wednesday, march 11 , 2020. the washington post eZ re A21
the coronavirus outbreak
BY CRAIG TIMBERGSen. Ron Wyden (D) is propos-
ing $500 million of federal fund-
ing to help states prepare for
possible voting disruptions
caused by the coronavirus out-
break. Wyden’s bill also would
give Americans the option to vote
by mail in case of a widespread
emergency.
The legislation, to be filed
Wednesday, could boost a nation-
al trend toward voting by mail. In
the 1990s, Wyden’s home state of
Oregon became the first state to
vote entirely by mail, and the
practice has grown to the point
that more than than 31 million
Americans — about one quarter
of all voters — cast ballots by mail
in 2018.
Election officials and experts in
recent days have been consider-
ing how they would handle a
major disease outbreak in which
quarantines or closures of facili-
ties would affect Americans’ abili-
ty to vote in primary elections,
party c aucuses and the November
general election.
While all states allow voting by
mail in some circumstances, the
availability of the option remains
uneven, with some states allow-
ing it only to seniors or those with
excuses for why they can’t appear
at polling places on Election Day.
Five Western states conduct all of
their statewide voting by mail,
and a sixth, California, is gradual-
ly shifting to the practice.
The wide variation in practices
could make it difficult to rapidly
expand voting by mail in time for
this November’s election. States
that handle few mail-in ballots
might struggle to build the sys-
tems and acquire the machinery,
such as high-speed optical scan-
ners, needed to expand the op-
tion.
“Every state could do this,” s aid
Kim Wyman, Washington’s secre-
tary of state, whose state transi-
tioned to voting by mail. But she
cautioned that “it takes time to
ramp up.”
Wyden’s bill would give all
Americans the right to vote by
mail if 25 percent of states de-
clared an emergency related to
the coronavirus outbreak. The bill
also would require state and local
officials to prepare for possible
coronavirus disruptions and to
offer prepaid envelopes with self-
sealing flaps to minimize the risk
of contagion from voters’ licking
of envelopes.
The bill would prohibit states
from using the $500 million to
implement mobile or other Inter-
net-based voting technologies,
though voters could still request
their ballots through online
means.
“No voter should have to
choose between exercising their
constitutional right and putting
their health at risk,” Wyden said.
“When disaster strikes, the safest
route for seniors, individuals with
compromised immune systems
or other at-risk populations is to
provide every voter with a paper
ballot they can return by mail or
drop-off site. This is a nonparti-
san, common-sense solution to
the very real threat is looming this
November.”
Voting over the Internet, while
tested in some countries, has
struggled with security problems.
A University of Michigan research
team successfully hacked into lo-
cal online voting systems in the
District of Columbia during a
mock election in 2010, succeeding
in altering hypothetical votes and
causing the system to play the
University of Michigan’s fight
song, “The Victors.”
Researchers at the Massachu-
setts Institute of Te chnology re-
ported in February that they
could penetrate a smartphone
voting app in a way that allowed
them to alter votes, suppress bal-
lots and learn how individual vot-
ers cast their supposedly secret
ballots.
Security experts say systems
for voting by mail are much more
secure. Election officials typically
provide ballots that voters return.
An outer envelope includes infor-
mation, such as a name and signa-
ture, to verify the identity of the
voter, and an inner envelope con-
tains that ballot itself, guarantee-
ing the secrecy of the vote.Security experts worry about
the potential for spouses, parents
or even community leaders to
coerce voters to cast their mail-in
ballots in a particular way, with-
out the secrecy of a voting booth,
though it’s not clear how wide-
spread such problems are. Voting
rates tend to be higher in places
where voting by mail is routine,
research shows.
“Vote by mail has its concerns,
but it’s the only solution we could
possibly do” i n the case of major
balloting disruptions, said Dan
Wallach, a Rice University com-
puter science professor who stud-
ies election security.
But rapid expansion of voting
by mail could complicate the
counting and reporting of elec-
tion results. States that now rare-
ly use such systems might strug-
gle to print enough ballots, mail
them out, handle the returns,
count the ballots and tabulate the
results.
Amber McReynolds, a former
Denver election official who now
heads the National Vote at Home
Institute, said that a major shift
toward voting by mail for the
November general election would
most likely require state officials
to expand their role in handling
ballots because local authorities
would find it difficult to add to
their capacity quickly enough.
“The logistics involved in that... would crush local elections
offices,” McReynolds said.
She estimated that Michigan,
which had its primary election
Tuesday, would need $48 million
to mail a ballot to every voter, pay
for postage and count the re-
turned ballots.
Wyden’s b ill also could run into
resistance from Republicans, who
traditionally have emphasized
ballot security over systems that
would expand access to voting.
Wyman, Washington’s secre-
tary of state, who is a Republican,
said voting by mail has become
largely bipartisan there and now
is widely embraced by most vot-
ers. But she said of her fellow
Republicans, “Our base doesn’t
like it.”
[email protected]
Voting by mail m ay get $ 500 million
federal boost via coronavirus fears
BY JOEL ACHENBACH
AND LAURIE MCGINLEYThe coronavirus i s most brutal
to the old and the chronically
ailing. That i s a vast c ohort i n the
United States — millions of peo-
ple — who are not blessed with
youth and good health and who
now face an enigmatic pathogen
that no human immune system
has ever encountered and for
which there is no vaccine.
Late Monday, the Centers for
Disease Control and Prevention
released new coronavirus guide-
lines that attempted to describe
who is at higher risk and provide
common-sense counsel on how
everyone can protect themselves
and their families and communi-
ties from covid-19, the flu-like
disease caused by the novel coro-
navirus.
The CDC stated that “older
adults” are at elevated risk, but it
did n ot define that phrase. I t said
those suffering from “serious
chronic medical conditions,”
such as heart disease, diabetes
and lung disease, are also at
greater risk.
People over the age of 80 with
one of these chronic diseases are
at the highest risk and should
take precautionary steps, s uch as
avoiding crowds and nonessen-
tial travel, officials advised. Stay
close t o home, stockpile e ssential
supplies and medicines, and fig-
ure out a backup plan if a
caregiver becomes too sick to
provide care.
“My parents are in their 80s,”
Nancy Messonnier, director of
the CDC’s National Center for
Immunization and Respiratory
Diseases, said on a teleconfer-
ence Monday. “They’re not in an
area where there is currently
community transmission. But
I’ve asked them to stick close to
home.”
The new CDC recommenda-
tions include familiar advice
about vigorous and frequent
hand-washing and avoiding
touching one’s f ace. But they also
included other suggestions, such
as avoiding touching surfaces
like elevator buttons in places
where many people gather. “To
the extent possible, avoid touch-
ing high-touch surfaces in public
places — elevator buttons, door
handles, handrails, handshaking
with people, etc. Use a tissue or
your sleeve to cover your hand or
finger if you must touch some-
thing.”
Although covid-19 has often
been compared to the flu, which
is also a respiratory infection,
data from China shows that it
has a significantly higher case
fatality rate than seasonal flu. A
recent World Health Organiza-
tion report by an international
team of researchers, including
from China, found that the case
fatality rate for covid-19 patients
over the age of 80 in China was
21.9 percent.
Few children have been seri-
ously ill from covid-19, and most
adults who get infected will
suffer only mild or moderate
symptoms, according to infec-
tious disease experts. But more
serious outcomes have been seen
among people over the age of 60.
More than 4,000 people, most of
them in China, have died so far.
Many of those had underlying
health problems.
Patients of all ages with no
underlying chronic conditions
had a fatality rate of 1.4 percent,
according to the WHO report.
Covid-19 patients with cardio-
vascular disease had a rate of
13.2 percent; with diabetes,
9.2 percent; with hypertension,
8.4 percent; with chronic respi-
ratory disease, 8 percent; and
with cancer, 7.6 percent.
How the disease will impact
the United States remains to be
seen. A ir p ollution i n big Chinese
cities such as Wuhan, where the
outbreak began, could be a factor
in the death rate there. So could
the high rates of smoking in
China, particularly among men,
who were more likely than wom-
en to die of covid-19.
But the United States has its
own health challenges. Life ex-
pectancy at birth has flattened
out over the past decade. Re-
search shows a rise i n death r ates
among young and middle-aged
adults.
The U.S. public is remarkably
unhealthy compared with people
in similarly affluent nations — a
phenomenon known as the U.S.
health disadvantage. One exam-
ple: A 2015 CDC study found that
30 million Americans have dia-betes.
“People don’t realize how bad
the health of the A merican p opu-
lation is,” said Eileen Crimmins,
a professor of gerontology at the
University of Southern Califor-
nia. “When we compare our
health to Europeans, we have
more disease, more disability.”
She said the 2016 Health and
Retirement Study found that
38 percent of people between the
ages of 50 and 5 9 had at least one
of four diseases: diabetes, can-
cer, h eart disease or lung d isease.
That percentage increases with
each decade, peaking at 70 per-
cent for people between 80 and
89.
Many Americans now have
two or more chronic diseases — a
phenomenon that has increased
in recent decades. According to
the CDC, 21 percent of people
between the ages of 45 and 64
had at least two chronic diseases
in a survey conducted in 2009-
2010, compared with 16 percent
in 1999-2000.
One explanation for the elder-
ly’s higher mortality is that as
people age, their immune sys-tems age, too, in the same way
that bones get weaker. Cell-me-
diated immunity is an extremely
complex p rocess, and the various
elements do not synchronize as
well in older people, said Wilbur
Chen, a University of Maryland
infectious disease physician.
“It’s like an orchestra that’s
out of tune,” Chen said. “One
section is not playing. The other
is playing too loud. One is out of
rhythm. One is playing two
beats; the other is playing three
beats. It totally sounds wrong.”
Michael Osterholm, director
of the Center for Infectious Dis-
ease Research and Policy at the
University of Minnesota, said
overreaction of the immune sys-
tem in some cases wreaks havoc
on blood vessels.
“You can’t keep the blood in
your circulatory system,” he said.
“It’s leaking out. With the dila-
tion of the blood vessels, it’s likea hose that’s got holes in it. I f you
keep giving them more fluid, you
drown the lungs.”
Among cancer patients, peo-
ple with blood malignancies
such as non-Hodgkin’s lympho-
ma, multiple myeloma and acute
lymphoblastic leukemia are at
highest risk for coronavirus com-
plications, said Steve Pergam, an
infectious disease specialist at
the Fred Hutchinson Cancer Re-
search Center in Seattle. Those
diseases affect the body’s infec-
tion-fighting cells. The treat-
ments for those illnesses — such
as bone-marrow transplants and
chemotherapy — further sup-
press the immune system, he
said.
Patients under treatment for
other malignancies also are at
elevated r isk. While chemothera-
py has the biggest immunosup-
pressive effects, radiation and
surgery also can inhibit thebody’s disease-fighting ability,
doctors say.
Cancer patients face another
problem — fear. And that can be
even more damaging.
Jalal Baig, a Chicago oncolo-
gist, said three of his patients
have told him recently they are
considering stopping chemo-
therapy because they are con-
cerned about contracting the
virus. He said only one — a
woman with breast cancer — has
actually followed through,
against his advice.
“It’s so frustrating,” Baig said,
adding that the patient has a
good chance of being cured by
the chemotherapy. “A llowing
cancer to progress is probably
more harmful over the long
term.”
Steven Nissen, a cardiologist
at the Cleveland Clinic, said the
higher mortality rate for virus-
stricken heart patients probably
reflects the buildup of fluid in
the lungs, which taxes the heart.
“ If you flood the lungs with
fluid, the workload on the heart
goes up,” he said. The pulmonary
problem “overloads the heart,
and the heart fails, and people
get into trouble.”
He told one patient on Mon-
day to forgo a cruise and others
to avoid large crowds and make
sure they have extra medication
in case they have to isolate
themselves.
Ann Partridge, a breast cancer
specialist at the Dana-Farber
Cancer Institute, said she is
trying to see healthy cancer
survivors for routine follow-ups
now so they don’t have to come
to the hospital if the outbreak
worsens. To protect both vulner-
able patients and health-care
workers, t he cancer center also is
exploring ways to do more tele-
medicine. And it has limited
patients to bringing just a single
companion to reduce the chance
of infection from people who
might have the virus but not be
diagnosed.
“It’s important not to over-
whelm the health-care system,”
she said. “We need to be avail-
able to the people who need us.”
[email protected]
[email protected]High rate of chronically ill older A mericans poses big risk
david Goldman/associated Press
Leo Marchand, 7 1, heads to the dining room at a nursing home in Rockland, Mass., on Friday. He has
chronic obstructive pulmonary disease and said the coronavirus outbreak scares him.CDC urges most at-risk
group to avoid crowds
and stockpile medicinesThat’s right! With our BUY NOW, PAY LATER
special off er, you can also BUY 2, GET 2 FREE!Quality, energy saving windows
to beautify your home..Schedule your free in-home
consultation today.
301-960-0385 | 7 03 -831-2134WindowNation.com$0 DOWN | $0 DOWN PAYMENTS | 0% INTEREST
UNTIL 2021 FOR QUALIFIED BUYERSGettwofree*Off er valid on Potomac and Imperial LS Models. 4 Window Minimum. Cannot be combined with any other off er. Excludes labor.
**Full Purchase Price Must be Paid in Full Within 12 Months of Installation Date. Subject to credit Approval. OffOffer Ends 3 er Ends 2/29/31/20/20