Category: Covid-19

Nearly one in three licensed doctors in the United States is older than 60 years, an age-group particularly vulnerable to adverse outcomes from COVID-19, according to a study published today on the preprint server medRxiv. And New York and California, two hard-hit states, have the most older physicians.

"The physician workforce is not only at risk of losing time spent in clinical care due to these exposures, but at a personal risk from severe disease that requires hospitalization and is associated with high morbidity and mortality," the authors said, noting that 80% of deaths in China were in people 60 and older and that, in the United States, nearly half of hospitalizations and intensive care admissions and up to 80% of deaths have been in that age-group.

Because excluding doctors older than 60 from patient care would severely strain the medical workforce, the authors suggest limiting their direct patient care and expanding their telehealth capabilities.

The researchers extracted summary data from the 2018 Federation of State Medical Boards physician database on doctor age-groups overall and by state to identify those at high risk due to their age and determine whether it would be feasible to exclude them from the medical workforce for this reason.

They found that of the country's 985,026 licensed doctors, 235,857 (23.9%) are 25 to 40 years old, 447,052 (45.4%) are 40 to 60, 191,794 (19.5%) are 60 to 70, and 106,121 (10.8%) are 70 or older. Age was not reported in 4,202 (0.4%) of doctors.

Overall, 297,915 (30.2%) of physicians are 60 years and older. According to state reports, a median of 5,470 licensed physicians (interquartile range [IQR], 2,394 to 10,108) are 60 years or older.

North Dakota (1,180) and Vermont (1,215) had the fewest doctors 60 and older, while California (50,786) and New York (31,582) had the most. The median proportion of doctors in this age-group across states was 28.9% (IQR, 27.2%, 31.4%), ranging from 25.9% in Nebraska to 32.6% in New Mexico.

"We do not have information on the specialty expertise of physicians, as some physicians may be more prone to encountering patients with COVID-19," the authors wrote. "However, as many individuals in the community may be asymptomatic carriers, physicians across specialties are at risk of acquiring the disease as a part of the patient contact during care delivery."

They also noted that doctors may be licensed in more than one state and that the absence of data on their health status could change their risk levels.

Peter Buerhaus, PhD, RN, director of the Center for Interdisciplinary Health Workforce Studies at Montana State University College of Nursing in Bozeman and co-author of a commentary on older clinicians and coronavirus yesterday in JAMA, said in an interview that healthcare systems need to plan for how to deploy frontline staff in the crisis to ensure workforce continuity and robustness.

"It's time to think about what we do with our older workforce," he said. "Are there things we can do to keep them less exposed?"

While every system will be affected differently depending on outbreak severity and availability of resources, Buerhaus said that some older doctors, particularly in rural areas, may have no choice but to provide direct patient care, exposing themselves to the virus and potentially reducing patient access to care where it is already limited.

But in less hard-hit areas or in hospitals with sufficient resources, it might make sense to have older physicians deliver telemedicine to keep more patients at home and out of the emergency department, as well as protect themselves. "Patients are told 'stay home,' but they may have questions," he said.

Older physicians could also coach less experienced doctors in making the difficult decisions they may face in the pandemic, or be a community resource. "Getting a well-known, respected physician in front of the community can be very powerful," he said.

Buerhaus added that hospital executives need to understand that the death of an older, established healthcare provider not only will result in the loss of that doctor's knowledge and ability to nurture future providers, it can also devastate hospital staff. "If you lose a beloved physician or nurse in an organization, that hurts, and it can have a very harmful effect on morale," Buerhaus said.

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Because of age, third of US doctors prone to worse COVID-19 - CIDRAP

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 ...

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Update: Coronavirus Disease (COVID-19) - The Mr. Cooper Blog

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

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29 March 2020 Statement Information sharing on COVID-19 - World Health Organization

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.

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Why It Takes So Long To Get Most COVID-19 Test Results - NPR

The first infant death related to COVID-19 in the United States has been reported in the Chicago area today (March 28).

"There has never before been a death associated with COVID-19 in an infant," said Dr. Ngozi Ezike, the director of the Illinois Department of Public Health (IDPH). "A full investigation is underway to determine the cause of death. We must do everything we can to prevent the spread of this deadly virus. If not to protect ourselves, but to protect those around us."

The age of the infant, who lived in Cooke County, has not been released. This isn't the first death in an infant confirmed to have COVID-19. In China, a 10-month-old with the disease, died 4 weeks after being admitted to the Wuhan Children's Hospital, according to a March 18 report published in the New England Journal of Medicine.

Related: 13 Coronavirus myths busted by science

Though as the pandemic unfolds, doctors are realizing that no age group is immune to the virus nor to its severe health effects, the disease caused by the novel coronavirus still appears to be more severe in older adults.

More than 85% of COVID-19 deaths in Illinois have been in patients aged 60 and older. And across the U.S., even though 31% of confirmed COVID-19 cases occurred in adults ages 65 and older, this age group represents 45% of hospitalizations, 53% of admissions to the ICU and 80% of the deaths, according to the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report on March 26.

Currently, Illinois has confirmed 3,491 COVID-19 cases and 47 related deaths in 43 counties. The ages of those infected, range from younger than 1 to 99 years, the IDPH reported.

Originally published on Live Science.

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First US infant death linked to COVID-19 reported in Illinois - Livescience.com

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).

43.038902-87.906474

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1,059 confirmed cases of COVID-19 in Wisconsin, 15K+ test negative - WITI FOX 6 Milwaukee

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?

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My Whole Household Has COVID-19 - The Atlantic

With much of the world on lockdown due to the spread of COVID-19, the last week has seen many city dwellers realise that they may be restricted to one place for a relatively prolonged period of time.

Rural areas from the U.K. to the U.S. have reported a dramatic increase in arrivals looking to self-isolate around nature.

However, the message from many is clear: we are closed to guests.

Just last weekend, the Snowdonia National Park in Wales experienced their busiest day in history. ... [+] Other villages in Wales have been erecting signs that tell tourists to return home due to COVID-19 travel and isolation restrictions imposed by the government. Narrow country road, Gwynedd, Snowdonia National Park, North Wales, UK. (Photo by: Education Images/Universal Images Group via Getty Images)

Just last weekend, the Snowdonia National Park in Wales experienced their busiest day in history. Other villages in Wales have been erecting signs that tell tourists to return home due to COVID-19 travel and isolation restrictions imposed by the government.

A spokesperson for Snowdonia National Park said: "Specific guidance is needed on what 'necessary travel' actually entails. We also call on all visitor and holiday owners to heed government advice and avoid all but essential travel, and to stay at home to stay safe.

BRECON, WALES - MARCH 28: A sign on the A470 near Pen y Fan warns motorists to stay at home to save ... [+] lives on March 28, 2020, in Brecon, Wales. Last weekend the area was busy with walkers. The Coronavirus (COVID-19) pandemic has spread to many countries across the world, claiming over 25,000 lives and infecting hundreds of thousands more. (Photo by Matthew Horwood/Getty Images)

With people seemingly trying to escape to rural areas in the U.K., the governments message has remained clear and firm: to stay at home unless strictly necessary to leave.

Derbyshire police have gone a step further and actually dyed the well-know Buxton Blue Lagoon the color black, to deter tourists from visiting.

Luxury properties in the countryside around the world have seen higher demand for the Easter period with city-dwellers moving to rural retreats during lockdowns.

In the Hamptons bookings for family homes have been reported to have increased ten-fold in the last two weeks, mostly driven by residents fleeing New York City.

Derbyshire police have gone a step further and actually dyed the well-know Buxton Blue Lagoon the ... [+] color black, to deter tourists from visiting.

With the Easter holidays approaching, demand for rural retreats has seemingly been one area of the travel market that has fared relatively well with lockdowns in place. One of the greatest testaments to globalization in 2020 is the fact that supply chains have remained robust and open despite the wider situation. Even with many people temporarily isolating in rural areas, there seems little concern about delivery and availability of essential items including groceries.

The message from governments, however, has remained clear: stay at home. With towns in the U.K. and the U.S. pushing back against new visitors, the same message is echoed even down in Australia.

The seaside town of Robe which lays close to the South Australian state border has also encouraged people not to visit during lockdowns. The towns mayor noted an increase in older travelers that are stretching the resources of a destination that has just one doctor and one clinic.

NEW YORK, USA - MARCH 28: Time Square is seen empty in New York, United States on March 28, 2020. ... [+] New York's famous Times Square has been on sleep due to the new type of coronavirus (COVID-19) pandemic. (Photo by Tayfun Coskun/Anadolu Agency via Getty Images)

In Scotland, East Lothian has also reported that their seaside town is becoming an isolation hotspot. The rural setting is just 30 minutes drive from the city of Edinburgh and locals have reporteda similar influx of visitors that are waiting it out.

Scotlands First Minister, Nicola Sturgeon,addressed these concerns directly in a statement. She urged people to practise social distancing and said: It may well be an understandable human instinct to think we can outrun a virus but the fact is we cant. What we do is risk taking it to the places we go. And in our remote and rural communities that means extra pressure on essential services and on health services that are already more distant from people.

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People Have Been Flocking To Rural Areas During COVID-19 Lockdowns - Forbes

Since 2004, when David Chang helped to reconfigure the dining establishments ideas about what a great restaurant could be with Manhattans Momofuku Noodle Bar, he has opened more than a dozen restaurants around the world; hosted two seasons of his Netflix documentary series, Ugly Delicious; started a hit podcast, The Dave Chang Show; published the defunct, much-loved food magazine Lucky Peach; and now written a memoir, the forthcoming Eat a Peach, with a co-author, Gabe Ulla. In doing all that, Chang, 42, has become a food-world icon, broadened the countrys palate and made us more thoughtful about what we eat. None of which is much help with moving forward in the wake of the economic destruction that the coronavirus has wrought in the culinary world. Im not being hyperbolic in any way, Chang said about the future of the field in which he made his name. Without government intervention, there will be no service industry.

Can you describe the state of things on your end right now? Were still trying to sort that out. We made the decision to close our restaurants before it was mandated, and were currently in the process of trying to figure out the best way to help our employees. Im not being hyperbolic in any way: Without government intervention, there will be no service industry whatsoever. Theres so many people that work for me whom I am incredibly concerned about. Where are they going to get their next meal? Do they have health care coverage? How are they going to pay their bills? But this is the way Ive been weirdly internalizing it: Its as if aliens came from outer space and decided to totally destroy restaurants. I wouldnt be like, I cant believe I didnt see this coming. In some way coronavirus is an invisible enemy that we could not have anticipated. No one could have.

What needs to happen next for restaurants? We may be headed for the worst-case scenario. Even with more government intervention, Im afraid that its not going to be adequate for the people who need it the most. I feel like its the polar opposite of 2008, when they helped the big banks and insurance companies because they had to or the world as we knew it would end. And now, in 2020, were talking about nonessential businesses and people who dont have the clout to be able to speak to the government. I have a hard time seeing all the mom-and-pop shops getting help from the government.

Ideally, though, what would that help look like? More than anything, David, I do not want to incite panic and hysteria, but I think for restaurants and the service industry, there is going to be a morbidly high business death rate. My fear is the restaurants that survive are going to be the big chains, and were going to eradicate the very eclectic mix that makes America and going out to eat so vibrant and great. And there is a lot of feeling that even in good times, if chefs cant make their numbers, theyre going to lose everything, so imagine what they must be feeling now. When the economy is booming, its hard for restaurants to get loans from the bank because theres no assets to back them. I dont know if its going to be feasible for the government to give out a stimulus loan to a restaurant or restaurant groups the way they were able to do in 2008 to the auto companies. So Im trying to figure out what the best way is. The government should give a greater bailout package to real estate owners so that there can be relief for restaurant owners. It has to move up the chain.

Chang at Momofuku Ko in 2012. Gabriele Stabile

And the hope there would be that bailing out real estate owners would give restaurants a little bit of financial breathing room? Correct. Most restaurants dont own their real estate, so if they are going to get help, its going to entail helping out the landlords and lenders who are higher up the chain. Then the next thing to help the restaurants out would be an amnesty of accounts payable and bills. I dont know how that plays out. This industry has a trickle-down effect in the sense that you have purveyors, you have farmers, you have delivery people. Its a massively intertwined, connected system. So if a restaurant cant pay its bills, thats a problem, but we need to figure that out. There are so many restaurants in different scenarios, from ones that do $70 million a year to $5,000 a week, and every one of those restaurants is going to need help because the burn rate per day is astronomically high. We have ingredients that if you dont sell, they literally deteriorate. Its the most exposed business. Theres a lot of successful chefs I know who have five to nine days left of money. And then what do you do? I dont know. Lastly, I think every hospitality worker should get universal basic income of $1,000 a month or minimum 500 bucks or whatever to stay afloat. On top of that, they all need to have some kind of health care assurance. Something like that probably has to happen. But I dont expect the government to actually come through on any of that.

I saw that the White House had a call with representatives from the restaurant industry, and it was McDonalds, Papa Johns All of Trumps [expletive] that he eats on a daily basis.

Do you have any reason to believe the White House will be responsive to independent restaurant operators? This is why it matters what you eat! I get really mad about this because of how Trump talks about immigrants, Mexicans, Chinese anyone thats not in his circle, why would he care about them? If he doesnt care about them as human beings, why would he care about the food that they make? But listen, if he decides to actually help out everyone, it may be the only time in my life I want to give him a hug and a kiss. If Momofuku and restaurants like Le Bernardin and Daniel Bouluds and Danny Meyers are exposed and in high-trouble situations, I cannot imagine the fear of someone who just opened up a restaurant or some immigrant who came to this country five years ago who just opened up a pizza shop and this is their American dream.

What about people who want to help the restaurants they care about? Is there anything they can do? Call your representatives. Were going to need to have our leadership make decisions for people whose vote they might not always represent. And support any restaurant thats doing delivery. The short-term solution is to buy as much as you can from a restaurant. If this thing goes as bad as its going, the landscape is going to be forever changed. Its going to be a whole new world.

Is there a sustained move toward delivery and away from in-restaurant dining in that new world? Yes. Not to sound callous, but thats it. I thought that shift was going to happen over the next 10, 15 years, and no one would have noticed because it wouldve happened gradually. This change is now going to happen instantaneously. Im not sure what that looks like. The same issues of delivery are going to remain: who delivers food and what kind of food is delivered.

Youve talked on your podcast about how food delivery is already changing insofar as more people are trying to deliver good-quality food thats not just pizza or Chinese. What would that change being accelerated mean for the restaurant business? I see the complete destruction of the midmarket restaurant, the mom-and-pop restaurants. If delivery can be a model that is viable and people can work fewer hours and have better balance, then it is something that we should explore. Im really worried for this industry. Sometimes cooks have gotten into this being sold a false bill of goods. No ones told you whats going to happen at the end of the rainbow. There is no rainbow. Its like glamorizing being an oil-rig worker or a coal miner. Yes, there is beauty and success, but for the most part cooking is a hard job, and it bothers me that theres not a better way to do it.

Chang with the scholar Psyche Williams-Forson on an episode of Ugly Delicious. From Netflix

What could be better? With delivery, you have two completely different worlds: the tech world and the restaurant world. The tech world is all about scaling and throwing money at something. But you cant fully automate cooking. Maybe someone will. Im worried about what that looks like. Would I like to be at home and be like boop, press a button and get something delicious delivered? That would be amazing, but it also scares me. Were not supposed to live this way.

You mean with the expectation of near-instant gratification? Yeah, if we just think about meat maybe it needs to be extremely expensive, and if it is expensive, were probably going to treat it how the Japanese cook their beef. Very thinly, very delicately, and eating it is a celebration. As humans, we dont want to suffer. Its not in our DNA. Its natural that we want to enjoy immediate gratification, and that has [expletive] everything up. Even steakhouses today, theyre getting the aging room removed because people dont want to see the meat. They used to trolley out the meat to people. Now thats gone. We dont want to be reminded of suffering. Just bring me the food. People dont even know where their food comes from, and that is a metaphor for a lot of our problems.

Its indisputable that lots of Americans are now open to foods that maybe they werent open to in the past, which seems like an obvious positive outgrowth of the rise of interest in food culture in this country. Has there been any downside to that rise? Its weird that in the history of the world, no one has ever known more about food than this generation. I talk to younger people that know different kinds of kimchi. That never stops boggling my mind. So what do we do with that knowledge? Its got to be two schools. You need the people who are going to try to maintain tradition. You have people cooking food who are artisans. Like Anthony Mangieri at Una Pizza Napoletana. Theres something religious about that. I admire it more than anything in this food world, to be like a Dom DeMarco. But then we have all this other stuff, and everyones doing the same. We should be seeing the most insane things. Were still a conservative steak-and-potatoes country, and that bums me out. Theres less risk-taking. Thats OK if you want to be a craftsman, but theres fewer people that want to do that, too.

What would the alternative to a steak-and-potatoes country look like? Every country has its staples. Thats a great question. I guess for me its: How do we find openness? So much of my life is because of the hell I experienced as a kid. A lot of it was like, as silly as it seems, Oh, Chang, you eat dog, or you eat poo, or your house smells. All of these things. What bothers me about steak and potatoes and I love steak, I love potatoes, I love them together is when people dont want to try anything else. That myopic viewpoint scares me. If I learn to appreciate something, then it better allows me to understand someone elses culture.

Whats the connection between more people being interested in food culture and the risk-aversion you just mentioned? When we talk about food, it almost always is about how awesome it is, how accessible it is. But how do you get to a place where it has meaning? Having so much accessibility maybe dulls our ability to appreciate things. I think about moments that are real, like when I had my first fresh-squeezed orange juice. I grew up with that frozen stuff. Then you taste fresh-squeezed, and you realize, this is orange juice. But that was a rarity. Now its something you could have every day. That accessibility were not supposed to have everything.

Momofuku Noodle Bar in New Yorks East Village in 2012. Gabriele Stabile

Do you think you still have innovations left in you? Well, yeah. What I want to get better at is making sure that I can prepare other people so they can tell their stories. That process is so hard, and in some ways, all I want to do is take that struggle away. I also realize that would be, like, the worst form of parenting possible. I had an argument with my mom this is a tangent. My mom got mad at my wife and me. She was like, Hugos crying. Why are you not going into the room? She came from the generation that was anything the baby needs, youre there. But Grace and I were huddled in the room next door looking at the monitor: Should we go in? Should we go in? This is the worst. This is the worst. Im going to go in. No, you cant. Being there but not intervening thats so hard.

According to your own memoir, you were a horrible boss for a long time. Absolutely. I was immature and a total jerk, and I developed a giant ego. I want to beat the [expletive] out of myself for not being better. This is what years of therapy have been about. I cant get mad at myself for not being perfect as much as I will continue to be mad at myself.

The macho, hotheaded behavior that you thought was acceptable in kitchens was that the result of your having bought into the whole myth of the swashbuckling genius male chef? Youre taught in kitchens that anything short of excellence is unacceptable. The only thing that matters is to make it perfect. So what are you supposed to do when youre told this is how youre supposed to run a kitchen? There were certainly people that were like well, thats stupid, but I didnt have that insight. And how I was raised: You suck, you suck, you suck. I do better when Im getting yelled at. Ive been yelled at my entire life. I have been conditioned to work better when getting yelled at. This may be completely inappropriate to make the comparison, but its like if youre stuck in a religious household, how are you supposed to know that something else exists?

You frame things in somewhat similarly paradigmatic terms when you talk in your book about #MeToo and the food world, including Mario Batali. Your conclusion was that you werent sure if you were ignorant or wanted to be ignorant. But Im wondering if you could revisit that question now: Why did you miss the signs? When I think about Mario or Ken, I felt like I was a freshman in high school and these were the seniors. Like: This is how it is. Im wrestling with all of this. Mario was one reason why Momofuku didnt go out of business. He would come in for lunch with politicians, businesspeople, celebrities, artists. But why didnt I say something when there was a joke or connect the dots? Its been a lot of processing. We have to hold ourselves accountable.

Have you taken steps to do that? A couple of years ago, you were the subject of a pregnancy-discrimination allegation. Right.I was so busy trying to be right that I wasnt looking at how to make things better. I was a [expletive].

Are there specific things that you implemented or can point to in terms of making your workplaces more inclusive for women? I think that weve just tried to build the best company possible. I want to build the most inclusive workplace possible. Thats a goal that we all should strive for and that we need to get better at. I think that were doing our very best, and I dont know what else you can say about that.

Chang with the actor Seth Rogen in the Netflix series Breakfast, Lunch & Dinner. From Netflix

But does doing your best translate to specific policies that youve implemented? Obviously we do everything we can with policies. To me, were reverse-engineering it. How do you get a place where people like when theyre at work and dont speak negatively about the place with their friends? And instead theyre like, This is great! Thats the goal, and making it inclusive and making it equal. That has to happen.

In your book, you talk about having had suicidal thoughts. Do you still have them? Um, a lot. I dont think theres a day that goes by where it doesnt happen. Its what I talk about with my doctor. Its weird to verbalize this not to my shrink but to you. Its just more, like, existential dread. What Im working on right now is what happens when at some point you dont want to push the boulder up the hill anymore. I worry about that day, and what happens when a lot of your heroes call it quits, whether its Tony Bourdain or Dave Berman. The way Ive determined a lot of happiness is weird. A lot of this is Camus: Happiness is saying no. I refuse. What I worry about is what happens if I dont want to do that anymore. Yes, there are rich relationships that I have, and I would do anything for my family but my depression is like an A.I., and its constantly getting smarter as I become more aware. The thing that happens when people get depressed is all you do is think about yourself in relation to the world because you have disassociated from everything else, and then it starts to destroy your sense of worth, your sense of identity. Ultimately I get through that, and I can center myself. Everythings telling you to stop, but you have to never give up. You have to pick yourself up and find some baseline. I know it sounds crazy, but you just have to push through.

Is cooking something that can help with these problems? I think people have lost the idea of why someone cooks for someone else: I want you to feel good. I want you to eat something delicious. I may not even know you, but heres a bowl of love. The other day, I made Hugo sockeye salmon. I shredded it, and then I blended spinach and broccoli with a little butter. Ive never cooked at home in my life. Ever. Being able to do that has been like, oh, this is what cooking should be.

What food is giving you comfort? Snow pea shoots with garlic and some chicken broth and a bowl of rice. I put a little MSG in it, and it was great. So right now its been a lot of snow pea shoots and its a lot of oxtails with broths and soups. I just cook like a grandma now. I would love to have a restaurant where it feels like youre at home. How do you open a restaurant where youre just giving people that?

David Marchese is a staff writer and the Talk columnist for the magazine.

This interview has been edited and condensed for clarity from three conversations.

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David Chang Isn't Sure the Restaurant Industry Will Survive Covid-19 - The New York Times

For the poor, work has dried up entirely, and so those migrant workers who could sought to beat the lockdown by heading home in huge numbers. Since the restrictions came into force, buses and trains have stopped ferrying passengers across the country, leaving them to walk, often for days, with their families back to their towns and villages.

Again, the authorities callousness has been on display: In one heartbreaking video that went viral, police in the northern state of Uttar Pradesh force young boys to perform frog jumps as punishment for violating the curfew. Another video shows police waiting outside a mosque in the southern state of Karnataka, beating worshippers with a stick as they leave. Similar cases of police brutality have been reported around the country, and social media have filled with messages of people running out of food yet afraid to leave their dwellings, fearful of the police.

All of that is to say nothing of the medical disaster that may well await India, one I am familiar withI have covered health care in India for 17 years, and was previously the health editor of The Hindu, one of the countrys biggest newspapers. As the government focused in recent months on passing the controversial anti-Muslim law, stoking protests and eventually communal violence, crucial time to prepare for this pandemic was lost. The World Health Organization warned on February 27 of a coming disruption in global supply chains, advising countries to create their own stockpiles of the personal protective equipment that medical workers would need. The Indian government waited until March 19, however, to finally issue an order prohibiting the export of domestically made PPE, and a further five days to ban the export of respiratory apparatuses. There are more such delays: Only last week did the government finally allow health-care workers treating patients suffering from COVID-19, the disease caused by the coronavirus, to be tested; it also only recently began testing those without a travel history, a long-overdue implicit admission that the virus was being transmitted locally; and it has just issued notices to private hospitals to submit tallies of the number of intensive-care beds and ventilators available and to cancel nonessential surgeries, and directed facilities nationwide to ensure those suffering COVID-19 are neither stigmatized nor turned away. Even the measures the authorities have taken have had unintended consequences. The lockdown, for example, bars factory workers from going to work, leading to a shutdown of the medical-device industry, and prevents truckers from transporting materials and stocks to hospitals.

There is, unfortunately, good reason to believe that all of this will not be enough. For one, India is still not testing enough people, having conducted the fewest number of tests of any country with confirmed cases of the coronavirus, at just 10.5 per million residents (South Korea, by contrast, has conducted more than 6,000 tests per million residents). That private laboratories are allowed to charge $60 per testremember, just $7 a month has been offered as income support for some residentsmeans significant barriers to confirmation and treatment remain in place. (The government argues that because of the size of the population, widespread testing is not feasible.) The authorities are also not meticulously contact tracing, people are fleeing isolation centers, and measures such as self-quarantines and social distancing are impractical in a country where much of the population lives in dense clusters in overcrowded megacities. Whereas the WHO recommends a ratio of one doctor for every 1,000 patients, India has one government doctor for every 10,000, according to the 2019 National Health Profile. A 2016 Reuters report noted that India needed more than 50,000 critical-care specialists, but has just 8,350. In short, the countrys health-care system is in no position to cope with an avalanche of patients with a contagious respiratory infection in the manner that China and Italy have been doingIndias continued inability to deal with the epidemic of tuberculosis speaks to that struggle.

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The Callousness of India's COVID-19 Response - The Atlantic