheerful and inquisitive man who was known as a peacemaker. He pored over his father’s National Geographic magazines and read the dictionary and encyclopedias as a child. He was fond of British shows, such as “Doctor Who,” and trivia games. For eight years, he organized a trivia fundraiser for the Rotary Club of Dupont Circle, his wife said. He even appeared on one episode of “Jeopardy!” in 2015. “Chad is the love of my life; he’s my best friend,” said Starkweather, who tested positive for the virus after she traveled to Wisconsin. “I’m devastated and heartbroken.” “This virus offers a very lonely death for people. Family can’t be with you when you die. You can’t have physical gatherings of people to mourn you at your funeral,” she said. The youngest of three, Capule was born in the Philippines and immigrated to Northern Virginia in elementary school. He graduated from the University of Virginia with a major in history and a minor in computer science, his family said. Starkweather recalled that she first saw Capule when he appeared at her desk fixing her computer at the educational development nonprofit they both worked at in the District. “I just knew in my heart this is the man I want to be with for the rest of my life,” she said. Capule’s sister, Benilda Capule, 51, recalled that her brother was looking forward to the party Starkweather was planning for his birthday on July 26. It was going to be a grand affair with more than 200 guests, games such as Dungeons and Dragons,


A New York City taxi driver kept working to pay bills. Now he and his family are sick

keep walking out the door to nanny for a Manhattan family. She was working. He would, too. At first, Raul mostly drove doctors and nurses, trip after trip from homes to hospitals. He felt almost heroic. Doing his part in the pandemic. He signed up to delivery groceries to seniors. Then he started getting patients who needed a ride to the hospital. Some told him they wanted a covid-19 test. Some work masks. Some did not. Some coughed in his small Toyota Camry. A few didn’t cover their mouths. Raul replayed all the faces of people he drove on Saturday, March 14. He thinks he knows who infected him. The man said he tested positive for covid-19. He wanted to get to the hospital. He coughed. Raul slumped in his seat. He pulled the hood of his sweatshirt over his head. He felt helpless. New York City taxi drivers can’t kick people out or refuse to drive them. Four days after that 20-minute ride, Raul got a fever. The Romeros don’t own a thermometer. But he was feeling bad enough that Sandra forced him to drink her “sick tea.” The kind she learned to make as a child in the Dominican Republic, full of herbs and garlic. Raul was hot and aching all over. Sandra barred him from leaving the apartment. He didn’t protest. Sandra called the health hotline to report his symptoms. She wanted him tested. “I called the hotline. I explained everything. My husband had a fever. He hurt all over. He couldn’t sleep. Could they get a coronavirus test?” asked Sandra. “They just told us to stay home because the hospitals are so full.” Their daughters wanted to help. Sandra said no. The family worried that the oldest, Stephanie, had already been exposed. She visited Raul on March 15. She has not been able to stop working. She teaches second grade in a public school. She’s doing virtual lessons from her living room. Trying to smile for the kids. Half her students don’t have a computer or tablet at home. She keeps calling around, trying to find them equipment. “Teachers have the job to teach the child the curriculum. Now, on top of that, we are teaching the child and their parents how to use electronic devices. It’s a challenge,” said Stephanie, who has been fighting headaches and a fever lately. It’s likely she has covid-19, but


My hospital used to have all kinds of ICUs. Now we just have the covid-19 one.

manageable. Patients on ventilators get better and regain the ability to breathe on their own. When they move to another floor, a space frees up. A new patient who had been intubated in the emergency department takes that bed. But the covid ICU only grows. Each day, new patients with the coronavirus require intubation and life support; they come to our department. And the patients already here aren’t getting better at the same rate as new patients get sick. Covid-19 is both a fast and a slow disease: It has overwhelmed our city at a frightening clip, and yet, once patients are on life support, we must wait days, even weeks, to see if they will recover. Our normal medical ICU has between 12 and 17 patients. The covid ICU has more than 50. In a normal ICU, I am not afraid of catching infections from my patients. I’ve drawn blood from patients with poorly controlled HIV. I’ve breathed the same air — filtered through an N95 mask — as patients with active tuberculosis. I’ve trusted existing protocols to keep me safe. And I knew that in the unlikely event that I did contract a disease like HIV or tuberculosis from a patient, I would quickly receive effective treatment. Now in the covid ICU, I fear that I will get sick and die. We have adequate PPE for the time being, but I’m not sure how long it will last or if it will really prevent all spread of the virus. Even though I’m in my 30s and healthy, I am by no means protected from this disease. I see my gray-haired colleagues, and I worry even more for them. I see how rapidly covid can take over someone’s body, and I can’t help but worry for my parents not too far away, in Upstate New York. I counsel them over FaceTime to stay home, wash their hands, keep distance from everyone else. I share some details of what I see at work with them to convey the seriousness of this pandemic. But I also hold back, wanting to shield them from the horror. A normal ICU is a hard place to work: We witness death. We deliver the worst news possible. We see families grieve. I am someone who feels things intensely. Even when we’re not in the midst of a pandemic, I rarely make it through a week


Rent, mortgage, car loans, utilities and child support. The other bills can wait.

More than 6.6 million people. That’s how many Americans applied for unemployment in the week ending March 28 — an all-time high. This is the latest aftershock of the coronavirus pandemic. The Coronavirus Aid, Relief and Economic Security Act (CARES) provided supersized unemployment benefits — even for workers not traditionally covered by unemployment insurance. But some states are reporting it’s going to take time to process their claims. Even before the outbreak, 59 percent of credit card holders were carrying a balance, according to a recent survey by CreditCards.com. Of those who didn’t pay off their credit card debt every month, 25 percent had been falling behind for at least three years. Another 15 percent had carried debt for more than five years. Cardholders most often used plastic to pay for medical expenses or car repairs, the CreditCards.com survey found. People on the brink have been shoved over the edge of financial stability by covid-19. Tough decisions on what gets paid when have become even more critical. If there’s not enough money coming in, you have to start taking care of your bills the same way medical staff handle an emergency room slammed with patients. A standard practice is to determine who needs to be seen first, a method called triage. This system is used when the demand for treatment is greater than the staff can handle. “Before the coronavirus impact, I worked in a nail salon,” Jennifer from Troy, Ala., said in an email. “My work closed. I don’t have enough money to pay my car loan and phone bill. I’m too stressed.” If you’ve lost your job or you’re facing a long furlough, triage your payments. Some creditors are just going to have to wait. In “Surviving Debt: Expert Advice for Getting Out of Financial Trouble,” a team of 20 experts from the National Consumer Law Center (NCLC) walk the reader through how to rank debts and expenses. The 2020-updated edition is the Color of Money Book Club pick for this month. During the pandemic crisis, the NCLC is offering free digital access to the book, which retails for $20. You can download, print or email it at nclc.org/readsurvivingdebt. If you want a hard copy, you’ll have to pay the retail price, but shipping is free. The book starts with six steps to surviving debt. The first step is prioritizing debts whose nonpayment will immediately harm your family.


The Ivy League was first to cancel sports. Here’s what it says about when games might return.

feels like a bygone era and provides insight into how sports may resurface. “It’ll be sort of a mirror of what we did,” Harris said. “We have to follow the lead of our schools. We are fortunate … that our schools have the benefit of having medical experts, public health experts, infectious disease specialists that we tap into on each campus and that are advising them on campus operations. Of course, government officials are very much involved more now.” How was the Ivy League ahead of the rest of the American sports world? Well, for starters, it’s the Ivy League — the doctors, scientists and researchers at those institutions are some of the most advanced in the world. Location mattered, too. Boston and New York suffered two of the earliest outbreaks in the country, which gave the Ivy League a sense it may have to alter its tournaments. “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 said. “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.” The astonishing acceleration of the impact of the coronavirus on American life can be captured in many ways. One is to recall the reaction to the Ivy League’s decision to cancel its basketball tournaments. The conference received immediate backlash that now seems tragicomically quaint. Penn men’s coach Steve Donahue called it “the most horrific thing I’ve dealt with as a coach.” Players started a petition to reschedule. At a congressional hearing the next morning, Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases and a member of the White House coronavirus task force, was asked whether the Ivy League had overreacted. Two weeks later, the Olympics were postponed. In the moment, Harris foresaw some of the disruptions that would come, but even she did not grasp the scope. When the Ivy League canceled its tournaments, she


Four additional inmates at D.C. jail test positive for the coronavirus

THE DISTRICT Four more inmates at the D.C. jail have tested positive for the novel coronavirus, a city official said Sunday, bringing the total number of confirmed infections among inmates to 18. Seven of the jail’s correctional officers have also tested positive for the infection, an attorney for the union that represents them said. The outbreak has spread as advocates urge jails and prisons across the country to release those who are accused of minor crimes or are medically vulnerable — such as those who are elderly or have underlying conditions. The city’s Public Defender Service has joined the American Civil Liberties Union in a federal class-action lawsuit alleging the city has not done enough to fight the outbreak within the jail, which houses about 1,600 inmates. The city would not comment on the pending litigation, but noted that it was making preparations. The jail quarantined in isolation units those who tested positive. The four new infections include two men who were housed in a unit where an inmate had contracted the virus, a man who was previously housed in another building at the jail, and a woman whose unit was quarantined after an inmate there tested positive for the coronavirus. — Moriah Balingit MARYLAND Leaders from Maryland’s Office of the Public Defender are asking Mary Ellen Barbera, chief judge of the state’s court of appeals, to use her emergency powers to “enable and expedite” the release of people confined in the state’s prisons and jails. The letter, sent this week, is separate from a petition filed on Friday that sought the release of juveniles currently in the system, and outlines the risk incarceration poses to this particular population. “Many of those who are confined in or work in these facilities are in one or more of the high-risk categories identified by the CDC,” the letter stated. “The need for staff to enter and exit multiple times per day, and the lack of widespread rapid testing to identify asymptomatic individuals who may enter the facility and spread the disease, makes it inevitable that COVID-19 will spread in these facilities very fast and very soon.” As of Friday, two additional inmates and 10 civilians had tested positive for covid-19 within Maryland’s sprawling prison system, officials said. That brings the total confirmed positive cases from the state’s prisons to 15 — three inmates, four correctional officers and eight contract workers, officials said.


Trump calls MBS his ‘friend’ — 18 months to the day after Jamal Khashoggi’s murder

responsible.” For a time, the Trump administration pretended to seek information about the killing. The truth would come out, Trump said. Secretary of State Mike Pompeo pressed the crown prince at least to move aside his chief henchman, Saud al-Qahtani. But any pretense is long gone. Qahtani remains influential. The administration has illegally ignored congressional mandates to furnish information on the killing and impose sanctions. And now, as though to mark a year and a half of Saudi nose-thumbing, Trump is prostrating himself again. The reason: As a pandemic imperils the American economy, the Saudis have threatened to devastate the U.S. oil industry further by flooding the market with cheap oil. “Just spoke to my friend MBS (Crown Prince) of Saudi Arabia, who spoke with President Putin of Russia, & I expect & hope that they will be cutting back approximately 10 Million Barrels, and maybe substantially more which, if it happens, will be GREAT for the oil & gas industry!” Trump tweeted on Thursday. This quickly turned out to be — surprise, surprise — false, at least in its details; the Kremlin denied that Putin and Mohammed bin Salman had spoken. It may well prove false in the big picture, too. There is no sign of an agreement between Russia and Saudi Arabia. The Wall Street Journal reported Friday that those two countries wouldn’t throttle back unless U.S. producers also reduced output, which could, among other complications, put them on the wrong side of U.S. antitrust law. All of which would fit the pattern of Trump’s infatuation with the Saudi royal family, which from the start has played him for a fool. Trump made Saudi Arabia his first overseas destination, and the king threw a dazzling reception and promised, Trump claimed, to buy hundreds of billions of dollars worth of U.S. weaponry. In the years since, few of those sales have materialized. Meanwhile, the administration has sent thousands of U.S. troops to help defend the kingdom, even as Trump claims to be disentangling from the Middle East. The United States has signed on to or acquiesced in every reckless MBS action — a feud with neighboring Qatar, a disastrous war in Yemen, his purges of princes, his torture of activists. And his murder of Jamal Khashoggi. Khashoggi was 59 at the time of his death. He will be forever 59. The rest of us get older. But not all


Gov. Cuomo is wrong, covid-19 is anything but an equalizer

in a higher death rate in the impoverished district. In 1918 Chicago, a team of modern epidemiologists identified a similar pattern. Chicagoans living in underprivileged neighborhoods with high rates of illiteracy — an indicator of poverty — died of the 1918 flu pandemic at much higher rates than the city’s wealthy. The inequalities of colonialism also amplified influenza’s toll in 1918. When the flu surfaced in colonial Mumbai (then Bombay), British colonizers’ complacency about Indians’ health fanned the flames of influenza in the city. Colonial officials believed in long-running stereotypes that portrayed Indians’ culture as inherently unhealthy. Predisposed by cultural biases to ignore disease outbreaks among locals, British officials refused to take seriously early reports that influenza was quickly spreading through Bombay. By the time they finally reacted, it was too late to reverse course. As a result, thousands of Indians contracted the flu as the virus ravaged the city. Unsurprisingly, Indians living in unsanitary, cramped urban housing fared much worse than the city’s European residents. The 1918 influenza pandemic teaches us that viruses often exacerbate existing inequalities, hurting marginalized people much more than others. We’re still in the relatively early phases of the 2020 coronavirus pandemic. But, as we saw a century ago, the effects of covid-19 will probably be much worse for the poor. Glimmers of this inequality are already apparent at home in the U.S. and globally. Not every American can realistically take part in social-distancing measures to flatten the curve. Smartphone location data reveals many wealthier Americans are heeding social distancing warnings and staying at home. Low-income Americans are less able to work from home, and have remained mobile out of necessity. Instacart grocery shoppers, for example, run a higher risk of contracting covid-19 than affluent Americans who can work and shop from home, avoiding stores and crowds. Acutely aware of the risks, Instacart workers have gone on strike in some places. Like Chicago and Oslo in 1918, residents of low-income neighborhoods in today’s New York City seem to be at an increased risk of contracting covid-19. According to newly released testing data, covid-19 tests among residents of low-income areas like the Bronx are turning out positive much more frequently than tests from wealthy neighborhoods like the Upper East Side. Data from Milwaukee also suggests covid-19 is devastating African American communities worse than other Americans. Many countries hoping to protect citizens from covid-19 through stay-at-home orders


saw a century ago, the effects of covid-19 will probably be much worse for the poor. Glimmers of this inequality are already apparent at home in the U.S. and globally. Not every American can realistically take part in social-distancing measures to flatten the curve. Smartphone location data reveals many wealthier Americans are heeding social distancing warnings and staying at home. Low-income Americans are less able to work from home, and have remained mobile out of necessity. Instacart grocery shoppers, for example, run a higher risk of contracting covid-19 than affluent Americans who can work and shop from home, avoiding stores and crowds. Acutely aware of the risks, Instacart workers have gone on strike in some places. Like Chicago and Oslo in 1918, residents of low-income neighborhoods in today’s New York City seem to be at an increased risk of contracting covid-19. According to newly released testing data, covid-19 tests among residents of low-income areas like the Bronx are turning out positive much more frequently than tests from wealthy neighborhoods like the Upper East Side. Data from Milwaukee also suggests covid-19 is devastating African American communities worse than other Americans. Many countries hoping to protect citizens from covid-19 through stay-at-home orders may be unintentionally compounding health risks for those living in poverty. In poor urban neighborhoods where residents live in proximity to neighbors, like Brazil’s favela communities, there is little opportunity for social distancing. Covid-19 could thrive in such settings. Stay-at-home orders are also impractical and even dangerous for those living in substandard housing without access to sanitary faculties or clean water. A world map showing the running totals of those who have tested positive for the virus further highlights unequal international capacity for covid-19 testing. More than 40 of the 50 countries having highest positive test counts fall within the top 50 GDPs in the world. This means current international tracking of positive covid-19 cases may simply be telling us which countries are able to afford tests. Some countries, like Bolivia, are only able to test 12 people per day — creating a silence around the possible spread of covid-19 that reflects structural inequalities in global health. We live in an unequal world, so it’s impossible for the novel coronavirus to be an equalizing force. Like the 1918 influenza pandemic, the 2020 covid-19 pandemic reflects and exacerbates inequalities at home in the U.S. and abroad. As government and public health


The time will come to reflect on how our political leaders handled this crisis

As science adviser to the director of the National Park Service from 2009 to 2017, I provided scientific advice to inform decisions impacting the national parks, employees and visitors. In the face of the novel coronavirus pandemic, the science is clear that all national parks should immediately close. By design, national parks funnel visitors through crowded pinch points: trailheads, parking lots, public restrooms, scenic overlooks and more. It is impossible to systematically achieve Centers for Disease Control and Prevention guidelines for social distancing at these sites. Risk of asymptomatic exposure can create new rural epicenters that expand the pandemic. Rural health clinics serving parks have little or no capacity to handle covid-19 outbreaks. Visits endanger gateway communities with few resources to combat infection of local citizens, park employees and visitors. Stress on employees is significant. The chaotic mix of closures, partial closures, park openings and ill-conceived encouragements to visit during this national emergency add to the confusion and harm. Public health officers of the National Park Service must provide transparent and public reporting of covid-19 cases. Conservation and outdoor industry groups should make clear that public health — not short-term economic and political benefit — is paramount. Gateway community mayors and doctors should demand action to protect their citizens. When the pandemic ends, the parks will reopen and visitors will return. Science should give Interior Department and Park Service leaders the courage to act above politics and do what is right for their employees, the American people and America’s “best idea,” and close all the national parks, now. Gary E. Machlis George T. Conway III’s April I was distracted by the impeachment, vainly looking for a sign that a Republican senator other than Mitt Romney (Utah) would acknowledge the evidence of malfeasance staring them in the face. Despite that distraction, and despite not being in the public health arena, I was aware of the serious threat of the novel coronavirus when travel and large gatherings were limited in China for the Lunar New Year. No security briefings, no special training, just the ability to read and connect the dots as to what could happen in other places, including here. Why couldn’t those with access to more targeted information have seen this and prepared? Maybe I just have a gift. Mary Bell In virtually every one Kenneth Oestreicher When the pandemic is over, I hope Americans will remember the leaders who


A World Series game on Christmas and more ideas for a postponed, shortened baseball season

Have you ever tried to reschedule an Olympic Games? Sure, many of us have postponed weddings — and there are at least two I should have canceled altogether — but those are much smaller affairs to manage. The Olympics? That’s got to be the biggest event in the world, even larger than a “Duck Dynasty” Easter egg hunt. Meanwhile … Have you ever tried to push a Major League Baseball season back into autumn and winter? It’s a scheduling and logistical nightmare — too many games to fit into too tight of a calendar. Pitchers and fans won’t like the weather, and, of course, the Houston Astros’ video equipment might freeze over. So International Olympic Committee and MLB officials, used to waking up around noon before strolling to the bank with those oversized checks usually reserved for Publishers Clearing House winners, are now scrambling to get their money trains back on track. I guess the IOC had the less difficult task: It simply plopped the 2020 Summer Games in Tokyo into the same time frame in 2021. Ah, if it were only that easy. So many factors — housing, venues, food services, security, vendors and more. Do you know how many sporks have to be reordered for the Olympic Village commissary? Those babies just disappear; sporks are always the first item to walk out of the supply closet. Heck, rebooking flights — airline change fees alone will kill you — is a financial strain. It’s a massive jigsaw puzzle, and every piece must fit. There are 32 sports, plus golf; you can’t just say, “We’re all good schedule-wise except for swimming — swimming doesn’t work that week, so, okey-doke, we’ll drop swimming.” NBC, naturally, will still be there to televise the 2021 version, but that still leaves a 7,777-hour gaping crater in its schedule this July 24 to Aug. 9. Sadly, NBC only has three viewable properties: the Olympics, “The Voice” and “America’s Got Talent.” And, sure, America’s got talent, but I don’t know if my beloved, beleaguered homeland has enough talent to fill all of the network’s needs. (Column intermission: With everyone safer at home at the moment, my immediate family is rather tired of hearing my dulcet tones ranting day and night; our pit mix, Daisy, is the only one who never leaves the room when I’m talking. So I have started the Couch Slouch podcast — for


Coronavirus restrictions on movement may jeopardize the lives of the most vulnerable

After years of seeing millions of migrants on the move, the world is facing a serious crisis of immobility. With diagnosed covid-19 cases over the 1 million mark, 140 countries have closed their borders to some or all foreign travelers. In fact, Pew Research Center estimates suggest 93 percent of the world’s people live in countries with sudden new border restrictions. From Albania to Zimbabwe, more than one-third of the global population is under lockdown or curfew conditions. These pandemic responses are disrupting long-established habits and patterns of movement within communities and countries, as well as global travel. Despite the shared experience of mass immobility, differences of wealth and status create large differences in how individuals are affected. This disparity also leaves some individuals more exposed than others to the virus itself, while others may face different challenges from the consequences of sudden restrictions on movement. Asylum seekers, seasonal workers, temporary workers and undocumented migrants face disproportionate risks, and some may be left fending for themselves. How these groups fare in the 2020 pandemic will depend on how governments define “nonessential movement,” and whether they are willing to make any exceptions. Wealthier individuals are more likely to be affected only marginally by current mobility restrictions, simply because they can stay at home. Paradoxically, the fact some people can work from the place where they live implies others, those who do essential work, “move” for them. For example, delivery people, cleaners, repair workers, gig workers, public service workers and those in the health care sector — as well as anyone with a precarious work contract — may not be able to self-isolate. While inequalities inherent in free market economies may also play out in the inequalities that arise from the current restrictions on movement, here’s another point to consider. In the new coronavirus society, citizenship plays a heightened role in who can live and work where. The data we have produced using daily updates from the International Air Transport Association show the coronavirus travel bans have adverse consequences on seasonal workers, people on short-term residence permits and, in some cases, even long-term residents and their family members. For instance, our data show over 100 countries make an exception for their own citizens who are repatriating — returning citizens may face a mandatory quarantine, but they can reenter their home country. But people with less-secure residence permits may find themselves unable to


return to the country where they are supposed to study, work or care for their spouses or families. These individuals may experience an overnight loss of their main source of welfare, as well as significant disruptions to their family and social networks. In most countries, access to medical treatment already depends on a person’s nationality and residence permit. These inequalities are likely to be exacerbated if countries find their health care systems stressed by covid-19 cases. A number of governments plan to exclude noncitizens from their economic stimulus plans. This is already the case in the U.S., where people on a legitimate work visa will not be covered by the job stimulus package, and in Australia, where 1.1 million people with temporary work permits will not receive government assistance. By contrast, Portugal extended citizenship rights to all migrants and asylum seekers who have residency applications underway, thus providing them public health care and social security during the state of emergency caused by covid-19. Restrictions to movement can also expose people with a precarious migration status to great dangers. Asylum seekers stuck on the U.S.-Mexico border or in Greece’s overcrowded refugee camps may have little access to clean water to wash their hands — and no way to self-isolate in densely populated temporary quarters. These people may rely almost entirely on volunteers, doctors, food and assistance arriving each day. In the event of further quarantine measures or travel restrictions, the situation for these vulnerable populations could quickly become dire. The coronavirus threat means political leaders confront hard choices in deciding what constitutes “nonessential movement” — who should stay at home, and who must go out each day to meet an essential public need. Of course, countries need essential public services: emergency workers, and those who ensure energy, water, food supplies — not to mention health care workers to tend to the growing numbers of critically ill covid-19 patients. But governments also face choices on who should have the possibility to travel back to a country and how to be sure medical equipment and food supplies reach those in need. The dilemma governments face is how to stop the spread of covid-19 while limiting the economic and human costs. The trade-off is between complete immobilization of a country through the absolute restriction of movement, and the protection of people whose lives could be jeopardized by these restrictions — including many of the


This year is not like all other years. Here’s how to find meaning in Passover anyway.

during the 2020 seder. That makes this the ideal time to push back against customs and habits that have kept many Jews from reaching out. So go forth and invite. It’s a small action that could make a big difference, now and for future generations. Nadine Epstein is the editor in chief of Moment magazine and After the Yom Kippur War of 1973, the Chief Rabbi of North Tel Aviv traveled to New York to visit the Lubavitcher Rebbe to seek his advice and blessing. The Rebbe asked what the mood was like in the streets of Israel? The Chief Rabbi told him, “The people are asking ‘what will be?’” Refusing to hear such words, the Rebbe responded “Jews do not ask ‘what will be?’ Jews ask ‘what are we going to do?’” This lesson on the rejection of individual passivity is meaningful during the covid-19 pandemic. Covid-19 — like the biblical Destroyer who killed the Egyptians’ first-born in retaliation for Pharaoh’s stubborn refusal to free the enslaved Jews — requires you to stay in your home to make sure the plague will pass over your family and community. And although staying home may feel like inaction, we can use this time well. The Rebbe explains that Passover “demands frequent and constant reflection so as to experience once again, in a personal way, the coming out from slavery into freedom.” While we are not enslaved like the Jews in Egypt, we may well be enslaved to our phones, our egos, or the thoughts of others. To quote the Rebbe: “What are you going to do?” about the parts of your life that could be improved. How can you free yourself from the enslavements that, prior to covid-19, you didn’t realize or realized and intended to change? If you suffer from an illness, like heart disease, which causes covid-19 to be a more serious and fatal virus, will you reflect and make changes to your lifestyle by cutting out red meat or fatty foods? Will you refocus your priorities away from video games and Instagram videos to appreciate the people around you? Is this the time you buckle down at work to get that promotion you deserve? You are the only one who can free yourself. Rabbi Zalmy Dubinsky runs a Chabad Young Professionals group in Raleigh, N.C. Robert Botkin is an attorney for Credit Suisse and also lives in Raleigh.


As coronavirus layoffs surge in richer countries, poorer ones lose vital remittance payments

worth $85 billion. In El Salvador and Honduras, remittances accounted for about 20 percent of the GDP, according to the World Bank. In Guatemala, it was 12 percent. On Monday, with Mexico on the brink of economic crisis, President Andrés Manuel López Obrador called on migrants in the United States to keep sending remittances to their relatives. “We know they are also going through a difficult situation, but they should not stop thinking about their loved ones,” he said. In the Mexican state of Michoacán, economist Jerjes Aguirre Ochoa estimates that 50 percent of the state’s 4.5 million people are the beneficiaries of remittances. Even before the coronavirus, Mexico’s economy had begun to contract, making the remittances especially important for many families. Rosy, 33, who lives in Michoacán, said she has been surviving mostly on remittances sent from four brothers and a sister who live in the United States, especially her brother Pedro who tends ranch animals in Idaho. “I spoke to my brother a few days ago, and he said that he is no longer going to be able to send us money because his employer is furloughing him — for how long? — until this virus is over,” she said, on the condition that her last name not be used because her relatives in the United States are undocumented. Rosy said she needs the money to buy food and medicine for her diabetic mother. One of the medications costs about $1.50 per pill. “I am more concerned with the economy than what they tell us about the virus,” Rosy said. The breadth of the pandemic’s economic shock is being felt around the world, and it is not possible to compensate for the loss of remittances from one country with those from others. “Even remittance source countries have been impacted, and perhaps even more so than recipient countries,” Dilip Ratha, lead economist for migration and remittances at the World Bank, said in an email. He added: “Remittances are expected to decline sharply during and after the COVID-19 outbreak.” The World Bank has previously documented how remittances have helped alleviate poverty in low- and middle-income nations, enhanced nutrition, contributed to better childhood education and helped reduce child labor. All those gains could now take a hit. “The loss of remittances is a loss of a crucial financing lifeline for many poor families and has a direct impact on nutrition, health


she said, on the condition that her last name not be used because her relatives in the United States are undocumented. Rosy said she needs the money to buy food and medicine for her diabetic mother. One of the medications costs about $1.50 per pill. “I am more concerned with the economy than what they tell us about the virus,” Rosy said. The breadth of the pandemic’s economic shock is being felt around the world, and it is not possible to compensate for the loss of remittances from one country with those from others. “Even remittance source countries have been impacted, and perhaps even more so than recipient countries,” Dilip Ratha, lead economist for migration and remittances at the World Bank, said in an email. He added: “Remittances are expected to decline sharply during and after the COVID-19 outbreak.” The World Bank has previously documented how remittances have helped alleviate poverty in low- and middle-income nations, enhanced nutrition, contributed to better childhood education and helped reduce child labor. All those gains could now take a hit. “The loss of remittances is a loss of a crucial financing lifeline for many poor families and has a direct impact on nutrition, health and education outcomes, which will in turn affect human capital formation,” Ratha said. Somalia, long racked by civil war, is among the most vulnerable of countries. A recent study found more than half of urban Somalis received remittances from abroad, and a significant portion of them said that without the money, they wouldn’t be able to afford food, education and health care. Somalis, mostly in the United States, Europe and Australia, have sent an average of more than $1 billion to Somalia every year, more than the country receives in aid from foreign governments. Remittances make up nearly a quarter of Somalia’s GDP. Most Somalis working abroad are employed in low-wage jobs — such as being hired as taxi drivers and retail workers or for domestic positions — that were among the first casualties of the pandemic, said Laura Hammond, a professor at SOAS University of London and author of a study on remittances in Somalia. Adding to the problems is that many money-transfer networks have shut down, and “so the question of how you get money to your relatives in Somalia, even if you have it, may be a challenge for many people,” Hammond said. Because of instability and


sent an average of more than $1 billion to Somalia every year, more than the country receives in aid from foreign governments. Remittances make up nearly a quarter of Somalia’s GDP. Most Somalis working abroad are employed in low-wage jobs — such as being hired as taxi drivers and retail workers or for domestic positions — that were among the first casualties of the pandemic, said Laura Hammond, a professor at SOAS University of London and author of a study on remittances in Somalia. Adding to the problems is that many money-transfer networks have shut down, and “so the question of how you get money to your relatives in Somalia, even if you have it, may be a challenge for many people,” Hammond said. Because of instability and a traditionally cash-driven economy, Somalia lacks a formal banking system — and Western financial institutions have steered clear, citing risks. That means almost all of Somalia’s remittances are transferred in the form of cash on flights from banking hubs in Kenya and the United Arab Emirates. With the closure of Somalia’s airports because of the pandemic, the remittance flow has all but stopped. “There is simply no cash coming into Somalia,” said Guleid Osman, chief executive of the Somali Bankers Association. “It is an enormous challenge despite only having a few covid-19 cases in Somalia. In a nutshell, we are facing a very critical moment, and we haven’t gotten a solution yet.” This sudden halt has left those who usually receive money from abroad in a tight spot, while Somalia’s money traders, who process the remittances, say they are facing financial ruin. “Most of our customers are withdrawing money from their accounts, and we are running out of cash to give them,” said Dahir Hassan Abdi, who runs a money-trading business in Mogadishu. After her daughter lost the Minneapolis hotel job, Ahmed said the family was left without financial support. Her husband, who once was the family’s breadwinner, has been ill for years. Ahmed said in a telephone interview that she felt lucky that schools were closed in the city of Hargeisa, where she lives with five of her children, so she wouldn’t have to pay their fees or suffer the indignity of taking them out of classes. But as each day passes, her worries deepen. “We can’t provide the basics of life to our kids anymore,” she said. sudarsan.raghavan@washpost.com max.bearak@washpost.com kevin.sieff@washpost.com


Let these children go

detention. The psychological and physical harms of detention on children are well documented, and the more restrictive the setting, the more children suffer. I have represented numerous children who attempted to kill themselves while detained before covid-19, including one teenager who tried to hang herself from a shower rod when her detention became indefinite. Whistleblowing doctors who oversee the medical care provided by U.S. Immigration and Customs Enforcement in Dilley have repeatedly decried it as inadequate. Before the virus, in July 2019, one former client told Congress about the lack of medical care and unsanitary conditions that led to the death of her 19-month-old daughter, Mariee, from an infection she received while detained. There are at least 46 mothers and children with preexisting medical conditions — such as anemia, pulmonary disease and respiratory issues that have required the ongoing use of a nebulizer — who could face death if infected by covid-19. When they contract the coronavirus — which is only a matter of time if they remain detained — the nearest hospital capable of providing them with emergency care is about 80 miles away and likely already overwhelmed with covid-19 cases. The length of time these families have been detained violates multiple court orders spanning decades. A pandemic is now added to the equation, placing everyone at risk. There is an easy alternative. Families detained in Dilley have family members and friends who are ready to receive them into their homes, where they can shelter in place as their asylum cases proceed. Numerous federal and state court judges have already ordered the release of individuals in criminal custody and immigration detention. We cannot ask mothers to wait patiently for their children — or themselves — to become too sick to travel or, worse, too sick to survive. These families must be released immediately, before it is too late. Read more: Fareed Zakaria: How the populist right is exploiting coronavirus Piper Kerman: To flatten the curve, free some prisoners. Please. The Post’s View: Officials must work quickly to help prevent the coronavirus in prisons Letter to the Editor: Looking back at what went wrong, and what we can now do right, in the coronavirus pandemic Marilyn Mosby, Carolyn Sufrin and Chris Beyrer: Larry Hogan can lead by addressing covid-19 in prisons and jails Josiah Rich, Scott Allen and Mavis Nimoh: We must release prisoners to lessen the spread of coronavirus


Coronavirus is different from AIDS

In the past few weeks, various commentators have drawn parallels between the Trump administration’s mishandling of the covid-19 outbreak and the Reagan administration’s callous inaction on HIV/AIDS. To be sure, the 1980s and 1990s AIDS epidemic — and the ugly political and interpersonal responses to it — can teach us a great deal about societal reactions to contagion and the relationship between the federal bureaucracy and the U.S. health-care system. Yet we must qualify and contextualize the comparison between covid-19 and HIV/AIDS. These are distinctly different illnesses, and conflating the two may obscure more than it reveals about today’s pandemic. People living with HIV/AIDS were (and remain) stigmatized and reviled in ways that those with covid-19 have not been. However, this may change if President Trump and his acolytes continue to racialize the virus and if politicians on either side of the aisle remain beholden to a for-profit health-care system that privileges those with the ability to pay. To guarantee the coronavirus pandemic remains distinct from the 1980s and 1990s AIDS crisis — and similar stigmas do not attach to those who test positive for coronavirus — we must name the abject injustices visited upon people with HIV/AIDS in the 1980s, 1990s and beyond. The history of HIV/AIDS diverges significantly from that of the new coronavirus, primarily because of the former’s inextricable association with historically subjugated populations — particularly gay men, people of color and intravenous drug users. In 1981, medical officials began to identify and trace mysterious cancer cases affecting young gay men in Los Angeles and New York City. “Rare Cancer Seen in 41 Homosexuals,” read one New York Times headline printed in July of that year. Just a month or so later, writer and activist Larry Kramer presciently recognized the urgency of the situation and the existential threat this “rare cancer” posed to gay men. “The men who have been stricken don’t appear to have done anything that many New York gay men haven’t done at one time or another,” Kramer observed. “We’re appalled that this is happening to them and terrified that it could happen to us. … This is our disease and we must take care of each other and ourselves.” But the federal government refused to act. The following year — just weeks after the Centers for Disease Control and Prevention first dubbed the illness “acquired immune deficiency syndrome” — President Reagan’s press secretary


A very important column about ... whether Passover should be observed this year

This Wednesday, the Jewish holiday of Passover begins. It commemorates the Jewish exodus from slavery in Egypt and the start of the trek to Israel. Passover begins with the customary Seder, a feast unique in the annals of the Jewish religion for several reasons. First, we do not eat bread, but matzoh, a poor crackerlike substitute for bread that is devoid of all pleasure. Second, we eat bitter herbs. Third, we slouch. Fourth, we have to explain why we do all these things before we eat, which means that by the time we get around to the tasty portions of the meal, we are all starving and annoyed at the person who refuses to skip anything. (Now that I think about it, some of these unique aspects might be limited to my own family.) One of the elements of the Seder is to recount the plagues that God wreaked on the Egyptians before the Pharaoh decided to free the Jews. Ordinarily, one would debate the utility and ethics of God’s sanctions on the oppressors. This year of coronavirus, however, raises some awkward questions. Consider that covid-19 represents pestilence. The pestilence is forcing many of us into a state of indolence, which can produce boils from sitting too much. There are also swarms of locusts in some parts of the world. Simply put, is it appropriate to celebrate escaping the plagues in Egypt if we are currently enduring the 21st-century Zack Snyder reboot? There are other ways in which the celebration of Passover will cut against established traditions this year. The Seder is traditionally a feast in which family, friends and even strangers are invited to participate. That contradicts this year’s social distancing. Furthermore, Passover Seders always end with the statement “next year in Jerusalem.” While that was always aspirational, this year such a statement carries with it a deeper pang of sorrow. So I’m just going to come out and ask the question: In a year of plague, do we Jews really need to observe the strict Passover dietary rules of no leavened bread and no flour? Even the original explanation for the eating of matzoh is, like the lifeless cracker itself, unsatisfying. Any after-action analysis of the relevant portions of Exodus would have to conclude that while Moses excelled at threat assessment, his logistics quartermaster was not up to the mark. After the Pharaoh decides to let the Jews


Facing covid-19, low-wage service workers are striking across the country. Here’s why — and why it matters.

retail sector in 2019 stood at 4 percent, compared with 6 percent for all private-sector workers. But the covid-19 pandemic has introduced a new, serious risk for these workers. Even as they faced heightened exposure to the virus, many employers did little to provide necessary protections such as hand sanitizer, soap, masks or gloves. Some large retail chains, including Walgreens, Target and Office Depot, asked — or demanded — that workers not wear masks or gloves on the job. Other employers have even fired workers for wearing protective equipment. Workers were expected to continue showing up to work, day after day, as the pandemic worsened. Some of the first rumblings of discontent happened at Instacart, the app-based food delivery platform. Thousands of its workers stopped responding to delivery orders on March 30, saying they would stay offline until their demands for things such as protective equipment, hazard pay and better paid sick leave were met. Instacart shoppers were quickly joined by Amazon warehouse workers in Staten Island and later by Whole Foods workers calling for a nationwide sickout, held Tuesday. Workers in other stores across the country are following suit. These actions are happening under difficult conditions. However, the same is true of other recent labor actions, including recent teacher protests and strikes that swept across conservative states in 2018 and 2019. We have been studying the teachers’ uprising. Our research revealed several reasons teachers in those states were able to organize for — and win — important concessions. Our findings offer lessons for the ongoing mobilization in low-wage retail jobs, despite the different labor markets faced by service workers today. The teacher strikes tended to happen in states that had cut education spending and pay so deeply that those states faced teacher and school staff shortages. Teachers in those states thus had a degree of labor market power — and they used it. The same is true of retail workers today. Quarantine has led to surging demand for essential food and home goods — and especially for the workers who can deliver those products to Americans working from home. It should come as no surprise, then, that the initial organizing and action have happened among delivery workers. The teacher strikes also revealed the importance of public awareness and support for worker action. Our research has revealed just how much teachers tried to build up goodwill in the run-up to


A pro cyclist was pulled from a virtual race for ‘superhuman’ powers

It was the virtual equivalent of a crash. Belgium’s Thomas De Gendt, who rides for Lotto Soudal, was doing what many elite athletes are doing during the suspension of sports by the novel coronavirus pandemic: He was using Zwift, an app for cyclists and runners that says it “turns indoor training into a game,” to work out and compete. He was tooling along nicely last week when, suddenly, he slowed to a crawl despite pedaling furiously. What the what was happening? Zwift detected something was amiss and pulled him from the race. “Either you missed your calling as a pro,” he said he was told in a message on his screen, “or there is something wrong with one of your devices.” De Gendt, of course, hadn’t missed his calling as a pro at all, and he quickly tweeted to the app: “i got thrown out of a race because of my superhuman power. Can you fix the stats for me?" More and more athletes are using apps such as Zwift, and De Gendt was showing Tim Wellens, a Lotto Soudal teammate, the ropes. “On a climb I just did the numbers that I more or less push in a race. Suddenly I was blocked and neutralized by the game,” he told Het Nieuwsblad, a Flemish newspaper. “You may still pedal so hard, but you are still set at a low speed. That’s a bit of a shame when you’re on a race.” He went on to say that he hoped Zwift and other online apps would expand the parameters for users. “It is only a game of course on Zwift, but I have a logo behind my name that I am a pro, so I hope those values can be lifted a bit,” De Gendt said. “Those races on Zwift are just perfect training for me."


Coughing tiger at the Bronx Zoo tests positive for coronavirus, ‘first case of its kind’ in U.S.

disease will develop in big cats since different species can react differently to novel infections, but we will continue to monitor them closely and anticipate full recoveries.” The tiger’s positive diagnosis follows scattered reports around the world of other animals contracting the virus, raising concerns among pet owners about whether their animals could be at risk. Officials in Hong Kong have discovered covid-19 in at least one cat and two dogs quarantined with their infected owners, while a cat in Belgium showed some signs consistent with the virus after its owner returned from Italy and later tested positive. While there have been no reports of pets in the United States contracting the virus, the USDA said it still recommends “people sick with COVID-19 limit contact with animals until more information is known about the virus.” “If a sick person must care for a pet or be around animals, they should wash their hands before and after the interaction,” the agency said. The USDA added that humans shouldn’t worry about catching it from pets or animals, saying there is currently “no evidence” to suggest animals who contract the virus can give it back to their keepers. The Bronx Zoo has been closed to the public since mid-March, as New York City continues to be the worst-hit area not only in the country but in the world. More than 67,000 people have tested positive for the virus in the city, of the known cases. Following Nadia’s positive coronavirus test, the Wildlife Conservation Society said Sunday that employees at the Bronx Zoo put in place “appropriate preventative measures,” leading some zoos elsewhere in the United States to follow suit. The Oakland Zoo, for example, said it was expanding its guidelines for personal protective equipment. The animals at the Bronx Zoo who developed the dry cough were housed in its Tiger Mountain exhibit, the conservation society said. They included Nadia’s sister, Azul, two Amur tigers and three African lions. But while all showed similar respiratory symptoms, the USDA said Nadia was the only big cat tested because undergoing diagnostic tests requires the animals be placed under general anesthesia. The attending veterinarian “felt it was in the best interest of the animals to limit the potential risks of general anesthesia to one tiger for diagnostics,” the USDA said. The Bronx Zoo also pointed out coronavirus tests for people and animals are different, with the latter


Maryland Gov. Hogan issues emergency order for nursing homes, D.C. shutters waterfront market as region continues coronavirus fight

The Washington region’s battle with the novel coronavirus intensified Sunday, as the number of confirmed cases soared to more than 7,000 and Maryland Gov. Larry Hogan (R) issued an emergency order requiring nursing home staff to wear protective gear and segregate infected patients to halt the spread of the disease following outbreaks in the state’s long-term care facilities. Meanwhile, the administration of D.C. Mayor Muriel E. Bowser (D) ordered the Wharf Fish Market in Southwest Washington shut down Sunday after customers crowded its open-air marketplace Saturday, defying social-distancing orders. The closure will last through at least April 24, according to a spokeswoman for Bowser, and may be extended. One month to the day of the first known coronavirus case in the metropolitan area, the region’s death toll hit 141, with 7,252 confirmed infections. As of Sunday morning, the District had 1,002 confirmed cases and 22 deaths; Maryland had 3,610 cases and 67 deaths; and Virginia had 2,640 cases and 52 deaths. Maryland, meanwhile, continued its struggle to contain outbreaks that have so far struck 81 nursing homes and long-term care facilities. At Pleasant View Nursing Home in Mount Airy, the site of the state’s largest outbreak, at least 99 residents and staff had tested positive and 10 residents had died. Hogan’s emergency order, issued Sunday, requires nursing homes and similar elder-care facilities to create isolation areas for residents infected with or suspected of having the virus; designate teams of workers to tend to the patients; and send coronavirus test kits to a state lab for expedited testing. “As we have been saying for several weeks, older Marylanders and those with underlying health conditions are more vulnerable and at a significantly higher risk of contracting, getting more severely ill and dying from this disease,” said Hogan, who, as chair of the National Governors Association, has represented states’ top elected officials and has also been one of the few Republicans to question President Trump’s statements about the pandemic. “We will use every tool at our disposal to protect the most vulnerable among us,” Hogan said. Hogan’s order, elements of which were mentioned by the state’s deputy health secretary at a Friday news conference, requires all staff in close contact with residents to wear face masks, gloves and gowns. The facilities can request additional equipment from the state. It also mandates that the facilities send coronavirus tests to the Maryland Public Health Laboratory,


Local digest: D.C. woman dies in carbon monoxide incident

THE DISTRICT A woman died Sunday after apparently being overcome by carbon monoxide in an apartment in Northeast Washington, authorities said. The woman died after being found unconscious in an apartment in the 100 block of Kenilworth Avenue NE, the D.C. fire department said. The carbon monoxide came from a stove that was left on, the fire department said. Other residents of the building were to return after it was ventilated, according to the fire department. The carbon monoxide was confined to one apartment, officials said. The victim was not named. — Martin Weil MARYLAND A 24-year-old man who was shot to death early Saturday in Baltimore’s Federal Hill neighborhood was hosting a “game night” party at his apartment and streaming on Facebook Live when his attacker scaled the property’s fence, according to a review of the video and a woman who attended the party. Ernest Wilson III was shot about 2:45 a.m. in the 1100 block of South Charles Street, police said. City Council member Eric Costello (D) said police told him that Wilson was killed at a short-term apartment and that he was hosting a game night when two people entered and demanded money. Wilson, according to his Instagram and Facebook posts and videos, routinely hosted parties around the city. — Baltimore Sun Maryland’s state schools superintendent will stay on the job for another year because of the coronavirus pandemic. The Baltimore Sun reported Tuesday that Karen Salmon agreed to extend her contract. She previously said she would leave her post June 30. The Maryland Board of Education said Salmon’s new contract runs through the end of June 2021. “We are grateful that Dr. Salmon has agreed to continue serving Maryland’s Students during this national crisis,” the board said in a news release. Salmon is a former Talbot County schools superintendent. It is unclear when the board with resume its search because of the coronavirus outbreak. — Associated Press


D.C. jail reports more inmates have tested positive; cases in Washington region climb past 7,000

The number of known coronavirus cases in the District, Maryland and Virginia stood at 7,252 Sunday morning, with 3,610 cases in Maryland, 2,640 in Virginia and 1,002 in the District. The total of virus-related deaths was 51 in Virginia, 67 in Maryland and 22 in the District, for a total of 140 fatalities. From Saturday: 21 new deaths as D.C. region marks largest one-day spike in covid-19 fatalities Here are some of the most significant and recent developments as the region responds to the pandemic of the novel coronavirus, which causes the disease covid-19: • As the number of coronavirus infections and deaths has surged, so has the national profile of Maryland Gov. Larry Hogan (R), who has emerged as chief spokesman for the nation’s governors — and one of few Republicans willing to question the statements and actions of President Trump. Read more here. • Another four members of the District’s Emergency Medical Services Department have tested positive for the virus, officials said Sunday. That brings the total number of infected firefighters, paramedics and emergency medical technicians to 32. What a stay-at-home order means for you


Retired D.C. firefighter died amid covid-19 outbreak at Pleasant View Nursing Home

D.C. firefighter who loved sports, pranks and being outside, died March 29 following an outbreak of covid-19 at Pleasant View Nursing Home in Mt. Airy, Md. The cause of death was pneumonia and possible covid-19, the disease caused by the novel coronavirus, said his daughter, Tracy Shavell. He was 77. “He was not supposed to go this way,” said Shavell, of Frederick, Md., who visited her father almost every day. Holmberg moved into Pleasant View in late February after taking a fall at a previous nursing home. He had been diagnosed with dementia about two years ago, Shavell said. He grew up in the District and joined the D.C. National Guard after graduating from Anacostia High School. He served for 22 years as a firefighter, retiring in 1988 from Engine 15. His son, Robert Holmberg, of St. Mary’s County, remembered his father bringing him to the fire station when he was growing up and letting him slide down the pole the firefighters used. On weekends, his father’s friends would gather at their house in St. Mary’s County, telling jokes and stories about work. Holmberg volunteered with the American Red Cross during Hurricane Katrina and helped with disaster relief throughout his retirement. His younger brother, Jim Holmberg, said Gary had saved lives “and birthed at least one baby.” “He cared about people,” said Jim Holmberg, of Shenandoah Junction, W.Va. “That was what his core was made of.” The elder brother was also a prankster who loved nothing more than a good laugh. Like all the brothers in the family, Gary had a temper at times, Jim Holmberg added. Gary Holmberg loved baseball — he once unsuccessfully tried out for the Washington Senators — fishing, crabbing and golf. Shavell said her father taught her how to play softball, loved to roughhouse with her and her brother, could fix anything around the house, and was the person that neighbors called if they needed anything. “He would help anyone,” she said. Holmberg was transported to Carroll County Hospital with a respiratory infection on March 27, the same day authorities announced the outbreak at Pleasant View. By March 28, he was gasping for air. Shavell and her brother said goodbye to their father, who died the next morning. They are awaiting results of a coronavirus test and an autopsy. In addition to his two children, Holmberg is survived by four grandchildren and three siblings. rachel.chason@washpost.com


Coronavirus death toll: Americans are almost certainly dying of covid-19 but being left out of the official count

the first known case of an American dying of the disease caused by the coronavirus. Death certificate data will be part of the CDC’s new effort to estimate total covid-19 fatalities. To estimate the total fatalities from a disease, scientists often look at “excess deaths” — the number of deaths over and above the average number during a particular period. The most robust estimates require national statistics that in the United States can take two or three years to compile, according to Cécile Viboud, a National Institutes of Health scientist who co-authored the study estimating the U.S. undercount during the H1N1 flu. The number of initially uncounted flu deaths typically includes people with pneumonia and other respiratory symptoms who were never tested for influenza, as well as a larger number of people who contract the flu and are left more susceptible to dying from such conditions as cardiac arrest, stroke and diabetes. Those people may not be reported as dying of the flu, but the flu still contributed to their deaths. Scientists do not yet know whether or how often covid-19 is killing people with these kinds of secondary problems. But it is clear that covid-19 can cause non-respiratory symptoms, scientists say. Last week, a group of Italian scientists published a study of a 53-year-old otherwise healthy woman who had arrived at a hospital complaining of extreme fatigue. She was suffering from acute heart problems, including inflammation of the heart muscle. She tested positive for the coronavirus. In Albany, Ga., home to one of the nation’s most explosive outbreaks, funeral director Jeffery F. Wakefield Sr. said he treats every body as if it is infected with the virus. Wakefield recently handled the body of a young man, around 40 years old, who died at home alone and was not found for several days. The man’s death was attributed to cardiac arrest. He was not tested for the coronavirus. “We’ll never really have true, true numbers,” Wakefield said. “We’ll get almost close, but we’ll never have the true numbers of who died from this.” Epidemiologists say that patients who need medical treatment for conditions other than covid-19 may also suffer and die in places where the health-care system becomes overwhelmed by the virus. Even as testing has become much more widely available, it remains limited in such places as prisons and nursing homes where the disease is spreading quickly. The CDC


residents are sick with respiratory symptoms, and some have died, but virtually no one is being tested, dead or alive. The exception is when residents are taken to hospitals, the operator said. “We’re assuming that everyone is positive,” the operator said. “To utilize a test on the deceased, it’s not going to be very helpful. Because at the end of the day, there’s a shortage of tests to begin with. We don’t have tests. We don’t have swabs.” The Federal Bureau of Prisons is no longer testing at a Louisiana prison where a dozen inmates have already tested positive and at least one has died. Sue Allison, a bureau spokeswoman, said that because the virus is spreading inside the facility, any inmate exhibiting symptoms is presumed infected. Allison said the decision on whether to posthumously test inmates who died of suspected covid-19 would be made with health officials on a case-by-case basis, depending on the availability of tests and other factors. In most states, people who die at home or have not been under medical care are reported to a patchwork system of medical examiners, lay and sheriff coroners, justices of the peace and other local authorities. Sally Aiken, the president of the National Association of Medical Examiners, wrote in a news release that “the public, in general, does not understand that there is not a uniform death investigation system in the United States. . . . So, a uniform response to COVID-19 by Medical Examiners will not occur.” Medical examiners typically investigate accidental deaths, homicides and suicides and are not going to get involved in a “natural death” such as that caused by covid-19, said Amy Schaefer, an investigator supervisor for the medical examiner’s office in Summit County, Ohio, near Akron. “You certainly are going to have numbers that aren’t being counted because deceased people aren’t being tested,” she said. “We need to test people who are still alive.” But in Wyoming — the only state that had not reported a covid-19 death as of Saturday — Laramie County Coroner Rebecca Reid said she is ready to test anyone with symptoms who dies at home. “We need an accurate cause of death to give the family some closure and make sure they have been safe,” she said. “It’s also very important that the public knows the truth.” She has supplies to test five people, she said. emma.brown@washpost.com beth.reinhard@washpost.com aaron.davis@washpost.com