The Doctor Will See You NowTrump's contribution to the national discussion on the pandemic this fine day: "It will go away, just stay calm. Be calm. It’s really working out. And a lot of good things are going to happen." People who listen to him-- see the graphic at the very bottom of the page-- are most likely to get sick. Old people who listen to him are most likely to die. That, tragically, is a kind of Darwinistic thinning of the herd.People my age who get Coronavirus seem to be prone to dying... and this morning NBC News reported that scientists aren't sure why-- nor are they sure why young children seem to be largely spared. "People over age 60, and particularly those with pre-existing health conditions, appear to be most vulnerable to the virus... While the immune systems of older people are typically not as robust as those of younger people, leaving them more vulnerable to a wide variety of illnesses, scientists say they can't definitively say why the coronavirus has been harder on people of advanced ages... Most people who have been infected have experienced mild to moderate symptoms, which... likely means either that the virus is not penetrating beyond the upper respiratory tract or that patients' immune systems are preventing it from reaching deep into the lungs.
It's thought that the virus spreads through close contact, traveling through tiny droplets and secretions when a patient coughs, sneezes or breathes.Typically, when a virus infects a cell in the human body, the cell's so-called innate immune system kicks in if foreign genetic material is detected. This is considered the body's first line of defense against invading pathogens. The second line of defense is known as the adaptive immune system, which first has to detect foreign invaders before producing antibodies and T cells to counteract the infection.But as people age, both of those systems can break down.Underlying medical issues also increase the risks of disease because pre-existing conditions influence how a person's immune system functions. The U.S. Centers for Disease Control and Prevention warned that people with serious chronic medical conditions, such as heart disease, diabetes and lung disease, are at higher risk of getting very sick from COVID-19.Very few children have been diagnosed with COVID-19 so far-- and most of the cases involving children have been mild. In China, children made up just 2.4 percent of confirmed cases, and no coronavirus deaths have been reported in young children to date.
I expect Trump supporters, like the ones in the video above, will be getting the virus in large numbers, going to work and social gatherings, spreading it and dying in large numbers. I've been tending to eat out less and less. Last night Roland said the celery root soup I made for dinner was the best soup he'd ever eaten. Today Emily Heil and Tim Carman, writing for the Washington Post took up the very touchy topic of going out to eat in restaurants. People are reconsidering their eating out habits-- especially at buffets and counter-service restaurants where customers may share serving spoons or credit-card touch screens or even condiment shakers."
Diners across the country are reassessing their relationship with restaurants, fast-casuals and even neighborhood bodegas as the coronavirus makes its rounds. Many diners remain wary of setting foot into eateries of all kinds, even though public health experts say restaurants are just as safe-- and perhaps even safer-- than other public spaces, such as buses, subways and event venues, where people are packed closer together than the three-foot buffer recommended by the World Health Organization between you and a coughing or sneezing person.Owners and operators across the United States, from corporations such as McDonald’s to your local pizzeria, are hyper-aware of customer concerns. They only have to read the stories out of Italy to know how quickly fortunes can change from a packed restaurant to a ghost town. So they’re trying to get ahead of the fears by implementing new procedures and tightening up current ones.... Right now, the CDC is advising people at high risk to avoid crowds. High-risk people-- older people and those with underlying conditions-- in areas where the virus is spreading should “take extra measures to put distance between yourself and other people,” according to the CDC, and “stay home as much as possible.”... While you can’t come into contact with the virus through food, the hard surfaces you encounter in a restaurant, like menus, utensils, salt shakers and the like, are another story. Larry Lynch, senior vice president of certification and operations at the National Restaurant Association, says his organization is telling restaurants to pay particular attention to wiping things down. Restaurants are being advised to use fresh cleaning cloths, and they are circulating the Environmental Protection Agency’s new list of disinfectants that are effective against the coronavirus.Lynch says diners should take comfort in the fact that restaurants have been meeting food safety and sanitation standards for decades, so they already have protocols in place.Regardless, restaurants and chains are implementing new procedures to deal with potential contamination. At McDonald’s, for example, operators have increased the number of hand-sanitizer dispensers at entrances and in the waiting areas of their restaurants. They are also disinfecting trays, dining room tables and chairs after each use. They have even increased the frequency of cleaning and sanitizing high-touch surfaces such as doors, kiosks, touch screens, restrooms and more. They have also reminded employees to stay home when sick.... There’s no indication, health officials say, that the coronavirus can be transmitted on food. Wen notes that the virus does not appear to be orally transmitted. Rather, it is a respiratory illness spread through droplets-- from a person’s sneeze, for example-- that are then transmitted through the nostrils or eyes of someone else.That means you’re not any more at risk in a restaurant than in other public places, like on public transit or in retail stores. “In fact, there may be less risk because the risk is the number of people you are in contact with and in close proximity to,” Wen says. “The number of people who come into close proximity to you on a crowded bus is far more.”One of the biggest concerns that diners cite is encountering restaurant workers who might be sick. Lynch, of the National Restaurant Association, says his organization is advising member restaurants around the country to make sure that members of their staffs aren’t reporting to work sick and that they have plans in place for how to deal with workers showing any type of cold or flu-like symptoms.Iricanin says the operation’s 280 employees have been told through emails and in meetings to stay home if they are sick. They are also being instructed to alert their managers to fellow employees or customers who might be.CapitalSpring, an investment firm that owns thousands of restaurants, including Taco Bell and Wendy’s franchises, told CNBC that it is offering its employees talking points to deal with customers or fellow employees they suspect of being ill.Patrons should be aware that they could be the ones spreading the virus, and Lynch says he is recommending that restaurants offer guests hand sanitizer and tissues.Not all restaurants are as careful-- and coronavirus threat or no, diners should always be aware of the potential for cross-contamination from objects at their tables, says Dawn Anderson, chair of the Department of Public & Allied Health at Bowling Green University. She conducted [a study] of fecal bacteria found on the menus, ketchup bottles and salt shakers at a few bar and grill-style restaurants in her area and found that at least one strain of such bacteria was present on every ketchup bottle and most menus.Wen says the virus can lurk in these places. Both she and Anderson say diners should wash their hands throughout their meals. “The advice is not ‘don’t touch anything,’ it’s ‘wash your hands after you touch things,’” she says.Delivery can be safer, but...Getting your favorite eatery’s dishes delivered to your door is one way to limit your exposure to other people. The CDC advice to high-risk people in virus-struck areas includes: “Consider ways of getting food brought to your house through family, social or commercial networks.”Taking the avoiding-people route a step further, food-delivery service Postmates last week introduced new drop-off options, including a “no contact” one in which customers can request that the delivery is left at their doors. Still, there is a chance that the person handling your delivery could have transmitted it to the packaging.Kathy Hollinger, the chief executive of the Restaurant Association of Metropolitan Washington, says she is helping to spread the directive from the National Restaurant Association that restaurant workers should keep an eye out. “We’re saying that if a delivery driver looks sick, there should be judgment used about whether the food should be given to them,” she says.
Last week two close old friends-- my age-- told me they were going to an informal school reunion in New Rochelle. I begged them not to. They went anyway. This morning, the NY Times reported that the State of New York has declared New Rochelle a coronavirus containment zone. "With New Rochelle, a small city just north of New York City in Westchester County, emerging as the center of the state’s outbreak, Gov. Andrew M. Cuomo of New York on Tuesday announced a targeted containment strategy to halt the spread of the virus. The state’s plan focuses on a 'containment area' in New Rochelle with a one-mile radius centered around a synagogue believed to be at the center of the cluster, officials said. Schools and other large gathering facilities like community centers and houses of worship within the area will be closed for two weeks beginning on Thursday, Mr. Cuomo said. Businesses such as grocery stores and delis would remain open. The state did not plan to close streets or implement travel restrictions, he said. 'You’re not containing people,' he said. 'You’re containing facilities.' The state also planned to deploy the National Guard to the containment area to clean the schools and deliver food to quarantined residents, Mr. Cuomo said."More of today's vital corona-news:
Nursing homes should bar most family and friend visits, the industry says.Nursing homes and assisted living centers should take unprecedented action to curtail most social visits, and should even take steps to keep some employees away, to slow the spread of the new coronavirus, the industry said on Tuesday.The recommendation follows an outbreak of the virus in the region around Seattle, where five long-term care facilities have been hit with cases, including a facility in Kirkland, Wash., where 18 residents have died. There have now been 794 cases of coronavirus in the United States, including 27 deaths.“The mortality rate is shocking,” said Mark Parkinson, president and chief executive officer of the American Health Care Association. He said that the death rate might well exceed the 15 percent reported in China for people aged 80 and older who were infected.The challenge of the virus “is one of the most significant, if not the most significant” issues the industry has ever faced, he said.Industry officials said they are recommending that nursing homes should allow people to enter only if it is essential.Staff members, contractors and government officials should be asked, “Do you need to be in-building to operate?” said Dr. David Gifford, the health care association’s chief medical officer.As for family members, he said, “Our recommendation is they should not be visiting.”Anyone who does visit, he said, should be screened carefully at reception and anyone who has signs of illness should be turned away.As the virus hits Europe, a variety of strategies are used to slow the spread.With the first reported cases in Cyprus, the coronavirus is now present in every country in the European Union, health officials said on Tuesday, hours after Italy imposed sweeping travel restrictions across the whole country.But the measures taken by the bloc’s member states to contain the virus varied widely from country to country, often with little relation to the actual size of the outbreaks, reflecting the lack of international coordination.Greece and the Czech Republic announced that all schools and universities would close, though each country’s caseload is in the dozens, far fewer than some of their neighbors.“We may decide on additional emergency measures later,” the Czech prime minister, Andrej Babis, said in a statement on Tuesday. “It is necessary to take active, exceptional measures at the start of an epidemic.”Spain, with one of the largest outbreaks, closed all education centers in the Madrid region, but not nationwide. In Poland, schools in Poznan, a city in the west of the country, were ordered closed after a single case of infection was discovered. Swimming pools and other public places were also to be shut for two weeks.Worldwide, schooling has been disrupted for more than 300 million students.Across the Continent, countries also increased travel regulations and guidelines.Austria barred travelers from Italy without a health certificate, Chancellor Sebastian Kurz said. Switzerland was considering a similar measure.Serbia has temporarily barred travelers from the worst-affected places, including Italy, while Croatian officials said that people entering the country from “highly infected areas” would be put into a mandatory 14-day quarantine.Italy, with the worst outbreak outside of China, had more than 9,000 infections and 463 deaths by Monday. France and Spain each reported on Tuesday that they had more than 1,600 cases; Germany, had almost 1,200 by Monday.The authorities in France, where 30 people have died, were resisting taking the kind of sweeping preventive measures seen in Italy or Japan.“We are only at the beginning of this epidemic,” President Emmanuel Macron of France said on Tuesday after visiting an emergency call center in Paris. “We have anticipated, we have prepared ourselves.”Trump pitches a tax cut to a skeptical Congress.President Trump plans to brief Senate Republicans on Tuesday on his ideas for an economic stimulus package to respond to the coronavirus, including a payroll tax cut.But the idea of a payroll tax reduction is running into bipartisan opposition on Capitol Hill, where Democrats are openly hostile to the idea and some Republicans are skeptical, including Senator Mitch McConnell, the Republican leader.Mr. Trump has suggested the tax cut as part of an array of measures to boost the economy, which some experts fear is headed into a recession.But Mr. McConnell, of Kentucky, has privately discouraged discussion of the idea, according to people familiar with his thinking. Two other top Senate Republicans, John Cornyn of Texas and Charles E. Grassley of Iowa, have said they do not think a stimulus package is necessary at this point.Mr. Trump is expected to discuss the coronavirus response with Senate Republicans at their policy luncheon on Tuesday, along with Steven Mnuchin, his treasury secretary, and Larry Kudlow, his top economic adviser.Democrats insist that any government response be tailored narrowly to the needs of patients and workers directly affected by the virus. They want enhanced unemployment benefits for those who lose their jobs, paid sick leave for people who must miss work and affordable testing and treatment for those who get sick.Speaker Nancy Pelosi dismissed suggestions that the House would decamp from Washington because of the coronavirus.“We are the captains of the ship,” she said at a closed door Democratic meeting focused on addressing the growing health epidemic, according to two people present. “We are the last to leave.”But she and her top lieutenants indicated they were unlikely to approve any additional emergency measures related to this week, before leaving town for a previously scheduled recess.Coachella organizers are in talks to postpone the festival to avoid canceling.Organizers of the Coachella Valley Music and Arts Festival are in talks to postpone next month’s event to avoid outright cancellation, according to a person briefed on the negotiations who was not authorized to speak about it.The postponement is not certain and would require the festival’s top acts to agree to move their performances to October, from April 10-12 and April 17-19, this person said. This year’s lineup features Travis Scott, Frank Ocean and a reunion of Rage Against the Machine, along with dozens of other acts.Even if rescheduled, the postponement of Coachella, the giant pop festival in the picturesque desert of Southern California, could disrupt the annual concert season. The event, founded in 1999, draws up to 125,000 people a day and is a bellwether for the multibillion-dollar touring business.Coachella joins a long list of cultural events that have been postponed or canceled over coronavirus fears, including the South By Southwest festival, which was set to begin on Friday. On Monday, Pearl Jam announced the postponement of its North American tour, and Neil Young said he was considering postponing his own tour.Pearl Jam wrote on its website that it had searched for other options, “but the levels of risk to our audience and their communities is simply too high for our comfort level.”On Friday, the South by Southwest festival was canceled just a week before it was set to start. Festival organizers have since said that they would be laying off one-third of their full-time staff.Executives at the major promotion companies and talent agencies-- among them Live Nation, AEG, WME, Creative Artists Agency and Paradigm-- have formed a task force to share information and establish practices for dealing with virus-related problems and delays.On the Iran-Iraq border, friends are kept at arm’s length.The border police commander rose quickly to meet the visitors who entered his office on the Iraq-Iran border recently, among them a fellow officer and a friend. Like many millions of Iraqi men, he usually hugs male friends and family, or kisses them at least once on both cheeks when they meet-- a sign of friendship, of a bond between them.But the commander, Brig. Gen. Ahmed Juma Abid, stopped short, and held his hands twisted together behind his back, looking down awkwardly.“I am sorry,” he said, as if he were ashamed. “You know, corona.”Instead of shaking the visitor’s hand, he reached out and squeezed his heavily clad arm, but kept him at arm’s length. General Abid, who runs a busy crossing with Iran-- where the government has reported 8,042 cases and 291 deaths since the outbreak began-- said he felt a responsibility to ensure the virus did not spread widely in Iraq.“Frankly, our tradition is to embrace, kiss and shake hands,” he said. “But now, I say no,”The lack of physical contact is not such an issue between women and men because typically the two sexes do not touch in public. Even shaking hands with the opposite gender is seen as slightly odd, or as a Western convention.But for men, there is a sense of having to choose between safety from the virus, which is transmitted through touch, and rudeness.It almost makes a person feel a little lonely, one tribal sheikh said. Another described the awkwardness of introducing physical distancing among his tribesmen.U.K. says extreme measures may be needed, just not yet.Prime Minister Boris Johnson of Britain has so far resisted imposing the sort of draconian restrictions on travel, school openings or mass gatherings that other European countries have introduced as the coronavirus has taken hold.Mr. Johnson and his advisers argue that putting in place “social distancing measures” while the outbreak is still in its early stages could have downsides.“There is a risk if we go too early, people will understandably get fatigued and it will be difficult to sustain this over time,” Chris Whitty, the chief medical officer for England, said.Many experts agree that some measures shunned by Britain, like screening airport travelers for a fever, are of limited use: Hand-held thermometers are unreliable, sick travelers can take temperature-reducing drugs and checks do not catch people still in the incubation phase.“I think that’s a bit of a red herring,” said Jonathan Ball, a professor of virology at the University of Nottingham, referring to such tests. “You either stop flights, or you acknowledge the fact that someone coming into the country could be infected.”But measures like school shutdowns and work-from-home policies do seem to be limiting the spread in parts of Asia, leading some public health experts to question why countries like Britain and the United States were not adopting them sooner.In Hong Kong, for example, which has discouraged large gatherings and has shut museums and sports facilities, the winter flu season ended early, a sign that the same measures could slow the spread of the coronavirus, too, experts have said. The more extreme lockdowns and surveillance efforts undertaken in China have also driven down the number of new cases, international health experts said.How the tactics of an authoritarian government can be translated to other countries, like Italy, is not clear. And some experts say they suspect that the memory of the SARS outbreak in places like Hong Kong has helped make people there more receptive to adopting personal hygiene practices like hand-washing and wearing face masks.But while “social distancing” may help, travel restrictions appear less effective. Researchers have found that even strong curbs on travelers from China “only modestly affect the epidemic trajectory” unless they are combined with public health measures and behavioral changes that significantly reduce person-to-person transmission in a country.
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