The Washington Post - 14.03.2020

SATURDAy, MARCH 14 , 2020. THE WASHINGTON POST eZ re A

contain the epidemic,” said Gio-

vanni rezza, director of the Infec-

tious Disease Department at the

Italian National Institutes of

Health.

“We are applying very tough

measures” in Italy, he said. “But

in other countries where the inci-

dents of the disease are increas-

ing, it’s like they are not looking

at L ombardy,” h e added, referring

to Italy’s worst-hit region.

“for the other countries

around us, we should be a lesson.

They know the virus is there, so

they should act more promptly,”

rezza said.

for the United States, rezza

said, there was still a “window of

opportunity” to try to contain the

virus, given the large geographi-

cal area and isolated outbreaks.

Infectious-disease specialists

say it is possible the case numbers

in the Northern Hemisphere will

soar in march and then begin to

go d own if the coronavirus proves

to be seasonal, like common flu,

which produces less infection in

the warmer summer months.

The British government, espe-

cially, appears to be hoping the

infection rate drops in April and

may, but so far, there is no

evidence to support the opti-

mism.

In northern Italy, where the

wards are running out of beds for

all the covid-19 patients, doctors

the time it may take for the virus

to cause symptoms and for pa-

tients to be tested and diagnosed.

Britain’s chief science adviser,

Patrick Vallance, said Thursday

that the United Kingdom had 600

confirmed cases, which he said

means that 5,000 to 10,000 peo-

ple there probably are infected.

If the virus continues to infect

people at i ts current rate, which is

not a certainty, a European coun-

try such as Spain, with 3,

cases, could see 250,000 infected

individuals in about a month,

based on doubling times of five

days.

“Those are the numbers that

epidemiologists are expecting,”

said roy Anderson, professor of

infectious disease at Imperial

College London.

“I think it’s highly likely we all

go the way of Italy” in the coming

weeks, he said.

Whether the caseloads explode

will depend in part on public

health controls, decisions by gov-

ernments and businesses, and

individual actions, the disease

modelers say.

“If governments do nothing, or

do things that are not effective,

and the population does nothing,

then you certainly could see

60 percent of a population infect-

ed,” Anderson said.

Some European countries ap-

pear to be “renouncing efforts to

The coronavirus outbreak

BY DARRYL FEARS

AND BRADY DENNIS

At her home in The Villages, a

sprawling central florida retire-

ment community that overlaps

three counties, Alicia Przybylow-

icz still greets neighbors with a big

smile and an outstretched hand.

“I’m a hand-shaker. I think I will

always be a hand-shaker and a

hugger,” t he 6 4-year-old s aid. Wor-

ries about the coronavirus aren’t

going to stop that. “It seems that

it’s b een blown out o f proportion.”

Not far away, at a house in the

same community, Judy Nieman,

66, said that attitude is alarming.

“We don’t know how this is going

to spread in this community,” she

said. “We’re all older here. This

place is full of people who go on

cruises all the time. They go on

safaris. And I don’t see them cur-

tailing their a ctivities a s much as I

would.”

Nieman is playing it safe, order-

ing groceries online and popping

open her car trunk at Walmart for

workers to stuff it with bags. Be-

fore entering another store to buy

beef and ribs, Nieman cleans the

shopping-cart handle with a sani-

tizing wipe.

As the coronavirus continues

its spread across the w orld a nd the

Centers for Disease Control and

Prevention warns that older

Americans are among those who

face the highest risk of hospital-

ization and death, retirees from

florida to Alaska are weighing

whether to continue living their

normal lives or do whatever it

takes to preserve them.

The Villages is one of the largest

retirement developments in the

United States, with 125,000 resi-

dents living on more than 15,

acres. When asked on the “Villag-

es friendly folks” facebook page

how they were managing the coro-

navirus, a majority o f people sided

with Przybylowicz, saying the cri-

sis i s being overblown.

Against mounting advice from

federal and private health e xperts,

many expressed a determination

to move forward with travel excur-

sions, such as cruises. But that is

getting harder to do.

In recent days, the industry

bowed to a federal directive forc-

ing passengers 70 and older to

provide a doctor’s note proving

their fitness to sail. multiple

cruise operators suspended oper-

ations because o f the c oronavirus.

on Wednesday night, as Presi-

dent Trump was announcing a

travel ban from Europe to the

United States, hundreds of resi-

dents at The Villages freely

roamed the sprawling property.

Partygoers danced to the live mu-

sic presented nightly, ignoring t he

warnings of the CDC to practice

social distancing — “remaining

out of congregate settings, avoid-

ing mass gatherings” and main-

taining a distance of about six feet

to guard against infection.

“We’re living the last third of

our lives,” Sal Gentile, 70, wrote in

response to a Washington Post

inquiry. “We’re bolder, not older.

Time to be mindful. Take a deep

breath and enjoy life. We worked

many decades to now have the

privilege of being older. ... Yep, I

have a pacemaker and recent fu-

sion; however my love for quality

of life is more important to me

than being r attled by a TV s tation.”

When her book club canceled

its cruise to the western Caribbe-

an, with one of the 10 club mem-

bers worried about getting sick

and others worried about getting

stuck at sea amid a potential out-

break, Przybylowicz was a little

miffed.

“for me, that would’ve just ex-

tended my vacation,” she said. “As

long as someone was feeding me

and changing my bed, I would be

fine.” S he said she thinks the ships

are sanitized and safe. “There’s no

reason w e can’t g o,” s he said. “ Peo-

ple are too worried. The flu has

killed more people than the coro-

navirus, and people haven’t been

as concerned over t he f lu.”

A significant number of other

residents said they were heeding

experts’ advice and canceling

cruise reservations, or at least

waiting t o see whether cruise lines

would do so. Nearly 50 million

Americans are 65 or older, accord-

ing to the census, and how aging

retirees alter their plans and hab-

its will affect almost every corner

of the economy, particularly in the

travel industry.

AArP estimates that Ameri-

cans age 50 and over spend more

than $149 billion each year on

leisure travel. According to the

group, large numbers of boomers

plan trips around the c ountry and

abroad each year, often spending

many thousands of dollars each

on their adventures.

“Travel is really the top aspira-

tion of older Americans,” said Bill

Walsh, an AArP vice p resident. “It

means a lot to them, and it means

a lot to the travel industry as well.

But these are n ot normal times we

are living in.”

At road Scholar, a Boston-

based educational travel tour

company that caters l argely t o old-

er adults, most trips are going

forward for now, aside from those

to countries where authorities

have restricted travel.

“Because things are evolving so

rapidly, we’ve put together a task

force that meets d aily to assess the

situation,” Stacie fasola, a road

Scholar spokeswoman, said in an

email. She noted that the compa-

ny has been posting updates on-

line that provide travelers the

most current advice to help them

decide what to do.

Despite resistance from many

older Americans to curtailing

their activities, other seniors said

they are fine exactly where they

are — a t home. At the G reenspring

retirement community in Spring-

field, Va., Wanda Hill, 92, was

gladly heeding the call for older

residents to hunker down: “I’m

very comfortable.”

Hill praised the administrators

who have put out robocalls and

appeared on the community’s lo-

cal TV station with updates each

day. for example, she said, resi-

dents were asked not to invite

family members or friends to visit

if they have recently traveled out-

side the country. When her son

came from New York for a recent

visit, he was asked about his trav-

els before being allowed past the

front gate.

The community’s several res-

taurants have remained open, as

have its pharmacy and grocery

store. Church services and bingo

games still draw crowds. resi-

dents continue to learn Spanish

and p lay pickleball. But that could

change, a nd Hill knows it.

“I’ve got a television and DVDs.

The Post has gotten so big that it

takes me two hours to read that

every day,” she said. “I’m perfectly

happy to spend the whole day

right here in my a partment.”

other aging A mericans a re pre-

paring, as well.

In Alaska, which saw its first

coronavirus case Thursday, the

staff at t he 3 5,000-square-foot An-

chorage Senior Activity Center is

preparing for what might come.

The community hub bustles with

daily classes, a fitness center, so-

cial events, a library and a restau-

rant.

rebecca Parker, the executive

director, said in an interview that

the center recently switched to

disposable paper products in the

restaurant to cut down on poten-

tial transmission. Employees are

wearing gloves. Hand sanitizer

has been added throughout the

building, and impossible-to-miss

signs hang on doors and mirrors

reminding visitors to wash their

hands long e nough to sing “Happy

Birthday” twice.

But there are more intimate

changes at t he center, which is t he

heart of its members’ social life,

where they see friends and loved

ones. “There a re some people w ho

still want to hug. I hug them, but I

don’t e xpect everybody to,” Parker

said. “A nd I probably need to step

back a little myself.”

Back at The Villages, Barbara

St. Lawrence Combs is also inch-

ing back, little b y little.

“We are told i n The Villages that

we live ‘in the bubble,’ ” she said.

“That would be great, but we

know better when watching the

news about this scare.” for now,

she is taking only a few precau-

tions, “fist-bumping instead of

hugging and shaking hands with

our friends,” Combs said. “We are

in our 70s and are healthy but

don’t want to take any chances.” A

planned family trip to Key West

was canceled because of the

crowds there.

Nieman said she was less wor-

ried about herself — “when I go to

the doctor, I get a clean bill of

health m ost every time” — b ut her

next-door neighbors are in their

80s. She is afraid of getting infect-

ed by the coronavirus and unin-

tentionally spreading it to friends

who are even more v ulnerable.

“I’m real protective of them,”

she s aid. “ I don’t w ant anything to

happen to them.”

She wonders why her friends

who say they will be fine aren’t

thinking beyond themselves

when they travel and return.

“They go everywhere.” Nieman

said. “Viking cruises, safaris, huge

trips all over the world. And I

worry about being around all

that.”

[email protected]

[email protected]

Many older Americans

unconvinced of threat

At retirement community

in Florida, some worry

while others wave it off

HAYoung Jeon/ePA-eFe/sHuTTersToCK

Members of the German parliament sit apart from each other during Thursday’s session amid fears of the spread of the coronavirus.

report they are battling out-of-

control transmission.

Earlier, a group of Italian doc-

tors sent out an appeal to their

colleagues working in intensive-

care units in Europe.

“Get ready,” they wrote.

Angelo Pan, h ead of infectious

diseases at a hard-hit hospital in

Cremona, Italy, warned that with-

out effective containment mea-

sures, a similar scenario could be

ahead for france, Germany and

possibly the United States.

“It’s just a matter of time,” he

said. “I think we are just maybe 10

days ahead.”

Benjamin maier, who is Brock-

mann’s research partner at the

robert Koch Institute, has plot-

ted the infection curves of coun-

tries in Europe and Asia that have

seen outbreaks.

Spain is showing galloping ex-

ponential growth, he said, while

Britain, Germany and france are

still on a steep trajectory.

“You can see that many coun-

tries will follow Italy’s example if

they don’t follow strict and strict-

er measures,” maier said.

Those measures can have a

significant impact on how many

cases develop. Brockmann and

maier examined the epidemio-

logical curves of the outbreak in

China. Although Hubei province

initially had an exponential

growth rate, the government’s

massive containment effort, in-

volving mandatory behavior

changes, managed to slow the

rate of infection.

South Korea, which has carried

out widespread testing, has iden-

tified nearly 8,000 cases, but the

numbers of new infections are

tapering off. Singapore, malaysia

and Japan a lso have seen flatter

growth.

for those countries facing

steep increases in c oming weeks,

all is not lost, said Alexander

Kekulé, a German virologist who

heads the institute of medical

microbiology at the University of

Halle.

Acting in advance, rather than

in reaction to numbers that lag

behind the picture on the ground

by weeks, he said, can make a

huge difference.

“This really decides if you win

the battle, or you lose it,” he

added. for weeks, Kekulé has

publicly urged Germany to act

more swiftly with measures to

ban mass events, close schools

and test everyone who has flu-

like symptoms.

But China’s swift and drastic

action is more of a challenge in

Western democracies.

Politicians in Europe have

been slow to make proactive deci-

sions that could be lifesaving

until the danger has sunk in for

the public, said Kekulé, meaning

they are reacting, rather than

getting ahead of the curve.

The fact that German Health

minister Jens Spahn recom-

mended events with more than

1,000 people be stopped on the

same day that the first German

national died was no coincidence,

he said.

“It’s always the problem of a

democratic system; you have to

explain yourself to your voters on

why this measure has to be tak-

en,” he said. “You have to wait

until it’s hurting.”

[email protected]

[email protected]

Morris reported from Berlin and

Milan. Booth reported from London.

“What we are seeing is not
rocket science,” Balloux said.
“You have two cases, then four,
then eight, then 16.”
Epidemiologists say that deci-
sive action is required to change
the rate of infection and “flatten
the curve.” That reality appeared
to sink in for some political
leaders in the United States and
Europe this week, as countries
closed schools, encouraged work-
ing from home, banned large
gatherings and imposed new
travel restrictions. french Health
ministry Director-General
Jérôme Salomon said france
must prepare itself for “the Ital-
ian scenario.”
Still, some experts worry that
governments aren’t doing
enough to reduce rates of trans-
mission so cases don’t soar expo-
nentially and overwhelm health
systems. A lack of urgency in
previous weeks may have wasted
valuable time, they say.
on friday, the director-general
of the World Health organiza-
tion, Te dros Adhanom Ghebreye-
sus, said, “Europe has now be-
come the epicenter of the pan-
demic, with more reported cases
and deaths than the rest of the
world combined, apart from Chi-
na.”
Irish doctors on friday warned
in a letter to the British medical
Journal that the country is “exact-
ly 14 days behind Italy.” They said
only stringent measures could
head off a medical crisis like
Italy’s and produce a more man-
ageable outbreak like South Ko-
rea’s.
At the beginning of an out-
break, experts say, viral spread
can be contained by isolating
individuals and tracing those in
contact. But when cases begin to
emerge where the infection
source is unknown, as they have
in parts of Europe and the United
States, mass behavioral changes
and social distancing appear to
be the better strategy.
Italy is one country that has
had to accept quickly the need for
drastic action. Just three weeks
ago, it did not have much of a
coronavirus problem. Now it has
had more than 15,000 confirmed
cases. Prime minister Giuseppe
Conte extended a lockdown on a
handful of small villages to wide
swaths across northern Italy on
Sunday morning and then to the
entire country m onday night. on
Wednesday, h e went even further,
with the announcement of a shut-
down of most commercial activi-
ty.
Italy may have been particular-
ly hard hit in part because the
virus spread in the community
for several weeks unchecked, and
the government has had to play
catch-up.
Dirk Brockmann, a professor
at Humboldt University in Berlin
who does infectious-disease mod-
eling for Germany’s robert Koch
Institute, the federal agency
tasked with disease control, said
looking at the number of con-
firmed cases at a particular mo-
ment can be misleading — if
people think it is just a few
thousand cases here and there.
“It’s almost like taking a still
picture of cars on a highway; it
doesn’t tell you anything,” he
said. “It’s about how the numbers
change.”
The current snapshot may be
as much as two weeks old, given

euroPe from A

European nations bracing for ‘the Italian scenario’

Source: Johns Hopkins CSSE

Data as of March 12

THE WASHINGTON POST

Total confirmed cases of covid-

0

2,

4,

6,

8,

10 ,

12,

JAN. FEB. MARCH MARCH 11

U.S.

2,3 84

2,

Italy

12,

The U.S. has a

similar number

of coronavirus

cases as Italy

had 8 days ago,

on March 3

First U.S.

case

First Italian

cases

TIM MEKO/THE WASHINGTON POST

1918

SEPT.OCT.NOV.DEC.

deaths per

100 ,000 people

250

200

150

100

50

0

Social

distancing

interventions

first enacted,

Oct. 3

First case in

Philadelphia,

Sept. 17

First case in St. Louis, Oct. 5

Social distancing

enacted Oct. 7

Philadelphia

St. Louis

Sources: Data derived from “Public health interventions and epidemic intensity during the

1918 influenza pandemic” by Richard J. Hatchett, Carter E. Mecher, Marc Lipsitch,

Proceedings of the National Academy of Sciences, May 2007.

Effects of social distancing on 1 91 8 flu deaths

As the first cases of the 1918 flu

were reported in Philadelphia in

September 1918, authorities

played down the significance and

allowed public gatherings to

continue. Closures in Philadelphia

were only enacted once the virus

had spread. The first cases in

St. Louis were reported in early

October, with measures to contain

the spread enacted two days later.

This resulted in a slower spread

and lower mortality rate.