The New York Times. April 04, 2020

THE NEW YORK TIMES, SATURDAY, APRIL 4, 2020 N A

Tracking an OutbreakTravel and Linguistics

NEW DELHI — Ana Pautler, a
trekker from San Francisco, was
partway up a Himalayan moun-
tain trail in Nepal when she no-
ticed something peculiar: People
were turning around.
As fears of the coronavirus
spread around the world, German
hikers told Ms. Pautler on March
17 that their embassy had advised
them to return to Kathmandu, the
capital, and was discussing flying
people out. Israeli tourists were
doing the same thing, she said,
spurred on by messages to leave.
But Ms. Pautler, 32, who has
been living in China, received no
such alert from the State Depart-
ment’s travel advisory system un-
til March 23, though she was
signed up for regular updates.
By that point, Nepal’s interna-
tional airspace had already been
closed for a day, following similar
shutdowns all over the world, and
her flight out had been canceled.
“Other embassies seemed to be
giving more information,” Ms.
Pautler said in a telephone inter-
view from Kathmandu, where she
is waiting out a nationwide lock-
down that will last until at least
mid-April. “The U.S. Embassy
wasn’t really saying anything.”
While the United States strug-
gles with surging cases of the co-
ronavirus and life-or-death deci-
sions in a fast imploding health
care system, citizens stranded
thousands of miles away fear that
they may be left behind.
A State Department spokesper-
son wrote in an email that person-
nel were “working tirelessly to
identify transportation options for
U.S. citizens seeking to return to
the United States.” The State De-
partment did not answer a ques-
tion about why Americans in Ne-
pal were notified of complications
returning home later than other
nations.
As coronavirus cases reached
one million worldwide, Americans
on three continents said in inter-
views that government repatria-
tion efforts had seemed slower
and less certain than those of
other countries, pointing to em-
bassy social media posts and
emails through the STEP pro-
gram, which provides travel up-
dates to citizens abroad.
In India, American beachgoers
in Goa, where many shops have
closed from a 21-day lockdown,
said they were rationing food as
other countries loaded their citi-
zens onto buses bound for the air-
port.
In Ghana, Halima Mahdee, 40, a
student from California, said she
was furious about not having been
evacuated weeks ago, when South
Korean and Chinese students
were sent home from her study
abroad program in Accra, the cap-
ital.
In Peru, hundreds of Americans
are still trapped, and activists
warned that a humanitarian crisis
was unfolding as tourists reported
being forcibly evicted from hotels
and unable to find medicine for
critical health conditions.
Diane Gallina, 68, from Long Is-
land, was frantically worried
about her daughter, who she said
was holed up alone in a hotel in
Lima and feeling despondent.
“She told me the Canadians got
out,” she said through sobs. “How
come Canada can get their people
out?”
Some tourists pointed out that
communication had been far

smoother with the embassies once it became clear that the United States was also going into lockdown mode. Parts of Europe, for instance, were initially reporting higher cases of the coronavirus than the United States, a possible reason for why they urged citizens to leave Nepal days earlier. The extraordinary challenge of evacuating Americans from far- flung corners of the world at the same time has overwhelmed dip- lomats. Last week, the United States Embassy in Kathmandu started posting regular updates on Face- book and organizing buses and flights to reach people in moun- tain towns, including those near Mount Everest base camp. But even as those messages were distributed among tourists, senior officials in Washington seemed unaware of the specifics. Asked at a news briefing on March 27 about the situation in Nepal, particularly for Americans stranded on trails leading to Mount Everest, Ian Brownlee, the State Department’s principal dep- uty assistant secretary in the con- sular affairs bureau, told a report- er he would have to get back to her. Embassies have faced daunting logistics coordinating with local government officials who are fo- cused on protecting their own citizens. Even reaching tourists in countries like Nepal has been complicated: Some popular trails are accessible only by chartering tiny planes that hold a dozen people. At a Tuesday news briefing, President Trump said the evacua- tions were some of the “largest

and most complex” in American history. He said the State Depart- ment had rescued more than 25,000 Americans from more than 50 countries. “Almost everybody’s out now,” Mr. Trump said, referring to those in Peru and Brazil. But in Nepal, hundreds are still stuck. Alarm bells sounded more than two weeks ago, when European nations started contacting their citizens. On March 17, as stringent lockdowns started rippling around the world, the German Embassy warned citizens of flight disrup-

tions on their Facebook page and urged them to contact their air- lines. Over the next week and a half, Germany and France organized flights to take out hundreds of people, including citizens of Finland, Austria, Denmark and Belgium. As Europeans were receiving early warnings to leave, John Arns, 47, who lives in the San Francisco Bay Area, tried to get information about what the Amer- ican government was doing. But all he could find on the embassy’s Facebook page was information about proper hand-washing tech- niques and Women’s History Month. “I am incredibly disappointed

with the embassy’s response,” he said. Some Americans stuck in Nepal said they were being pointed out and called “corona” when they stepped outside of their hostels. The perception among some South Asians is that foreigners are responsible for importing the virus; Nepal has just six confirmed cases, including one person who has recovered. “The Nepalis here are afraid of us,” said Stacy Kim, 58, from Santa Cruz, Calif., who was stranded in a remote town near the country’s border with India. “When we try to buy food they are scared we are exposing them to the virus and try to get us to go away.” Even in Kathmandu, tourists said they were worried about the logistics of something as basic as reaching the airport. The police have threatened people on the streets. Raj Gyawali, who is part of a government crisis committee helping tourists during the lockdown, said the Europeans — ex- cept for the British — had been highly proactive in getting their citizens out. “To speak frankly, they seemed so organized,” he said. And the Americans? “I don’t know why they are de- laying,” he said. It was not until March 26 that the State Department issued its first notice about a possible evacuation flight. Five days later, 302 Americans left Nepal for Wash- ington. In a video message, the ambas- sador, Randy Berry, said the flight was the result of “hundreds of hours of coordination and cooper- ation.” At a Tuesday news briefing, Secretary of State Mike Pompeo urged Americans “to work your way back here,” saying he could not guarantee “the U.S. government’s ability to arrange charter flights indefinitely where com- mercial options no longer exist.” But as Americans have watched medical personnel load bodies onto refrigerated trucks and the United States reports more cases than anywhere else in the world, some are having sec- ond thoughts about trying to leave on another evacuation flight. Amy Sellmyer, 34, from Okla- homa, who has worked in Nepal and built a life there, felt she was better off staying put. “I’m not planning to go,” she said.

Ana Pautler and Mike Dobie brought dinner back to their hotel in Kathmandu, where they have been waiting out a lockdown.

TOM VAN CAKENBERGHE FOR THE NEW YORK TIMES

STRANDED TOURISTS

Kai Schultz reported from New
Delhi, and Bhadra Sharma from
Kathmandu, Nepal. Lara Jakes
contributed reporting from Wash-
ington.

Americans Abroad Say They Were Left in the Lurch

By KAI SCHULTZ and BHADRA SHARMA

Travelers waited for a charter flight coordinated by the U.S. Em- bassy at La Aurora airport in Guatemala City on March 24.

MOISES CASTILLO/ASSOCIATED PRESS

Citizens of Scandinavian countries in Lima, Peru, prepared for a repatriation flight on Thursday.

SEBASTIAN CASTANEDA/REUTERS

A lack of guidance

and information from

the State Department.

Making sense of the coronavirus pandemic requires getting up to speed on semantics as much as epidemiology. Government officials and health care professionals toss off mentions of mortality rates, flat- tening the curve and lockdowns, assuming that we know what they mean. But the terms mean different things from country to country, state to state, even city to city and person to person. Officials use the same phrases about mass testing, caseloads and deaths to describe very different situations. That makes it hard to give clear answers to vital ques- tions: How bad are things? Where are they headed? People search for insight by comparing their countries to those that are further along in the epidemic. But if the terms are mis- leading or used in differing ways, the comparisons are flawed. Also, the statistics and vocabulary offer a false sense of precision while in reality, the information we have shows only a fraction of what’s going on. “The new cases or deaths each day are given as exact numbers, and we’re trained to take that at face value,” said Mark N. Lurie, an epidemiologist at Brown Univer- sity’s School of Public Health. “But those are far from exact, they’re deeply flawed, and their meaning varies from place to place and from time period to time period.”

‘Confirmed Cases’ The United States recently hit an attention-getting milestone, pass- ing China as the country with the most reported infections. But there is deep uncertainty about whether there really are more American cases, and about how well the figures reflect reality. Countries vary wildly in testing for the virus and how they report the numbers, and experts say most infections are going unde- tected. So the publicized national tallies are rough, incomplete pic- tures that may not be all that com- parable. And that’s if countries are forth- coming about their data. Officials in the United States say that China, which has reported more than 82,000 infections, has understated its epidemic. Until this week, the Chi- nese government excluded those patients who tested positive for the virus but had no symptoms. China also doesn’t say how many tests it has conducted, and doubts have been raised about whether it has tested extensively in Xinjiang, the province where it holds hundreds of thousands of Muslims in indoctrination camps. Few countries have done ag- gressive testing. And of course, the more testing there is, the more cases are found. The Covid Tracking Project, run by The Atlantic, has tried to com- pile all the numbers in the United States and reports more than 1. million tests so far, over 3,600 per million people.

‘Widespread Testing’ President Trump has boasted that more people have been tested in the United States than any other country, though on a per-capita basis, many developed countries have done more. But it matters not only how many people are tested, but also when, and who they are. Once again, countries differ, shaping what the numbers mean. A few countries, like South Ko- rea, Australia and Singapore, got serious about mass testing early on. They used the information to do ambitious contact-tracing — finding and testing those who had recently been near infected people, even if they had no symptoms. That provided a pretty full pic- ture of the outbreak while the numbers were still manageable, and made it possible to slow it down. Though it did not act on the same scale as those countries, Germany did more testing and contact-tracing in the early going than most of Europe. But most nations with large numbers of cases have done less testing, waited longer to do it in bulk, and made little attempt at contact tracing. They find them- selves playing catch-up with the virus, ramping up testing after their outbreaks had already mushroomed.

‘Fatality Rates’ It has been stated time and again: Italy and Spain have high mortality rates among coronavirus patients, Germany’s is low, and Chi- na’s is somewhere between. It may not be that simple. Counting the dead is as flawed and inconsistent as counting the infected. Recent reports say that mortu-

aries in Wuhan, China, where the disease was first discovered, have ordered thousands more urns than usual, suggesting a much higher death toll than the city’s of- ficial count, 2,535. The outbreaks in Wuhan, and parts of Italy and Spain, overwhelmed hospitals, forcing many sick people to ride it out at home. No one knows how many people have recovered or died without ever being tested. Italy and France have reported death tolls that generally included only those who died in hospitals. In Germany, even some of those patients are excluded, because post-mortem testing for the virus is not standard in hospitals. And if only the sickest patients are tested, then the number of infections will appear smaller and the percentage who die will seem higher. Germany’s low apparent fatality rate — about 1 percent of those infected — may stem partly from its broader testing of those who are healthy or who have mild to no symptoms, and its narrower testing of the dead.

‘The Peak’ Officials often talk about when the epidemic peaks or plateaus — when a country “flattens the curve.” But they rarely specify, the peak of what? And how can we be sure we’re past it? When an outbreak is growing unchecked, more people become infected and more die each day than the day before. Italy went from reporting a few hundred newly detected infections per day in early March to more than 6, on March 21. That acceleration cannot con- tinue indefinitely, and more im- portant, Italy has strengthened social distancing, apparently slowing transmission of the virus. Since March 21, new confirmed infections have varied between about 4,000 and 6,000 daily. De- spite the problems with the avail- able figures, and the dangers of drawing conclusions based on just a few days, it seems clear after almost two weeks that Italy has passed a turning point. On a graph, the curve showing the daily count of new cases has gone from rising sharply to mov- ing sideways — the curve has flat- tened — and even begun to move downward. That is one corner being turned: The rate of the spread of the virus has slowed down. It takes longer to turn another: the rate of people dying. But that, too, appears to have leveled off in Italy, fluctuating around 800 a day in the last week. But even when those curves flatten, the epidemic still has not “peaked” by another crucial measure: the number of active cases. That figure continues to rise until the number of patients who either die or recover each day is larger than the number of new infections. To ease the staggering load on health care systems, the active cases curve must also flatten and then fall.

‘Lockdowns’ More than two billion people, including most Americans, are living under something usually called a lockdown. But there is no set definition of that word — or re- lated terms like stay-at-home mandates and social distancing — so the details differ from place to place. The lockdowns have varying exceptions for certain lines of work, personal circumstances or exercise. Some allow gatherings of up to ten people, or five, or for- bid groups of any size; some ex- empt funerals, others do not. The biggest differences may be in enforcement. Some places, like those in the United States with lockdowns, mostly rely on people to follow the rules without coer- cion. But Italy and others have de- ployed soldiers to ensure compli- ance, and French police have fined hundreds of thousands of people for violating restrictions. China, in addition to using securi- ty forces, mobilized an army of volunteers, ratcheting up social pressure to obey. And on Wednesday, President Rodrigo Duterte of the Philippines threatened to have lockdown vio- lators shot. Italy’s experience shows the looseness of the term. It has gone through several phases of restrictions, applying them to more people, making them stricter and in- creasing enforcement. A few weeks ago, a person could travel around Italy for a valid work or family reason. Now, people are fined for nonessential walking too far from their homes. But each stage was widely called by the same name: lockdown.

VOCABULARY

Words From Pandemic

Cause Some Confusion

By RICHARD PÉREZ-PEÑA

The New York Times. April 04, 2020

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