The coronavirus has killed so many people in Iran that the country has resorted to mass burials, but in neighboring Iraq, the body count is fewer than 100.
The Dominican Republic has reported nearly 7,600 cases of the virus. Just across the border, Haiti has recorded about 85.
In Indonesia, thousands are believed to have died of the coronavirus. In nearby Malaysia, a strict lockdown has kept fatalities to about 100.
The coronavirus has touched almost every country on earth, but its impact has seemed capricious. Global metropolises like New York, Paris and London have been devastated, while teeming cities like Bangkok, Baghdad, New Delhi and Lagos have, so far, largely been spared.
The question of why the virus has overwhelmed some places and left others relatively untouched is a puzzle that has spawned numerous theories and speculations but no definitive answers. That knowledge could have profound implications for how countries respond to the virus, for determining who is at risk and for knowing when its safe to go out again.
There are already hundreds of studies underway around the world looking into how demographics, pre-existing conditions and genetics might affect the wide variation in impact.
Doctors in Saudi Arabia are studying whether genetic differences may help explain varying levels of severity in Covid-19 cases among Saudi Arabs, while scientists in Brazil are looking into the relationship between genetics and Covid-19 complications. Teams in multiple countries are studying if common hypertension medications might worsen the diseases severity and whether a particular tuberculosis vaccine might do the opposite.
Many developing nations with hot climates and young populations have escaped the worst, suggesting that temperature and demographics could be factors. But countries like Peru, Indonesia and Brazil, tropical countries in the throes of growing epidemics, throw cold water on that idea.
Draconian social-distancing and early lockdown measures have clearly been effective, but Myanmar and Cambodia did neither and have reported few cases.
One theory that is unproven but impossible to refute: maybe the virus just hasnt gotten to those countries yet. Russia and Turkey appeared to be fine until, suddenly, they were not.
Time may still prove the greatest equalizer: The Spanish flu that broke out in the United States in 1918 seemed to die down during the summer only to come roaring back with a deadlier strain in the fall, and a third wave the following year. It eventually reached far-flung places like islands in Alaska and the South Pacific and infected a third of the worlds population.
We are really early in this disease, said Dr. Ashish Jha, the director of the Harvard Global Health Research Institute. If this were a baseball game, it would be the second inning and theres no reason to think that by the ninth inning the rest of the world that looks now like it hasnt been affected wont become like other places.
Doctors who study infectious diseases around the world say they do not have enough data yet to get a full epidemiological picture, and that gaps in information in many countries make it dangerous to draw conclusions. Testing is woeful in many places, leading to vast underestimates of the viruss progress, and deaths are almost certainly undercounted.
Still, the broad patterns are clear. Even in places with abysmal record-keeping and broken health systems, mass burials or hospitals turning away sick people by the thousands would be hard to miss, and a number of places are just not seeing them at least not yet.
Interviews with more than two dozen infectious disease experts, health officials, epidemiologists and academics around the globe suggest four main factors that could help explain where the virus thrives and where it doesnt: demographics, culture, environment and the speed of government responses.
Each possible explanation comes with considerable caveats and confounding counter-evidence. If an aging population is the most vulnerable, for instance, Japan should be at the top of the list. It is far from it. Nonetheless these are the factors that experts find the most persuasive.
Many countries that have escaped mass epidemics have relatively younger populations.
Young people are more likely to contract mild or asymptomatic cases that are less transmissible to others, said Robert Bollinger, a professor of infectious diseases at the Johns Hopkins School of Medicine. And they are less likely to have certain health problems that can make Covid-19, the disease caused by the coronavirus, particularly deadly, according to the World Health Organization.
Africa with about 45,000 reported cases, a tiny fraction of its 1.3 billion people is the worlds youngest continent, with more than 60 percent of its population under age 25. In Thailand and Najaf, Iraq, local health officials found that the 20-to-29 age group had the highest rate of infection but often showed few symptoms.
By contrast, the national median age in Italy, one of the hardest hit countries, is more than 45. The average age of those who died of Covid-19 there was around 80.
Younger people tend to have stronger immune systems, which can result in milder symptoms, said Josip Car, an expert in population and global health at Nanyang Technological University in Singapore.
In Singapore and Saudi Arabia, for instance, most of the infections are among foreign migrant workers, many of them living in cramped dormitories. However, many of those workers are young and fit, and have not required hospitalization.
Along with youth, relative good health can lessen the impact of the virus among those who are infected, while certain pre-existing conditions notably hypertension, diabetes and obesity can worsen the severity, researchers in the United States say.
There are notable exceptions to the demographic theory. Japan, with the worlds oldest average population, has recorded fewer than 520 deaths, although its caseload has risen with increased testing.
And Dr. Jha of Harvard warns that some young people who are not showing symptoms are also highly contagious for reasons that are not well understood.
Cultural factors, like the social distancing that is built into certain societies, may give some countries more protection, epidemiologists said.
In Thailand and India, where virus numbers are relatively low, people greet each other at a distance, with palms joined together as in prayer. In Japan and South Korea, people bow, and long before the coronavirus arrived, they tended to wear face masks when feeling unwell.
In much of the developing world, the custom of caring for the elderly at home leads to fewer nursing homes, which have been tinder for tragic outbreaks in the West.
However, there are notable exceptions to the cultural distancing theory. In many parts of the Middle East, such as Iraq and the Persian Gulf countries, men often embrace or shake hands on meeting, yet most are not getting sick.
What might be called national distancing has also proven advantageous. Countries that are relatively isolated have reaped health benefits from their seclusion.
Far-flung nations, such as some in the South Pacific and parts of sub-Saharan Africa, have not been as inundated with visitors bringing the virus with them. Health experts in Africa cite limited travel from abroad as perhaps the main reason for the continents relatively low infection rate.
Countries that are less accessible for political reasons, like Venezuela, or because of conflict, like Syria and Libya, have also been somewhat shielded by the lack of travelers, as have countries like Lebanon and Iraq, which have endured widespread protests in recent months.
The lack of public transportation in developing countries may have also reduced the spread of the virus there.
The geography of the outbreak which spread rapidly during the winter in temperate zone countries like Italy and the United States and was virtually unseen in warmer countries such as Chad or Guyana seemed to suggest that the virus did not take well to heat. Other coronaviruses, such as ones that cause the common cold, are less contagious in warmer, moist climates.
But researchers say the idea that hot weather alone can repel the virus is wishful thinking.
Some of the worst outbreaks in the developing world have been in places like the Amazonas region of Brazil, as tropical a place as any.
The best guess is that summer conditions will help but are unlikely by themselves to lead to significant slowing of growth or to a decline in cases, said Marc Lipsitch, the director of the Center for Communicable Disease Dynamics at Harvard University.
The virus that causes Covid-19 appears to be so contagious as to mitigate any beneficial effect of heat and humidity, said Dr. Raul Rabadan, a computational biologist at Columbia University.
But other aspects of warm climates, like people spending more time outside, could help.
People living indoors within enclosed environments may promote virus recirculation, increasing the chance of contracting the disease, said Mr. Car of Nanyang Technological University.
The ultraviolet rays of direct sunlight inhibit this coronavirus, according to a study by ecological modelers at the University of Connecticut. So surfaces in sunny places may be less likely to remain contaminated, but transmission usually occurs through contact with an infected person, not by touching a surface.
No scientist has proposed that beaming light inside an infected person, as President Trump has suggested, would be an effective cure. And tropical conditions may have even lulled some people into a false sense of security.
People were saying Its hot here, nothing will happen to me, said Dr. Domnica Cevallos, a medical investigator in Ecuador. Some were even going out on purpose to sunbathe, thinking it would protect them from infection.
Countries that locked down early, like Vietnam and Greece, have been able to avoid out-of-control contagions, evidence of the power of strict social distancing and quarantines to contain the virus.
In Africa, countries with bitter experience with killers like H.I.V., drug-resistant tuberculosis and Ebola knew the drill and reacted quickly.
Airport staff from Sierra Leone to Uganda were taking temperatures (since found to be a less effective measure) and contact details and wearing masks long before their counterparts in the United States and Europe took such precautions.
Senegal and Rwanda closed their borders and announced curfews when they still had very few cases. Health ministries began contact tracing early.
All this happened in a region where health ministries had come to rely on money, personnel and supplies from foreign donors, many of which had to turn their attention to outbreaks in their own countries, said Catherine Kyobutungi, executive director of the African Population and Health Research Center.
Countries wake up one day and theyre like, OK, the weight of the country rests on our shoulders, so we need to step up, she said. And they have. Some of the responses have been beautiful to behold, honestly.
Sierra Leone repurposed disease-tracking protocols that had been established in the wake of the Ebola outbreak in 2014, in which almost 4,000 people died there. The government set up emergency operations centers in every district and recruited 14,000 community health workers, 1,500 of whom are being trained as contact tracers, even though Sierra Leone has only about 155 confirmed cases.
It is not clear, however, who will pay for their salaries or for expenses like motorcycles and raincoats to keep them operating during the coming wet season.
Uganda, which also suffered during the Ebola contagion, quickly quarantined travelers from Dubai after the first case of coronavirus arrived from there. Authorities also tracked down about 800 others who had traveled from Dubai in previous weeks.
The Ugandan health authorities are also testing around 1,000 truck drivers a day. But many of those who test positive have come from Tanzania and Kenya, countries that are not monitoring as aggressively, leading to worries that the virus will keep penetrating porous borders.
Lockdowns, with bans on religious conclaves and spectator sporting events, clearly work, the World Health Organization says. More than a month after closing national borders, schools and most businesses, countries from Thailand to Jordan have seen new infections drop.
In the Middle East, the widespread shuttering of mosques, shrines and churches happened relatively early and probably helped stem the spread in many countries.
A notable exception was Iran, which did not close some of its largest shrines until March 18, a full month after it registered its first case in the pilgrimage city of Qum. The epidemic spread quickly from there, killing thousands in the country and spreading the virus across borders as pilgrims returned home.
As effective as lockdowns are, in countries lacking a strong social safety net and those where most people work in the informal economy, orders closing businesses and requiring people to shelter in place will be difficult to maintain for long. When people are forced to choose between social distancing and feeding their families, they are choosing the latter.
Counter-intuitively, some countries where authorities reacted late and with spotty enforcement of lockdowns appear to have been spared. Cambodia and Laos both had brief spates of infections when few social distancing measures were in place but neither has recorded a new case in about three weeks.
Lebanon, whose Muslim and Christian citizens often go on pilgrimages respectively to Iran and Italy, places rife with the virus, should have had high numbers of infections. It has not.
We just didnt see what we were expecting, said Dr. Roy Nasnas, an infectious disease consultant at the University Hospital Geitaoui in Beirut. We dont know why.
Finally, most experts agree that there may be no single reason for some countries to be hit and others missed. The answer is likely to be some combination of the above factors, as well as one other mentioned by researchers: sheer luck.
Countries with the same culture and climate could have vastly different outcomes if one infected person attends a crowded social occasion, turning it into what researchers call a super-spreader event.
Because an infected person may not experience symptoms for a week or more, if at all, the disease spreads under the radar, exponentially and seemingly at random. Had the woman in Daegu stayed home that Sunday in February, the outbreak in South Korea might have been less than half of what it is.
Some countries that should have been inundated are not, leaving researchers scratching their heads.
Thailand reported the first confirmed case of coronavirus outside of China in mid-January, from a traveler from Wuhan, the Chinese city where the pandemic is thought to have begun. In those critical weeks, Thailand continued to welcome an influx of Chinese visitors. For some reason, these tourists did not set off exponential local transmission.
And when countries do all the wrong things and still end up seemingly not as battered by the virus as one would expect, go figure.
In Indonesia, we have a health minister who believes you can pray away Covid, and we have too little testing, said Dr. Pandu Riono, an infectious disease specialist at the University of Indonesia. But we are lucky we have so many islands in our country that limit travel and maybe infection.
Theres nothing else were doing right, he added.
Amid Ongoing COVID-19 Pandemic, Governor Cuomo Announces Results of Completed Antibody Testing Study of 15,000 People Showing 12.3 Percent of Population Has COVID-19 Antibodies | Governor Andrew M. Cuomo Skip to main content
State Will Distribute Over7 Million More Cloth Masks to Vulnerable New Yorkers and Frontline Workers Across the State
State is Distributing $25 Million to Food Banks Across the State Through the Nourish New York Initiative
Confirms 4,663 Additional Coronavirus Cases in New York State - Bringing Statewide Total to 312,977; New Cases in 44 Counties
Amid the ongoing COVID-19 pandemic, Governor Andrew M. Cuomo today announced the results of the state's completed antibody testing study, showing 12.3 percent of the population have COVID-19 antibodies. The survey developed a baseline infection rate by testing 15,000 peopleat grocery stores and community centers across the state over the past two weeks.Of those tested, 11.5% of women tested positive and 13.1% of men tested positive. A regional breakdown of the results is below:
Region
Percent Positive
Capital District
2.2%
Central NY
1.9%
Finger Lakes
2.6%
Hudson Valley(Without Westchester/Rockland)
3%
Long Island
11.4%
Mohawk Valley
2.7%
North Country
1.2%
NYC
19.9%
Southern Tier
2.4%
Westchester/Rockland
13.8%
Western NY
6%
Audio Photos
The Governor also announced that the state will distribute over seven million more cloth masks to vulnerable New Yorkers and essential workers across the state. The masks will be distributed as follows:
While we're in uncharted waters it doesn't mean we proceed blindly, and the results of the 15,000 people tested in our antibody survey program - thelargest survey in the nation - will inform our strategy moving forward
The Governor also announced the state is distributing $25 million to food banks across the state through the Nourish New York Initiative. The Nourish New York initiative, announced earlier this week by Governor Cuomo, is working to quickly reroute NewYork's surplus agricultural products to the populations who need them most through New York's network of food banks. Funding will be distributed as follows:
"While we're in uncharted waters it doesn't mean we proceed blindly, and the results of the 15,000 people tested in our antibody survey program - thelargest survey in the nation - will inform our strategy moving forward,"Governor Cuomo said."We're also going to undertake a full survey of antibody testing for transit workers, who have been on the front lines of this crisis. We've said thank you to our essential workers thousands of times but actions speak louder than words, and we want them to know that we're doing everything we can do to keep them safe."
Finally, the Governor confirmed 4,663 additional cases of novel coronavirus, bringing the statewide total to 312,977 confirmed cases in New York State. Of the 312,977 total individuals who tested positive for the virus, the geographic breakdown is as follows:
County
Total Positive
New Positive
Albany
1,238
34
Allegany
35
0
Broome
305
6
Cattaraugus
50
1
Cayuga
51
0
Chautauqua
35
0
Chemung
124
1
Chenango
99
0
Clinton
62
1
Columbia
205
3
Cortland
28
0
Delaware
61
0
Dutchess
3,049
47
Erie
3,598
117
Essex
28
0
Franklin
15
0
Fulton
79
4
Genesee
155
1
Greene
142
3
Hamilton
How safe is swimming during the COVID-19 coronavirus pandemic? (Photo: Getty)
It looks like the COVID-19 coronavirus may be able to live in water for a few days, potentially even a few weeks. There is a big but, though. And youll like this big but. Just because a virus can survive in water doesnt necessarily mean that its present in large enough concentrations to infect you.
Is this situation a bit like a teenager pointing out a few hairs on his face and then claiming that its a beard? There actually has to be enough hairs to make it a beard. When you can still count the number of hairs, its not a beard, unless, of course, the hairs are really, really long and very, very curly.
Similarly, consider what is known about the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in water. Indeed studies have suggested that the SARS-CoV2 could actually hang out in the wet stuff for a little while. For example, a study published in the journal Water Research in 2009 found that two viruses that have similarities to the original SARS virus, the transmissible gastroenteritis (TGEV) and mouse hepatitis (MHV) viruses, could survive up to days and even weeks in water. The University of North Carolina team (LisaCasanova, William A.Rutal, David J.Weber, and Mark D.Sobsey) that conducted the study concluded that coronaviruses can remain infectious for long periods in water and pasteurized settled sewage, suggesting contaminated water is a potential vehicle for human exposure if aerosols are generated.
Pictured here are sewer tunnels underneath the streets of Paris, France. (Photo: Getty)
Then there was the poopy study described by a paper posted April 17 on medRxiv. For this study, the team sampled sewage (you know, the watery stuff in sewers) in the greater Paris, France, area for over a month. They found that concentrations of the SARS-CoV2 correlated with the number of COVID-19 cases in the region over time. In other words, when COVID-19 cases were rising, so did the concentrations of the SARS-CoV2 in the sewage. This seems like one more reason why splashing sewage or taking a deep breath near sewage is probably not a great idea.
Take this second study with a grain of sewage though. It has not yet been published in a peer-reviewed scientific journal. That means real scientific experts havent had a chance to review the study for quality or accuracy. Telling people that youve posted something on medRxiv can be a bit like telling people that youve auditioned for Americas Got Talent. Theres no guarantee that this study will ever make it close to the final stage of getting published in a reputable peer-reviewed scientific journal.
Regardless, the results from both studies do suggest that the virus can survive for a little while in water, which initially may cause you to wet yourself. Before you do, heres the big but again. Neither study showed that you can actually get infected with the COVID-19 coronavirus from water under the conditions that youd normally be exposed to water. That means via drinking (assuming that you arent drinking sewage or some other type of dirty water), showering, or swimming (assuming that you dont swim in sewage.)
The CDC and EPA have emphasized the safety of drinking water supplies. (Photo: Getty)
In fact, according to the Centers for Disease Control and Prevention (CDC), the COVID-19 coronavirus hasnt even been found in drinking water. And the U.S. Environmental Protection Agency (EPA) has said that the risk to water supplies is low. Americans can continue to use and drink water from their tap as usual. Such a virus would have to get through all of the filtration and water treatments that drinking water typically goes through, and that can be harder than getting on to the red carpet at the Oscars.
Moreover, the great thing about water is that its water. It tends to dilute things. Even if the COVID-19 coronavirus were to somehow make the epic journey of getting into your drinking water, it may not be at high enough concentrations to be of risk to you. This goes back to the whole beard thing. Every virus has a minimum infectious dose, the amount of virus that needs to be present to cause illness. Although its not completely clear yet what the minimum infectious dose for SARS-CoV-2 may be, dilution makes it less likely that what reaches you can surpass this threshold.
The same probably goes for water in pools and hot tubs. The CDC indicates that there is no evidence that the virus that causes COVID-19 can be spread to people through the water in pools, hot tubs, spas, or water play areas. For these things, not only would the water dilute the virus, but also disinfection with chlorine and bromine would likely inactivate the virus.
If you are actually thinking of swimming or soaking in a pool or tub that is not properly chlorinated or bromated, dont. Just dont. Theres a whole lot of other nasty, disease-causing microbes that could then be swimming or soaking along with you. The poop about many swimming pools and hot tubs is thats what people may do in them. As I have described previously for Forbes, 24% of respondents to the2019 Healthy Pools survey indicated that they would enter a swimming pool "within one hour of having diarrhea." Yes, diarrhea. Yes, within one hour of having it. And those are just the people who admitted to doing this. Still dont want to social distance from others?
As for the ocean, it is pretty big. Then theres the motion of the ocean, so to speak. Both of these aspects can dilute and separate viruses fairly quickly. The salt in the water may decrease the survival of the virus as well.
This doesnt mean that you should rush to the beach to do whats seen in this Reuters video:
Sun of a beach. Does this look like social distancing to you? Is everyone in the video staying six feet away from each other? Six feet apart means roughly one Denzel Washington apart, since Washington is about six feet tall. See any people less than one Denzel apart?
When it comes to the COVID-19 coronavirus, the riskiest thing at swimming pools, hot tubs, and oceans is not the water itself. No, its the coughing, sneezing, panting, face-rubbing, and diarrhea-ing things that are in or next to the water: people. Its also the things that people touch frequently such as guard rails, chairs, towels, and thongs.
Do not do this. Not as long as the COVID-19 coronavirus is circulating. (Photo: Getty_
So, the key once again will be doing what you should be doing on land: practicing good social distancing, good hand hygiene, good disinfecting (of objects), and good avoid-touching-your-enormous face. And if you see any random objects such as a sign post, a statue, or a thong, dont touch it if you dont have to do so. You dont know where it has been. Actually, in the case of a thong, you know exactly where its been. Thats the problem.
Also, wait until beaches, swimming pools, and other water areas are officially open before going to them. Yes, staying inside is not easy. Yes, there are only so many episodes of Breaking Bad that you can watch or mind games that you can play with your cat. But patience now will pay off later.
Once such places are officially open, it wont be the time to release the kraken, so to speak. Sure you may have stored up all this energy, all those ingenious pick-up lines that probably wont work anyway, and all the urges to do what you have done before while cooped up inside. But (theres that word again), try to remember that the virus is still circulating. It will be some time before it is water under the bridge.
More than240,000 people worldwide have already died of Covid-19, and before the pandemic finishes, it could kill hundreds of thousands, even millions, more. But the final toll is destined to be far higher than just those who die of Covid-19. Experts warn that deaths from secondary impacts poverty, hunger, diseases, and violence exacerbated by the pandemic may dwarf the number of those who die of the coronavirus itself.
A new analysis by researchers from Kings College London and Australian National University, under the aegis of the United Nations University World Institute for Development Economics Research, for example, warns that the economic contraction caused by Covid-19 could push an additional 500 million people about eight percent of the earths population into poverty, reversing 30 years of economic improvement. We were surprised at the sheer scale of the potential poverty tsunami that could follow Covid-19 in developing countries, said Andy Sumner, one of the studys authors.
Not surprisingly, such financial fallout has grim knock-on effects. I want to stress that we are not only facing a global health pandemic but also a global humanitarian catastrophe,warned David Beasley, the executive director of the United Nations World Food Program. Millions of civilians living in conflict-scarred nations, including many women and children, face being pushed to the brink of starvation, with the specter of famine a very real and dangerous possibility. A new study by the WFP found that lockdowns and the economic recession caused by Covid-19 may exacerbate an already dire worldwide hunger crisis, almost doubling the number of people who could go hungry, pushing a total of 265 million people to the brink of starvation by the end of the year.
Meanwhile, the World Health Organizationnotes that a diversion of resources could have especially devastating effects on the fight against malaria. Under a worst-case scenario, in which all insecticide-treated bed net campaigns are suspended and there is a 75% reduction in access to effective antimalarial medicines, fatalities from the mosquito-borne illness could reach 769,000 double the number of deaths in 2018 effectively wiping out 20 years of gains in suppressing malaria mortality. Similarly, a new analysis by researchers at Imperial College London found that in low- and middle-income countries, disruptions to health services could cause deaths from HIV, tuberculosis and malaria to increase by up to 10, 20, and 36 percent respectively over five years.
As Covid-19 cases surge worldwide, the survival of pregnant women and children is at great risk due to strained healthcare systems, and the disruption of life-saving health services, said Dr. Stefan Peterson, associate director and global chief of health at the United Nations International Childrens Emergency Fund. In fact, researchers at the Johns Hopkins Bloomberg School of Public Health warn, for example, that the impact of the pandemic to newborn, child and adolescent health and nutrition services might lead to the deaths of 1.2 million children a 45 percent increase over existing child mortality levels.
The overall death toll among the young may actually be exponentially higher according to a recent report from the Christian aid organization, World Vision. An analysis of 24 countries with existing humanitarian crises from Afghanistan to Yemen found that as many as 30 million childrens lives are at risk from other diseases, like diphtheria, whooping cough, and tetanus, if healthcare systems are swamped by the pandemic and resources are diverted from immunizations. We are wrong if we think this is not a childrens disease, said Andrew Morley, World Visions president and chief executive. Experience tells us that when epidemics overwhelm health systems, the impact on children is deadly.
Among youths, girls will suffer most according to a recent analysis by Plan International, an aid organization that advocates for childrens rights and equality for girls. Since women and girls undertake more than three quarters of unpaid care and, in rural communities and low-income countries, spend up to 14 hours a day on such work, girls will likely be at greater risk of infection. But this is just one type of collateral damage. Covid-19 shutdowns will disrupt early learning, formal education and livelihoods, according to the report. Measures to curb the disease have worsened existing inequalities, forcing girls out of school and placing them at heightened risk of violence in their home.
UNHCR, the United Nations refugee agency, notes that even before the Covid-19 pandemic, an estimated one in three women had experienced physical or sexual abuse. Confinement, lockdowns, and quarantines coupled with deteriorating socioeconomic conditions have now created a perfect storm. These factors significantly increase the risks of intimate partner violence, with refugees, internally displaced and stateless persons among the most vulnerable, according to the agency. But the shadow pandemic of violence against girls and women extends far beyond refugees and displaced war victims, with reports of domestic violence having increased by 30% in France while calls to helplines have jumped 30% in Cyprus, and 33% in Singapore.
The United Nations study forecast that the greatest economic impact of Covid-19 will be in sub-Saharan Africa, where cases are rapidly increasing and, if projections prove accurate, up to half of the new poor will live. There, the effects will be felt in infant and maternal mortality, undernutrition, malnourishment, and educational achievement, among other indicators.
Alexandra Lamarche, senior advocate for West and Central Africa at Refugees International, explained that preventative measures aimed at countering Covid-19 were also impediments to humanitarian aid, leaving poor people without access to food. Were going to see significant impacts on malnutrition rates, she told The Intercept. And were seeing all sorts of secondary impacts. For example, theres a polio outbreak in Niger because they stopped vaccinating. Between hunger and disease, poverty and violence, the follow-on effects of Covid-19 threaten to be as wide-ranging as they are lethal. There are just so many different unexpected consequences, said Lamarche. Its extremely disheartening. And its going to be exceptionally dire.
To the Editor:
Clearly, no one really knows when local businesses can and should reopen. Thus reopening is somewhat of an experiment in public health.
I suggest that the reopening be considered medical research. Every patron entering any open establishment must sign a consent form both agreeing to participate in the study and granting permission to share his/her identification. There should be a log to sign with his/her identification, home address and telephone number.
We know that it will be imperative to be able to trace contacts of any new Covid-19 patients, and that can be very difficult. With the use of such logs, if any of the customers develop Covid, the public health workers can more easily track down all contacts and test, quarantine and otherwise care for future patients.
Steven M. MarcusMontville, N.J.The writer, a doctor who practiced medical toxicology and public health, is professor emeritus at Rutgers New Jersey Medical School.
To the Editor:
May I respectfully suggest that each one of us maintain a daily diary/journal that details where we went, with whom we interacted, whether or not we were wearing any protective gear, etc.? I have been doing this since March 6, and it only takes about two minutes to write a short paragraph before bedtime.
Its purpose is threefold: One, it is a way to get people invested in solving a problem that affects them and others. Two, the very process itself is an act of mindfulness. And three, if I get the virus, my journal may be helpful to researchers who are trying to trace its origins in my community and identify transmission patterns.
Steven WisensaleEssex, Conn.The writer is professor emeritus of public policy, Department of Human Development and Family Sciences, at the University of Connecticut.
To the Editor:
Re If We Cant Test Everyone for Coronavirus, This Is the Next Best Thing (Op-Ed, nytimes.com, April 24):
I fully agree with Louis Kaplows suggestion that random sampling is the most effective way to assess the U.S. population for Covid-19 if we cant do universal testing. In fact, random community sampling is already being done by Oregon State University in Corvallis, Ore., and we believe that it can be replicated nationwide.
Called TRACE-COVID-19, O.S.U. researchers are collecting up to 960 samples weekly from randomly identified households over four consecutive weekends to measure the prevalence of the virus in the community and determine if its prevalence is changing.
Winning the battle against the novel coronavirus will take science, random population sampling and community partnerships across America, just like whats occurring in Corvallis.
Edward J. RayCorvallis, Ore.The writer is president of Oregon State University.
Britains once bustling high streets are now eerily quiet, with all non-essential shops closed and thousands of staff furloughed. Many may never reopen as the lockdown accelerates shifts to online shopping, while others will have to find ways to adapt to a radically different retail world of long-term social distancing rules and nervous customers afraid of catching the virus.
The British Independent Retailers Association warned last week that one fifth of their members might close for good if footfall is low. Yet some of the big non-food retailers such as Homebase and B&Q are starting to reopen stores, and the British Retail Consortium has issued guidance on how non-essential shops could trade while keeping customers and staff safe.
The Observer spoke to five shop owners on one British high street to find out how they are faring and what the future holds for their businesses.
Hairdresser Anne Murray misses her regulars and the small intimacies that are shared during haircuts at her usually busy salon on Wares High Street. People really open up to you, she says from her home in the Hertfordshire commuter-belt town. Were like secondary counsellors.
Her salon, Mint, has been closed since the lockdown was announced at the end of March. She has been able to furlough the other hairdresser she employs and is planning to use a 10,000 cash grant to pay her bills. But she worries she might be one of the last shops to reopen as hairdressers will struggle to comply with social distancing rules, which are likely to stay in place until at least the end of the year. When you cut someones hair, you are rarely face to face, she says. But the physical proximity makes it hard. It is impossible to stay two metres away.
Murray, 37, would consider wearing PPE if it was made available to shop workers. I would definitely do that in order to protect other people and myself, she adds. But hairdressing is quite a personal service and so it would be very odd.
However, an extended closure could potentially put the salon at risk. I cant think of many businesses that could survive for that long unless they are online, she says. It makes me feel sad and anxious. In my household, it is a major source of income. My salon brings in more than my husbands business.
She sometimes walks down the High Street during her exercise and wonders how it will look after the coronavirus crisis is over: Its eerie and so quiet. I go past the other shops and cant help thinking which ones will and wont survive.
Al Bramley is getting ready for the phone to start ringing with takeaway orders in the Mexican restaurant he launched with his business partner, Brett Cahill-Moreno, in September.
People tend to do their own stuff at the start of the week and then treat themselves at weekend. Theres a lot of Zoom parties and quizzes and they tend to buy takeaways for those occasions, he says taking a quick break, while two chefs prep food in the kitchen.
Before the lockdown, the restaurant was packed with diners. Now the tables and chairs are stacked up against the walls. Bramley, 50, and Cahill-Moreno, 47, closed completely for two weeks, with all 10 staff furloughed. But last month they brought back two chefs and two front-of-house staff to provide takeaway meals. Weve had to adapt and change the way we do things, says Bramley.
Last weekend, they had 140 orders and they are hoping to expand beyond Ware. They have even launched an app to speed up ordering: It went live last week and weve had 650 downloads already.
However, their turnover has halved and they will only be able to keep going if they can secure a long-term rent reduction. We are going to have to renegotiate our rent with our landlord, Bramley says. I havent had that conversation yet, but its coming.
Bramley has been thinking hard about how he could lay out the tables in the restaurant to keep diners and staff two metres apart. We could do about 25 covers inside. And if the sun is shining, we could do another 30 covers outside, he says. With the takeaway market and a rent reduction, we could just about survive.
The tiny Book Nook on Wares High Street had not even been open a year before it was forced to shut. The owner Julia Chesterman, 49, had to mark the anniversary with a cup of tea and slice of cake in an empty shop. I sat down with the bookshop cat and I had a tear in my eye, she says. In a year we have become a little community hub and achieved so much.
Chesterman initially tried delivering books but it wasnt practical. I was taking telephone orders and leaving books on peoples doorsteps but to be honest I wasnt getting enough orders, she says. In the end she closed completely and furloughed herself.
Even though the shop is quite narrow, Chesterman is confident she could reopen safely. She would probably only need to limit the number of customers on a Saturday morning, when lots of people come in for tea and cake. We never really get overwhelmed, she adds.
Chesterman, who used to work for the library service, is not especially worried about reduced footfall. Bookselling can be quite challenging, she says. Im not in this business to make a massive profit. I just want to do something that I love and be part of the community.
The last time estate agent Jake Shropshire, 49, was in Wares branch of Jonathan Hunt was in March. I was able to rescue my telephone and computer, he says.
Since then the usual buying and selling of property has almost ground to a halt. Theres been no property viewings, he says. It has all stopped.
Shropshire is trying to keep existing house sales on track. We are nursing along sales as best we can, but 60% of the lawyers we deal with have been furloughed so there are challenges.
There are buyers stuck in property chains containing vulnerable individuals. We have one where a person is shielding so everyone else in that chain will have to wait, says Shropshire.
A few are moving, however. He is giving the keys to the buyers of a derelict Grade II-listed house this weekend. There is no crossover of people. There is no danger of contamination, he says. Im just going to leave the keys on their doorstep, ring the bell and run off.
While he can ride out rest of the lockdown, Shropshire has some concerns about reopening. Staff will need to be paid but it will take a while for new houses to be marketed and sold. Our income is not instantaneous. Its going to be three months at best before any money comes in, he says. Thats going to be the tough part.
Cathy Emmerson, 53, decided to close her card shop the day before Boris Johnson announced a national lockdown. We closed at the end of Mothers Day, she says. Ive got four members of staff and I didnt feel comfortable asking them to come to work.
It might be difficult to maintain social distancing when the shop eventually reopens as it is not much bigger than a living room. We deal with people directly. The elderly like us to read cards to them. Staff need to move around the shop too, she says.
Nonetheless, she is confident she will find a way to comply. If we have to put up a sign saying two customers only we will, she says. Its a card and greetings shop. It only gets busy on Saturday and around occasions.
She worries more about the market for party products. Im hoping people will want balloons to party but how much socialising will we be allowed to do? Some of our business came from people going out for meals and having drinks at parties. But the greetings card side will definitely remain because people like to send a card.
South Heartland District Health Department (SHDHD) officials reported nine new COVID-19 positive cases Saturday.
This brings the total number of cases in the four-county health district to 216 200 in Adams County, 11 in Clay County, 5 in Webster County and zero in Nuckolls County.
The new case is in Clay County a male in his 40s.
The new cases in Adams County are five females (1 under 20, 1 in her 20s, 1 in her 30s, 2 in their 40s) and three males (1 in his 40s, 1 in his 50s, 1 in his 60s).
Residents who are ill or have any symptoms consistent with coronavirus disease should stay home from work and isolate at home to avoid spreading the illness to others.
Health director Michele Bever reminds residents that they may have very mild or no symptoms at all, but the virus can spread easily through close person to person contact.
It is gatherings and close contact at work or other settings that often result in new cases of COVID-19, she said.
Bever encourages South Heartland residents to protect older adults and other individuals at higher risk.
Please continue practicing social distancing, including keeping 6 feet between people, and staying home when we are sick," she said. "Please continue practicing prevention, including wearing masks, washing your hands, keeping your hands away from your face, and disinfecting frequently-touched surfaces.
This week Gov. Pete Ricketts reminded Nebraskans that the 10-person rule for gatherings remains in effect through the month of May and encouraged residents to only celebrate and gather with their households.
The revised directed health measures issued by the governor and Nebraska Department of Health and Human Services for South Heartland Districts four counties will be effective at midnight on May 4 and continue until May 31.
All restrictions from the previous DHMs will continue through May 31, except for elective surgeries/procedures and religious services (to include wedding and funerals). NDHHS developed COVID-19 Guidelines for the Conduct of Faith-Based Services, which can be found on the South Heartland website: https://southheartlandhealth.org/public-health-data/corona-virus.html.
South Heartland District case counts by county are updated daily on SHDHDs COVID webpage: https://southheartlandhealth.org/public-health-data/corona-virus.html. The Nebraska Department of Health and Human Services (DHHS) provides daily updates to Nebraska's coronavirus COVID-19 cases on their Data Dashboard at http://dhhs.ne.gov/Pages/Coronavirus.
Apple and Google have released the first version of their exposure notification API, which they previously called the contact tracing API. This is a developer-focused release, and is a seed of the API in development, with the primary intent of collecting feedback from developers who will be using the API to create new contact tracing and notification apps on behalf of public health agencies.
Last week, Apple CEO Tim Cook told EU Commissioner Thierry Breton that the API would be arriving shortly, and this version is indeed now available albeit to a specific and limited group that includes select developers working on behalf of public health authorities globally, according to the companies. This is a test release thats intended to provide the opportunity for development and feedback in advance of the APIs public release in mid-May, at which time developers will be able to use the software feature on devices with publicly available apps released through the iOS and Google software stores, respectively.
Apple and Google say they will be providing this coming Friday additional details about the API and its release, including sample code to show how it operates in practice. Both are intent on providing updates to the documentation as they become available, and in adding access to new developers throughout testing, though this will be gated because the companies are limiting access to this API to authorized public health authorities only.
Already, Apple and Google have made available on their respective developer websites documents that describe the specification in detail, and provided an update with improvements to the techs functioning, including in terms of its protection of user privacy, and the ease with which developers can deploy it within their apps, as discussed during a press call last week.
This update includes an added ability for health authorities to define and calculate an exposure risk level for individuals based on their own criteria, as that varies organization to organization. This will be variable based on approximate distance of an individual to a confirmed exposed COVID-19 patient, as well as the duration of that exposure. Developers can customize notification messaging based on their defined exposure levels to ensure alerts correspond correctly to calculated risk.
The beta update also includes a new setting for users that allows them to toggle COVID-19 exposure notification access for individual apps, as pictured in the screenshot below.
Apple and Google first announced the combined API and eventual system-level contact tracing feature on April 10, and intend to release the first version of the API publicly in mid-May, with the system-level integration to follow in the coming months. The tech is designed to be privacy-preserving, ensuring that contact IDs are rotating and randomized, and never tied to an individuals specific identifying information.
Models predicting the potential spread of the COVID-19 pandemic have become a fixture of American life. Yet each model tells a different story about the devastation to come, making it hard to know which one is right. But COVID-19 models arent made to be unquestioned oracles. Theyre not trying to tell us one precise future, but rather the range of possibilities given the facts on the ground.
One of their more sober tasks is predicting the number of Americans who will die due to COVID-19. FiveThirtyEight with the help of the Reich Lab at the University of Massachusetts Amherst has assembled six models published by infectious disease researchers to illustrate possible trajectories of the pandemics death toll. In doing so, we hope to make them more accessible, as well as highlight how the assumptions underlying the models can lead to vastly different estimates. Here are the models U.S. fatality projections for the coming weeks.
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Forecasts like these are useful because they help us understand the most likely outcomes as well as best- and worst-case possibilities and they can help policymakers make decisions that can lead us closer to those best-case outcomes.
And looking at multiple models is better than looking at just one because it's difficult to know which model will match reality the closest. Even when models disagree, understanding why they are different can give us valuable insight.
Each model makes different assumptions about properties of the novel coronavirus, such as how infectious it is and the rate at which people die once infected. They also use different types of math behind the scenes to make their projections. And perhaps most importantly, they make different assumptions about the amount of contact we should expect between people in the near future.
Understanding the underlying assumptions that each model is currently using can help us understand why some forecasts are more optimistic or pessimistic than others.
Below are individual forecasts for all 50 states and the District of Columbia.
See forecasts from
Forecasts from
TodayMay 1April 21April 14April 7
Scroll to a state
AllAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
Show models
AllColumbia Univ.IHMELos AlamosMITNortheastern Univ.Univ. of Texas
288deathsas ofMay 2
9deaths
330deaths
72deaths
2,180deaths
832deaths
2,436deaths
168deaths
240deaths
1,364deaths
1,177deaths
16deaths
64deaths
2,559deaths
1,115deaths
175deaths
142deaths
248deaths
1,993deaths
56deaths
1,251deaths
3,846deaths
4,021deaths
394deaths
291deaths
376deaths
16deaths
73deaths
255deaths
84deaths
7,742deaths
138deaths
24,198deaths
431deaths
24deaths
1,022deaths
238deaths
109deaths
2,695deaths
296deaths
267deaths
21deaths
209deaths
863deaths
49deaths
51deaths
617deaths
830deaths
48deaths
334deaths
7deaths
The novel coronavirus tends to affect men more severely than it does women. Though nobody can yet explain the oddity, researchers are hot on the case.
It's possible that the sex hormones estrogen and testosterone play a role, according to previous research on respiratory illnesses. Or perhaps it's because the X chromosome (which women have two of, but men have only one) has a larger number of immune-related genes, giving women a more robust immune system to fight off the coronavirus, SARS-CoV-2. Or, maybe the virus is hiding in the testes, which has abundant expression of ACE2 receptors, the portal that allows SARS-CoV-2 into cells.
Uncovering the real reason is, of course, imperative because it could help improve patient "outcomes during an active public health crisis," according to an editorial published April 10 in the Western Journal of Emergency Medicine (WJEM).
Related: When will a COVID-19 vaccine be ready?
Since the first known COVID-19 case was reported in China late last year, countless studies have shown that the disease tends to be more severe and deadly in men than in women.
For instance, in an analysis of 5,700 COVID-19 patients hospitalized in New York City, just over 60% were men, according to an April 22 study published in the journal JAMA. What's more, "mortality rates were higher for male compared with female patients at every 10-year age interval older than 20 years," the researchers wrote in the study.
Furthermore, of the 373 patients who ended up in intensive care units, 66.5% were men, the JAMA study reported.
Related: 13 Coronavirus myths busted by science
Results are similar in other studies. When the WJEM editorial was published in early April, the authors noted that between 51% and 66.7% of hospitalized patients in Wuhan, China, were male; 58% in Italy were male; and 70% of all COVID-related deaths worldwide were male. In one large study of more than 44,600 people with COVID-19 in China, 2.8% of men died versus just 1.7% of women.
These COVID-19 sex differences are not unexpected. Other coronavirus outbreaks, including outbreaks of SARS in 2003 and the Middle East respiratory syndrome (MERS) in 2012, had higher fatality rates in men than in women, according to the WJEM editorial. For example, a 2016 study found that men had a 40 percent higher odds of dying of MERS than women did.
Even the comically labeled "man flu" is so named because men tend to have a weaker immune response to respiratory viruses that cause flu and the common cold. As a result, men tend to get more severe symptoms from these viruses than women do, a 2017 review in BMJ found. That review pinned these results on the differences in "sex dependent hormones" in men and women.
A mouse experiment offers clues about this hormonal mystery; when scientists infected both male and female mice of different ages with SARS, the male mice were more susceptible to the infection than females of the same age, according to a 2017 study, which was published in The Journal of Immunology. However, when the female mice had their estrogen-producing ovaries removed or were treated with an estrogen-receptor blocker, they died at higher rates than those with working ovaries and normal estrogen.
"These data indicate that sex hormones produced in female [mice] may help to defend against coronaviruses like SARS and SARS-CoV-2," Akiko Iwasaki, a professor of immunobiology at Yale University School of Medicine, who was not involved in the study, told Live Science.
Related: Is 6 feet enough space for social distancing?
To learn more, scientists at Cedars-Sinai Medical Center in Los Angeles and the Renaissance School of Medicine at Stony Brook University in New York are testing estrogen or another sex hormone called progesterone on small groups of people who have COVID-19, Live Science previously reported.
There's another way to look at the COVID-19 sex difference; perhaps the X chromosome is protective because it has more immune-related genes than the Y chromosome does. This may also explain why women are more likely than men to have autoimmune diseases, the authors of the WJEM editorial noted.
The second X chromosome is usually silenced in women, but almost 10% of those genes can be activated, Veena Taneja, who studies differences in male and female immune systems at the Mayo Clinic, told NPR. "Many of those genes are actually immune-response genes," she said. This could give women a "double-dose" of protection, Taneja said, although research is needed to see whether these genes factor into protection against COVID-19.
New research offers yet another idea; men seem to clear SARS-CoV-2 from their bodies more slowly than women do. To explain that possibility, researchers have suggested the virus may have found a hiding place in men: the testes.
In the research, published on the preprint medRxiv database, 68 people confirmed to have COVID-19 in Mumbai, India, were tested with nasal swabs until they tested negative for the virus. At the end of the experiment, scientists found that women cleared the virus from their bodies in an average of 4 days, compared with men's average of 6 days. The same test in three different Mumbai households found similar results.
Related: 13 Coronavirus myths busted by science
"Our collaborative study found that men have more difficulty clearing coronavirus following infection, which could explain their more serious problems with COVID-19 disease," study lead researcher Dr. Aditi Shastri, assistant professor of medicine at the Albert Einstein College of Medicine in New York City and a clinical oncologist at the Montefiore Einstein Center for Cancer Care, said in a statement.
Previous research has shown that SARS-CoV-2 invades certain human cells by plugging into these cells' ACE2 receptors. So, the researchers consulted a database, and found that the testes have high levels of ACE2 expression. In contrast, ACE2 could not be detected in the ovaries, the female equivalent of the testes.
However, the research did not actually look in the testes to see if SARS-CoV-2 is hanging out there, so "it does not tell us whether the virus infects testes or whether it is a reservoir of virus," said Iwasaki, who was not involved in the research.
Other research has suggested that smoking may play a role, as smoking is related to higher expression of ACE2 receptors. But while more men than women smoke in China, that's not true in other countries, which likely puts a kibosh on smoking to explain the sex difference.
"What we saw in Wuhan [with the sex difference] has been replicated in every country around the world where we have accurate reporting," Sabra Klein, a researcher at the Johns Hopkins Center for Women's Health, Sex, and Gender Differences, told NPR. "In countries like Spain, where the percentages of males and females who report smoking is not significantly different, we still are seeing this profound male bias in severity of COVID-19."
Other explanations: Women are simply less likely to engage in health-related risks and are better at washing their hands, studies find, and perhaps that's behind the gender disparity
Sex differences aren't the only factor at play, however. Other groups more vulnerable to COVID-19 include the elderly and people with diabetes, high blood pressure and obesity, Live Science previously reported.
Originally published onLive Science.
