One employee from that location has died, Jones said. It is unclear how many employees have tested positive at the store.
Jones said complaints from employees and customers last week led to an investigation into the Quincy store.
"I have had inspectors there everyday last week due to complaints from employees and patrons concerning overcrowding and lack of social distancing," Jones said. "Employees were also concerned that coworkers may be ill. I had been monitoring the number of cases in employees and was concerned with the increase in numbers and the death of an employee, suggesting they test all of the employees,"
The store in Quincy voluntarily closed Monday and the entire facility will be cleaned and disinfected, Jones said.
In a statement to CNN Monday, a Walmart spokesperson said they had been made aware of the loss of an associate from their Quincy store, and "are going through the necessary steps to get a confirmation from the health department, while keeping the associate's privacy in mind."
"Did I read this wrong or did the CDC just revised the national COVID-19 deaths to 37,308?!?!" tweeted Tim Young, who identifies himself as an author, host and comedian on his Twitter bio.
Soon, the idea was everywhere on the conservative side of the internet. The CDC was openly admitting that the number of dead from coronavirus was FAR less than the 67,000+ deaths commonly being reported by the media.
For many conservatives, the story was too good to resist, since it combined their belief that the government had overreacted to the threat posed by the coronavirus with their distaste for and distrust of the media.
"Provisional death counts are based on death certificate data received and coded by the National Center for Health Statistics as of May 4, 2020. Death counts are delayed and may differ from other published sources (see Technical Notes). Counts will be updated periodically."
So, the numbers that Young and others were peddling as evidence of some sort of revelation about the "real" death count were, in fact, numbers that the CDC acknowledges are weeks behind the actual mortality number.
Jonathan Swift may have died in 1745, but his quote that "a lie can travel halfway around the world while the truth is still putting on its shoes" rings truer today -- thanks to the internet's power to multiply falsehoods in seconds -- than it ever did back in the 18th century.
The Point: Coronavirus has laid plain just how big a mis- and dis-information problem we have in the United States. The stripping of context from facts in order to weaponize them to score partisan points is a war in its own right, and all of us are potential victims.
We've only seen a few elections since polling began where the incumbent was eligible to run for reelection and the economy wasn't clearly the most important issue, but these elections tell a consistent and worrisome message for President Donald Trump. Whoever is most trusted most on the non-economic issue is likely to win the election.
Trump probably wishes he had the type of polling Franklin Roosevelt had going into the 1944 election. By a 42-point margin in a National Opinion Research Center poll, Americans thought Roosevelt was better equipped to win World War II than Republican rival Thomas Dewey. Roosevelt would go on to win an unprecedented fourth term.
Trump likely would settle for the numbers George W. Bush had ahead of his successful 2004 re-election effort. Bush was more trusted than Democrat John Kerry on the Iraq war and terrorism. The final Fox News poll, for example, found that Bush was more trusted on Iraq by 6 points. The same poll had Bush up by 12 points on who would do a better job on terrorism.
But let's say the economy is viewed as being in better shape by the time of the election. A look at the 1952 and 1968 elections suggests that may not be enough for Trump.
Democratic incumbents Harry Truman in 1952 and Lyndon Johnson in 1968 didn't even run for re-election during the Korean War and Vietnam Wars respectively. The Republican candidates, Dwight Eisehower and Richard Nixon, were trusted by double digits in Gallup polling over the Democratic candidates, Adlai Stevenson and Hubert Humphrey, in those races to handle the war efforts. Republicans won both races.
The economy was strong ahead of both of these elections. Even so, the incumbent party lost the general election because they couldn't win on the big non-economic issue of the day.
Four years after Nixon took office, he was able to win a second term because he was trusted more on handling the Vietnam War by about 30 points than his Democratic opponent, George McGovern.
For 2020, these elections suggest Trump probably needs Americans to think he has a good handle on the coronavirus in order to beat Biden. Otherwise, he'll likely end up like Truman and Johnson: out of office.
Autumn Road in Little Rock, Ark., is the type of doctors practice that has been around long enough to be treating the grandchildren of its eldest patients.
For 50 years, the group has been seeing families like Kelli Rutledges. A technician for a nearby ophthalmology practice, she has been going to Autumn Road for two decades.
The groups four doctors and two nurse practitioners quickly adapted to the coronavirus pandemic, sharply cutting back clinic hours and switching to virtual visits to keep patients and staff safe.
When Kelli, 54, and her husband, Travis, 56, developed symptoms of Covid-19, the couple drove to the groups office and spoke to the nurse practitioner over the phone. She documented all of our symptoms, Ms. Rutledge said. They were swabbed from their car.
While the practice was never a big moneymaker, its revenues have plummeted. The number of patients seen daily by providers has dropped to half its average of 120. The practices payments from March and April are down about $150,000, or roughly 40 percent.
That wont pay the light bill or the rent, said Tabitha Childers, the administrator of the practice, which recently laid off 12 people.
While there are no hard numbers, there are signs that many small groups are barely hanging on. Across the country, only half of primary care doctor practices say they have enough cash to stay open for the next four weeks, according to one study, and many are already laying off or furloughing workers.
The situation facing front-line physicians is dire, three physician associations representing more than 260,000 doctors, wrote to the secretary of health and human services, Alex M. Azar II, at the end of April. Obstetrician-gynecologists, pediatricians, and family physicians are facing dramatic financial challenges leading to substantial layoffs and even practice closures.
By another estimate, as many as 60,000 physicians in family medicine may no longer be working in their practices by June because of the pandemic.
The faltering doctors groups reflect part of a broader decline in health care alongside the nations economic downturn. As people put off medical appointments and everything from hip replacements to routine mammograms, health spending dropped an annualized rate of 18 percent in the first three months of the year, according to recent federal data.
While Congress has rushed to send tens of billions of dollars to the hospitals reporting large losses and passed legislation to send even more, small physician practices in medicines least profitable fields like primary care and pediatrics are struggling to stay afloat. They dont have any wiggle room, said Dr. Lisa Bielamowicz, a co-founder of Gist Healthcare, a consulting firm.
None of the money allocated by lawmakers has been specifically targeted to the nations doctors, although the latest bill set aside funds for community health centers. Some funds were also set aside for small businesses, which would include many doctors practices, but many have faced the same frustration as other owners in finding themselves shut out of much of the funding available.
Federal officials have taken some steps to help small practices, including advancing Medicare payments and reimbursing doctors for virtual visits. But most of the relief has gone to the big hospital and physician groups. We have to pay special attention to these independent primary care practices, and were not paying special attention to them, said Dr. Farzad Mostashari, a former health official in the Obama administration, whose company, Aledade, works with practices like Autumn Road.
The hospitals are getting massive bailouts, said Dr. Christopher Crow, the president of Catalyst Health Network in Texas. Theyve really left out primary care, really all the independent physicians, he said.
Heres the scary thing as these practices start to break down and go bankrupt, we could have more consolidation among the health care systems, Dr. Crow said. That concerns health economists, who say the steady rise in costs is linked to the clout these big hospital networks wield with private insurers to charge high prices.
While the pandemic has wreaked widespread havoc across the economy, shuttering restaurants and department stores and throwing tens of millions of Americans out of work, doctors play an essential role in the health of the public. In addition to treating coronavirus patients who would otherwise show up at the hospital, they are caring for people with chronic diseases like diabetes and asthma.
Keeping these practices open is not about protecting the doctors livelihoods, said Michael Chernew, a health policy professor at Harvard Medical School. I worry about how well these practices will be able to shoulder the financial burden to be able to meet the health care needs people have, he said.
If practices close down, you lose access to a point of care, said Dr. Chernew, who was one of the authors of a new analysis published by the Commonwealth Fund that found doctors visits dropped by about 60 percent from mid-March to mid-April. The researchers used visit data from clients of a technology firm, Phreesia.
Nearly 30 percent of the visits were virtual as doctors rushed to offer telemedicine as the safest alternative for their staff and patients. Its remarkable how quickly it was embraced, said Dr. Ateev Mehrotra, a hospitalist and associate professor of health policy at Harvard Medical School, who was also involved in the study. But even with virtual visits, patient interaction was significantly lower.
Almost half of primary care practices have laid off or furloughed employees, said Rebecca Etz, an associate professor of family medicine at Virginia Commonwealth University and co-director of the Larry A. Green Center, which is surveying doctors with the Primary Care Collaborative, a nonprofit group. Many practices said they did not know if they had enough cash to stay open for the next month.
Pediatricians, which are among the lowest paid of the medical specialties, could be among the hardest hit. Federal officials used last years payments under the Medicare program to determine which groups should get the initial $30 billion in funds. Because pediatricians dont generally treat Medicare patients, they were not compensated for the decline in visits as parents chose not to take their children to the doctor and skipped their regular checkups.
This virus has the potential to essentially put pediatricians out of business across the country, said Dr. Susan Sirota, a pediatrician in Chicago who leads a network of a dozen pediatric practices in the area. Our waiting rooms are like ghost towns, she said.
Pediatricians have also ordered tens of thousands of dollars on vaccines for their patients at a time when vaccine rates have plunged because of the pandemic, and they are now working with the manufacturers to delay payments for at least a time. We dont have the cash flow to pay them, said Dr. Susan Kressly, a pediatrician in Warrington, Pa.
Even those practices that quickly ramped up their use of telemedicine are troubled. In Albany, Ga., a community that was an unexpected hot spot for the virus, Dr. Charles Gebhardt, a doctor who is treating some infected patients, rapidly converted his practice to doing nearly everything virtually. Dr. Gebhardt also works with Aledade to care for Medicare patients.
But the telemedicine visits are about twice as long as a typical office visit, Dr. Gebhardt said. Instead of seeing 25 patients a day, he may see eight. We will quickly go broke at this rate, he said.
Although he said the small-business loans and advance Medicare payments are a Godsend, and they will help us survive the next few months, he also said practices like his need to go back to seeing patients in person if they are to remain viable. Medicare will no longer be advancing payments to providers, and many of the small-business funding represents a short-term fix.
While Medicare and some private insurers are covering virtual visits, which would include telephone calls, doctors say the payments do not make up for the lost revenue from tests and procedures that help them stay in business. Telehealth is not the panacea and does not make up for all the financial losses, said Dr. Patrice Harris, the president of the American Medical Association.
To keep the practices open, Dr. Mostashari and others propose doctors who treat Medicare and Medicaid patients receive a flat fee per person.
Even more worrisome, doctors groups may not be delivering care to those who need it, said Dr. Mehrotra, the Harvard researcher, because the practices are relying on patients to get in touch rather than reaching out.
Some doctors are already voicing concerns about patients who do not have access to a cellphone or computer or may not be adept at working with telemedicine apps. Not every family has access to the technology to connect with us the right way, said Dr. Kressly, who said the transition to virtual care is making disparities worse.
Some patients may also still prefer traditional office visits. While the Rutledges appreciated the need for virtual visits, Kelli said there was less time to talk about other things.
Telehealth is more inclined to be about strictly what you are there for, she said.
Private equity firms and large hospital systems are already eying many of these practices in hopes of buying them, said Paul D. Vanchiere, a consultant who advises pediatric practices.
The vultures are circling here, he said. They know these practices are going to have financial hardship.
PITTSBURGH (KDKA) Gov. Tom Wolf said the southwest region can expect an announcement on moving from the red to yellow phase soon.
We will be making an announcement on that soon, said Gov. Tom Wolf on a conference call with reporters Tuesday. As I said last week, southwestern Pennsylvania is doing a really good job. Were doing the best we can to keep people safe within the constraints of this deadly virus.
The southwest is doing a great job, and the hope is that they can move into the yellow phase like the 24 counties I announced last Friday fairly quickly, Gov. Wolf went on to say.
On Friday, his administration released which 24 counties in the rural northern part of the state will reopen come May 8.
The southwest region will remain in the red phase, meaning the stay-at-home order wont be lifted until the region is moved into the yellow phase.
Allegheny County and the rest of the region easily met the governors criteria of new cases, staying under 50 per 100,000 over 14 days. Allegheny has had less than 30, and the region has had about 33.
Area hospitals have never been stressed, and Allegheny County says its testing and tracing of those who have come in contact with infected people has allowed it to isolate and contain spikes.
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When asked Friday why the southwestern part of the state would not open, Secretary of Health Dr. Rachel Levine cited population density as a concern.
We felt it prudent that, looking at all the different data and all the metrics, but then taking into consideration our ability to work with counties in terms of contact tracing and testing, and the population density of Allegheny County and Pittsburgh, that it was not prudent to go from red to yellow at this time. But we are hoping to do that in the future, Dr. Rachel Levine said.
Even Friday as the reopening announcement was made, Gov. Wolf acknowledged the progress the southwest region has made in flattening the curve.
Were already looking at other counties to move from red to yellow, says Gov. Tom Wolf. In particular, we have our eyes on counties in the southwest and a few in the south-central regions that have lower new case rates, but where we have a few concerns.
Gov. Wolf did not say how soon the southwest region can expect a reopening announcement.
More information on the Coronavirus pandemic:
But, toward the end of his tenure with the C.D.C., as a high-level bureaucrat, he was responsible for orchestrating, not investigating; science was a small slice of the job. Now its almost all science, he said. Virology, epidemiology, ecology, and other aspects of disease science provide the substance of his mission, educating the next generation of public-health practitioners.
The eclectic dcor of his current office includes electron micrographs of various pathogens hung like portraits in a rogues gallery, two sculptures of mosquitoes as big as crows, a Star Wars clock, a Big Hero 6 toy robot, cards sent from children all over the world, mementos and gifts from his travelsa Congolese incense burner, the Saudi beheading swordand a whiteboard on which he records what he calls my metrics. His precious metrics: measures of progress toward academic goals for his school, scientific goals, philanthropic goals to support the work. Im evidence-based and evidence-driven, he said.
I asked Khan about COVID-19. What went so disastrously wrong? Where was the public-health preparedness that he had overseen at the C.D.C.? Why were most countriesand especially the U.S.so unready? Was it a lack of scientific information, or a lack of money?
This is about lack of imagination, he said.
There were warnings. One of them was Khans favorite disease, SARS. In late 2002, an atypical pneumonia of unknown origin began spreading in and near the city of Guangzhou, in southern Chinaone of the largest urban agglomerations on the planet. In January, 2003, in the body of a portly seafood merchant suffering a respiratory crisis, the virus reached a Guangzhou hospital. In that hospital, and then at a respiratory facility to which he was transferred, the man coughed, gasped, spewed, and sputtered during his intubation, infecting dozens of health-care workers. He became known among Guangzhou medical staff as the Poison King. In retrospect, disease scientists have applied a different label, calling him a super-spreader.
One infected physician, a nephrologist at the hospital, experienced flu-like symptoms but then, feeling better, took a three-hour bus ride to Hong Kong for his nephews wedding. Staying in Room911 of the Metropole Hotel, the doctor became sick again, spreading the disease along the ninth-floor corridor. In the days that followed, other guests on the ninth floor flew home to Singapore and Toronto, taking the disease with them. Several weeks later, the World Health Organization called it SARS. (The Metropole, having become notorious, was later renamed.) By March15th, the W.H.O. was reporting a hundred and fifty new SARS cases worldwide.
Two mysteries loomed, one urgent and one haunting: What was the causea new virus, and if so what kind?and from what sort of animal had it come? The first mystery was soon solved by a team led by Malik Peiris, a Sri Lankan doctor who got a degree in microbiology at Oxford before going to the University of Hong Kong. Peiris specialized in influenza, and he suspected that H5N1, a flu virus that is troublesome in birds and often lethal in people but not infectious person-to-person, might have evolved into a form transmissible among humans. His team managed to isolate a new virus from two patients. It was a coronavirus, not a flu bugthat is, it was from a different virus family, with different familial traits. But the mere presence of this new virus in two SARS patients did not mean that it was the cause of the disease. Then Peiriss team showed with antibody testing that it might indeed be the SARS agent, and further work proved that they were right. Although earlier tradition tended toward naming new viruses by geographical associationEbola was a river, Marburg a city in Germany, Nipah a Malaysian village, Hendra an Australian suburbgreater sensitivity about stigmatization prevailed. The pathogen became known as SARS-CoV. Recently, the name has been revised to SARS-CoV-1, so that the agent of COVID-19 can be called not Wuhan virus but SARS-CoV-2.
SARS reached Toronto on February23, 2003, carried by a seventy-eight-year-old woman, who, with her husband, had spent several nights of a two-week trip to Hong Kong on the ninth floor of the Metropole Hotel. The woman sickened, then died at home on March 5th, attended by family, including one of her sons, who soon showed symptoms himself. After a week of breathing difficulties, he went to an emergency room and there, without isolation, was given medication through a nebulizer, which turns liquid into mist, pushing it down a patients throat. It helps open up your airways, Khan told mea useful and safe tool to prevent,say, an asthma attack. But, with a highly infectious virus, unwise. When you breathe that back out, essentially youre taking all the virus in your lungs and youre breathing it back out into the airin the E.R. where youre being treated. Two other patients in the E.R. were infected, one of whom soon went to a coronary-care unit with a heart attack. There he eventually infected eight nurses, one doctor, three other patients, two clerks, his own wife, and two technicians, among others. You could call him a super-spreader. One E.R. visit led to a hundred and twenty-eight cases among people associated with the hospital. Seventeen of them died.
In Singapore, the first SARS case was a young woman who had also stayed at the Metropole, and had, on March 1st, sought help for fever, cough, and pneumonia at Tan Tock Seng Hospital, one of Singapores largest facilities. She had visitors, and, when several of them returned as patients, doctors suspected something contagious. Then four nurses from the young womans ward called in sick on one day, an abnormality noticed by Brenda Ang, a physician who was in charge of infection control at the hospital. That was the defining moment for me, Ang, a tiny, forthright woman, said, when I visited her at the hospital. Everything was accelerating. It was Thursday, March 12, 2003, the day that the W.H.O. issued a global alert about this atypical pneumonia.
At about that time, Ali Khan arrived in Singapore, serving as a W.H.O. consultant (seconded from the C.D.C.) to help organize an investigation and a response. He met daily with Suok-Kai Chew, the chief epidemiologist at the Ministry of Health, and along with others they developed strategy and tactics, getting governmental coperation through a SARS task force. The public-health strategy was isolation and quarantine. Before this outbreak, quarantine and isolation were not often evoked for infectious-disease outbreaks, Khan told meat least, not in the recent past. During the medieval plagues in Europe, infected unfortunates were sometimes sent outside city walls, to die or recover; the Mediterranean seaport Ragusa (now Dubrovnik) established a trentino, a thirty-day quarantine for travellers arriving from plague zones. In late-nineteenth- and early-twentieth-century America, during smallpox outbreaks, victims showing pox (especially if they were poor people or people of color) could be confined in quarantine camps, surrounded by high fences of barbed wire, or in nightmarish pesthousesnot so much to be treated but for the safety of the general populace. That was a concept that had sort of gone out of vogue, Khan told me dryly. He and Chew and their colleagues revived it in a more humane version.
For countries battling the coronavirus pandemic, Sweden sets a seductive example. While the worlds biggest economies have shut down, one small, well-governed Scandinavian country has allowed most businesses to stay open. The strategy apparently relies on herd immunity, in which a critical mass of infection occurs in lower-risk populations that ultimately thwarts transmission.
But the reality is not so simple for Sweden. Government authorities there seem to be for this strategy, then against it, then for it again if the data look promising. And its dangerous to assume that even if the strategy works in Sweden, it will work elsewhere. Leaders are grasping for strategies in a time of great uncertainty but the Swedish model should be approached with caution.
In Sweden, business is not actually proceeding as usual. Most travel and mass gatherings are not allowed, and some schools have been closed. But restrictions from government are considerably less severe than many other countries. Restaurants and bars are still functioning, some of them only with minimal distancing taking place.
The results have been mixed. Sweden has the highest fatalities and case count per capita in Scandinavia, but is lower than some of its neighbors to the south. Economic disruption has been significant but not as debilitating as other countries. In the capital, Stockholm, the nations top infectious disease official recently estimated that approximately 25 percent of the population has developed antibodies.
It is too early to tell whether the approach has worked. Stockholm isnt all of Sweden. And 25 percent of its population with antibodies is not cause for an immunity celebration. We dont know if that percentage is accurate because the data isnt available, the antibody tests still appear to be of uncertain accuracy, and we dont even know what a positive antibody test means. There is some optimism that most people who are infected will have some temporary immunity. But if immunity is short-lived and only present in some individuals, that already uncertain 25 percent becomes even less compelling. We also still dont know what total population percentage would be necessary to reach the herd immunity goal. It could be as high as 80 percent of the population.
Even if we had perfect knowledge of the Swedish case, there are huge risks with copying the strategy in a country like the United States. The American people are far less healthy than Swedes. They have significantly higher rates of diabetes and hypertension, two of the most-risky underlying conditions. Four out of every 10 Americans are obese. A herd immunity strategy in America would mean that many of these people would be on some form of lockdown for many more weeks, most likely months.
Moreover, the Sweden example demonstrates that a targeted herd immunity strategy doesnt do much to protect at-risk populations either. Deaths among the elderly in Sweden have been painfully high. In a more densely populated country like the United States, and with a larger proportion of vulnerable people, the human toll of a herd immunity strategy could be devastating.
But what about the economy? The choice is not between indefinite shutdown and Russian roulette. A transition needs to occur that balances the risks at play. From that perspective, Sweden is the future. But not because of a herd immunity strategy. Because a more targeted approach to social distancing can be deployed when the timing calls for it, when old-fashioned public health methods can foster a gradual easing of restrictions in a way that can be tweaked as we learn more and develop new tools treatments, understanding of immunity, testing improvements, and epidemiological data.
The key will be for countries not to let their guard down too soon. They must roll out a testing and contact-tracing infrastructure that will allow them to identify outbreaks early and isolate and quarantine as necessary. In the United States, this is a realistic goal if theres enough political willpower, fiscal firepower, and coordination. These things not Swedens experience should guide our next steps.
Ian Bremmer (@ianbremmer) is president, Cliff Kupchan is chairman, and Scott Rosenstein (@scottrosenstein) is special adviser on global health at Eurasia Group.
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Image caption Thirty of the 34 residents at Home Farm care home tested positive for Covid-19
A care home boss has insisted his firm has "nothing to hide" over a major outbreak on Skye that has cost the lives of three residents.
They were among 57 residents and staff at Home Farm care home in Portree, run by HC One, who tested positive for coronavirus.
Sir David Behan also revealed that 10 people died in an outbreak at another Scottish care home run by his firm.
They were all residents at Mugdock House in Bearsden, East Dunbartonshire.
Sir David, HC One's executive chairman, said nine patients were now self-isolating at the care home and three had recovered.
A spokeswoman for Mugdock House said they were supporting the families of those who died and "doing everything we can" to keep residents and staff safe "throughout these challenging times".
Speaking to BBC Radio Scotland's Drivetime with John Beattie, Sir David revealed that HC One, which operates 56 homes in Scotland, has had Covid-19 cases at two thirds of its sites in recent weeks.
He said: "This is a virus which disproportionately affects older people. I don't think the situation that we're finding is due to any questions about the quality of the staff."
The outbreak on Skye - the first confirmed cases on the island - was announced last week, and an Army mobile testing unit has now been sent.
Sir David said the firm - the UK's biggest care home operator - had taken steps to secure protective equipment and began restricting visitors to its premises on 13 March.
Sir David, a former chief executive of the Care Quality Commission in England, accepted that an inspection report in January had highlighted some problems with cleanliness and staffing at Home Farm.
But he insisted an action plan had been drawn up to address these problems and told John Beattie he was not looking "to hide anything here. This is a matter of public of interest".
However, he conceded it had been difficult to recruit permanent staff on Skye.
"In this particular home we have competition from tourism and other industries.
"We have increased salaries... to try to recruit but we've had a large dependency on agency staff because of the difficulty in recruiting staff," he said.
The firm has had to bring in staff from outside the island to staff the Home Farm site, from other homes that have been virus-free, as an increasing number of workers self-isolated.
He said guidance had been followed, but a major problem was that staff could have been asymptomatic and spreading the virus.
"The delay in rolling out comprehensive testing of both staff and residents will no doubt have contributed to the virus being present in care homes," he said.
The GMB union wants an inquiry into the scale of the outbreak at Home Farm - a call which was backed by Scottish Labour's Monica Lennon.
In the Scottish Parliament her fellow Labour MSP Rhoda Grant said one of her constituents had complained weeks ago that staff at Home Farm were not wearing personal protective equipment and staff were being brought in from elsewhere without a proper period of isolation.
Health Secretary Jeane Freeman said there was clear guidance in place on infection control, but not all private providers were complying and a more direct approach may be needed.
Asked about conditions for care workers, Sir David said he backed a wider reform of social care in future and much greater investment in staff, putting them more on a par with nurses.
"One of the issues this virus has exposed is the underfunding of adult social care throughout the UK," he said.
Residents are creating local solutions to help curb the spread of the virus. In Nigeria, tailors are handmaking protective gear like face masks and medical overalls. And in Kenya, even though schools are closed, one woman is providing food for schoolchildren from poor families. Now, in Ghana, a software engineering company, Cognate Systems, is using technology to track coronavirus symptoms and hotspots in the West African country. Using a platform called Opine Health Assistant, the company is able to record and track the frequency of coronavirus symptoms like a cough and high temperature in different parts of the country.
The Opine Health Assistant platform, launched March 26, collects information from residents about their possible coronavirus symptoms and location through a USSD short code, says Kwabena Nuamah, co-founder of Cognate Systems.
When you dial a number that starts with * and ends with # to top up your phone credit or make a bank transfer, you are using USSD.
"To use the platform, they have to dial the short code *920*222# or *714*444# on their mobile phones and then follow the prompts to answer questions about symptoms and other risk factors," Nuamah told CNN.
"It is free to use and users can make use of it on any type of mobile device they have, even without credit," he added.
It also asks if they need essential supplies such as food and shelter in the wake of the pandemic.
"When people fill the form, with the information they give us, we can analyze and predict if the person is likely to be infected by the virus. We can also use the location of those who have symptoms to predict new regions that are likely to get hit by the virus," he said.
Data collected from USSD is built into Opine Health Assistant, and information provided by the public on coronavirus is visualized on maps and graphs to make it easier to understand, monitor, and share.
Where does the data go?
According to Nuamah, the data collected will be shared with public health experts, data scientists, relief providers, and disease surveillance teams who are better suited to understand the information and can use it to provide local solutions to coronavirus.
Nuamah ays Opine Health Assistant is helping the country predict the next possible high-risk areas for the virus, so that it is better prepared to handle the pandemic.
So far, 6,000 people have used it.
"We have seen some patterns over the past days that we launched. We have seen that the spread of the virus in Ghana has been mostly within the Greater Accra Region and the Ashanti region," he said.
"From the data we got, we were able to see certain patterns to suggest that the eastern region would have cases of the virus next before it was reported. And almost 24 hours after predicting the spread of the virus in that region, about 16 reported cases were reported there," he added.
With the tool, he said, experts and disease surveillance agencies in Ghana can start preparing to contain coronavirus before it hits a particular region.
Providing essential supplies
Opine Health Assistant also links the public with agencies and nonprofit organizations that provide essential supplies and relief materials.
Part of the data collected at the point of filling the form generated by the USSD code is information on where a person lives and if they need essentials like food and shelter.
"For people who might need food or shelter, within the series of questions, there is a part that asks for their location. We pass the locations to relief providers who are in our databases like churches and NGOs," Nuamah said.
"If a person says he is in Accra, for example, and needs food. We share this information with relief providers in Accra so they can identify people in that region and match them with supplies," he added.
Nuamah says the team has been in touch with the government of Ghana and one of their goals is to get the Ghanaian government to use their platform to identify coronavirus symptoms and hotspots.
After the coronavirus pandemic, Opine Health Assistant will be used to monitor different diseases in Ghana, according to Nuamah.
"We are already thinking outside of the current pandemic. We want to, in the future, be able to give heads-up as to what type of viruses are coming from different parts of the globe. We don't want to be chasing cases after they have occurred, we want to be able to predict cases coming for different diseases."
Singapore is seeing a spike in coronavirus cases among its hundreds of thousands of migrant workers. Above, a volunteer from a nonprofit group talks to migrant workers now confined to a factory that was converted to a dormitory as part of the effort to contain the spread of COVID-19. Ore Huiying/Getty Images hide caption
Singapore is seeing a spike in coronavirus cases among its hundreds of thousands of migrant workers. Above, a volunteer from a nonprofit group talks to migrant workers now confined to a factory that was converted to a dormitory as part of the effort to contain the spread of COVID-19.
Early on in the coronavirus pandemic, Singapore was praised as a shining example of how to handle the new virus. The World Health Organization pointed out that Singapore's aggressive contact tracing allowed the city-state to quickly identify and isolate any new cases. It quickly shut down clusters of cases and kept most of its economy and its schools open. Through the beginning of April, Singapore had recorded fewer than 600 cases.
By the end of April, however, the case count exceeded 17,000. And not only is all of Singapore now under a strict lockdown, but it has the most coronavirus cases in Southeast Asia.
The vast majority of these cases are in the overcrowded dormitories that house more than 300,000 of Singapore's roughly 1 million foreign workers and the number of cases is expected to continue to rise in the coming weeks.
"We have started our testing with the dormitories where there were a high number of cases detected," Singapore's health minister, Gan Kim Yong, said in a virtual press briefing this week.
Singapore ordered a lockdown on April 7 in response to an uptick in cases in the general population and then began to find a significant number of cases in the dorms.
Gan says Singapore is now testing more than 3,000 migrant workers a day but hopes to expand that number. The virus is spreading so rapidly in the dormitories, however, that the Health Ministry hasn't been able to test all of the suspected cases.
"For dormitories where the assessed risk of infection is extremely high, our efforts are focused on isolating those who are symptomatic even without a confirmed COVID-19 test," Gan says. "This allows us to quickly provide medical care to these patients."
Singapore is a small city-state with a population of just under 6 million inhabitants. On a per capita basis, it's the second-richest country in Asia.
But its economy relies heavily on young men from Bangladesh, India and other countries who work jobs in construction and manufacturing. Singapore has no minimum wage for foreign or domestic employees. The foreign workers' salaries can be as low as US$250 per month, but a typical salary is $500 to $600 a month.
Speaking to the media, Gan credited extensive screening in the dorms with finding many workers who are infected with SARS-CoV-2, the coronavirus that causes COVID-19, but who didn't appear sick.
"So far, the majority of the cases here have had relatively mild disease or no symptoms. And they do not require extensive medical intervention," Gan said. "About 30% require closer medical observation due to the underlying health conditions or because of old age."
As of this week, only a handful of the migrant workers fewer than two dozen were in intensive care units.
The city-state is setting up thousands of what it calls "community care beds" in convention centers and other public buildings to isolate and treat coronavirus patients. The hope is that most of the cases can be managed by medical staff in these temporary wards, rather than in hospitals. So far the city has 10,000 community care beds and plans to expand to 20,000 by mid-June.
It's no surprise that the migrant workers are now being infected, says Mohan Dutta, a professor at Massey University in New Zealand who has done research on these migrant laborers. He says conditions in the dorms put the workers at significant risk of catching a respiratory disease like COVID-19. There are 12 to 20 bunk beds per room.
And even though some of the workers are deemed "essential," most are no longer allowed to leave the dormitories. "There is little room to move around. They have little room to store their things, which really contributes to this sense of the rooms being unhygienic," says Dutta.
Dutta, who founded CARE, the Center for Culture-Centered Approach to Research and Evaluation, at the National University of Singapore in 2012, with a focus on marginalized communities, has just published a paper on migrant workers in Singapore during this pandemic.
He says many of them told him they are concerned about whether they'll get paid during the lockdown (Singapore's Ministry of Manpower insists they will) and about the overcrowding and lack of sanitation facilities in the dormitories.
Dutta says that in many dormitories, 100 workers share a block of five toilets and five shower stalls.
Migrant workers in Singapore congregate on the balcony of a workers dormitory now being used as an isolation facility that houses a cluster of coronavirus cases. Edgar Su/Reuters hide caption
"There is this sense of panic and fear, and part of that is related to this sense of not being able to move outside of the room," he says. "Everyone is pretty much stuck in the room at such close proximity."
Singapore's Health Ministry has moved aggressively to try to address the coronavirus outbreaks in the housing blocks. The government is trying to find alternative accommodations for people in the hardest-hit dorms, but Dutta says it's impossible to come up with safe, short-term lodging for more than 300,000 workers.
But he does believe there could be long-term changes that would help the workers. And Dutta hopes this outbreak will force Singapore to examine how it treats this often overlooked population, bringing major changes in how foreign workers are housed and treated.
Meanwhile, the explosion of cases in Singapore over the last three weeks has remained primarily among foreign workers. For example, on May 1 there were 11 new cases reported among Singapore's permanent residents and 905 new infections among the workers residing in the dorms.
Michael Merson, the head of the SingHealth Duke-NUS Global Health Institute in Singapore, says it's unlikely the outbreaks in the dormitories will spill over to the rest of the city.
"There's very little mixing between the foreign workers and the rest of the population," Merson says. He's confident that Singapore's health officials will be able to isolate the infected workers and give them, in his words, "the best medical care possible."
Nonetheless, the Singaporean government has extended the lockdown for the entire city-state until at least June 1.
