The dangerous fallout from cutting U.S. funding for the WHO

Michael Merson, a professor of global health at Duke University and visiting professor of global health at New York University, directed the Duke Global Health Institute from 2006 to 2017. He was dean of the Yale School of Public Health from 1995 to 2005. He directed the World Health Organization Global Program on AIDS from 1990 to 1995 and is the author of “The AIDS Pandemic: Searching for a Global Response.” The White House alleges that the World Health Organization in Geneva is partially to blame for the covid-19 pandemic and has suspended U.S. funding pending a review of its actions. It accuses the WHO of being China-centric and slow to criticize China for not reporting early cases of the disease. The administration is angry at the WHO’s criticisms of early travel restrictions the U.S. government imposed on foreign travelers coming from China and, later, Europe. These accusations are unjustified and dangerous. In early January, six days after being informed about cases of mysterious pneumonia in Wuhan, China, the WHO began to prepare for an emergency. It informed and started giving advice to countries, and it organized the visit of a technical team to Wuhan. By the end of January, the WHO declared a “public health emergency” of international concern. Furthermore, its caution against travel restrictions was directed broadly, not solely at the United States, and was based on data. Sound, evidence-based research had demonstrated that travel restrictions were ineffective in most situations in keeping viruses out of countries, that such restrictions could interrupt needed aid and technical support, and that they might inflict social and economic harms on countries. Recall that the United States faced some of these consequences when other countries imposed bans against travelers from North America during the 2009 H1N1 pandemic. This is not to say that the WHO has not had its problems. It did not declare the coronavirus outbreak a pandemic until mid-March. Its response to the Ebola outbreak in West Africa in 2015 was delayed, and justified concerns have been expressed over the years about its expenditures, organizational structure and governance. However, the election in 2017 of Tedros Adhanom Ghebreyesus as its director general, the organization’s first leader from Africa, was viewed by many as a turning point in setting the WHO on a better path. In a short time, the Ethiopian physician greatly improved the WHO’s pandemic response capabilities and emphasized the


the WHO declared a “public health emergency” of international concern. Furthermore, its caution against travel restrictions was directed broadly, not solely at the United States, and was based on data. Sound, evidence-based research had demonstrated that travel restrictions were ineffective in most situations in keeping viruses out of countries, that such restrictions could interrupt needed aid and technical support, and that they might inflict social and economic harms on countries. Recall that the United States faced some of these consequences when other countries imposed bans against travelers from North America during the 2009 H1N1 pandemic. This is not to say that the WHO has not had its problems. It did not declare the coronavirus outbreak a pandemic until mid-March. Its response to the Ebola outbreak in West Africa in 2015 was delayed, and justified concerns have been expressed over the years about its expenditures, organizational structure and governance. However, the election in 2017 of Tedros Adhanom Ghebreyesus as its director general, the organization’s first leader from Africa, was viewed by many as a turning point in setting the WHO on a better path. In a short time, the Ethiopian physician greatly improved the WHO’s pandemic response capabilities and emphasized the importance of strengthening national health systems, which are a vital component of such a response. The organization has also acknowledged the need to make the International Health Regulations — the guidelines designed to prevent, control and respond to public health emergencies were last updated in 2005 after the severe acute respiratory syndrome (SARS) outbreak — more effective and timely. This should include creating a stronger mechanism to hold countries more accountable for reporting. The covid-19 pandemic has had a profound impact on the world’s wealthy countries. The United States has by far the greatest number of cases and deaths to date. But the potential for much worse outcomes looms as the virus spreads to lower- and middle-income countries in Africa, Asia and Latin America. Populations in many of these countries lack water — as well as soap — to wash their hands, and many live in crowded conditions that make social distancing impossible. Moreover, their health systems have insufficient numbers of community workers to practice contact tracing and insufficient staffing, vital supplies or personal protective equipment to treat covid-19 cases in their hospitals. Those living in refugee camps are particularly vulnerable. The World Health Organization is the main lifeline for


importance of strengthening national health systems, which are a vital component of such a response. The organization has also acknowledged the need to make the International Health Regulations — the guidelines designed to prevent, control and respond to public health emergencies were last updated in 2005 after the severe acute respiratory syndrome (SARS) outbreak — more effective and timely. This should include creating a stronger mechanism to hold countries more accountable for reporting. The covid-19 pandemic has had a profound impact on the world’s wealthy countries. The United States has by far the greatest number of cases and deaths to date. But the potential for much worse outcomes looms as the virus spreads to lower- and middle-income countries in Africa, Asia and Latin America. Populations in many of these countries lack water — as well as soap — to wash their hands, and many live in crowded conditions that make social distancing impossible. Moreover, their health systems have insufficient numbers of community workers to practice contact tracing and insufficient staffing, vital supplies or personal protective equipment to treat covid-19 cases in their hospitals. Those living in refugee camps are particularly vulnerable. The World Health Organization is the main lifeline for these countries to avoid many millions of cases and deaths. The organization’s support is vital to provide accurate information on prevention and treatment, diagnostic tests and supplies. Its help is critical to strengthening surveillance systems and designing locally appropriate containment and mitigation strategies. Once there are an effective therapy and vaccine, the WHO will be responsible for certifying their use in these countries and ensuring adequate amounts are made available. With the advice of experts, the WHO has already laid out a comprehensive agenda for research that is needed to rapidly advance knowledge about the virus and the pandemic. The WHO is providing technical and other support for this research. No other organization in the United Nations system, or elsewhere, can fulfill these functions. Abrupt suspension of U.S. government funding to the WHO would severely compromise its operations, exacerbating the pandemic and its global impact. This is wrong not only in humanitarian terms but also would make the world less safe for Americans, as the continued presence of many covid-19 hot spots would likely result in our experiencing second or third waves of the virus. This action by the U.S. government would, ironically, also guarantee China’s predominance in global health


Amid the pandemic, an adventure addict finds solace in imagination

who has studied the happiness people derive from experiences, is that "experiential consumption resists adaptation." That's a fancy way of saying that the gratification we derive from a great trip far outlasts the positive emotions of buying, say, a new rug. “We quickly lose interest in a new material possession, but, as Humphrey Bogart said, ‘We’ll always have Paris,’ ” he explains. “I often recall some of my favorite hikes in New Zealand and think, ‘Wow, I can’t believe I got to do that.’ ” This is a good place to acknowledge the obvious: Any annoyance that I or any other healthy individual is experiencing because we can’t take a leisure trip pales in comparison to the problems many people face every day, especially those who are sick, grieving, jobless or otherwise unmoored because of covid-19. Still, traveler frustrations are valid and may be most acute in hardcore adventurers, says Frank Farley, a Temple University psychology professor and former president of the American Psychological Association who coined the term “Type T personality” to describe thrill seekers and risk takers. “People who are governed by T behavior are probably among the least likely to enjoy” the physical limitations of a quarantine, Farley says. “It’s the exact opposite of what they want, and they’ll probably start looking for a ‘Type T breakout’ — a way to escape incarceration.” For some, that might mean throwing caution to the wind and traveling in search of adventure — and by now you don’t need me to tell you how socially irresponsible that would be. Instead, Farley recommends shifting from what he calls “T-physical” to “T-mental.” My consciousness journeys are one way to do that because they allow me to kinda-sorta believe I’m engaged in a sport, which in turn triggers at least a minor surge of the pleasure-yielding neurotransmitter dopamine in my brain. Other T-mental activities include reading adventure literature — among my favorites are accounts of early polar explorations and the first forays by foreigners into the Sahara — and journaling on past trips. “People love stories, and adventurers are usually very interesting in the sense that they’ve let go of the handrails,” he says. “If you’ve done interesting adventures, share them. Your friends and family would love to have that. You’re not going to be out there for a while, so sit down and write.” But what Farley said next really grabbed me.


In a time of uncertainty, classical music provides a sense of permanence

gives us an experience of certainty, a structure we trust (the sonata form is itself an institution), a way things should go. It may be why classical fare has figured so prominently and so boldly into the mass migration of American culture online. My social media feed this week has been a virtual mob of quarantined musicians reaching deep into the past for works to pass the long days at home, and light the way forward. (I’ve observed a distinct spike in Bach-for-one, for one.) The past few weeks online have shown this in action. Italian communities besieged and locked-down by the novel coronavirus, quarantined on their balconies but clinging to the connection of earshot as they serenade each other — led, in spirit, by the tenor Maurizio Marchini, whose stirring “Nessun Dorma” carried from Florence around the world, and even into some hospital wards. We’ve seen virtual orchestras, like the Cunningham Piano Online Ensemble, use Mozart to overcome the distance of nine countries and four generations. And we’ve seen ensembles scattered by isolation — from Norway to Spain to Australia and everywhere in between — assemble to perform, and to help the rest of us regroup. Watching members of the Rotterdam Philharmonic Orchestra play Beethoven’s “Ode to Joy” online from 19 separate apartments, or 49 members of the Colorado Symphony doing the same, or 71 members of the New York Youth Symphony Orchestra sign on for a performance of Gustav Mahler’s “Titan” symphony resonates not only as a spectacle of technology or a salvo of resilience. The scattered togetherness of these performances are reassurance that, despite overwhelming evidence to the contrary — and even as our institutions shudder (and shutter) — some things last. This assertion of permanence against unceasing change may also be the impulse behind so many music institutions engaging with their audiences by re-engaging their own archives. On a purely practical level, archives are easier to pull together than live stream, and require no gathering. But on a more poetic level, archives represent a past we can return to — a souvenir of stability. The Baltimore Symphony Orchestra just launched its OffStage platform, mixing at-home recitals from BSO musicians and archived video footage of BSO performances. The Philadelphia Orchestra is releasing weekly treasures from its archives as well as solo performances from musicians’ homes via its Virtual Philadelphia Orchestra platform. New music mainstays Bang on a


Stranded in Kenya and abandoned by my country. Again.

the virus, which felt a world away. “How bad could it possibly get in two weeks?” I said to a friend as my boyfriend and I made the decision to go ahead with the trip, which represented the beginning of a new life as I honored my old one. In Kenya, travelers ate at buffets cheek-by-jowl, booked massages, ordered piña coladas at poolside bars. I had bottles of hand sanitizer on me at all times, just in case, and was personally not interested in massages. When I saw hundreds of elephants on a trail headed toward the base of Kilimanjaro, I knew I had made the right decision. Cleve would have cried with the biggest smile. I wept thinking about how much life he had missed out on. I also felt like a survivor. “Look how far I’ve come,” I thought. “I’m gonna be okay.” Seven days into our trip, I woke up to Facebook messages from friends saying Trump had announced he was closing the borders to travelers. “Are you okay?” they asked. “Come home now.” And then there were more messages saying the president had corrected himself and would allow American travelers to return. Reports of congested airports and canceled flights flooded social media. The first case of coronavirus in Kenya was confirmed on March 12. On March 14, Delta canceled our return flight by email. “We apologize for the inconvenience. . . . We will notify you again once your rebooking is completed,” it said. It didn’t. I rebooked myself. But this flight, too, was canceled, as we found when we arrived at the airport. As were the next two. Brent and I had budgeted just enough for the trip. We were already planning on putting off some bills until our next payday. We were nervous because both of us work in the school system and were out of jobs until schools opened again. We didn’t know yet if we would be paid. I wasn’t sure how we would afford to stay in Nairobi any longer. I updated a friend about our most recent canceled flight, and she warned me that the State Department was advising U.S. citizens “currently abroad to return home immediately, unless they are prepared to remain abroad for an indefinite period.” My mind raced. Our latest booked flight was six days away. I called Delta. When I asked if they could help with


America’s greatest bug expert — Charles V. Riley — is buried in Washington

doing more than merely studying or classifying insects. “That’s certainly why the Department of Agriculture hired him,” said Weber, a research entomologist at the USDA. Riley came to Washington in 1877 after serving as chief entomologist for the state of Missouri. Riley was a striking figure around town: tall, athletic, with an impressive mustache. He threw himself into his work. It was Riley who proposed grafting American grape roots onto French vines. An insect called phylloxera was causing French vines to wither. The bug was native to the United States, meaning American plants had immunity from it. “He basically saved French vines from American phylloxera,” said Weber, who worked on the biography with W. Conner Sorensen, Edward H. Smith and Janet R. Smith. When California orange groves were decimated by an insect called the cottony cushion scale, Riley figured out that the vedalia beetle from Australia was a natural predator. He recommended introducing the beetle to combat the scale. It’s regarded as the classic example of biological control of a pest, an alternative to harmful pesticides. (Riley was so pleased that he named his youngest daughter Cathryn Vedalia Riley.) Riley was a founding member of the Cosmos Club, an organization of leading District intellectuals. He was successful in real estate, too, building houses in the Logan Circle area, along with a large Romanesque Revival home called Sunbury in Adams Morgan for his family. Riley fought many turf battles and in 1894 he was forced to resign from the government after being accused of improper travel. (He’d gone to Montserrat to investigate an outbreak of scale there.) At the time of his death, he was contemplating taking up an offer from the government of New Zealand to become that country’s chief entomologist. On Sept. 14, 1895, Riley and his 14-year-old son got on their bicycles for a Saturday morning ride to Kalorama. After picking up speed on Columbia Road, Riley hit a broken paving stone at Connecticut Avenue and S Street NW and went over the handlebars. His head struck the ground and he died that night. “That’s still kind of an accident-prone intersection, even to this day,” said Weber. Today, the Riley family papers — including the colorful illustrations Charles did as a boy in Europe — are at the National Agricultural Library in Beltsville. Riley is remembered in Annapolis, too, where a bronze statuette presented to him by grateful


Russian medical workers say coronavirus is ravaging their ranks. But hospital chiefs are silent.

who had died and details on the numbers of quarantined hospitals. The health minister’s spokesman said figures were unavailable. Many hospitals have been sealed off and quarantined. A Moscow clinic was shuttered for disinfection after a covid-19 outbreak that included the chief doctor and deputy. The main hospital in Ufa, about 725 miles east of Moscow, with 1,200 medical staff, workers and patients, was sealed off after 170 staff members and patients tested positive. Komi Republic, a remote northern region with a scattered population, shot up to be the second-worst covid-19 locale in the country per capita after an outbreak that began in one hospital and spread to another. At least two medical staff members died, according to a local activist, Ernest Mezak, who compares the situation to “living inside a disaster movie.” Mezak took to social media last week urging doctors and health workers to document the problems online and to report each covid-19 case and death. “Do not play down the consequences of the pandemic,” he urged. “Lying about the scale of the disaster is the worst that you can do for your countrymen in general, and for the relatives of those who died of covid-19 in particular.” Putin on Monday warned that the worst was ahead and said protection for health workers was crucial. “Let me stress that increased, reliable protection from the infection must be ensured for medical personnel, and right now, every single one of them counts,” he said, adding that Russia had begun to step up production of protective gear as well as importing from China. A day earlier, he said the situation was “fully under control.” Earlier this month, he blamed the problems emerging in Russia’s regions on “sloppiness.” But anger is growing. Video surfaced of a shouting match at Sunzhenskaya Central District Hospital in the southern republic of Ingushetia as staff members demanded protective equipment. Meanwhile, ambulance drivers and paramedics in Moscow have faced queues of up to nine hours for admission to some hospitals or have had to dash from one hospital to another with patients, only to find no beds available. It was only on April 10 when Health Minister Mikhail Murashko admitted a shortage of protective equipment for staff: “We can see that all health care systems are under stress now due to a shortage of consumables — personal protective equipment and … ventilators,” he told Russian television. robyn.dixon@washpost.com


The Daily 202: Shifting coronavirus timeline shows how much experts still don’t know – and why testing matters

Korea of people recovering from covid-19 only to get re-infected. These cases are of immense interest to not just front-line physicians but also the researchers around the globe racing to develop a vaccine. The failure by the CDC to quickly produce a test kit for detecting the coronavirus was triggered by a glaring scientific breakdown at the CDC’s central laboratory complex in Atlanta, David Willman reported last weekend. Scientists say the CDC facilities that assembled the kits violated sound manufacturing practices, resulting in contamination of one of the three test components used in the highly sensitive detection process. That’s because it will probably coincide with the start of flu season. He explained during an interview on Tuesday with Lena Sun that having two simultaneous respiratory outbreaks would put immense strain on the health-care system and said federal and state officials need to use the coming months to prepare. As stay-at-home orders are lifted, Redfield added, states still need to massively scale up their ability to identify the infected through testing and find everyone they interact with through contact tracing. “As part of the White House guidelines released last week for a gradual reopening of the country, testing by CDC teams is already underway in nursing homes in four states for asymptomatic cases. The four states are Nebraska, New Mexico, North Dakota and Tennessee,” Lena reports. “Kentucky and Rhode Island might look similar on paper. They’ve done comparable numbers of diagnostic tests and lost similar numbers of residents to the disease. But there’s one key difference. Kentucky has more than four times Rhode Island’s population, meaning it has tested 0.7 percent of its residents, compared with Rhode Island’s 3.7 percent, the highest per capita testing level in the United States,” Juliet Eilperin and Chris Mooney report. “The difference suggests Rhode Island probably has a better sense of the virus’s spread throughout the state, making it better prepared to curb it.” Some Senate Republicans are looking for ways to get the federal government more involved in testing. “South Carolina, Georgia, Texas, Tennessee and Florida have announced limited easing of business and recreational closures and social gatherings, to start between this week and the end of April. While some of those states have shown a fall in confirmed virus cases on some recent days, other days have presented increased numbers. None has charted the sustained, 14-day ‘downward trajectory’ outlined in federal guidelines issued


the first child in Michigan to die of covid-19 … She was both young and without known underlying conditions. Her death serves as a reminder that the coronavirus can present peril to people at any age. … Her story disproves ‘the myth now that children couldn’t get it,’ said her father, Ebbie Herbert. The family has agreed that the hospital may use Skylar’s tissue to research covid-19, her mother said.” Skylar’s mom is a Detroit police officer, and her dad is a firefighter. “Boston Children’s has admitted 25 children … Children’s National Hospital in the District reported a steady increase in cases, as did Children’s Hospital of Philadelphia. … Mount Sinai Kravis Children’s Hospital in New York … has admitted about 20 children with covid-19.” “New York City has been distilled to its essential workforce. The Bronx, predominantly, is where they live, each day cramming into buses and subway trains that take them into Manhattan. As the city rallies around a mantra of ‘New York Tough,’ the marginalized here — among them city transit staff, garbage collectors and health-care workers — know that New Yorkers are not truly all in this together. There are now more coronavirus infections here per capita than in any of the city’s other boroughs,” Richard Morgan reports from Ground Zero of Ground Zero. “The Bronx is not just the poorest borough in the city. The 15th District, or NY-15, its chief congressional district, is the poorest in the nation. Of all the unsettling data points to have surfaced during the pandemic, one is front of mind among many of the 1.5 million people who live here: Of New York state’s 62 counties, the Bronx ranks dead last by most every measure. … A covid-19 testing site was announced for the neighborhood this month, but Manhattan — the city’s least affected borough with less than half the Bronx’s infection rate — has converted its Javits Center convention hall and a piece of Central Park into makeshift hospitals. What about the Bronx?” The Los Angeles Times The legislation, passed by unanimous consent, would increase funding for the Paycheck Protection Program, boost a separate small-business emergency grant and loan program by $60 billion, and direct $75 billion to hospitals and $25 billion to a new coronavirus testing program. The House is expected to approve the measure tomorrow. “Treasury Secretary Steven Mnuchin said Tuesday that larger firms would now


Climate news quiz: Carbon sinks and retreating glaciers

All right: Time to see if you’ve been paying attention to The Post’s climate-related coverage. If you have, this quiz should be an easy A. Answer: C. Answer: C Answer: B. Answer: D. Answer: C Answer: A. Answer: B. Answer: A. Answer: C Answer: A. 0 to 3 questions correct Climate novice: You’ve still got a lot to learn about climate change. But that’s okay: We’ve got you covered. Got a question? Ask us here. 4 to 7 questions correct Climate curious: Hey, not bad! You know a thing or two about climate change. But there’s still more to learn, and we’ve got you covered. Got a question? Ask us here. 8 to 10 questions correct Climate expert: Well done! You’re super climate-literate. You probably already know that one of the most important things you as an individual can do to combat climate change is to spread the word. Go ahead: Brag a little, share this quiz with your friends, and find out who knows the most about climate change.


San Francisco school board proposes giving A’s to all students for covid-19 period as districts adopt varying grading systems

The closing of most of America’s schools and the quick rush to distance learning because of the spread of covid-19 has prompted changes in the way many districts are asking teachers to grade student performance during this period. Most districts appear to be moving to a variant of a pass/fail system for the spring semester as they attempt to implement “hold harmless” policies during a time of transition and anxiety. In Ohio’s Perrysburg Schools, for example, officials posted to the district website a statement saying it was moving to a system in which students who usually get grades will get either a “P” for pass or an “I” for incomplete. For high school students, a “P” will have “the weight of a 4.0 for regular classes and 4.5 for Honors,” which are A’s. “We know that the stress put on families is tremendous and we are doing our best to determine the right path to take in the education of our students,” it says. “We continue to use the analogy of flying the plane as we build it.” Differences in districts in the state of California show the variety of approaches being implemented nationwide. The California Education Code says, “There is nothing [in the code] which governs whether a class can be offered as credit/no credit, pass/fail or a modified A-D. Given the circumstances of COVID-19, some districts are considering a variety of options.” In the San Diego Unified School District, students will not receive a grade lower than they received earlier in the year because of the stresses of the change to remote learning and overall anxiety. In the South Pasadena Unified School District, students will be able to individually decide whether they want to be assessed pass/fail or by a grade, with decisions due at the end of May. The Los Angeles Unified School District recently announced it was dropping F’s from the grading system — meaning that no student can actually fail. One district wants to go further: A majority of the San Francisco Board of Education wants to give all students all A’s for the time they are home because of covid-19 — which some are calling “the asterisk semester.” The idea was raised, board President Mark Sanchez said in an interview, at a meeting of the panel earlier this month. “It came from being compassionate and understanding that our students are up against the wall,


Covid-19 could detonate a ‘hunger pandemic.’ With millions at risk, the world must act.

David M. Beasley is the executive director of the U.N. World Food Program. Material from this column was used in an address to the U.N. Security Council. Just a few months ago, we could talk about the 1918 flu pandemic comforted by the sense that this was something of the past — a crisis of the early 20th century that would never happen to us. Covid-19 has smashed that illusion of safety and security and proved, beyond a doubt, that pandemics are a present and mortal threat to all of us. The same could be said for famine. You might think of it as a word that lives in the past, or even on the pages of the Bible, that we have tamed one of the four horses of the apocalypse. But just as this new coronavirus has ambushed the lives of millions, we should brace ourselves now for another pandemic, the hunger pandemic that may follow, sowing the seeds of famine in its wake. Just a few weeks ago, I was coming out of my very own brush with the virus, testing positive as I returned to the United States after a punishing travel schedule, mobilizing funds for the work of the U.N. World Food Program. Given time to recover at my home in South Carolina, I have had the time to think about the virus and the threat it poses to the world. My thoughts have taken me on a frightening journey, and the endpoint is something that we all need to wake up to before it is too late. What this pandemic has caused is nothing short of a global crisis, the likes of which we have not seen since World War II. And as a global crisis, it requires a global response, especially for the tens of millions whose lives will be crushed by the socioeconomic impact of this crisis. Even before covid-19, the year 2020 had the potential to be a disastrous one for those living on the edge. The unending wars in Syria and Yemen, the worsening conflicts in places such as South Sudan and the Central Sahel in Africa, more frequent natural disasters, the economic crisis in Lebanon affecting Syrian refugees — these crises had already upended the lives of millions, leaving them in extremely vulnerable situations. The coronavirus pandemic, added to the mix, now threatens to detonate an unprecedented global humanitarian catastrophe.


My cancer patients already face hard choices. Coronavirus makes them even worse.

melding available data with clinical judgment to determine the urgency for oncologic care. Ms. B’s case is instructive because her first impulse was an entirely understandable one: She was inclined to cancel or skip appointments that had been previously scheduled to check her blood cell counts, electrolytes, liver and kidney function. When that seemed insufficient to reduce her risk, she asked to delay further chemotherapy indefinitely until the pandemic abated. In her mind, the potential harm from the coronavirus had supplanted the reality of an increasingly terminal cancer. While she understood her cancer only in the abstract and had minimal symptoms, the coronavirus and its dangers were far more palpable because of the ubiquitous coverage and human stories that were emerging daily. But the cancer was unlikely to become suddenly dormant as the coronavirus advanced. A protracted break from treatment would allow the cancer to metastasize further, which would probably lead to significant, debilitating consequences. This current moment was, thus, her sole window to extract any meaningful benefit from chemotherapy. Nevertheless, her concerns spoke to important considerations. Even in the absence of treatment, cancer itself causes an immunocompromised state through various mechanisms, such as the release of immunosuppressive factors or the disruption of immune cells. And once chemotherapy causes wholesale destruction, white blood cells, the body’s front line against the coronavirus, become emasculated. The limited global data on covid-19 from hot spots underscores this. In Italy, 20 percent of overall deaths occurred in patients with active cancer. Studies and reports from China have noted that those with cancer have a higher risk of severe events (death, admission to the intensive care unit or need for invasive ventilation) than those without the diagnosis. As we study our patients’ vitals, there is some small solace in the knowledge that fever is commonplace with chemotherapy, given the obliteration of white blood cells. This is the sort of thing we learn to manage even under the best of circumstances. But now we must be even more vigilant, with an especially low threshold to test for covid-19. A recent call I received from the emergency room about a fever revealed how leery I was about missing a coronavirus diagnosis. Ms. J, a 76-year-old getting an intense chemotherapy regimen after breast cancer surgery revealed lymph node spread, had come in with an isolated fever and felt fine with no other associated symptoms. Despite her normal white


Transcript: Leading the Fight Against Climate Change

recovery package, to actually move that into some of these kinds of investments. That ideology has got to be shifted into this kind of investment. But I think the critical places we have to move rapidly with federal leadership is accelerating the move to cleaning, to decarbonizing our power grid, to decarbonizing our transportation, and decarbonizing to the degree--and we're going to have to help them. I'm not suggesting this is a draconian, bring the hammer down. But we need to work with our heavy industries in order to help them be able to make that transition. They're prepared to do it, if they have an affordable energy source and it's a clean energy source. They're just afraid, and legitimately, that if you were--suddenly said, "Oh, you're relying on renewables," that we don't have the storage necessary to guarantee that they're going to have the power they need when they need it. So, this is not a simple equation, but it's manageable. The United States of America has the greatest ability of any nation I know, when we put our minds to it, to innovate, to go to the moon, to invent the Internet, to do all kinds of things--to cure diseases, which we have done to a great degree in the last 70 years. So, if we apply ourselves with the historic concentration and capacity for creative solutions that our country produces, we will solve these problems. The problem is we're not even being asked to do that. We actually have an administration moving in the opposite direction. MS. JORDAN: We're going to have to wrap this up pretty soon, but I just want to ask each of you the same question as we wrap up. There's a lot of bad news lately about all kinds of things. So, is there--can you just point to one thing that, when it comes to climate--the climate and the care of the planet--that you see is a positive development? What is something--we'll go to Secretary Kerry, first--about something that you actually see as a positive development. MR. KERRY: Can I just mention, also, Mary, that we're going to have--World War Zero is going to have--at WorldWarZero.com, tonight, people can go and there will be a townhall. And the townhall will have Tony Goldwyn, well-known actor, et cetera; and also, an extraordinary individual, Alex Honnold who is the Free Solo climber, [audio distortion]


The government’s inefficient delivery means relief will come too late for many Americans

closer attention to benefit delivery, for too many Americans, emergency relief will be relief in name only. While tens of millions of taxpayers have received their awards via direct deposit, millions more won’t receive them for months, if they receive them at all. Originally, researchers at the New America think tank estimated that only half of eligible families would receive funds this month. Fortunately, the Internal Revenue Service recently clarified a payment process for the nearly 10 million Americans who earn below the federal filing minimum and others for whom the government did not have bank information on file. Though a welcome development, this effort should have been a priority from the start. The weeks it took to clarify the steps the lowest-income Americans need to follow to get emergency relief is precious time gone. The glitches in stimulus payments aren’t the only technical barriers facing those who need help right now — Americans are reaching for unemployment insurance and food assistance in record numbers and facing massive delays, due, in part, to computer systems in need of overhaul. The newly jobless around the country are battling with jammed phone lines and crashed websites as they try to file unemployment claims. New Jersey is asking retirees who can work the state’s glitchy unemployment system to volunteer their skills — it runs on COBOL, a 60-year-old programming language. The troubles are broader than these technical hurdles. When it comes to government benefits, appropriating the money is only part of the challenge. The devil is in the delivery. The earned-income tax credit is one of the most generous credits for low-income Americans, yet almost a quarter of those eligible fail to claim this credit. Why? At least some of it is in the delivery — research suggests that reminders and simplified forms can significantly raise take-up rates, getting much-needed money to those who’ve earned it. Simplifying application processes and focusing on delivery has had remarkable results elsewhere. In Michigan, delivery-driven reform cut the country’s longest assistance application (more than 40 pages) down to 18 pages and streamlined access to food and health-care benefits. Of course, this kind of reform takes time to test and scale, and time is scarce in an emergency. In the words of Jennifer Pahlka, former U.S. deputy chief technology officer, “The best time to modernize essential government systems was 15 years ago. The second best time is now.”


Lebanon is in a big mess. But on coronavirus, it’s doing something right.

it often takes Americans to receive their results. There is no shortage of protective equipment for health workers. Face masks, gloves and hand sanitizer are widely available in stores — and are widely used. Some supermarkets are handing out freebie face shields emblazoned with their logo. Health experts attribute the success above all to the swift and strictly observed lockdown. By way of comparison: Cook County in Illinois, which includes the city of Chicago and has a smaller population (5.1 million), reported its first coronavirus case on Jan. 24, nearly a month before Lebanon. The state of Illinois closed schools on March 13, two weeks after Lebanon. It issued a stay-at-home order on March 20, five days after Lebanon had locked down. As of Wednesday, Cook County had reported 24,546 infections and 1,072 deaths. Paradoxically, distrust of the country’s notoriously dysfunctional government may have helped, said Nasser Yassin, director of research at the American University of Beirut’s Issam Fares Institute for Public Policy and International Affairs. “Given the health system and the way the government operates, you cannot trust they’ll be able to cope.” And, in contrast to some other worse-hit countries, no senior politicians sought to dismiss or downplay the risks. “In Lebanon, everybody has been terrified from day one,” said Souha Kanj, who heads the infectious diseases department at the American University of Beirut Medical Center. “In a way, it’s good to be scared and panic because it forces you to be more vigilant.” Lebanon’s small size is another factor, enabling extensive contact tracing. Almost all the early cases detected among arrivals from Europe and Iran, no matter how mild their symptoms, were isolated in the Rafik Hariri University Hospital, the main government hospital charged with managing the epidemic, said Firass Abiad, the hospital’s general manager. Mild cases are now given the option of hospitalization or quarantining at home. Many poorer patients choose the hospital because it is free and at home they live in overcrowded conditions. This further aids the containment, Abiad said. Lebanon’s relatively young population has also helped, said Krystel Moussally, regional epidemiologist for the international aid agency Doctors Without Borders, who in March predicted over 630,000 infections in Lebanon, based on information available at the time. There are almost certainly unreported cases, including among asymptomatic people, as in other countries worldwide. There are suspicions around the low number of reported infections in southern Lebanon,


Covid-19 is posing serious questions about cancer treatment. There are no easy answers.

Bobak Parang is an oncology fellow at New York Presbyterian Cornell. As covid-19 continues its assault on New York, the medical community has redeployed its forces to buffer health-care workers on the front lines. Half of my co-fellows, who were caring for cancer patients at our New York hospital just days ago, have been deployed to support our heroic intensive care, emergency room and medicine colleagues treating patients infected with the disease. Those of us remaining have assumed their clinical responsibilities, sharing the enlarged burden of patient care both in and out of the hospital. We are facing serious, unresolved questions about how to practice oncology in the covid-19 world. First, what is our threshold for having patients come to the clinic to receive treatment if it means possibly exposing them to covid-19? Some scenarios have easy solutions. If they require lifesaving therapy, then the benefit of treating them outweighs the risk. Similarly, if patients are scheduled for routine follow-up visits, then these appointments can be delayed with little cost. But what about the ever-increasing gray areas of oncology? What if patients are scheduled for a drug that increases their chance of long-term survival but only modestly? Is it worth coming to the clinic and potentially exposing yourself to covid-19 for a treatment that increases your chance of survival from 85 percent to 90 percent? What about from 40 percent to 55 percent? What if that patient is 75 years old? What about 45 years old? Second, how do we take care of those newly diagnosed with cancer? The American Cancer Society estimates there will be 120,000 new cancer diagnoses in New York state in 2020, many of which are curable. A new diagnosis often involves a multidisciplinary team, including interventional radiologists, surgeons, medical oncologists and radiation oncologists working together to coordinate the timing and sequence of diagnostic tests and treatments. Curable, early-stage breast cancer, for example, can involve a biopsy, radiation, chemotherapy and surgery. But nonemergent surgeries and procedures are on hold across the city as operating rooms are being rapidly repurposed for covid-19 treatment. How long can we delay these procedures before we risk a curable cancer becoming incurable? There is, of course, no clear-cut answer to any of these questions, and New York is not unique. Almost hourly, there are newly published recommendations from institutions and professional organizations putting forth general frameworks for how to approach taking


continue to care for cancer patients safely. We now rely heavily on video visits with our patients. Instead of having them come in for bloodwork, we arrange for their blood to be drawn at local labs. For those patients in the gray zone, we work closely with our dedicated surgical and radiation-oncology colleagues to prioritize treatments. And how have our patients responded? They are asking how we are doing. They have asked us how they can help us. I have had multiple patients and their family members ask how they can volunteer their efforts to help our hospital. Perhaps it is not unexpected that cancer patients have remained calm amid the pandemic. The lack of control that we all feel from covid-19 — the sense of powerlessness — is not an unusual feeling for them. When patients are diagnosed with cancer, they experience the same dizzying uncertainty and confusion that upend their entire world. They are accustomed to living scan to scan, treatment to treatment, day to day. Uncertainty is their normalcy. Their grace in the face of this chaos has been stirring. Our mission to find answers for them continues, strengthened by their equanimity. A crisis can break bonds, but it can also reinforce them. For all of the hell covid-19 has wrought, it has awakened a deep solidarity within medicine. I have never felt closer to my patients than I do now. And I have never felt prouder to work alongside the fearless and selfless nurses, doctors and staff who are throwing their energies into holding the front lines against this wild force. Inscribed along the lobby wall of our pediatric floor, which has now been converted into a covid-19 ward, is the famous ending to Percy Shelley's poignant “Ode to the West Wind.” The poet, bearing witness to an agent of destruction, looks ahead and envisions an end to the darkness. “O Wind, If Winter comes, can Spring be far behind?” Read more: Craig Spencer: What it’s like being a New York ER doctor during this pandemic Craig Spencer: How long will we doctors last? Craig Spencer: When the coughing stops and the sense of helplessness begins David Lat: I spent six days on a ventilator with covid-19. It saved me, but my life is not the same. Michael Saag: Leana S. Wen: The one thing about giving birth during the covid-19 pandemic that I didn’t anticipate


The Energy 202: Climate activists worry #EarthDayAtHome won’t be as effective as in-person protests

Santa Barbara, Calif.: to get the politically disengaged to care about the environment. And some activists worry about the many options people have. In addition to the Future Coalition’s three-day live stream, the Smithsonian and Earth Day Network are hosting their own digital events. “That’s problematic,” Fisher said. “It's going to split the constituents in the movement.” But Rogers, head of the Earth Day Network, said the separate live streams made sense since each group is trying to reach a different audience. Still, she said, the groups talked “all day long, every stinking day” to coordinate speakers and help bolster each other’s online events. “Many of us are sharing content,” Rogers said. While the research is early, scientists are already finding links between two pollutants — soot and nitrogen dioxide — and lethal outcomes from the respiratory disease caused by the coronavirus. Those two pollutants are among the handful the first Earth Day protesters were demanding the federal government do something about. And protecting nature, scientists say, is the first line of defense against stopping another pathogen from jumping from animals to humans — as happened with the novel coronavirus, which likely came from a bat. Other well-known and worrisome infections, including SARS, MERS, Ebola and HIV, have their origins in animals too. With deforestation, urbanization and the global wildlife trade bringing people closer than ever to animals, so-called zoonotic infections have more opportunity than ever to pass between species. “This pandemic is the consequence of our persistent and excessive intrusion in nature and the vast illegal wildlife trade,” said Thomas Lovejoy, a conservation biologist and senior fellow at the U.N. Foundation. More broadly, said McCarthy, meeting the challenges of both climate change and covid-19 requires heeding the advice of experts — something she said the Trump administration frequently fails to do. “It’s just really important that we be prepared,” she said. “So you listen to the science, you prepare for these challenges based on science, so that you can be ready to act in a way that protects people.” Read more about the 50th anniversary of Earth Day from my colleague Sarah Kaplan here: The president said he ordered his administration plan to provide federal assistance to the nation’s oil and gas industry, which has been pummeled during the pandemic. “Until now, the American oil industry has been divided on whether to seek federal help, with the larger companies


There’s a growing possibility of a W-shaped economic recovery — and it’s scary

like Hogan Lovells are urging their lawyers to brush up on bankruptcy and restructuring law “in anticipation of a wave of bankruptcy filings in the coming months,” and the major banks spent a lot of time on their earnings calls last week predicting a surge in credit card, auto loan and business loan defaults. Companies and consumers are teetering on the financial edge. Many banks and mortgage firms have offered to give many Americans more time to pay their bills, but it’s unclear what will happen once this grace period ends. “There’s a difference between a grace period and outright abatement,” said Winnette Ambrose, owner of Souk Bakery and the Sweet Lobby in Washington, D.C. “It’s not like we will all make double when we go back out.” Constance Hunter, chief economist at KPMG, expects job losses of “at least 25 million” this spring, a sky-high level not seen since the Depression. An equally frightening number is the median forecast of 10 percent unemployment by the end of the year — meaning more than 15 million Americans would still be out of work in December. As people lose jobs, they stop paying their rent or mortgages, which can lead to eviction and a bad credit rating that drags them down for years. They lose health insurance and possibly their cars. Often, they lose hope. This is the scenario the nation needs to avoid, and policymakers could be doing a much better job trying to prevent this, many economists say. The nation already is experiencing modern-day bread lines as Americans flock to food banks after just a few weeks of the massive unemployment spike. On Friday, Dustin Sider, pastor of Fairland Church in the small town of Cleona, Pa., posted a message on Facebook offering 2,700 eggs free to anyone who needed them. A farmer had donated the eggs to the church. Sider figured it would take a few days to get rid of them. Instead, they were gone in 28 minutes. “I pretty much stood in the parking lot until 5 p.m. and kept telling people, ‘Sorry, we’re all out.’ The cars just kept on coming,” said Sider. “Many said they were laid off." Even among people who still have jobs, 25 percent are fearful they will be laid off or furloughed in the coming year, according to a Gallup poll released Wednesday. Pay cuts also are becoming common, with


Iran’s Revolutionary Guard capitalizes on pandemic to strengthen grip on the country

Last week, a powerful Iranian general went on state-run television to make an extraordinary claim: His elite military unit, the Revolutionary Guard Corps, possessed a machine that could detect the coronavirus from 100 meters away. Gen. Hossein Salami displayed the “Mustaan,” a handheld gizmo resembling a small satellite dish, and said its 80 percent success rate would help end the country’s coronavirus ordeal. He called it “an astonishing scientific phenomenon.” Iranian public health officials downplayed the claim, which was widely ridiculed on social media. Yet Salami’s TV pitch was merely a more theatrical rendering of a message that Iran’s hard-line rulers have been seeking to deliver in recent weeks. The country’s elite security force is aggressively promoting itself as Iran’s true guardian during the pandemic, a provider of medical treatment, clinics, relief aid and — occasionally — even dubious “cures” and fixes. Iran has been among the countries hardest hit by the coronavirus, with an official death toll of more than 5,000, a figure that many outside experts think vastly understates the virus’s true impact. But while the outbreak continues to ravage the country and its economy, the Revolutionary Guard and its allies are seizing opportunities amid the crisis to expand their already powerful base while also cracking down on public displays of discontent, Western intelligence officials and Iran analysts said. The moves to consolidate power follow a string of recent crises — including the downing of a Ukrainian civilian airliner — that challenged the Revolutionary Guard’s reputation both at home and abroad, and had appeared to put the force on the back foot. But now, with the explicit support of the supreme leader, Ayatollah Ali Khamenei, the army, Revolutionary Guard and its paramilitary Basij force have taken command of the country’s response to the pandemic, including the construction of hospitals and the enforcement of quarantine laws. U.S. and European officials say that the security branches’ bid for greater dominance during the crisis appears intended, in part, to discredit President Hassan Rouhani, whose more moderate government has been faulted by conservative leaders for a bungled early response to the pandemic. The Revolutionary Guard’s new role could leave Iran more firmly in the hands of virulently anti-Western elements who favor a more confrontational stance toward its adversaries, including the United States and Israel, U.S. and European analysts say. “Covid-19 has accelerated a trend that began long ago, which is Iran’s transition


Recapture the spirit of date night — remember that? — with takeout for 2 from these restaurants

Remember date night, when a couple could escape for a leisurely meal and spend time talking and catching up after a week of work? We can’t eat at restaurants now, but we can try to recapture some of that spirit, thanks to restaurants bringing multicourse meal packages and optional wine pairings into your home. Some are fine-dining establishments preparing swordfish or wagyu brisket, while others bring the vibe of a carefree Friday night. The Michelin-starred Masseria used to offer guided tasting menus with four to six courses in its dining room near Union Market. Now, the “Masseria a Casa” takeout menu offers one multicourse meal for two each day. Diners can check the restaurant website on Monday to see a week’s worth of dinners and plan ahead. The reduced number of options is the result of both a leaner team in the kitchen and the challenges of getting ingredients. “We used to get deliveries from the West Coast every day, or overnight from Italy,” chef Nick Stefanelli says. Now, “some deliver once a week, some every other day.” But the intent is still there: “We’re trying to stay within what Masseria’s experience was — being able to bring happiness through food,” he says. Creating a restaurant-like experience is also on the mind of Michael Rafidi, the chef at Albi near the Navy Yard. His weekly three-course menu features a limited number of courses, he says, to remove guesswork for customers. Albi’s staff has been trained to guide diners through the menu and answer questions about flavors and serving sizes, which just isn’t possible for people reading a menu from a screen. “When you’re ordering a la carte, you’re not getting the best of what we do here,” Rafidi says. However, just because you’re ordering a meal from a renowned chef doesn’t mean that their kitchen is doing all the work. A recent takeout dinner for two from the Michelin-starred Rose’s Luxury arrived in a fleet of 18 different plastic containers with a sheet of paper providing “a couple of tips” for each of the four courses, including advice to heat sausage in the microwave for 30 seconds before mixing it into the restaurant’s famous litchi salad. “There was a big learning curve” with packaging food to go, says Masseria’s Stefanelli, whose menu also arrives with detailed instructions. “We put a three-course meal in a bag but didn’t label each of


The saga of covid-19 is laying bare a conflict over who we want to be

Among the most useful lessons I learned in English class was that stories — the ones that grab you and pull you along and shape your understanding, anyway — are powered by engines of conflict. Perhaps the information conveyed by this power activates some wiring in the human brain. In the pre-enlightened days of my schooling, even female teachers employed masculine nouns to classify the essential conflicts: Man vs. Nature, Man vs. Man, Man vs. Himself. To see the current relevance of this antique wisdom, look no further than the media struggling to tell the huge and complex story of the novel coronavirus pandemic. News audiences are always wishing for less conflict — and promptly tuning out when they get what they’ve asked for. The storytellers fall back to basics, because the brain wants what it wants: a good guy and a bad guy, a hero facing a hurdle, a race against the clock. [Full coverage of the coronavirus pandemic] As a struggle to beat a dangerous disease, the pandemic is a classic of humanity vs. nature. This upstart from the animal kingdom finds a way somewhere in China to jump the barrier into a human host. From there, it begins infecting people by the thousands, then the millions. It is an enigmatic foe, sometimes killing, other times causing no symptoms at all. Humans in skyscrapers and laboratories and mansions are racing against time for treatments and even a cure — yet we still have only a shadow of understanding about the nature of the thing we’re up against. Is this a seasonal virus that will wane with warmer weather? Are survivors immune to another attack? Could remdesivir be a silver bullet? How much social distancing is enough to maintain a manageable level of threat? What are the prospects for an effective vaccine? The list goes on, and every mystery is another conflict awaiting resolution, an answer or set of answers that make the story of covid-19 more, or less, devastating. All the while, patients and their caregivers are battling for life itself, and businesses large and small are upended by a menace they can neither see nor measure. One day, these mysteries will all be resolved, but for now the unanswered questions, the flapping loose ends, feed the media’s hunger for a simpler story, one whose combatants are well-known and the confrontations rehearsed. If the conflict of human vs.


U.S. is deporting infected migrants back to vulnerable countries

United States in early April have tested positive, officials said. The country has 62 ventilators for 11 million people. The Trump administration reportedly was planning another deportation flight to Haiti this week. “Rather than be deported where they face serious harm if they fall ill and risk infecting thousands of others, they should be released from detention into the care of their friends and families so that they may safely quarantine,” a coalition of 164 human rights and religious organizations said in an open letter pleading for suspension of deportations. In Mexico over the past week, two deportees tested positive for the virus. Calderón’s team spotted a deportee in Reynosa who was visibly ill, with a dry cough, red eyes and a fever. They wondered how the man, who arrived from Atlanta, had made it through U.S. health screenings. A second man was deported to Nuevo Laredo from Houston “without knowing he was a carrier of the virus,” the Tamaulipas state government said in a statement, and was sent to a migrant shelter in the city. That case apparently prompted an outbreak in the shelter, Casa del Migrante Nazareth; 14 others have since tested positive. “The risk we face is bringing a massive contagion into our own country,” said Raúl Cardenas, the city manager of Nuevo Laredo. “We’re mortified that these deportations are continuing.” U.S. Immigration and Customs Enforcement reported Monday that 220 of the roughly 32,000 detainees it holds have tested positive. But given limited testing, officials say privately, the actual number is likely much higher. In an email, ICE said it had deported 2,985 people in the first 11 days of April, on track for a significant decrease from previous months. Between January and March, ICE deported an average of 20,881 people per month. The agency did not respond to questions about continuing deportations during the pandemic. On its website, the agency says it conducts medical screenings of detainees before they board deportation flights. Any detainee who fails a screening or is suspected of being contagious “will be denied boarding and referred to an ICE approved facility for screening,” the agency says. Starting last week, it said, “any detainee with a temperature of 99 degrees or higher will be immediately referred to a medical provider for further evaluation and observation.” Acting ICE director Matthew T. Albence told Congress last week that the agency had released about 700 people


Covid-19 death toll passes 1,000 in region, and Scripps National Spelling Bee is canceled

The covid-19 death toll in the District, Maryland and Virginia sailed past 1,000 Tuesday, and the finals of the National Spelling Bee were canceled for the first time since World War II, as the coronavirus pandemic continued to punish life and culture in and around the nation’s capital. In all, 102 new virus fatalities were reported. Maryland added 71, bringing its confirmed count to 659. Virginia reported 24, increasing the death toll to 327. The District disclosed another seven dead, bringing the total to 112. The region has now lost 1,098 people to the highly contagious virus. The Scripps National Spelling Bee finals are the latest local tradition to fall to concerns about the virus, following the canceled National Cherry Blossom Festival, Opening Day for the World Series champion Washington Nationals, and countless school graduations, family reunions and other special events. The Bee, normally held at National Harbor in Prince George’s County, tweeted its regrets but said “there is no clear path to . . . a new date in 2020.” In a solemn reminder of the human toll of the pandemic, about 30 registered nurses gathered near the White House to read the names of health-care workers who have died fighting the coronavirus and demand more personal protective equipment. “Let us remember . . . the ultimate sacrifice these nurses paid,” said Melody Jones of the National Nurses United union. “We commit ourselves to fight like hell for the living.” The rise in local deaths was expected, with officials still waiting to see if drastic social distancing measures have halted new infections. In general, people who contract the virus can take two weeks or more to develop symptoms, and more serious complications often develop a week or two after that. The District, Maryland and Virginia reported 1,327 new positive coronavirus test results Tuesday, bringing the regional total to nearly 27,000. Those figures are almost certainly an undercount because of delays in reporting test results and a shortage in testing kits, leaving many people with no symptoms or mild symptoms in the dark about their viral status. Officials said they want to see two weeks of declining new infections before lifting covid-19 restrictions. Daily increases in new cases have been fairly stable for the past week. D.C. Mayor Muriel E. Bowser (D) said Tuesday that the city is having “lower levels of infection than we expected, but we continue to


Hogan responds to Trump criticism over South Korean kits; virus death toll tops 1,000 in region

The number of known coronavirus cases in the District, Maryland and Virginia was 26,969 on Tuesday, with 14,206 cases in Maryland, 9,661 in Virginia and 3,102 in the District. The number of virus-related deaths was 659 in Maryland, 327 in Virginia and 112 in the District, for a total of 1,098 fatalities. Here are some of the most significant recent developments as the region responds to the pandemic of the novel coronavirus, which causes the disease covid-19: • The number of deaths attributed to covid-19 surpassed 1,000 on Tuesday in the District, Maryland and Virginia as known coronavirus cases in the region approached 27,000. • Maryland Gov. Larry Hogan (R) said Tuesday that he was doing what President Trump instructed states to do when he made the decision for Maryland to purchase 500,000 coronavirus tests from South Korea. During an appearance on MSNBC’s “Morning Joe,” Hogan said he did not know why Trump disparaged him during his news conference Monday night. • The Scripps National Spelling Bee was canceled this year because of the coronavirus outbreak. Officials made the announcement Tuesday and said in a statement they canceled the event because there is “no clear path to safely set a new date in 2020.” • Montgomery County lawmakers proposed a $2 million appropriation to protect tenants from eviction. The County Council introduced the proposal Tuesday, with funding set to go toward county efforts to end homelessness, including a short-term rental subsidy program, emergency eviction prevention and housing stabilization initiatives. What a stay-at-home order means for you


How to plan your first post-pandemic trip

The ability to travel is just one of the many luxuries temporarily suspended as the novel coronavirus outbreak continues its spread around the world. For now, we’ve been tasked with putting travel plans on hold and staying home to “flatten the curve.” But although experts are uncertain whether summer travel will be possible, not all future travel is off the table. “I’m reminding people this thing is not forever,” says Robert Reiner, a psychologist and executive director at Behavioral Associates. “It has a beginning, a middle and an end.” In the meantime, we can daydream and use these tips to start planning that glorious first post-pandemic vacation. According to Reiner, there are two crises going on during this pandemic: a biological one (the coronavirus outbreak) and a psychological one (coronavirus anxiety, economic uncertainty and social isolation, among other issues). Trip-planning can be a way to give yourself something to look forward to and provide an uplifting distraction from immediate pandemic problems. However, there are caveats. You’ll set yourself up for more stress if you finalize a trip too early. The outbreak could cancel it. “Right now, especially with people’s spirits so low, structuring something that you are excited about is a great thing, as long as you understand the fact that it might not happen,” Reiner says. As you start connecting your travel dots, remember that we can’t travel now, and stay-at-home orders as well as and restrictions aren’t predictable. You may want to keep staying home, even when travel technically becomes allowed. Reopening dates “do not mean that it will be safe to travel then,” says Adam Goldstein, the co-founder and former CEO of the now-shuttered travel aggregation site Hipmunk. “And will it be ethical to travel then? Even if you’re technically allowed to — which I think in some states you still are — if you don’t need to, you shouldn’t, because you might be an asymptomatic [covid-19] carrier.” So instead of planning for summer trips, think long-term, perhaps even into 2021. “Because companies are so lenient with their cancellation policies right now, there’s no reason why you shouldn’t look at” travel opportunities, says Misty Belles, the managing director of global PR for Virtuoso, a network of agencies specializing in luxury and experiential travel. “The escapism of being able to look and dream, and think about what you want to do, is ideal.” If you don’t have a


How to think about planning travel this summer — and if you even can in the pandemic

Despite the all-encompassing disruption of the coronavirus pandemic, time marches on. April showers are still due to bring May flowers, and spring is still bound to turn into summer. For many, the arrival of warmer weather used to be a signal that vacations were just around the corner. People plan their summer trips months and even years in advance, usually without factoring in the risk of a global health crisis. But as the novel coronavirus continues to spread, where does summer travel stand? Earlier this month, coronavirus task force member Anthony S. Fauci told “CBS This Morning” that although he does not personally take vacations, traditional summer plans “can be in the cards.” However, the nation’s top infectious-diseases expert continued that “we have to be prepared that when the infections start to rear their heads again, that we have in place a very aggressive and effective way to identify, isolate, contact trace and make sure we don’t have those spikes that we see now.” For anyone who had plans to take summer trips abroad, note that the U.S. Department of State is still advising Americans to avoid all international travel. It poses health and logistics risks to travelers. “Many countries are experiencing COVID-19 outbreaks, and implementing travel restrictions and mandatory quarantines, closing borders, and prohibiting non-citizens from entry with little advance notice,” a State Department official told The Washington Post in an email. “Airlines have cancelled many international flights, and several cruise operators have suspended operations or cancelled trips.” It’s not only international travel that could severely disrupt your plans. Because state regulations can change without much warning, travelers may find themselves having to follow new protocols like self-quarantining for 14 days on arrival. Government predictions and restrictions aside, it’s not yet clear whether summer travel will be possible from a health perspective. According to Gina Suh, head of the Mayo Clinic’s travel clinic, there’s no easy answer. “Summer vacation plans may have to be delayed to be safe,” she told The Washington Post in an email. “Travel often means congregating at unsafe distances, and that can be a risk. Also, your destination may be a major factor. The only safe answer here is to stay tuned.” Like the rest of the world, industry insiders can’t perfectly predict how the pandemic will affect our lives, let alone travel plans. “Given what’s going on right now, people may be reluctant or


Group homes for disabled adults grapple with the spread of coronavirus

Rosamund Thomas peeled off the latex gloves, washed her hands and slumped onto a seat in the bathroom of the condominium where she works as a caretaker. Working at a group home for adults with intellectual disabilities is often strenuous. But during the coronavirus pandemic, Thomas said, each day feels like walking a tightrope — a thin one, with no safety net. When she steps into the three-bedroom condominium in suburban Montgomery County, Md., to feed, bathe and care for the three disabled residents, she worries about what she may have carried inside. And after her eight-hour shift, when she returns to her apartment in nearby Layhill, she wonders whether she might have brought anything home to Keith, her 16-year-old son. “They are in their home. I am the one coming and going,” she said of her clients one recent afternoon. “If something should happen . . . ” her voice trailed off, and she began to cry. “I can’t even imagine,” Thomas continued. “If they get sick, I have to live with this for the rest of my life.” Thomas works for the Arc Montgomery County, which operates 36 group homes for developmentally disabled adults in a county of 1 million people. The residences have been in lockdown since mid-March, with no visitors allowed and only staff moving in and out. But in the past two weeks, six residents have tested positive for the coronavirus, along with four caregivers. On April 11, one group home resident, a man in his 60s, died of covid-19. For the Arc and dozens of providers in the Washington region, the outbreak confirmed their worst fears about caring for some of society’s most vulnerable members with stretched-thin resources. Thomas and other caregivers are paid just slightly more than minimum wage and frequently take shifts at multiple homes, increasing the risks of viral transmission. Their clients often have other underlying health conditions that make them more susceptible to the virus. Residents of group homes live in close quarters; some may not understand the importance of wearing masks or practicing social distancing, and many are not able to articulate whether they are experiencing covid-19 symptoms. In harder-hit states like New York, the virus has spread through dozens of group homes and infected hundreds of developmentally disabled adults, who are dying at higher rates than the general population. In the Washington region, providers who operate group homes


Va., D.C. extend shutdown orders for nonessential businesses, Md. to hire 1,000 additional disease investigators

The number of known coronavirus cases in the District, Maryland and Virginia stands at 18,765 on Wednesday, with 10,038 cases in Maryland, 6,526 in Virginia and 2,201 in the District. The number of virus-related deaths was 413 in Maryland, 195 in Virginia and 73 in the District, for a total of 681 fatalities. Here are some of the most significant recent developments as the region responds to the pandemic of the novel coronavirus, which causes the disease covid-19: • D.C. extended its public health emergency and closure of schools until May 15. Mayor Muriel E. Bowser (D) announced that other coronavirus restrictions in the city, including nonessential business closures, a stay-at-home order and a ban on gatherings of 10 or more people are also extended. • Virginia Gov. Ralph Northam (D) extended his shutdown order for nonessential businesses — which initially was set to expire April 23 — until May 8. A separate stay-at-home order for Virginia residents is in effect through June 10. • Maryland Gov. Larry Hogan said the state plans to hire 1,000 people to work in local health departments as investigators work to trace the path of the coronavirus. • The District, Maryland and Virginia reported a record high of 93 confirmed deaths on Wednesday. They also reported 1,030 new infections, bringing the total caseload across the three jurisdictions past 18,700. What a stay-at-home order means for you


A plan to defeat coronavirus finally emerges, but it’s not from the White House

the disease agency’s role has been diminished in the administration’s pandemic response. “We’re definitely in the middle of all of that. It’s premature for me to roll it out,” Redfield said. Technology, like the Apple-Google partnership, that could aid that effort is also being developed, but it comes with civil liberty concerns that need to be resolved. Unless states can aggressively trace and isolate the virus, experts say, there will be new outbreaks and another round of disruptive stay-at-home orders. “All people are talking about right now is hospital beds, ventilators, testing, testing, testing. Yes, those are important, but they are all reactive. You are dealing with the symptoms and not the virus itself,” said Tolbert Nyenswah, who led one of the most successful contact tracing efforts in Africa during the 2014 to 2016 Ebola epidemic. “You will never beat a virus like this one unless you get ahead of it. America must not just flatten the curve but get ahead of the curve.” Six years ago, Nyenswah watched an even deadlier disease, Ebola, tear through his homeland. Liberia’s president tapped him to lead its response, and Nyenswah began immediately hiring an army of surveillance officers to do “shoe-leather” tracing. It involved going door to door to find anyone who interacted with someone with a confirmed case of the hemorrhagic disease and persuading them to stay indoors, even providing food and services to make that more likely. Testing on its own is useless, Nyenswah explained, because it only tells you who already has the virus. Similarly, tracing alone is useless if you don’t place those you find into quarantine. But when all three are implemented, the chain of transmission can be shattered. Until a vaccine or treatment is developed, such nonpharmaceutical interventions are the only tools countries can rely on — besides locking down their cities. In 2014, Nyenswah’s army of 4,000 public health workers used tracing to eradicate Ebola in Liberia under even more difficult circumstances. Many homes didn’t have phone lines, much less house numbers, street names or Zip codes to navigate by. “We didn’t have the sophisticated systems you have in the U.S.,” Nyenswah said. “Many of the people we dealt with weren’t even literate, but we were able to win. What that tells you is that this can work.” But to expand that in a country as large as the United States will require a massive


No traveling? No problem. Vacation from home with these live streams from around the world

As confirmed cases of the coronavirus continue to increase, states and localities across the United States have extended stay-at-home orders through April, leaving many would-be travelers no option except to self-isolate in their homes. The State Department has issued a global Level 4 health advisory, out of four, warning against all international travel and urging U.S. citizens to return home lest they face being stuck abroad for an indefinite period of time. There has already been an increase in famous attractions offering virtual tours to promote social distancing. Vacationing from home has become a new way for life to proceed somewhat normally as spring enters full swing. Here is a list of beaches and attractions offering an escape from home, with sights and sounds to ease your cabin fever. The east side of the Adriatic Sea may not be the first destination that comes to mind for idyllic views, but this island, near the shores of Dubrovnik, offers a live stream of the port and Pakleni islands, along with more hours of sun per year than any other European island. Stick around for the sunset and enjoy the views of Mediterranean architecture. A destination well known for its history and sprawling canals, Venice has a rolling live-stream setup with cameras around the city showcasing views of the Rialto Bridge, St. Mark’s Square and Grand Canal. The live shots also include classical music to accompany the views from notable hotels, including Ruzzini Palace and Hotel Pausania. The aquarium receives nearly 2 million visitors per year. The offerings during the pandemic include a wide array of live streams from underwater exhibits. Calming music plays over videos featuring jellyfish dancing, sharks gliding and sea otters sunbathing while holding paws. Many national parks have been closed, and Yosemite National Park in California has added to the list of those live-streaming its park sites. At 2,425 feet tall, the upper section of Yosemite Falls gives virtual visitors a picturesque view of the peak of one of the world’s tallest waterfalls. Webcam viewers can also take in El Capitan wall, the Half Dome, High Sierra Camp and more. One of the latest national parks to close, Yellowstone National Park is offering a live stream of its most famous geysers complete with a diagram to map the locations of the notable sites. Viewers can see information on hydrothermal features and a calculated prediction for the next time


Which outdoor sports and athletic activities are safe during a pandemic?

Pro sports leagues have suspended or canceled their seasons. Gyms across the country have gone dark. Teleworkers sweat to the instructions of online fitness experts in their own homes. Sports and social exercise, as we know them, are over. Recent instructions from federal, state and local governments for containing the coronavirus include avoiding gatherings of more than 10 people, which would include many outdoor amateur sports. How should these athletes cope? Are board games and esports the only safe outlets for those who enjoy connecting through friendly competition? And what about sports that can involve smaller groups, such as running, cycling and tennis? After a weekend spent mostly indoors, I met a — healthy — tennis friend for a game, skipping our customary fist bump. Other players filled the courts around us. How much danger were we putting ourselves and others in? I spoke with directors and coaches of amateur leagues to learn how they’re interpreting and applying these directives, and with medical experts for their guidance about engaging in sports over the coming weeks. While the Centers for Disease Control and Prevention recommendations limiting gatherings to 10 or fewer people rule out team sports such as basketball, softball and volleyball, even smaller versions of these sports (pickup basketball) are to be avoided because they entail contact or proximity closer than six feet. But adults and children whose seasons have abruptly ended can enjoy what one expert calls a “covid-19 offseason,” referring to the disease the coronavirus causes. James Hudziak, chief of child psychiatry at the University of Vermont’s Larner College of Medicine, is also director of the University’s Wellness Environment. He advises head coaches to assemble their teams online for virtual sessions, 30 minutes long, three to five times per week, to help manage frustrations over the hiatus. After asking players to share how they’re dealing with the stress of the pandemic, coaches should establish interim team challenges, and individual exercise and skill-building routines that players can do in their homes or outside by themselves. Another objective of Hudziak’s covid-19 offseason is cultivating mental toughness. “Spend this time when you need to be socially distanced to build that part of your competitive package that separates you from other athletes — which is your brain,” Hudziak said. He suggested players use apps such as Stop, Breathe & Think to practice mindfulness and meditation, starting with one-minute “body scans,” gradually progressing


Could we come out of the coronavirus crisis with new, more healthful habits?

shelf-stable, low-priced, low-carbon, high-nutrient, high-flavor and low-calorie — it’s hard to think of a food that is more healthful or better meets the needs of the moment. Steve Sando, owner of Rancho Gordo dried heirloom beans in Napa, Calif., is overrun with orders and cannot keep up. “This isn’t joyous, this horrible crisis. I hate this stuff. I would really rather sales were normal. I would love to go back to begging people to buy beans and having them get excited when they try them,” he told Bon Appétit. But still, people are (re)discovering beans en masse, which might bode well for cholesterol levels and waistlines in the coming months and years. Speaking of seeds, another Amazon bestseller right now is the survival Heirloom Vegetable Kit, with 40 varieties of non-GMO seeds. It’s hard to think of a more healthful pursuit than growing one’s own food; it guarantees you a dependable supply of nutrient-rich cooking ingredients and a workout that might replace going to the gym (you can expend 200 to 400 calories per hour in the garden). Meanwhile, Apple’s App Store is showing a dramatic bump in downloads of mental health apps — top picks include Calm and Headspace — to help with guided meditation, conscious breathing and mindfulness. Of course, this is a sad reflection of our collective distress. But still, it’s hopeful that so many people are relying on effective and safe coping tools to get through this crisis. Mindful breathing, for example, has been shown to regulate sleep and to lower blood pressure and the stress hormone cortisol. Other more-healthful behaviors that people responding to my Twitter query mentioned: drinking less alcohol, trying to quit smoking and vaping, driving less, and spending quality time with housemates, family and pets. From a public health standpoint, one of the most hopeful fallouts from this pandemic has been its effect on our atmosphere. As we close factories and take vehicles off the road and airplanes out of the sky, air pollutants and greenhouse gas emissions have plummeted. While it’s difficult not to view these dramatic improvements as ill-gotten gains, they do give us a glimpse of how much healthier our environment would be if we reduced the emissions from manufacturing, mining, transportation and agriculture. And if you consider that our expansion into wildlife areas to build homes and cities, and extract natural resources, is a key reason that novel


How gyms and yoga studios are preparing for the coronavirus

The email blasts from gyms, yoga centers, cycling facilities and barre studios started hitting inboxes en masse last week, with messages such as, “Let’s stay calm and healthy together,” “Clean is kind,” “A warm smile is better than a handshake.” The missives included specifics about the businesses’ stepped-up efforts to sanitize their fitness spaces, such as disinfecting high-touch surfaces, adding more access to disinfectant wipes and hand sanitizers, and including doorknobs in cleaning routines. The Bar Method Life Time In addressing the growing concerns about how to limit the potential spread of covid-19 — the disease caused by the novel coronavirus — in places Americans gather to lift weights and practice yoga, the emails shared a common theme: We are doing our best to step up efforts to keep the place clean and safe for you, and we would like you to do the same for yourself and your fellow students. The Centers for Disease Control and Prevention “recommends everyday preventive actions to avoid the spread of respiratory disease — wash your hands frequently and distance yourself from those who are coughing or sick,” said the email from CorePower Yoga. “If you aren’t feeling well, we ask that you please stay home from class for your well-being and that of your fellow students and teachers.” Last week, Glenn Wortmann, section director of infectious diseases at MedStar Washington Hospital Center, says: “We don’t know if yoga mats or gym surfaces will present an opportunity to catch covid-19.” He suggests following general recommendations on how to clean surfaces and points to a CDC link (cdc.gov/coronavirus) that outlines cleaning practices for families who have someone living with them who has coronavirus. His main advice: Stay away from people who are coughing and sneezing. “The primary way the virus is spread is through droplets. If somebody sneezes and coughs and you are within six feet of the person, you would inhale those droplets.” Wortman added: “Just because you find a virus on a surface doesn’t mean if you put it on your hand you will get [covid-19]. For many infections, an inoculum effect must be there — a certain amount of the pathogen has to be present to cause an infection. It’s sometimes difficult to interpret the findings of these studies.” Iantha Carley Carley says bringing her own mat and blankets to class makes her feel more in control. “Sharing these items with hundreds


Military plan to roll out covid-19 testing would prioritize nuclear forces and troops deployed in combat zones

Reserve, is going to take us into the summer, but I think we’ll get to the deploying, redeploying forces, the forces engaged, all of the tier one forces next month,” Hyten said. Officials said the Pentagon would at the same time prioritize testing according to movements, such as submarine and aircraft carrier deployments and basic-training arrivals. Since the U.S. coronavirus outbreak accelerated, the military has already taken steps to adjust and even pause training recruits. “So we’re moving quickly. It is a supply issue right now, which is causing us not to be able to go down the full spectrum of all of the forces,” Hyten said. “That’s why we came up with the tiered approach.” While the U.S. military has been testing troops for weeks, focused on the sites of known outbreaks, including the aircraft carrier USS Theodore Roosevelt, a national shortage of supplies, restrictive testing policies and several other factors have limited testing. More than 3,500 uniformed service members have tested positive to date. Two have died — a relatively low number officials attribute to the overall youth and fitness of the force. The plan outlined by Hyten and Deputy Defense Secretary David Norquist provides the most detailed glimpse to date of how the Pentagon plans to expand preventive testing across the force in an attempt to avoid disruption of its core security mission. Gen. Mark A. Milley, the chairman of the Joint Chiefs of Staff, has publicly laid out an objective of being able to conduct 60,000 tests per day in the next month or so. However, asked about that goal, Norquist seemed to suggest that the department would initially have a much lower target of about 50,000 per week. The Pentagon has issued departmentwide guidelines on physical distancing, the use of masks, increased cleaning and other precautions. Close to a million employees are teleworking. Norquist said the department would take several steps for troops who cannot maintain physical distance, including recruits and personnel located in close quarters on ships. They include quarantines for 14 to 21 days, “depending on the risk tolerance,” in an attempt to identify those who might be infected but not yet exhibiting symptoms, and diagnostic tests and temperature checks before troops leave quarantine. “These interim measures enable us to reduce the risk so we continue to operate until we develop therapeutics and vaccines,” Norquist said. “And as we learn more about the


A mysterious blood-clotting complication is killing coronavirus patients

derangement.” In math, a derangement is a permutation in which no element is in its original position. Harlan Krumholz, a cardiac specialist at the Yale-New Haven Hospital Center, said no one knows whether blood complications are a result of a direct assault on blood vessels, or a hyperactive inflammatory response to the virus by the patient’s immune system. “One of the theories is that once the body is so engaged in a fight against an invader, the body starts consuming the clotting factors, which can result in either blood clots or bleeding. In Ebola, the balance was more toward bleeding. In covid-19, it’s more blood clots,” he said. A study published in JAMA on Wednesday found that a large number of covid-19 patients admitted to New York State’s largest health system came in with blood test readings that indicated clotting problems. And a Dutch study published April 10 in the journal Thrombosis Research provided more evidence the issue is widespread, finding 38 percent of 184 covid-19 patients in an intensive care unit had blood that clotted abnormally. The researchers called it “a conservative estimation” because many of the patients were still hospitalized and at risk of further complications. Early data from China on a sample of 183 patients showed more than 70 percent of patients who died of covid-19 had small clots develop throughout their bloodstream.Although acute respiratory distress syndrome still appears to be the leading cause of death in covid-19 patients, blood complications are not far behind, said Behnood Bikdeli, a fourth-year fellow at Columbia University Irving Medical Center, who helped anchor a paper about the blood clots in the Journal of The American College of Cardiology. “My guess is it’s one of the top three causes of demise and deterioration in covid-19 patients,” he said. That recognition is prompting many hospitals to change the way they think about the disease and manage it. When the novel coronavirus first hit, the Centers for Disease Control and Prevention and others put people with asthma at the top of their lists of those who might be the most vulnerable. But European researchers writing in the journal Lancet noted it was “striking” how underrepresented asthma patients had been. Earlier this month, when New York state released data about the top chronic health problems of those who died of covid-19, asthma was not among them. Instead, they were almost all cardiovascular conditions. Some


from China on a sample of 183 patients showed more than 70 percent of patients who died of covid-19 had small clots develop throughout their bloodstream.Although acute respiratory distress syndrome still appears to be the leading cause of death in covid-19 patients, blood complications are not far behind, said Behnood Bikdeli, a fourth-year fellow at Columbia University Irving Medical Center, who helped anchor a paper about the blood clots in the Journal of The American College of Cardiology. “My guess is it’s one of the top three causes of demise and deterioration in covid-19 patients,” he said. That recognition is prompting many hospitals to change the way they think about the disease and manage it. When the novel coronavirus first hit, the Centers for Disease Control and Prevention and others put people with asthma at the top of their lists of those who might be the most vulnerable. But European researchers writing in the journal Lancet noted it was “striking” how underrepresented asthma patients had been. Earlier this month, when New York state released data about the top chronic health problems of those who died of covid-19, asthma was not among them. Instead, they were almost all cardiovascular conditions. Some medical centers have begun giving all hospitalized covid-19 patients small doses of blood thinners as preventive measures, and many are adjusting doses upward for the most seriously ill. The challenge is the more you give, the greater the danger of upsetting the balance in the other direction and having the patient bleed to death. Another big mystery the doctors hope the blood issue will shed light on is why some maternity patients are collapsing during or after giving birth. A paper published in the American Journal of Obstetrics & Gynecology MFM in late March detailed how two women with no prior symptoms of covid-19 ended up in intensive care. The first was a 38-year-old patient of New York-Presbyterian/Columbia University Irving Medical Center in Manhattan who spiked a fever of 101.3 while undergoing a C-section delivery and began bleeding profusely. The second woman, 33, also underwent a C-section but the next day developed a cough that progressed to respiratory distress. Her heart beat irregularly and her blood pressure jumped to as high as 200/90. Several physician-researchers said the relationship between covid-19, clotting and pregnant women is “an area of interest.” Women in childbirth can experience clotting and bleeding complications because of


Here’s how the NFL can still have a 2020 season

Ezekiel J. Emanuel is vice provost of global initiatives and a professor in the department of medical ethics and health policy at the University of Pennsylvania. He is cohost of the podcast “Making the Call.” Aaron Glickman is a policy analyst in the department of medical ethics and health policy at the University of Pennsylvania. The facts are inescapable. There will be no covid-19 vaccine until fall 2021, at the earliest. Barring unexpected breakthroughs, there will not be an effective preventive treatment or therapy before then, either. So, from September 2020 through February 2021, we will not be able to safely fill stadiums with tens of thousands of people each week. A handful of asymptomatic carriers among 60,000 cheering fans could easily spread covid-19 to hundreds, even thousands, of others, causing additional outbreaks of the virus and, quite possibly, more death. Indeed, it was a Champions League soccer match with 40,000 fans in Lombardy, Italy, that seems to have ignited the explosion of covid-19 cases that shut the country down. That is not a risk the NFL — or the United States — can afford to take. But that doesn’t mean we can’t bring football into our living rooms. It will not be easy, ideal or cheap, but it can be done. And it is important that we try, in order to preserve our sense of normalcy and our social bonds. What follows are five key steps in a Hail Mary play for a 2020 NFL season. First, football must become a broadcast-only event — no fans in the stands at all. Physical distancing is impossible at sporting events, even if fans sit 6 feet apart. Between lines at entrances and concessions, shared bathrooms, high-fives and loud cheers spewing droplets into the air, games with fans are simply impossible to do safely. In doing without, the NFL would be following the lead of Taiwan and Germany. Second, to limit any potential spread, the NFL must restrict travel. This would mean centralizing games in one or two locations that have multiple local stadiums. Personnel will have to be quarantined for 14 days prior to the first game, the only travel out of their hotels will be for practice, and those who must leave will have to quarantine for 14 days upon return. These restrictions must last the entire season. Third, the players, coaches and training personnel must be tested and confirmed