But – a simple word said by epidemiologists cannot be stressed enough – this initial indication, though promising, cannot be interpreted as meaning that all will be well in the first days of summer. Although President Donald Trump tweeted Monday about the light at the end of the tunnel, warnings from scientists and other government officials conjured up a very, very long tunnel.
In the Chinese city of Wuhan, where the corona virus appeared in public in December, months of stopping locking out made residents take a small step towards some version of normality. In Italy, where the next wave of viruses has killed more than 17,000, a delayed but committed commitment to staying inside has greatly reduced transmission rates.
And in the United States, the death toll, which is now growing by more than 1,000 per day, continues to increase, with the last few days of the country being the deadliest so far in this pandemic. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said on Wednesday at Fox News that he was beginning to see “some hope,” such that he expected earlier projections from 100,000 to 200,000 viruses. Related deaths will be reduced.
Even in New York City, now a terrible epicenter where hundreds of people continue to die every day, officials cite slowing hospitalization as proof that social distance and other modifications – no exception to the closure of the spirit and economy of the city – work.
“We are leveling the curve,” Governor Andrew Cuomo of New York said Wednesday, a day when the country reported more than 700 deaths. “Thank you God. Thank you God. Thank you God.”
No doubt, frightening developments continue to emerge in many places throughout the United States, and scientists and political leaders warn that the picture is shifting day by day. At the center of the causes of angry optimism is a flash of new misery.
In Wayne County, Michigan, which includes Detroit, 192 deaths have been announced this week. In Mahoning County, Ohio, which includes Youngstown, the number of deaths increased Wednesday, to 28 from 19. In Illinois, state officials reported 82 additional deaths, many in the Chicago area. And near Louis, where cases and deaths have increased rapidly, the Missouri National Guard turned a hotel into a place of care that is ready to receive patients next week.
However, experts say, there are tentative signals of collateral. The reason is quite elemental, according to Ashish Jha, director of the Harvard Global Health Institute: “At a very simple level, you cannot give viruses to other people if you are not physically close to them.”
Home stay orders almost stopped traveling for most Americans in late March, an analysis of anonymous cellphone location data by The New York Times found. Americans in most Northeast, Northwest and West regions obey orders from state and local officials to stay at home, data shows, but delays in enforcing those orders in other areas, including the Southeast, have the potential to reduce the impact of measures socially alienating them. .
Staff at the Vi senior complex in La Jolla Village gather to exclude quarantined residents on their balconies to have fun and exercise during the coronavirus outbreak (COVID-19) in San Diego, California, USA, April 8, 2020. REUTERS / Mike Blake
“This is just mathematics,” said Natalie Dean, assistant professor of biostatistics at the University of Florida. “If people dramatically reduce the number of people who interact with them, it will reduce the spread of disease.”
“This type of strategy has worked,” he added.
But many variables that play a role – starting with the unpredictable nature of the virus – demand that the success of this strategy be placed in context.
In the United States, there have been decisions by several states not to enforce residence orders; fear that warmer weather will lure people to socialize; and, in particular, low and inconsistent availability of tests, a fundamental tool in tracking disease and preventing spread.
“What we have seen in the short term is that very stringent actions, which have many social impacts, have been effective in reducing the rate of growth,” said Joseph Lewnard, assistant professor of epidemiology at the University of California, Berkeley.
“Unfortunately, the smoothing curve that we see today does not necessarily paint a beautiful picture of reopening society as it was before the epidemic,” he said.
Without a vaccine, any progress is fragile, temporary. The act of social distance cannot continue forever. And if they relax without careful testing and isolation of new patients, the researchers say, the number of infections and deaths is likely to soar again.
Lewnard and Jha say months can pass before Americans will be able to return to their pre-pandemic lifestyle from the infinite movement. Even at that time, they said, such returns should be done in stages, with the government still wary of the signs of the plague.
“I can imagine from May to June, we might see things open 25 to 50%,” Jha said. “We might reach 70 to 80% in the summer but there are no big gatherings, no baseball games, no very crowded beaches.
“We must experiment.”
What Jha envisioned for the United States in a few months is where the city of Wuhan is basically now – largely because of the cruel actions taken by the Chinese authoritarian government, including the requirement that people with mild symptoms even be transferred to mass quarantine locations.
In December, doctors at Wuhan Hospital sounded alarms about diseases such as mysterious pneumonia, only to be reprimanded for spreading rumors. The Chinese government finally took action but only after a significant delay in overcoming the virus and informing the public about the possibility of transmission from human to human.
Wuhan, a city of 11 million, is locked, as is the surrounding Hubei province, with nearly 60 million residents. About the only hive of human activity is an overwhelmed hospital, where there are too few test kits for too many patients, which in turn infects others, including health workers.
Across the country, the imposition of Mao-era social control restricted the movement of citizens and slowed the economy to a near standstill. However, the most severe measures were applied to Wuhan, where sick and potentially affected people were separated from their families and sent to mass quarantine centers and isolation sites.
“The most important thing is not lockdown,” said Xihong Lin, a professor of biostatistics at Harvard University who recently took part in a paper that examined the government’s epidemic response in Wuhan. “The most important thing is removing the source of infection from the network so that family members can be protected.”
Paul Fragoso and his daughter Amber Fragoso sit on a window sill while practicing social distance to help slow the spread of coronavirus (COVID-19) in Cave Creek, Arizona, USA, April, 2020. REUTERS
On Wednesday, the corona virus has officially made 81,865 sick and killed 3,335 in China, even though the country has been accused by US intelligence officials of reporting very unreported epidemic statistics. In addition, extreme government action is not perfect at all; mismanagement of living costs, and their impact on the economy and mental health has not been determined.
However, experts agree that China’s rapid and cruel actions stem the invisible waves. “Every country can use the Wuhan experience and adapt it to its own situation and culture,” Lin said.
On Wednesday, when unfettered Wuhan stepped hesitantly toward its changed future, a commentary published by Xinhua, the government-run news agency, celebrated city determination and hard work through the epidemic – but noted that “careful blocking – the heart is far from the final victory. for health threats. “
From Wuhan, the coronavirus moved with the greatest intensity to Italy. Once again, delays in carrying out social forms that fully involve deadly consequences.
When a man in the Italian region of Lombardy tested positive for the virus, on February 20, he might have infected many people, including those at the local hospital. Three days later, health officials discovered a seemingly unrelated outbreak.
The north of the country began to close schools and museums and set a curfew in bars, while at the same time some politicians in Rome convinced the world that Italy was safe to visit and that only a small percentage of Italians had a virus.
That soon changes. While some responsible for debating and hesitating, the virus has become a big fire, with hundreds of cases multiplying to thousands. As the government closed down the entire country – an unprecedented lockout for Western democracy – on March 10, a wave of infections flooded the overwhelmed northern Italian health system, forcing doctors to make god-like decisions about which patients they were trying to save and which should be removed from respiratory equipment.
For the most part, Italians remain at home, because mortality is increasing every day by hundreds of people. And in early April, its restrictive measures appeared to slow the rate of transmission. On Tuesday, officials reported the fewest number of new infections since the first days after national closure.
Now the Italian government is preparing for a slow and measurable reopening. Schools will likely remain closed until September, and leaving home may depend on test results.
“This is an extraordinary result,” Italian Health Minister Roberto Speranza said on television late Tuesday, after the latest statistics showed that transmission rates had dropped from one person infecting around three people to one person who only infected one person. “Those steps worked, and finally we can start planning for the future.”
But he stressed that Italy could not reduce its guard. “It takes a little to ruin the work we’ve done so far,” Speranza said. “It just takes the wrong time, wrong behavior, a little bright – excessive optimism.”
After Italy, the world’s coronavirus hot spot became the state of New York, where 6,268 have died in a pandemic, including 779 in one day this week. While most of the deaths – more than 4,000 – have occurred in unusually quiet New York City, hundreds have been reported on the outskirts of Westchester and on Long Island, and officials say that others may be dying at home, not counted as victims virus. .
Typically, workers from the city’s Chief Medical Examiner’s Office arrive within a few hours to collect corpses. Now the wait can be for 24 hours, according to Lieutenant Edwin Raymond, a police officer who works in northern Brooklyn and who has responded to nine 911 calls involving bodies in six days.
Ambulance sirens have become the city’s soundtrack when deaths have surged, Raymond said. “These things – from coughing to fever to being pronounced within a week.”
Among the possible reasons for the high numbers, experts say, are the high population density in the city and the protracted time before a home stay order takes effect. “You only have a bad hand to get started,” George Rutherford, a professor of epidemiology at the University of California, San Francisco, told a reporter who called him from New York City.
During his daily press conference on Wednesday, Cuomo did not minimize the horror of death on such a scale, when even the basic rituals of mourning had been canceled. That’s why he said he had “mixed emotions” over the news that the number of hospitalizations had fallen in the past few days, indicating that social distance measures, at least for now, leveled the arc of infection.
“If we stop what we are doing, you will see the curve change,” Cuomo said.
A very good quality governor’s sense of progress is shared by Jeffrey Shaman, a professor of environmental health science at Columbia University who advises New York City.
Medical workers move corpses from refrigerated trucks outside Montefiore Medical Center in New York, April 4, 2020. (Kirsten Luce / The New York Times)
“There is some room for some optimism on this front,” Shaman said. But he also warned that “we must not be excited and not advance from ourselves,” and said that in two weeks’ time it might be possible to say whether the New York curve cannot be denied flat.
The professor looked for the right term to describe his state of mind before deciding “patiently optimistic.”
Elsewhere in the country, where people are struggling or preparing to face their pandemic, government officials stress the need for social exclusion by citing statistics that are simultaneously disappointing and convincing.
In the state of Washington, where in February the virus raged through a nursing home in Kirkland, eventually killing 37 people, the spread rate has begun to decrease, and some comfort is taken that the number of deaths does not increase as fast as stated.
Over the weekend, Governor Jay Inslee reported that the state returned ventilators provided by the federal government. And on Wednesday, he announced that an Army field hospital that had been built by the federal government next to CenturyLink Square in Seattle would be removed, now concerns about hospital capacity had diminished.
“These soldiers took their lives to help the citizens of Washington when we really needed them,” Inslee said. “Since then, it has become clear that other countries need them more than we do.”
Further evidence of the impact of social distance is found in California, where many states are moving earlier to impose orders to stay at home and where researchers have reduced their projected death rates. The country now lends hundreds of ventilators to other places in need.
Governor Gavin Newsom on Tuesday even called “a sense of optimism” that the country had kept infection rates below levels that would make hospitals ill.
Reducing optimism is the sheer number in California – 17,000 cases of the corona virus and at least 440 deaths – and predictions by state officials that the wave of infection will continue. Mark Ghaly, secretary of California’s Agency for Health and Human Services, said the state summit will come in late May.
With so much uncertainty about the way the corona virus is playing – in good measure because so little actual testing has been done – city and state leaders have used the tangible effects of social distance as a way to raise expectations and mobilize their communities to stay on course.
In Detroit, which has reported more than 5,800 cases and more than 250 deaths, hospitals cannot handle the number of sick people and the convention center has been turned into a field hospital. Hundreds of civil servants have been quarantined, and thousands of health workers have tested positive for the virus. Fear throbbed through the empty city streets.
But Mayor Mike Duggan on Tuesday reported what he called “the first light” – an indication that social distance was slowing the city’s death rate.
He seemed to channel Winston Churchill in his candor and certainty.
“We will lose many of our neighbors in the coming days,” said the mayor of Detroit. “It will get worse before it gets better. But we can defeat this if we continue to do what we do. “
c.2020 The New York Times Company
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