Coronavirus in the US

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Alejandro Giammattei, the president of Guatemala, has ordered an eight-day curfew from Sunday to stem the spread of coronavirus in the Central American country.

Albania has resorted to deploying the army to enforce a curfew that began at 1pm local time on Saturday – the country’s latest bid to stem the spread of coronavirus.

The measure, set to last 40 hours, was implemented after citizens continued to openly flout orders to stay at home. To date 76 people in the former Stalinist state have contracted the virus. Two deaths have also been recorded.

With some 120,000 people having returned from Italy – like Greece, host to a large Albanian community – prior to the country cutting air and sea links with its neighbour on 9 March, there are mounting fears over the ability of the nation’s health system to cope in the event of a sudden surge in confirmed coronavirus cases.

The prime minister, Edi Rama said authorities wouldn’t hesitate to use force if the curfew was violated. “Everyone will stay inside after 13:00,” he said. “Police and armed forces will use force against whoever breaks the law, including pensioners, and will use water canons and teargas if need be.”

Prior to the lockdown, Albanians had failed to uphold the appeals of authorities to social distance with news agencies in Tirana, the capital, describing joggers going out in groups to exercise, the elderly playing dominoes in the street and people converging on supermarkets with scant attention to those next to them.

Brazil’s far-right president is facing fierce criticism for what is widely seen as his chaotic and cavalier response to the coronavirus crisis.

Despite this, governors of some of Brazil’s key states are taking drastic action amid warnings that the country’s health service could collapse because of coronavirus in the coming weeks.

The governor of São Paulo state, João Doria, has just announced that it will begin a 15-day quarantine from this Tuesday.

“This will mean the order to close all non-essential commerce and services,” João Doria told reporters according to the Folha de São Paulo newspaper.

São Paulo is Brazil’s most economically important and populous state - home to more than 44 million of the country’s 209 million citizens. Its capital is the megacity of São Paulo with somewhere in the region of 20 million residents.

Guardian

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From CNN:

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Sometimes I wish I lived in a developed country like South Korea that has a 10 minute test.
https://www.npr.org/sections/goatsandsoda/2020/03/13/815441078/south-koreas-drive-through-testing-for-coronavirus-is-fast-and-free

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An Irish naval vessel is being transformed into a Covid-19 testing centre.

The LE Samuel Beckett is berthed at Sir John Rogerson’s quay on the Liffey River in Dublin city centre.

Hundreds of cases of the virus have been recorded in Ireland.

Army engineers provided power and lighting for the vessel, while others erected tents along the quayside close to the central bank.

It is part of a major effort by the defence forces to support the health service’s response to the coronavirus pandemic. (Guardian)

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The FDA authorized the use of a new test that can be used in point of care settings:

https://www.prnewswire.com/news-releases/cepheid-receives-emergency-use-authorization-from-fda-for-rapid-sars-cov-2-test-301027823.html

It is a cartridge-based test that does not require elaborate RNA extraction:

“ Xpert® Xpress SARS-CoV-2 can be utilized in multiple settings where actionable test results are needed to make informed treatment decisions quickly. The test delivers point-of-care results with the same level of performance seen in reference labs. The test is designed for use on Cepheid’s GeneXpert® Systems, which have a worldwide footprint of more than 23,000 placements.”

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427 new confirmed cases in NJ. Total number of cases reach 1,327.

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Pence: US Department of Health and Human Services has ordered “hundreds of millions of N95 masks”

CNN

Vice President Mike Pence announced Saturday during a coronavirus task force meeting that the Department of Health and Human Services has placed a huge order for N95 masks needed to fight the coronavirus pandemic.

“I am pleased to report to the President today that HHS just placed an order for hundreds of millions of N-95 masks made available to health care providers across the country,” Pence said.
Pence then addressed the need to postpone certain medical procedures across the US out of precaution.

“On behalf of the President, we do renew the call for Americans to postpone elective medical procedures, including dental services, and this is another way to make sure that the medical supplies are available, by postponing elective medical procedures, you are freeing up medical supplies for those dealing with the coronavirus,” he said.

Italy sees biggest daily increase in coronavirus deaths

The death toll from an outbreak of coronavirus in Italy rose by 793 to 4,825 on Saturday, officials said.

It is the largest daily rise in absolute terms since the contagion emerged a month ago.

On Thursday, Italy overtook China as the country to register most deaths from the highly contagious virus.

The total number of cases in Italy rose to 53,578 from a previous 47,021, an increase of 13.9%, the Civil Protection Agency said.

The hardest-hit northern region of Lombardy remains in a critical situation, with 3,095 deaths and 25,515 cases.

Of those originally infected nationwide, 6,072 had fully recovered on Saturday compared to 5,129 the day before.

There were 2,857 people in intensive care against a previous 2,655. (Guardian)

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Pence and his wife will be tested Saturday afternoon for coronavirus
From CNN’s Veronica Stracqualursi and Jason Hoffman

Vice President Mike Pence said Saturday during a news conference that he and his wife Karen would be tested for the coronavirus.

Pence said that more than 195,000 Americans have been tested for the virus. Pence noted that number does not include county hospitals or health care labs around the country.

Currently, only 19,343 tests have come back positive, Pence said.

Earlier Saturday: President Trump told reporters that Congress is close to reaching a deal on a proposal for the next stimulus bill to deal with the pandemic.

On Saturday, congressional and administration negotiators entered a crucial day in the effort to deploy more than $1 trillion in emergency stimulus to a staggering economy, with a growing consensus on a final agreement, but a handful of significant hang-ups still needed to be resolved.

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I can understand why Deaths in Italy keep rising, but why are cases still going up so fast. They have been under social distancing for about 10 plus days. Is there a timeframe as to when it should peak and start going down with social distancing?

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Look at Chinese numbers. Wuhan went on lockdown on 1/23. It takes time.

https://www.worldometers.info/coronavirus/country/china/

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Many places have been doing that - quietly - so as not to alarm the general population. Two weeks ago, my hospitalist neighbor told me a team at her facility was looking into ways of expanding their hospital, creating triage areas, and using empty city/government buildings.

I will add this note of HOPE. As a nation, we’re more accustomed to doing things on an individual/neighborhood/state level than at the federal level. All kinds of historical and cultural reasons for that, but my HOPE is that this ends up being more effective than the alternative. At least at the caregiving level.

(We certainly need a massive federally driven economic package, and I don’t mean a one time payment of a thousand bucks or a tax cut. But that’s another story.)

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Incubation period is 5 - 14 days, and then it takes about a week or so before sick people need medical intervention. So there will be a 2+ week lag on new cases, and then even longer for deaths to peak.

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Governor Murphy has ordered the physical closure of all non-essential businesses in New Jersey effective at 9 p.m. tonight and the cancellation of all gatherings (including parties, weddings, and worship services of any size). Stay in your primary residence and do not go to your Shore house.

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I think the Italians were not super compliant at first. (I recall reading about that anyway.)

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Top infectious disease doctor: “Not every single person in the United States needs to get tested”
From CNN’s Jason Hoffman

Dr. Anthony Fauci, director of National Institute of Allergy and Infectious Diseases, stressed that not all Americans should be tested for coronavirus during a White House press conference Saturday.

Fauci noted if people get tested unnecessarily, they will utilize important personal protective equipment that could be used for those who do need to be tested or are at a greater risk.

“Not every single person in the United States needs to get tested,” Fauci said
Fauci noted that right now there are disparities in the amount of available personal protective equipment though, “we are working hard to correct that.”

Fauci also reiterated doctors should put off elective surgeries for the time being so they don’t put themselves of others at risk by utilizing medical equipment.

Pret a Manger closes UK stores

High Street coffee chain Pret a Manger has just announced that it will be closing all 550 UK stores from this evening.

On Wednesday it switched to a ‘takeaway’ model and closed seating areas, later telling staff it was cutting working hours and pay by a quarter as customers followed government advice to stay at home to dampen the spread of coronavirus.

In a message to customers today, Pret’s chief executive Pano Christou said:

My priority is always to protect our teams as much as we can. For this reason, we will be closing all our UK shops temporarily from this evening.

We will of course ensure any excess food goes to those who need it most. We look forward to being a part of your daily lives again soon. Until then, stay healthy and look after each other.

Guardian

Texas governor is waiving regulations for nursing students to help expand medical workforce
From CNN’s Melissa Alonso

Texas will issue temporary permits to “nurses who have yet to take the licensing exam” and suspend other regulations for students to assist with the state’s response to Covid-19, Gov. Greg Abbott said in a press release Saturday.

Abbott is allowing “nurses with inactive licenses or retired nurses to reactivate their licenses,” the release said.

Nursing students in their final year will be allowed to “meet their clinical objectives by exceeding the 50% limit on simulated experiences,” the release added.

“In the coming weeks and months, Texas will continue to see a growing need for medical professionals to help us respond to these unique and challenging times,” Abbott said.

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Again, you do not need for your governor to implore you to: stay home, wash your hands (scrub for 20 sec - do the finger in between thing), disinfect high touch surfaces and maintain 6’ between yourselves. You do all of that on your own. It helps you and everyone you know and even people you don’t know.

https://coronavirus.ohio.gov/wps/portal/gov/covid-19/home/COVID-19-Checklists/COVID-19-Checklists

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Coronavirus cases cause ground stop at New York City-area airports, FAA says

Air traffic into major New York City-area airports was halted, the Federal Aviation Administration said as coronavirus continues to cause staffing issues at FAA facilities around the country. CNBC

New York’s airspace has been partially closed after a trainee at an air traffic control tower tested positive for coronavirus.

The Federal Aviation Administration (FAA) has issued a ground stop for New York airports as it adjusts its staffing to reopen the airspace.

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Ugh, people can be so ugly. One of my FB friends posted a meme showing the states that have failed to limit crowd sizes. It (incorrectly) included Texas on the list. A woman replied: <<george carlin="" had="" a="" particularly="" sharp="" joke="" years="" ago="" about="" the="" rate="" of="" executions="" in="" texas="" -="" “okay,=”" one="" good="" thing="" fewer="" texans"="">> (followed by a political comment I will not include since it’s not permitted). Really?!? I replied to her post about how insensitive and offensive it was and added, “I feel sorry for you - you have to live with yourself 24/7.” Sigh.

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NJ Governor orders nonessential retail businesses to close, issues stay-at-home order for nearly all residents

Scott Mlyn | CNBC

New Jersey Gov. Phil Murphy signed an executive order mandating that “nearly all” state residents stay at home, NBC New York reported.

“All gatherings are canceled,” Murphy tweeted. “ALL non-essential retail businesses must indefinitely close their physical stores to the public effective 9:00 p.m. [Saturday night].

In New Jersey, 1,327 people have tested positive for COVID-19, Murphy said Saturday, 442 more cases than the previous day. To date, 16 people have died from the virus, Murphy said.

New Jersey governor issues “stay at home” order
From CNN’s Melanie Schuman

New Jersey Gov. Phil Murphy announced a statewide “stay at home” order which will go in to effect at 9 p.m. ET Saturday.

This order follows New York and Connecticut which made similar orders Friday.

There are 1,327 confirmed Covid-19 cases in New jersey with 16 deaths in total, Murphy said at a press conference.

There were 400 more COVID-19 confirmed cases since yesterday, Murphy added

“From day one, we’ve made a commitment to be guided by the facts and take any action necessary to protect the health and safety of New Jersey’s nine million residents,” Murphy said in a press release. “We know the virus spreads through person-to person contact, and the best way to prevent further exposure is to limit our public interactions to only the most essential purposes. This is a time for us all to come together in one mission to ‘flatten the curve’ and slow – and eventually halt – the spread of coronavirus.”
The order will prohibit all gatherings, such as celebrations, the governor said.

Murphy’s executive order further directs the closure of all non-essential retail businesses to the public, with the exceptions of:

Grocery stores, farmer’s markets and farms that sell directly to customers, and other food stores, including retailers that offer a varied assortment of foods comparable to what exists at a grocery store
Pharmacies and medical marijuana dispensaries
Medical supply stores
Gas stations
Convenience stores
Ancillary stores within healthcare facilities
Hardware and home improvement stores
Banks and other financial institutions
Laundromats and dry-cleaning services
Stores that principally sell supplies for children under five years
Pet stores
Liquor stores
Car dealerships, but only for auto maintenance and repair, and auto mechanics
Printing and office supply shops
Mail and delivery stores

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Unfortunately, given human nature, some people do need it enforced. We’ve seen that with any country. Most people posting here know and follow this. But even here there are some selfish exceptions who think they know better than the epidemiologists.