Covid-19 Chaos Breeds Impatience, But It’s Only Just Begun

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The world learned Friday that U.K. Prime Minister Boris Johnson — whose own reluctance to act quickly against the Covid-19 threat had been widely criticized — has himself been infected by the novel coronavirus. It was the latest installment in what can sometimes feel like an hourly push-and-pull of narratives — with some officials agitating for a return to normal, while other experts insist that the crisis is really only getting underway in many parts of the world.

The radically divergent views of what the future of the Covid-19 pandemic might hold were on clear display in the United States, where President Donald J. Trump predicted this week that the country would be back to work by mid-April. One of the president’s close allies, Liberty University president Jerry Falwell Jr., confirmed that the evangelical Christian school in Virginia would be open to students coming back from their spring break. (All classes will be held online, but many students and faculty members, not to mention Virginia state officials, have expressed concern about the decision of allowing students back on campus.)

And yet, projections suggest that a rush of new cases will soon overwhelm already-strained hospitals in New York City, with other cities likely to follow. Confirmed Covid-19 cases in the United States pushed past 86,000 people this week, comfortably surpassing the total in China, and establishing the U.S. as the emergent center of a global pandemic. Already, more than 1,000 people have died in the U.S.

The extent of the outbreak is certainly much wider than the current numbers indicate. The surge in the case count is, in part, a reflection of better testing: After weeks of nationwide delays, some American cities and states are finally beginning to test people in large numbers. But testing shortages remain acute in many areas. Officials are still scrambling to come up with critical medical supplies, including simple protective masks, as well as essential financial support for millions of Americans facing layoffs, foreclosure, and eviction.

Trump’s sanguine view of the near future has received push-back from doctors and other experts, and the more realistic timeline is not that the national shutdown will end in a few weeks, but that the crisis has not yet really begun. “Everything we here in North America have gone through so far — the sitting at home, the anxiety, the toilet paper memes — is just preparation,” journalist Jonathan Katz, known for his coverage of the 2010 Haiti earthquake and other natural disasters, wrote in an essay earlier this week. “For us, the disaster has not happened yet.”

For all their disruptions and deprivations, the past several weeks have mostly been focused on building preparedness for the pandemic, Katz noted. Now, as cases begin to surge, the viral event itself is arriving. Speculating about how much to reopen the economy or leave the house, Katz argues, “is like arguing about whether people should leave their homes and run around in the streets just as the hurricane is coming onshore.”

In this week’s Abstracts, as in previous weeks, we offer a roundup of coronavirus themes that have defined the news this week, and that are likely to stay relevant in the days ahead.

New York City has become a global epicenter of Covid-19, as other parts of the country show signs of a coming spike in cases.

As of Thursday evening, New York City had recorded 23,112 confirmed cases of Covid-19 — some 5 percent of the world total — and 365 deaths, as the city became a pandemic epicenter. Those numbers are only growing, and New York City hospitals are already struggling to deal with an influx of patients with coronavirus symptoms. In a dispatch on Thursday from the Brooklyn Hospital Center, The New York Times’ Sheri Fink reported that the facility only has enough beds for 250 to 300 people, but hopes to double that number as they face a surge of new patients. Already, more than 40 percent of the hospital’s inpatients were either suspected or confirmed cases. Meanwhile, other regions of the country are preparing for incoming cases — and the impact of the virus is unlikely to be equally distributed. As Laura Beil reported for Undark this week, some states in the American South may be uniquely vulnerable to the pandemic. Hospital closures, supply shortages, low insurance rates, and high rates of preexisting conditions have left some experts concerned that Mississippi, Alabama, Louisiana, and other Southern states will be ill-prepared for a rapid increase in cases.

Some political figures and commentators are arguing that lockdowns have gone too far, ignoring the objections of public health experts.

In a Rose Garden interview on Tuesday, President Trump reiterated his earlier pledge that America would “soon be open for business,” suggesting that municipal lockdowns and other measures to limit the spread of Covid-19 could be lifted by April 12, Easter Sunday. The remarks echo a growing chorus of conservative economists, pundits, and lawmakers who argue that the effort to contain the pandemic should not come at the expense of the U.S. economy. Among them is Texas Lieutenant Governor Dan Patrick, who on Monday suggested that senior citizens — the demographic most vulnerable to Covid-19 — would be willing to “take a chance” on their survival for the sake of their country. Trump has promised to reassess newly implemented coronavirus guidelines by May 30, but others have noted that the authority to end the coronavirus lockdowns resides largely with state governments. Meanwhile, health experts warn that it remains too soon to ease the restrictions. “If we let up now we can be virtually certain that health care will be overwhelmed in many if not all parts of the country,” Harvard epidemiologist Mark Lipsitch told The Washington Post. “This is the view of every well-informed infectious epidemiologist I know of.”

The virus poses special risks and uncertainties for pregnant women and the parents of small children.

As scientists race to understand the idiosyncrasies of SARS-Cov-2 — from its behavior in the air and on surfaces to its vexing tendency to render even some young and healthy people critically ill while leaving others asymptomatic — one particular group of people remains particularly eager for answers: pregnant women. Can the virus pass from mother to fetus? What about during the birth process, or through breastmilk? Should a mother who is known — or even suspected — to be infected be separated from her newborn? These and other questions continue to swirl, with few definitive answers. The U.S. Centers for Disease Control and Prevention has suggested that expectant mothers and health care providers consider briefly separating newborns from mothers with a known or suspected Covid-19 infection. More recently, a trio of studies has raised the possibility that an expectant mother could pass a Covid-19 infection to her child while it is still in the womb, though the details remain murky. There is also little indication — at least thus far — that pregnant women are more susceptible to a Covid-19 infection, though experts highly recommend taking the usual precautions to avoid getting sick while pregnant. One certainty: With hospitals scrambling to combat the virus within their own walls, expectant mothers everywhere should plan for the possibility of having their partners or other personal support being barred from the delivery room — or even from visiting at all.

As cases mount and a ventilator shortage looms, bioethicists and doctors are debating who will get potentially lifesaving treatment.

As March progressed and Covid-19 cases soared in Italy and Spain, doctors in both countries, faced with shortages of hospital beds and equipment, were forced to cut some patients off and let them die. Italian doctors called the decision to bar the oldest and frailest patients from the ICUs “disaster medicine.” “That grandpa, in any other situation, would have a chance,” said a Spanish physician. Now with both coronavirus cases and deaths rapidly climbing in the United States, both hospitals and medical ethicists expect doctors to face similar decisions here. Earlier this week, ethicists at the University of Pennsylvania published guidelines for hospitals around the country, suggesting that critical equipment like ventilators be saved for the strongest patients and those with the most years potentially ahead of them. The Pennsylvania bioethics group also argued that caring for doctors, nurses, and other health workers should be a priority. “It would be irresponsible,” agreed a Colorado bioethicist, “not to get ready to make tragic decisions about who lives and who dies.” These discussions, though, have also prompted concerns among rights activists that some policies could discriminate against people with disabilities.

Researchers are continuing to investigate treatments — some new, and some old — that may help treat Covid-19.

Remdesivir, an antiviral made by Gilead Sciences and originally intended to treat ebola, has been fast-tracked for clinical trials and compassionate use to treat SARS-CoV-2, after animal lab studies showed some promise in its ability to disrupt the SARS-CoV-2 virus’s ability to replicate. Meanwhile, the New York Blood Center has begun collecting purified plasma from recovered COVID-19 patients for new, FDA-approved trials of a century-old treatment, used during the 1918 Spanish flu pandemic, that transfuses blood from recovered patients into severely ill patients. There, antibodies developed during recovery may help the sick patient fight off the virus. Another longstanding treatment that may be repurposed for Covid-19 is hydroxychloroquine, a drug used to treat malaria as well as lupus and rheumatoid arthritis. But the drug’s promise has produced a rush on hydroxychloroquine supplies, making it difficult for some lupus patients to get their prescriptions filled.

There’s a lot of excellent reporting and analysis out there.

Below is a list — updated and expanded from last week’s Abstracts — of some of the journalists, experts, and publications that Undark is following.

Undark will continue to provide weekly roundups of Covid-19 news each Friday for as long as the pandemic continues. You can find our own Covid-19 coverage here.

Deborah Blum, Ashley Smart, Bettina Urcuioli, Lucas Haugen, and Tom Zeller Jr. contributed to this roundup.

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Michael Schulson is a contributing editor for Undark. His work has also been published by Wired, Salon, Slate, Pacific Standard, the Daily Beast, and The Washington Post, among other publications.