Powells, a beloved bookstore chain in Portland, Ore., laid off more than 300 people in mid-March, temporarily closed its five storefronts and issued a dire warning for the years to come. When we do open our stores again, we expect the landscape of Oregon, and all of our abilities to spend money on books and gifts, will have changed dramatically, wrote Powells chief executive, Emily Powell. We see the path ahead more clearly: it is dark and scary.
While millions of Americans shelter at home, stores have been forced to close and lay off or furlough employees. The most vulnerable companies are those that failed to prepare for a future dominated by e-commerce.
Unfortunately, the federal $2 trillion coronavirus stimulus package does little to mitigate retailers woes, despite their executives pleas for relief, though the Federal Reserve is working to ensure that larger companies have continued access to credit markets. The aid plan gives tax relief for prior property improvements, and it establishes a $350 billion fund for small-business loans that could help those firms maintain payroll and rent, but little else.
Though the cracks in bricks-and-mortar retail began forming years ago, the widening coronavirus outbreak stands to hasten physical retails decline and strengthen the monopoly hold of Amazon and other online giants. Such a consolidation of power among just a few retailers threatens to leave consumers with higher prices and less choice.
During the pandemic, reliable delivery of essentials like milk, eggs, toilet paper and cleaning supplies has been a lifeline for those who are reluctant or unable to venture outside their homes Amazon-branded trucks have remained a familiar sight in residential neighborhoods. The competitive advantages of Amazons meticulously constructed worldwide logistics network, built to shuttle nearly every imaginable item to customers in as little as an hour, are especially evident in this crisis.
While many other traditional retailers are struggling with falling demand, Amazon has pledged to hire 100,000 temporary workers to keep up with it. Several other retail giants, including Walmart and Target, have kept pace with coronavirus quarantine demands by keeping physical stores open and leaning on their own delivery networks for grocery shipments and other necessary items. Walmart plans to hire 150,000 new workers.
After a surge in online orders after its physical stores closed, Powells is rehiring some of its workers, though the nationwide loss of some 3.3 million jobs in March spells darker times ahead for retailers.
While Amazon and Walmart deserve credit for preparing for a calamity such as the coronavirus pandemic, some of their ability to deliver during the crisis may come at the cost of employee protections.
Both companies are offering two weeks of paid leave to workers diagnosed with Covid-19, though some employees told The Atlantic that the policies are confusing. Walmart has been reluctant to give employees sufficient leave if they get sick or are fearful about coming to work.
At Amazon, white-collar employees were sent home while the companys army of pickers and packers have had to brave outbreaks in at least 21 facilities. Some 1,500 Amazon employees signed a petition this month seeking workplace improvements in the face of Covid-19. And attorneys general in 14 states and the District of Columbia sent a letter to Amazons chief executive, Jeff Bezos, urging him to loosen its sick leave policy.
A few workers at a Staten Island Amazon warehouse walked off the job Monday in protest, after one employee tested positive for coronavirus, prompting Amazon to fire one of the organizers. New York States attorney general said Monday she was investigating the dismissal.
Others were planning to skip work at the companys Whole Foods grocery stores Tuesday over its sick leave policies.
Contract drivers for those ubiquitous Amazon delivery vans say the frantic pace of the job requires them to forgo preventive measures like the use of gloves, sanitizers and masks, potentially imperiling customers and other drivers.
Consumers may be at a disadvantage, too. Because Amazon relies on smaller sellers for the majority of sales, price gouging remains a problem. And while prioritizing storage and delivery of products it deems essential during the pandemic such as household staples, medical supplies, and other high-demand products Amazon has also appeared to include its own branded devices in the essential category.
Though it may seem a lifetime ago, before the coronavirus struck, Amazon was in the throes of a congressional antitrust investigation and was a frequent target of elected officials who criticized it for its workplace conditions and for evading corporate taxes. To quell a steady drumbeat of criticism, Jay Carney, Amazons head of communications and policy, wrote a New York Times Op-Ed article in February extolling the companys $15-an-hour minimum wage and arguing that what we do can generate positive ripple effects across the country.
That may be true, but it can also compel competitors to adopt Amazons strong-arm business practices. Last month, a group of labor unions petitioned the Federal Trade Commission to open an inquiry into Amazons market power.
Even in less frantic times, Amazon has been criticized for its workplace culture and its heavy-handed tactics with sellers. Last year, The Wall Street Journal contended that Amazon may be losing control of its own marketplace, allowing dangerous counterfeits to appear on its virtual shelves that would never pass muster at traditional retailers. Both Walmart and Amazon have quashed unionization efforts.
Amazon and Walmart have offered critical delivery services during this crisis, but regulators and elected officials should not lose sight of the dangers of monopoly power falling into the hands of the fortunate few that survive the coronavirus fallout.
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The casinos are deserted and thousands of hotel rooms are empty. But when Las Vegas, gripped by the coronavirus, needed space for a temporary homeless shelter, officials chose a location that does not have walls, or even a roof: an outdoor parking lot.
The City of Las Vegas and Clark County on Saturday opened the shelter, on the upper floor of a convention center parking lot, after the temporary closure of a 500-person homeless shelter run by Catholic Charities after a homeless man there tested positive for the coronavirus.
Medical students from Touro University, wearing protective gear, have been tasked with screening each homeless person for coronavirus symptoms before they enter the parking area, which has been partly covered with blue mats and closed off by metal barriers. The shelter will remain open until Friday, when the Catholic Charities shelter is expected to reopen, according to a joint statement by the city and county.
More than 6,500 Las Vegas residents lack permanent housing and nearly 70 percent of the citys homeless population sleeps outside, according to the Las Vegas government. With a nearby homeless shelter overflowing, officials decided to expand into the parking lot, at the Cashman Center convention complex about seven miles from the Las Vegas Strip.
More than 50 volunteers laid out 24,000 square feet of carpet for the homeless to use as sleeping mats, which have been spaced six feet apart to abide by social distancing protocols, said David Riggleman, a spokesman for the City of Las Vegas. The shelter also has portable toilets and washing stations.
It was a logistical heavy lift, said Mr. Riggleman, describing the effort, which was accomplished with essentially a days notice. That was a lot to pull together in a very short amount of time.
Officials chose to use the parking lot instead of the buildings at the convention complex to reserve the space indoors for possible hospital overflow, he said.
Still, the city has struggled to provide the temporary services while also addressing concerns about sanitation and the virus. Initially, officials had hoped to have the carpeting cleaned each day, but later found that the service provider was unable to adequately disinfect the material, Mr. Riggleman said, and so many are sleeping on concrete.
Las Vegas officials said they are concerned about the long-term financial impacts of the coronavirus shutdowns. Gov. Steve Sisolak of Nevada issued a 90-day moratorium on Sunday on all evictions and foreclosures in the state in an effort to stave off some of the most severe economic consequences.
But Mr. Riggleman said it was not clear whether that will be enough to prevent a rise in the citys homeless population.
We know were in for a rough road, Mr. Riggleman said.
michael barbaro
From The New York Times, Im Michael Barbaro. This is The Daily.
Today: As the pandemic quickly spreads across the U.S., hundreds of hospitals are now confronting their first serious cases of the coronavirus. Susan Dominus on the lessons from the first confirmed case in New Jersey.
Its Monday, March 30.
Sue, tell me how you first heard about James Cai.
Well, a few weeks ago I heard about this young guy, a 32-year-old physician assistant, who was the very first patient in all of New Jersey to test positive for Covid-19.
And so I reached out to him while he was still at the hospital. And I was sort of wondering, would it possibly be OK, could you maybe find some time to talk? And he said, sure, call me now. Im in isolation, in other words, and I have time.
Hello? [COUGHING]
Are you there?
Yes. [COUGHING]
OK.
And what was the story that he told you?
So James lives and works in New York City.
So my name is James Cai, and Im a physician assistant.
And his mother and grandfather live in New Jersey, and so he spends quite a bit of time there as well.
And I work as a primary care, urgent care and nursing home P.A.
He came to this country when he was about 16 from Shanghai. And hes married and has a 20-month-old daughter, whom he adores.
Why did you go into medicine in the first place? Why were you drawn to medicine?
Oh, because of my grandparents. They are doctors. My grandfather is an anesthesiologist in Shanghai. And when I was young, I always sick, so I always went to his hospital. So I had a good impression.
And as someone working in the medical field, was James expecting to interact with this epidemic, the coronavirus? Was he maybe even thinking he would end up treating coronavirus patients?
Well, he doesnt work in a hospital. And because he works in private practice, I think he probably imagined he might be working remotely with telemedicine.
I actually heard about coronavirus many months ago when China had outbreak. But I always followed the disease.
But because of the family background and because he does work in medicine, when news of the coronavirus did start coming out of Wuhan, he definitely understood how quickly the virus could spread. And he definitely understood that the only way to guarantee that you could survive this was by not getting it in the first place.
Around end of February, I started to pile up all the food, like canned foods, frozen vegetables, dumplings.
So soon after the coronavirus landed on the west coast, he and his family went to Costco and stocked up
Our family plan is to stay home for two months.
for like, two months worth of supplies.
Right. So they were going to avoid any meaningful exposure to the virus?
Yeah, if there was communal spread and it had become widespread, their plan was to shelter in place.
And well ahead of the rest of us.
Yeah, I think thats right.
So you werent sure at what point you would start doing that, but you felt youd know when it was time?
Yes.
But, you know, hes stocking up at the end of February. You know, people in the U.S. were still flying all over the country. Kids were going to school. Bloomberg was in the race for president. People were planning vacations and weddings and all sorts of conferences and events. And the same was true of James. So like everybody else, hes going about his life. And around this time, without really too much concern about his health, he went to a medical conference in Times Square.
So I changed diaper for my daughter and gave her morning milk. And I kissed my wife and to go to conference.
On the fourth day of the conference, Monday, March 2, he comes down with a cough. And he starts to realize hes actually getting sick.
I start to cough and a fever and tired.
So he leaves and texts his wife that hes going to go to New Jersey, where his mom has a house. His moms away. And he doesnt want to come home and get his wife and the baby sick.
Because of my daughter, when I went home, she always hugged me and kissed me. And she will catch it.
And whats running through his head at this moment? Is he thinking, I have a bad cough? I might have the flu? Is coronavirus even on his mind?
Not really. I mean, there had not been a single case in all of New Jersey. He thought he probably had the flu. By then, he was mostly feeling this bad cough. He had an elevated heart rate. His eyes were really runny. He had diarrhea. He was not feeling well at all. But he also was not alarmed. You know, he decided to go to one of those drop-in centers to get a flu test, because he wanted to be told he didnt have the flu so he could go home. So the doctor gives him a strep test and a flu test. They discuss whether he should get a coronavirus test, in fact, but the doctor didnt have one. So they moved on. And the results came back that although the strep and the flu tests were negative, his symptoms were consistent with something called a pulmonary embolism, which is a clot in your lung that can be fatal.
So this could potentially be even more serious than just a seasonal flu or
Yes. Certainly more serious than the flu.
So after, I went direct to the Hackensack emergency room.
So the doctor sends him to the E.R. at the Hackensack University Medical Center, which is not far from that doctors office.
And in the emergency room, they asked me questions. Asked me if I cough. I said, I do, I do have cough. I do have shortness of breath.
So as called for, the doctors do a CT scan. And after they do, they realize that, no, he does not have a pulmonary embolism. But that in fact, because of the symptoms hes having and the way his lungs look in the scan
They see a ground glass nodules. So this can be coronavirus.
he might actually have coronavirus.
And how do the doctors at this hospital react to that?
Well, at this point, they havent seen any coronavirus patients. So they dont seem to him terribly alarmed. That said, they do put him in a tiny isolation room, a windowless room on the floor of the emergency room. Thats where he spends the night, texting his friends and his wife and getting increasingly unnerved and feeling quite ill.
I was nervous. And at the same time, since Im in the hospital, Im going to check everything. Make sure Im OK and then I go home.
So then on Tuesday, March 3, which is the second day in the hospital
They decide to do a test on me. So the test takes about 24 hours or 48 hours.
they do a Covid-19 test. And they tell him hes going to have to wait a few days for the result, but he shouldnt worry, hes young and healthy. At the same time, hes wildly Googling symptoms for Covid-19 and realizing that he has almost every one of them.
I had maybe lied to myself, was like, trying to calm myself down. I dont have the Covid-19, I shouldnt have it.
And so, its day three for James in the hospital. Its Wednesday, March 4. Hes still waiting for the results in his tiny little room with a TV. And
[SOUND OF LOCAL NEWS THEME]
a local news report comes on.
We we begin tonight with breaking news regarding the coronavirus.
Yeah, that virus arriving in the Garden State tonight. Governor Phil Murphy announcing the first presumptive positive case of the virus right here in New Jersey.
And the news report says
A man in his thirties is hospitalized in Bergen County.
Theres a guy in his thirties in Bergen County, which is where he is, whos tested positive for coronavirus. Its the first case in New Jersey.
Governor Murphy saying
Theres even a tweet from the governor of New Jersey confirming it.
We take this situation very seriously and have been preparing for this for weeks. I urge residents to remain calm
And it occurs to James, they really might be talking about him.
And then I asked the doctor, saying, is this me? And the doctors saying, no, your test is not back yet.
And of course, he hasnt heard anything about the results of his test yet?
No, he has not heard anything.
Wow. So you found out from the news from the governor of New Jersey?
Yes. On TV. And I asked the doctor. The doctor say, the result is not back yet.
And then the next day, his doctors come to him and say, yes, you have tested positive. And he is the first person in New Jersey to have tested positive for Covid-19.
Right. And perhaps the first person in the history of the universe to find out he has a disease, not from his doctor, but from TV news.
Lets hope so.
And how does the hospital react in this moment?
So hes really scared. But the hospital is telling him that he really has nothing to worry about. Hes a 32-year-old guy. Hes got no preexisting conditions.
Even Dr. [INAUDIBLE] was telling me, oh youre so young. Its like a flu.
In fact, one doctor even told him
If its not because everybody is talking about corona, you can go home already.
You know, if it werent for all this attention about the coronavirus, youd be home right now, just getting better in the comfort of your own bedroom.
In other words, it would probably just self-resolve in somebody of his health?
That was definitely the expectation.
I mean, that day, I was so depressed.
I think he felt that as a medical professional, he actually he knew that he was quite vulnerable, that nobody was invulnerable. And there was this disconnect between his own concerns and their own insistence that he was overly anxious.
America is not ready.
It also dawns on him that he is the first person in this hospital to be treated for coronavirus.
I feel like, Im in real trouble. Why I come to this hospital? Because I feel they dont know how to treat this disease, and they dont have deep understanding about this disease.
Nobody there has any experience. Nobody there can make good predictions. Nobody there has institutional knowledge about what happens when this goes wrong or something unexpected happens. Hes the first person, and thats a very frightening position to be in.
Well be right back.
So Sue, James is newly diagnosed. Hes in isolation at this hospital in Hackensack, New Jersey. Hes been there for about four days. Physically, how is he doing at this point?
When you first got the results of the positive test, on a scale of 1 to 10, how bad did you feel physically? 10 being the worst?
I would say 10.
Wow.
He is feeling worse by the day.
Getting worse. So my heart is compensating, beating very fast.
He definitely has that cough. And he also is having real trouble breathing.
Its like Im in the water.
Tell me more about that.
NHS staff are being gagged from speaking out about widespread shortages of personal protective equipment that they fear could risk their lives from the coronavirus, frontline medics claim.
Doctors and nurses are being warned by hospitals and other NHS bodies not to raise their concerns publicly, according to a dossier of evidence collated by the Doctors Association UK (DAUK).
Tactics being used to deter staff from voicing their unease include threatening emails, the possibility of disciplinary action and in two cases being sent home from work. Some doctors have been given a ticking-off after managers were irritated by material they had posted on social media.
Doctors across the frontlines are extremely concerned about the lack of personal protective equipment [PPE]. Many have told us they have tried to raise concerns through the proper channels but have been warned against taking these concerns further, said Dr Samantha Batt Rawden, DAUKs president.
At this time when we desperately need every single doctor on the frontline, some have had their careers threatened, and at least two doctors have been sent home from work. This is unacceptable. Doctors have a moral duty to make their concerns regarding Covid-19 public if these cannot be resolved locally, she added.
The NHS organisations involved appear to want to stop staff from highlighting the lack of facemasks, goggles, visors and gowns that has created huge alarm and fear at the frontline. Many health professionals are worried that they may contract the virus during the course of their work, especially if their PPE is inadequate, and pass it on to patients or their families.
In recent weeks staff have posted photographs on social media platforms such as Twitter and Instagram of makeshift PPE they have put together using materials such as bin bags.
For example, A&E staff at Southend hospital in Essex have been warned that they could face disciplinary action if they raise the issue of PPE publicly.
In a memo on 26 March they were told: The posting of inappropriate social media commentary or the posting of photographs of staff in uniform who are not complying with IPC [infection prevention and control] standards and social distancing requirements is unacceptable. Such behaviour will be considered under the disciplinary policy.
Now, perhaps more than ever, NHS staff are in the public eye and we have a responsibility to convey a professional image and to role model positive messages about social distancing. It would be very sad for moments of inappropriate or unprofessional behaviour to undermine the respect that we and our colleagues have from the public.
Ministers and NHS bosses have organised thousands of deliveries of millions of pieces of PPE to hospitals, GP surgeries and other healthcare settings in England over the last 10 days, often with army drivers bringing it. However, many staff still report ongoing shortages.
In other testimonies given to DAUK:
An intensive care doctor who voiced unease about facemasks was told by their hospital that if we hear of these concerns going outside these four walls your career and your position here will be untenable.
Another intensive care specialist was called into a meeting with their bosses and disciplined after raising concerns.
A GP working at Chase Farm hospital in London was sent home for voicing unease.
A consultant paediatrician in Yorkshire was told in an email from their hospital that their social media output was being monitored and they should be careful.
A GP who appealed to her community on social media for more supplies of PPE was then barred by her local NHS clinical commissioning group from speaking out. I was being warned I wasnt toeing the party line, she said.
Helen O Connor, an organiser with the GMB union, said: Just as it seemed that the widespread and dangerous culture of gagging clauses and suppressing the voices of NHS workers might be coming to an end it is now intensifying.
It is scandalous that hospital staff speaking out publicly face being sacked by ruthless NHS bosses who do not want failings in their leadership to be exposed. Suppression of information is not just a matter of democracy, it is now a major public health issue.
NHS England pointed out that staff were continuing to speak to the media about Covid-19.
An NHS spokesperson said: Once a major incidents occurs it is vital that the public receive fast, authoritative, open, clear and consistent information from their NHS, which is why, in line with longstanding emergency preparedness, resilience and response protocols, official communications are therefore always coordinated nationally.
But staff continue to speak in a personal, trade union or professional body capacity, and it is self-evident from print and broadcast media coverage throughout this incident that staff are able and do in fact speak freely.
The British Medical Association, the main doctors trade union, on Tuesday called on Robert Jenrick, the communities secretary, to clarify what NHS staff who felt they did not have the right PPE for dealing with Covid-19 patients should do, given his comment that we cannot and should not ask healthcare workers to be on the frontline without appropriate protective equipment.
For some time this pandemic will focus almost all of our attention. It is a tragedy that will play out differently in different parts of the world; the poor world will suffer more than the rich one. We will see it as a potential turning point, a portent, a sign that we should have cared more and prepared better. However, human progress was slowing before this pandemic began, and our world will continue to slow down for some time to come long after the pandemic has ended. I mean slowing down in almost every way that matters. Because the slowdown was itself slow, we had hardly noticed it. In fact, many people thought that we were still accelerating.
For older generations everything had changed so fast, but in fact that fast pace ended years ago. There is no normal for us to return to; the normality of economic growth is an illusion.
A century ago the pace of change was faster than it had ever been and would become faster again. During the Spanish global flu pandemic of 1918-19, carbon emissions fell by 14%. Industrial production and consumption slowed down dramatically. But then, just a year later when most of the sick had recovered, production and pollution rose by 16% in the year to 1920. Back then we were on the upswing. We were seeing ever faster population growth worldwide; back then a pandemic could not slow us down for long.
In 1918, influenza had a far greater effect on worldwide trends in industry, production and consumption than the first world war which was a war almost entirely confined to Europe. A century ago that worldwide influenza pandemic killed tens of millions of people, no one knows for sure how many. Yet today when we look back at demographic and economic trends, that last great pandemic appears as a small blip with few long-term consequences.
Over the past two centuries, the number of people alive in the world has doubled and doubled and doubled again; from 1 billion shortly before 1820, to 2 billion by 1926 and 4 in 1974; it will be 8 billion in 2023. But crucially the rise is slowing. As I write, our numbers are rising by 80 million people a year. Next year it will be by 79 million, the year after by 78 million. We are still growing in number as a species, but that growth has been slowing for more than half a century already.
We do not yet know what effect the current pandemic will have on worldwide demographics. But it is actually slightly more likely to increase future populations than decrease them. If the actions of governments, or at least of most governments, make people feel more insecure, economically and socially, then younger people may in the near future have more children than they would have had; and the pandemic will, counterintuitively, very slightly increase the total future population.
Security matters. In normal times this point has to be laboured because many readers of newspapers in affluent countries do not realise how precarious the safety net is for most people in the world. But today they are feeling as most people in poorer countries feel most days. Such insecurity played a part in the great acceleration in human population that began more than two centuries ago. It is worth looking back before looking forward.
In 1859 Charles Darwin wrote about the numerous recorded cases of the astonishingly rapid increase of various animals in a state of nature, when circumstances have been favourable to them during two or three following seasons. Darwin used examples ranging from minuscule seedlings to giant elephants; he discussed the very rare cases in nature when exponential population growth occurred in a species. Darwin had no way of knowing it, but he was writing just as his own species was about to have its favourable seasons.
The word slowdown was first used in the 1890s, with its meaning being to go forward more slowly. Our current belief systems economic, political and sociological are all built on assumptions of rapid future technological change and perpetual growth. Yet even since the 1930s, technological change has slowed; the rate of economic growth has slowed every decade after the 1950s; population growth similarly has slowed since before the 1970s; and since at least the 1990s we have started to behave more like our parents again. By the 2010s we (at least in the rich world) were no longer seeing each generation better-off than the one before.
The general slowdown we are living through is advantageous. Recognising this requires us to shift our fundamental view of change, innovation and discovery as unalloyed benefits. We need to stop expecting ceaseless technological revolutions. We need to worry about what mistakes we will make if we carry on assuming that slowdown is unlikely and new great shifts lie just around the corner.
The time has come to properly contemplate what will happen if things stay much the same as they are now, while the rate of change simply slows down.
An era is ending and this was obvious years before the pandemic arrived. The great acceleration that has occurred in recent generations created the culture in which we still live. It created our current expectation for a particular kind of progress. By us I mean the large majority of older people now living on Earth, those who have for the most part seen their health, housing and workplaces improve, those who had seen both absolute and relative poverty recede, but who now have a sense that their childrens generation will not be better off than they themselves are, those who are feeling a sense of let-down due to slowdown.
The alternative to slowdown is unimaginably bad. If we do not slow down, there is no escape from disaster far worse than a pandemic. We would wreck the planet we live on. Slowdown means we need not fear the nightmare scenario of worldwide famine depicted at the end of Paul and Anne Ehrlichs 1968 book The Population Bomb, in which they concluded of India that its people should be allowed to starve: Under the triage system [suggested by them] she [India] should receive no more food. This kind of brutal conclusion was rife in the recent past. Images of out-of-control acceleration became commonplace. That was just half a century ago, at the peak of human population acceleration.
Although now may not be the time to point it out, the frequency and severity of disaster are both falling. The great Chinese famine of 195861 was worse in its effect than any of the earlier terrible huge Indian famines, or the east Africa famine of the 1980s. But the flu pandemic of 40 years before that famine had been worse still in terms of millions of deaths.
Today almost everything is increasing at a slower pace. Prior to the 2020 pandemic, the four great exceptions were: university graduates enrolled worldwide, consumption of goods, carbon pollution and air flights. They have all suddenly slowed due to the pandemic. Before January of this year they all appeared to be rising exponentially and uncontrollably. Today it is even possible that worldwide temperature will not rise in 2020 in the way it rose in 2019, as a reaction to reduced pollution.
Outside brief periods of wartime and pandemic, the global rates of population growth have exceeded 1% every year since 1901. However, according to the latest UN estimates published in June 2019, they will now almost certainly fall below that level by 2023, then quickly drop to below 0.9% annual growth around the year 2027. Everything was slowing down already, everything will still slow down when the current crisis ends. But the slamming on of the brakes on the train we were travelling on might, at the very least, wake us out of our stupor.
Danny Dorling is the author of Slowdown: The End of the Great Acceleration and Why Its Good for the Planet, the Economy, and Our Lives, published 14 April (14.99, Yale).
Update: Coronavirus Disease (COVID-19) March 13, 2020. First and most importantly we hope you and your loved ones are safe and healthy. The situation with COVID-19 has developed quickly and continues to change fast. We know this is a confusing time. As your home loan servicer, were here to set your mind at ease about your home and ...
After an initial verbal screening, one driver at a time gets a COVID-19 nasal swab test from a garbed health worker at a drive-up station in Daly City, Calif. Justin Sullivan/Getty Images hide caption
After an initial verbal screening, one driver at a time gets a COVID-19 nasal swab test from a garbed health worker at a drive-up station in Daly City, Calif.
After a slow start, testing for COVID-19 has begun to ramp up in recent weeks. Giant commercial labs have jumped into the effort, drive-up testing sites have been established in some places, and new types of tests have been approved under emergency rules set by the Food and Drug Administration.
But even for people who are able to get tested (and there's still a big lag in testing ability in hot spots across the U.S.), there can be a frustratingly long wait for results not just hours, but often days. Even Sen. Rand Paul, R-Ky., didn't get his positive test results for six days and has been criticized for not self-quarantining during that time.
We asked experts to help explain why the turnaround time for results can vary widely from hours to days or even a week and how that might be changing.
It's a multistep process
First, a sample is taken from a patient's nose or throat, using a special swab. That swab goes into a tube and is sent to a lab. Some large hospitals have on-site molecular test labs, but most samples are sent to outside laboratories for processing. More on that later.
That transit time usually runs about 24 hours, but it could be longer, depending on how far the hospital is from the processing laboratory.
Once at the lab, the specimen is processed, which means lab workers extract the virus's RNA, the molecule that helps regulate genes.
"That step of cleaning the RNA extraction step is one limiting factor," says Cathie Klapperich, vice chair of the department of biomedical engineering at Boston University. "Only the very biggest labs have automated ways of extracting RNA from a sample and doing it quickly."
After the RNA is extracted, technicians also must carefully mix special chemicals with each sample and run those combinations in a machine for analysis, a process called polymerase chain reaction, which can detect whether the sample is positive or negative for COVID.
A lab technician adds vials to a Covid-19 polymerase chain reaction testing device at a Co-Diagnostics facility in Salt Lake City. George Frey/Bloomberg via Getty Images hide caption
"Typically, a PCR test takes six hours from start to finish to complete," says Kelly Wroblewski, director of infectious disease programs at the Association of Public Health Laboratories.
Some labs have larger staffs and more machines, so they can process more tests at a time than others. But even for those labs, as demand grows, so does the backlog.
Capacity is expanding, but not fast enough
Initially, only a few public health labs and the federal Centers for Disease Control and Prevention processed COVID-19 tests. Problems with the first CDC test kits also led to delays.
Now the CDC has a better kit, and 94 public health labs across the country do COVID-19 testing, says Wroblewski.
But those labs can't possibly do all that's needed. In normal times, their main function is regular public health surveillance detecting more common threats such as outbreaks of measles or monitoring seasonal influenza "but not to do diagnostic testing of the magnitude that is required in this response," she says.
Large commercial labs like those run by companies such as Quest Diagnostics and LabCorp were given the go-ahead by the FDA late last month to start testing, too.
The FDA has said it won't stop certain private labs and universities and diagnostic companies from developing their own test kits. Labs at some big-name hospital systems, such as AdventHealth, the Cleveland Clinic and the University of Washington, are among those doing this.
In addition, the FDA has approved more than a dozen testing kits by various manufacturers or labs under special emergency rules designed to speed the process. Those include tests by Quest Diagnostics, LabCorp, Roche, Quidel Corp. and others. The kits are used in PCR machines, either in hospital labs or large commercial labs.
"A chief medical officer on the East Coast said that, up until two days ago, on average, it was taking 72 hours to get results," says Susan Van Meter, executive director of AdvaMedDx, a division of the Advanced Medical Technology Association, a device and diagnostics industry trade group. "That will get better as our member companies come on the market."
Even so, supply is not keeping up with demand, Roche CEO Severin Schwan told CNBC on Monday. Roche won the first approval from the FDA for a test kit under emergency rules, and it has delivered more than 400,000 kits so far.
"Demand continues to be much higher than supply," Schwan told CNBC. "So we are glad that overall capacity is increasing, but the reality is that broad-based testing is not yet possible."
How many tests can be done at a time?
That varies. Large commercial labs can do a lot. LabCorp, for example, says it is processing 20,000 tests a day and hopes to do more soon. Other test kit makers and labs are also ramping up capacity.
Smaller labs such as molecular testing labs at some hospitals can do far fewer per day but get results to patients faster because they save on transit time.
Still, it's usually only large academic medical centers and some health systems that have their own molecular testing labs, which require complex equipment.
One of those is Medstar Georgetown University Hospital in Washington, D.C.
"From beginning to results can take five to six hours," says Joeffrey Chahine, technical director for the molecular pathology division there.
Even at such hospitals, the tests are often prioritized for patients who have been admitted and staff who might have been exposed to COVID-19, says Chahine. His lab can process 93 samples at a time and run a few cycles a day up to 279 tests per day, he says.
A doctor examines Juan Vasquez as part of a COVID-19 check inside a testing tent outside the emergency department at St. Barnabas Hospital in New York City last week. Misha Friedman/Getty Images hide caption
A doctor examines Juan Vasquez as part of a COVID-19 check inside a testing tent outside the emergency department at St. Barnabas Hospital in New York City last week.
But even hospitals with this ability are generally "not testing from their outpatient centers or the ER," he says. In other words, the in-house labs aren't running tests from walk-in patients. Those tests are sent to large outside labs "so as not to overwhelm the hospital lab."
While those outside labs have large staffs, "the demand is so high that these outpatient clinics and ERs say the turnaround time can be four to seven business days," Chahine says.
Supply shortages are slowing test production
As the worldwide demand for testing has grown, so, too, have shortages of the chemical agents used in the test kits, the swabs used to get the samples, and the protective masks and gear used by health workers taking the samples.
"There is an inadequate supply of so many things associated with testing," says Wroblewski, which is why her group, along with officials in states including New York and cities including Los Angeles, recommend prioritizing who should be tested for COVID-19.
At the front of the line, she says, should be health care workers and first responders; older adults who have symptoms, especially those living in nursing homes or assisted living residences; and people who may have other illnesses that would be treated differently if they were infected.
Bottom line: Prioritizing who is tested will help speed the turnaround time for getting results to people in these circumstances and reduce their risk of spreading the illness.
Still, urgent shortages of some of the chemicals needed to process the tests are hampering efforts to test health care workers, including at hospitals such as SUNY Downstate medical center in hard-hit New York.
Looking forward, companies are working on quicker tests. The FDA in recent days has approved tests from two companies that promise results in 45 minutes or less, but those likely will be available only in hospitals that have special equipment to run them. One of those companies, Cepheid of Sunnyvale, Calif., says about 5,000 U.S. hospitals already have the equipment needed to process these tests. Both firms say they will ship to the hospitals soon but have given few specifics on quantity or timing.
But many public health officials say primary care doctors and clinics need a truly rapid test they can use in their offices one like the tests already in use for influenza or strep throat.
A number of companies are moving in that direction. Late Friday, for instance, Abbott Laboratories announced that the FDA has given emergency use authorization for the company's rapid, point-of-care test, which can deliver positive results in as little as five minutes and negative results in 13.
The tests are processed on a small device already installed in thousands of medical offices, ERs, urgent care clinics and other settings. Abbott said it will begin next week to make 50,000 tests available per day.
"That's going to make a meaningful difference," says Van Meter at AdvaMedDx, who believes the rapid tests are a key additional piece in the continuum of available testing.
Even though lab-based PCR tests, which are done at large labs and academic medical centers can take several hours to produce a result, the machines used can test high numbers of cases all at once. The rapid test by Abbott and other, similar tests now under development do far fewer at a time, but deliver results much faster.
"This can be provided in a doctor's office or an ER, helping to triage patients who are waiting to get in," says Van Meter. "It's a very fine complement to the testing that exists."
Kaiser Health News is a nonprofit, editorially independent program of the Kaiser Family Foundation. KHN is not affiliated with Kaiser Permanente.
WHOs focus at all times is to ensure that all areas of the globe have the information they need to manage the health of their people. In a recent interview, the WHO official who headed the joint international mission to China, did not answer a question on Taiwans response to the COVID-19 outbreak.
The question of Taiwanese membership in WHO is up to WHO Member States, not WHO staff. However,WHO is working closely with all health authorities who are facing the current coronavirus pandemic,including Taiwanese health experts.
The Taiwanese caseload is low relative to population. We continue to follow developments closely.WHO is taking lessons learned from all areas, including Taiwanese health authorities, to share best practices globally.
With respect to the COVID-19 outbreak, the WHO Secretariat works with Taiwanese health experts and authorities, following established procedures, to facilitate a fast and effective response and ensure connection and information flow.
WHO staff work around the world to respond to this pandemic with the best evidence-based guidance and operational support available for all people, based on public health needs. Membership in WHO and status issuesare decided by Member Statesand the rules they set atWHOs governing body, the World Health Assembly.
Information about COVID-19 can be found here:https://www.who.int/emergencies/diseases/novel-coronavirus-2019
The next day my temperature was back down to 97.1, but the UTI had worsened. I called the nearby urgent-care center to see if they could prescribe me a new antibiotic, but no one was answering the phone. Figuring the place was overwhelmed with coronavirus calls, I walked over to the urgent care, opened the front door, and poked my head in. Hi, I said. Im so sorry to bother you at this time, but no ones answering your phones. I explained that the antibiotic course Id just finished hadnt worked, and I needed a different prescription.
Do you have a temperature? I remember the receptionist asking, as she walked over to the door and handed me a mask. Wait, what?
No. I had a slight fever yesterday. Can I just leave a message for the doctor? I dont want to come in. I could hear a hacking cough coming from one of the exam rooms.
If you need a new antibiotic, youll have to pee in a cup again.
But you guys already have my pee from last week! Use the same pee!
Sorry, we cant treat you unless you meet with the doctor again and give us a new sample.
Youve got to be kidding me, I thought. Why are we talking about pee during a shit storm? I weighed my options: either endure the UTI for who knows how long until this pandemic is over, which could lead to a kidney infection, which might eventually mean being forced to enter an overwhelmed, COVID-19-infected hospital anyway, or walk into this urgent care right now and possibly get exposed to the virus, but only from the two people coughing. I didnt like this game of Would you rather.
Read: A New York doctors warning
I put on that mask and walked straight inin my regular clothes, with no eye protectionwhere I stayed for a good 30 to 40 minutes until I could pee into a new cup, meet with the doctor, get a prescription, and go home. To say it was scary sitting there listening to all that coughing in the other rooms would be an understatement. The other patients sounded as if they should be on respirators, not in a neighborhood urgent care.
When I came home, I immediately stripped and washed all my clothes. That night, I got word that I did, indeed, have an ever-worsening UTI. (Duh.) A few hours later, Will came down with a fever and diarrhea and fell asleep watching Rachel Maddow, which he never does.
We isolated ourselves in separate rooms. My son stayed in his room, Will stayed in my other sons roomthat son, 24, had been volunteering for several months with Syrian refugees in Samos, Greece, and was self-quarantining in a nearby Airbnband me in the master bedroom, but not before I wiped down the entire apartment with Clorox wipes again. The next night, March 20, I cooked some rice and beans that no one ate.
Will stayed quite sick for three days, his temperature spiking and then retreating, but he never came down with a cough. Just the diarrhea, which is a rare COVID-19 symptom. We considered heading over to the drive-through test site that had just been set up on Staten Island, but by the time Will was feeling well enough to sit in a car for several hours, New York City had been declared a FEMA disaster zone. All masks and pieces of personal protective equipment were needed to treat the sick and dying, and the city put out a statement saying that people whose illnesses didnt require hospitalization should not get tested. So we stayed home.
We missed each others company, though, so I threw caution to the wind, washed my hands, and invited Will to wash his hands and lie on the bed with me, as far from my body as possible, to listen to a recording of the 1977 Cornell Grateful Dead show while watching the sunset from our bedroom window. I kept it together until Jerry, in Morning Dew, sang, Where have all the people gone, my honey? Where have all the people gone today?
MILWAUKEE There are 1,059 confirmed cases of coronavirus as of 7:45 a.m. Sunday, March 29. The total number of positive cases and deaths is a combination of data reported by the Wisconsin Department of Health Services and individual county health departments and officials.
There have been over15,000 negative tests and the total number of deaths remained at 17.
Milwaukee Countys coronavirus dashboardshowed 559 cases in the county Sunday morning. The countys reported number of cases represented additionalcases to those listed by the Wisconsin Department of Health Services inits Sunday afternoon report.
CLICK HERE to view the Milwaukee County COVID-19 dashboard.
CLICK HERE to view the latest COVID-19 totals (updated daily at 2 p.m.) from the Wisconsin Department of Health Services.
CoronavirusNow.com: A Fox Television Stations initiative to provide you with the most up-to-date national and international news on COVID-19.
Helpful phone numbers
About COVID-19 (from the CDC)
Symptoms: Reported illnesses have ranged from mild symptoms to severe illness and death for confirmed coronavirus disease 2019 (COVID-19) cases. These symptoms may appear2-14 days after exposure(based on the incubation period of MERS-CoV viruses).
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