The Washington Post - 05.03.2020

A10 eZ M2 THE WASHINGTON POST.THURSDAy, MARCH 5 , 2020

the coronavirus outbreak

BY BRADY DENNIS, JAY GREENE AND HANNAH SAMPSON

The spread of coronavirus
around the country showed few
signs of slowing on Wednesday, a s
the disease known as covid-
claimed two more lives on the
West Coast, clusters of new infec-
tions surfaced in California and
New York, and lawmakers on Cap-
itol Hill raced to finalize an $8.
billion emergency spending bill to
combat the deadly outbreak.
California Gov. Gavin Newsom
(D) declared a state of emergency,
after officials there announced
the state’s first coronavirus-
linked death, bringing the death
toll in the United States to 11. The
fatality, w hich occurred northeast
of Sacramento in Placer County,
represents the first U.S. death out-
side Washington state.
Public health officials de-
scribed the deceased California
patient as an “elderly adult with
underlying health conditions.”
The patient was probably exposed
during a mid-february round trip
from San francisco on a Princess
cruise ship, officials said.
The head of the Centers for
Disease Control and Prevention
on Wednesday said the agency is
working with California to exam-
ine the passenger manifest for
that trip. The ship, known as the
Grand Princess, is a sister ship to
the Diamond Princess, which was
at the center of a coronavirus
outbreak in february that sick-
ened more than 700 people and
led to seven deaths.
meanwhile, at the epicenter of
the U.S. outbreak in Washington
state, officials confirmed another
death and 10 new cases of corona-
virus in King County. The state’s
10 deaths all have occurred in
King and Snohomish counties —
largely consisting of elderly pa-
tients with existing health prob-
lems who have been linked to the

Life Care Center nursing facility in Kirkland. “This is a shifting landscape and is shifting by the hour,” King County Executive Dow Constan- tine said during a Wednesday news conference. County officials advised people over 60 and with underlying conditions, as well as pregnant women, to stay home and avoid large groups. They also urged employees to telecommute for the next three weeks if possi- ble. King County is in the process of purchasing an 85-bed Econo Lodge motel in Kent, Wash., just south of Seattle, for $4 million to provide emergency housing for people with covid-19, the disease caused by coronavirus. The two-story motel met crite- ria set by the county’s public health agency, including separate heating and air-conditioning in each unit and doors that open to the outside rather than a hallway. The county has not yet deter- mined who will stay in the motel, located just off Highway 167. The county wants to make sure that as patients begin to recover, they can move out of hospital beds to make room for others. “It’s a rapidly m oving emergency situation,” said Chase Gallagh- er, a spokesman for the county. In California, Los Angeles County declared a local health emergency Wednesday as officials detailed six new cases of coronavirus, bringing t he countywide total to seven. Several of the patients recently traveled to northern Ita- ly, which remains among the pa rts of the globe hardest hit by the virus, officials said. The other new cases were either family members of the travelers or people who worked in close contact with them. “This is not a response rooted in panic,” K athryn Barger, chair of the Los Angeles County Board of Supervisors, said in a news con-

ference. “We’ve been preparing with our local, state and federal partners for the likelihood of this scenario.” In New York, Gov. Andrew m. Cuomo (D) on Wednesday announced a flurry of new cases, raising the state’s total to 11. The new cases, which involved people linked to a 50-year-old Westchester County attorney di- agnosed Tuesday, underscored the virus’s capacity to spread rapidly. The man’s wife and two chil- dren were among those who tested positive, as was a neighbor who drove the man to the hospital, Cuomo said. The attorney’s co- workers at his midtown manhat- tan law firm also are being tested. “Some of the tests are pending, but nobody has come back positive yet,” Cuomo said. The synagogue the man’s family attends will be closed until Sunday, officials said. His daughter’s high school will be closed until Tuesday. Its related elemen- tary and middle school will be closed through friday. The gover- nor later announced that a 45- year-old friend of the man who lives in New rochelle, N.Y., also tested positive for coronavirus. That person’s 46-year-old wife, two sons and a daughter also tested positive. New Jersey Gov. Phil murphy (D) announced late Wednesday the first positive case of covid- in the state. officials said the patient is a man in his 30s who has been hospitalized since Tues- day. As some businesses instructed employees to abandon nonessen- tial travel and encouraged tele- work, and as an increasing number of conferences and meetings are canceled, the effects rippled through the economy — e ven on a day that saw the Dow Jones indus- trial average end the day up nearly 1,200 points, or more than 4.

percent. The rebound came a day after the federal reserve delivered its first emergency rate cut since the 2008 financial crisis and amid volatile trading that saw concerns over coronavirus trigger a sell-off that erased trillions in value from global markets. United Airlines on Wednesday announced it will cut domestic flights by 10 percent and interna- tional flights by 20 percent next month. Executives are planning “similar reductions” in may, the airline said, underscoring the steep drop-off in travel demand. The airline is seeking volun- teers to take unpaid leaves of absence and is instituting a hiring freeze “except for roles that are critical to our operation,” the executives said. Amid the ongoing uncertainty, officials in the nation’s capital sought to once again reassure the public. At a late afternoon White House briefing, Vice President Pence said he would travel to minneapolis on Thursday to visit 3m, which is ramping up produc- tion of masks for health-care workers. Later, he plans to fly to Washington state to meet with Gov. Jay Inslee (D) and state health officials. “We understand the anxiety this has created,” said Pence, who added that he intends to make sure local officials have “every- thing they need.” In a near unanimous vote, the House on Wednesday approved an $8.3 billion emergency spending bill to fight the coronavirus. The Senate could follow suit as soon as Thursday, and President Trump is expected to quickly sign the legislation. The funding — m ore than triple what the White House initially requested to combat the outbreak — would set aside billions of dol- lars for vaccine development,

medical supplies, support for local health agencies and other preparation. The package includes more than $3 billion for research and development on vaccines and other treatments, as well as $2.2 billion for the CDC to support state and local agencies responding to the outbreak. The bill also would provide $1 billion in loan subsi- dies for small businesses, which Democrats said would enable the Small Business Administration to provide $7 billion in low-interest loans for companies affected by the outbreak. While the vast majority of the funding would be spent domesti- cally, Wednesday’s emergency bill also includes $1.25 billion for the State Department to assist in bat- tling the spread of the coronavirus overseas. Italy on Wednesday said it will close schools and universities throughout the country in an at- tempt to control the spread of the coronavirus, as it battles the most serious outbreak in Europe. A total of 2,706 people have tested positive for the virus in the country, and more than 10 percent of those who have tested positive are in intensive care, straining Italy’s health-care system, which is scrambling to add extra beds. Saudi Arabia suspended offsea- son pilgrimage trips to its holy cities of mecca and medina for all citizens and residents as part of an effort to combat the spread of the virus, the state news agency reported. Iraq’s health ministry announced the country’s first offi- cial death from covid-19 on Wednesday. The patient was iden- tified as a woman being t reated in Baghdad, the capital. Israel reported three more covid-19 patients on Wednesday, including a teenager whose diag- nosis resulted in the health minis-

try ordering about 1,400 students in his high school into quarantine. In London, British Prime min- ister Boris Johnson announced Wednesday that the U.K. govern- ment will introduce emergency coronavirus legislation that will allow sick pay for people who self-isolate from the first day of their illness. Under the current rules, em- ployers have to give sick pay only from the fourth day of illness. Australia’s top physician warned citizens against stockpil- ing toilet paper, after stores across the country ran out as shoppers bought supplies amid the coronavirus outbreak.“We are trying to reassure people that removing all of the lavatory paper from the shelves of supermarkets probably isn’t a proportionate or sensible thing to do at this time,” Chief medical officer Brendan murphy told a Senate hearing Wednesday, according to local reports. meanwhile, in China, fewer new cases were reported outside the country than within, suggest- ing that authorities’ efforts to curb transmission may be paying off at home, even as the casualty count rises elsewhere. China tightened restrictions on arrivals amid concern about cases being imported. Iran and Italy have re- corded 92 and 107 deaths, respec- tively. India reported a sharp rise in cases Wednesday after Italian tourists tested positive. [email protected] [email protected] [email protected]

seung Min Kim, Miriam Berger, rick Noack, siobhán O’Grady, Loveday Morris, Andrew Fr eedman, Louisa Loveluck, Benjamin soloway, Paul schemm, Karla Adam, ruth eglash, Adam taylor, Jennifer Hassan, Felicia sonmez, Kim Bellware, Ben Guarino and Michael Laris contributed to this report.

Death toll continues to rise in the U.S. as clusters of new cases emerge

tors,” said Elijah A. White, president of ZoLL resuscitation. “It’s not just China, it’s not just the United States, it’s all over the place.” If the outbreak expands and individual states have hundreds or thousands of patients instead of just a few, regional plans must be established to coordinate care, said Christopher Greene, an emergency room doctor at the University of Alabama at Bir- mingham. Severely ill p atients needing t o be placed on mechanical ventilators will have to be moved to hospitals with higher levels of care, and t hat presents further challenges for ambulance opera- tors and staff, Greene said. “This is a rapidly evolving thing. In a matter of days you can go from 60 cases to many, m any more,’ ’ he said. Large hospitals are devising contingency plans for a growing outbreak, he said, but “we want t o see that level of urgency at the federal level a s well.’’ Leaders at r hode I sland Hospi- tal in Providence have been planning for weeks for the arrival of the coronavirus. The virus ap- peared last week in one student and one staff member who traveled to Italy on a trip sponsored by a parochial high school. As worry spread through the state , people who called the hospital to seek a test were asked to remain in their cars until a doctor could go out to screen them. “We have a physician in protec- tive equipment go out to the car and put masks on anybody in the car, and take a history, and do a limited screening exam, and then do the testing, which i n most cases is a nasal swab,’’ said John B. murphy, president of rhode Is- land Hospital and Hasbro Chil- dren’s Hospital. In the two positive cases, the results were avail- able in four hours. Now, officials are tracing con- tacts of all students and staff members o n the trip t o Italy. rhode Island Hospital has 7 0 “negative-pressure’’ patient rooms — which means airborne particles cannot escape — that can be used to isolate people. The hospital’s engineers are an- alyzing how to t urn entire floors of the hospital into isolation wards. The hospital has about 25 patients on ventilators on an average day. It can treat more than 100 people on ventilators in a demand surge, murphy said. Be- yond that, he said, the hospital would be forced to work with state officials to find outside f acilities to isolate and treat patients. [email protected] [email protected]

and manage the ill residents.” A similar study of assisted- living facilities published in 20 14 found that 41 percent had no pandemic p lan. Lona mody, a professor of med- icine a t the University of michigan and co-author of both studies, said that she thinks many nursing homes have improved since the study but that more needs to be done. federal officials estimated in 2005 that in the event of a severe pandemic, such as the 1918 flu, more than 740,000 people would require ventilators. But there are only about 200,000 ventilation machines in U.S. medical facilities and a national stockpile, according to experts. “If it is the severe scenario, we will not have enough ventilators,” said Watson, of the Johns Hopkins Center for Health Security. “I don’t think this [novel coronavirus] is the severe scenario, b ut if it is, we will have to make some difficult decisions.” The makers of ventilators said that, indeed, they have seen a dramatic r ise in demand. “We are seeing — and I suspect all the players are seeing — an increased demand for ventila-

they’re incentivized to work when sick, u nfortunately,” S weet said. A survey of hundreds of nursing homes published in the Jour- nal of the American m edical Asso- ciation in 2008 showed that slightly more than half lacked a plan to deal with a pandemic. only about half had stockpiled supplies such as gloves, alcohol rub, surgical masks and antiviral medications, the study found. The nursing homes surveyed for the study were in Nebraska and michigan, but experts said the findings probably were repre- sentative of the n ation. Advocates of the nursing home industry said facilities are better prepared now because of regula- tions in 2016 regarding emergency preparedness and infection co ntrol. “A ll facilities need to have an infection-control plan in place, which includes what to do during an outbreak,” said Beth martino, senior vice president of public af- fairs for the A merican Health Care Association. “These plans include the infection-control strategies a center has in place for surveil- lance of new infectious cases, w ho to report to and the steps to take to minimize the spread of an illness

ly on the ball,” said Sweet, who keeps up with reports from members at n ursing homes. At the better facilities, she said, managers have taken special steps: checking the temperatures of employees as they report for work; reminding family members and vendors to steer clear if they are not feeling well; and running special training for infection control. At others, members have reported to Sweet, there seems to be no urgency to prepare. “They’re not prepared at all,” Sweet said. “They are putting their residents i n jeopardy.” one of the challenges at nursing homes, aside from the vulner- ability of residents, is that one worker, if infected, can become a “super-spreader,” said Lauren An- cel meyers, a professor at the Uni- versity of Te xas at Austin who has studied infectious-disease sur- veillance. moreover, many nurse’s aides at such facilities might be reluc- tant to stay home if they are not feeling well, because they lack sick leave. “There’s a large proportion of single mothers in this group who need to put food on the table, and

preparedness in health care has been in a slow, steady decline for more than 15 years. The amount of federal funding given to state and local officials to prepare for health emergencies has been cut in half or more over the past couple of decades, according to Crystal Watson, senior scholar at t he Johns Hopkins Cen- ter for Health S ecurity. The two key federal programs amounted to $1.4 billion in 2003. Those two programs amount to $662 million this year. “Every administration has made cuts to these programs,” Watson said. Seven of the 11 deaths in the United States have been linked to the Life Care Center nursing home in Kirkland, Wash., and that has focused attention on the nation’s more than 15,000 nursing homes and 20,000 residential care facilities. Some facilities are prepared for the outbreak, and some are not, according to Lisa Sweet, chief clinical officer of the National As- sociation of Health Care Assis- tants, a group that represents nursing aides. “It runs the gamut — there are some good providers who are real-

emergency measure was being
wound down Tuesday as the
state’s testing capacity grows.
officials in King County, Wash.,
this week said they were purchas-
ing a motel to house patients who
needed to be placed in isolation.
In r ural areas of Te xas and else-
where, small hospitals do not have
test kits, and central labs for test-
ing samples are hours away.
“There’s not anywhere near a
sufficient number of kits to con-
firm or deny virus, or quarantine
or control all these patients,’’ said
John Henderson, who heads the
association for Te xas’s rural hospi-
tals.
Ventilators and intensive care
units, necessary to keep the most
acutely ill patients alive, are large-
ly limited to larger hospitals and
academic medical centers in cit-
ies.
front-line providers are dust-
ing off old protocols for handling
previous global health threats in-
cluding severe acute respiratory
syndrome ( SArS), middle East re-
spiratory syndrome (mErS),
H1N1 and E bola. B ut the coronavi-
rus is spreading rapidly and, with
mild symptoms that mimic the
flu, difficult to detect.
Nationwide, worries are grow-
ing about a lack of hospital beds to
quarantine and treat infected pa-
tients. major medical centers are
typically full even without a flood
of coronavirus patients.
“We just don’t h ave the c apacity
in the hospitals and health sys-
tems to deal with a massive influx
of patients and keep them isolat-
ed,’’ said Gerard Anderson, a pro-
fessor of health policy and man-
agement at Johns Hopkins Uni-
versity.
Despite weeks of preparations,
health planners continue to fret
about shortages of masks and
gowns for hospital staff, as well as
lifesaving mechanical respirators
for patients with severe cases of
the disease.
“We need masks, w e need venti-
lators for our medical facilities,
and we need it fast,” Sen. Patty
murray (D-Wash.), whose state
has experienced the largest fatal
outbreak in the country, said on
Tuesday.
Budget-conscious health sys-
tems do not maintain large vol-
umes of reserve supplies just for
the possibility of a pandemic, said
William Jaquis, president of the
American College of Emergency
Physicians. That l eaves the system
vulnerable.
“We don’t necessarily have the
backup readiness all the time for
these i ssues,’’ he said. “A nd they do
keep repeating.’ ’
f ederal funding for emergency

HospItAls from A

U.S. nursing homes appear especially vulnerable

dAVId ryder/reuters Medics move a patient to an ambulance at the life Care Center of Kirkland, Wash., a nursing home that has been linked to seven of the 11 coronavirus deaths in the United states. officials in King County said they were purchasing a motel to house patients needing i solation.

The Washington Post - 05.03.2020

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