KATHMANDU, Nepal Just last year, Nepal attracted so many mountain climbers that a human traffic jam of hundreds of hikers in puffy jackets snarled a trail to the top of Mount Everest.
The crowds were proof of how fast too fast, some have said Nepals alpine tourism industry had grown, becoming a lifeline for the country. Last year tourism brought in more than $2 billion to Nepal, one of Asias poorest nations, and employed a million people, from porters to pilots.
The pandemic has stopped all of that.
The trails snaking through the Himalayas are deserted, including those leading up to Everest Base Camp. Fewer than 150 climbers have arrived this fall season, immigration officials said, down from thousands last year.
Countless Sherpas and experienced mountain guides have been put out of work, leaving many to plant barley or graze yaks across the empty slopes to survive.
Many Nepalis fear that the combined effect of the coronavirus and the hammer blow to the economy could set this nation back for years.
I often think I will die of hunger before corona kills me, said Upendra Lama, an out-of-work mountain porter who now relies on donations from a small aid organization to feed himself and his children. How long will this go on?
Although the whole world is asking similar questions, Nepal has few resources to help people cope. Covid-19 cases are steadily rising, and with around 1,000 intensive-care beds for a population of 30 million, the authorities have instructed people who get sick to stay home unless they slip into critical condition. An unknown number may die out of sight and undetected.
The economic wreckage is easier to see. Hotels and the teahouses clinging to the sides of mountains are boarded up. Restaurants, gear shops and even some of the most popular watering holes in the capital, Kathmandu, have closed for the foreseeable future, including the Tom and Jerry pub, which for decades served as a beacon for backpackers.
Theres no hope in sight, said the pubs owner, Puskar Lal Shrestha.
Remittances from Nepalis working abroad have become another casualty. When times were good, millions sent back money from across Asia, especially from Persian Gulf countries. Last year, total remittances were almost $9 billion. Nepal relies on remittances more than just about any other country.
Many Nepalis held unglamorous jobs, such as security guards or maids. But the money was good, especially for people from a country where the average income is the equivalent of $3 a day.
Now many of them have been laid off. Some have been sent home, while others remain trapped in foreign countries, with no work and the specter of deportation hanging over them.
The pause in remittances has frightened many families. Several people who were interviewed said they had been forced to move to cheaper apartments and to take their children out of private schools and send them instead to government schools they considered inferior.
If the world does not get a corona vaccine soon, our remittances, which contribute around 30 percent to the national G.D.P., will completely dry up, said Sujit Kumar Shrestha, the general secretary of Nepals Association of Foreign Employment Agencies.
As the economy ails, hospitals are filling up. Doctors say that the wealthy and the politically connected are monopolizing hospital beds, leaving the poor who get sick with nowhere to go.
Our health system is weak, and the monitoring mechanism is even weaker, said Dr. Rabindra Pandey, who works for Nepal Arogya Kendra, an independent organization of public health experts. Well-connected and wealthy people can easily access private hospitals and afford their fees, but many of the poor are dying.
With winter fast approaching and the Hindu festival season in full swing, public health experts warn that Nepals Covid-19 crisis is about to get worse. The country has reported around 175,000 infections, roughly the same rate per capita as India next door. And although its reported deaths remain fewer than 1,000, testing remains low and the consensus among Nepali doctors is that virus infections and deaths are many times higher.
The virus has reached its tentacles into rural areas and remote towns that just a few months ago had few or no reported cases. Government officials have been accused of exploiting the pandemic to make money. A parliamentary committee is looking into accusations that officials close to the prime minister, K.P. Sharma Oli, inflated prices of key medical supplies. The officials have denied the allegations.
In some areas, Covid-19 has cut through entire families.
Dharma Kumar Shrestha, an elderly man who ran a small business importing clothes, checked into a hospital in southern Nepal in late September to seek treatment for asthma, the beginning of a chain of events that killed nearly half his family. He caught Covid-19 in the hospital, family members said. Two of his sons who visited him then got infected.
With the hospitals filling up, and the authorities ordering people to recover at home, the sons went back to their village. They got sicker. When one called for an ambulance, the driver refused, afraid of getting sick himself.
Within two weeks, Mr. Dharma and two sons had died.
What could be worse news than this? asked Suman Shrestha, a younger relative. Lets pray no one else has to face our fate.
Health experts say that many of Nepals infections have come from Nepali workers traveling back from India. India is now No. 2 in the world in terms of reported Covid-19 infections around eight million, right behind the United States.
Nepal lives in Indias shadow. Its economy, strategic affairs and overall health are constantly rearranged by what happens in its huge neighbor to the south.
Partly because of the boost from tourism, Nepals economy had been growing faster than Indias, at nearly 6 percent in 2019. Usually at this time of year, jet after jet would thread the mountain ranges by Kathmandus international airport and disgorge thousands of well-heeled tourists, including many Indians, eager to hike in the Annapurnas or up to Mount Everest base camp.
Last year, more than a million tourists visited. The average spent more than $50 a day.
Tourism officials expect that at least 800,000 people employed in the tourism industry will lose their jobs. Among the first to go, officials said, will be the 50,000 or so high-altitude guides, Sherpas and others in the trekking ecosystem. Some have started protesting on the streets of Kathmandu, urging the government to give them loans to help feed their families and threatening to vandalize the tourism boards office if they get no relief.
Guides, once known as the real agents of tourism, have been left in the lurch, said Prakash Rai, a climbing guide who participated in the recent protests. We have no means to survive this crisis.
Not long ago, some people inside and outside the country were saying it grew too fast. Some experienced climbers have complained that Nepal had become so eager to welcome climbers that the Everest scene had become unruly and dangerous. Another problem has been the growing trash heaps on Everests slopes.
Despite the rise in Covid-19 cases, other parts of the economy, like manufacturing, are trying to sputter back to life, and some schools have reopened. Travel restrictions imposed this spring and summer have been eased. A mass exodus has begun from the cities to far-flung villages as Nepalis head home to celebrate the Hindu holidays of Dashain and Tihar.
Yet such movement is bypassing tourist areas.
Pokhara, a beautiful lakeside city in the center of the country, has become a ghost town. At this time last year, it teemed with trekkers.
But as Baibob Poudel, a Pokhara hotelier, said, I havent seen a single foreigner here since April.
Bhadra Sharma reported from Kathmandu, and Jeffrey Gettleman from New Delhi.
Nearly half of Slovakias entire population took Covid-19 swabs on Saturday, the first day of a two-day nationwide testing drive the government hopes will help reverse a surge in infections without a hard lockdown.
The scheme, a first for a country of Slovakias size, is being watched by other nations looking for ways to slow the virus spread and avoid overwhelming their health systems.
The defence minister, Jaroslav Na said on Sunday 2.58 million Slovaks had taken a test on Saturday, and 25,850 or 1% tested positive and had to go into quarantine.
The EU country has a population 5.5 million and aims to test as many people as possible, except for children under 10.
More than 40,000 medics and support teams of soldiers, police, administrative workers and volunteers staffed about 5,000 sites to administer the antigen swab tests. The testing was free and voluntary, but the government has said it will impose a lockdown on those who do not participate, including a ban on going to work.
The prime minister, Igor Matovi, apologised for putting pressure on people to take part, but said the requirement was justified. Freedom must go together with responsibility toward those who ... are the weakest among us, oncology patients, old people, people with other diseases, he told a news conference.
Slovakia had relatively few cases in the spring and summer after swiftly imposing restrictions. But infections have soared in recent weeks, raising concerns the country may follow the Czech Republic, which has the highest two-week death rate in Europe.
The scheme has faced opposition from some experts who doubted it made sense as an one-off measure, or pointed to the antigen tests used, which are less accurate than the laboratory PCR tests and may thus return more false negatives and false positives.
The government is planning a second round of testing next weekend.
On Sunday, Slovakia reported 2,282 new cases through PCR tests, putting the total at 59,946, not including those identified in the nationwide scheme, and 219 deaths to date.
The restrictions were part of new measures that also closed cinemas, gyms and theaters until Nov. 24. The government also required 75 percent of high school students to return to online learning, and continued earlier bans on large parties, including wedding receptions. But they seem likely to be replaced any day with stricter measures and the government was already weighing closing stores and limiting movement.
Some critics of the governments response have come from within its own parliamentary majority.
Better a total lockdown than these half measures, former Prime Minister Matteo Renzi told Italian reporters last week. He argued that closing restaurants for dinner but not lunch made no sense, and did nothing to limit infections, but increased unemployment.
The populist opposition also has supported the protests around the country. Matteo Salvini, the leader of the nationalist League party and former mask skeptic, showed up in a mask to talk to chefs at the Pantheon protests, where some onlookers jeered him.
Despite previously expressing skepticism about a second wave, Mr. Salvini now criticizes the government for dallying on its laurels over the summer. The government should have procured more buses to alleviate overcrowding and issued tenders for more ambulances in May, not October, he says constantly. If the state of emergency were real, then a total lockdown, not a half measure that targeted business, was in order.
Amid the political jostling, some regions have already gone beyond the national restrictions in fear of the virus overwhelming their hospitals.
Campania, the southern region that is home to Naples, where violent protests broke out last week, has banned movement across provincial lines except for work, health or extenuating circumstances. It has also canceled nursery school and mandated remote learning for students from elementary school to college. Other vulnerable southern regions, including Calabria and Sicily, have also adopted strict measures.
Each week since August, a team of LSU researchers suit up in protective gear as they collect and inspect wastewater samples beneath campus living halls with the hopes of spotting microscopic coronavirus samples that could indicate a potential outbreak.
With less than a quarter-cup of liquid that looks like dirty water, theyve at times detected thousands of viral particles people shed when they go to the bathroom around campus, as well as broader testing in parts of Baton Rouge.
LSU student leaders are calling for mandatory coronavirus testing among students in a push to allow for student organizations to safely hold e
Its a time-consuming process, often taking at least two days to deliver results. But it has provided an early alert and greater ability to find and isolate people before they spread the virus to others.
Some people don't have symptoms, and some people just don't go to the doctor, and when they get tested it's a week later," said Civil and Environmental Engineering Professor John Pardue, who is collaborating with the school of veterinary medicine to sample wastewater. "It's helping the state and city understand the virus."
The process of using wastewater has become a growing trend for colleges like LSU across the nation, which brought students back to classrooms and campuses after the pandemic forced them to shut down this spring.
Some schools have struggled to keep the virus at bay, forcing them to revert to online classes. LSU school leaders say the wastewater monitoring is among the tools they're using to keep students on campus while limiting the risk of spread.
Since students returned to campus in August, some 1,150 students and 66 employees have contracted the coronavirus out of roughly 39,000 people, according to the schools online dashboard as of Friday. More than 10,650 people have been tested in that time.
Louisiana's efforts to fight the coronavirus particularly mask-wearing and social distancing are saving lives, a top White House health of
School leaders say wastewater monitoring gives an early opportunity to catch the virus because it can detect an infection days before symptoms like a high fever or cough show up.
Younger, healthier people -- like most college students -- tend to have mild symptoms when theyre sickened by the virus, compared to older adults and those with underlying health problems. Some never develop symptoms at all but can still spread the virus to others through respiratory droplets from coughing, sneezing, talking and sometimes breathing.
"They could go spread it to someone else who might have a worst case," Pardue said.
People also shed virus particles through their feces when they go to the bathroom, making wastewater testing a non-intrusive means to measure the level of virus in a given area.
Pardue said he was surprised at how well the system worked with just a small amount of water tested, as well as how closely it appeared to mirror reporting done by the state Department of Health.
To get a clearer picture of how many people have the novel coronavirus in Baton Rouge and New Orleans, LSU and Tulane researchers are studying
Within two weeks of the governor issuing a statewide mandate on face coverings, his team observed a significant drop in coronavirus cases. They also observed trends mirroring state data when new cases surged this summer, as well as "blips" when students returned to college campuses and schools, Pardue said.
The testing does have its limits, however.
Because the water is collected from several sources, including multiple showers, sinks and toilets, its difficult to determine the exact number of cases a dorm or apartment may have. But of the four or five times the wastewater team has found signs of infections, as well as warning signs from the schools symptom tracker, all students living in a dorm or apartment are required to get tested.
Similar, wider tests, LSU is conducting for East Baton Rouge Parish also arent able to pinpoint the exact area of infections. But they have given early warning signs that cases may be rising as samples are collected at southern and northern parts of the parish.
The parish soon plans to add five additional wastewater testing sights that will allow them to hone in on specific neighborhoods and subdivisions that may be experiencing high levels of infections.
We expect this virus to be around for the next few years, so itll be useful for some time, said the mayor's spokesman Mark Armstrong.
Instead of simply reporting how many coronavirus cases have been found in Louisiana nursing homes, the state also began reporting Wednesday th
Parish Environmental Director Richard Speer said he hopes to include the results from the added test sites on the parish's online dashboard, but so far hasn't made any direct policy decisions based on data LSU has collected.
Virus samples found wastewater have dropped in recent weeks, as have new positive cases in East Baton Rouge Parish, according to data collected by the Louisiana Department of Health and LSU researchers.
Recently, researchers even recorded no new cases for the first time since they started testing city wastewater, Pardue said.
When you're seeing high levels of virus, you realize there's a lot of people in the city who are sick or shedding it, he said while recalling this summer's spike. I'm glad we haven't seen those numbers go up very high again.
Long-lasting effects on health feared
FITCHBURG (CBS) The Fitchburg Health Department announced Sunday that nearly 150 coronavirus cases have been connected to church services and programs at Crossroads Church on or around Oct. 18.
Contract tracers have also identified more than 40 COVID-19 cases related to ice and deck hockey, the health department said.
The FHD has concerns that many cases are asymptomatic. This is particularly dangerous as it may be contributing to further spread of COVID-19, in the community, a statement said.
There will be a free coronavirus testing popup site Tuesday at the Coggshall Park Stonehouse from 10 a.m. to 5 p.m. Attendees are asked to use the 165 Electic Ave. entrance.
Some states in the U.S. are doubling down, while others are resisting stricter safety measures as COVID-19 cases rise in 47 states.
ICU beds are 80% full in nearly a quarter of U.S. hospitals, according to a federal government memo obtained by NPR. It's a mounting tragedy that could have been avoided, Michael George reported for "CBS This Morning: Saturday."
A third of the population believes this pandemic is a hoax, "and they believe that it will end next Wednesday," said Dr. Michael Osterholm. "And no public health messaging is having an impact on that population."
In Wisconsin, Democratic Governor Tony Evers can't get the Republican legislature to support safety.
"If we want to do this right and stop it in its tracks, people have to wear a freaking mask," he said.
South Dakota is battling a positivity rate of 46%. California wants to avoid that, and has halted some plans to loosen restrictions.
"You see 20, 30% positivity rates now in other parts of the country, we're at 3.0% over a 14-day period but we are not taking our eye off the ball. We've got to box this disease in," said Governor Gavin Newsom said.
Oregon, too, is considering clamping down, after the state saw record case numbers this week.
"Oregon's cases are rising, just like the rest of the countries are, and frankly, cases around the globe. The second wave that we've all been worried about is here," said Governor Kate Brown.
Abstract
Between early March and 1 August 2020, COVID-19 took the lives of more than 150,000 Americans. Here, we examine the political consequences of the COVID-19 epidemic using granular data on COVID-19 fatalities and the attitudes of the American public. We find that COVID-19 has led to substantial damage for President Trump and other Republican candidates. States and local areas with higher levels of COVID-19 fatalities are less likely to support President Trump and Republican candidates for House and Senate. Our results show that President Trump and other Republican candidates would benefit electorally from a reduction in COVID-19 fatalities. This implies that a greater emphasis on social distancing, masks, and other mitigation strategies would benefit the president and his allies.
COVID-19 has killed about 5 times as many Americans as were killed in the Korean War, over 3 times as many as in Vietnam, and 40 times as many Americans as were killed in the entire Iraq War. Americans broadly disapprove of the presidents handling of the pandemic (1), but as of yet, there has been no clear causal evidence about whether the rise in COVID-19 fatalities has led Americans to turn away from President Trump.
A large academic literature has shown that the American public holds presidents accountable for their performance in office (2, 3). Among other things, the public penalizes a president and others in their party for casualties in war. Areas with more local casualties, for example, were among the first to turn against the Vietnam War between 1965 and 1972 (4), and during the Iraq War, people who knew someone who died on 9/11 or in the Iraq War were consistently more likely to disapprove of George W. Bush (5). As a result, states with greater losses were more likely to vote against President Bush in the 2004 presidential election (6). Voters also punished Republican candidates at other levels of office: Areas with higher casualties from the war in Iraq were more likely to support Democratic House and Senate candidates in the 2006 midterm elections (7, 8). Last, areas with higher casualties in the war in Afghanistan penalized Barack Obamas Democratic successor in 2016, Secretary of State Hillary Clinton, by supporting Donald Trump in greater numbers (9).
The U.S. president has likened his battle against COVID-19 to that of a war-time president (10). Voters may also see him that way. On the basis of previous studies of the political costs of war-time casualties, we hypothesize that the American public will be less likely to support President Trump and other Republican candidates for federal offices in areas with higher levels of COVID-19 fatalities.
We examine whether Americans are penalizing the president and other Republicans for the fatalities due to COVID-19 using several granular data sources (see Materials and Methods for more details). We leverage both temporal and geographic variation in the magnitude of the COVID-19 pandemic using local-level data on fatalities gathered by the New York Times. We use the Democracy Fund + UCLA Nationscape Project to measure the attitudes of the American public at a local level. This survey includes the responses of more than 300,000 people between the summers of 2019 and 2020 (11).
Figure 1 (below) examines the state-level association between cumulative COVID-19 fatalities as of 31 May 2020 and changes in Americans attitudes between the first 2 months of 2020 and June. It shows that states with more COVID-19 fatalities were less likely to support Republican candidates. For example, people in the states with the highest fatalities were about 6% less likely to approve of President Trumps performance in office than people in the states with the lowest level of fatalities (Fig. 1A). The states with the highest level of fatalities were about 3% less likely to support President Trumps reelection in the presidential race against Democrat Joseph R. Biden (Fig. 1B). The hardest-hit states were nearly 13% less likely to support Republican Senate candidates (Fig. 1C) and about 5% less likely to support Republican House candidates (Fig. 1D).
These associations, however, could be confounded by other state-level factors and may be affected by sampling variability at the state level (particularly for smaller states). Thus, we move next to a more rigorous difference-in-differences regression design to assess the causal effect of COVID-19 fatalities on political preferences. This approach examines the effect of COVID-19 fatalities over the past 30 days in each respondents state or county on their attitudes about President Trump and other politicians. In addition to providing a more granular test, county-level results characterize the impact of the information environment surrounding the pandemic relative to the actual number of fatalities. We use fixed effects for geography and week of interview to account for area- and time-specific confounders. We also control for a host of preCOVID-19 individual-level attributes of the survey respondents, including 2016 vote choice, making our results net of factors such as race, education, gender, and partisan preference in 2016 (see Materials and Methods).
We find consistent results at every level of geography and for every office (Fig. 2): The effect of fatalities is a drain on Republican vote share (see Materials and Methods for a variety of robustness checks and the Supplementary Materials for a table with the regression results). Overall, areas with higher COVID-19 fatalities are significantly less likely to support President Trump and other Republican candidates. A doubling of COVID-19 fatalities (0.69 U on the natural log scale) at the county level leads to a roughly 0.19% reduction in President Trumps approval rating, and a doubling in fatalities at the state level leads to a 0.5% reduction in the presidents approval. In the presidential election, a doubling of COVID-19 fatalities at the county level makes Americans about 0.14% less likely to support President Trump against Joseph R. Biden and a doubling in fatalities at the state level leads to a 0.37% reduction in support for Trump. In Senate races, a doubling of COVID-19 fatalities at the county level makes Americans about 0.28% less likely to support Republican candidates and a doubling in fatalities at the state level leads to a 0.79% reduction in support for Republicans. Last, in House races, a doubling of COVID-19 fatalities at the county level makes Americans about 0.22% less likely to support Republican candidates and a doubling in fatalities at the state level leads to a 0.58% reduction in support for Republicans.
This graph shows the results of regression models of the effect of a doubling in COVID-19 deaths per 100,000 people in the past 30 days in each state and county on Trump approval and whether respondents plan to vote for Republican candidates for president, Senate, and House. The dots show the point estimates, and the bars show 95% confidence intervals.
Our results show that the COVID-19 pandemic has already substantially damaged the political standing of President Trump. Just as the public penalizes the president for casualties during wars, the public is penalizing the president and other members of his party for local fatalities during the pandemic. The number of local fatalities due to COVID-19 appears to be at least as important as the local economy in Americans evaluations of their leaders (12, 13). COVID-19 could cost Trump and other Republicans several percentage points in the 2020 election. This could swing the presidential election and the U.S. Senate toward Democrats, with particularly high effects in swing states such as Michigan, Wisconsin, Pennsylvania, New Hampshire, Arizona, and Florida. All of these states had tight margins in the 2016 presidential election. Michigans margin was particularly narrow (0.2%), as was New Hampshires (0.4%), suggesting that COVID-related fatalities may be consequential not only at the individual level in 2020 but also in terms of Electoral College results. Similarly, there were very close U.S. Senate elections in 2018. In Florida, 0.2% of the vote separated the Republican winner from the Democrat.
These narrow margins in 2016 and 2018, coupled with the realization that fatalities from COVID-19 are not unlike casualties of war in voters minds, suggest that a winning strategy for President Trump and other Republican candidates on the ballot in 2020 should be to adopt mitigation strategies to limit the spread and consequences of COVID-19 in the American population. Increasing fatalities from the disease leads to losses for Republicans.
This section describes the methods and data that we use in our paper. The first building block of our study is granular data on reported COVID-19 fatalities across geography and time. For this, we use data that the New York Times has collected on the basis of state websites and databases (see https://github.com/nytimes/covid-19-data). We then aggregate the county-level data on COVID-19 deaths at the state level. County-level population data are taken from the 2014 to 2018 American Community Survey (ACS).
The next building block is data on attitudes of the American public about President Trump and vote intentions for the 2020 elections. For this, we use the Democracy Fund + UCLA Nationscape Project to measure the attitudes of the American public at a local level (11). This survey includes the responses of more than 300,000 people, about 6400 of whom were interviewed each week between the summers of 2019 and 2020 (through 29 July 2020). The survey is fielded online and is representative of the nation as a whole (14). The Nationscape staff generate sampling weights for the weekly datasets. The technique is based on processes used by the American National Election Studies. In table S1, we show a detailed comparison of the weighted Nationscape sample with population targets. Overall, the weighted sample appears to be extremely representative of observable population targets. Owing to its large size, Nationscape can also be disaggregated to reflect opinions at the state and local levels.
The survey asks about a variety of political attitudes and preferences. We use four specific questions from the survey. First, we use data on whether respondents approve of President Trumps job performance. We collapse this four-point question to a dichotomous variable. Second, we use data on whether people would vote for President Trump or Joseph R. Biden in a head-to-head matchup in the 2020 presidential election. Third, we use data on whether respondents plan to vote for the Republican or Democratic candidate in the 2020 House election in their district. Last, we use data on whether respondents plan to vote for the Republican or Democratic candidate in the 2020 Senate elections in their state (if they have one). For each, we are excluding individuals who answered Not sure. (Note that fig. S4 shows that the results are similar in models that include dont know responses.)
Our main paper reports the results of two sets of analyses. The next two sections describe the details for these analyses.
First, we look at the state-level association between COVID-19 fatalities and Americans attitudes about President Trump and their vote intentions in the 2020 election. For this analysis, the independent variable is the natural log of the number of COVID-19 fatalities per 100,000 people in each state before 1 June 2020. The outcome variable is the change in the publics attitudes before the COVID-19 pandemic (defined as the first 2 months of 2020) and their attitudes after the arrival of COVID-19, between 1 June and 2 July 2020. We use the appropriate state-level sampling weights to calculate the publics state-level attitudes in each time period. We then graph the relationship between COVID-19 fatalities and the changes in political attitudes in each state. By focusing on changes in political attitudes, our analysis implicitly accounts for time-invariant confounders (omitted variables) in each state and common shocks that affect all states. However, there is large sampling variability at the state level, particularly in smaller states, which we will address in further analyses.
Next, we move to a more rigorous difference-in-differences regression design. We use a linear probability model to examine the effect of COVID-19 fatalities over the past 30 days in each survey respondents state or county with their attitudes about President Trump and other politicians. For this analysis, the independent variable is the natural log of the number of COVID-19 fatalities per 100,000 people in the last 30 days (relative to the date each respondent was interviewed) in each geographic area. A 0.69-U increase on the natural log scale can be interpreted as approximately a doubling of fatalities (15). Here, we use fixed effects for geography and survey wave (week) to account for area- and time-specific confounders and identify the causal effects of COVID-19 on political attitudes (16). The geographic fixed effects account for the tendency of different areas to have varying levels of baseline support for President Trump and other Republican candidates. The temporal fixed effects account for national-level changes in political attitudes due to the pandemic, the economy, and national events such as the Black Lives Matter movement. We also control for a host of individual-level pretreatment attributes of the survey respondents. These are not crucial for our identification strategy, but they reduce the variance in our results (17). Specifically, we control for respondents gender, race/ethnicity, education, Hispanic ancestry, and their vote choice in the 2016 presidential election. The SEs in our regression results are clustered at the state-day or county-day level depending on the model (18). We use national sampling weights in all our analysis. So, our results are representative of the American public at the national level. While our main analyses use a linear probability model, we find substantively similar results using logistic regression models.
To validate our research design, we run a placebo check where we examine the effect of future COVID deaths on an index of approval, presidential voting, senate voting, and house voting at the state level. Specifically, we look at future COVID deaths over the next 30 and 90 days using survey data before the start of the COVID-19 pandemic, from between July 2019 and March 2020. Figure S1 shows that there is no effect of future COVID-19 deaths on political preferences.
Note that the state of the art in panel research designs is constantly moving forward. In recent years, a number of scholars have conducted innovative work (1921). However, to our knowledge, all of this work currently requires dichotomous treatment variables. So, overall, we believe that our design is the best available research design for our data and that our placebo checks validate a causal interpretation of our results.
We have also run a number of robustness checks for our main research design and results. For simplicity, each of these robustness checks focuses on our state-level model using an index of our four outcome variables to capture aggregate political preferences.
1) First, we examine the results if we use several different numbers of days as cutoffs rather than just 30 days. Specifically, we examine cutoffs ranging from 10 to 90 days. In fig. S2, we find that the results are quite similar across models, although the point estimates decrease a bit for longer cutoffs. Overall, this suggests that our results are not especially sensitive to the choice of cutoffs. They are also significant across all cutoffs.
2) Our next robustness check examines the results if we do not include any control variables in our analyses (fig. S3). We find that our results are slightly noisier without any control variables, but the results are still significant without controls. In our main analyses, we prefer to retain control variables because of the increase in efficiency that they provide.
3) In our main analysis, we dropped dont knows. However, it is reasonable to think that dont knows could be an important middle category, and voters could move into this category because of concern about COVID-19. To assess this possibility, we coded alternative variables for all our outcomes with dont know as a middle category (0.5). Figure S4 shows the results at the state level. It indicates that the results are generally very similar with and without dont knows, especially for the presidential race. The point estimates in Senate and House races are a bit smaller when we include dont knows, but the results are significant both with and without dont knows at all levels of geography. Likewise, our county level results are also similar with and without dont knows.
4) Last, we examine whether the results change if we drop each state one by one. Figure S5 shows that our results are not sensitive to dropping individual states. The point estimates are generally quite similar across models. The highest P value is in a model that drops Texas. Even in this model, however, we still find a P value of 0.02.
Overall, these robustness checks indicate that our results are not sensitive to alternative regression specifications or driven by outliers.
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Thurston County COVID-19 cases on the rise, outbreaks reported in 6 nursing homes KOMO News
LEWISTON Central Maine Medical Center allowed employees to walk through the hospital without masks, didnt consistently or correctly screen workers and visitors entering the building, and failed to keep its Intensive Care Unit clean even as the hospital was dealing with a COVID-19 outbreak an outbreak that started in the ICU according to state investigators.
In a report issued in August and released this week to the Sun Journal, investigators said the hospitals actions put people in immediate jeopardy, causing a situation in which a patient already had or likely could die or suffer serious injury. CMMC was ordered to quickly fix its problems, and hospital officials say they have.
CMMCs COVID-19 outbreak began the third week of July and lasted well into August. In all, 17 people were infected, including 15 employees and two patients. According to the hospital, almost 50 people had to quarantine, most of them connected to the ICU.
The 32-page report details what CMMC did and didnt do during that time:
It did not implement all the infection control strategies it could have in order to prevent and control the transmission of COVID-19, nor was it monitoring the strategies it did have;
It did not keep the ICU clean. Investigators noted dirt build up, overflowing trash, a dirty towel on the floor, splatter stains and brown stains on the floor, and IV tubing touching the floor, among other sanitation issues. Some dirty areas were in the hallway, others were in rooms.
Investigators said they were told housekeeping staff did not clean any room that had a COVID-19 patient in it. Investigators also said the system director of infection prevention told them that she had not seen the condition of ICU, the unit where CMMCs outbreak began;
It did not screen everyone who entered the building, despite U.S. Centers for Disease Control recommendations to do so. Temperature taking and screening questions were haphazard for both employees and visitors and nonexistent at some entrances, even as the hospital was in the middle of an outbreak;
It did not monitor all entrances or ensure that only employees used employee entrances;
It did not stay up to date on U.S. CDC guidelines. Hospital leaders told investigators they thought a fever was anything over 100.4 degrees, but the latest CDC guidelines set a COVID-concerning fever at 100 degrees;
It did not screen employees once they got to their units, despite what appeared to be a new hospital policy requiring it.
We used to get screened before coming into the hospital, but now we wear a mask and if we dont have any of the symptoms, we are good to work. It is an honor system for screening in the morning. There is no screening to come onto this unit or for the lab, a phlebotomist told investigators;
It did not adequately document what was going on;
It did not have enough signs with instructions about face coverings and hand washing;
It did allow at least some employees to screen just once in June and then forgo future screening.
After that date (June 25), we had the employees sign an attestation form one time, electronically, and then the only thing they do daily when they come in is get a new mask, if they dont have one, and complete hand hygiene, the hospitals regulatory compliance coordinator told investigators;
It did allow some employees to enter the hospital and walk through the building without a mask.
When the investigation started, CMMCs outbreak included 12 staff members and one patient. By the time the investigation was over, three more employees and one more patient had the virus.
John Alexander, chief medical officer for the health system, said CMMC immediately fixed the issues raised by investigators. The report acknowledged that CMMC officials quickly created a plan of correction and fixed the problems.
Those fixes include better screening for employees and visitors, as well as entrances that are restricted and monitored.
Weve really enhanced our processes to the point where we feel we have one of the best screening standards in the state, he said.
Alexander said some of the issues within the ICU, such as cleanliness, were the result of the outbreak, which caused dozens of ICU workers to quarantine and miss work. Without those staff members, he said, some paperwork fell behind.
It wasnt so much that we werent maintaining the environment, it was more that we werent maintaining the documentation to support how we were maintaining the environment, he said. And thats an important part of what we do.
Alexander also said checklists werent being maintained, which meant employees coming on shift didnt know what had or hadnt been done by the previous shift. When asked why staff members couldnt see on their own that trash needed to be emptied or the floor was dirty, Alexander said, I cant answer that.
Alexander said the state investigators, who work on behalf of the federal Centers for Medicare & Medicaid Services, or CMS, had been inspecting all Maine hospitals and arrived at CMMC as part of a routine screening. However, the report notes that investigators were there because a complaint had been filed against the hospital.
Alexander said he considers investigators to be good partners.
We rely on them as another set of eyes to help us find areas where we may have opportunities for improvement, he said. We look forward to when those situations occur so that we can correct them and we can make sure we continue to work toward patient safety.
CMMC has been the subject of a number of investigations in recent years, including last year when CMS investigators found a series of problems so serious that CMS threatened to stop paying for Medicare and Medicaid patients to go there. The hospital fixed those problems and did not lose payments.
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ALBUQUERQUE, N.M.(KRQE) Election Day is four days away but what happens if youre in quarantine and cant cast your ballot? At this point, its too late to request an absentee ballot, so for people whove contracted COVID-19 and have to stay home, theres still a way they can vote.
She came down with symptoms and had to go to the hospital, said Mario Madrid. Madrids sister was planning on going to the polls to vote in-person in Santa Fe County, but recently, she tested positive for COVID-19.
And she was being transported from a Santa Fe hospital to an Albuquerque hospital, said Madrid. After getting released from the hospital, she still had to quarantine in her home which means she cant go to the polls anymore and its too late to request an absentee ballot. But for people like her, there is a backup plan.
We have something in New Mexico called an Emergency Voting Affidavit and this is definitely applicable for people during this COVID crisis, said a spokesperson for the Secretary of State Alex Curtas.
People can download this affidavit from the Secretary of States website, which requires the voter and their healthcare provider to sign off on saying theyre too sick to go to the polls.
At that point a provisional ballot will be issued to that voter who is too sick to come to the polls, it would be taken back to the voter by that caretaker or healthcare or healthcare provider, said Curtas.
In New Mexicos election code, the voters caretaker or an immediate family member would have to be the one to drop off that ballot. For people like Madrids sister, theyre glad she can still vote.
Its a relief they already have something in place, said Madrid.
In order for that provisional ballot to be counted, it has to be returned to their County Clerks Office no later than 7 p.m. on Election day. KRQE News 13 asked the Secretary of States office how many people have requested these emergency ballots but they did not have the exact number.
