The next day, Minnoli Aya returned from the University at Buffalo, where she was a freshman. She believed her mother had pneumonia and hoped to surprise her. Instead, she learned her mother had contracted the coronavirus.
I was just on the floor, and I was broken, Minnoli said.
Over the next week, she texted with her mother, who continued to deteriorate. Doctors called Mr. Aya daily. By the end of the week, his wife was increasingly having trouble breathing.
By the morning of March 29, doctors got ready to put Ms. Aya on a ventilator. But there was a life-threatening complication, and they asked Mr. Aya if he wanted to see his wife for what could be the last time. He worried that his heart condition would put him at risk if he caught the virus, and Minnoli could be left without a parent.
The decision not to go, he said, has haunted him. That afternoon, the hospital called to say that his wife had died.
Minnoli, her father and grandmother could not hug each other, because they were required to stay six feet apart, even though they lived in the same house. Nor did they want to plan a funeral service that almost no one would attend, one where they would not be able to view Ms. Ayas body. They decided to have her cremated.
Even after her mother died, Minnoli still texted, trying to stay connected.
I miss u, she wrote before going to bed that night. When she woke the next morning, Minnoli texted, Thank you for coming to me last night in my dreams.
Mr. Aya, concerned about Minnoli, arranged for her to speak to a therapist by video after his wifes death. But he is not sure how long he can afford the expense because Ms. Ayas health care plan had covered the family. A representative of her union benefit fund told him by email that benefits would end 30 days after his wifes death. My heart is broken for you, the representative wrote in the email, which was reviewed by The New York Times.
A good example of the genre is an op-ed co-authored by former Education Secretary William Bennett and talk radio host and author Seth Leibsohn . It is titled, tendentiously and not very accurately, Coronavirus Lessons: Fact and Reason vs. Paranoia and Fear. Bennett and Leibsohn are intelligent and public-spirited men whom Ive known for years, but theyve got this wrong, and in rather elementary ways.
They cite the latest estimate of the Institute for Health Metrics and Evaluation in Washington state that the current outbreak will kill 68,000 Americans. Then, they note that about 60,000 people died of the flu in 2017-18. For this, they thunder, weve scared Americans and imposed huge economic and social costs on the country.
This is such an obviously flawed way of looking at the question, its hard to believe that Bennett and Leibsohn dont realize it.
If we are going to have 60,000 deaths with people not leaving their homes for more than a month, the number of deaths obviously would have been highermuch higherif everyone had gone about business as usual. We didnt lock down the country to try to prevent 60,000 deaths; we locked down the country to limit deaths to 60,000 (or whatever the ultimate toll is) from what would have been a number multiples larger.
By Bennett and Leibsohn s logic, we could just as easily ask: Why did we expend all that blood and treasure fighting Hitler when he couldnt even take Britain or conquer Moscow? Why did we adopt tough-on-crime policies, when crime rates are at historic lows? Why did we work so hard to find a treatment for HIV/AIDs, when so many of the people with the disease now have normal life expectancies?
Of course, it was precisely the actions we took that caused those welcome outcomes.
Consider the perversity of their line of reasoning a different way. If we had shut down the country a month sooner and there had been, say, only 2,000 deaths, then on their terms theyd have even a stronger argument, i.e., We did all this and there were only a couple of thousand fatalities?
In other words, the more effective a lockdown would have been, the more opposed Bennett and Leibsohn would be to it.
As for the flu comparison, it isnt as telling as Bennett and Leibsohn believe. The flu season stretches as long as from October to April, although it usually peaks between December and February. The 2017-18 season, with 60,000 flu-related deaths, was particularly bad. But the coronavirus might kill a similar number of peoplewith the country on lockdown.
In the 2011-12 season, 12,000 people died of the flu in the entire country. New York alone has eclipsed that in a little more than a month, and recorded roughly 9,000 deaths the first 15 days of April (again, while on lockdown). In 2018-19, there were 34,000 flu-related deaths in the United States. We are going to surpass that number nationally sometime soon (yet again, while on lockdown).
Why have people reacted so dramatically to this virus, despite the fact that is supposedly comparable to the run-of-the-mill flu? Bennett and Leibsohn have a theory: New York City is where the epidemic has struck the hardest. The media is centered in New York City.
Theres no doubt that New York is always going to get disproportionate attention. But New York City is the biggest in the country, and New York state accounts for 8 percent of the U.S. economy. If New York were an independent state, it would rank as the 11th-biggest economy in the world. What happens there matters.
New York is also, as all of us had no hesitation in recognizing on Sept. 11, 2001, part of America.
If the disease struck smaller heartland cities like Omaha, Kansas City and Witchita would Bennett and Leibsohn hope that the story got ignored and no one took any precautions based on major media companies not being headquartered in those places?
Bennett and Leibsohn ignore the key fact that the economy began to shut down before there were widespread official shutdown orders. People voted with their feet, because they were fearful of a highly transmissible, virulent disease. Bennett and Leibsohn may want to portray Americans as lemmings of the media, cowering in their homes, but they acted rationally. If everything had gone on as normal, the outbreak would have been much worse, and we would have shutdowns anyway, just with even worse health outcomes.
The most objectionable part of the Bennett and Leibsohn posture is its sneering attitude toward frenzied, panicked ordinary Americans who have sacrificed so much during this crisis to protect their families and their neighbors.
By all means, lets open up the economy as soon as we can, but it will require more careful thought than the most fervent critics of the shutdowns have demonstrated during the peak of this epidemic.
Countries under coronavirus lockdowns should only ease those restrictions if they can control new infections and trace contacts, the World Health Organization says. Here, Hashim, a health care worker, recently greeted his daughter through a glass door as they maintained social distance due to the COVID-19 outbreak in New Rochelle, N.Y. Joy Malone/Reuters hide caption
Countries under coronavirus lockdowns should only ease those restrictions if they can control new infections and trace contacts, the World Health Organization says. Here, Hashim, a health care worker, recently greeted his daughter through a glass door as they maintained social distance due to the COVID-19 outbreak in New Rochelle, N.Y.
For the billions of people now living under some form of stay-at-home or lockdown orders, experts from the World Health Organization have new guidance: We should be ready to "change our behaviors for the foreseeable future," they say, as the agency updates its advice on when to lift COVID-19 lockdown orders.
The question of when to ease shutdowns is a hot topic, as economic output is stalled in many countries including the U.S., now the epicenter of the global pandemic.
"One of the main things we've learned in the past months about COVID-19 is that the faster all cases are found, tested, isolated & care for, the harder we make it for the virus to spread," said WHO Direct0r-General Tedros Adhanom Ghebreyesus via Twitter as the guideline was released. "This principle will save lives & mitigate the economic impact of the pandemic."
The coronavirus has killed tens of thousands of people. It has also reshaped society and disrupted daily life for people around the world including 1.4 billion children whose educations are now derailed by shutdowns, WHO says. The pandemic has triggered massive losses for big companies and small businesses, and forced millions of people out of work.
While full national lockdowns remain uncommon, at least 82 countries have some form of lockdown in place, according to UNICEF.
The global economy is now predicted to shrink by 3% this year, the International Monetary Fund says in its most recent analysis. That includes a contraction of nearly 6% for the U.S. economy.
Despite all the personal and economic pain the coronavirus has caused, WHO officials say that in many places, it's too soon to get back to normal. And because any premature attempts to restart economies could trigger secondary peaks in COVID-19 cases, they warn that the process must be deliberate and widely coordinated.
"You can't replace lockdown with nothing," Dr. Mike Ryan, executive director of WHO's emergencies program, said at a recent briefing. Stressing the importance of a well-informed and committed population, he added, "We are going to have to change our behaviors for the foreseeable future."
Any government that wants to start lifting restrictions, said Tedros of WHO, must first meet six conditions:
1. Disease transmission is under control
2. Health systems are able to "detect, test, isolate and treat every case and trace every contact"
3. Hot spot risks are minimized in vulnerable places, such as nursing homes
4. Schools, workplaces and other essential places have established preventive measures
5. The risk of importing new cases "can be managed"
6. Communities are fully educated, engaged and empowered to live under a new normal
The worldwide number of COVID-19 cases is quickly approaching the 2 million mark, including more than 120,000 people who have died, according to a COVID-19 dashboard created by Johns Hopkins University's Whiting School of Engineering.
The number of new cases continues to rise sharply in the U.S., where disagreements over the potential restarting of economies recently prompted at least 10 states to band together in regional coalitions. The governors of those states say they not President Trump or the federal government will determine when to resume normal activities, based on health statistics and science.
Even in instances where governments can lift some lockdown conditions, Ryan said, "Health workers are going to have to continue to have protective equipment and we're going to have to continue to have intensive care beds on standby, because as we come out of these lockdown situations, we may see a jump back up in cases."
The goal is to taper restrictions so governments in communities, cities and nations can avoid a cycle of new COVID-19 outbreaks.
"We don't want to lurch from lockdown to nothing to lockdown to nothing," Ryan said. "We need to have a much more stable exit strategy that allows us to move carefully and persistently away from lockdown."
The whole nationalist populist surge was connected to an historical moment where you could afford to play with fire, she noted. But now the situation is really bad, so much more dangerous, and people dont want the easy nonsense from media-savvy populists.
She cited polls showing that Matteo Salvini, the noisy Italian populist, has been losing support on the right, while another far-right opposition politician, Giorgia Meloni, on the rational, coolheaded, nonpopulist right, has done better.
Much of the public reaction may ultimately depend on how long the sense of crisis lasts, the onslaught of the virus being uncertain and open-ended. The unlocking of the lockdown will itself be fraught with political danger.
Though we see these leaders making decisions, theyre not making them from a position of strength, but from uncertainty and weakness, said Nicholas Dungan, a Paris-based senior fellow at the Atlantic Council.
Theyre not leading so much as administering, he said. And once people are out and about, and not confined anymore doing their duty, people are going to be quite angry, and this will lead to greater instability.
Tony Travers, professor of government at the London School of Economics, noted that Winston Churchill was revered for having presided over the victory over Hitler, but was summarily tossed out of office in 1945.
Winning a war is absolutely no recipe for staying in office, Mr. Travers said. When the threat of illness goes away, then the consequences of being protected from the threat are very different.
Cave nectar bat (Eonycteris spelaea) from Singapore. Justin Ng/Linfa Wang hide caption
Cave nectar bat (Eonycteris spelaea) from Singapore.
Updated at 11 a.m. ET
Dr. Linfa Wang, a virologist at the Duke-National University of Singapore, has been working around the clock to help Singapore fight this coronavirus. He hasn't hugged his daughter in over two months.
"We're in a war zone right now. Everything comes to me very fast," Wang said in an interview with NPR's Short Wave podcast. He's given over 100 interviews since January, when international reports first surfaced of a new coronavirus.
Since then, scientists have learned a great deal about the coronavirus, now called SARS-CoV-2. And one of the mysteries they're still trying to untangle is where the virus came from in the first place. Scientific evidence overwhelmingly points to wildlife, and to bats as the most likely origin.
Wang is an expert in emerging zoonotic diseases, or diseases hosted in animals that spread to humans. The CDC estimates that six out of ten infectious diseases in people come from animals. Among them are Lyme disease, Rabies, West Nile, and diseases caused by coronaviruses, including this coronavirus and the SARS virus.
The 2003 outbreak of SARS was eventually traced to horseshoe bats in a cave in the Yunnan province of China, confirmed by a 2017 paper published in the journal Nature. It was a detective hunt that took over a decade, sampling the feces, urine, or blood of thousands of horseshoe bats across the country and seeing if those samples are a genetic match to the virus.
The work of virus hunting of tracking an outbreak to its origin point can take years. Wang stresses that pinpointing the true origin of this coronavirus will take time as well. "Of course, the technology and everything is much more advanced 17 years later [since the 2003 SARS outbreak]. But, for us to try to solve everything in two to three months is just not feasible."
'This is a product of nature'
In early January 2020, Chinese scientists sequenced the entire genome for SARS-CoV-2 and published it online. Researchers at the Wuhan Institute of Virology in China compared its genome to a library of known viruses and found a 96% match with coronavirus samples taken from horseshoe bats from Yunnan.
"But that 4% difference is actually a pretty wide distance in evolutionary time. It could even be decades," says Dr. Robert F. Garry, professor of microbiology and immunology at Tulane University School of Medicine.
That extra 4% suggests the SARS-CoV-2 may not have evolved from bats alone, but may include viral material from another animal. In that case, the virus would have continued to evolve through natural selection in that animal. Moreover, that other animal may have acted as an "intermediate host," ultimately transmitting the virus to humans.
With this coronavirus, scientists aren't fully clear on whether an intermediate host was involved nor the chain of cross-species transmission to humans. Studies have found a genetic similarity between this coronavirus and coronaviruses found in pangolins, also called scaly anteaters, which are vulnerable to illegal wildlife trade.
Given that some China's earliest COVID-19 patients were connected to the Hunan Seafood Wholesale Market in Wuhan, it is likely the seafood market played a role in amplifying the virus. However, there is not enough evidence to prove that is where the virus transmitted from animals to humans. There is also evidence emerging that among the first 41 patients hospitalized in China, 13 had no connection to this particular marketplace. The path of the pathogen is still unknown.
As for clues the virus holds about its animal origins, Robert Garry and fellow researchers have hypothesized that SARS-CoV-2 could be a blend of viruses from bats and another animal.
"The receptor binding domain actually shares a lot of sequence similarity to a virus that's found in the pangolin" Garry said, referring to the receptor-binding mechanism that allows the virus to form a strong attachment to human cells. "So, those sequences probably did arise from a virus like the pangolin coronavirus, or maybe some other coronavirus that can circulate in pangolins or some other animals." Further genetic analysis is needed to figure this out.
In studying the genome, Garry also confirms the virus came from wildlife. "This is a product of nature. It's not a virus that has arisen in a laboratory by any scientist, purposely manipulating something that has then been released to the public," he said.
'It's A Billion Dollar Question'
So, why are bats such good hosts for viruses?
"I used to say it's a million dollar question. Now I say it's a billion dollar question," said Wang, speaking to NPR's Short Wave podcast on Tuesday.
Bats are critically important for pollinating flowers and dispersing seeds. They catch bugs, the same ones that bite us and eat some of our crops. But bats also harbor some of the toughest known zoonotic diseases.
The Rabies virus, the Marburg virus, the Hendra and Nipah viruses all find a natural reservoir in bats, meaning those viruses live in bats without harming them. The Ebola outbreak in West Africa was traced to a bat colony. The SARS virus originates in bats, along with other coronaviruses. And now, SARS-CoV-2 is linked to bats too.
Wang believes bats' high tolerance for viruses may have to do with the fact that they are the only mammal that's adapted for flight.
"During flight, their body temperature goes all the way to 42 degrees (or 108 degrees Fahrenheit). And their heartbeat goes up to 1000 beats per minute," Wang said.
Flying several hours a day, bats burn a great deal of energy. This creates toxic free radicals that damage their cells, but Wang's research has shown that bats have also evolved abilities to repair and minimize that cellular damage. Those same defensive abilities may help them not only tolerate flight, but also to fight infectious diseases in a way that human bodies cannot.
"Our hypothesis is that bats have evolved a different mechanism to get the balance right for defensive tolerance. And that favors the virus to live peacefully with bats," said Wang.
Peter Daszak, President of the U.S.-based non-profit Ecohealth Alliance, says that even if bats are the origin, they are not to blame for the pandemic.
"It's not bats. It's us. It's what we do to bats that drives this pandemic risk," Daszak said. His research demonstrates how interactions between wildlife and livestock, food and agriculture practices, as well as humans close proximity to animals in densely populated areas, create the conditions for viral outbreaks.
"One of the positive things about finding out that we're actually behind these pandemics is that it gives us the power to do something about it. We don't need to get rid of bats. We don't need to do anything with bats. We've just got to leave them alone. Let them get on, doing the good they do, flitting around at night and we will not catch their viruses," Daszak said.
Given that infectious and zoonotic diseases have been on the rise for decades, Wang is frustrated by the fact that countries around the world failed to understand the impact this novel coronavirus outbreak would have.
"I'm so angry right now. This COVID-19 outbreak, before January 20th, you could say it's China's fault. The Chinese government. But after January 20th, the rest of the world is still not taking it seriously. Our political system, our diplomatic system, our international relationship system is just not ready," Wang said.
January 20th is when Chinese health officials confirmed the new coronavirus could be transmitted between humans and the World Health Organization kicked into high gear to evaluate the global risk. There were more than 200 cases then. Now, the confirmed case count is nearing 2 million worldwide.
Email the show at shortwave@npr.org.
This episode was produced by Brit Hanson, edited by Viet Le, and fact-checked by Emily Vaughn.
Do the tiny, everyday things that help you feel better
My wife and I joke that weve been actually training for this pandemic for the past year dealing with Nusaybas cancer. We stopped socializing, abandoned work projects, read science and medical papers, and placed hand sanitizers, masks and gloves throughout the house. Were used to obsessing over any fevers because Nusayba is immuno-compromised.
With life rapidly spiraling, we took ownership over the daily routines we could still control. You can declutter and clean your house. The simple act of making your bed, brushing your teeth, wearing clothes and choosing your breakfast gives you a sense of autonomy.
If youre up for it, take time to cook or eat your favorite meal. The experience will provide a moment of comfort, a delicious taste you savor more during hardship. If you believe in God, then still maintain your prayers. Also, try to stick with the daily push-up routine, and continue reading the newspaper. Reunite with beloved sitcom characters on The Simpsons, flip through an old book or graphic novel, chain saw demons in Doom, or watch Goodfellas for the 12th time.
All of these seemingly mundane habits and activities will keep you spiritually, physically, creatively and mentally alive for the marathon and it will be a marathon.
A crisis like cancer helps us answer the question: What truly matters when we are stripped overnight of our comfort, wealth and plans?
Kindness does. Its the only way our humanity will endure during this crisis. After all, along with medicine, it was a strangers kindness that helped Nusayba survive.
I recommend focusing and investing in people and relationships. Make a list of your elders, your mentors, your friends, your family members, all those who helped you along the way. Spend a few minutes a day to call them, catch up, reconnect, and make amends if you must. A five-minute call can unburden a lifetime of regret and heal wounds.
The prevalence of these effects is too great to attribute them solely to the cytokine storm, a powerful immune-system response that attacks the body, causing severe damage, doctors and researchers said.
Almost half the people hospitalized because of covid-19 have blood or protein in their urine, indicating early damage to their kidneys, said Alan Kliger, a Yale University School of Medicine nephrologist who co-chairs a task force assisting dialysis patients who have covid-19.
Even more alarming, he added, is early data that shows 14to 30percent of intensive-care patients in New York and Wuhan, China birthplace of the pandemic have lost kidney function and require dialysis, or its in-hospital cousin, continuous renal replacement therapy. New York intensive care units are treating so much kidney failure, he said, they need more personnel who can perform dialysis and have issued an urgent call for volunteers from other parts of the country. They also are running dangerously short of the sterile fluids used to deliver that therapy, he said.
Thats a huge number of people who have this problem. Thats new to me, Kliger said. I think its very possible that the virus attaches to the kidney cells and attacks them.
But in medicine, logical inferences often do not prove true when research is conducted. Everyone interviewed for this story stressed that with the pandemic still raging, they are speculating with much less data than is normally needed to reach solid clinical conclusions.
Many other possible causes for organ and tissue damage must be investigated, they said, including respiratory distress, the medications patients received, high fever, the stress of hospitalization in an ICU and the now well-described impact of cytokine storms.
It does raise the very clear suspicion that at least a part of the acute kidney injury that were seeing is resulting from direct viral involvement of the kidney, which is distinct from what was seen in the SARS outbreak in 2002, said Paul M. Palevsky, a University of Pittsburgh School of Medicine nephrologist and president-elect of the National Kidney Foundation.
One New York hospital recently had 51 ICU patients who needed 24-hour kidney treatment but had just 39 machines to do it, he said. The hospital had to ration the care, keeping each patient on the therapy less than 24 hours a day, he said.
The virus also may be damaging the heart. Clinicians in China and New York have reported myocarditis, an inflammation of the heart muscle, and, more dangerous, irregular heart rhythms that can lead to cardiac arrest in covid-19 patients.
They seem to be doing really well as far as respiratory status goes, and then suddenly they develop a cardiac issue that seems out of proportion to their respiratory issues, said Mitchell Elkind, a Columbia University neurologist and president-elect of the American Heart Association. This seems to be out of proportion to their lung disease, which makes people wonder about that direct effect.
One review of severely ill patients in China found that about 40percent suffered arrhythmias and 20percent had some form of cardiac injury, Elkind said. There is some concern that some of it may be due to direct influence of the virus, he said.
The new virus enters the cells of people who are infected by latching onto the ACE2 receptor on cell surfaces. It unquestionably attacks the cells in the respiratory tract, but there is increasing suspicion that it is using the same doorway to enter other cells. The gastrointestinal tract, for instance, contains 100 times more of these receptors than other parts of the body, and its surface area is enormous.
If you unfurl it, its like a tennis court of surface area this tremendous area for the virus to invade and replicate itself, said Brennan Spiegel, co-editor in chief of the American Journal of Gastroenterology.
In a subset of covid-19 cases, researchers have found, the immune system battling the infection goes into hyperdrive. The uncontrolled response leads to the release of a flood of substances called cytokines that, in excess, can result in damage to multiple organs. In some severely ill covid-19 patients, doctors have found high levels of a pro-inflammatory cytokine called interleukin-6, known by the medical shorthand IL-6.
The unfettered response, also called cytokine release syndrome, has long been recognized in other patients, including those with autoimmune diseases such as rheumatoid arthritis or in cancer patients undergoing certain immunotherapies.
For covid-19 patients, cytokine storms are a major reason that some require intensive care and ventilation, said Jeffrey S. Weber, deputy director of the Perlmutter Cancer Center at NYU Langone Medical Center.
When your cytokines are systemically out of control, bad stuff happens, he said. It can be a complete disaster. It isnt clear why cytokine storms occur in some patients and not others, though genetic factors may play a role, some doctors say.
To treat cytokine storms, some doctors are using anti-IL-6 drugs such as tocilizumab, which is approved for cancer patients who develop cytokine storms as a result of immunotherapy.
Another odd, and now well-known, symptom of covid-19 is loss of smell and taste. Claire Hopkins, president of the British Rhinological Society, said studies of patients in Italy and elsewhere have shown that some lose their sense of smell before they show signs of being sick.
The coronavirus can actually attack and invade olfactory nerve endings, Hopkins said. When these aroma-detecting fibers are disrupted, they cant send odors to the brain.
Anosmia the medical term for the inability to smell was not initially recognized as a symptom of covid-19, Hopkins said. Doctors were so overwhelmed by patients with severe respiratory problems, she said, that they didnt ask the question.
But subsequent data from a symptom-tracking app has shown that 60percent of people later diagnosed with covid-19 reported losing their senses of smell and taste. About a quarter of participants experienced anosmia before developing other symptoms, suggesting it can be an early warning sign of infection.
Intriguingly, Hopkins said, people who lose their sense of smell dont seem to develop the same severe respiratory problems that have made covid-19 so deadly. But a very small number of patients have experienced confusion, low blood oxygen levels and even lost consciousness a sign that the virus may have traveled along their olfactory nerve endings straight to the central nervous system.
Why you get this different expression in different people, nobody knows, she said.
There are also reports that covid-19 can turn peoples eyes red, causing pinkeye, or conjunctivitis, in some patients. One study of 38 hospitalized patients in Hubei province, China, found that a third had pinkeye.
But like many of the non-respiratory effects of the virus, this symptom may be relatively uncommon and may develop only in people already severely ill. The fact that the virus has been found in the mucus membrane that covers the eye in a small number of patients, however, does suggest that the eye could be an entryway for the virus and is one reason that face shields and goggles are being used to protect health-care workers.
The virus also is having a clear impact on the gastrointestinal tract, causing diarrhea, vomiting and other symptoms. One study found that half of covid-19 patients have gastrointestinal symptoms, and specialists have coined a Twitter hashtag, #NotJustCough, to raise awareness of them.
Studies suggest that patients with digestive symptoms will also develop a cough, but one may occur days before the other.
The question is, is it kind of behaving like a hybrid of different viruses? Spiegel said. What were learning is, it seems anyway, that this virus homes in on more than one organ system.
Reports also indicate that the virus can attack the liver. A 59-year-old woman in Long Island came to the hospital with dark urine, which was ultimately found to be caused by acute hepatitis. After she developed a cough, physicians attributed the liver damage to a covid-19 infection.
Spiegel said he has seen more such reports every day, including one from China on five patients with acute viral hepatitis.
A particular danger of the virus appears to be its tendency to produce blood clots in the veins of the legs and other vessels, which can break off, travel to the lung and cause death by a condition known as pulmonary embolism.
Across New York City, blood thinners are being used with covid-19 patients much more than expected, said Sanjum Sethi, an interventional radiologist and assistant professor of medicine at Columbia Universitys Irving Medical Center.
Were just seeing so many of these events that we have to investigate further, he said.
The IRS declined to comment about whether the payments to the deceased would have to be repaid to the government. Generally the agency has said that recipients will not have to pay back any of the money.
Representative Thomas Massie, a Kentucky Republican, said he was alerted to the situation by a text message from a friend whose late father received a payment.
This stimulus program is ripe for waste, fraud and abuse and this dead person receiving a check is just the tip of the iceberg, Massie, one of the few lawmakers who opposed the $2.2 trillion economic rescue bill, said in an interview. He said the government should move away from stimulus payments and reopen the economy.
Errors such as payments to the recently departed are a consequence of lawmakers trying to balance accuracy with getting the money into bank accounts and mailboxes quickly, said Gordon Gray, director of fiscal policy at the American Action Forum, a conservative policy research group.
Congress erred on the side of speed, which nearly everyone agreed was the right answer in this case, said Gray, a former tax counsel in the U.S. Senate. The mechanisms we have to get money to people mean that some people have died since they last interacted with Treasury and as far as Treasury knows, that person should get a check.
Michael Zona, a spokesman for the Senate Finance Committee, said the panel was looking into the issue.
The payments to the deceased were one of the glitches with the program as the payments began hitting bank accounts and the IRS launched a web page to let recipients see when their money will be sent and whether they will receive it by direct deposit or a mailed check.
Phyllis Jo Kubey, a tax preparer in New York City, said several of her clients received error messages after trying to access the IRSs Get My Payment tool earlier Wednesday. The website said high demand was causing some delays.
The IRS said in a statement that the website is operating smoothly and more than 6.2 million taxpayers have successfully received their payment status while almost 1.1 million taxpayers have successfully provided banking information.
If the site volume gets too high, users are sent to an online waiting room for a brief period until space becomes available. The IRS said in a statement that the online tool will be updated once a day.
The IRS urges taxpayers to only use Get My Payment once a day given the large number of people receiving Economic Impact Payments, according to the statement.
The IRS began sending more than 80 million payments via direct deposit this week to middle- and low-income households. Mailed checks for those who dont have bank account information on file will start going out next week, but it could take months for all the payments to be distributed.
Individuals earning up to $75,000 or couples earning up to $150,000 are eligible for a $1,200 payment per adult and $500 per child under 17. The payments phase out above that income level, and individuals earning more than $99,000 or couples with a combined income of $198,000 dont get anything.
To see when payments will be sent, people will need to provide their Social Security number, date of birth and mailing address. Those wishing to submit bank account information also need to upload the adjusted gross income on their most recent tax return, as well as the amount of their most recent refund or amount owed.
People who filed tax returns in 2018 or 2019 can add bank account information to receive direct payments instead of waiting to receive a paper check.
The IRS released a separate website last week to allow people who arent required to file tax returns to provide their bank account information.
The agency will send recipients a notification about two weeks after they were scheduled to receive their payment with the details of how they should have received the money and how to report payments that dont arrive.
To see when payments will be sent, people will need to provide their Social Security number, date of birth and mailing address. Those wishing to submit bank account information also need to upload the adjusted gross income on their most recent tax return, as well as the amount of their most recent refund or amount owed.
People who filed tax returns in 2018 or 2019 can add bank account information to receive direct payments instead of waiting to receive a paper check.
The IRS released a separate website last week to allow people who arent required to file tax returns to provide their bank account information.
Trump Halts U.S. Funding of World Health Organization The New York Times
A priest in Innsbruck, Austria, views photographs of his absent congregation. Austria easedsocial distancing today.
By Kai KupferschmidtApr. 14, 2020 , 4:10 PM
Sciences COVID-19 reporting is supported by the Pulitzer Center.
The world is holding its breath.
After the novel coronavirus made its way from China around the world, one country after another adopted harsh measures to stop SARS-CoV-2 from spreading and overwhelming hospitals. They have hit the pause button on their economies and their citizens lives, stopping sports events, religious services, and other social gatherings. School closures in 188 countries affect more than 1.5 billion students. Borders are closed and businesses shuttered. While some countries are still seeing daily case numbers increase, othersfirst in Asia but increasingly in Europehave managed to bend the curve, slowing the transmission of COVID-19.
But what is the exit strategy? Weve managed to get to the life raft, says epidemiologist Marc Lipsitch of the Harvard T.H. Chan School of Public Health (HSPH). But Im really unclear how we will get to the shore.
As they seek a path forward, governments around the world must triangulate the health of their citizens, the freedoms of their population, and economic constraints. Could schools be reopened? Restaurants? Bars? Can people go back to their offices? How to relax the lockdown is not something around which there is a scientific consensus, says Caroline Buckee, an epidemiologist at HSPH. Most researchers agree that reopening society will be a long haul, marked by trial and error. Its going to have to be something that were going to have to take baby steps with, says Megan Coffee, an infectious disease researcher at New York University.
The number to watch in the next phase may no longer be the actual number of cases per day, but what epidemiologists call the effective reproduction number, or R, which denotes how many people the average infected person infects in turn. If R is above 1, the outbreak grows; below 1 it shrinks. The goal of the current lockdowns is to push R well below 1. Once the pandemic is tamed, countries can try to loosen restrictions while keeping R hovering around 1, when each infected person on average infects one other person, keeping the number of new cases steady.
To regulate R, Governments will have to realize that there are basically three control knobs on the dashboard, says Gabriel Leung, a modeler at the University of Hong Kong: isolating patients and tracing their contacts, border restrictions, and social distancing.
Singapore, Hong Kong, and South Korea have all managed to keep their epidemics in check through aggressive use of the first control. They identify and isolate cases early and trace and quarantine their contacts, while often imposing only light restrictions on the rest of society. But this strategy depends on massively scaling up testing, which has been hampered by a scarcity of reagents and other materials everywhere. The United States will be able to do millions of tests per week, says Caitlin Rivers of the Johns Hopkins Center for Health Security. Although our testing capacity has grown a lot in the last couple of weeks, we are not where we need to be yet, she says.
Contact tracing is another hurdle, and it is labor intensive. Massachusetts is hiring 500 contact tracers, buta recent report by Rivers and othersestimates that the United States as a whole needs to train about 100,000 people.
Mobile phone apps could help by automatically identifying or alerting people who recently had contact with an infected person. (Public health departments, not generally known anywhere in the world to be at the forefront of technological innovation, will have to adapt very quickly, Leung says.) But Western countries have yet to implement these systems. Google and Apple have teamed up to incorporate a contact tracing app in their operating systems. Germany, France, and other countries are developing apps based on a protocol calledPan-European Privacy Preserving Proximity Tracing. It relies on short-range Bluetooth signals to gauge the proximity between two devices without logging their exact locations, which helps sidestep some privacy concerns.
But short of making these technologies compulsory, as China has done, how can a country ensure that enough people download an app for it to provide reliable information and influence the spread of disease? And what exactly counts as a contact? If I live in a big apartment block, am I going to be getting dozens of notifications a day? asks epidemiologist Nicholas Davies of the London School of Hygiene & Tropical Medicine (LSHTM). Davies adds that widespread use of the apps will further drive up the demand for testing.
As to the second control knob, border restrictions, most countries have already banned entry to almost all noncitizens. Quarantining returning citizens, as New Zealand and Australia began to do in the past few weeks, further minimizes the risk of new introductions of the virus. Such measures are likely to remain in place for a while; the more a country reduces transmission domestically, the greater the risk that any new outbreaks will originate with travelers. And foreign visitors are generally harder to trace than citizens and more likely to stay at hotels and visit potential transmission hot spots, says Alessandro Vespignani, a disease modeler at Northeastern University. As soon as you reopen to travelers, that could be something that the contact tracing system is not able to cope with, he says.
The third dashboard dial, social distancing, is the backbone of the current strategy, which has slowed the spread of the virus. But it also comes at the greatest economic and social cost, and many countries hope the constraints can be relaxed as case isolation and contact tracing help keep the virus in check. In Europe, Austria took the lead by opening small shops today. Other stores and malls are scheduled to follow on 1 May, and restaurants maybe a few weeks later. A13 April report from the German National Academy of Sciencesargued for slowly reopening schools, starting with the youngest children, while staggering break times and making masks mandatory. But French President Emmanuel Macron has said Frances lockdown will remain in place until 11 May.
Choosing a prudent path is difficult, Buckee says, in part because no controlled experiments have compared the effectiveness of different social distancing measures. Because we dont have really strong evidence, she says, its quite hard to make evidence-based policy decisions about how to go back. But Lipsitch says that as authorities around the world choose different paths forward, comparisons could be revealing. I think theres going to be a lot of experimentation, not on purpose, but because of politics and local situations, he says. Hopefully the world will learn from that.
Lockdowns lower the number of new cases as well as R, the effective reproduction number. If R drops below 1, the epidemic shrinks.
Centre for mathematical modeling of infectious diseases/CC BY 4.0; ADAPTED BY X. LIU/SCIENCE
Finding out how any particular measure affects R is not straightforward, because infections that occur today can take weeks to show up in disease reports. In 2004, mathematician Jacco Wallinga of the Dutch National Institute for Public Health and the Environment and colleagues published a statistical method to estimate R in real time, which is now used around the world. Researchers are also incorporating data on mobility patterns and peoples behavior to make the estimates more accurate. Having real-time estimates of R is important, says Adam Kucharski, a modeler at LSHTM: If governments put a measure in or lift it, they can get a sense of what the immediate implications are, rather than having to wait, he says.
Theres one other, unknown factor that will determine how safe it is to loosen the reins: immunity. Every single person who becomes infected and develops immunity makes it harder for the virus to spread. If we get 30% or 40% of the population immune, that really starts to change that whole picture, it helps us a lot, because it would bring R down by the same percentage, says Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, Twin Cities.
Immunity will inevitably build up as more people become infected, but some researchers argue for ramping up immunity more quickly, by letting the virus spread in younger people, who are less susceptible to severe illness, while cocooning more at-risk patients, such as the elderly. The United Kingdom floated this herd immunity idea in February but backed away from it, as did the Netherlands. If you get to herd immunity any way other than through widespread vaccination, it is devastating, says Jeremy Konyndyk, a senior policy fellow at the Center for Global Development. Even briefly considering it left the United Kingdom in a dramatically worse place than they needed to be, he says.
But some scientists say other countries should consider it once the strain that the first wave of cases has put on their health care systems eases. Is it better to have a controlled burn in younger populations right now than it is to prevent it? I think thats a very important conversation to have, Osterholm says.
Skeptics doubt that vulnerable populations could really be protected. In many countries, multiple generations live under one roof, and young people work at nursing homes. Nor are scientists certain that COVID-19 produces robust, long-lasting immunity. Several studies seek to address these questions.
For now, the most likely scenario is one of easing social distancing measures when its possible, then clamping down again when infections climb back up, a suppress and lift strategy that both Singapore and Hong Kong are pursuing. Whether that approach can strike the right balance between keeping the virus at bay and easing discontent and economic damage remains to be seen.
Even Singapore and Hong Kong have had to toughen some social distancing measures in recent weeks after a surge of cases, Lipsitch notes; Singapores social distancing regime is no longer very different from that in New York City or London. And both cities strategies are much harder to implement across a big country like the United States. We have to have every single town and city and county be as good as Singapore for this to work, he says.
Jeremy Farrar, head of the Wellcome Trust, says a path out of the dilemma now facing the world will come from research. It might take the form of an effective treatment for severely ill patients, or a drug that can prevent infections in health care workers, orultimatelya vaccine. Science is the exit strategy, Farrar says.
With reporting by Kelly Servick.
