Group items tagged

“For every death, there’s about 21 other infections,” she said modeling showed. So most of Philadelphia’s 50,000 people probably were infected. “They were either lucky that they didn’t develop disease or had mild disease compared to those that were unlucky and died.”Yellow fever is one of more than 200 known human viruses, according to the National Institutes of Health. They include those that cause HIV/AIDS, Ebola, polio, smallpox, measles, mumps, rabies, the common cold and now the novel coronavirus.

In the late 1800s, scientists were just starting to realize that strange microbes smaller than bacteria were causing disorders in plants and animals. Bacteria, which had been discovered in the 1670s, had been associated with human illnesses such as typhoid fever, cholera and tuberculosis.

U.S. Army physician Walter Reed reported in 1900 that the leading suspect bacteria was not found in the blood of fever cases he studied in Cuba.There was an alien “parasite” at work, he believed.“At the time they didn’t even call it a virus,” Staples said. “They didn’t know really what a virus was.”

In 1900, Reed set up what he called an “experimental sanitary station” in Cuba, where yellow fever was prevalent. He named it Camp Lazear, for Jesse W. Lazear, a medical colleague who had died of the fever that year.

After extensive testing on volunteer patients who were infected, Reed confirmed that mosquitoes were the carrier and eliminated bacteria as a cause.

The yellow fever virus was isolated in 1927, and scientists soon came up with an effective vaccine, called 17D, a weakened form of the virus itself. It’s still in use, and a recent scholarly paper called it “one of the most outstanding human vaccines ever developed.”

But in Philadelphia in 1793, the only remedy would be something that killed mosquitoes.

It also was used by Nazi doctors in human malaria experiments in the Dachau concentration camp during World War II.German scientist Claus Schilling, an expert in tropical diseases, infected hundreds of patients with malaria by exposing them to parasite-carrying mosquitoes.He then treated them with quinine and other drugs to see how they reacted.“Thirty or forty died from the malaria itself,” Franz Blaha, a physician and Czech inmate at Dachau, testified after the war. “Three hundred to four hundred died later … because of the physical condition resulting from the malaria attacks. In addition there were deaths resulting from poisoning due to overdoses.”

At that time, malaria was mostly treated with the quinine-like synthetic Atabrine, a medicine designed by German chemists in the early 1930s.

Other bizarre remedies hadn’t worked, Duran-Reynals, the quinine historian, reported.One ancient cure went: “Take the urine of the patient and mix it with some flour to make … seventy-seven small cakes … Proceed before sunrise to an anthill and throw the cakes therein. As soon as the insects have devoured the cakes the fever vanishes.”

But Atabrine, like quinine, had side effects, including gastritis, hallucinations and psychosis, Masterson wrote. Plus, it turned the skin of GIs and Marines yellow.“The most hair-raising [side effects] were rashes that … progressed grotesquely, with skin falling off in sheets, creating open sores that attracted flies,” Masterson wrote. Other side effects included “erratic mood swings, violent anger, and deep depression …[along with] the standard diarrhea, vomiting, and cramps.”Then came the rumor the drug caused impotence.During the fight for the Pacific island of Guadalcanal, Marines rejected Atabrine. Their officers had to watch them take the pills and make sure the pills were swallowed. But the Marines would later spit them out.Thousands got sick. “For every battle casualty, ten men lay sick with malaria,” Masterson wrote.

“A tree grows which they call ‘the fever tree’ … whose bark, of the color of cinnamon, made into powder … and given as a beverage, cures the fevers … it has produced miraculous results,” he reported.“Thus … did Father Calancha announce to the world that a cure had been found for the most widespread disease of the time,” Duran-Reynals wrote.

In the 1670s, despite the hidebound medical establishment, a young English pharmacist, Robert Talbor, became an expert in treating fevers. He had moved to the southeast coast of England, where fevers were “epidemical."By trial and error, he came up with a secret formula — “my particular … medicine,” he called it. He would reveal only that it was “a preparation of four vegetables,” and he warned people about using the “Jesuits’ Powder.”

The whole virtue of the pills consisted in the quinine alone.

Outbreaks can be influenced by seasonal weather conditions, which affect the numbers of the virus's natural host - the multimammate rat.

Most people catch Lassa fever from anything contaminated with rat urine, faeces, blood or saliva - through eating, drinking or simply handling contaminated objects in the home.

It is likely that a vaccine could be found for Lassa - reducing the possibility of an outbreak becoming a global health emergency - but as with other epidemic diseases that mainly affect poorer countries, progress has stalled.

Vaccine development is a long, complex and costly process. This is especially true for emerging epidemic diseases, where a prototype vaccine can usually only be tested where there is an outbreak.

the coronavirus more often infects clusters of family members, friends and work colleagues,

“You can contain clusters,” Dr. Heymann said. “You need to identify and stop discrete outbreaks, and then do rigorous contact tracing.”

The microphone should not even be at the White House, scientists said, so that briefings of historic importance do not dissolve into angry, politically charged exchanges with the press corps, as happened again on Friday.

Americans must be persuaded to stay home, they said, and a system put in place to isolate the infected and care for them outside the home

Travel restrictions should be extended, they said; productions of masks and ventilators must be accelerated, and testing problems must be resolved.

It was not at all clear that a nation so fundamentally committed to individual liberty and distrustful of government could learn to adapt to many of these measures, especially those that smack of state compulsion.

What follows are the recommendations offered by the experts interviewed by The Times.

they were united in the opinion that politicians must step aside and let scientists both lead the effort to contain the virus and explain to Americans what must be done.

medical experts should be at the microphone now to explain complex ideas like epidemic curves, social distancing and off-label use of drugs.

doing so takes intelligent, rapidly adaptive work by health officials, and near-total cooperation from the populace. Containment becomes realistic only when Americans realize that working together is the only way to protect themselves and their loved ones.

Above all, the experts said, briefings should focus on saving lives and making sure that average wage earners survive the coming hard times — not on the stock market, the tourism industry or the president’s health.

“At this point in the emergency, there’s little merit in spending time on what we should have done or who’s at fault,”

The next priority, experts said, is extreme social distancing.If it were possible to wave a magic wand and make all Americans freeze in place for 14 days while sitting six feet apart, epidemiologists say, the whole epidemic would sputter to a halt.

The virus would die out on every contaminated surface and, because almost everyone shows symptoms within two weeks, it would be evident who was infected. If we had enough tests for every American, even the completely asymptomatic cases could be found and isolated.

The crisis would be over.

Obviously, there is no magic wand, and no 300 million tests. But the goal of lockdowns and social distancing is to approximate such a total freeze.

In contrast to the halting steps taken here, China shut down Wuhan — the epicenter of the nation’s outbreak — and restricted movement in much of the country on Jan. 23, when the country had a mere 500 cases and 17 deaths.Its rapid action had an important effect: With the virus mostly isolated in one province, the rest of China was able to save Wuhan.

Even as many cities fought their own smaller outbreaks, they sent 40,000 medical workers into Wuhan, roughly doubling its medical force.

Stop transmission within cities

the weaker the freeze, the more people die in overburdened hospitals — and the longer it ultimately takes for the economy to restart.

People in lockdown adapt. In Wuhan, apartment complexes submit group orders for food, medicine, diapers and other essentials. Shipments are assembled at grocery warehouses or government pantries and dropped off. In Italy, trapped neighbors serenade one another.

Each day’s delay in stopping human contact, experts said, creates more hot spots, none of which can be identified until about a week later, when the people infected there start falling ill.

South Korea avoided locking down any city, but only by moving early and with extraordinary speed. In January, the country had four companies making tests, and as of March 9 had tested 210,000 citizens — the equivalent of testing 2.3 million Americans.

As of the same date, fewer than 9,000 Americans had been tested.

Fix the testing mess

Testing must be done in a coordinated and safe way, experts said. The seriously ill must go first, and the testers must be protected.In China, those seeking a test must describe their symptoms on a telemedicine website. If a nurse decides a test is warranted, they are directed to one of dozens of “fever clinics” set up far from all other patients.

Isolate the infected

As soon as possible, experts said, the United States must develop an alternative to the practice of isolating infected people at home, as it endangers families. In China, 75 to 80 percent of all transmission occurred in family clusters.

Cellphone videos from China show police officers knocking on doors and taking temperatures. In some, people who resist are dragged away by force. The city of Ningbo offered bounties of $1,400 to anyone who turned in a coronavirus sufferer.

In China, said Dr. Bruce Aylward, leader of the World Health Organization’s observer team there, people originally resisted leaving home or seeing their children go into isolation centers with no visiting rights — just as Americans no doubt would.

In China, they came to accept it.“They realized they were keeping their families safe,” he said. “Also, isolation is really lonely. It’s psychologically difficult. Here, they were all together with other people in the same boat. They supported each other.”

Find the fevers

Make masks ubiquitous

In China, having a fever means a mandatory trip to a fever clinic to check for coronavirus. In the Wuhan area, different cities took different approaches.

In most cities in affected Asian countries, it is commonplace before entering any bus, train or subway station, office building, theater or even a restaurant to get a temperature check. Washing your hands in chlorinated water is often also required.

The city of Qianjiang, by contrast, offered the same amount of money to any resident who came in voluntarily and tested positive

Voluntary approaches, like explaining to patients that they will be keeping family and friends safe, are more likely to work in the West, she added.

Trace the contacts

Finding and testing all the contacts of every positive case is essential, experts said. At the peak of its epidemic, Wuhan had 18,000 people tracking down individuals who had come in contact with the infected.

Dr. Borio suggested that young Americans could use their social networks to “do their own contact tracing.” Social media also is used in Asia, but in different ways

When he lectured at a Singapore university, Dr. Heymann said, dozens of students were in the room. But just before he began class, they were photographed to record where everyone sat.

Instead of a policy that advises the infected to remain at home, as the Centers for Disease and Prevention now does, experts said cities should establish facilities where the mildly and moderately ill can recuperate under the care and observation of nurses.

There is very little data showing that flat surgical masks protect healthy individuals from disease. Nonetheless, Asian countries generally make it mandatory that people wear them.

The Asian approach is less about data than it is about crowd psychology, experts explained.All experts agree that the sick must wear masks to keep in their coughs. But if a mask indicates that the wearer is sick, many people will be reluctant to wear one. If everyone is required to wear masks, the sick automatically have one on and there is no stigma attached.

Also, experts emphasized, Americans should be taught to take seriously admonitions to stop shaking hands and hugging

Preserve vital services

Only the federal government can enforce interstate commerce laws to ensure that food, water, electricity, gas, phone lines and other basic needs keep flowing across state lines to cities and suburbs

“I sense that most people — and certainly those in business — get it. They would prefer to take the bitter medicine at once and contain outbreaks as they start rather than gamble with uncertainty.”

Produce ventilators and oxygen

The manufacturers, including a dozen in the United States, say there is no easy way to ramp up production quickly. But it is possible other manufacturers, including aerospace and automobile companies, could be enlisted to do so.

Canadian nurses are disseminating a 2006 paper describing how one ventilator can be modified to treat four patients simultaneously. Inventors have proposed combining C-PAP machines, which many apnea sufferers own, and oxygen tanks to improvise a ventilator.

One of the lessons of China, he noted, was that many Covid-19 patients who would normally have been intubated and on ventilators managed to survive with oxygen alone.

Retrofit hospitals

In Wuhan, the Chinese government famously built two new hospitals in two weeks. All other hospitals were divided: 48 were designated to handle 10,000 serious or critical coronavirus patients, while others were restricted to handling emergencies like heart attacks and births.

Wherever that was impractical, hospitals were divided into “clean” and “dirty” zones, and the medical teams did not cross over. Walls to isolate whole wards were built

Decide when to close schools

Recruit volunteers

China’s effort succeeded, experts said, in part because of hundreds of thousands of volunteers. The government declared a “people’s war” and rolled out a “Fight On, Wuhan! Fight On, China!” campaign.

Many people idled by the lockdowns stepped up to act as fever checkers, contact tracers, hospital construction workers, food deliverers, even babysitters for the children of first responders, or as crematory workers.

“In my experience, success is dependent on how much the public is informed and participates,” Admiral Ziemer said. “This truly is an ‘all hands on deck’ situation.”

Prioritize the treatments

Clinicians in China, Italy and France have thrown virtually everything they had in hospital pharmacies into the fight, and at least two possibilities have emerged that might save patients: the anti-malaria drugs chloroquine and hydroxychloroquine, and the antiviral remdesivir, which has no licensed use.

An alternative is to harvest protective antibodies from the blood of people who have survived the illness,

The purified blood serum — called immunoglobulin — could possibly be used in small amounts to protect emergency medical workers, too.

“Unfortunately, the first wave won’t benefit from this,” Dr. Hotez said. “We need to wait until we have enough survivors.”Find a vaccine

testing those candidate vaccines for safety and effectiveness takes time.

The roadblock, vaccine experts explained, is not bureaucratic. It is that the human immune system takes weeks to produce antibodies, and some dangerous side effects can take weeks to appear.

After extensive animal testing, vaccines are normally given to about 50 healthy human volunteers to see if they cause any unexpected side effects and to measure what dose produces enough antibodies to be considered protective.

If that goes well, the trial enrolls hundreds or thousands of volunteers in an area where the virus is circulating. Half get the vaccine, the rest do not — and the investigators wait. If the vaccinated half do not get the disease, the green light for production is finally given.

In the past, some experimental vaccines have produced serious side effects, like Guillain-Barre syndrome, which can paralyze and kill. A greater danger, experts said, is that some experimental vaccines, paradoxically, cause “immune enhancement,” meaning they make it more likely, not less, that recipients will get a disease. That would be a disaster.

One candidate coronavirus vaccine Dr. Hotez invented 10 years ago in the wake of SARS, he said, had to be abandoned when it appeared to make mice more likely to die from pneumonia when they were experimentally infected with the virus.

Reach out to other nations

Chloroquine had produced what he called “spectacular improvements” in the Chinese patients. “It’s excellent news — this is probably the easiest respiratory infection to treat of all,” Raoult said. “The only thing I’ll tell you is, be careful: Soon the pharmacies won’t have any chloroquine left!”

Raoult wrote his first research paper, in 1979, on a tick-borne infection sometimes known as Marseille fever. The disease was also called “benign summer fever,” and more than 50 years of science said it was nonlethal. And yet one of the 41 patients in his data set had died.

Before submitting the paper, Raoult, who was then a young resident, gave it to a supervising professor for review. “And he takes it,” Raoult told me, “he doesn’t show it to me again, and he publishes it — and he’d taken out the death. Because he didn’t know how to make sense of the death.”

Raoult was disgusted, and the incident shaped his philosophy of scientific inquiry. “I learned that the people who wanted to follow the familiar path were prepared to cheat in order to do it,” he said.

In Raoult’s view, French science was a duchy of appearances, connections and self-reverence. “It was people saying” — he mimed the drone of an aristocrat — “ ‘Oh, him, yes, he’s very good.’ And this reputation, you don’t know what it’s based on, but it’s not the truth.”

“He was a ‘follower,’” Raoult said of the professor. “And these ‘followers’ are all cheaters. That’s what I thought. And it’s still what I think.”

He is, fundamentally, a contrarian. In Raoult’s view, little of consequence has been accomplished by researchers who endorse the habitual tools and theories of their age.

“I’ve spent my life being ‘against,’” he told me. “I tell young scientists: ‘You know, you don’t need a brain to agree. All you need is a spinal cord.’” He is thrilled by conflict. It is a matter both of philosophy — the influence, no doubt, of the thinker he refers to admiringly as “master Nietzsche” — and of temperament.

His peers shake their heads at this behavior but grant him a grudging respect. “You can’t knock him down,” said Mark Pallen, a professor of microbial genomics at the University of East Anglia. “In terms of his place in the canon, the sainthood of science, he’s pretty secure there.”

In 1985 and 1986, Raoult worked at the Naval Medical Research Institute in Bethesda, Md., where he discovered the Science Citation Index. The index, a tool that can be used to measure a scientist’s influence on the basis of his or her publication history, was relatively unknown in France. Raoult looked up the researchers reputed to be the best in Marseille. “It was really the emperor wears no clothes,” he said. “These people didn’t publish. There was one who hadn’t written a paper in 10 years.”

In subsequent work, he demonstrated that Marseille fever was indeed fatal in almost precisely one in every 41 cases.

Raoult’s name sits atop several thousand; in each of the past eight years, he has produced more than 100. In 2020, he has already published at least 54.

Like many doctors, Molina viewed Raoult’s study with skepticism, but he was also curious to see if his proposed treatment regimen might in fact work. He tested hydroxychloroquine and azithromycin in 11 of his own patients. “We had severe patients, and we wanted to try something,” Molina told me. Within five days, one had died, and two others had been transferred out of his service to intensive care. In another patient, the treatment was suspended after the onset of cardiac issues, a known side effect of the drugs. Eight of the 10 surviving patients still tested positive for SARS-CoV-2 at the conclusion of the study period

Raoult is reputed to be an indefatigable worker, but he also achieves his extreme rate of publication by attaching his name to nearly every paper that comes out of his institute.

In recent years, Raoult has amused himself, it seems, by staking out tendentious scientific claims, sometimes in territories that are well beyond the scope of his expertise.

He is skeptical, for instance, of the utility of mathematical modeling in the realm of epidemiology.

The same logic has led him to conclude that climate modelers are no more than “soothsayers” for our “scientistic era” and that their dire predictions are mostly just an attempt to expiate our intense but irrational feelings of guilt.

Raoult’s most recent book, “Epidemics: Real Dangers and False Alerts,” was published in late March, by which time the W.H.O. had reported more than 330,000 confirmed cases of Covid-19 worldwide and more than 14,500 deaths. “This anguish over epidemics,” he writes, “is completely untethered from the reality of deaths from infectious diseases.”

Testing had been scheduled to run for two weeks per patient, but after only six days, the results were so favorable that Raoult decided to end the trial and publish

Others might have proceeded with more caution or perhaps waited to confirm these results with a larger, more rigorous trial. Raoult likes to think of himself as a doctor first, however, with a moral obligation to treat his patients that supersedes any desire to produce reliable data.

For decades, Raoult has boasted of his prodigious rates of publication and citation, which, as objective statistics, he considers to be the best measure of his worth as a researcher.

This observation has come to be known as the parachute paradigm: We tend to accept the claim that parachutes reduce injury among people who leap from airplanes, but this effect has never been proved in a randomized study that compares an experimental parachute group to an unlucky parachuteless control.

“If you don’t have something that’s visible in 10 patients, or 30, it’s useless. It’s not of any consequence.” An effective treatment for a potentially lethal infectious disease will be visible to the naked eye.

There is much about Raoult that might make him, and by extension his proposed treatment, appealing to a man like Trump. He is an iconoclast with funny hair; he thinks almost everyone else is stupid, especially those who are typically regarded as smart; he is beloved by the angry and conspiracy-minded; his self-congratulation is more or less unceasing.

Raoult classified Trump’s psychology as that of an “entrepreneur,” by way of contrast with that of a “politician.” “Entrepreneurs are people who know how to decide, who know how to take risks,” he said. “And at a certain point, to decide is to take a risk. Every decision is a risk.”

The French waited far too long, in his estimation, to approve the use of hydroxychloroquine in Covid-19 patients. The authorization came only after Raoult announced in the press that he would continue, “in accordance with the Hippocratic oath” and effectively in defiance of the government, to treat patients with his combination therapy. “I’m convinced that in the end, everyone will be using this treatment,” Raoult told Le Parisien. “It’s just a matter of time before people agree to eat their hats.”

Raoult had already begun assembling data for a larger study, but he dismissed the need for anything particularly vast or lengthy. Like other critics of the R.C.T., he likes to point out that a number of self-evidently useful developments in the realm of human health have never been validated by such rigorous tests.

Raoult’s study had measured only viral load. It offered no data on clinical outcomes, and it was not clear if the patients’ actual symptoms had improved or indeed whether the patients lived or died. At the outset, 26 patients were assigned to receive hydroxychloroquine, six more than the 20 who appeared in the final results.

The six additional patients had been “lost in follow-up,” the authors wrote, “because of early cessation of treatment.” The reasons given were concerning. One patient stopped taking the drug after developing nausea. Three patients had to be transferred out of the institute to intensive care. One patient died. (Another patient elected to leave the hospital before the end of the treatment cycle.)

“So four of the 26 treated patients were actually not recovering at all,” noted Elisabeth Bik, a scientific consultant who wrote a widely circulated blog post on Raoult’s study. She paraphrased the sarcasm circulating on Twitter: “My results always look amazing if I leave out the patients who died.”

The report was also riddled with discrepancies and apparent errors.

This apparent sloppiness was unsurprising to many of those who have tracked Raoult’s work in the past. A prominent French microbiologist told me that, in terms of publication, Raoult’s reputation among scientists has been “long gone” for some time.

Beyond its apparent errors and omissions, the study’s design — its small size, its flawed control, the unrandomized assignment of patients to the treatment and control groups — was widely viewed to render its results meaningless. Fauci repeatedly called its results “anecdotal”;

Large, well-controlled randomized trials are by no means the only way to arrive at useful scientific insights. Their utility is that they enhance statistical signals such that, amid the noise of human variability and random chance, even the faint effect of some new treatment can be detected.

The results of his initial trial have yet to be replicated. “I think what he secretly hopes is that no one will ever be able to show anything,”

The prime statistical hurdle that any proposed treatment for Covid-19 will have to overcome — one that is delicate for even Raoult’s critics to make note of, amid the sorrow and fear of this pandemic — is that the signal is likely to be very faint, because the disease is, in the end, rarely fatal. Nearly everyone survives; an effective treatment will save the life of the one or so patients in every hundred who would not have lived without it.

“Alzheimer’s drugs, obesity drugs, cardiovascular drugs, osteoporosis drugs: Over and over, there have been what looked like positive results that evaporated on closer inspection. After you’ve experienced this a few times, you take the lesson to heart that the only way to be sure about these things is to run sufficiently powered controlled trials. No shortcuts, no gut feelings — just data.”

“I’ve invented 10 or so treatments in my life,” Raoult told me. “Half of them are prescribed all over the world. I’ve never done a double-blind study in my life, never. Never! Never done anything randomized, either.”

“When you tell the story, it’s extremely straightforward, no? It’s subject, verb, complement: You detect a disease; there’s a drug that’s cheap, whose safety we know all about because there’s two billion people who take it; we prescribe it, and it changes what it changes. It might not be a miracle product, but it’s better than doing nothing, no?”

Raoult had by then begun to lose his composure. He accused Lacombe of being a shill for the pharmaceutical industry; his fans sent her death threats. On Twitter, he called Bik, the consultant who wrote critically about the first study, a “witch hunter” and called a study that she tweeted — one of several published in April and May that seemed to suggest that Raoult’s treatment regimen was ineffectual or even harmful — “fake news.” The authors of another such study were accused of “scientific fraud.” “My detractors are children!” Raoult told an interviewer.

It is possible that hydroxychloroquine and azithromycin are an effective treatment for Covid-19. But Raoult’s study showed, at best, that 20 people who would almost certainly have survived without any treatment at all also survived for six days while taking the drugs Raoult prescribed.

In recent weeks, Raoult has in fact tempered his claims about the virtues of his treatment regimen. The published, peer-reviewed version of the final study noted that another two patients had died, bringing the total to 10. Where the earlier version called the drugs “safe and efficient,” they were now described merely as “safe.”

He has shown flickers of what appears to be doubt.

“I don’t trust popularity,” he told the interviewer. “When too many people think you’re wonderful, you should start to wonder.” His initial YouTube video, “Coronavirus: Game Over!” has also been renamed. The new language is more measured, and in place of the exclamation point there now stands a question mark.

El Salvador’s Health Ministry is particularly concerned about the rise of cases of Guillain-Barré syndrome, which leads to paralysis, usually temporary; researchers are exploring a possible link between Guillain-Barré and Zika. Forty-six suspected cases of the syndrome had been reported as of last week, Violeta Menjívar, the health minister, said in a radio interview.

virus has appeared in only three Mexican states. The mosquitoes that carry the virus, he said, could not survive in the high altitudes of the central plateau, including Mexico City.“I think it’s good to have these warnings,” he said, “but these things should be explained to people.”

Their model for Zika’s possible spread, using worldwide temperature profiles and air travel routes, also determined that more than 60 percent of the population in the United States lives in areas conducive to seasonal Zika transmission. And about 23 million people in the United States live in places with climates like Florida and parts of Texas where Zika can be transmitted by mosquitoes year-round, the researchers said.The authorities in Brazil insist that they are taking steps to fight Zika, including vaccine research.

Preparation is the key to a good plan.

Hopefully, you've been following standard hygiene practices. These are behaviors we should be doing daily, automatically, to protect ourselves from germs, colds and flu:

Avoid touching your eyes, nose and mouth with unwashed hands; cough and sneeze into elbows or tissues that you immediately throw away, and regularly wash, wash, wash those hands with warm water and lots of soapy bubbles.

Parents and guardians should plan well in advance by setting up a structure in which all kids and potential caregivers know their roles and expectations, said pediatrician Dr. Tanya Altmann, Editor-in-Chief of the American Academy of Pediatrics' book "Caring for Your Baby and Young Child: Birth to Age 5 and The Wonder Years."

A working thermometer to monitor fever, which is considered to be 100 degrees Fahrenheit (37.7 degrees Celsius), and a method to clean it, such as Isopropyl alcohol.

Fever reducing medications, such as acetaminophen.

Regular soap and 70% alcohol-based hand sanitizer (antibacterial soap isn't necessary if you wash properly, and that way you won't will contribute to the world's growing antibiotic-resistant superbugs).

Tissues to cover sneezes and coughs. But there's really no need to hoard toilet paper -- this is a respiratory disease.

Regular cleaning supplies, kitchen cleaning gloves and trash can liners.

Disinfectant cleaning supplies -- the CDC suggests picking from a list that meets the virus-fighting standards of the US Environmental Protection Agency, but says you can also make your own version by using 1/3 cup unexpired bleach per gallon of water or 4 teaspoons bleach per quart of water. Never mix bleach with ammonia or any other cleanser -- it produces toxic gases.

If you live alone, that's not difficult. Your challenge is to monitor your symptoms and care for yourself when you're not feeling well. Be sure to have a plan in place to deliver food and medications, and find someone who can be responsible for virtually checking in on you on a regular basis.

The rest of the family should practice isolation as well, Radesky added.

If you are running short on face masks, or don't have any because of hoarding, try to protect the caregiver as best you can, the CDC says.

Altmann stresses maximizing isolation and protective actions.

"You can have a healthy person leave the sick one food and drinks at the door, and then go wash their hands," Altmann explained. "Wear gloves to pick up the empty plates, take them back to the kitchen and wash them in hot water with soap, or preferably with a dishwasher, and wash your hands again."

One last, very important thing: Call 911 immediately if you or your loved ones have any of these symptoms: increased or sudden difficulty breathing or shortness of breath; a persistent pain or pressure in the chest; and any sign of oxygen deprivation, such as new confusion, bluish lips or face, or you can't arouse the sick person.

To be clear: Everyone in the house needs to isolate themselves from the outside world as much as possible.

Only 2% of the patients in a review of nearly 45,000 confirmed Covid-19 cases in China were children, and there were no reported deaths in children under 10

Among nearly 6,300 Covid-19 cases reported by the Korea Centers for Disease Control & Prevention on March 8, there were no reported deaths in anyone under 30. Only 0.7% of infections were in children under 9 and 4.6% of cases were in those ages 10- to 19-years-old.

Studies from China show that the rate of deaths for those with cardiovascular issues is 10.5% while it’s 7.3% for diabetes patients and about 6% for those with hypertension or lung and respiratory disease. In cancer patients, it was reported as 5.6%.

Is Covid-19 more contagious than influenza or other viral respiratory diseases? It appears to be. Both are very contagious. The R0—pronounced “R naught”—is an estimate of how many healthy people one contagious person will infect. The R0 for Covid-19 is estimated to be 2.6. “That’s a lot,” says Dr. Schaffner.

In comparison, for influenza the figure is somewhere around 1.2 to 1.8

Are there any precautions or steps different in coronavirus prevention than in influenza prevention? What about treatment? No. Both illnesses are infectious respiratory illnesses caused by different viruses but spread the same way, says Vanessa Raabe, an infectious disease specialist at NYU Langone Health. They are transmitted through droplets from a sick person sneezing or coughing or talking within 2 meters or 6 feet. If such a droplet enters your eyes, mouth or nose, you could become infected.

There is some concern that the new coronavirus can also be transmitted by tiny fine droplets that remain suspended in the area after an ill person leaves, but Dr. Raabe says that it’s not believed to be the main way it’s transmitted and it’s more of a worry in the health care setting.

Do allergy and asthma sufferers have a higher rate of illness contraction? There is no evidence that allergy sufferers have a higher rate of getting the new coronavirus. But asthma suffers do. The groups with the highest risk of fatalities are the elderly and those with diabetes, heart disease, lung disease, including respiratory illnesses, and smokers

When should I go to the hospital? Experts say you should go to a hospital if you’re sick enough that you think you should be admitted. The telltale sign is difficulty breathing or shortness of breath combined with a high fever

shortness of breath and difficulty breathing is a sign that the lungs are being affected and the virus has moved from being an upper tract respiratory illness to a lower tract one. Upper tract illness is usually defined by a runny nose, congestion, and sore threat. Once a virus moves to the lower tract symptoms can include shortness of breath and a lot of coughing that produces mucus

A high fever would be 101 or higher

How do you distinguish the new coronavirus from the flu or the common cold? It’s impossible to do based on symptoms alone, says Dr. Raabe. The main symptoms of the new coronavirus are fever, cough, shortness of breath, and general fatigue and muscle aches. These overlap with the symptoms of the flu or any other respiratory virus. The only way to know for sure is to get tested by a doctor

The data, aggregated by ZIP code, will also be incorporated into illness signals that Kinsa makes available in its public HealthWeather map. The company sometimes shares this ZIP-code-level information with pharmacies, vaccine distributors and other companies. Clorox, for instance, has used Kinsa’s data to determine where to target its ads. (Lysol will have no special access to the data, Kinsa says.)

And then, of course, there are the inevitable privacy concerns. Kinsa emphasizes that all data provided to the city will be aggregated and anonymized.

City health officials will also have access to this aggregated, anonymized data, which they hope will help them identify unusual illness clusters earlier than is currently possible. “It’s measuring something that we’ve never really been able to measure before,” Dr. Varma said. “This is information about people’s biological measurements, being taken by somebody in their home before they’ve actually, in many situations, sought care.”

Over the coming months, city officials will keep close tabs on how well the program is working, Dr. Varma said.

Frank M. Snowden, a Yale historian who studies pandemics, wrote in his book “Epidemics and Society” that definitive accounts of this plague have largely vanished.

History Today, a monthly magazine of historical writing published in London, calls this pandemic “the greatest catastrophe ever.” The number of deaths — 200 million — is just astounding. Put it this way: That would be like wiping out roughly 65 percent of the current U.S. population. (Covid-19 disease modeling predicts U.S. deaths to potentially reach 240,000.)

Like the Plague of Justinian, the Black Death was caused by the bubonic plague.

Explorers arrived to the New World bearing more than just turnips and grapes. They also brought smallpox, measles and other viruses for which New World inhabitants had no immunity.

There were no treatments. If you caught it, you had roughly two weeks to live. This caused people to become desperate.

Again, blame the rats with those pesky fleas on their backs: “They were attracted by city streets filled with rubbish and waste, especially in the poorest areas,” according to the National Archives in England. While doctors, lawyers and royalty fled town, the poor were ravaged by the disease

it is estimated that upwards of 80–95 percent of the Native American population was decimated within the first 100–150 years following 1492

The epidemic that swept London in 1854 spawned the sort of epidemiological investigations that take place in disease outbreaks today. That’s thanks to John Snow, an English physician who almost single-handedly took on the bacteria. While some scientists suspected cholera was transmitted through the air, Snow thought otherwise. “Through carefully mapping the outbreak, he finds that everyone affected has a single connection in common: they have all retrieved water from the local Broad Street pump,”

according to a CDC history. He ordered the pump-handle turned off, and people stopped getting sick.

In 1793, yellow fever swept through Philadelphia, then the nation’s capital, killing roughly 10 percent of the population. President George Washington and Secretary of State Thomas Jefferson high-tailed it out of town, ultimately settling on Washington as the nation’s capital.

It wasn’t until 1900 that U.S. Army researchers “pinpointed mosquitoes as the transmission vector for the disease,” according to a vaccine history project at the College of Physicians of Philadelphia.

The covid-19 pandemic has inspired lots of comparisons to the 1918 flu, sometimes called the Spanish flu, which got its name not because it originated in Spain but because it was World War I, and Spain was the only country being honest about the toll the pandemic took on the country.

The flu came in two waves, starting in 1918 and ending in 1920. The number of infected is staggering —as many as 500 million, with estimates of 50 million deaths worldwide, according to the CDC.

One man saw it coming: Maurice Hilleman. The doctor later regarded as the godfather of vaccines was working at the Walter Reed Army Institute of Research in 1957 when he read a New York Times article about a nasty flu outbreak in Hong Kong that mentioned glassy-eyed children at a clinic.

Hilleman requested samples of the virus be shipped to U.S. drugmakers right away so they could get a vaccine ready. Though 70,000 people in the United States ultimately died, “some predicted that the U.S. death toll would have reached 1 million without the vaccine that Hilleman called for,” according to the Philadelphia vaccine history project. “Health officials widely credited that vaccine with saving many lives.”

Before covid-19, this was the world’s most recent pandemic, infecting as much as 21 percent of the world’s population. Swine flu was a hodgepodge of several different flu strains that had never been collectively seen together

Essays and books about philosophy and theology are important for determining the ultimate health of the church, but on the ground or in the pews? They’re much less important than emotion, prophecy and spiritualism.

Christians will claim that the Holy Spirit spoke to them directly. As one longtime friend told me, “David, I was with you on opposing Trump until the Holy Spirit told me that God had appointed him to lead.”

a key part of Trump’s appeal is the joy and fellowship that Trump supporters feel with each other. But there’s one last element that cements that bond with Trump: faith, including a burning sense of certainty that by supporting him, they are instruments of God’s divine plan.

It’s not a serious position to argue that this diverse, secularizing country will shed liberal democracy for Catholic or Protestant religious rule. But it’s exceedingly dangerous and destabilizing when millions of citizens believe that the fate of the church is bound up in the person they believe is the once and future president of the United States.

That’s why the Trump fever won’t break. That’s why even the most biblically based arguments against Trump fall on deaf ears. That’s why the very act of Christian opposition to Trump is often seen as a grave betrayal of Christ himself.

In 2024, this nation will wrestle with Christian nationalism once again, but it won’t be the nationalism of ideas. It will be a nationalism rooted more in emotion and mysticism than theology. The fever may not break until the “prophecies” change, and that is a factor that is entirely out of our control.

Almost half of the voters who said they “somewhat disapprove” of Biden as president still voted for Democrats, presumably because they were not going to vote for Trumpianism

In a Reuters/Ipsos poll in September, 58 percent of respondents said that the MAGA movement was threatening America’s democratic foundations.

The Republicans are weak because of Trump. The Republican weakness is easier to expunge. If Republicans get rid of Trump, they could become the dominant party in America

Gov. Tony Evers of Wisconsin had the quotation that summarized the election: “Boring wins.”

I am saying voters have built a wall around that movement to make sure it no longer wins the power it once enjoyed. I am saying voters have given Republicans clear marching orders — to do what Democrats did and beat back the populist excesses on their own side.

There are two large truths I’ll leave you with. The first is that both parties are fundamentally weak. The Democrats are weak because they have become the party of the educated elite.

Americans are still deeply unhappy with the state of the country, but their theory of change seems to have begun to shift. Less histrionic media soap opera. Less existential politics of menace. Let’s find people who can get stuff done.

Second, the battle to preserve the liberal world order is fully underway. While populist authoritarianism remains a powerful force worldwide, people, from Kyiv to Kalamazoo, have risen up to push us toward a world in which rules matter, practicality matters, stability and character matter.

As Irving Kristol once wrote, the people in our democracy “are not uncommonly wise, but their experience tends to make them uncommonly sensible.”

It is, after all, the right-wing radio, TV and Internet fever swamps that have gotten them into this mess, that have led to massive misinformation, disinformation and cynicism among Republican voters. And draining those fever swamps is the only way to get them out of it.

If Republicans truly want to save the Republican Party, they need to go to war with right-wing media.

they need to dismantle the media machine persuading their base to believe completely bonkers, bigoted garbage.

The sickness in today’s Republican Party is not confined to its current standard-bearer.

Among just Trump voters, 7 in 10 believe government economic data are fabricated. Half don’t trust that votes will be counted accurately in the November election.

Republicans and Trump backers didn’t come to these conclusions independently. They learned them from the influential TV, radio and Web outfits whose imprimaturs Republican politicians desperately seek, and whose more troubling content these politicians have been reluctant to criticize.

Data trutherism — claims that the economy is worse than the official numbers indicate, that polls are “skewed” to favor Democrats, that hurricane forecasts are exaggerated to scare the public into fearing climate change

Never-ending witch hunts — against Planned Parenthood, climate scientists, Hillary Clinton — similarly galvanized supporters in the near term but increased bloodlust for punishment of political enemies in the long run.

And unless the party establishment grapples with its own complicity in misinforming, misleading and frightening the masses, it’s doomed to field more Donald Trumps in the future.

Sailors balanced out the weight by leaving behind their ships' ballast: stones, gravel and soil. They swapped English dirt for Virginia tobacco. That dirt very likely contained the common nightcrawler and the red marsh worm. So, almost certainly, did the rootballs of plants that the colonists imported.

In worm-free woodlands, leaves pile up in drifts on the forest floor. Trees and shrubs in wormless places depend on litter for food. When earthworms arrive, they quickly consume the leaf litter, packing the nutrients deep in the soil in the form of castings (worm excrement). Suddenly, the plants can no longer feed themselves; their fine, surface-level root systems are in the wrong place. Wild sarsaparilla, wild oats, Solomon's seal and a host of understory plants die off; grass-like species such as Pennsylvania sedge take over. Sugar maples almost stop growing, and ash seedlings start to thrive.

Transported in the bodies of sailors, malaria may have crossed the ocean as early as Columbus's second voyage. Yellow fever, malaria's frequent companion, soon followed. By the 17th century, the zone where these diseases held sway—coastal areas roughly from Washington, D.C., to the Brazil-Ecuador border—was dangerous territory for European migrants, many of whom died within months of arrival

Initially, American planters preferred to pay to import European laborers—they spoke the same language and knew European farming methods. They also cost less than slaves bought from Africa, but they were far less hardy and thus a riskier investment. In purely economic terms, the historian Philip Curtin has calculated, the diseases of the Columbian Exchange made the enslaved worker "preferable at anything up to three times the price of the European."

At the time, England and Scotland shared a monarch but remained separate nations. England, the bigger partner, had been pushing a complete merger for decades. Scots had resisted, fearing a London-dominated economy, but now England promised to reimburse investors in the failed Panama project as part of a union agreement. As Mr. McNeill wrote, "Thus Great Britain was born, with assistance from the fevers of Panama."

Eighteenth-century farmers who planted potatoes reaped about four times as much dry food matter as they did from wheat or barley. Hunger was then a familiar presence in Europe. France had 40 nationwide food calamities between 1500 and 1800, more than one every decade, according to the French historian Fernand Braudel. England had still more. The continent simply could not sustain itself. The potato allowed most of Europe—a 2,000-mile band between Ireland and the Ukraine—to feed itself. (Corn, another American crop, played a similar role in Italy and Romania.) Political stability, higher incomes and a population boom were the result. Imported from Peru, the potato became the fuel for the rise of Europe.

The sweet potato played a similar role in China. Introduced (along with corn) from South America via the Pacific silver trade in the 1590s, it suddenly provided a way for Chinese farmers to cultivate upland areas that had been unusable for rice paddies. The nutritious new crop encouraged the fertility boom of the Qing dynasty, but the experiment soon went badly wrong. Because Chinese farmers had never cultivated their dry uplands, they made beginners' mistakes. An increase in erosion led to extraordinary levels of flooding, which in turn fed popular unrest and destabilized the government. The new crops that had helped to strengthen Europe were a key factor in weakening China.

European ships accidentally imported the fungus-like organism, native to Peru, that causes the potato disease known as late blight. First appearing in Flanders in June 1845, it was carried by winds to potato farms around Paris in August. Weeks later it wiped out fields in the Netherlands, Germany, Denmark and England. Blight appeared in Ireland on Sept. 13.

the Columbian Exchange, like a biological Internet, has put every part of the natural world in contact with every other, refashioning it, for better or worse, at a staggering rate.

Such an approach gives a clear picture of a vaccine's effectiveness without having to immunise thousands of people. It showed the vaccine was up to 87% effective.

Before antibiotics, typhoid killed one-in-five people infected. Now there is growing levels of typhoid that is resistant to drugs.

The Lancet report said the lack of progress “threatens both human lives and the viability of the national health systems they depend on, with the potential to overwhelm health services”

A survey in the report of leaders of almost 500 global cities found half expected their public health infrastructure to be seriously compromised by climate change, meaning systemic failures such as the shutdown of hospitals.

157 million more vulnerable people were subjected to a heatwave in 2017 than in 2000

The Lancet report said 153bn hours of work were lost in 2017 due to extreme heat, 80% of it in agriculture

Almost half the losses were in India, equivalent to 7% of its total working population, while China lost the equivalent of 1.4% of its workers

Relatively small changes in temperatures and rainfall could cause large changes in the transmission of infectious diseases spread via water and mosquitoes. The ability of the dengue fever virus to be transmitted – its “vectorial capacity” – reached a record high in 2016, according to the report, 10% above a 1950s baseline.

Prof Paul Ekins, of University College London, said the health benefits of tackling climate change had long been undervalued, with just 5% of funding for adaptation to global warming being spent on health

“These benefits are enormous, near-term and affect our health immediately,” Ekins said. “If you factor in these benefits, cutting emissions to [keep the temperature rise below] 1.5C is going to be a net benefit to humanity in monetary terms.”

Dr. Gallo is leading the charge to test the O.P.V. live polio vaccine as a treatment for coronavirus.

B.C.G. may actually be able to ramp up the body’s initial immune response in ways that reduce the amount of virus in the body, such that an inflammatory response never occurs.

Case and Deaton report that poor health is becoming more common for each new generation of middle-aged, less-educated white Americans. And they are going downhill faster.

Case said the new research found a “sea of despair” across America. A striking feature is the rise in physical pain.

The nation’s obesity epidemic may be another sign of stress and physical pain, she continued: “People may want to soothe the beast. They may do that with alcohol, they may do that with drugs, they may do that with food.”

white men today are about twice as likely as they were in 1999 to die from one of the “diseases of despair,” while women are about four times as likely.

Deaton cited suicide as an action that could be triggered not by a single event but by a cumulative series of disappointments: “Your family life has fallen apart, you don’t know your kids anymore, all the things you expected when you started out your life just haven’t happened at all.”

“It’s just a background of continuous decline. You’re worse off than your parents,” Lleras-Muney said. “Whereas for Hispanics, or immigrants like myself” — she is from Colombia — “or blacks, yes, circumstances are bad, but they’ve been getting better.”

declining health of white, working-class Americans suggests that Republican plans to replace the Affordable Care Act are akin to bleeding a sick patient. As he put it, “Treat the fever by causing an even bigger fever.”

Graphs accompanying the new paper suggest that death rates for blacks with only a high school education began rising around 2010 in many age groups, as if following the trend that began about a decade earlier among whites.

ess-educated white Americans tend to be strikingly pessimistic when interviewed about their prospects.

white mortality rates fell in the biggest cities, were constant in big-city suburbs and rose in all other areas. The Washington Post’s analysis published last year highlighted the same geographical signature, with a break in death rates between the two most urban classifications (big cities and big-city suburbs) and the four less urban classifications, which The Post described as an urban-rural divide.

That urban-rural divide appears to have widened, particularly in recent years, the CDC reported.

In Israel, more than half of its 9 million people have been inoculated and have been given access to an app that allows exclusive access to a host of venues, including indoor dining.